bluuebunny/crossref_metadata_2025 huggingface dataset:
Six new species of Afrotropical Allodia (Diptera: Mycetophilidae): DNA barcodes indicate recent diversification with a single origin
Authors: MAGNUSSEN TRUDE , KJÆRANDSEN JOSTEIN , JOHNSEN ARILD , SØLI GEIR E. E.
Published: April 2018

Only one species of the genus Allodia has been previously recorded from the Afrotropical region, Allodia (Brachycampta) flavorufa Matile, 1978. Six new species are described here, all representing the nominotypical subgenus, Allodia s.s. The new species are described from material collected in different mountainous areas in south and east Africa; A. jaschhofi sp. nov., A. karkloofensis sp. nov., A. drakensbergensis sp. nov., A. nyeriensis sp. nov., A. mazumbaiensis sp. nov. and A. keurbosensis sp. nov. The species are morphologically very similar, and can only be separated based on minor differences in wing venation and characters of the male terminalia. The genetic differences between the species in the DNA barcode region (CO1), however, support delimitation. The origin and distribution of these Afrotropical taxa, in relation to each other and to their Holarctic relatives, is discussed.
On the Linkage between Labrador Sea Water Volume and Overturning Circulation in the Labrador Sea: A Case Study on Proxies
Authors: Li Feili , Lozier M. Susan
Published: April 2018

Although proxies have generally been used to study deep ocean convection and overturning circulation in the Labrador Sea, their efficacy has not been explicitly evaluated because observations that directly measure those variables are scarce. In this study, the volume of newly formed Labrador Sea Water (LSW) and the overturning circulation in the Labrador Sea are estimated using observational data and output from a high-resolution ocean model and then compared to proxies used to represent those variables. The comparisons reveal the limitations of proxies, highlighting the desirability of robust estimates derived from direct monitoring in the region [i.e., from Argo and Overturning in the Subpolar North Atlantic Program (OSNAP)]. A linkage among LSW formation, overturning circulation in the Labrador Sea, and the export of LSW from the basin on interannual time scales is found in the model.
Hydroclimate Variability and Change over the Mekong River Basin: Modeling and Predictability and Policy Implications
Authors: Ruiz-Barradas Alfredo , Nigam Sumant
Published: April 2018

The Mekong River is the lifeblood of the Southeast (SE) Asian economies. In situ and satellite-based precipitation are analyzed to assess the amount of water received as precipitation in the river basin (Mekong basin water), in particular, the amount each country receives. Laos, Thailand, and Cambodia contribute ~75% of the basin water during March–September, whereas China’s contribution is 10%–15%, except in winter when it rises to 25%. The processing of Mekong basin water into Mekong streamflow entails accounting for the uncertain water losses but, interestingly, interannual variations in Mekong basin water can be processed into Mekong streamflow using a simple hydrologic model, which is validated using monthly river discharge data from four stations. Preliminary evidence for the impact of upbasin dams on downstream flow, especially the timing of peak summer flow, is presented. Characterization of El Niño’s influence on SE Asian rainfall reveals significant rainfall reductions in the fall preceding and the spring following El Niño’s peak phase (winter); such reductions at the bookends of the dry season in SE Asia (winter) generate droughts, as in 2015–16. The linear trend in twentieth-century rainfall assesses the vulnerability of the region to climate change. The analysis indicates the feasibility of streamflow prediction using a simple hydrologic model driven by high-resolution precipitation observations and forecasts. It raises the prospects of drought prediction based on El Niño’s emergence/forecast. Finally, by showing the Mekong to be largely a rain-fed and not snowmelt-fed river, it provides quantitative context for assessing the notion of Chinese control on the lower Mekong via upbasin dams.
Is Teaching English as an International Language All about Being Politically Correct?
Authors: Matsuda Aya
Published: April 2018

One comment I often receive when I talk about teaching English as an international language (TEIL) is that TEIL is all about being politically correct – a mere gesture to be inclusive and egalitarian, promoted by a certain ideological stance. It is true that there are certain ideologies, language and beyond, that are compatible with certain aspects of TEIL and this encourages some English Language Teaching (ELT) professionals to embrace or reject this approach to English language teaching. My stance on this issue, however, is that TEIL is not about being politically correct or promoting certain ideologies; rather, it is about understanding and accepting the realities of global use of English today and having our teaching grounded in this reality. The article provides a brief overview of what TEIL is and reviews some ideological arguments that seem compatible with TEIL. It then moves on to argue that TEIL is something all English language teachers can and should embrace, regardless of their ideological stance or beliefs about what English should be. This is for a pragmatic reason: to better prepare our students for the messy world of English today.
Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California
Authors: Ko Michelle , Newcomer Robert J. , Harrington Charlene , Hulett Denis , Kang Taewoon , Bindman Andrew B.
Published: April 2018

Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.
Contribution of Implicit/Explicit Self-Esteem and Gender in Psychopathic Traits at Adolescence
Authors: Habersaat Stéphanie , Suter Maya , Stephan Philippe , Urben Sébastien
Published: April 2018

The present study aimed to investigate gender-specific combinations of implicit and explicit self-esteem, helping to understand psychopathic traits (lifestyle, affective, and interpersonal) in adolescents at risk of delinquency. Two hundred thirty-one adolescent boys and girls (from public schools and child welfare and juvenile justice institutions) completed questionnaires measuring explicit self-esteem and psychopathic traits, as well as a computerized Implicit Association Test (IAT) assessing implicit self-esteem. Boys at risk of delinquent behaviors with anxious self-esteem (high implicit/low explicit) as well as at-risk girls with defensive self-esteem (low implicit/high explicit) displayed the highest scores in interpersonal and lifestyle traits. No relationship was found between gender-specific combinations of self-esteem and affective traits. Two gender-specific profiles were identified among the group at risk of delinquent behaviors: Girls with a defensive self-esteem (low implicit/high explicit) and boys with an anxious (or damaged) self-esteem (high implicit/low explicit) presented more interpersonal and lifestyle traits than other groups.
Evaluation of the role of carbon nanotubes on the electrical properties of poly(butylene terephthalate) nanocomposites for industrial applications
Authors: Dorigato A , Freitas V , Covas JA , Paiva MC , Brugnara M , Pegoretti A
Published: April 2018

In this article, innovative electrically conductive polymer nanocomposites based on poly(butylene terephthalate) (PBT) filled with carbon nanotubes (CNTs) at different concentrations, to be used in the automotive field, have been investigated. Field emission scanning electron microscopy (FESEM) analysis revealed how a good nanofiller dispersion was obtained, especially by using surface treated nanotubes and by processing these materials using a more restrictive screw configuration. Melt flow index measurements highlighted that the processability of these nanocomposites was reduced at elevated filler amounts, even if CNT surface treatment promoted a partial retention of the fluidity of the neat PBT. Thermal degradation stability was improved upon the addition of CNT, even at limited filler amounts. Differential scanning calorimetry measurements evidenced how the presence of CNT slightly increased both the crystallization temperature and the crystalline fraction of the materials. The additivation of CNTs promoted a stiffening effect at elevated CNT contents, associated to an evident embrittlement of the samples. Electrical resistivity measurements showed that the most interesting results (i.e. 2.6 × 101 Ω·cm) were obtained for nanocomposites with a total filler content of 3 wt%, processed using the more restrictive screw configuration. For these materials, it was possible to obtain a rapid surface heating through Joule effect at applied voltages of 12 V.
A ritual of integration: Power, elections and cultural reconstruction among Mexican migrants in New Zealand
Authors: Merelo Guillermo
Published: April 2018

Drawing on four years of ethnographic research, this article explores the political integrative dynamics of members of the Mexican community in New Zealand. It illustrates how political cultural reconstruction occurs at the center of two opposing political worlds and results in contextual understandings of the role one is expected to play in a new polity. In this context, voting is collectively understood as a ritual through which people express their good character, gratitude and appreciation toward New Zealand. However, in the broadest possible sense, further political involvement is seen as an intrusion in the internal affairs of an alien nation.
Cultural Generalists and Cultural Specialists: Examining International Experience Portfolios of Subsidiary Executives in Multinational Firms
Authors: Rickley Marketa
Published: April 2018

On the basis of the observation that today’s executives increasingly possess significant international experiences, this study of foreign subsidiary executive staffing strategies looks beyond the local/expatriate dichotomy and shifts the theoretical and empirical focus from executive nationality to a more nuanced examination of subsidiary executives’ international experience portfolios. The intended contribution of this study is to explore the relationship between home country–host country institutional differences and the quantity and quality of subsidiary executives’ previous international experience. I draw on executive cognition theory and the literature on international experience to hypothesize that variety and specificity of previous educational and professional international experiences facilitate subsidiary executives’ abilities to manage liabilities of foreignness arising from institutional distance. The findings indicate a positive relationship between home country–host country institutional distance and the presence of subsidiary executives with higher duration, count, and variety of international experiences. However, the findings provide no statistical evidence of higher levels of institutional distance being associated with a higher presence of subsidiary executives with specific international experiences that are relevant to the home country–host country pair.
What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review
Authors: Rotter Thomas , Plishka Christopher , Lawal Adegboyega , Harrison Liz , Sari Nazmi , Goodridge Donna , Flynn Rachel , Chan James , Fiander Michelle , Poksinska Bonnie , Willoughby Keith , Kinsman Leigh
Published: April 2018

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization’s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
Arguing with the enemy
Authors: Hvidsten Andreas H.
Published: April 2018

I consider the problem of political pluralism for (Rawlsian) political liberalism: that not everybody agrees on fundamental political principles. I critically examine three defenses of liberal principles in situations of political pluralism—the realist defense, the pragmatic defense, and Gerald Gaus’ “justificatory liberalism”—all of which I find wanting. Instead, I propose a dialectical approach to justifying political liberalism. A dialectical approach is based on engaging (ostensibly) contradictory positions through conceptual investigation of key concepts claimed by both sides. Through such dialectical engagement, I seek a way to deal with contradictions between liberal and non-liberal philosophies as conceptual issues, rather than as antagonisms beyond reason. The ambition is to contribute to a more robust liberalism capable of defending itself in contexts of political pluralism. As an example, I apply this dialectical approach to the disagreement between political Islam and political liberalism on the issue of public religion.
Contesting the EU in times of crisis: The Front National and politics of Euroscepticism in France
Authors: Ivaldi Gilles
Published: April 2018

This article examines the performance and party system diffusion of Euroscepticism of the French Front National (FN) during recent European crises. The article argues that Europe’s successive crises since 2008 have been essentially ‘absorbed’ by the FN into its existing Eurosceptic framework which is guided by its radical right-wing ideology. While allowing the FN to successfully mobilize issues and grievances about the European Union (EU), Euroscepticism is, however, significantly impeding its strategy of governmental credibility. The article identifies the main political outcomes of these crises and finds differences in impact between the different EU crises on party competition over Europe. These findings provide insight into the relationship between the radical Right, Euroscepticism, and party competition. They also inform our current knowledge of Euroscepticism in French politics, and changes that EU crises have triggered, according to party system location and whether FN influence can be postulated.
Transforming Conflict: A Peacebuilding Approach for an Intergroup Conflict in a Local Congregation
Authors: Jun Guichun
Published: April 2018

An intergroup conflict based on fundamental incompatibilities such as different group identity and values is the highest and the unhealthiest level of conflict in a local congregation setting. In this case, a peacebuilding process is required in order to transform the conflict situation to achieve sustainable peace. Different from peacemaking and peacekeeping, peacebuilding takes a longer period to transform the cultural, social and structural problems on the macro level as well as to change behaviours, perceptions and perspectives of individuals on the micro level. This article attempts to disclose the characteristics of intergroup conflict in an urban congregation in the UK to describe its serious intensity by analysing its nature and scale. Furthermore, it demonstrates how the conflict transformation approach, as a long-term peacebuilding process, can be used effectively not only to alleviate intergroup conflict but also to eventually promote rehabilitation and reintegration through fostering a culture of peace.
Abdominal organ protection strategy for aortic arch aneurysm surgery
Authors: Miyamoto Satoshi , Takahashi Shinya , Okahara Shigeyuki , Takahashi Hidenobu , Katayama Keijiro , Watanabe Masazumi , Maeda Kazuki , Go Seimei , Morita Shohei , Kurosaki Tatsuya , Herlambang Bagus , Sueda Taijiro
Published: April 2018

Introduction:

Body temperature maintained during open distal anastomosis in patients who undergo aortic surgery has been showing an upward trend; however, a higher temperature may increase visceral organ and spinal cord injury. Distal perfusion may reduce abdominal organ injury, especially acute kidney injury (AKI).

Methods:

From 2009 to 2016, 56 patients who underwent ascending aortic and/or aortic arch surgery were enrolled. Open distal anastomosis was performed using one of three protection strategies: 1) systemic temperature of 25°C followed by selective cerebral perfusion (SCP) with lower body circulatory arrest (Group CA25, n=27); 2) systemic temperature of 28°C followed by SCP with lower body circulatory arrest (Group CA28, n=4); and 3) systemic temperature of 28°C followed by SCP with distal aortic perfusion (Group DP, n=25).

Results:

During the postoperative course, levels of blood urea nitrogen, creatinine, liver enzymes, lactate dehydrogenase and lactate in Groups CA28 and CA25 were significantly higher than those in Group DP. AKI defined by the AKI Network occurred in 28 cases (50%) and 3 cases required permanent hemodialysis. AKI was significantly higher in Groups CA25 and CA28 than in Group DP (p=0.026). Mid-term follow-up showed that patients who developed postoperative AKI were more likely to suffer from cardiovascular events.

Conclusions:

Distal perfusion during open distal anastomosis reduced kidney and liver injury after thoracic aortic surgery despite an increased body temperature of up to 28°C. This strategy may be useful to prevent AKI, liver dysfunction, the need for hemodialysis and multiple organ failure and could improve mid-term results.
MEF2C promotes gefitinib resistance in hepatic cancer cells through regulating MIG6 transcription
Authors: Zhang Hui , Liu Wei , Wang Zhi , Meng Lin , Wang Yunhua , Yan Huawu , Li Lin
Published: April 2018

Introduction:

Mitogen-inducible gene 6 ( MIG6) holds a special position in epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) resistance. As MIG6 regulates the activity of EGFR signal pathway negatively, high level of MIG6 can increase the EGFR TKI resistance of cancer cells, and limit the therapeutic action of EGFR TKI, such as gefitinib or erlotinib. Therefore, better understanding of the molecular mechanisms underlying the regulation of EGFR TKI resistance holds great value in cancer therapy.

Methods:

In our study, we mainly explored the function of transcription activator, myocyte enhancer factor 2C (MEF2C), on MIG6 expression as well as gefitinib-resistant ability of hepatic cancer cells.

Results:

Our results indicated that both MEF2C and MIG6 could be upregulated in gefitinib-resistant cancer tissues and cancer cell lines compared with gefitinib-sensitive ones. Chromatin immunoprecipitation assay and dual luciferase assay showed that MEF2C could bind to the MEF2C element in the promoter sequence of MIG6 and promote the transcription of MIG6. This effect increased the gefitinib-resistant ability of cancer cells. Therefore, MEF2C knockdown inhibited the gefitinib resistance and limited the proliferation of hepatic cancer cells in vitro and in vivo, while overexpression of MEF2C showed opposite effect on cancer cell proliferation.

Conclusion:

Our study provides novel insight into the regulation mechanism of MIG6 and suggests potential implications for the therapeutic strategies of gefitinib resistance through inhibiting MEF2C in hepatic cancer cells.
Predictive value of dual-time 18F-FDG PET/CT to distinguish primary lung and metastatic adenocarcinoma in solitary pulmonary nodule
Authors: Pahk Kisoo , Chung Jae Ho , Kim Sungeun , Lee Sung Ho
Published: April 2018

Aims and background:

Distinction between primary lung adenocarcinoma and metastatic adenocarcinoma from extrapulmonary origin in solitary pulmonary nodule (SPN) is crucial for cancer treatment. We investigated the predictive role of dual-time-point 18F-FDG PET/CT to distinguish primary and metastatic lung adenocarcinoma in SPN.

Methods:

A total of 96 consecutive patients with newly diagnosed SPN and biopsy-proven adenocarcinoma were enrolled in this study, retrospectively (54 male; 42 female; age 59.68 ± 8.2 years). They all underwent dual-time-point 18F-FDG PET/CT at 60 minutes (early) for whole body and 120 minutes (delayed) for chest region after FDG injection. Maximum standardized uptake values (early SUVmax and delayed SUVmax) and retention index (RI) were acquired for analysis. Final pathology results were confirmed by surgical specimens.

Results:

Metastatic adenocarcinoma showed significantly higher early SUVmax, delayed SUVmax, and RI compared to primary lung adenocarcinoma. Delayed SUVmax and RI presented superior diagnostic performance for prediction of metastatic adenocarcinoma than early 18F-FDG PET/CT. Among metastatic adenocarcinoma, metastasis from colorectal origin showed significantly higher RI than from other origins. In addition, RI significantly predicted metastatic adenocarcinoma from colorectal cancer than early or delayed SUVmax.

Conclusions:

Dual-timepoint 18F-FDG PET/CT can be useful to distinguish primary and metastatic lung adenocarcinoma in SPN. Furthermore, it may also be useful to predict metastatic adenocarcinoma from colorectal origin.
Stereotactic body radiotherapy for lung oligometastases: Literature review according to PICO criteria
Authors: Alongi Filippo , Mazzola Rosario , Figlia Vanessa , Guckenberger Matthias
Published: April 2018

Exhaustive criteria and definitive data to identify the ideal lung oligometastatic patient as a candidate for stereotactic body radiotherapy (SBRT) are lacking. Three distinct cohorts of oligometastatic patients could be distinguished: (1) patients with upfront diagnosis of oligometastases (synchronous or metachronous); (2) patients with oligorecurrent disease in terms of relapsed oligometastatic phase; (3) oligoprogressive patients after cytoreductive treatment. The aim of the present review is to analyze available data concerning the efficacy/safety of SBRT for oligometastatic/oligoprogressive/oligorecurrent lung metastases.
Factors associated to chronic migraine with medication overuse: A cross-sectional study
Authors: Viana Michele , Bottiroli Sara , Sances Grazia , Ghiotto Natascia , Allena Marta , Guaschino Elena , Nappi Giuseppe , Tassorelli Cristina
Published: April 2018

Background and aim

Factors implicated in the evolution of episodic migraine into chronic migraine are largely elusive. Medication overuse is considered to be one of the main determinants, but other possible clinical and psychological factors can play a role. The aim of this study is to identify factors that are associated with chronic migraine with medication overuse.

Method

We enrolled consecutive migraine patients, subdividing them in two groups: Subjects with a long history of episodic migraine and subjects with chronic migraine and medication overuse. We then compared their clinical and psychological variables in a cross-sectional study.

Results

Three hundred and eighteen patients were enrolled, of which 156 were episodic migraine and 162 were chronic migraine and medication overuse patients. The mean age was 42.1 ± 10.3, 80.8% were female. The duration of migraine was 24.6 years in episodic migraine and 24.0 years in chronic migraine and medication overuse ( p = 0.57). After the multivariate analysis, the factors associated to chronic migraine and medication overuse were: Marital status (married vs. unmarried, OR 3.65, 95% CI 1.63–8.19, p = 0.002; separated/divorced/widowed vs. unmarried, OR 4.19, 95% CI 1.13–15.47, p = 0.031), physical activity (OR 0.42, 95% CI 0.19–0.91, p = 0.029), age at onset of migraine (OR 0.94, 95% CI 0.89–0.98, p = 0.016), use of at least one migraine preventive medication (OR 2.36, 95% CI 1.18–4.71, p = 0.014), history of depression (OR 2.91, 95% CI 1.25–6.73, p = 0.012), insomnia associated with the use of hypnotics (OR 5.59, 95% CI 1.65–18.93, p = 0.006), traumatic head injuries (OR 3.54, 95% CI 1.57–7.99, p = 0.002), snoring (OR 2.24, 95% CI 1.05–4.79, p = 0.036), previous and/or actual use of combined oral contraceptives (OR 3.38, 95% CI 1.10–10.3, p = 0.031) and higher scores in the Childhood Trauma questionnaire (OR 1.48, 95% CI 1.09–2.02, p = 0.012).

Conclusion

We considered several aspects that may be involved in the development of chronic migraine and medication overuse. A multivariate analysis identified 10 factors belonging to five different areas, to suggest that chronic migraine and medication overuse onset is likely influenced by a complex mixture of factors. This information is useful when planning strategies to prevent and manage chronic migraine and medication overuse.
Impact of Wide-Base Tires on Pavements: A National Study
Authors: Al-Qadi Imad L. , Hernandez Jaime A. , Gamez Angeli , Ziyadi Mojtaba , Gungor Osman Erman , Kang Seunggu
Published: April 2018

This paper summarizes a multi-year effort comparing the new-generation wide-base tires (NG-WBT) and dual-tire assembly from a holistic point of view. The tires were compared considering not only pavement damage but also environmental impact. Numerical modeling, prediction methods, experimental measurements, and life-cycle assessment were combined to provide recommendations about the use of NG-WBT. A finite element (FE) approach considering variables that are usually omitted in the conventional analysis of flexible pavement was used for modeling pavement structures combining layer thickness, material properties, tire load, tire-inflation pressure, and pavement type (interstate and low volume). A prediction tool, ICT-Wide, was developed based on an artificial neural network to obtain critical pavement responses in cases excluded from the FE analysis matrix. Based on the bottom-up fatigue cracking, permanent deformation, and international roughness index, the life-cycle energy consumption, cost, and green-house gas emissions were estimated. To make this research useful for state departments of transportation and practitioners, a modification to AASHTOware is proposed to account for NG-WBT. The revision is based on two adjustment factors, one accounting for the discrepancy between the AASHTOware approach and the FE model of this study, and the other addressing the impact of NG-WBT. Although greater pavement damage may result from NG-WBT, for the analyzed cases, the extra pavement damage may be outweighed by the environmental benefits when NG-WBT market penetration is considered.
A Model of the Probability of a Cross-Median Crash When a Vehicle Fully Crosses the Median
Authors: Carrigan Christine E. , Ray Malcolm H.
Published: April 2018

The consequences of cross-median crashes are often catastrophic but crashes into median barriers can also be severe. Wide medians provide traversable space where vehicles can recover or stop but sometimes even wide medians can be crossed over. Determining if a median barrier is needed at a particular site involves balancing the risks associated with crossing completely over the median and striking a vehicle in the opposing lanes with the risks of an errant vehicle striking a median barrier. Median crossover crashes can be viewed as a conditional probability model: first the vehicle must enter the median; second, the vehicle must cross completely over the median; third, a vehicle must be in the opposing lanes where it is struck and, finally, there is a chance of a severe or fatal injury if all these conditions are met. All the elements of this conditional probability model are documented in the literature except the third; the probability of a crash with an opposing-direction vehicle given that a vehicle has completely traversed the median. Estimating this probability is the subject of this paper.
Hemodialysis of Acetaminophen in Uremic Patients
Authors: Marbury T.C. , Wang L.H. , Lee C.S.
Published: April 2018

The effect of the artificial kidney on the removal of acetaminophen was investigated in 6 chronic hemodialysis patients. Acetaminophen, 650 mg, was given orally 2 hrs prior to hemodialysis. Plasma and dialysate samples were collected periodically over 3 hours and analyzed by HPLC for acetaminophen content. Dialysis clearance was calculated by Arterial-Venous difference and simultaneous dialysate measurement. The extraction efficiency of the hollow-fiber dialyzers averaged 47.5%. The mean dialysis clearance of 112 ml/min measured with blood as the body fluid of reference was confirmed by calculation of clearance using dialysate measurement. A mean of 70.5 mg of acetaminophen or 11% of the administered dose was removed during the 3 hour dialysis period. The beta phase had a mean half-life of 1.6 hours in our patients on hemodialysis compared with 2.0 hours reported for both normal patients and uremic patients. Despite the favorable extraction ratio and dialyzer clearance, the artificial kidney is not very effective in competing with the liver for removal of the parent compound acetaminophen because of the drug's short half-life and rapid hepatic metabolism. Hence, the chronic hemodialysis patient may not need a dosage adjustment during or following hemodialysis.
The Glutaraldehyde-Treated Porcine Aortic Valve. A Study of the Leaflets’ Mechanical Properties
Authors: De Biasi S. , Pilotto F. , Pozzoni F.
Published: April 2018

The modifications of mechanical properties produced in valvular tissue by glutaraldehyde fixation were studied. Porcine aortic leaflets, fresh and fixed with glutaraldehyde in a stressed state, were tested with a mechanical device. The results we obtained show that the fixed leaflets have a failure load higher than fresh ones and an increased elastic recovery. The time of preservation (up to one year) does not affect the mechanical properties of fixed samples. The temperature of shrinkage was also studied, and we found that fixed leaflets show no shrinkage at all.
A Simple Method for Ex Vivo Evaluation of Biomaterial Interaction with Blood Platelets
Authors: Mantovani F. , Marconi W. , Caprino L. , Goglia G. , Togna G.
Published: April 2018

The process of thrombus formation, as a consequence of the interaction of artificial surfaces with blood, is related to the activation of blood platelets. A simple ex vivo method, which is suitable for the evaluation of the platelet-surface interaction is described. This method has been used to compare the haemocompatibility of several artificial materials, including nylon-6, Silastic and pyrolytic carbon.
Double Lumen Needle in Unipuncture Dialysis Type Double Headpump
Authors: Vanholder R. , De Paepe M. , Hoenich N.A. , Ringoir S. , De Cubber A. , Arno L. , Kazimoto F.
Published: April 2018

Single needle dialysis is used as a method of vascular access in many European dialysis centres. However, recirculation has been incriminated as a disadvantage of this procedure. According to in vitro studies, recirculation should be limited to a minimum when using double lumen needles. The present study makes an in vivo comparison between single and double lumen needles in unipuncture (single needle) dialysis of the type double headpump (Bellco, BL 760) and studies the role of recirculation in dialysis performance. Although recirculation is significantly reduced with the double lumen needle, compared to the single lumen needle, the clearance of small molecules is not significantly different for both needle types.
The Bioartificial Organ: Review and Progress Report
Authors: Schmer G. , Rastelli L. , Newman M.L. , Dennis M.B. , Holcenberg J.S.
Published: April 2018

A definition and a review is given for the bioartificial organ. In addition new developments are reported with the successful lyophilization of enzime filled RCG with cryoprotective polyethylene glycol (PEG).

The successful use of an enzyme reactor consisting of crosslinked fibrin with asparaginase covalently attached is reported in sheep. The small organ (0.4 m2) removes 70% of the animal's asparagine in 6 hours. No enzyme leakage down to 10-5 units per ml. plasma could be found. The highly preserved substrate affinity of insolubilized asparaginase as well as its high activity and stability when bound to fibrin are additional outstanding features of this system.
Propranolol-Associated Hypoglycemia in Patients on Maintenance Hemodialysis
Authors: Zarate A. , Gelfand M. , Novello A. , Knepshield J. , Preuss H.G.
Published: April 2018

Propranolol is widely employed in hemodialysis patients for the control of renin-dependent hypertension. Infrequent reports have linked hypoglycemia and propranolol, especially in complex situations such as malnutrition, anesthesia, and excessive insulin use. Three patients on maintenance hemodialysis taking propranolol developed severe hypoglycemia resulting in cardiac arrest. The life-threatening hypoglycemia occurred without apparent precipitating cause and unaccompanied by the classical signs and symptoms of hypoglycemia. These three cases suggest that propranolol in a setting of chronic renal failure and dialysis may bring about severe hypoglycemia, a complication previously unsuspected.
Concomitant Renal and Hepatic Failure Treated by Polyacrylonitrile Membrane Hemodialysis
Authors: Strand V. , Mayor G. , Ristow G. , Greenbaum D. , Mayle J. , Rosenbaum R.
Published: April 2018

A patient with fulminant hepatic encephalopathy and acute renal failure progressively deteriorated following daily hemodialysis with a hollow fiber artificial kidney improved dramatically after an initial dialysis with a polyacrylonitrile membrane system. Following repetitive dialysis with this system the patient continued to improve and is well many months following discharge. His course during hemodialysis with membrane systems having different clearances for substances of various molecular weights suggests the hypothesis that a substance(s) with a molecular weight between 1,500 and 15,000 daltons is involved in the pathogenesis of hepatic encephalopathy and offers and additional therapeutic modality for his devastating disease.
Effect of PGI2 Infusion During Long Term Extracorporeal Circulation with Membrane Lung in Sheep
Authors: Uziel L. , Agostoni A. , Pirovano E. , Pesenti A. , Pelizzola A. , Gattinoni L. , Galmarini D.
Published: April 2018

PGI2 plus very low dose of heparin was infused in 6 lambs connected for long term extracorporeal circulation with a membrane lung. Hemodynamic and hemostasis parameters were compared to those of a control group treated only with standard doses of heparin.

PGI2 efficacy in inhibiting platelet aggregation and platelet fall was confirmed. A small platelet release, measured as antiheparin activity, was observed during all the by-pass, but did not influence platelet capacity of recovering when PGI2 effect dissolved.

Heparin needed resulted less than a quarter of the quantity used for the control group.

In our experimental conditions the hemodynamic changes were mainly limited to a decrease in diastolic blood pressure.
A Study of the Influence of Single Needle Dialysis on the Principal Parameters of Haemodialyser Performance
Authors: Hoenich N.A. , Piron M. , de Cubber A. , Larno L. , Ringoir S.
Published: April 2018

The clearance and ultrafiltration characteristics of flat plate and hollow fibre hemodialysers have been established using conventional two needle dialysis and unipuncture with a Bellco BL 760 double head pump system. The results obtained are comparable with no detriment to the performance when in the unipuncture mode. Furthermore, the unipunture system used for our studies enables control of ultrafiltration to be achieved enabling the use of high flux dialysers without the need for special equipment.
The role of Hemolysis during Extracorporeal Homologous Liver Perfusion
Authors: Fischer M. , Jokiel H.J. , Sommoggy S. v. , Wustrow T.
Published: April 2018

The rate of hemolysis and the behaviour of platelets were investigated during extracorporeal pig liver perfusions. In 8 animals whose iliac vessels had been cannulated and which were perfused for 6 hours in our circuit, packed cell volume, number of red blood cells and concentration of hemoglobin changed moderately after hemodilution with the machine's priming volume. Similiar results were obtained in 10 pigs which were perfused with homologous isolated pig livers up to 6 hours.

The best parameter to determine hemolysis was the plasma hemoglobin. Its level was twice as high as the initial value after mixture of the blood with the machine's priming volume in the iliac bypass experiments. Instead it remained practically unchanged throughout 6 hours of extracorporeal liver perfusions.

The liver seemed to act as a filter under these experimental conditions. It had similar filtration effects on the enzymes LDH and alpha-HBDG which are set free in hemolysis.

The decrease of platelets was more pronounced in extracorporeal liver perfusions than in iliac bypass experiments. Especially the functioning platelets decreased significantly in extracorporeal liver perfusions after 4–5 hours. The filtration effect of the liver seemed to be due to its intact RES. Xenogenous immunreactions played a minor role.
L-Glutaminase and L-Asparaginase by Extracorporeal Route in Acute Lymphoblastic Leukemia Therapy
Authors: Giordano C. , Esposito R. , Mazzola G. , Vecchio G. , Pluvio M. , Cirillo D. , Capasso G.B. , Buonanno G.
Published: April 2018

Use of L-asparaginase by the extracorporeal route in the therapy of acute lymphoblastic leukemia (ALL) has been proposed.

Results, however, are not so satisfactory as i.v. administration of this enzyme, because the levels of L-asparagine do not fall for a sufficient length of time due to the antagonistic action of the L-asparagine-synthetase.

To avoid the L-asparagine rebound we have utilized, by extracorporeal route, L-glutaminase together with L-asparaginase, in order to reduce L-asparagine and L-glutamine levels.

We have therefore performed a series of experiments in vitro and in vivo either using L-asparaginase alone or together with L-glutaminase.

Results show that, contrary to what happens when L-asparaginase is used alone, L-asparagine levels decrease and remain low even after 24 hours from the treatment, when L-glutaminase is added to the system. Thus a lowering of L-glutamine levels, which seems to play an important role in the therapy of ALL, is obtained.
Study of the Hemocoagulative Parameters in Hemoperfusion on Polymer Coated Resins
Authors: Marrano D. , Plicchi G. , Spighi M. , Casadei M. Maldini , Betti V. , Andollina A. , Liguori L. , Campione O. , Roversi C.A. , Giulianini G.
Published: April 2018

A hemoperfusion column containing anionic exchange resin coated with a new polymer has been tested in vivo for blood compatibility.

The hemocoagulative parameters, evaluated before and after the cartridge during hemoperfusion, did not show any significant alteration even as regards the number and the functionality of the platelets nor as regards a possible activation of the fibrinolysis process.

On the basis of these results, the hemoperfusion system examined can be regarded as hemocompatible from the hemocoagulative standpoint.
Fistula Survival in Single Needle Hemodialysis
Authors: De Clippele M. , Vanholder R. , De Roose J. , Derom F. , Ringoir S.
Published: April 2018

This study presents an average follow up per patient of 33.5 ± 3.7 and 70.1 ± 5.9 months (hospital and home dialysis) showing an actuarial fistula survival rate of 86.2% and 85.5% respectively after 5 years.

The data suggest a satisfactory survival rate of the fistula when a single needle technique is used in comparison to the survival observed with the two needles technique.
Comparison of Apheresis and Other Methods for Separation and Purification of Hemopoietic Stem Cells: Initial Experience with a Blood Buffy Coat Model for the use of Autologous Bone Marrow Transplantation
Authors: Arnaud F. , Riemersma G. , Sibinga C. Th. Smit , Das P.C.
Published: April 2018

With an increasing number of bone marrow transplantations (BMT) being contemplated in leukemia and cancer patients, it is prudent for blood banks to develop a suitable program within their resources for harvesting, purifying and freezing bone marrow stem cells. In order to do this, initially a prototype has been developed involving buffy coat model (BC) using normal donor blood. Centrifugation, sedimentation and machine apheresis methods were separately evaluated leading to a combined and sequential handling procedure. Blood was passed through a cell separator resulting collection of BC with 90% reduction of the volume showing 80% recovery of total leucocytes and 87% yield of mononuclear cells. Following centrifugation the cells with DMSO were frozen in a controlled freezing system and stored in liquid nitrogen. After thawing 94% cells were recovered with 93% viability. The initial experience gained in the model system could be incorporated in autologous BMT program in patients but requires modifications for improved results; the latter will be described separately.
Plasma Exchange in Patients with Guillain-Barré Syndrome: Clinical Improvement in Patients with Serum IgG Antibodies to Peripheral Nerve Tissue
Authors: Nyland H. , Vedeler C.A. , Matre R. , Halvorsen K. , Fagius J. , Osterman P.O. , Janzen R.W.C. , Skre H.
Published: April 2018

The mixed hemagglutination technique was used to demonstrate IgG antibodies to peripheral nerve tissue in sera from patients with Guillain-Barré syndrome. The clinical effect and the effect on the antibodies of plasma exchange (PE) were examined in 24 patients, 16 patients with acute form and 8 patients with the chronic form of the disease. Neurological examination with muscle testing and neurophysiological examination of the patients were performed before and immediately after the PE. Before PE antibodies were detected in sera from 15 of the patients. These patients showed clinical improvement during the treatment, however in one of the patients only after a time interval of 2 weeks. After PE, antibodies were detected in sera from only 3 of the patients. The 9 patients without detectable antibodies showed no clinical improvement.
Therapeutic Leukapheresis in a Patient with Prolymphocytic Transformation of B-cell Chronic Lymphocytic Leukemia
Authors: Steenssens L. , Van Camp B.
Published: April 2018

A 64-year old woman with chronic lymphocytic leukemia (CLL) developed a prolymphocytic transformation with severe anemia, thrombocytopenia and deterioration of the general clinical condition.

Neither treatment with chlorambucil and prednisolone, nor a combination chemotherapy (cyclophosphamide, vincristine, prednisolone) were successful. Splenectomy was not considered as the bone marrow presented signs of dyserythropoiesis.

Encouraged by the results of therapeutic leukapheresis in different forms of leukemia, it was decided to start such therapy in our patient.

During a seven-month period, thirty weekly aphereses were performed. The white blood cell count did not decrease, but the clinical condition of the patient improved dramatically.
A Native whole Blood Test for the Evaluation of Blood-surface Interaction: Determination of Thromboxane Production
Authors: Mantovani E. , Marconi W. , Cebo B. , Togna A.R. , Togna G. , Caprino L.
Published: April 2018

The method developed to evaluate the hemocompatibility of artificial materials involves the determination of thromboxane production during the clotting of rabbit blood, in test tubes of different materials.

The concentration of serum TXB2 obtained after incubation of whole blood in glass test tubes, for 40 min at 37°C, averaged 416.8 ± 23.3 ng/ml (mean ± SE). Polymethylpentene, recognised as having a relatively poor blood compatibility, elicited 309.5 ± 17.2 ng/ml of serum TXB2, while silicone and Avcothane, considered of better hemocompatibility, showed thromboxane levels of 276.2 ± 28.2 and 222.9 ± 31.5 ng/ml, respectively. These values validate the usefulness of the proposed method as a preliminary in vitro screening test of artificial materials intended for biomedical application.
Total Creatine Kinase and Isoenzyme Fractions in Chronic Dialysis Patients
Authors: Lal S.M. , Nolph K.D. , Hain H. , Moore H.L. , Khanna R. , Van Stone J.C. , Twardowski Z.J.
Published: April 2018

We measured total serum creatine kinase (CK) and serum creatine kinase MB fraction (CK-MB) in 53 patients on continuous ambulatory peritoneal dialysis (CAPD) and 52 patients on maintenance hemodialysis (HD), using Scalva UV methodology for CK and electrophoresis for CK-MB. Seven of the 53 CAPD patients (13%) had an elevated total CK, and only one of these 7 patients had an elevated CK-MB > 5%. In contrast 22 HD patients (42%) had increased total CK values, and 6 of these 22 HD patients (27%) showed elevated CK-MB isoenzyme > 5%. For each sex, blacks had higher mean CK values than whites. Twenty-one out of the 43 HD patients who received intramuscular injections had elevated total CK values and 6 of these 21 patients had elevated CK-MB isoenzyme independent of the timing of injection. The increased frequency of higher total CK values in HD patients appears to be related to race and androgen administration. The modest elevations in CK-MB fraction (5 to 8%) in these patients require careful interpretation.
Continuous ambulatory peritoneal dialysis (CAPD): Experience with the first 100 patients in a Hong Kong Centre
Authors: Chan M.K. , Lam S.S. , Chan P.C.K. , Cheng I.K.P.
Published: April 2018

We treated 100 Chinese patients age 16 to 83 years by CAPD, using three 2-litre exchanges per day. The treatment was self-financed in 69 patients, by charitable organisations in 25 patients, and by government funds in 6 patients. Satisfactory biochemistry was maintained and there was no gross hyperlipidaemia, renal osteodystrophy, or loss of ultrafiltration capacity of the peritoneum. Rehabilitation was good and 62% of patients returned to full-time employment. The average duration of hospitalization was 11.3 days per patient year. Peritonitis usually due to Staphylococcus pyogenes occurred at a frequency of one episode per 12.3 patient-months. Sixteen patients were transplanted and had a 2-year graft survival of 78.5%. The cumulative patient survival was 97% at 1 year and 84% at 2 years. The corresponding technique survival rates were 87% and 76% respectively.