bluuebunny/crossref_metadata_2025 huggingface dataset:
Nanomedicine for Inner Ear Diseases: A Review of Recent In Vivo Studies
Authors: Kim Dong-Kee
Published: October 2017

Nanoparticles are promising therapeutic options for inner ear disease. In this report, we review in vivo animal studies in the otologic field using nanoparticles over the past 5 years. Many studies have used nanoparticles to deliver drugs, genes, and growth factors, and functional and morphological changes have been observed. The constituents of nanoparticles are also diversifying into various biocompatible materials, including poly(lactic-co-glycolic acid) (PLGA). The safe and effective delivery of drugs or genes in the inner ear will be a breakthrough for the treatment of inner ear diseases, including age-related hearing loss.
Study on Electrophysiological Signal Monitoring of Plant under Stress Based on Integrated Op-Amps and Patch Electrode
Authors: Cai Weiming , Qi Qingke
Published: October 2017

Electrophysiological signal in plant is a weak electrical signal, which can fluctuate with the change of environment. An amplification detection system was designed for plant electrical signal acquisition by using integrated op-amps (CA3140, AD620, and INA118), patch electrode, data acquisition card (NI USB-6008), computer, and shielded box. Plant electrical signals were also studied under pressure and flooding stress. The amplification detection system can make nondestructive acquisition for Aquatic Scindapsus and Guaibcn with high precision, high sensitivity, low power consumption, high common mode rejection ratio, and working frequency bandwidth. Stress experiments were conducted through the system; results show that electrical signals were produced in the leaf of Aquatic Scindapsus under the stress of pressure. Electrical signals in the up-leaf surface of Aquatic Scindapsus were stronger than the down-leaf surface. Electrical signals produced in the leaf of Guaibcn were getting stronger when suffering flooding stress. The more the flooding stress was severe, the faster the electrical signal changed, the longer the time required for returning to a stable state was, and the greater the electrical signal got at the stable state was.
An Unusual Mechanism of Closure of Muscular Ventricular Septal Defects
Authors: Dasgupta Soham , Aly Ashraf M.
Published: October 2017

Ventricular septal defects (VSDs) are the most common congenital heart defects. Most of the small or moderate size (<6 mm) muscular VSDs close spontaneously within the first two years of life. The usual mechanism of spontaneous closure involves muscular tissue encroachment with superimposed fibrosis or primary fibrous tissue formation around the margins of the defect. We describe an unusual mechanism of spontaneous closure of a muscular VSD.
Right Atrial Fibroelastoma Presenting as Typical Atrial Flutter: Rare Disease in Unusual Location
Authors: Abuarqoub Ahmad , Elshimy Ghada , Shittu Muhammed , Hamdan Aiman , Shamoon Fayez
Published: October 2017

Typical atrial flutter as initial presentation of papillary fibroelastoma involving the cavotricuspid isthmus is not described before in literature. To our knowledge only 14 cases have been reported in literature involving the right atrium. Very unusual location is at the junction between inferior vena cava (IVC) and right atria as only 1 case has been reported.
Adult Sporadic Burkitt’s Lymphoma Presenting with Rapid Development of Peritoneal Lymphomatosis
Authors: Fei Naomi , Shah Nilay
Published: October 2017

Sporadic Burkitt’s Lymphoma (BL) is a highly aggressive form of non-Hodgkin’s lymphoma which requires prompt diagnosis and treatment. Though usual presentation involves abdominal lymphadenopathy with possible solid organ involvement, sporadic BL can rarely present with peritoneal lymphomatosis. We present a unique case with rapid evolution of BL presenting as peritoneal and omental lymphomatosis with hepatic lesions and pelvic and pericardial adenopathy.
Evaluation and Analysis of Variance of Storage Stability of Asphalt Binder Modified by Nanotitanium Dioxide
Authors: Zou Xiaolong , Sha Aimin , Ding Biao , Tan Yuqiao , Huang Xiaonan
Published: October 2017

To investigate the effects of nanoparticle content, storage time, and storage temperature on the storage stability of asphalt binders modified by nanoparticles, hot tube storage tests, softening point tests, and dynamic-shearing rheometer (DSR) tests were adopted to evaluate the properties of two kinds of nanotitanium dioxide (TiO2) modified asphalt binders. A statistical one-way analysis of variance (ANOVA) test was employed to analyze the effects of those variations on the storage stability of the nano-TiO2 modified asphalt binders. The results indicated that the softening point, the failure temperature, the dynamic-shear viscosity, and G⁎/sinδ of the binders increased with nanoparticle content. The storage stability of the binders decreased with nanoparticle content. The impact of storage time on the storage stability of the binders was remarkable when the storage time was more than 48 h. Moreover, the storage stability of the binders at low temperatures was better than that at high temperatures. Based on the one-way ANOVA, the size of nanoparticle had little influence on the storage stability of the nano-TiO2 modified asphalt binders in this study. Reducing the nanoparticle size cannot effectively enhance the storage stability of the nanoparticle modified asphalt binder due to the agglomeration of nanoparticle.
Acute-Onset Panhypopituitarism Nearly Missed by Initial Cosyntropin Testing
Authors: Blum Claudine A. , Schneeberger Daniel , Lang Matthias , Rakic Janko , Michot Marc Philippe , Müller Beat
Published: October 2017

Introduction. Diagnosis of adrenal crisis and panhypopituitarism in patients with septic shock is difficult but crucial for outcome. Case. A 66-year-old woman with metastasized breast cancer presented to the ED with respiratory insufficiency and septic shock after a 2-day history of the flu. After transfer to the ICU, corticosteroids were started in addition to antibiotics, as the patient was vasopressor-nonresponsive. Diabetes insipidus was diagnosed due to polyuria and treated with 4 mg desmopressin. Thereafter, norepinephrine could be tapered rapidly. On day 2, basal cortisol was 136 nmol/L with an increase to 579 nmol/L in low-dose cosyntropin testing. Polyuria had not developed again. Therefore, corticosteroids were stopped. On day 3, the patient developed again nausea, vomiting, and polyuria. Adrenal crisis and diabetes insipidus were postulated. Corticosteroids and desmopressin were restarted. Further testing confirmed panhypopituitarism. MRI showed a new sellar metastasis. After 2 weeks, stimulated cortisol in cosyntropin testing reached only 219 nmol/l, confirming adrenal insufficiency. Discussion. The time course showed that the adrenal glands took 2 weeks to atrophy after loss of pituitary ACTH secretion. Therefore, a misleading result of the cosyntropin test in the initial phase with low basal cortisol and allegedly normal response to exogenous ACTH may be seen. Cosyntropin testing in the critically ill should be interpreted with caution and in the corresponding clinical setting.
Patients’ Knowledge and Attitude toward the Disposal of Medications
Authors: AlAzmi Aeshah , AlHamdan Hani , Abualezz Rayf , Bahadig Faiz , Abonofal Noha , Osman Mohamed
Published: October 2017

Background. Safe disposal of medications is of high concern as malpractice may lead to harmful consequences such as undesirable effects, prescription drug abuse, overstocking, self-medication, accidental overdose, and even death. There is a lack of uniform and nationwide guidance on how patients should safely dispose their leftover medications. This study aims to assess patients’ knowledge and attitude regarding the disposal of medications. Method. This research is a cross-sectional study. A self-administered questionnaire was used to collect data from various outpatient pharmaceutical services in King Abdulaziz Medical City (KAMC), Jeddah. Results. The study revealed that 73% of the respondents throw the medications in the trash, 14% return the medications to a pharmacy, 5% never dispose them, and 3% donate the medications to a friend or charity centers. More than 80% of the respondents never received any information or advice from healthcare providers about safe and proper disposal of medications. Conclusion. Our findings suggest that there is an immediate requirement for the establishment of collaborative and uniform guidelines for the safe disposal of leftover medications. A policy for drug donation needs to be included in routine patient education as well as educational and collective programs for the public.
Debut of Gastroesophageal Reflux Concomitant with Administration of Sublingual Immunotherapy
Authors: Juel Jacob
Published: October 2017

Gastroesophageal reflux disease (GORD) is an often debilitating condition characterised by retrograde flow of content from stomach into the oesophagus, where the low pH of the stomach acid irritates the mucosa of the oesophagus. The most dominant symptoms in GORD are pyrosis, regurgitation, and dysphagia. Sublingual immunotherapy (SLIT) was first described in 1986. Following this description, the use has greatly increased in the treatment of allergic rhinitis, as an alternative to subcutaneously administered immunotherapy. Side effects are commonly of oropharyngeal and gastrointestinal nature, for example, swelling, itching, irritation, ulceration of the oropharynx and nausea, abdominal pain, vomiting, and diarrhoea. More serious side effects are dominated by respiratory tract and systemic manifestations. A 30-year-old male experienced refractory, relentless, and debilitation GORD subsequent to administration of sublingual immunotherapy for house dust mite in allergic rhinitis. The patient had to stop the SLIT after two weeks of administration due to GORD. The cessation resulted in rapid resolution of symptoms.
Hair Germ Model In Vitro via Human Postnatal Keratinocyte-Dermal Papilla Interactions: Impact of Hyaluronic Acid
Authors: Kalabusheva Ekaterina , Terskikh Vasily , Vorotelyak Ekaterina
Published: October 2017

Hair follicle (HF) reconstructionin vitrois a promising field in alopecia treatment and human HF development research. Here, we combined postnatal human dermal papilla (DP) cells and skin epidermal keratinocytes (KCs) in a hanging drop culture to develop an artificial HF germ. The method is based on DP cell hair-inducing properties and KC self-organization. We evaluated two protocols of aggregate assembling. Mixed HF germ-like structures demonstrated the initiation of epithelial-mesenchymal interaction, including WNT pathway activation and expression of follicular markers. We analyzed the influence of possible DP cell niche components including soluble factors and extracellular matrix (ECM) molecules in the process of the organoid assembling and growth. Our results demonstrated that soluble factors had little impact on HF germ generation and Ki67+cell score inside the organoids although BMP6 and VD3 maintained effectively the DP identity in the monolayer culture. Aggrecan, biglycan, fibronectin, and hyaluronic acid (HA) significantly stimulated cell proliferation in DP cell monolayer culture without any effect on DP cell identity. Most of ECM compounds prevented the formation of cell aggregates while HA promoted the formation of larger organoids. In conclusion, our model could be suitable to study cell-cell and cell-niche interactions during HF reconstructionin vitro.
In Vivo Detection of HSP90 Identifies Breast Cancers with Aggressive Behavior
Authors: Osada Takuya , Kaneko Kensuke , Gwin William R. , Morse Michael A. , Hobeika Amy , Pogue Brian W. , Hartman Zachary C. , Hughes Philip F. , Haystead Timothy , Lyerly H. Kim
Published: October 2017

Purpose: Hsp90, a chaperone to numerous molecular pathways in malignant cells, is elevated in aggressive breast cancers. We hypothesized that identifying breast cells with elevated Hsp90 activity in situ could result in early detection of aggressive breast cancers.

Experimental Design: We exploited the uptake of an Hsp90 inhibitor by malignant cells to create an imaging probe (HS131) of Hsp90 activity by linking it to a near-infrared (nIR) dye. HS131 uptake into cells correlated with cell membrane expression of Hsp90 and was used to image molecular subtypes of murine and human breast cancers in vitro and in murine models.

Results: HS131 imaging was both sensitive and specific in detecting the murine 4T1 breast cancer cell line, as well as subclones with differing metastatic potential. Highly metastatic subclones (4T07) had high HS131 uptake, but subclones with lower metastatic potential (67NR, 168FARN) had low HS131 uptake. We generated isogenic cell lines to demonstrate that overexpression of a variety of specific oncogenes resulted in high HS131 uptake and retention. Finally, we demonstrated that HS131 could be used to detect spontaneous tumors in MMTV-neu mice, as well as primary and metastatic human breast cancer xenografts. HS131 could image invasive lobular breast cancer, a histologic subtype of breast cancer which is often undetectable by mammography.

Conclusions: An HSP90-targeting nIR probe is sensitive and specific in imaging all molecular subtypes of murine and human breast cancer, with higher uptake in aggressive and highly metastatic clones. Clinical studies with Hsp90-targeting nIR probes will be initiated shortly. Clin Cancer Res; 23(24); 7531–42. ©2017 AACR.
Sensing External and Self-Motion with Hair Cells: A Comparison of the Lateral Line and Vestibular Systems from a Developmental and Evolutionary Perspective
Authors: Chagnaud Boris P. , Engelmann Jacob , Fritzsch Bernd , Glover Joel C. , Straka Hans
Published: October 2017

Detection of motion is a feature essential to any living animal. In vertebrates, mechanosensory hair cells organized into the lateral line and vestibular systems are used to detect external water or head/body motion, respectively. While the neuronal components to detect these physical attributes are similar between the two sensory systems, the organizational pattern of the receptors in the periphery and the distribution of hindbrain afferent and efferent projections are adapted to the specific functions of the respective system. Here we provide a concise review comparing the functional organization of the vestibular and lateral line systems from the development of the organs to the wiring from the periphery and the first processing stages. The goal of this review is to highlight the similarities and differences to demonstrate how evolution caused a common neuronal substrate to adapt to different functions, one for the detection of external water stimuli and the generation of sensory maps and the other for the detection of self-motion and the generation of motor commands for immediate behavioral reactions.
Thiadiazolidinone-8 Ameliorates Inflammation Associated with Experimental Colitis in Mice
Authors: Mateus Vanessa , Rocha João , Alves Paula , Mota-Filipe Hélder , Sepodes Bruno , Pinto Rui
Published: October 2017

Thiadiazolidinone-8 (TDZD-8) is an effective thiadiazolidinone derivate that is able to suppress the expression of inflammatory cytokines; it also presents tissue protective actions by glycogen synthase kinase (GSK)-3β inhibition, promoting thus an anti-inflammatory effect. Since inflammatory bowel disease is a chronic disease with reduced quality of life, where currently available therapies are only able to induce or maintain the patient in remission, it is crucial to investigate new pharmacological approaches. The main objective of this study was to evaluate the effect of TDZD-8 in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis. Male CD-1 mice with TNBS-induced colitis were treated with a daily dose of TDZD-8 5 mg/kg/day IP during 4 days. The anti-inflammatory properties of TDZD-8 in the TNBS-induced colitis were confirmed by suppression of pro-inflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β and myeloperoxidase, as well as by the significant increase of the anti-inflammatory cytokine, IL-10. These treated mice also presented a reduction in fecal hemoglobin and alkaline phosphatase, suggesting a beneficial effect of TDZD-8. Furthermore, renal and hepatic biomarkers remained stabilized after treatment. In conclusion, TDZD-8 reduces the inflammatory response associated with TNBS-induced colitis in mice, and modulation of GSK-3β seems to be an interesting pharmacological target in colitis.
Over Troubled Water: E-Health Platforms and the Protection of Personal Data: The Case of Portugal
Authors: Gonçalves Maria Eduarda , Raimundo João
Published: October 2017

How healthcare is being administered is nowadays one of the distinctive traits expressing the progress of a given society. The steadfast implementation of e-health services has become an indispensable tool in order to bring the provision of healthcare to the next level. Notwithstanding e-health’s actual and promising applications, e-health hinges on highly sensitive information on patients’ personal lives and even intimacy, which, in Member States of the European Union (EU), must comply with the pertinent personal data protection legislation. In effect, health data have been classified as a special category of personal data by Directive 95/46/EC, the Data Protection Directive (DPD). The DPD subjects the processing of personal health data to a specific, stronger protection compared to less sensitive personal data in the form of a prohibition, which can only be excepted when the data subjects grant their explicit consent to the processing or if such consent is overridden by a superior interest provided by the law. Aware of the major changes brought about by technological progresses in this field, the EU initiated in January 2012 a revision of the DPD. Eventually, Regulation (EU) 2016/679 of the European Parliament and the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) were published in May 2016, to be applicable as of spring 2018. Regulation 2016/679 displays an even greater carefulness with the safeguard of health data than the DPD. Yet, it is unclear whether this legal reform is up to the challenge of current technological developments, particularly, as so-called big data technologies advance. Notwithstanding the impulse that the EU is placing on e-health and cross-border cooperation, e-health systems are developing primarily at the domestic level. In this article, we will seek to review and compare different e-health platforms now operating under the public health system of a EU member state, Portugal, with a specific focus on how the legal protection of personal data is being configured for each of them. Given the growing importance of big data in the field of health, we extend our comparative endeavour to this emerging phenomenon.
The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease
Authors: Shenai Mahesh B. , Patel Daxa M. , Romeo Andrew , Whisenhunt J. Dylan , Walker Harrison C. , Guthrie Stephanie , Guthrie Barton L.
Published: October 2017

Background: Intraoperative measurement of subthalamic nucleus (STN) width through microelectrode recording (MER) is a common proxy for optimal electrode location during deep brain stimulation (DBS) surgery for Parkinson disease. We assessed whether the MER-determined STN width is a predictor of postoperative Unified Parkinson Disease Rating Scale (UPDRS) improvement. Methods: Records were reviewed for patients who underwent single-sided STN DBS placement for Parkinson disease between 2005 and 2010 at the UAB Medical Center. Reviews of preoperative and 3-month postoperative UPDRS part III, intraoperative MER records, and postoperative MRI scans were conducted. Results: The final cohort consisted of 73 patients (mean age 59 ± 9.7 years, length of disease 13 ± 9.7 years). STN widths were defined as depths associated with increased background activity and motor-driven, spiking action potentials on MER. The mean contralateral UPDRS improvement was 58% (± 24). The mean STN width was 5.1 mm (± 1.6, min = 0.0, max = 8.7). No significant relationship between STN width and UPDRS improvement was found, with and without AC-PC normalization (R2 < 0.05). Conclusion: This analysis raises questions about seeking the maximal electrophysiological width of STN as a proxy for optimal outcome in DBS for PD. We suggest this strategy for DBS placement in Parkinson disease be subject to more robust prospective investigation.
Clearance of Selected Plasma Cytokines with Continuous Veno-Venous Hemodialysis Using Ultraflux EMiC2 versus Ultraflux AV1000S
Authors: Eichhorn Tanja , Hartmann Jens , Harm Stephan , Linsberger Ingrid , König Franz , Valicek Gerhard , Miestinger Georg , Hörmann Christoph , Weber Viktoria
Published: October 2017

Background: High cutoff hemofilters might support the restoration of immune homeostasis in systemic inflammation by depleting inflammatory mediators from the circulation. Methods: Interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor-alpha depletion was assessed in 30 sepsis patients with acute renal failure using continuous veno-venous hemodialysis with high cutoff versus standard filters (CVVHD-HCO vs. CVVHD-STD) over 48 h. Results: The transfer of IL-6 and IL-8 was significantly higher for CVVHD-HCO, as shown by increased IL-6 and IL-8 effluent concentrations. The mean plasma cytokine concentrations decreased over time for all cytokines without detectable differences for the treatment modalities. No transfer of albumin was observed for either of the filters. C-reactive protein remained stable over time and did not differ between CVVHD-HCO and CVVHD-STD, while procalcitonin decreased significantly over 48 h for both treatment modalities. Conclusion: CVVHD-HCO achieved enhanced removal of IL-6 and IL-8 as compared to CVVHD-STD, without differentially reducing plasma cytokine levels.
Prognostic Factors of Human Immunodeficiency Virus-Infected Patients on Chronic Hemodialysis
Authors: Laranjinha Ivo , João Matias Patrícia , Dickson Jorge , Estibeiro Hermínia , Boquinhas Helena , Barata José Diogo
Published: October 2017

Background/Aims: The number of human immunodeficiency virus (HIV)-infected patients on hemodialysis (HD) have increased, and their prognostic factors are still poorly clarified. The study aimed to identify factors that can influence the survival of HIV-infected patients on HD. Methods: We performed a retrospective cohort study of 44 HIV-infected patients on HD. Results: A total of 17 patients (39%) died. Median survival on HD was 30.8 months and the survival rate at 1 and 5 years was 82.5 and 62.9%, respectively. Male (relative risk [RR] 3.1, p = 0.040) and blacks (RR 2.5, p = 0.037) had higher risk of death. The patients who died had a shorter duration of HIV infection (p = 0.028), had a higher viral load (p = 0.044), more opportunistic infections (p = 0.013), and a lower serum albumin (p = 0.009). Lower serum albumin, nonsexual HIV transmission, viral load, opportunistic infections, and usage of catheters were associated with lower survival. Conclusion: Several demographic, viral, and dialysis variables may help to predict survival of this population. The intervention in these factors could improve their prognosis.
Biology of the Tongue Coating and Its Value in Disease Diagnosis
Authors: Sun Shipeng , Wei Huamin , Zhu Ruili , Pang Bo , Jia Shuming , Liu Guijian , Hua Baojin
Published: October 2017

Tongue diagnosis is one of the most important diagnostic tools in traditional Chinese medicine and has been verified for thousands of years. However, its subjectivity and repeatability has been disputed continuously. The tongue coating as the primary coverage of tongue diagnosis provides more objectivity and reproducibility due to its relatively clear molecular basis; it also has a close relationship with many system diseases and may be used as a potentially valuable disease diagnostic tool. This article describes the material basis of the tongue coating, including its biology (epithelial cells, blood cells, vascular endothelial cells, and bacteria) and its metabolites; moreover, we summarize the diseases that are most correlated with the tongue coating. This will be valuable not only for fundamental research of tongue diagnosis but also for the diagnosis and differential diagnosis of disease. We suppose that the tongue coating could serve as a valuable auxiliary diagnosis tool in many diseases, and more research should focus on how to colligate the various information about the tongue and provide useful information for disease diagnosis.
Efficacy of Stannous Ions on Enamel Demineralization under Normal and Hyposalivatory Conditions: A Controlled Randomized in situ Pilot Trial
Authors: Pini Núbia Inocencya Pavesi , Schlueter Nadine , Sundfeld Daniel , Semper Hogg Wiebke , Santos-Silva Alan Roger , Lopes Marcio Ajudarte , Aguiar Flávio H.B. , Lovadino J.R. , Lima D.A.N.L.
Published: October 2017

The study aim was to investigate the effect of antierosive agents on enamel under normal and hyposalivatory conditions. This double-blind crossover in situ pilot study evaluated 4 toothpastes: placebo (0 ppm F), sodium fluoride (NaF, 1,450 ppm), stannous/sodium fluoride (SnF/NaF, 1,450 ppm F-, 1,090 ppm Sn2+), and sodium fluoride, stannous chloride and chitosan (NaF/Sn/Ch, 1,450 ppm F-, 3,500 ppm Sn2+, 0.5% Ch). Twenty participants were assigned to 2 groups (n = 10 each): normal and low salivary flow. Participants wore palatal appliances holding 4 bovine enamel specimens previously eroded in vitro (D1) for 20 min prior to an in situ phase after which they were eroded again (D2). Surface microhardness was determined at baseline (BL), after D1, in situ phase and D2 to assess hardness loss (%SMH), residual hardness loss (%RHL) and erosion resistance (%RER). Additional specimens were evaluated by scanning electron microscopy after the in situ phase. ANOVA and a factorial analysis for between-subject effects were performed. Sn-based toothpastes showed the best effects (p < 0.05). Under normal flow, SnF/NaF showed higher efficacy, with a significant difference compared to NaF/Sn/Ch, NaF, and placebo (p < 0.05). Under low flow, SnF/NaF and NaF/Sn/Ch were comparable (p > 0.05); NaF and placebo were statistically similar. Comparing salivary conditions, there were significant differences for SnF/NaF for %SMH after the in situ phase (%SMHtotal)), %RHL and for all toothpastes in case of %RER. Factorial analysis revealed interactions between toothpaste and saliva flow for %SMHtotal and %RHL. Salivary flow can influence the efficacy of the antierosive toothpastes; however, Sn2+ preparations show even under low salivary flow conditions the highest efficacy in the prevention of enamel erosion.
How to Train to Discharge a Dermatology Outpatient: A Review
Authors: Harun A. , Finlay Andrew Y. , Salek M. Sam , Piguet Vincent
Published: October 2017

Background/Aims: The decision to discharge is a critical and common outpatient consultation event. However, little guidance exists over how discharge decision-making can be taught. We aimed to provide educational recommendations concerning outpatient discharge decision-making. Methods: Recommendations were drawn from prior interviews with 40 consultant dermatologists and 56 dermatology outpatients, and from the “traffic light” design discharge information checklist, developed using the Delphi technique. Results: The key strategies to follow to appropriately manage the outpatient discharge process are: to warn patients in advance, to understand patients' agendas, to allow extra time for the discharge process, to prepare patients to self-manage, to provide a “safety net” and provide the GP with a clear management plan. Aspects to be considered include patient mobility, presence of carer, type of employment, diagnostic certainty, and use of the checklist or guidelines. Key training aspects include teaching structured thought processes when discharging, discharging according to context, developing communication and negotiation skills, avoiding decision biases and encouraging good interprofessional collaboration. Training should include the consideration of the possibility of discharge at each consultation. Novel training strategies have been developed on how to appropriately manage the outpatient discharge process, including involving and informing patients. These strategies focus on safe decision-making, being patient-centred and organizing an efficient health care service framework. Conclusion: Structured outpatient discharge training for dermatologists is now possible, based on information from detailed doctor- and patient-based qualitative studies.
Prevalence and Incidence of Autoimmune Pancreatitis in the Population Living in the Southwest of Germany
Authors: Schneider Alexander , Michaely Henrik , Weiss Christel , Hirth Michael , Rückert Felix , Wilhelm Torsten J. , Schönberg Stefan , Marx Alexander , Singer Manfred V. , Löhr J. Matthias , Ebert Matthias P. , Pfützer Roland H.
Published: October 2017

Background/Aims: The prevalence and incidence of autoimmune pancreatitis (AiP) in those living in western countries are largely unknown. We aimed to determine the prevalence of AiP among patients with pancreatitis presenting to our tertiary referral center in Mannheim, Germany; and to estimate the incidence of AiP in the Southwest of Germany. Methods: We performed a retrospective cross-sectional analysis and determined the prevalence of AiP in patients with acute pancreatitis (AP) or chronic pancreatitis (CP). Patients (n = 704; alcoholic pancreatitis n = 373, nonalcoholic pancreatitis n = 331) were stratified into the Retrospective-Pancreas-Cohort (RPC, period 1998-2008, n = 534) and the Pancreas-Clinic-Cohort (PCC, periods 2008-2010 and 2013-2014, n = 170, with detailed investigation for features of AiP). Diagnosis of AiP was established by International-Consensus-Diagnostic-Criteria and Unifying-Autoimmune-Pancreatitis-Criteria. Results: In the RPC, the prevalence of AiP was 5.9% (n = 13/221) among individuals with nonalcoholic pancreatitis (n = 1/61 with AP, 1.6%; n = 12/160 with CP, 7.5%). In the PCC, the prevalence of AiP was 9.1% (n = 10/110) among patients with nonalcoholic pancreatitis (n = 2/24 with AP, 8.3%; n = 8/86 with CP, 9.3%), and 1.7% (n = 1/60) among subjects with alcoholic pancreatitis. We estimated the incidence of AiP with 0.29 per 100,000 population each year. Conclusion: The prevalence rate of AiP may account for 9% of patients with nonalcoholic pancreatitis but is almost never observed in patients with alcoholic pancreatitis. The incidence of AiP in Germany appears lower than 1 per 100,000 population.
Reliability, Reproducibility and Prognostic Accuracy of the Alberta Stroke Program Early CT Score on CT Perfusion and Non-Contrast CT in Hyperacute Stroke
Authors: Naylor Jillian , Churilov Leonid , Chen Ziyuan , Koome Miriam , Rane Neil , Campbell Bruce C.V.
Published: October 2017

Background: Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset. Methods: Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs. ASPECTS was assessed by 2 independent raters, blinded to stroke onset time, with agreement determined by weighted kappa (κw). Prognostic accuracy for favourable outcome (modified Rankin Scale 0-2) was assessed using the receiver-operating characteristic analysis. Results: A total of 227 participants were included. There was significant time-by-CT modality interaction for ASPECTS, p < 0.0001. The inter-rater agreement of ASPECTS on NCCT significantly increased as onset to CT time increased (κw epoch 1 = 0.76 vs. κw epoch 2-4 = 0.89, p = 0.04), whereas agreement using CTP parameters was stable across epochs. Inter-rater agreement for CTP-ASPECTS was significantly higher than NCCT in early epoch: Tmax κw = 0.96, p = 0.002; cerebral blood volume (CBV) κw = 0.95, p = 0.003; cerebral blood flow (CBF) κw = 0.94, p = 0.006, with no differences in the later epochs. Prognostic accuracy of ASPECTS on NCCT in epoch 1 were (area under the ROC curves [AUC] = 0.52, 95% CI 0.48-0.56), CBV (AUC = 0.55, 95% CI 0.42-0.69, CBF (AUC = 0.58, 95% CI 0.46-0.71) and Tmax (AUC = 0.62, 95% CI 0.49-0.75), p = 0.46 between modalities. Conclusions: CTP can improve reliability when assessing the extent of ischemic changes, particularly in patients imaged early after stroke onset.
Comments on the Updated Tetrapartite Pallium Model in the Mouse and Chick, Featuring a Homologous Claustro-Insular Complex
Authors: Puelles Luis
Published: October 2017

This essay reviews step by step the conceptual changes of the updated tetrapartite pallium model from its tripartite and early tetrapartite antecedents. The crucial observations in mouse material are explained first in the context of assumptions, tentative interpretations, and literature data. Errors and the solutions offered to resolve them are made explicit. Next, attention is centered on the lateral pallium sector of the updated model, whose definition is novel in incorporating a claustro-insular complex distinct from both olfactory centers (ventral pallium) and the isocortex (dorsal pallium). The general validity of the model is postulated at least for tetrapods. Genoarchitectonic studies performed to check the presence of a claustro-insular field homolog in the avian brain are reviewed next. These studies have indeed revealed the existence of such a complex in the avian mesopallium (though stratified outside-in rather than inside-out as in mammals), and there are indications that the same pattern may be found in reptiles as well. Peculiar pallio-pallial tangential migratory phenomena are apparently shared as well between mice and chicks. The issue of whether the avian mesopallium has connections that are similar to the known connections of the mammalian claustro-insular complex is considered next. Accrued data are consistent with similar connections for the avian insula homolog, but they are judged to be insufficient to reach definitive conclusions about the avian claustrum. An aside discusses that conserved connections are not a necessary feature of field-homologous neural centers. Finally, the present scenario on the evolution of the pallium of sauropsids and mammals is briefly visited, as highlighted by the updated tetrapartite model and present results.
Intraoperative Neurophysiological Monitoring (Motor and Somatosensory Evoked Potentials) in Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Pain
Authors: Son Byung-Chul , Choi Jin-Gyu , Ha Sang-Woo , Kim Deog-Ryeong
Published: October 2017

Aims: To address the feasibility and importance of intraoperative neurophysiological monitoring (IONM) in dorsal root entry zone (DREZ) lesioning for brachial plexus avulsion pain. Methods: Muscle motor evoked potential (mMEP) and somatosensory evoked potential (SSEP) were applied during DREZ lesioning for brachial plexus avulsion pain. Results: IONM of mMEPs and SSEPs was feasible for monitoring of the spinal cord during DREZ lesioning. With the exception of 3 unrecordable mMEPs in ipsilateral arms, mMEPs were preserved and referenced to look for changes according to lesioning in 6 upper extremities (66.6%) and 8 lower extremities. All 3 patients with >50% reduction in baseline mMEP amplitude after lesioning in either the ipsilateral upper or lower extremities showed postoperative ataxia and weakness of the lower extremities (100%). Only 2 out of 9 patients (22.2%) with brachial plexus avulsion pain had discernible baseline SSEPs in the ipsilateral upper extremities. One of 2 patients with discernible SSEPs in the upper extremities showed significant SSEP events during the DREZ lesioning and experienced postoperative ataxia and weakness in the legs despite the absence of a SSEP event in the lower extremities. Conclusion: Significant events on IONM were common during DREZ lesioning for brachial plexus avulsion pain and were closely related to the occurrence of postoperative neurological deficits.
The Peritoneum: Health, Disease, and Perspectives regarding Tissue Engineering and Cell Therapies
Authors: do Amaral Ronaldo J.F.C. , Arcanjo Kátia D. , El-Cheikh Márcia C. , de Oliveira Felipe L.
Published: October 2017

There are several pathologies associated with the peritoneum, such as mesothelioma and peritonitis. Moreover, the peritoneum is widely used in ultrafiltration procedures, i.e., peritoneal dialysis, presenting advantages over hemodialysis. On the other hand, ultrafiltration failure may lead to dialysis-induced fibrosis and hypervolemia. Therefore, the pathophysiological study of this tissue is of extreme biomedical importance. Studies investigating the biology of the cells dwelling in the peritoneum wall provide evidence of their plasticity and progenitor features. For instance, both mesothelial and submesothelial cells present characteristics similar to mesenchymal stem cells, including osteogenic and adipogenic differentiation potential, support of extramedullary hematopoiesis, modulation of inflammatory responses, and regulation of tumor progression. Indeed, the participation of each cell type in peritoneal pathological and physiological phenomena is still under debate, especially regarding a possible differentiation pathway connecting these peritoneal cells. The primary aim of this review is to raise this discussion. In order to do so, we will firstly provide an overview of the peritoneum anatomy, histology, and ontology, and finally we will address how a better understanding of peritoneal cell biology may contribute to future cell therapy and tissue engineering approaches.
B Chromosome Variants of the Grasshopper Xyleus discoideus angulatus Are Potentially Derived from Pericentromeric DNA
Authors: Bernardino Andrezza C.S. , Cabral-de-Mello Diogo C. , Machado Carolina B. , Palacios-Gimenez Octavio M. , Santos Neide , Loreto Vilma
Published: October 2017

B chromosomes, extra elements present in the karyotypes of some eukaryote species, have been described in the grasshopper Xyleus discoideus angulatus. Although some studies have proposed an autosomal origin of the B chromosome in X. d. angulatus, little is known about its repetitive DNA composition and evolutionary dynamics. The aim of the present work was to shed light on the B chromosome evolution in X. d. angulatus by cytogenetic analysis of 27 populations from Pernambuco and Ceará states (Brazil). The frequency of B chromosomes in the different populations was determined, and chromosome measurements and fluorescence in situ hybridization (FISH) with C0t-DNA and telomeric and B chromosome sequences were performed in cells from B-carrying individuals. The results revealed variations in B chromosome prevalence among the populations and showed that some B chromosomes were smaller in certain populations. FISH produced similar patterns for the C0t-DNA probe in all hybridized individuals, whereas telomeric and B chromosome probes, obtained by microdissection, exhibited variations in their distribution. These results indicate the presence of 3 morphotypes of B chromosomes in X. d. angulatus, with variation in repetitive DNA composition during their evolution. In this species, B chromosomes have an intraspecific origin and probably arose from the pericentromeric region of A chromosomes.
Postpolypectomy Intramural Colonic Hematoma: The Conservative Management of a Potentially Fatal Complication
Authors: Mankoo Ravinder , Kuwajima Vanessa
Published: October 2017

Most medical professionals consider colonoscopy to be a safe procedure with a low rate of severe complications such as bowel perforation, gastrointestinal tract bleeding, or mortality. Bowel wall hematoma is a rare complication associated with colonoscopy that can result in significant morbidity and even mortality. We present a case of postpolypectomy hematoma diagnosed with CT imaging and successfully managed in a conservative fashion.
Cerebral Cavernous Malformations: Patient-Reported Outcome Validates Conservative Management
Authors: Bicalho Vitor Chehuen , Bergmann Anke , Domingues Flávio , Frossard João Thiago , de Souza Jorge Paes Barreto Marcondes
Published: October 2017

Background: Cerebral cavernous malformations (CCM) are clusters of dilated sinusoidal channels lined by a single layer of endothelium. In contradistinction to arteriovenous malformations, these lesions do not have smooth muscle or elastin in their lining and they are angiographically occult, and the MRI is the most sensitive test for CCM detection. CCM are one of the most prevalent vascular malformations of the central nervous system, affecting about 0.4-0.6% of the general population. The main complication of this malformation is the risk of bleeding, which may cause neurological deficits that affect the quality of life (QoL) in patients. When symtomatic, they may be surgically treated for relieving the mass effect and seizures refractory to drug uses, hemorrhage and drug-refractory epilepsy. Patient-reported outcome (PRO) may be a strategy that can be used to evaluate QoL of CCM population and was used in a sample of non-operated patients. Methods: An observational, cross-sectional analysis to evaluate the PRO using the SF-36 and EuroQol 5 dimensions (EQ-5D) questionnaires of QoL added to functional metrics using the Karnofsky Performance Status (KPS) in 49 patients not submitted to intervention and with long-term follow-up. Results: During the 364 person-years of follow-up, there was an average of individual follow-up of 7.42 years. The mean age was 46.8 years (18-84) - 57% of them were female, 71% had superficial lesions, and 65% had the familial form. Comparisons of SF-36 dimensions with KPS graded <100 had a worse score only in terms of the pain (p = 0.04), vitality (p = 0.001), and general state of health (p = 0.03) domains. The domain mental health was worse in patients without surgical indication (p = 0.032). The functional capacity domain had the highest overall grading in the group. The EQ-5D dimensions of mobility (p = 0.03) and pain/discomfort (p = 0.001) were the ones with lower score compared to KPS <100. Conclusion: The study is the first to evaluate, with validated tools, the PRO of non-operated CCM patients and has demonstrated in a selected group of patients that it was possible to achieve long-term clinical stability, thereby maintaining QoL and functional neurological outcome.
Misoprostol Prior to Diagnostic Office Hysteroscopy in the Subgroup of Patients with No Risk Factors for Cervical Stenosis: A Randomized Double Blind Placebo-Controlled Trial
Authors: Fouda Usama M. , Elsetohy Khaled A. , Elshaer Hesham S. , Hammad Bahaa Eldin M. , Shaban Mona M. , Youssef Mohamed A. , Hashem Ahmed T. , Attia Ahmed H.
Published: October 2017

Aims: To assess the effectiveness of vaginal misoprostol in minimizing the pain perceived by patients with no risk factors for cervical stenosis (i.e., parous women of reproductive age who have no history of cesarean section or cervical surgery) during diagnostic office hysteroscopy. Methods: A total of 100 patients with no risk factors for cervical stenosis were randomized to the misoprostol group (n = 50) or the placebo group (n = 50). In the misoprostol group, 2 misoprostol tablets (400 µg) were administered vaginally 12 h before office hysteroscopy. In the placebo group, 2 placebo tablets were administered. The patients rated the intensity of pain perceived during the procedure and at 30 min after the procedure with the use of a 100 mm visual analog scale (VAS). The hysteroscopists also scored the difficulty of hysteroscope insertion into the uterine cavity with the use of a 100 mm VAS. Results: There were no significant differences between both groups in the VAS pain scores during or at 30 min after the procedure (28.3 ± 13.58 vs. 30.42 ± 15.13 and 11.1 ± 10.23 vs. 13.32 ± 11.12, respectively). The difficulty of hysteroscope insertion into the uterine cavity was comparable between both groups. Conclusion: Misoprostol administration prior to diagnostic office hysteroscopy appears to have no beneficial role in the subgroup of patients with no risk factors for cervical stenosis.
Macrophage Extracellular Traps: A Scoping Review
Authors: Doster Ryan S. , Rogers Lisa M. , Gaddy Jennifer A. , Aronoff David M.
Published: October 2017

Tissue macrophages are derived from either circulating blood monocytes that originate in the bone marrow, or embryonic precursors that establish residence in tissues and are maintained independent of bone marrow progenitors. Macrophages perform diverse functions including tissue repair, the maintenance of homeostasis, and immune regulation. Recent studies have demonstrated that macrophages produce extracellular traps (ETs). ETs are an immune response by which a cell undergoes “ETosis” to release net-like material, with strands composed of cellular DNA that is studded with histones and cellular proteins. ETs are thought to immobilize and kill microorganisms, but also been implicated in disease pathology including aseptic inflammation and autoimmune disease. We conducted a scoping review to define what is known from the existing literature about the ETs produced by monocytes or macrophages. The results suggest that macrophage ETs (METs) are produced in response to various microorganisms and have similar features to neutrophil ETs (NETs), in that METs are produced by a unique cell death program (METosis), which results in release of fibers composed of DNA and studded with cellular proteins. METs function to immobilize and kill some microorganisms, but may also play a role in disease pathology.
Combined Impact of Telomere Length and Mitochondrial DNA Copy Number on Cognitive Function in Community-Dwelling Very Old Adults
Authors: Lee Jee-Yon , Kim Jung-Ha , Lee Duk-Chul
Published: October 2017

Background: This study was conducted to investigate the combined impact of telomere length and mitochondrial DNA (mtDNA) copy number on cognitive function in community-dwelling very old adults. Methods: In total, 186 subjects over 75 years participated in this study. Cognitive function was assessed using the Korean Mini-Mental State Examination, and leukocyte telomere length and mtDNA copy number were measured using real-time polymerase chain reaction methods. Results: Both the fourth quartile of telomere length and mtDNA copy number were associated with cognitive dysfunction with an adjusted odds ratio of 0.23 (95% confidence interval (CI), 0.10-0.75) and 0.18 (95% CI, 0.03-0.54), respectively. Participants in the high telomere length/high mtDNA copy number group were more likely to have cognitive dysfunction than participants in the low telomere/low mtDNA copy number group with an adjusted odds ratio of 0.19 (95% CI, 0.07-0.58). Conclusion: Our results collectively suggest that the combination of telomere length and mtDNA copy number may be useful for monitoring cognitive decline in older adults.