bluuebunny/crossref_metadata_2025 huggingface dataset:
Should We Keep Changing the Diagnostic Criteria for Behçet's Disease?
Authors: Kronborg Caroline , Mahar Patrick D. , Kelly Robert
Published: February 2014

In medicine, clinical acumen is used to achieve diagnosis, guide management and prevent disease. While for some diseases, diagnosis is reached with the assistance of objective tests, many conditions rely upon the use of clinical diagnostic criteria; Behçet's disease is one such case. In order to remain clinically relevant, as knowledge of a condition changes over time so too must its diagnostic criteria. Preferably, when new criteria for a disease are conceptualised it is through sound methodology, followed by a confirmation of accuracy by way of systematic validation and response to treatment. The most recently proposed revised International Criteria for Behçet's Disease for the diagnosis of Behçet's disease have been systematically validated and should replace the use of the clinically inferior International Study Group criteria, while not displacing the role of clinical judgement. Effort should now be invested in acquiring better understanding of the pathogenesis of the disease in the hope of developing a more objective test.
Ventilator-Associated Pneumonia in Neonatal Patients: An Update
Authors: Cernada María , Brugada María , Golombek Sergio , Vento Máximo
Published: February 2014

Ventilator-associated pneumonia (VAP) is a serious complication related to mechanical ventilation in the neonatal period. However, lack of a specific definition and difficulties obtaining noncontaminated samples of the lower respiratory airway render microbiological diagnosis and etiological treatment extremely difficult. Thus far, only few studies have approached VAP using accepted Centers for Disease Control and Prevention criteria and reliable sampling techniques. In recent years, however, the blind-protected bronchoalveolar lavage technique with protected specimen brush and the development of validated biomarkers have attempted to overcome the diagnostic difficulties and assess the response to therapy. This updated review on neonatal VAP aims to stimulate neonatologists' interest in this subtle but serious complication of mechanical ventilation.
Current Concepts in the Diagnosis and Classification of Renal Dysfunction in Cirrhosis
Authors: Mindikoglu Ayse L. , Weir Matthew R.
Published: February 2014

Background: Renal dysfunction is one of the most common complications of cirrhosis with high morbidity and mortality. Summary: In subjects with cirrhosis, renal dysfunction can present either as a direct consequence of cirrhosis (e.g. hepatorenal syndrome type I and type II) or secondary to etiologies other than cirrhosis (chronic kidney disease due to diabetic nephropathy, prerenal azotemia), or patients with cirrhosis may have renal dysfunction resulting directly from cirrhosis and an underlying chronic kidney disease. Key Messages: Given the challenges in the differential diagnosis of renal dysfunction and insufficient accuracy of serum creatinine and creatinine-based glomerular filtration rate estimating equations in cirrhosis, there is an urgent need for more accurate biomarkers of renal dysfunction in this population. This review will discuss novel concepts for the diagnosis and classification of renal dysfunction in cirrhosis to overcome at least some of the diagnostic and therapeutic challenges. Additionally, a new classification will be proposed for renal dysfunction in cirrhosis.
The Non-Neuronal Cholinergic System in Health and Disease
Authors: Beckmann Janet , Lips Katrin Susanne
Published: February 2014

Acetylcholine (ACh) is not only a neurotransmitter but is an ancient molecule that can be released by and act on non-neuronal cells. In these cells the system of ACh-synthesizing enzymes, transporters, receptors and degrading enzymes is termed the non-neuronal cholinergic system (NNCS). There is increasing evidence that the NNCS is dysregulated in various diseases and can have an influence on their pathology. However, for many organ systems not much is known about the expression and function of the NNCS. Thus, this review focusses on the role of the NNCS in different organ systems in health and disease. Dysregulation of ACh synthesis and release, mutations or polymorphisms in genes encoding NNCS components, and auto-antibodies against NNCS components are common factors influencing disease progression. Pharmacological agents targeting the NNCS are already successfully in clinical use for some disorders, indicating that interfering with this system is very promising and more research is needed to elucidate the role of the NNCS in different tissues and pathological states.
Clinical Application of Liver Stiffness Measurement Using Transient Elastography: A Surgical Perspective
Authors: Kim Seung Up , Kim Beom Kyung , Han Kwang-Hyub
Published: February 2014

Liver biopsy (LB) remains the gold standard for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra-/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are ineligible in real clinical practice. Thus, due to the pressing need for non-invasive surrogates, over the past decade, significant progress has been made in non-invasively assessing liver fibrosis. Of the methods now available, transient elastography (TE) appears to be an excellent tool for assessing liver fibrosis and also has some prognostic value in surgical settings. Recent studies have proposed the extended role of TE in the surgical field, based on the concept that TE values show significant correlations with portal hypertension and hepatocellular carcinoma development. TE appears promising in predicting postoperative short-term outcomes such as hepatic insufficiency or complications and long-term outcomes such as recurrence or liver-related death. Furthermore, TE may be useful in predicting the severity of liver fibrosis progression due to recurrence of hepatitis C virus infection or other underlying liver diseases after transplantation. TE cannot completely replace other tests accompanied with hepatic surgical treatments, including LB, endoscopic examination, hepatic venous pressure gradient evaluation, or the indocyanine green retention test. However, TE represents an important non-invasive tool that enables more efficient and tailored management strategies for patients who were treated with liver resection or transplantation. This review discusses extended TE applications in the surgical setting, such as hepatic resection or transplantation.
Stroke in Dialysis and Chronic Kidney Disease
Authors: Power Albert
Published: February 2014

Background: Renal impairment is a potent risk factor for stroke that is a leading cause of morbidity and mortality worldwide. Dialysis patients experience a 10-fold higher incidence, with case fatality rates reaching 90%. It is important to understand the factors predisposing to stroke in patients with chronic kidney disease (CKD) coupled with an appreciation of preventative strategies. Summary: The heightened risk of stroke in CKD represents the interplay of the vascular comorbidities that cluster with renal impairment as well as pathology inherent in uremia, such as accelerated vascular calcification and the malnutrition-inflammation-atherosclerosis syndrome. These factors are most marked in hemodialysis where stroke rates peak at 10-35/1,000 patient years and where hemorrhagic stroke accounts for 20-30% of all events. Older age, hypertension, diabetes and established cerebrovascular disease are all risk factors for stroke with dialysis initiation constituting the highest risk period. Patients with CKD stages 3-5D have worse survival as well as diminished functional outcomes following stroke. Thrombolytic therapy for acute stroke appears safe in all stages of CKD although the therapeutic effect may be attenuated. Control of hypertension and the use of antiplatelet agents form the mainstay of stroke prevention. The benefit of antiplatelet therapies and oral anticoagulants must be balanced against the real risks of bleeding that are most evident in dialysis cohorts. Key Messages: Understanding the risks and benefits of established stroke treatments is vital in patients with CKD, especially in those on dialysis therapies who are at highest risk of adverse outcomes.
Physiology and Pharmacology of Erythropoietin
Authors: Jelkmann Wolfgang
Published: February 2014

Human erythropoietin (Epo) is a 30.4 kDa glycoprotein hormone composed of a single 165 amino acid residues chain to which four glycans are attached. The kidneys are the primary sources of Epo, its synthesis is controlled by hypoxia-inducible transcription factors (HIFs). Epo is an essential factor for the viability and proliferation of erythrocytic progenitors. Whether Epo exerts cytoprotection outside the bone marrow still needs to be clarified. Epo deficiency is the primary cause of the anemia in chronic kidney disease (CKD). Treatment with recombinant human Epo (rhEpo, epoetin) can be beneficial not only in CKD but also for other indications, primarily anemia in cancer patients receiving chemotherapy. Considering unwanted events, the administration of rhEpo or its analogs may increase the incidence of thromboembolism. The expiry of the patents for the original epoetins has initiated the production of similar biological medicinal products (‘biosimilars'). Furthermore, analogs (darbepoetin alfa, methoxy PEG-epoetin beta) with prolonged survival in circulation have been developed (‘biobetter'). New erythropoiesis-stimulating agents are in clinical trials. These include compounds that augment erythropoiesis directly (e.g. Epo mimetic peptides or activin A binding protein) and chemicals that act indirectly by stimulating endogenous Epo synthesis (HIF stabilizers).
HER2 Expression and PI3K-Akt Pathway Alterations in Gastric Cancer
Authors: Sukawa Yasutaka , Yamamoto Hiroyuki , Nosho Katsuhiko , Ito Miki , Igarashi Hisayoshi , Naito Takafumi , Mitsuhashi Kei , Matsunaga Yasutaka , Takahashi Taiga , Mikami Masashi , Adachi Yasushi , Suzuki Hiromu , Shinomura Yasuhisa
Published: February 2014

The anti-HER2 antibody trastuzumab has led to an era of personalized therapy in gastric cancer (GC). As a result, HER2 expression has become a major concern in GC. HER2 overexpression is seen in 7-34% of GC cases. Trastuzumab is an antibody that targets the HER2 extracellular domain and induces antibody-dependent cellular cytotoxicity and inhibition of the HER2 downstream signals. Mechanisms of resistance to trastuzumab have been reported in breast cancer. There are various mechanisms underlying trastuzumab resistance, such as alterations of HER2 structure or surroundings, dysregulation of HER2 downstream signal effectors and interaction of HER2 with other membrane receptors. The PI3K-Akt pathway is one of the main downstream signaling pathways of HER2. It is well known that PIK3CA mutations and phosphate and tensin homolog (PTEN) inactivation cause over-activation of the downstream signal without an upstream signal activation. Frequencies of PIK3CA mutations and PTEN inactivation have been reported to be 4-25 and 16-77%, respectively. However, little is known about the association between HER2 expression and PI3K-Akt pathway alterations in GC. We have found that HER2 over-expression was significantly correlated with pAkt expression in GC tissues. Furthermore, pAkt expression was correlated with poor prognosis. These results suggest that the PI3K-Akt pathway plays an important role in HER2-positive GC. Moreover, PIK3CA mutations and/or PTEN inactivation might affect the effectiveness of HER2-targeting therapy. Hence, it is necessary to clarify not only HER2 alterations but also PI3K-Akt pathway alterations for HER2-targeting therapy in GC. This review will introduce recent investigations and consider the current status of HER2-targeted therapy for treatment of GC.
Short-Chain Fatty Acid Receptor and Its Contribution to Glucagon-Like Peptide-1 Release
Authors: Kaji Izumi , Karaki Shin-ichiro , Kuwahara Atsukazu
Published: February 2014

Background: Gut microbiota affects host homeostasis and dysbiosis causes host diseases. Therefore, uncovering the sensing mechanism of bacterial metabolites such as short-chain fatty acid (SCFA) may help us to understand the host-microbiota interaction both in physiological and nonphysiological conditions. Summary: The colonic lumen is continually exposed to many kinds of chemicals, including beneficial and harmful compounds that are produced by gut microbiota in addition to ingested nutrients. In the mammalian colon SCFAs such as acetate, propionate and butyrate are produced by bacterial fermentation and reach about 100 mM under physiological conditions. In this decade, SCFA receptor genes and their expression in the intestine have been identified as free fatty acid receptor (FFA)2 and FFA3. The FFAs are located in colonic enteroendocrine L cells producing and releasing an insulinotropic hormone, glucagon-like peptide-1 (GLP-1), and an anorectic hormone, peptide YY. Recent in vivo and in vitro studies suggest that SCFAs stimulate gut hormone secretion. Therefore, the SCFA-FFA signal is likely to be important for gut physiological functions. Key Message: Colonic epithelial cells express chemical receptors that detect the luminal contents, particularly bacterial metabolites, and may be involved in the host's energy metabolism via GLP-1 release, as well as the mucosal defense system.
Drug Therapy in Stroke: From Preclinical to Clinical Studies
Authors: Kaur Harjeet , Prakash Ajay , Medhi Bikash
Published: February 2014

Background: Stroke is one of the major challenges to health and the reason for increasing disability-adjusted life years. Despite tremendous progress in preclinical studies, none of the treatment options has proven efficacious in clinical studies. The basic aim of neuroprotection is to interfere with the events of the ischemic cascade, halt the pathological processes and prevent the death of vulnerable nerve cells in the ischemic penumbra. Summary: This review will provide a brief overview of the current understanding of stroke, including the global epidemiology of stroke, its pathophysiology, the targeting of specific pathways and the success and failure of preclinical as well as clinical studies, and it will discuss the emerging targets for novel therapeutic strategies under investigation. Key Messages: New advancing investigational drugs for the prevention and treatment of stroke are on the way and may someday give hope to neuroscientists and clinicians. A novel approach should adopt preclinical testing, advance the understanding of the pathophysiology of stroke and make it possible to translate it from bench to bedside. We should learn from the past failures and move on with more enthusiasm.
Caveat Emptor: Single Nucleotide Polymorphism Reporting in Pharmacogenomics
Authors: Tekin Izel , Vrana Kent E.
Published: February 2014

While it is arguably the most comprehensive source of genetic information, the NCBI's dbSNP database (National Center for Biotechnology Information database of single nucleotide polymorphisms; http://www.ncbi.nlm.nih.gov/projects/SNP/) is imperfect. In this commentary, we highlight the issues surrounding this database, while considering the great importance and utility of this resource for those in the pharmacology and pharmacogenomics communities. We describe our experience with the information in this database as a cautionary tale for those who will utilize such information in the future. We also discuss several measures that could render it more reliable.
‘Essential Tremor' or ‘the Essential Tremors': Is This One Disease or a Family of Diseases?
Authors: Louis Elan D.
Published: February 2014

There is accumulating evidence that the entity referred to as ‘essential tremor' (ET) is not a single disease. It may be a family of diseases better referred to as ‘the ETs'. This review will summarize the following evidence: (1) the presence of etiological heterogeneity; (2) the heterogeneity of findings in postmortem studies, thus suggesting several diseases; (3) the recent discussion that age of onset may be an important marker of disease heterogeneity; (4) the clinical expansion of the concept of ET in recent years to include a broader range of tremor phenomenology, other motor features (gait ataxia), other involuntary movements (dystonia), and nonmotor features (cognitive problems, psychiatric problems), some of which could be primary; (5) the heterogeneity of pharmacological response profiles and clinical progression, and (6) the association of ET with Parkinson's disease, Alzheimer's disease, and possibly progressive supranuclear palsy, with the possibility that some ET patients are more predisposed to develop one of these.
Optimal Oxygenation of Extremely Low Birth Weight Infants: A Meta-Analysis and Systematic Review of the Oxygen Saturation Target Studies
Authors: Saugstad Ola Didrik , Aune Dagfinn
Published: February 2014

Background: The optimal oxygen saturation for extremely low birth weight infants in the postnatal period beyond the delivery room is not known. Objectives: To summarize and discuss the results of the randomized trials, constituting the NEOPROM (Neonatal Oxygenation Prospective Meta-analysis) collaborative study, examining the effect of low versus high functional oxygen saturation targets in the postnatal period in premature infants with gestational age <28 weeks. Methods: A meta-analysis of SUPPORT (Surfactant, Positive Pressure and Pulse Oximetry Randomized Trial), the three BOOST II (Benefits of Oxygen Saturation Targeting) studies and the COT (Canadian Oxygen Trial) was performed including a total of 4,911 infants randomized to either a low (85-89%) or high (91-95%) functional oxygen saturation (SpO2) within the first 24 h after birth. Results: Relative risks (RR; 95% CIs) comparing a low versus a high oxygen saturation target were 1.41 (1.14-1.74) for mortality at discharge or at follow-up, 0.74 (0.59-0.92) for severe retinopathy of prematurity, 0.95 (0.86-1.04) for physiologic bronchopulmonary dysplasia, 1.25 (1.05-1.49) for necrotizing enterocolitis, 1.02 (0.88-1.19) for brain injury, and 1.01 (0.95-1.08) for patent ductus arteriosus. RR >1.0 favors a high oxygen saturation. Conclusions: RRs for mortality and necrotizing enterocolitis are significantly increased and severe retinopathy of prematurity significantly reduced in low compared to high oxygen saturation target infants. There are no differences regarding physiologic bronchopulmonary dysplasia, brain injury or patent ductus arteriosus between the groups. Based on these results, it is suggested that functional SpO2 should be targeted at 90-95% in infants with gestational age <28 weeks until 36 weeks' postmenstrual age. However, there are still several unanswered questions in this field.
Big Data in Nephrology: Friend or Foe?
Authors: Ketchersid Terry
Published: February 2014

The phrase ‘big data' has arrived in today's lexicon with great fanfare and some degree of hyperbole. Generally speaking, big data refer to data sets that are too complex to be successfully interrogated using standard statistical software. A wide variety of business sectors has utilized big data to garner competitive advantage within their respective markets. Medicine and nephrology, in particular, have been late to this table. This is beginning to change, however, as data scientists begin to work with these large data sets, developing predictive models that permit us to peer into the future. Coupled with an expanding understanding of genomics, predictive models constructed with the assistance of big data may soon provide us with a powerful tool to use as we provide care to patients with renal disease.
Prooxidative-Antioxidative Balance of Cells in Different Types of Renal Replacement Therapy
Authors: Stępniewska Joanna , Dołęgowska Barbara , Popińska Marlena , Sałata Daria , Budkowska Marta , Gołembiewska Edyta , Myślak Marek , Domański Maciej , Marchelek-Myśliwiec Małgorzata , Ciechanowski Kazimierz
Published: February 2014

Background: Patients suffering from chronic kidney disease (CKD) are exposed to increased oxidative stress and disturbances manifesting in the enzymatic and non-enzymatic antioxidative defence system. The object of the research was to assess the differences between conservative treatment, peritoneal dialysis and haemodialysis in moderating cellular antioxidative agents. Methods: The group examined comprised 145 patients. The activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and glucose-6-phosphate dehydrogenase were obtained using kinetic methods. The spectrophotometric method established the concentrations of reduced glutathione, albumin, uric acid, glucose, total protein and lipids. Results: The type of treatment determined significant changes in antioxidative enzyme activities and concentrations of non-enzymatic antioxidative compounds. Conclusions: Peritoneal dialysis provides better antioxidant protection than other types of therapy in CKD and should be considered as first-choice treatment despite more metabolic disorders.
Antiepileptic Drugs and Suicide: A Systematic Review of Adverse Effects
Authors: Ferrer Pili , Ballarín Elena , Sabaté Mònica , Vidal Xavier , Rottenkolber Marietta , Amelio Justyna , Hasford Joerg , Schmiedl Sven , Ibáñez Luisa
Published: February 2014

Background: Since the FDA (Food and Drug Administration) report on antiepileptic drugs (AEDs) and suicide risk was released (2008), several studies have been published on this controversial relationship. This systematic review (SR) gives an updated approach to this health issue. Summary: We searched 6 databases. We ultimately included 11 publications: 4 cohort studies, 1 case-crossover study, 2 community case-control studies, and 4 SRs. Overall, 1 SR described studies already included; 3 studies reported a 2- to 4-fold overall increase in risk; 1 study reported an increased risk of suicide among epilepsy patients on AEDs with high risk of depression; 1study showed a protective effect among epilepsy patients; 2 studies were conducted with patients with bipolar disorder (1 showed a protective effect, whereas the other showed a 3-fold increase in risk of suicide), and the other 3 studies reported results for single AEDs. Several biases affected the published results. Key Messages: There is no clear evidence of an association between the use of AEDs and an increased risk of suicide because of the heterogeneity in the studies at the clinical and methodological level. A future study should cover all indications for use, retrieve information from a healthcare database, and include a defined set of covariates to avoid bias.
The Inverted CD4:CD8 Ratio Is Associated with Cytomegalovirus, Poor Cognitive and Functional States in Older Adults
Authors: Luz Correa Bruna , Ornaghi Ana Paula , Cerutti Muller Guilherme , Engroff Paula , Pestana Lopes Rodrigo , Gomes da Silva Filho Irênio , Bosch Jos A. , Bonorino Cristina , Bauer Moisés Evandro
Published: February 2014

Background: Some premature features of immunosenescence have been associated with persistent viral infections and altered populations of T cells. In particular, the inverted T CD4:CD8 ratio has been correlated with increased morbidity and mortality across different age groups. Objective: Here, we investigated the role of persistent viral infections, cognitive and functional states as predictors of inverted CD4:CD8 ratio of older adults in a developing country. Methods: Three hundred and sixty community-dwelling older adults (aged 60-103 years) were recruited. Cognitive function was evaluated by the Instrument of Brief Neuropsychological Assessment and Mini-Mental State Examination inventory. Functional Activities Questionnaire was used to determine activities of daily living. Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) serologies were determined by ELISAs. Peripheral blood was assessed for lymphocyte subsets by flow cytometry (CD4+, CD8+, NK, NKT, B and CD8+CD28-). Results: Fifty-nine individuals were identified with CD4:CD8 ratio <1, and had increased IgG titers to CMV (p < 0.01), but not to EBV, compared to subjects with CD4:CD8 ratio >1. The older adults with inverted CD4:CD8 ratio had impairments in some cognitive dimensions and had more functional disability and dependency (p = 0.01) than subjects with CD4:CD8 ratio >1. The lymphocyte subsets did not vary between groups. The increased CMV-IgG titers alone contributed to 8× higher chance to invert CD4:CD8 T cell ratio (OR 8.12, 95% CI 1.74-37.88, p < 0.01). Conclusion: Our data further indicate the role of CMV on circulating T cells, poor cognition and functional disability/dependency during aging.
Verlust der Transfusionsabhängigkeit nach Therapie der Eisenüberladung mit Deferasirox bei einer Patientin mit Myelofibrose und Sphärozytose - ein Fallbericht
Authors: Tesch Hans , Ihling Christian
Published: February 2014

Hintergrund: Viele Patienten mit primärer Myelofibrose (PMF), die zur Gruppe der myeloproliferativen Neoplasien zählt, werden aufgrund einer Anämie im Verlauf ihrer Erkrankung transfusionsabhängig. Die Transfusionsabhängigkeit ist bei diesen Patienten mit einem schlechteren Überleben assoziiert. Fallbericht: Wir berichten über eine 67-jährige Patientin, bei der die Diagnose einer PMF gestellt worden war. Die zytogenetische Untersuchung erbrachte einen 46,XX, del(20)(q11,2)-Karyotyp, der mit einer myeloproliferativen Erkrankung vereinbar ist. Obwohl ihr wegen einer schweren Anämie und Leukozytose dazu geraten wurde, lehnte die Patientin eine allogene hämatopoetische Stammzelltransplantation ab. Nach Transfusion von kumulativ mehr als 70 Erythrozytenkonzentraten wurde eine Eisenchelat-Therapie mit Deferipron zur Behandlung der Eisenüberladung eingeleitet und nach 3 Monaten auf Deferasirox umgestellt. Innerhalb von 2 Monaten Therapie mit Deferasirox kam es zu einer signifikanten Reduktion der Serumferritin-Konzentrationen; die Patientin verlor ihre Transfusionsabhängigkeit über einen Zeitraum von 17 Monaten und erreichte normale Hämoglobinkonzentrationen. Schlussfolgerung: Die Eisenchelat-Therapie mit Deferasirox führte zu einer Verbesserung hämatologischer Parameter und zum Verlust der Transfusionsabhängigkeit. Übersetzung aus Onkologie 2013;36:205-208 (DOI: 10.1159/000349939)
Brown Bowel Syndrome: A Rare Complication in Diseases Associated with Long-Standing Malabsorption
Authors: Albrecht Heinz , Hagel Alexander , de Rossi Thomas , Rau Tilman T. , Kirchner Thomas , Neurath Markus F. , Raithel Martin
Published: February 2014

Background/Aims: Longtime chronic malabsorption may among other things cause a lack of liposoluble vitamins. Vitamin E deficiency can lead to formation of lipofuscin aggregates. Its deficiency is also associated with an increased lipofuscinosis of the bowel, i.e. brown bowel syndrome. Methods: Systematic research via Medline on brown bowel syndrome, lipofuscinosis, and vitamin E deficiency was performed. We combined our own clinical experience and a review of the literature for this paper. Its goal is to inform about the possible consequences of severe malabsorption and brown bowel syndrome. Results: Systematic data about the occurrence of severe malabsorption and brown bowel syndrome are rare. Only about 27 scientific reports can be found on this subject. Brown bowel syndrome is found mostly in conjunction with vitamin E deficiency and lipofuscinosis of the bowel. The clinical findings are caused by both malabsorption and lipofuscinosis. Case reports show a therapeutic effect of vitamin E. Conclusion: Vitamin deficiency caused by longtime chronic malabsorption can lead to the development of brown bowel syndrome, which is seen as the expression of lipofuscinosis of the bowel, and can cause further clinical disorders. Patients with malabsorption should therefore be monitored regarding their vitamin E levels.
A New Scoring Method of the Mini-Mental Status Examination to Screen for Dementia
Authors: Choe Jin Yeong , Han Ji Won , Kim Tae Hui , Kim Jeong Lan , Moon Seok Woo , Park Joon Hyuk , Kim Shin Gyeom , Kim Bong-Jo , Kwak Kyung-Phil , Ryu Seung-Ho , Yoon Jong Chul , Lee Dong Young , Lee Dong Woo , Lee Seok Bum , Lee Jung Jae , Jhoo Jin Hyeong , Kim Ki Woong
Published: February 2014

Background: Although the Mini-Mental Status Examination (MMSE) is the most widely used screening instrument for dementia, it has several limitations. Methods: We developed and validated a new scoring method of the MMSE, namely the short form of the MMSE (MMSE-S). Results: The MMSE-S was more robust to demographic influences than the MMSE. The influence of education, in particular, was smaller in the MMSE-S compared to the MMSE (p < 0.01). The diagnostic accuracy of the MMSE-S for very mild to mild dementia was also better than that of the original MMSE (p < 0.0001). Its specificity, in particular, was higher than that of the original MMSE. In Korea, we could improve the post-test probability for dementia from 46.88 to 64.76% by employing the MMSE-S instead of the MMSE. We also provided optimal cut-off scores for dementia stratified by age, education, and gender, which may further improve the diagnostic accuracy of the MMSE-S for dementia. Conclusion: Due to its good accuracy and brevity, the MMSE-S may contribute to enhancing the cost-effectiveness of and accessibility to dementia screening as well as early diagnosis and treatment of dementia, particularly in low- and middle-income countries.
Renal Denervation: Intractable Hypertension and Beyond
Authors: Ariyanon Wassawon , Mao Huijuan , Adýbelli Zelal , Romano Silvia , Rodighiero Mariapia , Reimers Bernhard , La Vecchia Luigi , Ronco Claudio
Published: February 2014

Background: Hypertension continues to be a major burden of public health concern despite the recent advances and proven benefit of pharmacological therapy. A certain subset of patients has hypertension resistant to maximal medical therapy and appropriate lifestyle measures. A novel catheter-based technique for renal denervation (RDN) as a new therapeutic avenue has great promise for the treatment of refractory hypertension. Summary: This review included the physiology of the renal sympathetic nervous system and the renal nerve anatomy. Furthermore, the RDN procedure, technology systems, and RDN clinical trials as well as findings besides antihypertensive effects were discussed. Findings on safety and efficacy seem to suggest that renal sympathetic denervation could be of therapeutic benefit in refractory hypertensive patients. Despite the fast pace of development in RDN therapies, only initial and very limited clinical data are available. Large gaps in knowledge concerning the long-term effects and consequences of RDN still exist, and solid, randomized data are warranted.
Elettariopsis biphylla, a new species of Zingiberaceae from Thailand
Authors: Saensouk Surapon , SAENSOUK PIYAPORN
Published: February 2014

A new species of Elettariopsis from Phu Wua Wildlife Sanctuary, Bung Khla District, Bueng Kan Provice, Thailand is described as a new species. The new species is similar to E. monophylla (Gagnep.) Loesener (1930: 603), but differs in having two leaves and dark red veins in parts of the labellum, in the length of the petioles, the tall pseudostem and the apex of the anther-crest. Differences are pointed out in Table 1. The species is locally rare occurring in lowland Phuwou forest. It is described and illustrated below.
Development and Maintenance Mechanism for the Semiannual Oscillation of the North Pacific Upper-Level Circulation
Authors: Chen Tsing-Chang , Tsay Jenq-Dar
Published: February 2014

The north–south semiannual oscillation (SAO) of the North Pacific jet stream, part of the atmospheric SAO in the Northern Hemisphere, can be well depicted by the semiannual component of the monthly-mean eddy streamfunction. Expressed by the semiannual eddy streamfunction budget, the dynamic processes develop and maintain the SAO, including the adjustment between vorticity advection and convergence of vorticity flux of the monthly-mean mode and the convergence of transient vorticity flux. An empirical orthogonal function analysis of these dynamic processes shows an east–west elongated cyclonic (anticyclonic) cell of the semiannual eddy streamfunction anomaly, which appears in January and July (October and April) south of the Siberia–Alaska landmass. The maximum (minimum) adjustment processes by the monthly-mean mode and the maximum (minimum) feedback impact of transient activity on the SAO occur in December and June (September and March), a month ahead of the maximum (minimum) north–south SAO of the North Pacific jet stream. Because vorticity is supplied by the convergence of vorticity flux associated with divergent flow, the SAO for the rotational flow is established by diabatic heat and heat transport through the divergent circulation over the North Pacific Ocean, and by precipitation maintained by convergence of water vapor flux along the oceanic storm track. Additionally, the feedback impact of the modulated transient activity affects the SAO development of the atmospheric rotational and divergent circulations, and the hydrological cycle.
Transatlantic convergence? The archaeology of immigrant integration in Canada and Europe
Authors: Banting Keith
Published: February 2014

At first glance, Canada and Europe seem to be diverging dramatically in their approach to immigrant integration. While support for a multicultural approach seems to remain strong in Canada, a potent backlash pervades European debates. This paper argues that beneath the image of transatlantic divergence, there are important elements of convergence. First, the retreat from multiculturalism in Europe is more complete at the level of discourse than policy. With a few notable exceptions, multicultural policies have remained stable or even grown stronger since 2000. In many countries, new integration programs are being layered over multicultural initiatives introduced in earlier decades. Second, many of the new integration policies celebrated as evidence of a U-turn away from multiculturalism resemble programs that have long been part of immigrant integration in Canada. As a result, transatlantic convergence is indeed part of the contemporary story. However, there are also limits to this convergence. While some European countries are opting for liberal, voluntary approaches to integration, which can be combined with a multicultural approach to diversity, others are adopting more obligatory, illiberal versions of civic integration that seem inconsistent with the support for diversity central to a multicultural approach.
Modeling Two Types of Peace
Authors: Bagozzi Benjamin E. , Hill Daniel W. , Moore Will H. , Mukherjee Bumba
Published: February 2014

A growing body of applied research on political violence employs split-population models to address problems of zero inflation in conflict event counts and related binary dependent variables. Nevertheless, conflict researchers typically use standard ordered probit models to study discrete ordered dependent variables characterized by excessive zeros (e.g., levels of conflict). This study familiarizes conflict scholars with a recently proposed split-population model—the zero-inflated ordered probit (ZiOP) model—that explicitly addresses the econometric challenges that researchers face when using a “zero-inflated” ordered dependent variable. We show that the ZiOP model provides more than an econometric fix: it provides substantively rich information about the heterogeneous pool of “peace” observations that exist in zero-inflated ordinal variables that measure violent conflict. We demonstrate the usefulness of the model through Monte Carlo experiments and replications of published work and also show that the substantive effects of covariates derived from the ZiOP model can reveal nonmonotonic relationships between these covariates and one’s conflict probabilities of interest.
Reduction of mortality due to tetanus by immunisation and proper wound management of the patients in Sengerema Designated District Hospital, Tanzania
Authors: Melkert D , Kahema L , Melkert P
Published: February 2014

Tetanus is a life-threatening, preventable infection with a high mortality. Our aim was to determine the changes in incidence and case fatality rate at Sengerema Designated District Hospital in a retrospective review of patients who had been hospitalised with tetanus between 1962 and 2012. In the 1970s and 1980s a vaccination campaign was organised in order to cover the whole district and to provide immunity for tetanus. Data are based on 476 cases with a fatal outcome in 305 cases. The case fatality rate has declined from 74% between 1982 and 1991 to 11.1% currently. Improved facilities are required in order to significantly reduce adverse outcome from tetanus.
Incidence of Spontaneous Central Nervous System Tumors in CD-1 Mice and Sprague-Dawley, Han-Wistar, and Wistar Rats Used in Carcinogenicity Studies
Authors: Bertrand Lise , Mukaratirwa Sydney , Bradley Alys
Published: February 2014

The incidence and range of spontaneous central nervous system tumors were determined in control Charles River rodents (Sprague-Dawley, Han-Wistar, Wistar rats, and CD-1 mice) from regulatory carcinogenicity studies carried out over the period 2002 to 2013 and were compared with the previously published data. In both species, the brain was notably more affected than the spinal cord. Incidences were comparable overall between rat strains (2.33%, 2.54%, and 2.89% in Wistar, Sprague-Dawley, and Han-Wistar strains, respectively) and were low in CD-1 mice (0.42% in 104-week studies and 0.2% in 80-week studies). Predominant tumor types were granular cell tumors in Wistar and Han-Wistar rats and malignant astrocytoma in Sprague-Dawley rats. Male rats were more frequently affected than females, but no sex predilection was apparent in CD-1 mice. Occasional early-onset tumors were diagnosed in rats from study week 23 onward. It is hoped that these results will provide the pathologist and the toxicologist with an up-to-date database of background neoplastic findings in widely used rodent strains.
The Black–White Swimming Disparity in America
Authors: Wiltse Jeff
Published: February 2014

This article offers a historically informed answer to the question why are Black Americans less likely to know how to swim than Whites. It contends that past discrimination in the provision of and access to swimming pools is largely responsible for this contemporary disparity. There were two times when swimming surged in popularity—at public swimming pools during the 1920s and 1930s and at suburban swim clubs during the 1950s and 1960s. In both cases, large numbers of White Americans had easy access to these pools, whereas racial discrimination severely restricted Black Americans’ access. As a result, swimming never became integral to Black Americans’ recreation and sports culture and was not passed down from generation to generation as commonly occurred with Whites.
Systematic Review and Meta‐analysis of Robotic vs Conventional Thyroidectomy Approaches for Thyroid Disease
Authors: Sun Gordon H. , Peress Lilia , Pynnonen Melissa A.
Published: February 2014

Objective

This study compared postoperative technical, quality‐of‐life, and cost outcomes following either robotic or open thyroidectomy for thyroid nodules and cancer.

Data Sources

PubMed, Ovid MEDLINE, EMBASE, ISI Web of Science, and the Cochrane Central Register of Controlled Trials.

Review Methods

We examined relevant controlled trials, comparative effectiveness studies, and cohort studies for eligible publications. We calculated the pooled relative risk for key postoperative complications, mean differences for operative time, and standardized mean differences for length of stay (LOS) using random effects models. Quality‐of‐life outcomes were summarized in narrative form.

Results

The meta‐analysis comprised 11 studies with 726 patients undergoing robotic transaxillary or axillo‐breast thyroidectomy and 1205 undergoing open thyroidectomy. There were no eligible cost‐related studies. Mean operative time for robotic thyroidectomy exceeded open thyroidectomy by 76.7 minutes, while no significant difference in LOS was identified. There were no significant differences in hematoma, seroma, recurrent laryngeal nerve injury, hypocalcemia, or chyle leak rates. The systematic review included 12 studies. Voice, swallowing, pain, and paresthesia outcomes showed no significant differences between the 2 approaches. The robotic cohort reported higher cosmetic satisfaction scores, although follow‐up periods did not exceed 3 months and no validated questionnaires were used.

Conclusions

Transaxillary and axillo‐breast robotic and open thyroidectomy demonstrate similar complication rates, but robotic approaches may introduce the risk of new complications and require longer operative times. Robotic thyroidectomy appears to improve cosmetic outcomes, although longer follow‐up periods and use of validated instruments are needed to more rigorously examine this effect.
Errors in Otolaryngology Revisited
Authors: Shah Rahul K. , Boss Emily F. , Brereton Jean , Roberson David W.
Published: February 2014

Objective

A decade ago, a survey study identified areas of risk and proposed a classification schema for otolaryngology errors. The objective of the present study is to obtain current data for comparison using a similar methodology.

Study Design

Survey study.

Setting

An anonymous online survey was distributed via the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) weekly email.

Subjects and Methods

Members of the AAO‐HNS were asked to describe any event in their practice that they felt should not have happened. Events were classified using the prior schema with minor modifications.

Results

Of 681 respondents, 445 (66%) reported an event within the past 6 months, from which 222 reports were extracted. The mean age of the affected patients was 41 ± 24 years. An adverse consequence occurred in more than half of events, with corrective action taken in 82.8%. Of the respondents, 68% subsequently changed their practice patterns. The domains with the most reported errors were technical (27.9% of all events, 71% with major morbidity), administrative (12.2%, 3.7%), diagnostic testing (10.8%, 8.3%), and surgical planning (9.9%, 45.5%). There were 8 wrong‐site surgeries, 23 cranial nerve injuries (91.3% major morbidity), and 9 errors during endoscopic sinus surgery (55.6% major morbidity). There were 4 deaths.

Conclusion

There has been disappointingly little overall change. Otolaryngologists remain vulnerable to errors and related adverse events. The domains with the greatest risk for error‐related major morbidity have changed little and include errors in technical, administrative, diagnostic testing, surgical planning, and surgical equipment. Awareness of high‐risk areas may help to focus preventive efforts in these domains.
Hand-shape classification with a wrist contour sensor: Analyses of feature types, resemblance between subjects, and data variation with pronation angle
Authors: Fukui Rui , Watanabe Masahiko , Shimosaka Masamichi , Sato Tomomasa
Published: February 2014

Hand gestures can potentially express rich information for communication between humans or between a human and a machine. However, existing hand-shape recognition methods have several problems in utilizing hand gestures in home automation. We have focused on ‘wrist contour’, and have developed a wrist-watch-type device that measures wrist contour using photo reflector arrays. In this paper, we address three challenges: improvement of hand-shape recognition performance, making clear the effect of personal difference, and identifying problems caused by pronation angle changes. To address the former two challenges, we have collected wrist contour data from 28 subjects and conducted two experiments. For the first challenge, three different feature types are compared. The results extract several important contour statistics and the classification rate is also improved by introducing multiple subjects’ data for training. For the second challenge, we compose a resemblance matrix to evaluate resemblance among subjects. The results indicate that training data selection is important to improve classification performance. To address the third challenge, two inertial measurement units are installed in the device. We have collected wrist contour data in various pronation angles, and specific relationships are found between wrist contour data and pronation angles.
Primary distal femur T-cell lymphoma after allogeneic haematopoietic stem cell transplantation for chronic myeloid leukaemia: A rare case report and literature review
Authors: Han Qiaoyan , Sun Miao , Wu Lingyu , Chen Jing , Wang Wei , Liu Chunhua , Chen Haoyue , Du Guibin
Published: February 2014

Post-transplant lymphoproliferative disorders originating from T lymphocytes are a rare complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) that are not usually associated with Epstein–Barr virus infection. A male patient diagnosed at the age of 15 years with chronic myeloid leukaemia (in the chronic phase) was initially treated with oral hydroxyurea. The disease entered an accelerated phase when the patient was 22 years old. Complete remission was achieved after one course of homoharringtonine and cytarabine. The patient then underwent human leucocyte antigen-matched sibling donor allo-HSCT. Just over 6.5 years after the allo-HSCT, a second primary tumour was located in the distal femur and diagnosed as T-cell non-Hodgkin’s lymphoma (stage IV, group B). This was treated with various chemotherapy and radiotherapy regimens, but the outcomes were poor and the disease progressed. The T-cell lymphoma invaded many sites, including the skeleton, spleen and skin, and the patient died within 8 months of the diagnosis. This current case report highlights the need for the early detection and prevention of subsequent primary malignancies after allo-HSCT.
EMLA® cream: A pain-relieving strategy for childhood vaccination
Authors: Abuelkheir Manal , Alsourani Deema , Al-Eyadhy Ayman , Temsah Mohamad-Hani , Meo Sultan Ayoub , Alzamil Fahad
Published: February 2014

Objectives

To evaluate the effectiveness of topical eutectic mixture of local anaesthetics (EMLA®) cream in reducing the pain associated with vaccination injections.

Methods

This was a randomized, double-blind, placebo-controlled study that included children who presented for routine immunization. Eligible children were randomly assigned to receive either EMLA® or placebo cream. The Modified Behavioural Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores, while a visual analogue scale (VAS) was used to assess pain at the time of the needle prick and at the end of the injection.

Results

A total of 107 children were enrolled in the EMLA® group and 109 children in the placebo group. The difference between the pre- and postvaccination MBPS scores was significantly lower in the EMLA group than in the placebo group (2.56 ± 1.96 versus 3.95 ± 2.20, respectively). The VAS scores at the time of the needle prick and after the injection were significantly lower in the EMLA® group compared with the placebo group (1.60 ± 1.67 versus 3.24 ± 2.01; 3.29 ± 2.27 versus 4.86 ± 2.20; respectively).

Conclusions

Application of EMLA® cream can be effectively incorporated as a routine pain-relieving intervention within routine vaccination appointments.