bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term repetitive transcranial magnetic stimulation therapy: new research questions arising from one tinnitus case?
Authors: Labar Douglas Richard , Cortes Mar , Edwards Dylan
Published: December 2014

Tinnitus may become refractory to treatment and disabling. Brain transcranial magnetic stimulation (TMS) has shown promise as a therapy, but has been employed primarily short-term. We treated a patient with 5 weeks of weekly repetitive TMS (rTMS), followed by 6 months of monthly rTMS. He was a 75-year-old dentist with chronic tinnitus from occupational noise exposure. Physical examination and MRIs of the auditory canals and brain had revealed no lesions. The patient showed a general gradual, progressive improvement on per cent of severe tinnitus diary days (from baseline 100% to 33%), tinnitus handicap inventory (from baseline score 70 to 18), and mini-tinnitus questionnaire (from baseline score 17 to 6). No changes occurred in serial audiograms. Transient adverse events were a headache during stimulation, and dizziness 30 min after treatment. Implications and questions for future non-invasive neuromodulation clinical research raised by our case are discussed.
Childhood hypopigmented mycosis fungoides: a commonly delayed diagnosis
Authors: Gameiro Ana , Gouveia Miguel , Tellechea Óscar , Moreno Ana
Published: December 2014

Primary cutaneous lymphomas (PCLs) are exceedingly rare in children and adolescents, with mycosis fungoides (MF) being the most frequent PCL diagnosed in childhood. There are numerous unusual clinical variants of MF, including the hypopigmented type form (HMF). HMF is exceptional overall, but comparatively common among children. We present an 8-year-old boy with a 3-year history of progressive, generalised, scaly, hypopigmented round patches and few erythematous papules. He was first diagnosed with pityriasis alba (PA), and moisturisers were prescribed with no improvement. Skin biopsy showed typical features of MF, and the patient was successfully treated with narrowband ultraviolet B. HMF may simulate atopic dermatitis, PA, pityriasis lichenoides, tinea versicolour, vitiligo, postinflammatory hypopigmentation or leprosy. Therefore, persistent and unusual hypopigmented lesions should be biopsied to rule out this rare variant of MF.
Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective ‘before/after’ cohort study
Authors: Nachtigall I , Tafelski S , Deja M , Halle E , Grebe M C , Tamarkin A , Rothbart A , Uhrig A , Meyer E , Musial-Bright L , Wernecke K D , Spies C
Published: December 2014

Objectives

Antibiotic resistance has risen dramatically over the past years. For individual patients, adequate initial antibiotic therapy is essential for clinical outcome. Computer-assisted decision support systems (CDSSs) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines. The aim of this study was to evaluate long-term effects after implementation of a CDSS.

Design

This prospective ‘before/after’ cohort study was conducted over four observation periods within 5 years. One preinterventional period (pre) was compared with three postinterventional periods: directly after intensive implementation efforts (post1), 2 years (post2) and 3 years (post3) after implementation.

Setting

Five anaesthesiological-managed intensive care units (ICU) (one cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate care) at a university hospital.

Participants

Adult patients with an ICU stay of >48 h were included in the analysis. 1316 patients were included in the analysis for a total of 12 965 ICU days.

Intervention

Implementation of a CDSS.

Outcome measures

The primary end point was percentage of days with guideline adherence during ICU treatment. Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence.

Main results

Adherence to guidelines increased from 61% prior to implementation to 92% in post1, decreased in post2 to 76% and remained significantly higher compared with baseline in post3, with 71% (p=0.178). Additionally, antibiotic-free days increased over study periods. At all time periods, mortality for patients with low guideline adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56 (95% CI 1.05 to 2.31).

Conclusions

Implementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence. Even without further measures, adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure. Improved guideline adherence was associated with reduced ICU mortality.

Trial registration number

ISRCTN54598675.
Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature
Authors: Twyman Laura , Bonevski Billie , Paul Christine , Bryant Jamie
Published: December 2014

Objectives

To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth.

Design

A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups.

Data sources

MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014.

Study selection

Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included.

Data extraction

Two authors independently assessed studies for inclusion and extracted data.

Results

65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco).

Conclusions

Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups.

Trial registration number:

A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761).
Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study
Authors: Kitamura Tetsuhisa , Kiyohara Kosuke , Sakai Tomohiko , Iwami Taku , Nishiyama Chika , Kajino Kentaro , Nishiuchi Tatsuya , Hayashi Yasuyuki , Katayama Yusuke , Yoshiya Kazuhisa , Shimazu Takeshi
Published: December 2014

Objectives

To evaluate epidemiological characteristics of out-of-hospital cardiac arrests (OHCAs) by detailed non-cardiac cause and factors associated with the outcomes after OHCAs of non-cardiac origin.

Design

A prospective, population-based observational study.

Setting

The Utstein Osaka Project.

Participants

14 164 adult patients aged ≥20 years old with OHCAs due to non-cardiac origin who were resuscitated by emergency-medical-service personnel or bystanders, and then were transported to medical institutions from January 2005 to December 2011.

Primary outcome measures

One-month survival after OHCA. Multiple logistic regression analysis was used to assess factors that were potentially associated with the outcome.

Results

During the study period, the 1-month survival rate was 5.3% (755/14 164). The proportion of 1-month survival was 6.2% (510/8239) in external causes, 6.5% (94/1148) in respiratory diseases, 0.8% (11/1309) in malignant tumours, 4.9% (55/1114) in strokes and 4.1% (85/2054) in others. As for external causes, the proportion of 1-month survival was 14.3% (382/2670) in asphyxia, 4.2% (84/1999) in hanging, 0.7% (9/1300) in fall, 1.1% (12/1062) in drowning, 1.6% (12/765) in traffic injury, 3.7% (7/187) in drug overuse and 1.6% (4/256) in unclassified external causes. In a multivariate analysis, adults aged <65 years old with arrests witnessed by bystanders, with normal activities of daily living before the arrests, having ventricular fibrillation arrests, having arrests in public places, intravenous fluid levels and early Emergency Medical Service response time were significant predictors for 1-month outcome after OHCAs of non-cardiac origin. The proportion of 1-month survival of all OHCAs of non-cardiac origin did not significantly increase (from 4.3% (86/2023) in 2005 to 4.9% (105/2126) in 2011) and the adjusted OR for one-increment of year was 1.01 (95% CI 0.97 to 1.06).

Conclusions

From a large OHCA registry in Osaka, we demonstrated that 1-month survival after OHCAs of non-cardiac origin was poor and stable.
Quantum convolutional codes derived from constacyclic codes
Authors: Yan Tingsu , Huang Xinmei , Tang Yuansheng
Published: December 2014

In this paper, three families of quantum convolutional codes are constructed. The first one and the second one can be regarded as a generalization of Theorems 3, 4, 7 and 8 [J. Chen, J. Li, F. Yang and Y. Huang, Int. J. Theor. Phys., doi:10.1007/s10773-014-2214-6 (2014)], in the sense that we drop the constraint q ≡ 1 ( mod 4). Furthermore, the second one and the third one attain the quantum generalized Singleton bound.
Investigation of optical properties of Zn1-xVxO (x = 0.0, 0.125, 0.25, 0.5) by first principles calculations
Authors: Mendi R. Taghavi , Elahi S. M. , Abolhassani M. R.
Published: December 2014

In this paper, some optical properties of Zn 1-x V x O (0 ≤ x ≤ 0.5) such as real and imaginary part of dielectric function, energy loss function, plasmon energies and refractive index are investigated by first principles calculations. The calculations were performed in density functional theory (DFT) framework using full potential linear augmented plane wave (FP-LAPW) and generalized gradient approximation (GGA). Analysis of dielectric function shows that by substituting V instead of Zn in Zn 1-x V x O , static dielectric function, absorption and anisotropy at low energies are increased. The investigations show that V doping in ZnO affects plasmon energies. The plasmon energies have been compared with free electron model. The calculated plasmon energy for pure ZnO is nearly close to other works. The refractive index at low energies is increased significantly, so that V -doped ZnO can be used as a high refractive material.
Artificial Intelligence Basic Research Directions at the U.S. Air Force
Authors: Revesz Peter Z.
Published: December 2014

This survey gives a review of recent artificial intelligence-related research directions that are considered priority areas by the U.S. Air Force and targeted for basic research funding by Air Force Office of Scientific Research. These research areas include space situational awareness, autonomous systems, sensing and information fusion, surveillance, navigation, robust decision making, human-computer interfaces, and computational and machine intelligence. The possible contributions of artificial intelligence to these topics will be described and illustrated whenever possible by recently awarded grants.
Computer Supported Collaborative Environmental Scanning: Diagnostic Framework and Its Application for a Tunisian Case Study
Authors: Kamoun-Chouk Souad
Published: December 2014

The case study describes how the team members of a Tunisian Environmental Scanning Agriculture Observatory dealt with new ways of communicating introduced by technology. An inter-organizational computer supported collaborative work (CSCW) platform was implemented within the agriculture observatory to ameliorate the communication of information and knowledge between the stakeholders. Our study aims to determine what contextual conditions could impede the adoption of the new ways of communicating and sharing knowledge. A diagnostic tool was designed and used to assess the impact of culture, structure and top management attitude, as contextual conditions, on the achievement of the collaborative environmental scanning and knowledge exchange activity. To understand the dynamic between these variables and their interplay during the implementation phases of the CSCW, we conducted a longitudinal study. The results could assist managers at the organizational level; indeed they will be able to avoid failures and to better support the process of organizational change.
Photoperiodic Flowering: Time Measurement Mechanisms in Leaves
Authors: Song Young Hun , Shim Jae Sung , Kinmonth-Schultz Hannah A , Imaizumi Takato
Published: December 2014

Many plants use information about changing day length (photoperiod) to align their flowering time with seasonal changes to increase reproductive success. A mechanism for photoperiodic time measurement is present in leaves, and the day-length-specific induction of the FLOWERING LOCUS T (FT) gene, which encodes florigen, is a major final output of the pathway. Here, we summarize the current understanding of the molecular mechanisms by which photoperiodic information is perceived in order to trigger FT expression in Arabidopsis as well as in the primary cereals wheat, barley, and rice. In these plants, the differences in photoperiod are measured by interactions between circadian-clock-regulated components, such as CONSTANS (CO), and light signaling. The interactions happen under certain day-length conditions, as previously predicted by the external coincidence model. In these plants, the coincidence mechanisms are governed by multilayered regulation with numerous conserved as well as unique regulatory components, highlighting the breadth of photoperiodic regulation across plant species.
Non-Nutritive Sweeteners and Obesity
Authors: Fernstrom John D.
Published: December 2014

Non-nutritive sweeteners (NNSs) provide sweetness to foods and beverages without adding calories. They have thus been found useful in minimizing the dietary sugar content of diabetics and the dietary energy content of individuals attempting to lose or maintain body weight. Their usefulness in weight reduction has recently been questioned, however, based on the notion that they can actually increase hunger and food intake and thereby promote weight gain. The evidence offered in support of this idea comes principally from the fields of taste physiology, metabolic endocrinology, human behavior, and epidemiology. This review evaluates this evidence and does not find it compelling. Indeed, the most straightforward findings to the contrary derive from several intervention studies in both children and adults showing that the chronic, covert replacement of dietary sugar with NNSs does not increase, and can in fact reduce, energy intake and body weight.
Immunity to Helminths: Resistance, Regulation, and Susceptibility to Gastrointestinal Nematodes
Authors: Grencis Richard K.
Published: December 2014

Helminth parasites are a highly successful group of pathogens that challenge the immune system in a manner distinct from rapidly replicating infectious agents. Of this group, roundworms (nematodes) that dwell in the intestines of humans and other animals are prevalent worldwide. Currently, more than one billion people are infected by at least one species, often for extended periods of time. Thus, host-protective immunity is rarely complete. The reasons for this are complex, but laboratory investigation of tractable model systems in which protective immunity is effective has provided a mechanistic understanding of resistance that is characterized almost universally by a type 2/T helper 2 response. Greater understanding of the mechanisms of susceptibility has also provided the basis for defining host immunoregulation and parasite-evasion strategies, helping place in context the changing patterns of immunological disease observed worldwide.
Mechanisms of Virus Assembly
Authors: Perlmutter Jason D. , Hagan Michael F.
Published: December 2014

Viruses are nanoscale entities containing a nucleic acid genome encased in a protein shell called a capsid and in some cases are surrounded by a lipid bilayer membrane. This review summarizes the physics that govern the processes by which capsids assemble within their host cells and in vitro. We describe the thermodynamics and kinetics for the assembly of protein subunits into icosahedral capsid shells and how these are modified in cases in which the capsid assembles around a nucleic acid or on a lipid bilayer. We present experimental and theoretical techniques used to characterize capsid assembly, and we highlight aspects of virus assembly that are likely to receive significant attention in the near future.
Electoral Rules, Mobilization, and Turnout
Authors: Cox Gary W.
Published: December 2014

This essay reviews models of strategic mobilization and turnout, focusing on two important questions about the effects of electoral rules. First, how does the disproportionality of the electoral system affect the variance and mean of mobilization and turnout? This question has been investigated at least since Gosnell (1930) . In addition to reviewing the literature, I argue that extant models should pay more explicit attention to secondary mobilization (conducted by interest groups, activists, and ordinary voters). Second, how do electoral rules regulating the electoral calendar and vote fusion affect mobilizational spillovers and, hence, incentives to build mobilizational alliances? This question has attracted less attention from modelers but is well represented in the empirical literature.
Primary Injuries and Secondary Organ Failures in Trauma Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy
Authors: Beitland Sigrid , Os Ingrid , Sunde Kjetil
Published: December 2014

Background. Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) is a severe complication in trauma patients. The aim of the study was to assess primary traumatic injuries and secondary organ failures in severe posttraumatic AKI.Methods. Retrospective review of adult trauma patients admitted to the trauma centre at Oslo University Hospital Ullevål. Injury severity score (ISS) was used to assess the severity of primary injuries, and sequential organ failure assessment (SOFA) score was utilized to measure secondary organ failures.Results. Forty-two (8%) of 506 trauma patients admitted to intensive care unit developed AKI treated with CRRT, whereof 40 (95%) suffered blunt trauma mechanisms. Patients had extensive primary organ injuries with median (interquartile range) ISS 36 (27–49). The majority of the patients had respiratory (93% intubated) and cardiovascular (67% with inotropic and/or vasoactive medication) failure within 24 hours after admission. AKI was often part of multiple organ failure, most frequently respiratory and cardiovascular failure, affecting 33 (75%) and 30 (71%) of the patients, respectively.Conclusion. Trauma patients with AKI undergoing CRRT often had severe primary injuries due to blunt trauma. Most of them suffered from secondary multiple organ failure concomitant to AKI.
An Emotion Detection System Based on Multi Least Squares Twin Support Vector Machine
Authors: Tomar Divya , Ojha Divya , Agarwal Sonali
Published: December 2014

Posttraumatic stress disorder (PTSD), bipolar manic disorder (BMD), obsessive compulsive disorder (OCD), depression, and suicide are some major problems existing in civilian and military life. The change in emotion is responsible for such type of diseases. So, it is essential to develop a robust and reliable emotion detection system which is suitable for real world applications. Apart from healthcare, importance of automatically recognizing emotions from human speech has grown with the increasing role of spoken language interfaces in human-computer interaction applications. Detection of emotion in speech can be applied in a variety of situations to allocate limited human resources to clients with the highest levels of distress or need, such as in automated call centers or in a nursing home. In this paper, we used a novel multi least squares twin support vector machine classifier in order to detect seven different emotions such as anger, happiness, sadness, anxiety, disgust, panic, and neutral emotions. The experimental result indicates better performance of the proposed technique over other existing approaches. The result suggests that the proposed emotion detection system may be used for screening of mental status.
Desmopressin Acetate in Intracranial Haemorrhage
Authors: Kapapa Thomas , Röhrer Stefan , Struve Sabine , Petscher Matthias , König Ralph , Wirtz Christian Rainer , Woischneck Dieter
Published: December 2014

Introduction. The secondary increase in the size of intracranial haematomas as a result of spontaneous haemorrhage or trauma is of particular relevance in the event of prior intake of platelet aggregation inhibitors. We describe the effect of desmopressin acetate as a means of temporarily stabilising the platelet function.Patients and Methods. The platelet function was analysed in 10 patients who had received single (N=4) or multiple (N=6) doses of acetylsalicylic acid and 3 patients (control group) who had not taken acetylsalicylic acid. All subjects had suffered intracranial haemorrhage. Analysis was performed before, half an hour and three hours after administration of desmopressin acetate. Statistical analysis was performed by applying a level of significance ofP≤0.05.Results. (1) Platelet function returned to normal 30 minutes after administration of desmopressin acetate. (2) The platelet function worsened again after three hours. (3) There were no complications related to electrolytes or fluid balance.Conclusion. Desmopressin acetate can stabilise the platelet function in neurosurgical patients who have received acetylsalicylic acid prior to surgery without causing transfusion-related side effects or a loss of time. The effect is, however, limited and influenced by the frequency of drug intake. Further controls are needed in neurosurgical patients.
Maraviroc Failed to Control Progressive Multifocal Leukoencephalopathy-Associated IRIS in a Patient with Advanced HIV Infection
Authors: Rodríguez Mónica , Silva-Sánchez Fernando Antonio , Luna-Rivero César , Vega-Barrientos Ricardo , Alvarado-de la Barrera Claudia , Reyes-Terán Gustavo
Published: December 2014

Due to the lack of therapeutic options for patients with progressive multifocal leukoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-associated IRIS), maraviroc has generated expectations among the medical community. However, we report a patient with advanced HIV infection, who developed PML-associated IRIS and had a fatal outcome despite the addition of maraviroc to suppressive ART. Future studies are required to define the therapeutic role of maraviroc in PML-associated IRIS and differentiate individuals who may benefit from maraviroc from those who may develop neurological deterioration.
Premature Calcifications of Costal Cartilages: A New Perspective
Authors: Rhomberg Walter , Schuster Antonius
Published: December 2014

Background. Calcifications of the costal cartilages occur, as a rule, not until the age of 30 years. The knowledge of the clinical significance of early and extensive calcifications is still incomplete.Materials and Methods. A search was made to find patients below the age of 30 years who showed distinct calcifications of their lower costal cartilages by viewing 360 random samples of intravenous pyelograms and abdominal plain films. The histories, and clinical and laboratory findings of these patients were analyzed.Results. Nineteen patients fulfilled the criteria of premature calcifications of costal cartilages (CCCs). The patients had in common that they were frequently referred to a hospital and were treated by several medical disciplines. Nevertheless many complaints of the patients remained unsolved. Premature CCCs were often associated with rare endocrine disorders, inborn errors of metabolism, and abnormal hematologic findings. Among the metabolic disorders there were 2 proven porphyrias and 7 patients with a suspected porphyria but with inconclusive laboratory findings.Conclusion. Premature CCCs are unlikely to be a normal variant in skeletal radiology. The findings in this small group of patients call for more intensive studies, especially in regard to the putative role of a porphyria.
Existence and Algorithm for the Systems of Hierarchical Variational Inclusion Problems
Authors: Wairojjana Nopparat , Kumam Poom
Published: December 2014

We study the existence and approximation of a solution for a system of hierarchical variational inclusion problems in Hilbert spaces. In this study, we use Maingé’s approach for finding the solutions of the system of hierarchical variational inclusion problems. Our result in this paper improves and generalizes some known corresponding results in the literature.
Genetic Algorithm Based PID Controller Tuning Approach for Continuous Stirred Tank Reactor
Authors: Jayachitra A. , Vinodha R.
Published: December 2014

Genetic algorithm (GA) based PID (proportional integral derivative) controller has been proposed for tuning optimized PID parameters in a continuous stirred tank reactor (CSTR) process using a weighted combination of objective functions, namely, integral square error (ISE), integral absolute error (IAE), and integrated time absolute error (ITAE). Optimization of PID controller parameters is the key goal in chemical and biochemical industries. PID controllers have narrowed down the operating range of processes with dynamic nonlinearity. In our proposed work, globally optimized PID parameters tend to operate the CSTR process in its entire operating range to overcome the limitations of the linear PID controller. The simulation study reveals that the GA based PID controller tuned with fixed PID parameters provides satisfactory performance in terms of set point tracking and disturbance rejection.
ACE Insertion/Deletion Polymorphism and Diabetic Nephropathy: Clinical Implications of Genetic Information
Authors: Ha Sung-Kyu
Published: December 2014

Approximately 20–40% of diabetic patients develop nephropathy which is the leading cause of ESRD in developed countries. The ACE I/D polymorphism is thought to be a marker for functional polymorphism which regulates circulating and tissue ACE activity. While the initial study found a protective effect of the II genotype on the development of nephropathy in IDDM patients, subsequent studies have addressed the role of ACE I/D polymorphism in the development and progression of diabetic nephropathy. RAAS blockers are the first line drugs for the treatment hypertension associated with diabetes and have been widely used in everyday clinical practice for the purpose of reducing proteinuria in patients with various renal diseases. However, the antiproteinuric effect of RAAS blockers is variable and the percentage of reducing proteinuria is in the range of 20–80%. The antiproteinuric effect of RAAS blockers may be related to a number of factors: the type or the dose of RAAS blockers, the duration of therapy, the level of sodium intake, and the type of patient’s ACE I/D genotype. Besides the nongenetic factors, drug responses, can be influenced by ACE gene polymorphism. In this review, we discuss the relationship between ACE I/D polymorphism and diabetic nephropathy and therapeutic response of RAAS blockers.
Essential Oils from Fructus A. zerumbet Protect Human Aortic Endothelial Cells from Apoptosis Induced by Ox‐LDL In Vitro
Authors: Chen Yan , Li Duo , Xu Yini , Zhang Yanyan , Tao Ling , Li Shouqiao , Jiang Yan , Shen Xiangchun
Published: December 2014

Alpinia zerumbet is a miao folk medicinal plant widely used in the Guizhou Province of southwest China that contains several bioactive constituents and possesses protective effects against cardiovascular diseases. In the present study, we evaluated the protective effect of essential oils derived from Fructus Alpiniae zerumbet (EOFAZ) on oxidized lowdensity‐lipoprotein‐ (ox‐LDL‐) induced apoptosis in human aortic endothelial cells (HAECs). Following exposure to ox‐LDL, HAECs presented with classical characteristics of apoptosis. However, EOFAZ ameliorated these morphological alterations and also inhibited the decrease in cell viability. In addition, EOFAZ abrogated the number of TUNEL or Hoechst 33258 stained positive cells observed after ox‐LDL challenge. Investigation into the mechanisms of this inhibition revealed that EOFAZ treatment resulted in a downregulation of Bax and Caspase‐3 at both the protein and mRNA expression levels. Moreover, EOFAZ was found to upregulate Bcl‐2 protein and mRNA levels and to attenuate ox‐LDL‐induced HAECs injury caused by apoptosis, revealing both its therapeutic potential for endothelial cell injury protection and its clinical application for atherosclerosis.
Hemodynamic Behavior During Hemodialysis: Effects of Dialysate Concentrations of Bicarbonate and Potassium
Authors: Silva Bruno C. , Freitas Geraldo R.R. , Silva Vitor B. , Abensur Hugo , Luders Claudio , Pereira Benedito J. , de Oliveira Rodrigo B. , Castro Manuel C.M. , Moysés Rosa M.A. , Elias Rosilene M.
Published: December 2014

Background/Aims: Ultrafiltration that occurs during hemodialysis (HD) promotes profound alterations in a relatively short period of time. The dialysate content of bicarbonate (DBic) and potassium (DK) may have impact over intradialytic hemodynamics, which goes beyond ultrafiltration, and its impact was evaluated in a prospective cohort. Methods: 30 patients under HD were submitted to hemodynamic assessment (HA) at the beginning and at the end of HD sessions, through a non-invasive method. Serum minus dialysate potassium concentration was expressed as K-Gap. Cardiac index (CI) and peripheral arterial resistance (PAR) variation (post-HD minus pre-HD) were expressed as ΔCI and ΔPAR. Dialysate content of sodium and calcium were expressed as DNa and DCa, respectively. Results: Mean DNa, DK and DBic were, respectively, 136.4 ± 1.1, 2.1 ± 0.6 and 38.2 ± 2.1 mEq/L. In 15 patients, DCa was >1.5 mmol/L and in the other 15 patients ≤ 1.5 mmol/L. The K-Gap ranged from 1.4 to 5.1 mEq/l (median 3.0 mEq/L). There was a reduction in post-HD CI and systolic blood pressure (ΔCI = -0.72l/min/m2 and -11.3±15.1mmHg, respectively, p<0.001 for both). Conversely, PAR increased (ΔPAR = 272dyn.s/cm5, p<0.001). Lower post-HD CI was was associated to higher DBic (p=0.0013) and lower K-Gap (p=0.026). In multivariate analysis, ΔCI was dependent on DBic and K-Gap, whereas ΔPAR was dependent on dialysate calcium during HD. Conclusion: We confirmed that Na and Ca dialysate content exerts and important role on hemodynamic during HD. In addition, our findings pointed out that higher dialysate concentrations of bicarbonate and potassium promote lower cardiac performance at the end of hemodialysis session.
Bone Metabolism and Arterial Stiffness After Renal Transplantation
Authors: Cseprekál Orsolya , Kis Eva , Dégi Arianna A. , Kerti Andrea , Szabó Attila J. , Reusz György S.
Published: December 2014

Background/Aims: To assess the relationship between bone and vascular disease and its changes over time after renal transplantation. Metabolic bone disease (MBD) is common in chronic kidney disease (CKD) and is associated with cardiovascular (CV) disease. Following transplantation (Tx), improvement in CV disease has been reported; however, data regarding changes in bone disease remain controversial. Methods: Bone turnover and arterial stiffness (pulse wave velocity (PWV)) were assessed in 47 Tx patients (38 (3-191) months after Tx). Results: Bone alkaline phosphatase (BALP), osteocalcin (OC) and beta-crosslaps were significantly higher in Tx patients, and decreased significantly after one year. There was a negative correlation between BALP, OC and steroid administered (r=-0.35;r=-0.36 respectively). PWV increased in the Tx group (1.15 SD). In patients with a follow up of <24 months, PWV was correlated with BALP and beta-crosslaps (r=0.53; r=0.69 respectively) while in the ≥24 months group, PWV was correlated with cholesterol (r=0.38). Conclusions: Increased bone turnover and arterial stiffness are present following kidney transplantation. While bone turnover decreases with time, arterial stiffness correlates initially with bone turnover, after which the influence of cholesterol becomes significant. Non-invasive estimation of bone metabolism and arterial stiffness may help to assess CKD-MBD following renal transplantation.
Mortality Prediction Using Modern Peptide Biomarkers in Hemodialysis Patients - A Comparative Analysis
Authors: Artunc Ferruh , Nowak Albina , Müller Christian , Peter Andreas , Heyne Nils , Häring Hans-Ulrich , Friedrich Björn
Published: December 2014

Background/Aims: Determination of peptide biomarkers such as troponins, natriuretic peptides or the recently reported FGF23 can be useful to identify hemodialysis patients with a high risk of mortality. However, it is desirable to focus on few robust parameters to warrant their routine application. Methods: In a prospective cohort study with 239 prevalent hemodialysis patients we studied the prognostic significance of 10 simultaneously determined modern peptide biomarkers (high sensitive troponin I and T, NT-pro-BNP, BNP, MR-pro-ANP, MR-pro-ADM, CT-pro-ET1, copeptin, FGF23 and a-Klotho) and compared them with parameters traditionally associated with mortality (PTH, Ca, Pi, albumin, CRP, cholesterol, AP). Results: After a follow-up of 4 years, plasma concentration of troponins, natriuretic peptides, MR-pro-ADM, FGF23 as well as PTH, CRP, AP were significantly higher in deceased patients (n=95). Hazard ratios from cox regression on a continuous scale (doubling of plasma concentration) or relative in tertiles were highest for high sensitive troponins, followed by natriuretic peptides and MR-pro-ADM (1.6-2.0 and 2.3-5.5, resp.). C-indices were also highest for troponins (0.708-0.746), followed by natriuretic peptides (0.706-0.731). Traditional parameters had low c-indices (0.598-0.655). Stepwise cox regression revealed that among all parameters troponin I, NT-pro-BNP, PTH and CRP remained independent predictors of mortality and a composite score had the highest c-index (0.799 [0.740-0.849]). Conclusions: Among peptide biomarkers high sensitive troponins and to a lesser extent natriuretic peptides are strong predictors of mortality in asymptomatic hemodialysis patients, followed by markers of mineral-bone disease and inflammation.
Effects of Spironolactone in Combination with Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers in Patients with Proteinuria
Authors: Kim Ha Yeon , Bae Eun Hui , Ma Seong Kwon , Kim Soo Wan
Published: December 2014

Background/Aims: This study aimed to investigate the potential beneficial anti-proteinuric effect of an add-on aldosterone blockade and the impact of the aldosterone escape phenomenon. Methods: We retrospectively analyzed data of 304 patients with persistent proteinuria, who were administered spironolactone (25 mg/day) after treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) for >3 months. Patients were divided according to their aldosterone levels during ACEI/ARB treatment into an escape group (plasma aldosterone >80 pg/mL, N=95, 31.5%) and a non-escape group (plasma aldosterone ≤80 pg/mL, N=209, 68.5%) and according to their urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Results: After 12 months, the UACR decreased significantly in patients with 1≤UACR<3.5 g/g Cr, UACR ≥3.5 g/g Cr, and eGFR ≥60 mL/min/1.73 m2, and in the non-escape group. Severe hyperkalemia (K≥7.0 mEq/L) developed in 9 of 137 patients with eGFR<60 mL/min/1.73 m2 (6.5%) and in none of the 167 patients with eGFR≥60 mL/min/1.73 m2. Conclusions: Proteinuria decreased significantly after add-on spironolactone treatment in patients with 1≤UACR<3.5 g/g Cr, UACR ≥3.5 g/g Cr, and eGFR ≥60 mL/min/1.73 m2, and in the non-escape group. The anti-proteinuric effect of spironolactone may vary according to the degree of albuminuria, impaired eGFR, and aldosterone escape.
Effects of Paricalcitol and Aliskiren Combination Therapy on Experimental Diabetic Nephropathy Model in Rats
Authors: Eren Zehra , Günal Mehmet Yalçin , Bakir Elif Arı , Coban Jale , Çağlayan Berrak , Ekimci Nur , Ethemoglu Sinem , Albayrak Ozgur , Akdeniz Tuba , Demirel Gülderen Yanikkaya , Kiliç Ertuğrul , Kantarci Gülçin
Published: December 2014

Background/Aims: The aim of the present study was to investigate the effect of combination of aliskiren with paricalcitol on experimental diabetic nephropathy (DN) model in rats. Methods: Forty male Sprague Dawley rats were divided into 5 groups of 8 rats each, namely the control (Group C), diabetes (Group D), aliskiren (Group A), paricalcitol (Group P), and aliskiren plus paricalcitol (Group A+P) groups. Aliskiren was given by oral-gavage at a dose of 50 mg/kg/day once daily for 12 weeks. Paricalcitol was given by intraperitoneally at a dose of 0,4 µg/kg/three day of week for 12 weeks. Renal function parameters, oxidative stress biomarkers, mRNA expression of renin-angiotensin system parameters and kidney histology were determined. Results: Group A+P had lower mean albümin-to-creatinine ratio (ACR) (p=0.004) as well as higher creatinine clearance (CCr) (p<0.005) than the diabetic rats (Group D). Combination therapy significantly increased CCr (Group A+P vs Group A, p<0.005; Group A+P vs Group P, p=0.022) and reduced ACR (Group A+P vs Group A, p=0.018; Group A+P vs Group P, p<0.005) when compared to monotherapy. Serum malondialdehyde levels were significantly lower (p=0.004); glutathion levels (p=0.003), glutathion peroxidase (p=0.004) and superoxide dismutase (p<0.005) activities were significantly higher in group A+P than in group D. The mean scores of mRNA expression of renin (p<0.005), angiotensin II (p=0.012) and angiotensin type 1 receptor (p=0.018) in group A+P were significantly lower. Although combination therapy showed no additional effect on oxidative system, renin-angiotensin system and renal histology, aliskiren plus paricalcitol significantly decreased interstitial fibrosis volume when compared to monotherapy (Group A+P vs Group A, p<0.005; Group A+P vs Group P, p=0.002). Conclusion: Our data seem to suggest a potential role of aliskiren plus paricalcitol acting synergystically for reducing the progression of diabetic nephropathy in an experimental rat model.
5. Kongress der Stiftung für Naturheilkunde und Erfahrungsmedizin: «Heilung findet zuhause statt - Lebensthemen»
Authors: Ganz Chrischta
Published: December 2014

Am 3. und 4. Oktober 2014 fand in Solothurn zum 5. Mal der Kongress der Stiftung für Naturheilkunde und Erfahrungsmedizin (SNE) statt. Der Kongress mit dem Titel «Heilung findet zuhause statt - Lebensthemen» ist eine Aktivität der 1995 von der EGK-Gesundheitskasse gegründeten SNE.
Sympathetic Nerve Stimulation, Not Circulating Norepinephrine, Modulates T-Peak to T-End Interval by Increasing Global Dispersion of Repolarization
Authors: Yagishita Daigo , Chui Ray W. , Yamakawa Kentaro , Rajendran Pradeep S. , Ajijola Olujimi A. , Nakamura Keijiro , So Eileen L. , Mahajan Aman , Shivkumar Kalyanam , Vaseghi Marmar
Published: December 2014

Background—

T-peak to T-end interval (Tp-e) is an independent marker of sudden cardiac death. Modulation of Tp-e by sympathetic nerve activation and circulating norepinephrine is not well understood. The purpose of this study was to characterize endocardial and epicardial dispersion of repolarization (DOR) and its effects on Tp-e with sympathetic activation.

Methods and Results—

In Yorkshire pigs (n=13), a sternotomy was performed and the heart and bilateral stellate ganglia were exposed. A 56-electrode sock and 64-electrode basket catheter were placed around the epicardium and in the left ventricle (LV), respectively. Activation recovery interval, DOR, defined as variance in repolarization time, and Tp-e were assessed before and after left, right, and bilateral stellate ganglia stimulation and norepinephrine infusion. LV endocardial and epicardial activation recovery intervals significantly decreased, and LV endocardial and epicardial DOR increased during sympathetic nerve stimulation. There were no LV epicardial versus endocardial differences in activation recovery interval during sympathetic stimulation, and regional endocardial activation recovery interval patterns were similar to the epicardium. Tp-e prolonged during left (from 40.4±2.2 ms to 92.4±12.4 ms;
P
<0.01), right (from 47.7±2.6 ms to 80.7±11.5 ms;
P
<0.01), and bilateral (from 47.5±2.8 ms to 78.1±9.8 ms;
P
<0.01) stellate stimulation and strongly correlated with whole heart DOR during stimulation (
P
<0.001,
R
=0.86). Of note, norepinephrine infusion did not increase DOR or Tp-e.

Conclusions—

Regional patterns of LV endocardial sympathetic innervation are similar to that of LV epicardium. Tp-e correlated with whole heart DOR during sympathetic nerve activation. Circulating norepinephrine did not affect DOR or Tp-e.
Effect of Inorganic Nitrate on Exercise Capacity in Heart Failure With Preserved Ejection Fraction
Authors: Zamani Payman , Rawat Deepa , Shiva-Kumar Prithvi , Geraci Salvatore , Bhuva Rushik , Konda Prasad , Doulias Paschalis-Thomas , Ischiropoulos Harry , Townsend Raymond R. , Margulies Kenneth B. , Cappola Thomas P. , Poole David C. , Chirinos Julio A.
Published: December 2014

Background—

Inorganic nitrate (NO
3
−
), abundant in certain vegetables, is converted to nitrite by bacteria in the oral cavity. Nitrite can be converted to nitric oxide in the setting of hypoxia. We tested the hypothesis that NO
3
−
supplementation improves exercise capacity in heart failure with preserved ejection fraction via specific adaptations to exercise.

Methods and Results—

Seventeen subjects participated in this randomized, double-blind, crossover study comparing a single dose of NO
3
-rich beetroot juice (NO
3
−
, 12.9 mmol) with an identical nitrate-depleted placebo. Subjects performed supine-cycle maximal-effort cardiopulmonary exercise tests, with measurements of cardiac output and skeletal muscle oxygenation. We also assessed skeletal muscle oxidative function. Study end points included exercise efficiency (total work/total oxygen consumed), peak

o
2
, total work performed, vasodilatory reserve, forearm mitochondrial oxidative function, and augmentation index (a marker of arterial wave reflections, measured via radial arterial tonometry). Supplementation increased plasma nitric oxide metabolites (median, 326 versus 10 μmol/L;
P
=0.0003), peak

o
2
(12.6±3.7 versus 11.6±3.1 mL O
2
·min
−1
·kg
−1
;
P
=0.005), and total work performed (55.6±35.3 versus 49.2±28.9 kJ;
P
=0.04). However, efficiency was unchanged. NO
3
−
led to greater reductions in systemic vascular resistance (−42.4±16.6% versus −31.8±20.3%;
P
=0.03) and increases in cardiac output (121.2±59.9% versus 88.7±53.3%;
P
=0.006) with exercise. NO
3
−
reduced aortic augmentation index (132.2±16.7% versus 141.4±21.9%;
P
=0.03) and tended to improve mitochondrial oxidative function.

Conclusions—

NO
3
−
increased exercise capacity in heart failure with preserved ejection fraction by targeting peripheral abnormalities. Efficiency did not change as a result of parallel increases in total work and

o
2.
NO
3
−
increased exercise vasodilatory and cardiac output reserves. NO
3
−
also reduced arterial wave reflections, which are linked to left ventricular diastolic dysfunction and remodeling.

Clinical Trial Registration—

URL:
www.clinicaltrials.gov
. Unique identifier: NCT01919177.
Central Aortic Reservoir-Wave Analysis Improves Prediction of Cardiovascular Events in Elderly Hypertensives
Authors: Narayan Om , Davies Justin E. , Hughes Alun D. , Dart Anthony M. , Parker Kim H. , Reid Christopher , Cameron James D.
Published: December 2014

Several morphological parameters based on the central aortic pressure waveform are proposed as cardiovascular risk markers, yet no study has definitively demonstrated the incremental value of any waveform parameter in addition to currently accepted biomarkers in elderly, hypertensive patients. The reservoir-wave concept combines elements of wave transmission and Windkessel models of arterial pressure generation, defining an excess pressure superimposed on a background reservoir pressure. The utility of pressure time constants derived from reservoir-wave analysis in prediction of cardiovascular events is unknown. Carotid blood pressure waveforms were measured prerandomization in a subset of 838 patients in the Second Australian National Blood Pressure Study. Reservoir-wave analysis was performed and indices of arterial function, including the systolic and diastolic time constants, were derived. Survival analysis was performed to determine the association between reservoir-wave parameters and cardiovascular events. The incremental utility of reservoir-wave parameters in addition to the Framingham Risk Score was assessed. Baseline values of the systolic time constant were independently predictive of clinical outcome (hazard ratio, 0.33; 95% confidence interval, 0.13–0.82;
P
=0.016 for fatal and nonfatal stroke and myocardial infarction and hazard ratio, 0.38; 95% confidence interval, 0.20–0.74;
P
=0.004 for the composite end point, including all cardiovascular events). Addition of this parameter to the Framingham Risk Score was associated with an improvement in predictive accuracy for cardiovascular events as assessed by the integrated discrimination improvement and net reclassification improvement indices. This analysis demonstrates that baseline values of the systolic time constant predict clinical outcomes in elderly patients with hypertension and incrementally improve prognostication of cardiovascular events.
Histogram Mapping Synthesis: A Cellular Automata-Based Technique for Flexible
Sound Design
Authors: Serquera Jaime , Miranda Eduardo Reck
Published: December 2014

Histogram mapping synthesis (HMS) is a new technique for sound design based on cellular automata (CA). Cellular automata are computational models that create moving images. In the context of HMS, and based on a novel digital signal processing approach, these images are analyzed by histogram measurements, giving a sequence of histograms as a result. In a nutshell, these histogram sequences are converted into spectrograms that, in turn, are rendered into sounds. Unlike other CA-based systems, the HMS mapping process is not intuition-based, nor is it totally arbitrary; it is based instead on resemblances discovered between the components of the histogram sequences and the spectral components of the sounds. Our main concern is to address the problem of the sound-design limitations of synthesis techniques based on CA. These limitations stem, fundamentally, from the unpredictable and autonomous nature of these computational models. As a result, one of the main advantages of HMS is that it affords more control over the sound-design process than other sound-synthesis techniques using CA. The timbres that we have designed with HMS range from those that are novel to those that are imitations of sounds produced by acoustic means. All the sounds obtained present dynamic features, and many of them, including some of those that are novel, retain important characteristics of sounds produced by acoustic means.