bluuebunny/crossref_metadata_2025 huggingface dataset:
Expiratory activation of abdominal muscle is associated with improved respiratory stability and an increase in minute ventilation in REM epochs of adult rats
Authors: Andrews Colin G. , Pagliardini Silvia
Published: September 2015

Breathing is more vulnerable to apneas and irregular breathing patterns during rapid eye movement (REM) sleep in both humans and rodents. We previously reported that robust and recurrent recruitment of expiratory abdominal (ABD) muscle activity is present in rats during REM epochs despite ongoing REM-induced muscle atonia in skeletal musculature. To develop a further understanding of the characteristics of ABD recruitment during REM epochs and their relationship with breathing patterns and irregularities, we sought to compare REM epochs that displayed ABD muscle recruitment with those that did not, within the same rats. Specifically, we investigated respiratory characteristics that preceded and followed recruitment. We hypothesized that ABD muscle recruitment would be likely to occur following respiratory irregularities and would subsequently contribute to respiratory stability and the maintenance of good ventilation following recruitment. Our data demonstrate that epochs of REM sleep containing ABD recruitments (REMABD+) were characterized by increased respiratory rate variability and increased presence of spontaneous brief central apneas. Within these epochs, respiratory events that displayed ABD muscle activation were preceded by periods of increased respiratory rate variability. Onset of ABD muscle activity increased tidal volume, amplitude of diaphragmatic contractions, and minute ventilation compared with the periods preceding ABD muscle activation. These results show that expiratory muscle activity is more likely recruited when respiration is irregular and its recruitment is subsequently associated with an increase in minute ventilation and a more regular respiratory rhythm.
Characterizing pinprick-evoked brain potentials before and after experimentally induced secondary hyperalgesia
Authors: van den Broeke Emanuel N. , Mouraux André , Groneberg Antonia H. , Pfau Doreen B. , Treede Rolf-Detlef , Klein Thomas
Published: September 2015

Secondary hyperalgesia is believed to be a key feature of “central sensitization” and is characterized by enhanced pain to mechanical nociceptive stimuli. The aim of the present study was to characterize, using EEG, the effects of pinprick stimulation intensity on the magnitude of pinprick-elicited brain potentials [event-related potentials (ERPs)] before and after secondary hyperalgesia induced by intradermal capsaicin in humans. Pinprick-elicited ERPs and pinprick-evoked pain ratings were recorded in 19 healthy volunteers, with mechanical pinprick stimuli of varying intensities (0.25-mm probe applied with a force extending between 16 and 512 mN). The recordings were performed before (T0) and 30 min after (T1) intradermal capsaicin injection. The contralateral noninjected arm served as control. ERPs elicited by stimulation of untreated skin were characterized by 1) an early-latency negative-positive complex peaking between 120 and 250 ms after stimulus onset (N120-P240) and maximal at the vertex and 2) a long-lasting positive wave peaking 400–600 ms after stimulus onset and maximal more posterior (P500), which was correlated to perceived pinprick pain. After capsaicin injection, pinprick stimuli were perceived as more intense in the area of secondary hyperalgesia and this effect was stronger for lower compared with higher stimulus intensities. In addition, there was an enhancement of the P500 elicited by stimuli of intermediate intensity, which was significant for 64 mN. The other components of the ERPs were unaffected by capsaicin. Our results suggest that the increase in P500 magnitude after capsaicin is mediated by facilitated mechanical nociceptive pathways.
An Enhanced Quantum-Behaved Particle Swarm Algorithm for Reactive Power Optimization considering Distributed Generation Penetration
Authors: Jiao Runhai , Li Bo , Li Yuancheng , Zhu Lingzhi
Published: September 2015

This paper puts forward a novel particle swarm optimization algorithm with quantum behavior (QPSO) to solve reactive power optimization in power system with distributed generation. Moreover, differential evolution (DE) operators are applied to enhance the algorithm (DQPSO). This paper focuses on the minimization of active power loss, respectively, and uses QPSO and DQPSO to determine terminal voltage of generators, and ratio of transformers, switching group number of capacitors to achieve optimal reactive power flow. The proposed algorithms are validated through three IEEE standard examples. Comparing the results obtained from QPSO and DQPSO with those obtained from PSO, we find that our algorithms are more likely to get the global optimal solution and have a better convergence. What is more, DQPSO is better than QPSO. Furthermore, with the integration of distributed generation, active power loss has decreased significantly. Specifically, PV distributed generations can suppress voltage fluctuation better than PQ distributed generations.
Correlative Microscopy of Lamellar Hole-Associated Epiretinal Proliferation
Authors: Compera Denise , Entchev Enrico , Haritoglou Christos , Mayer Wolfgang J. , Hagenau Felix , Ziada Jean , Kampik Anselm , Schumann Ricarda G.
Published: September 2015

Purpose. To describe morphology of lamellar hole-associated epiretinal proliferation (LHEP) removed from eyes with lamellar macular holes (LMH).Methods. Based on optical coherence tomography data, 10 specimens of LHEP were removed from 10 eyes with LMH during standard vitrectomy. Specimens were prepared for correlative light and electron microscopy (CLEM) using an immunonanogold particle of 1.4 nm diameter that was combined with a fluorescein moiety, both having been attached to a single antibody fragment. As primary antibodies, we used antiglial fibrillary acidic protein (GFAP), anti-CD45, anti-CD64, anti-α-smooth muscle actin (α-SMA), and anticollagen type I and type II.Results. In LHEP, GFAP-positive cells possess ultrastructural characteristics of fibroblasts and hyalocytes. They represent the major cell types and were densely packed in cell agglomerations on vitreous collagen strands. Epiretinal cells of LHEP rarely demonstrated contractive properties asα-SMA-positive myofibroblasts were an infrequent finding.Conclusion. CLEM indicates that epiretinal cells in LHEP might originate from the vitreous and that remodelling processes of vitreous collagen may play an important role in pathogenesis of eyes with LMH.
How to Isolate a Plant’s Hypomethylome in One Shot
Authors: Wischnitzki Elisabeth , Sehr Eva Maria , Hansel-Hohl Karin , Berenyi Maria , Burg Kornel , Fluch Silvia
Published: September 2015

Genome assembly remains a challenge for large and/or complex plant genomes due to their abundant repetitive regions resulting in studies focusing on gene space instead of the whole genome. Thus, DNA enrichment strategies facilitate the assembly by increasing the coverage and simultaneously reducing the complexity of the whole genome. In this paper we provide an easy, fast, and cost-effective variant of MRE-seq to obtain a plant’s hypomethylome by an optimized methyl filtration protocol followed by next generation sequencing. The method is demonstrated on three plant species with knowingly large and/or complex (polyploid) genomes:Oryza sativa,Picea abies, andCrocus sativus. The identified hypomethylomes show clear enrichment for genes and their flanking regions and clear reduction of transposable elements. Additionally, genomic sequences around genes are captured including regulatory elements in introns and up- and downstream flanks. High similarity of the results obtained by ade novoassembly approach with a reference based mapping in rice supports the applicability for studying and understanding the genomes of nonmodel organisms. Hence we show the high potential of MRE-seq in a wide range of scenarios for the direct analysis of methylation differences, for example, between ecotypes, individuals, within or across species harbouring large, and complex genomes.
Treatment of Breakthrough and Refractory Chemotherapy-Induced Nausea and Vomiting
Authors: Navari Rudolph M.
Published: September 2015

Despite significant progress in the prevention of chemotherapy-induced nausea and vomiting (CINV) with the introduction of new antiemetic agents, 30–50% of patients receiving moderately or highly emetogenic chemotherapy (MEC or HEC) and guideline directed prophylactic antiemetics develop breakthrough CINV. International guidelines recommend the treatment of breakthrough CINV with an agent from a drug class that was not used in the prophylactic antiemetic regimen and recommend using the breakthrough medication continuously rather than using it on an as needed basis. There have been very few studies on the treatment of breakthrough CINV. A recent double-blind, randomized, phase III study suggested that olanzapine may be an effective agent for the treatment of breakthrough CINV. Refractory CINV occurs when patients develop CINV during subsequent cycles of chemotherapy when antiemetic prophylaxis has not been successful in controlling CINV in earlier cycles. Patients who develop refractory CINV should be considered for a change in their prophylactic antiemetic regimen. If significant anxiety exists, a benzodiazepine may be added to the prophylactic regimen. If a refractory patient is receiving HEC, olanzapine may be added to the prophylactic regimen. If the patient is receiving MEC, olanzapine or an NK-1 receptor antagonist may be added to the prophylactic regimen.
Validated HPTLC Method for Quantification of Luteolin and Apigenin inPremna mucronataRoxb., Verbenaceae
Authors: Patel Nayan G. , Patel Kalpana G. , Patel Kirti V. , Gandhi Tejal R.
Published: September 2015

A simple, rapid, and precise high-performance thin-layer chromatographic method was developed for quantitative estimation of luteolin and apigenin inPremna mucronataRoxb., family Verbenaceae. Separation was performed on silica gel 60 F254HPTLC plates using toluene : ethyl acetate : formic acid (6 : 4 : 0.3) as mobile phase for elution of markers from extract. The determination was carried out in fluorescence mode using densitometric absorbance-reflection mode at 366 nm for both luteolin and apigenin. The methanolic extract ofPremna mucronatawas found to contain 10.2 mg/g % luteolin and 0.165 mg/g % of apigenin. The method was validated in terms of linearity, LOD and LOQ, accuracy, precision, and specificity. The calibration curve was found to be linear between 200 and 1000 ng/band for luteolin and 50 and 250 ng/band for apigenin. For luteolin and apigenin, the limit of detection was found to be 42.6 ng/band and 7.97 ng/band while the limit of quantitation was found to be 129.08 ng/band and 24.155 ng/band, respectively. This developed validated method is capable of quantifying and resolving luteolin and apigenin and can be applicable for routine analysis of extract and plant as a whole.
Monitoring Pesticide Residues in Surface and Ground Water in Hungary: Surveys in 1990–2015
Authors: Székács András , Mörtl Mária , Darvas Béla
Published: September 2015

Over 2000 surface, ground and raw drinking water samples have been analyzed in the frame of different monitoring projects in Hungary and watercourses in neighboring countries between 1990 and 2015. Effects of pesticide contamination on ecological farming and drinking water supply have been assessed. Main water pollutant ingredients of agricultural origin in Hungary are herbicides related to maize production. After EU pesticide re-registration, diazinon, atrazine, and trifluralin gradually disappeared as contaminants. High levels of water soluble pollutants (e.g., acetochlor) in surface water result in temporarily enhanced levels in raw drinking water as well. Extreme levels observed for herbicide residues were of agrochemical industrial origin.
Minimized Cost Gateway Deployment in Cyber-Physical Systems
Authors: Wang Hao , Li Jianzhong , Gao Hong
Published: September 2015

Wireless networks have been widely used in Cyber-Physical System (CPS) for data transmission. A CPS usually contains lots of sensors, and these sensors generate massive data. To make use of these data, we have to collect them through wireless communication. Sensors in a certain CPS do not always adopt same wireless technology, and these sensors formed heterogeneous wireless networks. Communication between different types of wireless networks can only be achieved by utilizing wireless gateways. In this paper, we address the problem of gateway placement for satisfying the bandwidth-requirement of each node by using minimum gateways. This problem can be formulated as a variant of Minimum Geometric Disk Cover problem which has been proved NP-complete. In order to solve our problem, one heuristic gateway placement algorithm and one grid-based heuristic algorithm are proposed. The result of simulation demonstrates that the heuristic algorithm can offer a good solution with big probability.
The Roles of Hedgehog Signaling in Upper Lip Formation
Authors: Kurosaka Hiroshi
Published: September 2015

Craniofacial development consists of a highly complex sequence of the orchestrated growth and fusion of facial processes. It is also known that craniofacial abnormalities can be detected in 1/3 of all patients with congenital diseases. Within the various craniofacial abnormalities, orofacial clefting is one of the most common phenotypic outcomes associated with retarded facial growth or fusion. Cleft lip is one of the representative and frequently encountered conditions in the spectrum of orofacial clefting. Despite various mechanisms or signaling pathways that have been proposed to be the cause of cleft lip, a detailed mechanism that bridges individual signaling pathways to the cleft lip is still elusive.Shhsignaling is indispensable for normal embryonic development, and disruption can result in a wide spectrum of craniofacial disorders, including cleft lip. This review focuses on the current knowledge about the mechanisms of facial development and the etiology of cleft lip that are related toShhsignaling.
Management of Chemotherapy Induced Nausea and Vomiting in Patients on Multiday Cisplatin Based Combination Chemotherapy
Authors: Ranganath Praveen , Einhorn Lawrence , Albany Costantine
Published: September 2015

Introduction of cisplatin based chemotherapy has revolutionized the treatment of germ cell tumors. A common side effect of multiday cisplatin chemotherapy is severe nausea and vomiting. Considerable progress has been made in the control of these side effects since the introduction of cisplatin based chemotherapy in the 1970s. Germ cell tumor which is a model for a curable neoplasm has also turned into an excellent testing ground to develop effective strategies to prevent chemotherapy induced nausea and vomiting (CINV) in multiday cisplatin based regimens. The use of combination of a 5-hydroxytryptamine (HT)3receptor antagonist, a neurokinin-1 (NK1) antagonist, and dexamethasone has greatly improved our ability to prevent and control acute and delayed CINV. Mechanism and pattern of CINV with multiday chemotherapy may differ from those in single day chemotherapy and therefore efficacy of antiemetic drugs as observed in single day chemotherapy may not be applicable. There are only few randomized clinical trials with special emphasis on multiday chemotherapy. Further studies are essential to determine the efficacy, optimal dose, and duration of the newer agents and combinations in multiday cisplatin based chemotherapy.
Effects of Screen Size on Biochemical Conversion of Big Bluestem Biomass for Biofuel Production
Authors: Song Xiaoxu , Zhang Meng , Zhang Ke , Pei Z. J. , Wang Donghai
Published: September 2015

Biomass size reduction is the first step for biofuel production from cellulosic biomass through biochemical pathway, and it is usually performed on a mill with screen installed to control the size of the produced particles. The absence of in-depth knowledge about the effects of screen size throughout the biochemical conversion of cellulosic biomass makes it difficult to choose the screen size to conduct biomass size reduction to minimize the energy consumption on mills, maximize the cellulose recovery rate after pretreatment, and maximize the enzymatic hydrolysis efficiency. The objective of this work is to address this issue by generating new knowledge on the effects of screen size in these three processes: size reduction, pretreatment, and enzymatic hydrolysis in conversion of big bluestem biomass for biofuel production. Four screen sizes used in this study were 1, 2, 4, and 8 mm. It was found that using a larger screen size saved energy in biomass size reduction on a knife mill. Moreover, particles produced with larger screen sizes achieved higher cellulose recovery rate after pretreatment, higher enzymatic hydrolysis efficiency, and higher total sugar yield.
Krüppel-like Factor 4 Blocks Hepatocellular Carcinoma Dedifferentiation and Progression through Activation of Hepatocyte Nuclear Factor-6
Authors: Sun Hongcheng , Tang Huamei , Xie Dacheng , Jia Zhiliang , Ma Zhenyu , Wei Daoyan , Mishra Lopa , Gao Yong , Zheng Shaojiang , Xie Keping , Peng Zhihai
Published: September 2015

Purpose: Tumor differentiation is a behavioral index for hepatocellular carcinoma (HCC) and a prognostic factor for patients with HCC who undergo orthotopic liver transplantation (OLT). However, the molecular basis for HCC differentiation and prognostic value of the underlying molecules that regulate HCC differentiation are unclear. In this study, we defined a potential driver pathway for HCC differentiation and prognostication.

Experimental Design: The regulation and function of Krüppel-like factor 4 (KLF4) and hepatocyte nuclear factor-6 (HNF-6) in HCC differentiation was evaluated using human tissues, molecular and cell biology, and animal models, and its prognostic significance was determined according to its impact on patient survival.

Results: There was a direct relationship between the expression levels of KLF4 and HNF6 in HCC. Reduced KLF4 or HNF6 expression correlated with high HCC grade. Poorly differentiated HCC cells had lower expression of KLF4 or HNF6 and differentiation-associated markers than did well-differentiated cells. Elevated KLF4 of HNF6 expression induced differentiation of poorly differentiated hepatoma cells. Mechanistically, KLF4 trans-activated HNF-6 expression. Restored HNF-6 expression upregulated expression of differentiation-associated markers and inhibited HCC cell migration and invasion, whereas HNF-6 knockdown did the opposite. Loss of KLF4 expression in primary HCC correlated with reduced overall survival and shortened relapse-free survival durations after OLT. Combination of KLF4 expression and the Milan criteria improved prognostication for HCC after OLT.

Conclusions: The dysregulated KLF4/HNF-6 pathway drives dedifferentition and progression of HCC, and KLF4 is a biomarker for accurate prognostication of patients with HCC treated by OLT when integrated with the Milan Criteria. Clin Cancer Res; 22(2); 502–12. ©2015 AACR.
Music Therapy Using Singing Training Improves Psychomotor Speed in Patients with Alzheimer's Disease: A Neuropsychological and fMRI Study
Authors: Satoh Masayuki , Yuba Toru , Tabei Ken-ichi , Okubo Yukari , Kida Hirotaka , Sakuma Hajime , Tomimoto Hidekazu
Published: September 2015

Background/Aims: To investigate the effect of singing training on the cognitive function in Alzheimer's disease (AD) patients. Methods: Ten AD patients (mean age 78.1 years) participated in music therapy using singing training once a week for 6 months (music therapy group). Each session was performed with professional musicians using karaoke and a unique voice training method (the YUBA Method). Before and after the intervention period, each patient was assessed by neuropsychological batteries, and functional magnetic resonance imaging (fMRI) was performed while the patients sang familiar songs with a karaoke device. As the control group, another 10 AD patients were recruited (mean age 77.0 years), and neuropsychological assessments were performed twice with an interval of 6 months. Results: In the music therapy group, the time for completion of the Japanese Raven's Colored Progressive Matrices was significantly reduced (p = 0.026), and the results obtained from interviewing the patients' caregivers revealed a significant decrease in the Neuropsychiatric Inventory score (p = 0.042) and a prolongation of the patients' sleep time (p = 0.039). The fMRI study revealed increased activity in the right angular gyrus and the left lingual gyrus in the before-minus-after subtraction analysis of the music therapy intervention. Conclusion: Music therapy intervention using singing training may be useful for dementia patients by improving the neural efficacy of cognitive processing.
Sociodemographic and Behavioural Determinants of a Healthy Diet in Switzerland
Authors: Marques-Vidal Pedro , Waeber Gérard , Vollenweider Peter , Bochud Murielle , Stringhini Silvia , Guessous Idris
Published: September 2015

Background/Aims: The determinants of a healthy diet have not been studied in Switzerland. This study aimed at assessing the individual and behavioural factors associated with a healthy diet in a Swiss city. Methods: Cross-sectional, population-based study conducted between 2009 and 2013 (n = 4,439, 2,383 women, mean age 57.5 ± 10.3 years) in Lausanne. Food consumption was assessed using a validated food frequency questionnaire. Two Mediterranean diet scores (classic score and specific for Switzerland) and the Harvard School of Public Health alternate healthy eating index were computed. Results: For all three dietary scores considered, living in couple or having a high education were associated with a healthier diet. An unhealthy lifestyle (smoking, sedentary behaviour) or a high body mass index were associated with an unhealthier diet. Participants born in Italy, Portugal and Spain had healthier diets than participants born in France or Switzerland. Women and elderly participants had healthier diets than men and young participants according to 2 scores, while no differences were found for the Swiss-specific Mediterranean score. Conclusions: In Switzerland, healthy eating is associated with high education, a healthy lifestyle, marital status and country of origin. The associations with gender and age depend on the dietary score considered.
Impact of Smoking History on the Efficacy of Gefitinib in Patients with Non-Small Cell Lung Cancer Harboring Activating Epidermal Growth Factor Receptor Mutations
Authors: Igawa Satoshi , Sasaki Jiichiro , Otani Sakiko , Ishihara Mikiko , Takakura Akira , Katagiri Masato , Masuda Noriyuki
Published: September 2015

Background: Gefitinib treatment has come to be recognized as the standard therapy for patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. However, resistance to gefitinib has been observed in certain subpopulations of these patients. The purpose of this study was to evaluate the impact of smoking status on the efficacy of gefitinib in patients with NSCLC harboring EGFR mutations. Methods: The records of NSCLC patients harboring EGFR mutations who were treated with gefitinib at Kitasato University Hospital were retrospectively reviewed, and the treatment outcomes were evaluated. Results: In 153 patients with NSCLC harboring EGFR mutations, the overall response rate and progression-free survival (PFS) were 66.7% and 9.0 months, respectively. PFS differed significantly among the current smokers and never-smokers/former light smokers (10.7 vs. 5.4 months, p = 0.0002), and the response rate was significantly higher in the never-smokers/former light smokers than in the current smokers (72.3 vs. 55.8%, p = 0.04). Multivariate analysis identified smoking status as an independent predictor of PFS. Conclusion: The clinical data obtained in this study provide a valuable rationale for considering smoking status as a predictor of the efficacy of gefitinib in patients with NSCLC harboring activating EGFR mutations.
Bilateral Diffuse Uveal Melanocytic Proliferation Presenting as a Giant Unilateral Choroidal Nevus: A Case Report
Authors: Menezes Carlos , Carvalho Rui , Neves-Martins Joana , Teixeira Carla
Published: September 2015

Background/Aims: The aim of our study was to report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) with a markedly asymmetric presentation and fundoscopic response to palliative chemotherapy. Case Report: We report a 67-year-old Caucasian man who presented with vision loss in his right eye. The best-corrected visual acuities were 2/10 in the right eye and 10/10 in the left eye, and biomicroscopy revealed bilateral mild cataracts. Fundoscopy of the right eye showed a macular flat and pigmented lesion extending beyond the posterior pole with areas of giraffe-type pigmentation and an overlying exudative retinal detachment. Nothing remarkable was detected in the left eye apart from a small round hypopigmented area of retinal pigment epithelium atrophy in the papillomacular bundle. BDUMP was diagnosed, and the workup for systemic malignancy revealed a pulmonary adenocarcinoma. After chemotherapy, not only did the right eye's visual acuity improve and the serous detachment resolve, but also the pigmentation decreased. Conclusion: BDUMP presentation can be markedly asymmetric and resemble a giant unilateral choroidal nevus. Response to chemotherapy was unique not only for the usual retinal detachment resolution, but also because of an evident regression of pigmentation.
Long Term Outcomes after Acute Kidney Injury: Lessons from the ARID Study
Authors: Horne Kerry L. , Shardlow Adam , Taal Maarten W. , Selby Nicholas M.
Published: September 2015

The high incidence and poor short-term outcomes of acute kidney injury (AKI) have focused attention on this global healthcare issue. Concurrently, the long-term effects of AKI are increasingly appreciated, namely, increased risk of subsequent chronic kidney disease, end stage kidney disease requiring renal replacement therapies and a higher rate of cardiovascular events. Whilst there is little doubt about the strength of these associations, knowledge gaps remain. To address some of these, the AKI Risk In Derby study commenced in 2013. This is a prospective case-control study investigating the long-term effects of AKI in a general hospitalized population (including those with less severe AKI). This review will summarize the background and rationale of this study, its design and methodology, as well as the 1-year outcome results from a preceding pilot study.
Tourette Syndrome: Bridging the Gap between Genetics and Biology
Authors: Richer Petra , Fernandez Thomas V.
Published: September 2015

Tourette syndrome is a childhood neuropsychiatric disorder, which presents with disruptive motor and vocal tics. The disease also has a high comorbidity with obsessive-compulsive disorder and attention deficit hyperactivity disorder, which may further increase the distress experienced by patients. Current treatments act with varying efficacies in alleviating symptoms, as the underlying biology of the disease is not fully understood to provide precise therapeutic targets. Moreover, the genetic complexity of the disorder presents a substantial challenge to the identification of genetic alterations that contribute to the Tourette phenotype. Nevertheless, genetic studies have suggested involvement of dopaminergic, serotonergic, glutamatergic, and histaminergic pathways in the pathophysiology of at least some cases. In addition, genetic overlaps with other neuropsychiatric disorders may point toward a shared biology. The findings that are emerging from genetic studies will allow researchers to piece together the underlying components of the disease in the hopes that a deeper understanding of Tourette syndrome can lead to improved treatments for those affected by it.
Posterior Spinal Cord Syndrome after Flexible Ureteroscopy for Kidney Stones
Authors: Carrouget Julie , Ammi Myriam , Nedelcu Cosmina , Cassereau Julien , Lebdai Souhil , Azzouzi Abdel Rahmène , Bigot Pierre
Published: September 2015

A 49-year-old woman was treated for right kidney stones using flexible ureteroscopy and laser lithotripsy. She was readmitted 2 weeks after the treatment with complaints of walking difficulties. On neurologic examination, it was found that she had a bilateral proprioceptive dysfunction. Spinal MRI revealed an intramedullary lesion at the T10-T11 level consistent with an intramedullary cavernoma. The final diagnosis was a spinal compression consecutive to the cavernoma bleeding associated with the prolonged lithotomy position. Symptoms have not been reversible and the patient continued to have walking difficulties. We report for the first time a major complication that arises as a result of using flexible ureteroscopy for treating kidney stones.
A Case Report of Vogt's Limbal Girdle and Retinitis Pigmentosa in a Thirteen-Year-Old Boy: A Rare and Unusual Association
Authors: Vignesh A.P. , Srinivasan Renuka , Karanth Swathi , Vijitha Sai
Published: September 2015

Aim: To describe a rare case of Vogt's limbal girdle in a boy with retinitis pigmentosa. Methods: A 13-year-old boy from India presented to us with progressive diminution of vision and nyctalopia for 5 years. On examination, he had the characteristic features of retinitis pigmentosa with the fundus showing disc pallor, bony spicules and arteriolar attenuation. His anterior segment examination showed Vogt's limbal girdle in both eyes. Results: Vogt's limbal girdle is a corneal degeneration usually seen in elderly individuals. This is the first time it is seen in association with retinitis pigmentosa. It has also never been reported at such a young age. Conclusion: We report a rare case where Vogt's limbal girdle was observed in a 13-year-old boy with retinitis pigmentosa. This gives further insight into the pathogenesis of the disease.
Gastrointestinal Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy Specimens: Adequate Diagnostic Yield and Accuracy Can Be Achieved without On-Site Evaluation
Authors: O'Connor Kate , Cheriyan Danny G. , Li-Chang Hector H. , Kalloger Steven E. , Garrett John , Byrne Michael F. , Weiss Alan A. , Donnellan Fergal , Schaeffer David F.
Published: September 2015

Background: Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is the preferred method for biopsying the gastrointestinal tract, and rapid on-site cytological evaluation is considered standard practice. Our institution does not perform on-site evaluation; this study analyzes our overall diagnostic yield, accuracy, and incidence of nondiagnostic cases to determine the validity of this strategy. Design: Data encompassing clinical information, procedural records, and cytological assessment were analyzed for gastrointestinal EUS-FNA procedures (n = 85) performed at Vancouver General Hospital from January 2012 to January 2013. We compared our results with those of studies that had on-site evaluation and studies that did not have on-site evaluation. Results: Eighty-five biopsies were performed in 78 patients, from sites that included the pancreas, the stomach, the duodenum, lymph nodes, and retroperitoneal masses. Malignancies were diagnosed in 45 (53%) biopsies, while 24 (29%) encompassed benign entities. Suspicious and atypical results were recorded in 8 (9%) and 6 (7%) cases, respectively. Only 2 (2%) cases received a cytological diagnosis of ‘nondiagnostic'. Our overall accuracy was 72%, our diagnostic yield was 98%, and our nondiagnostic rate was 2%. Our results did not significantly differ from those of studies that did have on-site evaluation. Conclusion: Our study highlights that adequate diagnostic accuracy can be achieved without on-site evaluation.
An Unusual Case of Nasolacrimal Obstruction Caused by Foodstuffs
Authors: Matsumoto Hirohiko , Matsumoto Akiyo
Published: September 2015

Here we report a case of nasolacrimal obstruction resulting from rice grains ingested over many years that had formed an obstructive mass. This is a hitherto unreported cause of nasolacrimal obstruction. We exclusively treated the obstruction safely with repeated irrigation with physiological saline. Although there have been various reports on new techniques such as the blind insertion of a bougie and insertion of a silicon tube under endoscopic guidance, successful treatment of this condition is possible with an old-fashioned approach using the time-honored tools of a syringe and an irrigation needle, if utilized patiently and repeatedly. In Japan, we call this ‘learning new lessons from the past'. This implies that newer techniques may not necessarily be superior and traditional techniques can offer advantages of safety and simplicity in treating this condition.
Niacin (Vitamin B3) Supplementation in Patients with Serotonin-Producing Neuroendocrine Tumor
Authors: Bouma Grietje , van Faassen Martijn , Kats-Ugurlu Gursah , de Vries Elisabeth G.E. , Kema Ido P. , Walenkamp Annemiek M.E.
Published: September 2015

Background/Aims: Tryptophan is the precursor of serotonin and niacin (vitamin B3). The latter is critical for normal cellular metabolism. Tryptophan and niacin can be deficient in patients with serotonin-producing neuroendocrine tumors (NETs). Niacin deficiency may lead to severe symptoms including pellagra. In patients with serotonin-producing NET, data on niacin status are scarce and niacin supplementation hardly receives attention. We aimed to assess the niacin status before and after supplementation in these patients. Methods: We identified serotonin-producing NET patients who had received oral niacin supplementation (mean dose 144 mg daily) for tryptophan deficiency and/or pellagra-associated symptoms. Presupplementation plasma tryptophan levels and niacin status based on the urinary niacin metabolite N1-methylnicotinamide (N1-MN) before (n = 42) and after the start of the supplementation (in 34 paired samples) were assessed. Reference values for urinary N1-MN levels were established in 133 healthy individuals. Results: The mean presupplementation plasma tryptophan level was 31.8 ± 9.7 µmol/l (reference value 40.0-70.0). Presupplementation urinary N1-MN levels were lower in patients (median 17.9 µmol/24 h, range 2.6-70.3) compared to healthy controls (median 43.7 µmol/24 h, range 9.5-169.3, p < 0.0001) and below normal in 45% of the patients. Niacin supplementation increased urinary N1-MN levels to high normal levels (median 55.5 µmol/24 h, range 7.4-489.0) in 86% of the niacin-deficient patients. Conclusion: In serotonin-producing NET patients, niacin deficiency is prevalent. Therefore, urinary N1-MN deserves to be included in their standard biochemical evaluation. Niacin supplementation normalizes the niacin status in most niacin-deficient serotonin-producing NET patients. A prospective study is warranted.
VEGF gene promoter polymorphisms and risk of VTE in chemotherapy-treated cancer patients
Authors: Palmirotta Raffaele , Riondino Silvia , Marchis Maria Laura De , Nardecchia Antonella , Formica Vincenzo , Ferroni Patrizia , Guadagni Fiorella , Roselli Mario
Published: September 2015

Among the possible genetic contributors to cancer-related venous thromboembolism (VTE), vascular endothelial growth factor (VEGFA) could play an important role, as an imbalance of the VEGFA system (either disease-related or drug-induced) may result in a disturbance of vascular homeostasis. Thus, this study was designed to investigate the predictive role of eight different VEGFA gene promoter single nucleotide polymorphisms (SNPs) for a first VTE episode in cancer out-patients undergoing chemotherapy. To this purpose, VEGFA gene promoter polymorphisms were analysed in 297 cancer patients using polymerase chain reaction amplification and direct DNA sequencing analysis. One hundred forty unrelated healthy subjects from the same geographical area were also analysed in order to evaluate and compare genotype/haplotype frequencies in our ethnicity. VTE occurred in 26 (9 %) of cancer patients with a median time-to-event of 3.4 months. Association analyses showed that –1154G/A polymorphism was significantly associated with the risk of chemotherapy-triggered VTE, with the A allele exerting a protective role both in the overall population (hazard ratio [HR]: 0.21; 95 % confidence interval [CI]: 0.07–0.58) or in bevacizumab-treated metastatic patients (HR: 0.09, 95 %CI: 0.01–0.86) in whom VEGFA –1154AA genotype also conferred a reduced risk of early progression (HR: 0.58, 95 %CI: 0.34–0.98). These results suggest that VEGFA may represent a candidate gene contributing to VTE development in chemotherapy treated cancer patients and that –1154G/A SNP might provide useful clinical information on the efficacy and toxicity of bevacizumab in metastatic patients. Validation studies are needed for translation into clinical practice.

Note: This study has been presented in part at the Congress on Controversies in Thrombosis & Haemostasis, Berlin, Germany, October 30-November 1, 2014.
Splanchnic vein thrombosis and myeloproliferative neoplasms: molecular-driven diagnosis and long-term treatment
Authors: Betti Silvia , Rossi Elena , Stefano Valerio De , Qi Xingshun
Published: September 2015

Splanchnic vein thrombosis (SVT) encompasses Budd-Chiari syndrome (BCS), extrahepatic portal vein obstruction (EHPVO), and mesenteric vein thrombosis. Philadelphia-negative myeloproliferative neoplasms (MPNS) are the leading systemic cause of non-cirrhotic and non-malignant SVT and are diagnosed in 40 % of BCS patients and one-third of EHPVO patients. In SVT patients the molecular marker JAK2 V617F is detectable up to 87 % of those with overt MPN and up to 26 % of those without. In the latter, other MPN molecular markers, such as mutations in JAK2 exon 12, CALR and MPL genes, are extremely rare. Immediate anticoagulation with heparin is used to treat acute patients. Upon clinical deterioration, catheter-directed thrombolysis or a transjugular intrahepatic portosystemic shunt is used in conjunction with anticoagulation. Orthotopic liver transplantation is the only reliable option in BCS patients with a lack of a response to other treatments, without contraindication due to MPN. Long-term oral anticoagulation with vitamin K–antagonists (VKA) is recommended in all SVT patients with the MPN-related permanent prothrombotic state; the benefits of adding aspirin to VKA are uncertain. Cytoreduction is warranted in all SVT patients with an overt MPN, but its appropriateness is doubtful in those with molecular MPN without hypercythaemia.
Caracterização de adolescentes do sexo masculino em relação a comportamentos antissociais
Authors: VileLa Komatsu André , Rezende Bazon Marina
Published: September 2015

(analítico): O objetivo deste estudo é caracterizar os comportamentos divergentes e infracionais em amostras de adolescentes brasileiros, uma composta por 133 da população geral, recrutados em escolas públicas, e outra formada por 60 judicializados recrutados em programas de medida judicial. Os participantes responderam a um questionário de comportamentos juvenis, compreendendo perguntas sobre comportamentos divergentes e delituosos. Resultados: a maioria dos adolescentes da população revelou ter feito uso de álcool (61%) e já ter cometido algum delito (77%), e uma pequena parte mencionou uso de maconha (12%). Entre os judicializados, todos revelaram delitos e 93% uso de álcool e 85% uso de maconha. As médias do número de delitos distintos já realizados e o volume de delitos no último ano foram significativamente maiores entre os adolescentes judicializados.
Análisis diferencial de la percepción de jóvenes sobre maltrato en el noviazgo
Authors: Bringas-Molleda Carolina , Cortés-Ayala Lourdes , Antuña-Bellerín María Ángeles , Flores-Galaz Mirta , López-Cepero Javier , Rodríguez-Díaz Francisco Javier
Published: September 2015

En este estudio nuestra pretensión es la de conocer el grado de victimización sufrida en una muestra de individuos mexicanos de ambos sexos y escolarizados, y analizar en cada uno de los niveles educativos el poder predictivo de las distintas formas de victimización en la pareja, sobre el uso de las etiquetas de maltrato-sentirse maltratado y tener miedo-. Participaron 3495 estudiantes de México escolarizados a quienes les aplicamos el Cuestionario de Violencia entre Novios. Los niveles de victimización y la percepción de maltrato son mayores en estudiantes de universidad, en ambos sexos. La percepción de miedo es mayor en las mujeres universitarias y en los varones preuniversitarios. Es importante destacar el número de jóvenes que declaran no sentirse maltratados ni tener miedo, pues eso dificultará su disposición para finalizar la relación sentimental.
Socialización e interés en la política en jóvenes de Chile
Authors: Vargas-Salfate Salvador , Oyanedel Juan Carlos , Torres-Vallejos Javier
Published: September 2015

(analytical): The purpose of this article is to discuss the relationship between socialization and interest in politics among young people in Chile in the framework of theories relating to political socialization and political culture. These state that the orientations of individuals are acquired through processes of reciprocal relationships with others and with institutions. Using the results of the Metropolitan Survey on Youth Political Behavior (2012), conducted with young people (aged 18 to 25 years) resident in the city of Santiago, and applying logistical regression models, the authors verify that the main explanatory factor of interest in politics is engaging with friends on this topic, highlighting the importance of the socializing context.

Key words: social influence, socialization, interest in politics, political behavior (Unesco Social Sciences Thesaurus).
Potential for Recombinant ADAMTS13 as an Effective Therapy for Acquired Thrombotic Thrombocytopenic Purpura
Authors: Tersteeg Claudia , Schiviz Alexandra , De Meyer Simon F. , Plaimauer Barbara , Scheiflinger Friedrich , Rottensteiner Hanspeter , Vanhoorelbeke Karen
Published: September 2015

Objective—

The metalloprotease ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) regulates the size of von Willebrand factor multimers. A deficiency in ADAMTS13 activity is associated with the life-threatening disease thrombotic thrombocytopenic purpura (TTP). The vast majority of patients have acquired TTP, where circulating anti-ADAMTS13 autoantibodies are causative for the decreased ADAMTS13 activity. Current treatment consists of plasma exchange, but improved therapies are highly warranted.

Approach and Results—

We have developed a new rat model mimicking various aspects of acquired TTP to investigate the therapeutic efficacy of human recombinant ADAMTS13. A polyclonal antibody against ADAMTS13 completely blocked endogenous rat ADAMTS13 activity in Sprague–Dawley rats. When TTP was triggered using recombinant von Willebrand factor, the animals displayed severe TTP-like symptoms, such as thrombocytopenia, hemolytic anemia, and von Willebrand factor–rich thrombi in the kidneys and brain. Subsequent injection of 400, 800, or 1600 U/kg recombinant ADAMTS13 prevented full development of these symptoms. Analysis of plasma samples confirmed that recombinant ADAMTS13 was able to override circulating anti-ADAMTS13 inhibitory antibodies, resulting in restoration of ADAMTS13 activity and degradation of ultralarge von Willebrand factor multimers.

Conclusions—

Recombinant ADAMTS13 was shown to be effective in averting severe acquired TTP-like symptoms in rats and holds promising value for the treatment of this severe and life-threatening disease in humans.
Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment
Authors: Calvo David , Ávila Pablo , García-Fernández F. Javier , Pachón Marta , Bravo Loreto , Eidelman Gabriel , Hernández Jesús , Miracle Ángel L. , Rubín José , Pérez Diego , Arenal Ángel , Atienza Felipe , Jimenez-Candil Javier , Arias Miguel Ángel , Datino Tomás , Martínez-Camblor Pablo , Gonzalez-Torrecilla Esteban , Almendral Jesús
Published: September 2015

Background—

Differential diagnosis between tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal reentry can be challenging. We hypothesized that an immediate versus delayed pace-related advancement of the atrial electrogram, once the local septal parahisian ventricular electrogram (SVE) has been advanced, may help in this diagnosis.

Methods and Results—

We focused on differential timing between SVE and atrial signals at the initiation of continuous right ventricular apical pacing during tachycardia. SVE advancement preceding atrial reset was defined as SVE advanced by the paced wave fronts while atrial signal continued at the tachycardia cycle. We analyzed 51 atypical atrioventricular nodal reentry (45% posterior type) and 80 AP tachycardias (anteroseptal [10], parahisian [18], midseptal [12], and posteroseptal [40]). SVE advancement preceding atrial reset was observed in 98% of atrioventricular nodal reentries during 4±1.1 cycles; this phenomena was observed in 6 (8%) of the atrioventricular reentrant tachycardia mediated by septal AP (
P
<0.001; sensitivity 98%; specificity 93%; positive predictive value 90%; negative predictive value 99%) and lasted 1 single cycle (
P
<0.001). Right posteroseptal AP tachycardias were distinctly characterized by atrial reset preceding SVE advancement (with ventricular fusion; specificity 100%; positive predictive value 100%). In 11 cases, it was impossible to achieve sustain entrainment. In all of them, the differential responses at the entrainment attempt allowed for appropriate diagnosis.

Conclusions—

The differential response of the SVE and the atrial electrogram at the initiation of continuous right ventricular apical pacing during tachycardia effectively distinguishes between atypical atrioventricular nodal reentry and atrioventricular reentrant tachycardia mediated by septal APs.
Risk of Rupture or Dissection in Descending Thoracic Aortic Aneurysm
Authors: Kim Joon Bum , Kim Kibeom , Lindsay Mark E. , MacGillivray Thomas , Isselbacher Eric M. , Cambria Richard P. , Sundt Thoralf M.
Published: September 2015

Background—

Current practice guidelines recommend surgical repair of large thoracic aortic aneurysms to prevent fatal aortic dissection or rupture, but limited natural history data exist to support clinical criteria for timely intervention.

Methods and Results—

Of 3247 patients with thoracic aortic aneurysm registered in our institutional Thoracic Aortic Center Database, we identified and reviewed 257 nonsyndromic patients (age, 72.4±10.5 years; 143 female) with descending thoracic or thoracoabdominal aortic aneurysm without a history of aortic dissection in whom surgical intervention was not undertaken. The primary end point was a composite of aortic dissection/rupture and sudden death. Baseline mean maximal aortic diameter was 52.4±10.8 mm, with 103 patients having diameters ≥55 mm. During a median follow-up of 25.1 months (quartiles 1–3, 8.3–56.4 months), definite and possible aortic events occurred in 19 (7.4%) and 31 (12.1%) patients, respectively. On multivariable analyses, maximal aortic diameter at baseline emerged as the only significant predictor of aortic events (hazard ratio=1.12; 95% confidence interval, 1.08–1.15). Estimated rates of definite aortic events within 1 year were 5.5%, 7.2%, and 9.3% for aortic diameters of 50, 55, and 60 mm, respectively. Receiver-operating characteristic curves for discriminating aortic events were higher for indexed aortic sizes referenced by body size (area under the curve=0.832–0.889) but not significantly different from absolute maximal aortic diameter (area under the curve=0.805).

Conclusions—

Aortic size was the principal factor related to aortic events in unrepaired descending thoracic or thoracoabdominal aortic aneurysm. Although the risk of aortic events started to increase with a diameter >5.0 to 5.5 cm, it is uncertain whether repair of thoracic aortic aneurysms in this range leads to overall benefit, and the threshold for repair requires further evaluation.