bluuebunny/crossref_metadata_2025 huggingface dataset:
Metal on metal (MoM) hip arthroplasty: An observational study on the effect of bearing contact surface area and contact pressure on metal ion levels
Authors: Tucker Adam , Jones Morgan , Hodgins N , Heyes Gavin , Acton Danny
Published: September 2015

Metal on metal wear has attracted significant media attention in recent years, owing to the issues associated with adverse reactions to metal ion debris, with subsequent revision arthroplasty procedures. To date, implant orientation has been the key. Studies on ceramic implants have utilised mathematical models in order to assess contact surface areas and pressures generated within the hip joint and their correlation to wear. To date, this has not been undertaken in metal on metal hips. We applied a previously published Hertzian ball in plane model to a cohort of metal on metal hip replacement patients from a single surgeon practice to evaluate the effect of contact pressures on metal ion levels. Statistical analysis was performed using SPSS v20. A total of 58 patients, with a male preponderance (65%), from a single surgeon practice were identified and recruited. Anaverage age of 52 (±9) years, mean body mass index 28.91 kg/m2 (±4.41) with no proportional difference between groups were noted ( p > 0.05). Mean ion levels were calculated for both cobalt 34.93(±21.90) nmol/L and chromium 40.10(±25.85) nmol/L. Implant orientation was recorded and, using the method described, contact pressures were calculated. Correlation testing revealed that abduction angle was significantly associated with cobalt ( r=0.344, p = 0.040) and chromium ( r = 0.336, p = 0.045) levels, but that the contact pressures were not associated with metal ion levels (Co, r = −0.033, p = 0.803, Cr, r = −0.095, p = 0.479).Our results reinforce that it is neither the body mass index nor the contact surface area or pressure generated that increases metal ion level, and that abduction angle remains essential in metal ion generation. The surgeon should be vigilant in ensuring correct implant orientation intra-operatively in order to reduce metal ion generation.
Born again, or born anew
Authors: Beyens Stefanie , Deschouwer Kris , van Haute Emilie , Verthé Tom
Published: September 2015

New-Flemish Alliance (N-VA) burst on the scene barely a decade ago and is now Belgium’s largest political party. One explanation for this success is that N-VA is not brand new but rose from the ashes of a dissolved party. How exactly should we differentiate between new and old parties? We use Barnea and Rahat’s (2011) analytical framework to assess dimensions of N-VA’s newness and capture the party at two stages – start-up and more developed. This shows that N-VA is a successor party, building on its predecessor’s ideology and programme, its electorate, activists and organization. However, we also find indicators that the party actively renewed in terms of ideology and party organization. The empirical evidence illustrates that newness of political parties should be conceived of as multi-dimensional, which allows for a more subtle approach to questions about the origin and varying success of new political parties.
If not now, when? Prescription of evidence-based medical therapy prior to hospital discharge increases utilization at 6 months in patients with symptomatic peripheral artery disease
Authors: Renard Brian M , Seth Milan , Share David , Aronow Herb D , Laveroni Eugene W , De Gregorio Michele , Hans Sachinder S , Henke Peter K , Gurm Hitinder S , Grossman P Michael
Published: September 2015

We evaluated the impact of the prescription of evidence-based medical therapy (EBMT) including aspirin (ASA), beta-blockers (BB), ACE-inhibitors or angiotensin receptor blockade (ACE/ARB), and statins prior to discharge after peripheral vascular intervention (PVI) on long-term medication utilization in a large multi-specialty, multicenter quality improvement collaborative. Among patients undergoing coronary revascularization, use of the component medications of EBMT at hospital discharge is a major predictor of long-term utilization. Predictors of EBMT use after PVI are largely unknown. A total of 10,169 patients undergoing PVI between 1 January 2008 and 31 December 2011 were included. Post-PVI discharge and 6-month medication utilization in patients without contra-indications to ASA, BB, ACE/ARB, and statins were compared. ASA was prescribed at discharge to 9345 (92%) patients, BB to 7012 (69%), ACE/ARB to 6424 (63%), and statins to 8342 (82%), and all four component drugs of EBMT in 3953 (39%). Compared with patients not discharged on the appropriate medications, post-procedural use was associated (all p<0.001) with reported 6-month use: ASA (84.5% vs 39.2%), BB (82.5% vs 11.1%), ACE/ARB (78.2% vs 11.8%), statins (84.6% vs 21.8%). Multivariable analysis revealed that prescription of EBMT at the time of discharge remained strongly associated with use at 6 months for each of the individual component drugs as well as for the combination of all four EBMT medications. In conclusion, prescription of the component medications of EBMT at the time of PVI is associated with excellent utilization at 6 months, while failure to prescribe EBMT at discharge is associated with low use of these medications 6 months later. These data suggest that the time of a PVI is a therapeutic window in which to prescribe EBMT in this high-risk cohort and represents an opportunity for quality improvement.
Optimism and hope as predictors of subjective health in post–myocardial infarction patients: A comparison of the role of coping strategies
Authors: Wlodarczyk Dorota
Published: September 2015

This study explored the effects intervening in the linkages of optimism and hope with subjective health in the short term after myocardial infarction. A two-wave study design was used. The sample consisted of 222 myocardial infarction survivors. When adopting a cross-sectional design, optimism and hope predicted subjective health at Time 1 and Time 2. After controlling for baseline subjective health, they were no longer significant predictors of subjective health at Time 2. Parallel indirect effects of seeking social support and problem solving were significant for both optimism and hope. After controlling for the shared variance between optimism and hope, these effects remained significant only for optimism.
Fair care
Authors: Brake Elizabeth
Published: September 2015

Caring relationships and material caregiving are politically significant goods that should be distributed according to principles of justice. I argue that, within Rawlsian liberalism, care should be considered a primary good and propose a third principle of justice requiring access to the social and legal supports of caring relationships. I examine what social and legal institutions supporting care might require, with particular attention to allowing the infirm elderly and persons with disabilities access to caring relationships. I propose the formation of a Care Corps, providing access to caring relationships for elderly and housebound citizens. If universally required and compensated, the Care Corps could address two other injustices related to care: the unjust distribution of caring labor between men and women and the relatively low status of caring work.
Reply to Wiens
Authors: Estlund David
Published: September 2015

In Human Nature and the Limits (If Any) of Political Philosophy, I argued that justice might require things of people that they cannot bring themselves to do. A central step was to argue that this does not entail an inability to ‘do’ the putatively required thing. David Wiens challenges that argument of mine, and this piece is my reply.
Electrolytic Effects During Tissue Ablation by Electroporation
Authors: Rubinsky Liel , Guenther Enric , Mikus Paul , Stehling Michael , Rubinsky Boris
Published: September 2015

Nonthermal irreversible electroporation is a new tissue ablation technique that consists of applying pulsed electric fields across cells to induce cell death by creating permanent defects in the cell membrane. Nonthermal irreversible electroporation is of interest because it allows treatment near sensitive tissue structures such as blood vessels and nerves. Two recent articles report that electrolytic reaction products at electrodes can be combined with electroporation pulses to augment and optimize tissue ablation. Those articles triggered a concern that the results of earlier studies on nonthermal irreversible electroporation may have been tainted by unaccounted for electrolytic effects. The goal of this study was to reexamine previous studies on nonthermal irreversible electroporation in the context of these articles. The study shows that the results from some of the earlier studies on nonthermal irreversible electroporation were affected by unaccounted for electrolysis, in particular the research with cells in cuvettes. It also shows that tissue ablation ascribed in the past to irreversible electroporation is actually caused by at least 3 different cytotoxic effects: irreversible electroporation without electrolysis, irreversible electroporation combined with electrolysis, and reversible electroporation combined with electrolysis. These different mechanisms may affect cell and tissue ablation in different ways, and the effects may depend on various clinical parameters such as the polarity of the electrodes, the charge delivered (voltage, number, and length of pulses), and the distance of the target tissue from the electrodes. Current clinical protocols employ ever-increasing numbers of electroporation pulses to values that are now an order of magnitude larger than those used in our first fundamental nonthermal irreversible electroporation studies in tissues. The different mechanisms of cell death, and the effect of the clinical parameters on the mechanisms may explain discrepancies between results of different clinical studies and should be taken into consideration in the design of optimal electroporation ablation protocols.
Quantitative EEG of Rapid-Eye-Movement Sleep
Authors: Brayet Pauline , Petit Dominique , Frauscher Birgit , Gagnon Jean-François , Gosselin Nadia , Gagnon Katia , Rouleau Isabelle , Montplaisir Jacques
Published: September 2015

The basal forebrain cholinergic system, which is impaired in early Alzheimer’s disease, is more crucial for the activation of rapid-eye-movement (REM) sleep electroencephalogram (EEG) than it is for wakefulness. Quantitative EEG from REM sleep might thus provide an earlier and more accurate marker of the development of Alzheimer’s disease in subjects with mild cognitive impairment (MCI) subjects than that from wakefulness. To assess the superiority of the REM sleep EEG as a screening tool for preclinical Alzheimer’s disease, 22 subjects with amnestic MCI (a-MCI; 63.9 ± 7.7 years), 10 subjects with nonamnestic MCI (na-MCI; 64.1 ± 4.5 years) and 32 controls (63.7 ± 6.6 years) participated in the study. Spectral analyses of the waking EEG and REM sleep EEG were performed and the [(delta + theta)/(alpha + beta)] ratio was used to assess between-group differences in EEG slowing. The a-MCI subgroup showed EEG slowing in frontal lateral regions compared to both na-MCI and control groups. This EEG slowing was present in wakefulness (compared to controls) but was much more prominent in REM sleep. Moreover, the comparison between amnestic and nonamnestic subjects was found significant only for the REM sleep EEG. There was no difference in EEG power ratio between na-MCI and controls for any of the 7 cortical regions studied. These findings demonstrate the superiority of the REM sleep EEG in the discrimination between a-MCI and both na-MCI and control subjects.
Key issues in the management of patients with systemic lupus erythematosus: latest developments and clinical implications
Authors: Jordan Natasha , D’Cruz David
Published: September 2015

Systemic lupus erythematous (SLE) is a chronic multisystem disease with significant associated morbidity and mortality. A deeper understanding of the pathogenesis of SLE has led to the development of biologic agents, primarily targeting B cells and others inhibiting costimulatory molecules, type I interferons and cytokines such as interleukin-6. Several of these agents have been studied in clinical trials; some have shown promise while others have yielded disappointing results. Economic and regulatory issues continue to hamper the availability of such therapies for SLE patients. With increasing recognition that recurrent flares of disease activity lead to long-term damage accrual, one of the most important recent developments in patient management has been the concept of treat-to-target in SLE while minimizing patient exposure to excessive corticosteroid and other immunosuppressive therapy. This article reviews these key issues in SLE management, outlining recent developments and clinical implications for patients.
Clinical Use and Evaluation of Insulin Pens
Authors: Ginsberg Barry H.
Published: September 2015

Insulin pens are more accurate and easier to teach than other methods of insulin delivery. They also do not suffer from the risk of mismatch of insulin concentration and type of insulin syringe. The ISO standard used to test insulin pens, however, needs to be updated to reflect their clinical use.
How to Get the Full Prism Effect
Authors: Pochopien Klaudia , Fahle Manfred
Published: September 2015

We investigate how the immediate correction effect decreases mispointing under prisms. Subjects performed rhythmic pointing movements under different conditions with horizontally shifting prisms. Even the first (initial) pointing error is much smaller than the prismatic shift, a phenomenon called the immediate correction effect. Knowledge about the structure of the room and of objects in the room obtained before the prisms were worn may limit the amount of the prismatic displacement perceived. We therefore compared the direct prism effect as well as prismatic adaptation with room illumination switched on versus switched off. Our 44 subjects participated in two experiments, with varying amounts of information about room structure available. The results show a direct effect corresponding to the optical power of the prisms in the dark condition, when in addition body position was slightly rotated in direction of the prismatic shift. But even in the dark, a significant immediate correction effect arises with the fixed body position. The largest immediate correction amounting to almost half of optical displacement arose in the standard condition of bright light and fixed body position.
Warning leak of intracranial aneurysm masquerading as sinus node dysfunction: A case report
Authors: Bisht Devendra Singh , Verma Puneet K , Garg Nitin
Published: September 2015

We describe the successful endovascular repair of an intracranial aneurysm causing subarachnoid hemorrhage in a 62-year-old man, who was initially diagnosed and treated as a case of symptomatic sinus bradycardia. The aim of this report and following discussion is to discuss the subtle warning signs of intracranial aneurysm that may masquerade as sinus node dysfunction.
Multiple papillary fibroelastomas in the right heart
Authors: Muraoka Arata , Kurumisawa Soki , Kaminishi Yuichiro , Misawa Yoshio
Published: September 2015

Background:

Cardiac multiple papillary fibroelastonas are rare.

Methods and Results:

A 70-year-old woman presented with an exertional dyspnea. A trans-thoracic echocardiogram showed a moving mass near the inferior vena cava in the right atrium. She underwent an operation for a cardiac tumor. A trans-esophageal echocardiogram during the operation showed a mass in the right ventricle, which had echo properties similar to the mass in the right atrium. The mass in the atrium was resected including the attached intima, and the mass in the ventricle was resected by the shave method. Her postoperative course was uneventful. A pathological examination showed that the two tumors were papillary fibroelastomas.

Conclusion:

A precise examination should be performed when a cardiac tumor is diagnosed to investigate the possibility of multiple lesions.
Parameter optimisation and microstructural characterisation of pulsed electric current bonded Al6061-SS304 joints
Authors: Liu Y. , Zhang F. Q. , Xia L. H. , Zhao M. C. , Wang X. X.
Published: September 2015

The pulsed electric current bonding method was adopted to join Al6061 and SS304 using an aluminium powder as the interlayer. Taguchi method was performed to optimise the bonding parameters. The decreasing sequence of factors affecting the shear strength of the joints is bonding temperature, surface treatment and holding time. The microstructural characterisation and shear fracture of the optimal joint have been further analysed. A uniform diffusion layer was formed at the Al/SS304 interface, and the high hardness value of the layer could be attributed to the formation of the intermetallic compounds. The most promising joint was obtained under the optimal parameter condition, and failure of the joint was caused inside the Al interlayer.
How I treat fragile myeloma patients
Authors: Larocca Alessandra , Palumbo Antonio
Published: September 2015

Multiple myeloma is a disease typical of elderly people, with a median age at diagnosis of 70 years. Much progress has been made in the past few years thanks to the introduction of new drugs. However, increases in survival were much less pronounced in patients aged 60 to 69 years, and no improvement was seen in older patients. Furthermore, the currently approved treatment regimens were tested in clinical trials with stringent inclusion criteria. Aging is associated with a high prevalence of frailty, that is, a state of increased vulnerability to stressors due to a critical decline in physiologic reserves. Elderly people may be categorized as fit or frail according to clinical, functional, cognitive, and socioeconomic criteria. The presence of frailty may complicate the management and outcome of myeloma patients. To date, the choice of treatment of myeloma patients has focused primarily on chronological age and performance status as markers of frailty. However, the elderly population is highly heterogeneous, and improved assessment strategies are needed to define the frailty profile of patients and provide them with the most adequate treatment, thus avoiding the overtreatment of frail patients and the undertreatment of fit patients. The geriatric assessment is a fundamental tool for the evaluation of cognitive and functional status.
Local quantized extrema patterns for content-based natural and texture image retrieval
Authors: Koteswara Rao L. , Venkata Rao D.
Published: September 2015

This paper proposes a novel feature descriptor, named local quantized extrema patterns (LQEP) for content based image retrieval. The standard local quantized patterns (LQP) collect the directional relationship between the center pixel and its surrounding neighbors and the directional local extrema patterns (DLEP) collect the directional information based on local extrema in 0°, 45°, 90°, and 135° directions for a given center pixel in an image. In this paper, the concepts of LQP and DLEP are integrated to

propose the LQEP for image retrieval application. First, the directional quantized information is collected from the given image. Then, the directional extrema is collected from the quantized information. Finally, the RGB color histogram is integrated with the LQEP for a feature vector generation. The performance of the proposed method is tested by conducting three experiments on Coel-1K, Corel-5K and MIT VisTex databases for natural and texture image retrieval. The performance of the proposed method is evaluated in terms of precision, recall, average retrieval precision and average retrieval rate on benchmark databases. The results after investigation show a considerable improvements in terms of their evaluation measures as compared to the existing methods on respective databases.
NCBI BLAST+ integrated into Galaxy
Authors: Cock Peter J. A. , Chilton John M. , Grüning Björn , Johnson James E. , Soranzo Nicola
Published: September 2015

Background

The NCBI BLAST suite has become ubiquitous in modern molecular biology and is used for small tasks such as checking capillary sequencing results of single PCR products, genome annotation or even larger scale pan-genome analyses. For early adopters of the Galaxy web-based biomedical data analysis platform, integrating BLAST into Galaxy was a natural step for sequence comparison workflows.

Findings

The command line NCBI BLAST+ tool suite was wrapped for use within Galaxy. Appropriate datatypes were defined as needed. The integration of the BLAST+ tool suite into Galaxy has the goal of making common BLAST tasks easy and advanced tasks possible.

Conclusions

This project is an informal international collaborative effort, and is deployed and used on Galaxy servers worldwide. Several examples of applications are described here.
Development of a novel conservation treatment of stone monuments with bioactive nanocomposites
Authors: van der Werf Inez Dorothé , Ditaranto Nicoletta , Picca Rosaria Anna , Sportelli Maria Chiara , Sabbatini Luigia
Published: September 2015

In this study a conservation treatment of stone monuments meant for consolidation, protection, and inhibition of biofilm formation is proposed. The method is developed as a part of a systematic investigation aimed at producing nanocomposite coatings able to exert a marked biological activity over a long period of time thanks to their peculiar structure. Zinc oxide nanoparticles, synthesised by means of simple and reproducible electrochemical procedures, are embedded in commercially available and commonly used consolidant/water repellent matrices to obtain nanostructured materials. Products based on tetraethoxysilane and/or polysiloxanes were tested. In a first step the nanomaterials were applied on stone samples and studied with scanning electron microscopy and spectrophotocolorimetry. Then, in situ experimentation was undertaken by applying nanocomposite coatings on the exterior of a 12th-century church in the south of Italy. The performances of the ZnO-nanoparticles based composite coating were compared with a previously investigated copper nanoparticles based material, successfully tested and monitored in situ for more than two years. Finally, preliminary tests on the inhibitory effect on the growth of the fungus Aspergillus niger were also carried out. The results showed that in case of zinc oxide a tenfold higher concentration of nanoparticles as compared with Cu-NPs can be utilized in the matrices without affecting the colour of the stone substrate, which means that the new material should be able to exert a long-lasting biocide activity. Laboratory and in situ tests of the developed innovative nanomaterials yielded very promising, though preliminary, results in terms of chromatic changes, morphological characteristics and bioactivity. Constant monitoring of the coatings will be continued in order to obtain all necessary information on their long term behaviour and inhibition of biological colonisation.
A Virtual Ward for Home Hemodialysis Patients – A Pilot Trial
Authors: Raphael Michael J. , Nadeau-Fredette Annie-Claire , Tennankore Karthik K. , Chan Christopher T.
Published: September 2015

Background:

Patients with end-stage renal disease (ESRD) have a high rate of hospitalization and are prone to care gaps that may occur during the transition from hospital to home. The virtual ward (VW) is an innovative model that provides short-term transitional care to patients upon hospital discharge. The VW may be an effective intervention to address care gaps.

Objectives:

The primary objective of the pilot study was to assess the feasibility and practicality of implementing the Home Dialysis VW (HDVW) on a broader scale.

Design:

The HDVW Pilot Study enrolled home hemodialysis patients following one of four inclusion criteria: 1. Discharge from hospital, 2. Completion of an in-hospital medical procedure, 3. Prescription of an antibiotic, 4. Completion of home hemodialysis training. Patients were followed in the HDVW for 14 days and during this time were assessed serially with a clinician-led telephone interview for one of three transitional care gaps: 1. Requirement for change in hemodialysis prescription, 2. Requirement for coordination of follow-up care, 3. Requirement for medication change.

Setting:

The study was conducted in Toronto, Ontario, Canada at a quaternary care academic teaching hospital from 2012–2013.

Patients:

This study included 52 HDVW admissions among 35 patients selected from the existing home hemodialysis program.

Measurements:

The primary outcome was the identification of the number of care gaps at each HDVW admission. Secondary outcomes included the identification of potential predictors of care gaps and description of clinical adverse events following HDVW admission (readmissions, emergency department visits, unplanned visits to the home hemodialysis in-center).

Results:

The implementation and execution of the HDVW Pilot Study proved to be technically feasible and practical. A care gap was identified in 35 (67 %) of the HDVW admissions. In total, the cohort experienced 85 care gaps. There were no baseline demographic characteristics predictive of experiencing a care gap. In the total cohort observed for 2912 patient days, there were 9 readmissions, 13 visits to the emergency department, and 7 unplanned visits to the home hemodialysis in-center unit.

Limitations:

The results of this study are limited by the small study size and single-center experience.

Conclusion:

The implementation of a virtual ward for home hemodialysis patients is practical, feasible and identifies many care gaps which have the potential to result in subsequent adverse events. A larger, multi-center prospective clinical trial is justified to identify if the HDVW can prevent adverse events among home dialysis patients.
Integration of well data into geostatistical seismic amplitude variation with angle inversion for facies estimation
Authors: Azevedo Leonardo , Nunes Ruben , Soares Amílcar , Mundin Evaldo C. , Neto Guenther Schwedersky
Published: September 2015

We have developed a new iterative geostatistical seismic amplitude variation with angle (AVA) inversion algorithm that inverts prestack seismic data, sorted by angle gathers, directly for high-resolution density, P-wave velocity, S-wave velocity, and facies models. This novel iterative geostatistical inverse procedure is based on two key main principles: the use of stochastic sequential simulation and cosimulation as the perturbation technique of the model parameter space and a global optimizer based on a crossover genetic algorithm to converge the simulated earth models toward an objective function, in this case, the mismatch between the recorded and synthetic prestack seismic data. As a geostatistical approach, all the elastic models simulated during the iterative procedure honors the well-log data at its own locations, the marginal prior distributions of P-wave velocity and S-wave velocity, and density estimated from the available well-log data, and the corresponding joint distributions between density versus P-wave velocity and P-wave versus S-wave velocity. We successfully tested and implemented this new algorithm on a synthetic prestack data set that mimicked the main properties of a real reservoir, and on a real seismic data set acquired over a deepwater turbidite oil reservoir. In both cases, the results showed a good convergence between the recorded and synthetic seismic. The synthetic example showed high-resolution inverted petroelastic models that reproduced the true petroelastic models. The inverted petroelastic models retrieved from the real case study found high resolution and do agree with previous seismic reservoir characterization studies.
Schizophrenia in children and adolescents
Authors: Hollis Chris
Published: September 2015

This article summarises new research, together with core features, course
and outcome of schizophrenia with onset in childhood and adolescence, and
investigates its neurobiology and continuity into adult life. It concludes
that, in conformity with other disorders of childhood, adult-based
diagnostic criteria have validity in adolescence. Sadly, the disorder has a
poorer outcome when onset is in youth.
Do apps have anything to offer mental health?
Authors: Morriss Richard K.
Published: September 2015

Many people with mental health problems spend a large proportion of their
life online and an increasing number of apps address mental health and
well-being. This article offers reasons why psychiatrists should learn how
to use mental health apps to enhance patient care and gives some caveats for
both professionals and patients regarding their use.
But when can I go home?
Authors: Findlay David J.
Published: September 2015

Assessment of mental capacity is, or should be, a regular part of daily
clinical practice in general hospitals. It is both particularly important
and potentially complex in relation to an older person with dementia wishing
to return home despite concern over perceived risk. Case law provides some
guidance, but an ethical duty remains for clinicians to develop and hone
their professional judgement in this increasingly important area of
practice.
Psychiatry in public mental health: easy to say, but harder to achieve
Authors: Foreman David M.
Published: September 2015

Psychiatrists are currently ill equipped to exploit the growing interest in public mental health. Training, service infrastructure and organisational links are deficient, which will impede population-based interventions. However, the potential benefits make correcting this worthwhile.
Waltz with Bashir (2008; director/writer: Ari Folman)
Authors: Rampling Jeremy
Published: September 2015

Ari Folman's Waltz with Bashir is an animated documentary about the 1982 Lebanon War through the eyes of Israeli Defence Forces (IDF) veterans. The narrative, which follows Folman on a quest to uncover his lost memories of the War through interviews with his peers, plays out like psychotherapeutic intervention; Folman questions his own responsibilities, his hereditary scars and, ultimately, his guilt as he ‘unwillingly [takes on] the role of the Nazi’. While it would be disingenuous to call the film apolitical, it is not as political as one might expect from such evocative history. Rather, it is a treatise on memory and psychological survival through predominantly neurotic defence mechanisms.
The importance of psychiatry in public mental health
Authors: Mehta Nisha , Davies Sally C.
Published: September 2015

There is a lack of consensus over fundamental issues in public mental health in England. A move away from poorly evidenced ‘well-being’ policy approaches is needed. The authors have developed a more inclusive model using the World Health Organization's approach to public mental health. Public mental health policy makers must acknowledge the importance of psychiatry within the field.
Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
Authors: Masters Gregory A. , Temin Sarah , Azzoli Christopher G. , Giaccone Giuseppe , Baker Sherman , Brahmer Julie R. , Ellis Peter M. , Gajra Ajeet , Rackear Nancy , Schiller Joan H. , Smith Thomas J. , Strawn John R. , Trent David , Johnson David H.
Published: September 2015

Purpose

To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non–small-cell lung cancer (NSCLC).

Methods

An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014.

Results

This guideline update reflects changes in evidence since the previous guideline.

Recommendations

There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy. Decisions regarding systemic therapy should not be made based on age alone. Additional information can be found at http://www.asco.org/guidelines/nsclc and http://www.asco.org/guidelineswiki .
Extreme Outlier Analysis Identifies Occult Mitogen-Activated Protein Kinase Pathway Mutations in Patients With Low-Grade Serous Ovarian Cancer
Authors: Grisham Rachel N. , Sylvester Brooke E. , Won Helen , McDermott Gregory , DeLair Deborah , Ramirez Ricardo , Yao Zhan , Shen Ronglai , Dao Fanny , Bogomolniy Faina , Makker Vicky , Sala Evis , Soumerai Tara E. , Hyman David M. , Socci Nicholas D. , Viale Agnes , Gershenson David M. , Farley John , Levine Douglas A. , Rosen Neal , Berger Michael F. , Spriggs David R. , Aghajanian Carol A. , Solit David B. , Iyer Gopa
Published: September 2015

Purpose

No effective systemic therapy exists for patients with metastatic low-grade serous (LGS) ovarian cancers. BRAF and KRAS mutations are common in serous borderline (SB) and LGS ovarian cancers, and MEK inhibition has been shown to induce tumor regression in a minority of patients; however, no correlation has been observed between mutation status and clinical response. With the goal of identifying biomarkers of sensitivity to MEK inhibitor treatment, we performed an outlier analysis of a patient who experienced a complete, durable, and ongoing (> 5 years) response to selumetinib, a non-ATP competitive MEK inhibitor.

Patients and Methods

Next-generation sequencing was used to analyze this patient's tumor as well as an additional 28 SB/LGS tumors. Functional characterization of an identified novel alteration of interest was performed.

Results

Analysis of the extraordinary responder's tumor identified a 15-nucleotide deletion in the negative regulatory helix of the MAP2K1 gene encoding for MEK1. Functional characterization demonstrated that this mutant induced extracellular signal-regulated kinase pathway activation, promoted anchorage-independent growth and tumor formation in mice, and retained sensitivity to selumetinib. Analysis of additional LGS/SB tumors identified mutations predicted to induce extracellular signal-regulated kinase pathway activation in 82% (23 of 28), including two patients with BRAF fusions, one of whom achieved an ongoing complete response to MEK inhibitor–based combination therapy.

Conclusion

Alterations affecting the mitogen-activated protein kinase pathway are present in the majority of patients with LGS ovarian cancer. Next-generation sequencing analysis revealed deletions and fusions that are not detected by older sequencing approaches. These findings, coupled with the observation that a subset of patients with recurrent LGS ovarian cancer experienced dramatic and durable responses to MEK inhibitor therapy, support additional clinical studies of MEK inhibitors in this disease.
Oleate Abrogates Palmitate-Induced Lipotoxicity and Proinflammatory Response in Human Bone Marrow-Derived Mesenchymal Stem Cells and Osteoblastic Cells
Authors: Gillet C. , Spruyt D. , Rigutto S. , Dalla Valle A. , Berlier J. , Louis C. , Debier C. , Gaspard N. , Malaisse W. J. , Gangji V. , Rasschaert J.
Published: September 2015

Osteoporosis is a metabolic bone disease associated with unequilibrated bone remodeling resulting from decreased bone formation and/or increased bone resorption, leading to progressive bone loss. In osteoporotic patients, low bone mass is associated with an increase of bone marrow fat resulting from accumulation of adipocytes within the bone marrow. Marrow adipocytes are active secretory cells, releasing cytokines, adipokines and free fatty acids (FA) that influence the bone marrow microenvironment and alter the biology of neighboring cells. Therefore, we examined the effect of palmitate (Palm) and oleate (Ole), 2 highly prevalent FA in human organism and diet, on the function and survival of human mesenchymal stem cells (MSC) and MSC-derived osteoblastic cells. The saturated FA Palm exerted a cytotoxic action via initiation of endoplasmic reticulum stress and activation of the nuclear factor κB (NF-κB) and ERK pathways. In addition, Palm induced a proinflammatory response, as determined by the up-regulation of Toll-like receptor 4 expression as well as the increase of IL-6 and IL-8 expression and secretion. Moreover, we showed that MSC-derived osteoblastic cells were more sensitive to lipotoxicity than undifferentiated MSC. The monounsaturated FA Ole fully neutralized Palm-induced lipotoxicity by impairing activation of the pathways triggered by the saturated FA. Moreover, Ole promoted Palm detoxification by fostering its esterification into triglycerides and storage in lipid droplets. Altogether, our data showed that physiological concentrations of Palm and Ole differently modulated cell death and function in bone cells. We therefore propose that FA could influence skeletal health.
In memoriam – Alan Hall
Authors: Burridge Keith
Published: September 2015

On May 3 of this year, cell biology lost a giant with the untimely passing of Alan Hall (Fig. 1). Alan didn't discover the Rho family of GTPases but, more than anyone else, he and his laboratory brought these key regulatory proteins to the prominent position that they now occupy. I first met Alan in the early 1990s shortly after his landmark papers with Anne Ridley were published (Ridley and Hall, 1992; Ridley et al., 1992). Over the years our interests frequently overlapped, we met often at conferences and became friends. Ultimately, we became collaborators, each of us directing projects within a Program Project Grant that is headed by Klaus Hahn, and that also includes Gaudenz Danuser and John Sondek. Shortly before his death we had been in conversation about this grant and were discussing when we would next get together as a group. I was looking forward to seeing him again, not only because I enjoyed his company but because I always learned something new from every interaction. Other obituaries have covered Alan Hall's career, research accomplishments and service to the research community, such as being Chair of Cell Biology at the Memorial Sloan Kettering Cancer Center and Editor-in-Chief of the Journal of Cell Biology. Here, I wish to share my perspective on his enormous contribution to the Rho GTPase field, particularly focusing on the decade of the 1990s when he and his laboratory thrust Rho GTPases to the forefront of cell biology.
The use of DBS stimulation in mental disorders - opportunities and risks.
Authors: Antosik-Wójcińska Anna , Święcicki Łukasz
Published: September 2015

Powiększanie się zasobu wiedzy na temat biologicznego podłoża zaburzeń psychicznych jest przyczyną wzrostu zainteresowania współpracą między psychiatrami a neurochirurgami. Doświadczenia zebrane w ciągu ostatnich 20 lat podczas badań nad zastosowaniem technik neuromodulacji w chorobach neurologicznych wskazują, że głęboka stymulacja mózgu (DBS), oprócz poprawy stanu neurologicznego, może prowadzić do korzystnych zmian nastroju i napędu. Zastosowanie czynnościowych badań mózgu i metod neuroobrazowania pozwoliło na wyodrębnienie obszarów kluczowych dla powstawania objawów depresyjnych i obsesyjno-kompulsyjnych. Wyniki prowadzonych w ostatnich latach badań nad zastosowaniem DBS z zaburzeniach psychicznych wskazują jednak zarówno na wysoką skuteczność tej metody, jak i możliwe powikłania i ryzyko z nią związane. W artykule pokrótce przedstawiono szanse związane z zastosowaniem tej metody w grupie pacjentów lekoopornych, nie o reagujących na inne, mniej inwazyjne formy leczenia, jak i potencjalne zagrożenia i trudności. Aby określić rzeczywistą skuteczność metody, optymalne cele stereotaktyczne, parametry neurostymulacji, ryzyko objawów niepożądanych oraz metody ich uniknięcia- konieczne są jednak dalsze prace w tym obszarze.
Quality of life of patients with irritable bowel syndrome before and after education
Authors: Joć Ewa , Mądro Agnieszka , Celiński Krzysztof , Słomka Maria , Kasztelan-Szczerbińska Beata , Pacian Anna , Kulik Teresa
Published: September 2015

Cel

Celem przeprowadzonych przeze mnie badań była analiza wpływu edukacji pacjentów z ZJD na jakość ich życia.

Metoda

Badania zostały przeprowadzone w latach 2010 – 2011 w Poradni Gastroenterologicznej SPSK 4 w Lublinie oraz Poradni Gastroenterologicznej WSS im. Stefana Kardynała Wyszyńskiego w Lublinie.
Badania dotyczące jakości życia były przeprowadzone za pomocą Kwestionariusza Poczucia Jakości Życia ( QOL-Q R. Schalock, K. Keith).

Wyniki

Badani przeze mnie pacjenci edukowani zarówno przez lekarza, pielęgniarkę oraz przy pomocy informacji pisemnej uzyskali znacząco wyższe wyniki po otrzymanej edukacji w wielowymiarowych aspektach jakości życia.
Pacjenci z ZJD sześć miesięcy od przeprowadzonej wykazali znacząco wyższą JŻ we wszystkich badanych aspektach czyli Zadowolenie, Umiejętność/Produktywność, Możliwość działania/Niezależność, Przynależność do społeczności/Integracja ze społecznością. W tym przypadku zrozumienie istoty choroby przyczyniło się do obniżenia lęku przed chorobą nowotworową oraz niepokojącymi objawami, co tym samym znacząco wpłynęło na zmniejszenie występowania dolegliwości chorobowych.

Wnioski

1. Jakość życia pacjentów z zespołem jelita drażliwego (ZJD) jest znacząco obniżona w każdym z rozpatrywanych zakresów.

2. Edukacja pacjentów z ZJD spowodowała wzrost jakości życia i zarazem zmniejszenie dolegliwości związanych z chorobą.

3. Edukacja pacjentów z ZJD odgrywa istotną rolę w całości procesu terapeutycznego.
Clinical utility of chosen factors in predicting post-stroke depression: a one year follow-up.
Authors: Wichowicz Hubert , Gąsecki Dariusz , Landowski Jerzy , Lass Piotr , Świerkocka Małgorzata , Wiśniewski Grzegorz , Nyka Waldemar N. , Wilkowska Alina
Published: September 2015

Cel

Celem pracy była ocena ewentualnej zależności pomiędzy wystąpieniem depresji poudarowej (DPU) a wybranymi parametrami klinicznymi oraz demograficznymi.

Metoda

Zbadano pacjentów hospitalizowanych w Klinice Neurologii AMG (kwiecień 2003 - grudzień 2005) z powodu pierwszego, niedokrwiennego udaru mózgu. Wstępnie zakwalifikowano 116 osób (61,4±12,6 lat, kobiety N=42). Analizie podlegały dane demograficzne, strona udaru i miejsce uszkodzenia w oparciu o badania neuroobrazowe, oraz globalny deficyt neurologiczny oceniany w pierwszej dobie po udarze i w dniu wypisu, wg NIHSS (National Institutes of Health Stroke Scale) i Wskaźnika Barthel (BI – Barthel Index of Activity of Daily Living).
Badania psychiatrycznie wykonano: 6 (42 dni±3 dni) i 12 tygodni (84 dni±7 dni) oraz 6 (± 14 dni) i 12 miesięcy (± 14 dni) po udarze z oceną w oparciu o kryteria ICD-10 wraz z oceną stopnia sprawności funkcjonalnej (skalą Rankina).

Wyniki

Depresja wystąpiła u 29 pacjentów (27,6%). Nie potwierdzono związku jej wystąpienia z płcią ani wiekiem. W dniu udaru i wypisu osoby bez DPU były nieco sprawniejsze, jednak w stopniu nieznaczącym statystycznie. Potwierdzono zależność pomiędzy obecnością DPU a wynikami skali Rankina, poza stopniem poprawy w czasie obserwacji. W grupie osób z depresją udary lewopółkulowe były nieco częstsze, jednak różnica ta nie osiągnęła istotności statystycznej. Obecności zmian w obrębie płatów czołowych i jąder podstawy towarzyszyło częstsze występowanie depresji.

Wnioski

Stwierdzono związek pomiędzy obecnością DPU i lokalizacją zmian udarowych (w płatach czołowych lub jądrach podstawy) oraz stopniem sprawności funkcjonalnej ocenianej w okresie 12 m-cy po udarze.
The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy
Authors: Nakamura R. , Komatsu N. , Murao T. , Okamoto Y. , Nakamura S. , Fujita K. , Nishimura H. , Katsuki Y.
Published: September 2015

The objective of this study was to validate the efficacy of Takeuchi classification for lateral hinge fractures (LHFs) in open wedge high tibial osteotomy (OWHTO). In all 74 osteoarthritic knees (58 females, 16 males; mean age 62.9 years, standard deviation 7.5, 42 to 77) were treated with OWHTO using a TomoFix plate. The knees were divided into non-fracture (59 knees) and LHF (15 knees) groups, and the LHF group was further divided into Takeuchi types I, II, and III (seven, two, and six knees, respectively). The outcomes were assessed pre-operatively and one year after OWHTO. Pre-operative characteristics (age, gender and body mass index) showed no significant difference between the two groups. The mean Japanese Orthopaedic Association score was significantly improved one year after operation regardless of the presence or absence of LHF (p = 0.0015, p < 0.001, respectively). However, six of seven type I cases had no LHF-related complications; both type II cases had delayed union; and of six type III cases, two had delayed union with correction loss and one had overcorrection. These results suggest that Takeuchi type II and III LHFs are structurally unstable compared with type I.

Cite this article: Bone Joint J 2015;97-B:1226–31.
Physical functioning, pain and quality of life after amputation for musculoskeletal tumours
Authors: Furtado S. , Grimer R. J. , Cool P. , Murray S. A. , Briggs T. , Fulton J. , Grant K. , Gerrand C. H.
Published: September 2015

Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision.

Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p < 0.001). Many reported significant pain. In addition, TESS was negatively associated with increasing age, and pain interference scores. QOL for Cancer Survivors was significantly correlated with TESS (p < 0.001). This relationship appeared driven by pain interference scores.

This unprecedented national survey confirms amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs.

Cite this article: Bone Joint J 2015;97-B:1284–90.