bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Message Framing and Source Credibility on Green Messages in Hotels
Authors: Kim Sung-Bum , Kim Dae-Young
Published: October 2013

This study used an experimental approach to examine the influence of message framing and source credibility on potential hotel customers’ attitudes, behavioral intentions, attention, and environmentally friendly activities (EFAs) toward messages about protecting the environment. With 386 participants, this study employed a 2 × 2 between-subject design comparing a positive message frame, a negative message frame, a credible source, and a noncredible source. The results reveal that messages from a credible source that are positively framed led to the most positive attitudes toward the messages themselves, visit intention, and EFAs. Even without regard to source credibility, positively framed messages were more effective than those with a negative frame. The implication for hospitality practitioners is to maintain a positive frame for messages that encourage guests to participate in a hotel’s sustainability programs, and to add a credible source for additional message strength.
The Impact of Environmental Certification on Hotel Guest Ratings
Authors: Peiró-Signes Angel , Segarra-Oña María-del-Val , Verma Rohit , Mondéjar-Jiménez José , Vargas-Vargas Manuel
Published: October 2013

In this article, we analyze the impact on hotels of the ISO 14001 environmental certification system from the customers’ perspective. Based on a comparison of customer ratings of 6,850 hotels in Spain with and without ISO 14001 certification, overall guests rate the hotels with ISO 14001 certification higher than those without the certification. These results are stronger for hotel comfort and hotel services compared with other hotel attributes. Moreover, the most significant differences were found in the upscale four-star hotels. While the study does not reveal causes for these findings, the implication is that the highest end five-star luxury hotels do not gain distinctive differentiation by having the ISO 14001 certification, while for three-star hotels, guests’ price sensitivity overrides environmental concerns. At the four-star level, however, hotels seem to be able to gain a distinct market advantage from environmental certification. For all hotels, the management discipline provided by ISO 14001 can provide a competitive advantage.
Competing through customization
Authors: Hong Ying , Liao Hui , Sturman Michael C. , Zhou Yu
Published: October 2013

Given the increasingly diverse customer preferences, customization has become a strategic opportunity for organizations to create value. There is no systematic effort, however, in understanding the implementation of customization as a competitive strategy. Based on theories of resources and capabilities and the multidimensional view of economic rents, we derive three strategies of customization—mass production, mass customization, and total customization—each creating a unique value for customers and incurring different costs. To bridge the gap in the human resources literature in delineating the strategic capabilities as an intermediate outcome of human resources systems, we further draw from organizational psychology perspectives to infer how the strategic capabilities for customization can be created through different human resources management systems.
A specially tailored vancomycin continuous infusion regimen for renally impaired critically ill patients
Authors: Eldemiry Eman Mohamed Bahgat , Sabry Nirmeen A , Abbassi Maggie M , Abdel Shafy Sanaa S , Mokhtar Mohamed S , Abdel Bary Ahmed
Published: October 2013

Background:

Vancomycin remains the gold standard for treatment of methicillin-resistant Staphylococcus aureus. Specially designed continuous infusion of vancomycin leads to better therapy.

Methodology:

A total of 40 critically ill patients who suffered from pneumonia susceptible to vancomycin, had serum creatinine >1.4 mg%, and oliguria <0.5 mL/kg/h for 6 h were included in the study with respiratory culture sensitivity to vancomycin ≤2 mg/L. Patients’ clinical, microbiological, and biological data were obtained by retrospective analysis of the corresponding medical files before and after vancomycin treatment. Patients with serum creatinine level ≥4 mg% and patients who received renal replacement therapy during the treatment period were excluded. The patients were divided into two groups—group 1 (intermittent dosing) and group 2 (continuous infusion) based on the following formula: rate of vancomycin continuous infusion (g/day) = [0.0205 creatinine clearance (mL/min) + 3.47] × [target vancomycin concentration at steady state (µg/mL)] × (24/1000). Trough vancomycin serum levels were also assessed using high-performance liquid chromatographic technique. Patients’ outcomes such as clinical improvement, adverse events, and 15-day mortality were reported.

Results:

Group 2 showed significant reduction in blood urea nitrogen, creatinine serum levels, white blood cells, partial carbon dioxide pressure, body temperature, and Sequential Organ Failure Assessment score, while significant increase in partial oxygen pressure and saturated oxygen was also observed. A significantly shorter duration of treatment with a comparable vancomycin serum levels was also reported with group 2.

Conclusion:

After treatment, comparison in patients’ criteria supports the superiority of using continuous infusion of vancomycin according to this equation in renally impaired patients.
Late Bidirectional Glenn Anastomosis in a 54-Year-Old Patient With Unoperated Functionally Univentricular Heart
Authors: Abdelbar Abdelrahman , Mahadevan Vaikom S. , Austin Conal , Hoschtitzky J. Andreas
Published: October 2013

We report the case of a 54-year-old patient with complex univentricular physiology who presented with worsening exercise intolerance, chronic cyanosis, and uncontrolled heart failure. Investigations included echocardiography, cardiac magnetic resonance imaging, and cardiac catheterization. After discussion in a multidisciplinary meeting, the patient underwent successful surgery that included a bidirectional Glenn anastomosis and repair of the atrioventricular (AV) junction. She recovered well and on follow-up had substantially less cyanosis and heart failure. We demonstrated that common AV valve repair and Glenn shunt can be used together successfully in appropriately selected older patients as palliation for complex congenital heart disease with functionally univentricular physiology.
Thoracoscopic Pericardiectomy for Constrictive Pericarditis in a Pediatric Patient With Mulibrey Nanism
Authors: Christov Georgi , Burch Michael , Andrews Rachel , Hurst Jane , Ashworth Michael , Mustafa Muhammad , Muthialu Nagarajan
Published: October 2013

Mulibrey nanism is a rare autosomal recessive disease with multisystem involvement. Clinical deterioration is most often related to cardiac involvement in the form of restrictive or constrictive disorders, and pericardiectomy may be required. We report a case of Mulibrey nanism in a patient of non-Finnish origin, where a thoracoscopic pericardiectomy helped in good palliation and clinical recovery.
The Effect of Epinephrine on Coronary Flow in the Setting of a Systemic-to-Pulmonary Artery Shunt
Authors: DeCampli William M. , Tsai Felix W. , Argueta-Morales I. Ricardo , Smith Cathy , Munro Hamish M.
Published: October 2013

Background:

Indirect clinical evidence suggests that coronary blood flow (CBF) is altered in patients palliated with systemic-to-pulmonary artery shunts (SPSs). The addition of epinephrine may exert additional effects.

Methods:

A total of 11 newborn piglets underwent placement of a 3.5- to 4-mm graft between the innominate artery and the pulmonary artery. Doppler probes measured flow continuously in the aorta (aortic flow [AoF]), pulmonary artery and left coronary artery at baseline (SPS closed), SPS open, and during epinephrine administration (SPS closed and open). Each animal served as its own control. Systolic and diastolic CBF, resistance (coronary vascular resistance index [CVRI]), and myocardial oxygen supply demand ratio were calculated.

Results:

Opening the SPS increased AoF and decreased systolic and diastolic pressure from baseline, with and without the presence of epinephrine. The CBF and CVRI decreased on opening the SPS in the presence of epinephrine. The decrease occurred only in diastole and was proportional to pulmonary-to-systemic flow ratio (Qp/Qs). Epinephrine infusion itself reduced CVRI with SPS closed, but there was little further decrease on opening SPS. Myocardial oxygen supply–demand ratio decreased on opening SPS at baseline and with epinephrine.

Conclusions:

This study suggests that SPS decreases CBF, especially in the presence of a higher Qp/Qs and epinephrine. The mechanism is largely due to the decrease in diastolic pressure and the inability of the coronary arteries to compensate with vasodilation.
Surgical Unroofing of an Anomalous Right Coronary Artery Arising From the Posterior Left Sinus of Valsalva
Authors: Elhmidi Yacine , Nöbauer Christian , Hörer Jürgen , Schreiber Christian , Lange Rudiger
Published: October 2013

A 25-year-old male patient presented with sudden collapse due to a cardiac arrest during physical exercise. An electrocardiogram revealed ST-T wave abnormalities. A coronary catheterization and complementary computer tomography angiography showed an anomalous right coronary artery arising from the posterior left sinus of Valsalva. A successful surgical unroofing was performed.
Descending Aortic and Innominate Artery Cannulation for Aortic Arch Repair With Mildly Hypothermic Continuous Cardiopulmonary Bypass in Infants and Children
Authors: Hammel James M. , Deptula Joseph J. , Siecke Rebecca , Abdullah Ibrahim , Duncan Kim F.
Published: October 2013

A technique is described for exposure of the descending aorta, allowing separate arterial cannulation for perfusion of the upper and lower body during reconstruction of the aortic arch, maintaining continuous full-flow cardiopulmonary bypass to the entire body. This single technique is applicable to all aortic arch pathologies and allows an unhurried aortic reconstruction in an unobstructed field.
Methicillin-Resistant Staphylococcus aureus in Patients With Congenital Heart Disease in the Pediatric Intensive Care Unit
Authors: Wells Saran , Anderson Tiffany , Tiemieier Alexander , Wrobel Joanna , Maraqa Nizar , Smotherman Carmen , Wheeler Sarah , Bailey Christine , Kraemer Dale , Rathore Mobeen H.
Published: October 2013

Background:

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been recognized as a significant problem among hospitalized patients. Available data about prevalence of MRSA among children with congenital heart disease (CHD) are minimal. The aim of the study was to determine the prevalence of MRSA colonization and to identify risk factors for MRSA colonization among children <19 years old with CHD admitted to a pediatric intensive care unit (PICU).

Methods:

Admission and weekly MRSA nasal surveillance testing was performed, and patients were stratified into six risk groups based on the Risk Adjustment for Congenital Heart Surgery-1 Method. The MRSA-colonized children were compared to the MRSA noncolonized children.

Results:

During the 3-year study period, there were 372 admissions of children with CHD to the PICU. Of the 372, 72 (19.4%) had no surveillance cultures performed or had no prior history of MRSA and were excluded from further analysis. Of the remaining 300 admissions, 29 (9.7%) (263 individual children) were found to be colonized. The mean age of the 263 children when first admitted to the PICU was 3.29 years (range 0.03-18.30, median 0.66). Age distribution was not significantly different between the colonized and noncolonized groups ( P = .236). Gender ( P = .667), race ( P = .837), and CHD complexity ( P = .395) were not significantly associated with colonization. The odds of being colonized if previously hospitalized were 4.42 times greater than if not previously hospitalized (95% confidence interval 1.89, 10.34).

Conclusion:

Routine MRSA surveillance should be performed in patients with CHD to identify colonized patients.
Single-Stage Surgical Correction of Combination Lesions Through Thoracotomy
Authors: Ramanan Sowmya , Sasikumar Navaneetha , Pradeep Kizakke K. , Rajasekaran Premsekar , Rema Krishna Manohar Soman , Cherian Kootturathu Mammen
Published: October 2013

Coarctation of the descending aorta is associated with significant cardiac lesions in up to 50% of the patients. Under such circumstances, surgical management requires consideration of the nature of the associated lesion which usually requires a median sternotomy for surgical correction. Coarctation of the aorta (COA) is, therefore, rarely associated with lesions that are amenable to surgical correction through a thoracotomy incision. In this case report, we report a case of COA with significant associated cardiac disease that was repaired through a left thoracotomy incision. A 13-year-old boy was found to have COA and also partial anomalous pulmonary venous drainage of the left upper pulmonary vein to the innominate vein. Both the lesions were surgically corrected simultaneously through a thoracotomy.
Functionally Univentricular Heart and the Fontan Operation
Authors: Jacobs Jeffrey Phillip , Maruszewski Bohdan
Published: October 2013

Background:

“The term “functionally univentricular heart” describes a spectrum of congenital cardiovascular malformations in which the ventricular mass may not readily lend itself to partitioning that commits one ventricular pump to the systemic circulation and another to the pulmonary circulation.” The purpose of this article is to review patterns of practice and outcomes in the Congenital Heart Surgery Databases (CHSDBs) of the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) in patients with functionally univentricular hearts undergoing the Fontan operation.

Methods:

We examined all index operations performed on patients with functionally univentricular hearts in the EACTS and STS-CHSDBs over 4 years from 2007 to 2010, inclusive.

Results:

The most common diagnostic categories are hypoplastic left heart syndrome, tricuspid atresia, and double inlet left ventricle. The Fontan operation makes up 3.2% of all cardiac operations in the EACTS and STS-CHSDBs over 4 years from 2007 to 2010, inclusive. Of all the patients undergoing a Fontan procedure, 65.1% had an extracardiac Fontan, 21.5% had a lateral tunnel, and 5.8% had a Fontan revision or conversion (Re-do Fontan). In operations where fenestration status is known, 68.5% of the Fontan operations were fenestrated. During the four years of this analysis, only 5 patients had ventricular septation. Exclusive of Fontan revision or conversion (Re-do Fontan), all remaining Fontan operations had a discharge mortality of 2.3%. Fontan revision or conversion (Re-do Fontan) had a discharge mortality of 12.8%.

Conclusions:

The STS database is largest CHSDB in North America. The EACTS database is largest CHSDB in Europe. This review of data from EACTS and STS allows for unique documentation of practice patterns and outcomes. From this analysis, it is clear that patients with functionally univentricular hearts present a challenging problem; however, exclusive of Fontan revision or conversion (Re-do Fontan), the Fontan operation has a discharge mortality of 2.3%.
Pulmonary Artery Aneurysm With Patent Arterial Duct
Authors: Tefera Endale , Teodori Michael
Published: October 2013

Congenital or acquired aneurysm of the pulmonary artery (PA) is rare. Although aneurysms are described following surgical treatment of patent ductus arteriosus (PDA), occurrence of this lesion in association with PDA without previous surgery is extremely uncommon. An eight-year-old patient with PDA and aneurysm of the main PA is described in this report. Clinical diagnosis of PDA was made upon presentation. Diagnosis of PA aneurysm was suspected on chest x-ray and was confirmed on transthoracic echocardiography. Successful surgical resection of the aneurysm and division of the duct were performed under cardiopulmonary bypass. The patient did well on follow-up both from clinical and echocardiographic point of view.
Repair Options in Rheumatic Aortic Valve Disease in Young Patients
Authors: d’Udekem Yves , Sharma Varun
Published: October 2013

This article outlines the arguments against cusp extension, which were put forward at the debate entitled “Repair options in rheumatic aortic disease in young patients” at the Symposium on Surgery for Rheumatic Heart Disease organized by The World Society for Pediatric and Congenital Heart Surgery at The Sixth World Congress of Paediatric Cardiology and Cardiac Surgery, February 17-22, 2013, Cape Town, South Africa. We propose that cusp extension should be avoided because (1) these patients are usually old enough to receive the same valve substitutes as adults, (2) lack of antibioprophylaxis compliance will likely result in early reintervention, (3) cusp extension mandates rerepair within four to five years and is more expensive in the long term, and (4) it is fraught with myocardial ischemic complications. Thus, a mechanical, bioprosthetic, or autograft valve replacement may be superior for patients unless they have unrestricted access to repetitive interventions. A single surgical technique does not suffice in the treatment of rheumatic aortic valve disease, and a diversified approach should be adopted dependent on both the patients’ characteristics and the financial constraints.
Secondary Prophylaxis for Rheumatic Fever
Authors: Wilson Nigel
Published: October 2013

Registers of those with rheumatic heart disease or a history of acute rheumatic fever (RF) are key to prevent RF recurrences and improve disease control. Randomized controlled trials show intramuscular long-acting benzathine penicillin G is more effective than oral penicillin to prevent recurrences. Although some guidelines recommend three-weekly benzathine penicillin, four weekly is effective if compliance rates are high. Four-weekly penicillin delivery is also preferable to three-weekly regimens for health resource and logistical reasons and for patient acceptability and compliance.
Use of β-Blockade and Levosimendan for Separation From Extracorporeal Life Support in an Infant With Postoperative Diastolic Dysfunction
Authors: Pandey Ragini , Ramakrishnan Karthik , Gooi Alex , Karl Tom
Published: October 2013

Diastolic dysfunction is common in infants and neonates with left ventricular (LV) outflow tract obstruction and may lead to low-cardiac output in the postoperative period. We present a management strategy for severe postrepair diastolic dysfunction in an infant with critical congenital aortic stenosis and LV hypertrophy, employing β-blockade and levosimendan.
Aortic Cusp Extension for Surgical Correction of Rheumatic Aortic Valve Insufficiency in Children
Authors: Kalangos Afksendiyos , Myers Patrick O.
Published: October 2013

Surgical management of aortic insufficiency in the young is problematic because of the lack of an ideal valve substitute. Potential advantages of aortic valve repair include low incidences of thromboembolism and endocarditis, avoiding conduit replacements, the maintenance of growth potential, and improved quality of life. Aortic valve repair is still far from fulfilling the three key factors that have allowed the phenomenal development of mitral valve repair (standardization, reproducibility, and stable long-term results); however, techniques of aortic valve repair have been refined, and subsets of patients amenable to repair have been identified. We have focused on the oldest technique of aortic valve repair, cusp extension, focusing on children with rheumatic aortic insufficiency. Among 77 children operated from 2003 to 2007, there was one early death from ventricular failure and one late death from sudden cardiac arrhythmia. During a mean follow-up of 12.8 ± 5.9 years, there were 16 (20.5%) reoperations on the aortic valve, at a median of 3.4 years (range, 2 months to 18.3 years) from repair. Freedom from aortic valve reoperation was 96.2% ± 2.2% at 1 year, 94.9% ± 2.5% at 2 years, 88.5% ± 3.6% at 5 years, 81.7% ± 4.4% at 10 years, 79.7% ± 4.8% at 15 years, and 76.2% ± 5.7% at 20 years. Although aortic cusp extension is technically more demanding, it remains particularly more suitable in the context of evolving rheumatic aortic insufficiency in children with a small aortic annulus as a bridge surgical approach to late aortic valve replacement with a larger valvular prosthesis.
Early Cyanosis After Stage II Palliation for Single Ventricle Physiology
Authors: Zampi Jeffrey D. , Hirsch-Romano Jennifer C. , Armstrong Aimee K.
Published: October 2013

Background:

In the early postoperative period after stage II palliation, patients with single ventricle physiology can have cyanosis due to a variety of causes. This cyanosis can be significant and necessitate cardiac catheterization to determine etiology and attempt treatment. Our objective was to determine the etiology of early postoperative cyanosis and outcomes in patients referred to the catheterization laboratory from the cardiac intensive care unit (CICU) after stage II palliation.

Methods:

We performed a retrospective analysis of all patients referred for cardiac catheterization from the CICU for evaluation of early cyanosis after stage II palliation. Etiology for hypoxemia, treatment strategy, and patient outcomes were examined for each patient.

Results:

Between January 1, 2006, and December 31, 2011, 244 patients underwent stage II palliation of which 22 required cardiac catheterization during the early postoperative period because of severe cyanosis. The etiologies for cyanosis were venovenous collaterals (n = 12), cavopulmonary pathway thrombosis (n = 3), hemi-Fontan pathway baffle leak (n = 2), and undetermined (n = 5). Overall, transplant-free survival to hospital discharge was 50% and survival to hospital discharge with stage II physiology was 32%. Venovenous collateral occlusion, cavopulmonary anastomosis takedown, and addition of a second source of pulmonary blood flow were not associated with improved outcome.

Conclusions:

Regardless of the etiology or treatment strategy, severe cyanosis in the early postoperative period after stage II palliation imparts high mortality and usually indicates failing stage II physiology. Venovenous collateral occlusion and thrombectomy are usually futile, and those who survive have a low likelihood of having stage II physiology at hospital discharge.
Secondary Repair of Ebstein's Anomaly With Atrioventricular Septal Defect Using the Cone Technique
Authors: Kumar Gaurav , Panda Biswa Ranjan , Gooi Alex , Alphonso Nelson , Karl Tom R.
Published: October 2013

A nine-year-old boy with incomplete atrioventricular septal defect (AVSD) and Ebstein's anomaly had undergone a closure of primum atrial septal defect and repair of right and left AV valves at four years of age. He presented with severe regurgitation of the right AV valve. He underwent further surgery, and a cone reconstruction of the right AV valve was performed. The association of Ebstein's anomaly with AVSD has been reported only rarely. We present a case of this association treated with the previously unreported application of the cone reconstruction (da Silva repair) as a secondary strategy.
Native Pulmonary Valve Restoration After Remote Tetralogy of Fallot Repair
Authors: Mavroudis Constantine , Mavroudis Constantine D. , Frost Jennifer
Published: October 2013

Methods to repair tetralogy of Fallot have evolved from large ventriculotomy, large transannular patch placement techniques to smaller, transatrial approaches with valve-sparing strategies in select patients. Despite these advances, there continue to be patients in whom transannular patch is inevitable, and the management of the resulting pulmonary insufficiency that develops from this has been the source of considerable discussion. Techniques aimed at restoring pulmonary valve competence utilizing the remaining valve leaflets after transannular patch placement have recently been proposed for very select patient populations. We review the technical aspects of the operation including removal of the transannular patch and bicuspidization of a formerly tricuspid pulmonary valve, which results in a competent, nonstenotic valve. This report confirms the feasibility of these operative details and highlights the importance of planning before initial repair of tetralogy of Fallot as a way to prepare for a future valve restoration procedure and therefore avoid prosthetic valve placement.
Hospital Charges and Practice Patterns for General and Regional Anesthesia in Arthroscopic Anterior Cruciate Ligament Repair
Authors: Foster Brock D. , Terrell Rodney , Montgomery Scott R. , Wang Jeffrey C. , Petrigliano Frank A. , McAllister David R.
Published: October 2013

Background:

Anesthetic use for arthroscopic anterior cruciate ligament (ACL) reconstruction may display variability in hospital charges and utilization in the United States.

Purpose:

To evaluate practice patterns and hospital charges for anesthesia in arthroscopic ACL reconstruction.

Study Type:

Cross-sectional study.

Methods:

The PearlDiver Patient Records Database, a national database of insurance billing records, was searched using the current procedural terminology (CPT) codes for arthroscopic ACL reconstruction in combination with different types of anesthesia. The search included the years between 2004 and 2009. Age, sex, number of procedures performed, geographic region, and hospital charges for each type of anesthesia were recorded and compared. Anesthetic types were categorized as general anesthesia (GA) only, GA with concomitant single femoral injection, GA with concomitant other regional anesthesia (RA), single femoral injection only, or other RA only.

Results:

Between 2004 and 2009, a total of 53,968 arthroscopic reconstructive procedures were identified. The mean per patient hospital charge for GA alone, GA in combination with single femoral injection, GA in combination with other RA, single femoral injection alone, and RA alone was $1065 (63% of cases), $1614 (29%), $1849 (4%), $630 (3%), and $612 (1%), respectively. The use of GA in combination with RA or single femoral nerve injection significantly increased during this time period ( P = .004 and P < .001, respectively).

Conclusion:

The mean per patient hospital charges for arthroscopic ACL reconstruction varied with the mode of anesthesia utilized, where regional anesthetic techniques alone were least expensive. RA alone was utilized infrequently, and there was a significant increase in the rate of utilization of GA in combination with any form of RA.

Clinical Relevance:

This study provides information on current trends and hospital charges for anesthesia in arthroscopic ACL reconstruction.
Unraveling a novel transcription factor code determining the human arterial-specific endothelial cell signature
Authors: Aranguren Xabier L. , Agirre Xabier , Beerens Manu , Coppiello Giulia , Uriz Maialen , Vandersmissen Ine , Benkheil Mohammed , Panadero Joaquin , Aguado Natalia , Pascual-Montano Alberto , Segura Victor , Prósper Felipe , Luttun Aernout
Published: October 2013

Key Points

Freshly isolated arterial/venous endothelial cells differ in their gene signature, which is only partially controlled by the Notch pathway. Eight transcription factors codetermine the arterial fingerprint in a complementary and overlapping fashion.
How I treat monoclonal gammopathy of renal significance (MGRS)
Authors: Fermand Jean-Paul , Bridoux Frank , Kyle Robert A. , Kastritis Efstathios , Weiss Brendan M. , Cook Mark A. , Drayson Mark T. , Dispenzieri Angela , Leung Nelson
Published: October 2013

Recently, the term monoclonal gammopathy of renal significance (MGRS) was introduced to distinguish monoclonal gammopathies that result in the development of kidney disease from those that are benign. By definition, patients with MGRS have B-cell clones that do not meet the definition of multiple myeloma or lymphoma. Nevertheless, these clones produce monoclonal proteins that are capable of injuring the kidney resulting in permanent damage. Except for immunoglobulin light chain amyloidosis with heart involvement in which death can be rapid, treatment of MGRS is often indicated more to preserve kidney function and prevent recurrence after kidney transplantation rather than the prolongation of life. Clinical trials are rare for MGRS-related kidney diseases, except in immunoglobulin light chain amyloidosis. Treatment recommendations are therefore based on the clinical data obtained from treatment of the clonal disorder in its malignant state. The establishment of these treatment recommendations is important until data can be obtained by clinical trials of MGRS-related kidney diseases.
Anxiety and depression disorders in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension
Authors: Harzheim Dominik , Klose Hans , Pinado Fabiola Peña , Ehlken Nicola , Nagel Christian , Fischer Christine , Ghofrani Ardeschir , Rosenkranz Stephan , Seyfarth Hans-Jürgen , Halank Michael , Mayer Eckhard , Grünig Ekkehard , Guth Stefan
Published: October 2013

Background

The objective of this prospective study was to assess the prevalence of anxiety and depression disorders and their association with quality of life (QoL), clinical parameters and survival in patients with pulmonary hypertension (PH).

Methods

We prospectively assessed 158 patients invasively diagnosed with pulmonary arterial hypertension (n = 138) and inoperable chronic thromboembolic PH (n = 20) by clinical measures including quality of life (QoL, SF-36 questionnaire), cardiopulmonary exercise testing and six minute walking distance and by questionnaires for depression (PHQ-9) and anxiety (GAD-7). According to the results of the clinical examination and the questionnaires for mental disorders (MD) patients were classified into two groups, 1) with moderate to severe MD (n = 36, 22,8%), and 2) with mild or no MD (n = 122). Patients were followed for a median of 2.7 years. Investigators of QoL, SF-36 were blinded to the clinical data.

Results

At baseline the 2 groups did not differ in their severity of PH or exercise capacity. Patients with moderate to severe MD (group 1) had a significantly lower QoL shown in all subscales of SF-36 (p < 0.002). QoL impairment significantly correlated with the severity of depression (p < 0.001) and anxiety (p < 0.05). During follow-up period 32 patients died and 3 were lost to follow-up. There was no significant difference between groups regarding survival. Only 8% of the patients with MD received psychopharmacological treatment.

Conclusion

Anxiety and depression were frequently diagnosed in our patients and significantly correlated with quality of life, but not with long term survival. Further prospective studies are needed to confirm the results.
Genetic and biochemical markers of hydroxyurea therapeutic response in sickle cell anemia
Authors: Silva Danilo Grunig Humberto , Belini Junior Edis , Carrocini Gisele Cristine de Souza , Torres Lidiane de Souza , Ricci Júnior Octávio , Lobo Clarisse Lopes de Castro , Bonini-Domingos Claudia Regina , de Almeida Eduardo Alves
Published: October 2013

Background

Sickle cell anemia (SCA) presents a complex pathophysiology which can be affected by a number of modifying factors, including genetic and biochemical ones. In Brazil, there have been no studies verifying βS-haplotypes effect on oxidative stress parameters. This study evaluated βS-haplotypes and Hb F levels effects on oxidative stress markers and their relationship with hydroxyurea (HU) treatment in SCA patients.

Methods

The studied group was composed by 28 SCA patients. Thirteen of these patients were treated with HU and 15 of them were not. We used molecular methodology (PCR-RFLP) for hemoglobin S genotype confirmation and haplotypes identification. Biochemical parameters were measured using spectrophotometric methods (Thiobarbituric-acid-reactive substances and Trolox equivalent antioxidant capacity levels, catalase and GST activities) and plasma glutathione levels by High-performance liquid chromatography coupled to electrochemical detection.

Results

We found the highest frequency of Bantu haplotype (48.2%) which was followed by Benin (32.1%). We observed also the presence of Cameroon haplotype, rare in Brazilian population and 19.7% of atypical haplotypes. The protective Hb F effect was confirmed in SCA patients because these patients showed an increase in Hb F levels that resulted in a 41.3% decrease on the lipid peroxidation levels (r =−0.74, p=0.01). Other biochemical parameters have not shown differential expression according to patient’s haplotypes. Bantu haplotype presence was related to the highest lipid peroxidation levels in patients (p < 0,01), but it also conferred a differential response to HU treatment, raising Hb F levels in 52.6% (p = 0.03) when compared with the group with the same molecular profile without HU usage.

Conclusions

SCA patients with Bantu haplotype showed the worst oxidative status. However these patients also demonstrated a better response to the treatment with HU. Such treatment seems to have presented a “haplotype-dependent” pharmacological effect.
Correlation between the prevalence of herniation pits and the alpha angle of the hip: computed tomography evaluation in healthy Chinese adults
Authors: Guo Zhe , Xu Li , Su Yong-bin , Cheng Xiao-guang
Published: October 2013

Background

Herniation pits (HPs) commonly develop over time at the femoral head–neck junction in adults, but their cause is still under debate. The purpose of study reported here was to investigate the correlation between the prevalence of HPs of the femoral neck and the alpha angle of the hips of healthy Chinese adults, by using computed tomography (CT).

Methods

Six hundred and seventy Chinese adults (representing 1145 hips) who had no known diseases affecting the proximal femur and had no symptoms of femoroacetabular impingement underwent a 64-slice CT scan for medical purposes that included the hip in the scan range. Their CT data were analyzed for the prevalence of HPs in the femoral necks and for hip alpha angles.

Results

The overall prevalence of femoral-neck HPs was 12.5% (143 of 1145 hips). The prevalence in the left versus right femoral necks was 12.1% (69 of 569 hips) versus 12.8% (74 of 576 hips). There was no statistically significant difference between the two sides (χ2 = 0.136; p = 0.712). The prevalence of HPs was greater in men than in women (15.9% vs 7.7%; p < 0.01) and greater in adults older than 30 years than in adults younger than 30 years (χ2= 14.547; p < 0.01). The alpha angles were greater in the 143 proximal femora with HPs than in the 1002 without pits (39.95° ± 6.01° vs 37.97° ± 5.14°; p < 0.01).

Conclusions

The prevalence of HPs of the femoral neck in healthy adults was 12.5%, and the prevalence was greater in men than in women. There is a correlation between the prevalence of HPs and the contour of the femoral head–neck junction. The formation of pits may be attributed to the combination of degeneration and morphologic variances in the femoral head–neck junction.
Analysis of MAT3 gene expression in NSCLC
Authors: Zheng Shangen , Du Yuwen , Chu Heying , Chen Xudong , Li Ping , Wang Yuanyuan , Ma Yunyun , Wang Huaqi , Zang Wenqiao , Zhang Guojun , Zhao Guoqiang
Published: October 2013

Background

Many studies have suggested different roles of Metastasis-associated protein 3 (MAT3) in different types of human cancers. However, expression of MAT3 in primary lung cancer and its relationship with clinicopathological factors have not been examined and the biological roles of MTA3 in lung cancer cells are still unclear.

Methods

The expression of MAT3 mRNA and protein were detected with quantitative real-time RT-PCR and immunohistochemical methods in 118 NSCLC samples and corresponding non-neoplastic samples. Survival curves were made with follow-up data. The relations of the prognosis with clinical and pathological characteristics were analyzed.

Results

The expression level of MAT3 mRNA and the positive rate of MAT3 protein were significantly higher in NSCLC samples than that in non-neoplastic samples, and in NSCLC samples with lymph node metastasis than that in NSCLC samples without lymph node metastasis (P < 0.01). MAT3 mRNA expression level was a risk factor of lymph node metastasis in patients with NSCLC (P = 0.006). There were significant differences in survival curves between lymph node metastatic group and non-metastatic group (P = 0.000), among groups of MAT3 positive and negative (P = 0.000), among groups of TNM stage I, II and III (P = 0.000) and among groups of tumor status T1, T2 and T3T4 (P = 0.000); but no statistical significance between male patients and female patients (P = 0.516), between ≥60 years old patients and <60 years old patients (P = 0.133), between histology types adenocarcinoma and squamous cell carcinoma (P = 0.865) and between well differentiation and moderate-poor differentiation (P = 0.134). The level of MAT3 mRNA (P = 0.000) and protein (P = 0.000) were risk factors of survival.

Conclusion

Our study showed that MAT3 over-expression in NSCLC tissue, and MAT3 mRNA level is a risk factor of lymph node metastasis. The level of MAT3 mRNA and protein were risk factors of survival in patients with NSCLC. It suggested that this antigen could be used as a simple and efficient parameter with which to identify high-risk patients.

Virtual slides

The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5585901065503943.
Reproductive behavior of the male rose bitterling Rhodeus ocellatus as influenced by the operational sex ratio
Authors: Liao Cai-ping , Yu Dan , Chen Yi-yu , Liu Huan-zhang
Published: October 2013

Background

Game theory predicts that as the operational sex ratio (OSR; the ratio of sexually active males to fertilizable females) increases, reproductive males may adopt alternative reproductive behaviors. Empirical studies indicated that alternative behaviors may differ for different species. In the present study, we investigated the influence of different male-biased OSRs on male reproductive behaviors shown by a freshwater fish, the rose bitterling Rhodeus ocellatus.

Results

Six levels of the OSR (1:1, 2:1, 3:1, 5:1, 7:1, and 9:1) were established, and male leading, aggression, and preoviposition ejaculation behaviors were recorded. Our experiments showed that at low OSRs, the leading behavior of male rose bitterling increased with an increasing OSR, reaching a maximum at an OSR of 3:1, and then decreased as the OSR further increased. In contrast, aggression and preoviposition ejaculation behavior continually increased with an increasing OSR. Notably, males possibly lost their territorial position to other males and became sneakers when facing more rivals.

Conclusions

These observations suggest that at lower OSRs, male rose bitterling mainly rely on leading behavior, while at higher OSRs, they increasingly adopt aggression and preoviposition ejaculation. Therefore, for the rose bitterling, (1) decreased leading behavior and (2) increased aggression and preoviposition ejaculation are two alternative responses in the face of an increasing OSR, which is a more straightforward strategy for facing an increased risk of sperm competition than that adopted by its congener, the European bitterling.
Embryonic stem cells shed new light on the developmental roles of p53
Authors: Shin Min Hwa , He Yunlong , Huang Jing
Published: October 2013

The viability and subtle developmental defects of p53 knockout mice suggest that p53 does not play major role in development. However, contradictory evidence also exists. This discrepancy mainly results from the lack of molecular and cellular mechanisms and the general fact that p53 activation requires stresses. Recent studies of p53 in mouse and human ES cells and induced pluripotent stem (iPS) cells shed new light on the mechanisms of the developmental roles of p53. This review summarizes these new studies that support the developmental roles of p53, highlights the possible underlying molecular mechanisms, and discusses the potential relationship between the developmental roles and the tumor suppressive function of p53. In summary, the molecular mechanisms underlying the developmental roles of p53 are emerging, and the developmental roles and tumor suppressive function of p53 may be closely related.
At the Bench: Preclinical rationale for exploiting NK cells and γδ T lymphocytes for the treatment of high-risk leukemias
Authors: Norell Håkan , Moretta Alessandro , Silva-Santos Bruno , Moretta Lorenzo
Published: October 2013

NK cells and γδ T lymphocytes display potent cytolytic activity against leukemias and CMV-infected cells and are thus, promising immune effector cells in the context of allo-HSCT. NK cells express HLA class I-specific inhibitory receptors and preferentially kill HLA class Ilow tumors or virus-infected cells. Killing occurs upon engagement of activating NKRs with ligands that are up-regulated on tumors and infected cells. A similar activating receptor/ligand interaction strategy is used by γδ T cells, which in addition, use their TCRs for recognition of phosphorylated antigens and still largely undefined ligands on tumor cells. In the haploidentical allo-HSCT setting, alloreactive NK cells, derived from donor HSCs, can exert potent antileukemia activity and kill residual patient DCs and T cells, thus preventing GvHD and graft rejection. However, generation of KIR+ alloreactive NK cells from HSCs requires many weeks, during which leukemia relapses, and life-threatening infections may occur. Importantly, mature NK cells and γδ T cells can control certain infectious agents efficiently, in particular, limit CMV reactivation, and infusion of such donor cells at the time of HSCT has been implemented. Development of novel, cell-based immunotherapies, allowing improved trafficking and better targeting, will endow NK cells and γδ T lymphocytes with enhanced anti-tumor activity, also making them key reagents for therapies against solid tumors. The clinical aspects of using NK cells and γδ T lymphocytes against hematological malignancies, including the allo-HSCT context, are reviewed in the related side-by-side paper by Locatelli and colleagues [1].
Tolerogenic dendritic cells: molecular and cellular mechanisms in transplantation
Authors: Švajger Urban , Rožman Primož
Published: October 2013

During the discovery of mechanisms that govern immune activation and suppression, immune tolerance always came second in the scientific timeline. This has subsequently shaped the advances in the clinical translation of DC therapy protocols used for immunostimulation or immunosuppression. With several hundred clinical trials already registered within the U.S. National Institutes of Health for the use of DCs in cancer vaccination, only a few involve TolDCs for use as negative vaccines. However, as a result of the strong scientific rationale from preclinical and clinical trials, the use of negative vaccination in organ transplantation is likely on its way to reach the extent of the use of positive cancer vaccines in the future. As the underlying mechanisms emerge, the role of DCs in the induction of transplant tolerance is recognized unambiguously as central in the bidirectional communication with various types of immune cells. This is achieved by a complex interplay of numerous tolerogenic signals involving regulatory cytokines and other surface-bound or soluble inhibitory molecules associated with corresponding inhibitory signaling cascades. A detailed understanding of these processes will accelerate the advances of clinical immunologists in translating their knowledge from bench to bedside. In this review, we present the role of TolDCs as well as the most recent findings concerning associated molecular and cellular mechanisms that shape the balance between regulatory and effector immune responses during organ transplantation.
Maternal Dietary Restriction During the Periconceptional Period in Normal-Weight or Obese Ewes Results in Adrenocortical Hypertrophy, an Up-Regulation of the JAK/STAT and Down-Regulation of the IGF1R Signaling Pathways in the Adrenal of the Postnatal Lamb
Authors: Zhang Song , Morrison Janna L. , Gill Amreet , Rattanatray Leewen , MacLaughlin Severence M. , Kleemann David , Walker Simon K. , McMillen I. Caroline
Published: October 2013

Maternal dietary restriction during the periconceptional period results in an increase in adrenal growth and in the cortisol stress response in the offspring. The intraadrenal mechanisms that result in the programming of these changes are not clear. Activation of the IGF and the signal transducer and activator of transcription (STAT)/suppressors of cytokine signaling (SOCS) pathways regulate adrenal growth. We have used an embryo transfer model in sheep to investigate the impact of exposure to either dietary restriction in normal or obese mothers or to maternal obesity during the periconceptional period on adrenal growth and function in the offspring. We assessed the adrenal abundance of key signaling molecules in the IGF-I and Janus kinase/STAT/SOCS pathways including IGF-I receptor, IGF-II receptor, Akt, mammalian target of rapamycin, ribosomal protein S6, eukaryotic translation initiation factor 4E-binding protein 1, eukaryotic translation initiation factor 4E, STAT1, STAT3, STAT5, SOCS1, and SOCS3 in female and male postnatal lambs. Maternal dietary restriction in the periconceptional period resulted in the hypertrophy of the adrenocortical cells in the zona fasciculata-reticularis and an up-regulation in STAT1, phospho-STAT1, and phospho-STAT3 (Ser727) abundance and a down-regulation in IGF-I receptor, Akt, and phospho-Akt abundance in the adrenal cortex of the postnatal lamb. These studies highlight that weight loss around the time of conception, independent of the starting maternal body weight, results in the activation of the adrenal Janus kinase/STAT pathway and adrenocortical hypertrophy. Thus, signals of adversity around the time of conception have a long-term impact on the mechanisms that regulate adrenocortical growth.
Growth Hormone Secretion Is Correlated With Neuromuscular Innervation Rather Than Motor Neuron Number in Early-Symptomatic Male Amyotrophic Lateral Sclerosis Mice
Authors: Steyn F. J. , Lee K. , Fogarty M. J. , Veldhuis J. D. , McCombe P. A. , Bellingham M. C. , Ngo S. T. , Chen C.
Published: October 2013

GH deficiency is thought to be involved in the pathogenesis of amyotrophic lateral sclerosis (ALS). However, therapy with GH and/or IGF-I has not shown benefit. To gain a better understanding of the role of GH secretion in ALS pathogenesis, we assessed endogenous GH secretion in wild-type and hSOD1G93A mice throughout the course of ALS disease. Male wild-type and hSOD1G93A mice were studied at the presymptomatic, onset, and end stages of disease. To assess the pathological features of disease, we measured motor neuron number and neuromuscular innervation. We report that GH secretion profile varies at different stages of disease progression in hSOD1G93A mice; compared with age-matched controls, GH secretion is unchanged prior to the onset of disease symptoms, elevated at the onset of disease symptoms, and reduced at the end stage of disease. In hSOD1G93A mice at the onset of disease, GH secretion is positively correlated with the percentage of neuromuscular innervation but not with motor neuron number. Moreover, this occurs in parallel with an elevation in the expression of muscle IGF-I relative to controls. Our data imply that increased GH secretion at symptom onset may be an endogenous endocrine response to increase the local production of muscle IGF-I to stimulate reinnervation of muscle, but that in the latter stages of disease this response no longer occurs.