bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping with Chronic Social Stress in Mice: Hypothalamic-Pituitary-Adrenal/ Sympathetic-Adrenal-Medullary Axis Activity, Behavioral Changes and Effects of Antalarmin Treatment: Implications for the Study of Stress-Related Psychopathologies
Authors: Pérez-Tejada Joana , Arregi Amaia , Gómez-Lázaro Eneritz , Vegas Oscar , Azpiroz Arantza , Garmendia Larraitz
Published: September 2013

The aim of this study was to analyze the individual differences that lead to the development of psychopathological changes in response to chronic social stress. We also assessed the ability of an antagonist of the corticotrophin-releasing hormone (CRH) receptors to reverse the effects of stress. Male adult mice were exposed to repeated defeat experiences for 21 days using a sensorial contact model. After 18 days of defeat, two groups of subjects were established (active and passive), according to their behaviors during social confrontation. Antalarmin treatment was given for 4 and 6 days. The results corroborated previous data indicating that subjects who adopted a passive coping strategy had higher corticosterone levels after 21 days of defeat and decreased resting levels 3 days later. Moreover, they showed higher resting expression levels of hypothalamic CRH than their active counterparts. On day 24, the experimental animals were subjected to another social defeat to determine whether the stress response remained. The increase in corticosterone and hypothalamic CRH levels was similar for all of the stressed subjects, but the passive subjects also had a greater CRH response in the amygdala. Passive subjects had decreased levels of adrenal dopamine β-hydroxylase, tyrosine hydroxylase and plasma adrenaline compared to the active subjects, and lower plasma noradrenaline levels than manipulated controls. The passive profile of physiological changes in both the hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary (SAM) axes has been associated with changes related to mood disorders, such as posttraumatic stress disorder and depression. The active coping profile is characterized by similar corticosterone resting levels to controls and increased SAM activity. Both profiles showed alterations in the novel palatable and forced swimming tests, with the passive profile being the most vulnerable to the effects of stress in this last test. Pharmacological treatment with antalarmin failed to reverse the effects of stress.
Very Small Cerebellar Infarcts: Integration of Recent Insights into a Functional Topographic Classification
Authors: De Cocker Laurens J.L. , van Veluw Susanne J. , Fowkes Mary , Luijten Peter R. , Mali Willem P.Th.M. , Hendrikse Jeroen
Published: September 2013

Background: Very small cerebellar infarcts (diameter <2 cm) are a frequent finding on MRI. With an increasing scientific interest in cerebral microinfarcts, very small infarcts in the cerebellum deserve more of our attention as well. The goal of the present article was to review infarct terminology and mechanisms, as well as to critically appraise the current classification system for very small cerebellar infarcts. Methods: A search strategy was designed to identify all relevant studies on very small cerebellar infarcts in the English language. This search was restricted to papers published up to February 21, 2013. Studies were initially identified from the MEDLINE/PubMed database using the search terms ‘small cerebellar infarct', ‘lacunar infarct', ‘microinfarct', ‘end zone infarct', ‘border zone infarct', ‘watershed infarct', ‘territorial infarct', and ‘nonterritorial infarct'. Furthermore, a similar search strategy was directed to identify all relevant articles on (descriptive and functional) neuroanatomy and neuroimaging of the cerebellum. Results: Very small cerebellar infarcts have been referred to as lacunar infarcts, as junctional, border zone or watershed infarcts, as nonterritorial infarcts, as very small territorial or end zone infarcts, or simply as (very) small cerebellar infarcts. Since the original clinicoradiological study on these small infarcts, the classification into border zones remains in common use. This classification is based upon the assumption that these infarcts occur secondary to low flow in between arterial perfusion territories, where flow is believed to be the lowest. Later studies, however, have suggested occlusion of small (end-) arteries as a prerequisite for the pathogenesis of even small cerebellar infarcts, with low flow merely as a potential contributor. Therefore, it is likely that infarcts may as well occur in a nonborder zone distribution. Moreover, the classification into border zones may be considered unreliable since the location of border zones is highly variable among individuals and is not known in a particular patient. Recently, a functional topographic organization has been found in the cerebellum with evidence for a motor-nonmotor dichotomy between the anterior and posterior lobe. Since the cerebellar lobes can be easily and reliably distinguished with both CT and MRI, we recommend the classification of very small cerebellar infarcts according to topographic location. Conclusion: There are several fundamental concerns with the current classification of very small cerebellar infarcts according to border zones, which we would like to overcome by recommending a new classification system based on topography. This will allow for a reliable and reproducible way of classifying very small cerebellar infarcts and is expected to improve clinicoradiological correlation.
Circulating Markers of Endothelial Dysfunction and Platelet Activation in Patients with Severe Symptomatic Cerebral Small Vessel Disease
Authors: Lavallée Philippa C. , Labreuche Julien , Faille Dorothée , Huisse Marie-Geneviève , Nicaise-Roland Pascale , Dehoux Monique , Gongora-Rivera Fernando , Jaramillo Arturo , Brenner David , Deplanque Dominique , Klein Isabelle F. , Touboul Pierre-Jean , Vicaut Eric , Ajzenberg Nadine ,   on behalf of the Lacunar-B.I.C.H.A.T. Investigators
Published: September 2013

Background: Small deep infarcts (SDI), also called lacunar infarcts, resulting from the occlusion of deep branch arteries, account for 25% of ischemic strokes. The physiopathology of the disease remains largely unknown. However, evidence about the role of endothelial dysfunction has emerged. Whereas chronic platelet activation is of major importance in acute thrombosis of large atherosclerotic arteries, its role in SDI remains unclear. Frequently associated risk factors are hypertension and diabetes mellitus. The aim of this study was to determine platelet and endothelial activation in patients with recent SDI in comparison to population-based control subjects matched for age, sex and vascular risk factors. Methods: Platelet activation markers (activated glycoprotein IIb/IIIa, P-selectin and platelet microparticles), shear-induced platelet aggregation (SIPA) studied in the SIPAgreg device at 4,000 s-1, endothelial activation markers [including von Willebrand factor (vWF) antigen and homocysteine] and high-sensitivity C-reactive protein (hsCRP) were measured in 74 consecutive patients with recent SDI, in whom detectable large artery atherosclerosis or cardiac embolism had been ruled out. Blood samples were collected 1 and 3 months after symptom onset. These factors were also measured in 74 population-based controls with no stroke history and matched for age, sex, hypertension and diabetes. Results: One month after symptom onset, the patients had similar levels of platelet activation to matched controls (p > 0.40 for all comparisons). In contrast, endothelial activation parameters were increased in patients in comparison to controls (vWF: p = 0.002 and homocysteinemia/creatinemia: p = 0.025). The level of hsCRP was slightly increased in patients compared to controls (p = 0.059). At 3 months, we observed a significant decrease in vWF and hsCRP levels in patients (median change in vWF = 10%, p = 0.004; median change in hsCRP = 0.4 mg/l, p = 0.02). Homocysteine levels and all platelet parameters remained unchanged at this time compared to at 1 month. Conclusions: Our results confirm that chronic platelet activation, when compared to controls matched for age, sex and vascular risk factors, did not seem to play a central role in the pathophysiology of lacunar stroke. In contrast, we found markers of endothelial dysfunction, the role of which in the occurrence of lacunar infarction has still to be clarified in further studies.
Efficacy and Side Effects of Granulocyte Collection in Healthy Donors
Authors: Brockmann Franziska , Kramer Michael , Bornhäuser Martin , Ehninger Gerhard , Hölig Kristina
Published: September 2013

Background: We report on the efficacy and side effects of granulocyte collection, which is comparatively infrequently performed in Germany. Methods: Data from 378 healthy donors who underwent 914 granulocyte collections between 1999 and 2007 were retrospectively analyzed. Donors received G-CSF (lenograstim) at a median dose of 5.58 (3.25-7.36) µg/kg body weight with (n = 243) or without (n = 57) 4 mg dexamethasone. Side effects were recorded by donor monitoring and interview (questionnaire). Results: The median granulocyte yield in apheresis products was 8.47 × 1010 (3.07-14.92 × 1010). Granulocyte yields correlated significantly with gender, baseline WBC, PMN and PLT counts, and nicotine consumption. Dexamethasone and lenograstim administration was more effective than lenograstim administration alone (p < 0.001). Side effects of granulocyte mobilization were generally mild: bone pain in 31.4%, headache in 19.6%, and fatigue in 15.7% of donors. During follow-up (4 weeks), pruritus and/or exanthema were reported in 17.6% of donors. Conclusions: Granulocyte mobilization with lenograstim with or without dexamethasone was a safe and effective regimen for granulocyte mobilization. Side effects were tolerable and milder than those seen in peripheral blood stem cell donors. Long-term monitoring of granulocyte donors is important to establish optimal standards for the procedure.
Role of Pulsatile Hemodynamics in Acute Heart Failure: Implications for Type 1 Cardiorenal Syndrome
Authors: Sung Shih-Hsien , Chen Chen-Huan
Published: September 2013

Heart failure has become a major health problem worldwide with a substantial financial burden mainly from hospitalization due to acute heart failure syndrome (AHFS). A considerable number of patients hospitalized for the treatment of AHFS experience significant worsening of renal function, which is now recognized as type 1 cardiorenal syndrome (CRS) and is associated with worse outcomes. Currently known risk factors for acute CRS in AHFS include obesity, cachexia, hypertension, diabetes, proteinuria, uremic solute retention, anemia, and repeated subclinical acute kidney injury events. Venous renal congestion due to hemodynamic changes also contributes to type 1 CRS. Vascular aging and its aggravated pulsatile hemodynamics have been shown to be involved in the pathogenesis of AHFS. Suboptimal recovery of the perturbation of the pulsatile hemodynamics may predict 6-month post-discharge cardiovascular outcomes in patients hospitalized due to AHFS. Furthermore, on-admission pulsatile hemodynamics may also be helpful to identify and stratify patients with aggravated pulsatile hemodynamics who may benefit from customized therapy. There are close interplays and feedback loops between heart and kidney dysfunction. Increased arterial stiffness accelerates pulse wave velocity and causes an earlier return of the reflected wave, resulting in higher systolic, lower diastolic, and higher pulse pressure in the central aorta and renal arteries. Increased pulsatile hemodynamics have been associated with deterioration of renal function in subjects with a high coronary risk and patients with hypertension or chronic kidney disease. Thus, there is a potential role of vascular aging/pulsatile hemodynamics in the pathophysiological pathways of acute CRS in AHFS.
Extremely Low Doses of Arsenic Affect in vitro Pollen Germination
Authors: Betti Lucietta , Zurla Michela , Trebbi Grazia , Brizzi Maurizio , Borghini Giovanni , Borghini Francesco
Published: September 2013

Introduction: This study deals with the effects of extremely low doses or high dilutions of pharmacological compounds on in vitro pollen germination of kiwifruit (Actinidia deliciosa). Material and Methods: The biological efficacy of As2O3 at the 5th and 45th decimal dilution/succussion level (As 5x and As 45x) was tested on pollen previously stressed with As2O3 150 or 200 μM. The outcome variable was the pollen germination rate, as detected blind after 3 h 30 min by an Axioplan microscope. Results: A directionally consistent recovery of germination percentage was observed in both As 5x and As 45x after stressing with As2O3 150 μM. When pollen was stressed with As2O3 200 μM only as 45x induced a general and significant germination increase. Conclusions: Our results suggest that both treatments might partially remove the inhibitory effect caused by the stressor. Similar effects were observed on the same model using weak extremely low frequency magnetic fields (ELF-MFs) mediated through water. Although preliminary, the findings seem to indicate the in vitro pollen performance as adequate to study the effects of physicochemical subthreshold stimuli (extremely low doses or high dilutions of pharmacological compounds, weak ELF-MFs), mediated through water.
Innate Immunity and Chronic Obstructive Pulmonary Disease: A Mini-Review
Authors: Shaykhiev Renat , Crystal Ronald G.
Published: September 2013

Chronic obstructive pulmonary disease (COPD), a major smoking-associated lung disorder characterized by progressive irreversible airflow limitation, affects >200 million people worldwide. Individuals with COPD have increased susceptibility to respiratory infections, resulting in exacerbations of the disease. A growing body of evidence indicates that multiple host defense mechanisms, such as those provided by the airway epithelial barrier and innate immune cells, including alveolar macrophages, neutrophils, dendritic cells and natural killer cells, are broadly suppressed in COPD in a smoking-dependent manner. Inactivation of the innate immune system observed in COPD smokers is remarkably similar to the immunosenescence phenotype associated with aging. As a consequence of defective innate immune defense, the lungs of COPD smokers are frequently colonized with pathogens and commonly develop bacterial and viral infections, which cause secondary inflammation, a major driver of the disease progression. In this review, we summarize the evidence from human studies related to disordering of the innate immune system in COPD, discuss possible relationships between those changes and aging, and provide insights into potential therapeutic strategies aimed at the prevention of COPD progression via normalization of the disordered innate immune mechanisms.
Facilitating Self-Healing in Anthroposophic Psychotherapy
Authors: Lees John
Published: September 2013

Background: The fields of complementary and alternative medicine and psychotherapy have many similar characteristics. This study investigates the self-healing capacity of the patient as one shared characteristic and as an important mechanism of change. Case Report: This investigation adopts naturalistic qualitative case study methodology to describe the treatment of a patient in his late fifties who also had an adjustment disorder with mixed anxiety and depressed moods. The data was collected retrospectively from existing data sets and was analysed using narrative analysis and the analysis of narratives. The clinical work integrated anthroposophic psychotherapy and anthroposophic medicine in order to support the patient's self-healing capacities. Conclusions: The study forms the beginning of a research programme and so should ideally be followed up by rigorous efficacy and effectiveness studies.
Frailty and Technology: A Systematic Review of Gait Analysis in Those with Frailty
Authors: Schwenk Michael , Howe Carol , Saleh Ahlam , Mohler Jane , Grewal Gurtej , Armstrong David , Najafi Bijan
Published: September 2013

Background: New technologies for gait assessment are emerging and have provided new avenues for accurately measuring gait characteristics in home and clinic. However, potential meaningful clinical gait parameters beyond speed have received little attention in frailty research. Objective: To study gait characteristics in different frailty status groups for identifying the most useful parameters and assessment protocols for frailty diagnosis. Methods: We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Age Line. Articles were selected according to the following criteria: (1) population: individuals defined as frail, prefrail, or transitioning to frail, and (2) outcome measures: quantitative gait variables as obtained by biomechanical analysis. Effect sizes (d) were calculated for the ability of parameters to discriminate between different frailty status groups. Results: Eleven publications met inclusion criteria. Frailty definitions, gait protocols and parameters were inconsistent, which made comparison of outcomes difficult. Effect sizes were calculated only for the three studies which compared at least two different frailty status groups. Gait speed shows the highest effect size to discriminate between frailty subgroups, in particular during habitual walking (d = 0.76-6.17). Gait variability also discriminates between different frailty status groups in particular during fast walking. Prominent parameters related to prefrailty are reduced cadence (d = 1.43) and increased step width variability (d = 0.64), whereas frailty (vs. prefrail status) is characterized by reduced step length during habitual walking (d = 1.32) and increased double support during fast walking (d = 0.78). Interestingly, one study suggested that dual-task walking speed can be used to predict prospective frailty development. Conclusion: Gait characteristics in people with frailty are insufficiently analyzed in the literature and represent a major area for innovation. Despite the paucity of work, current results suggest that parameters beyond speed could be helpful in identifying different categories of frailty. Increased gait variability might reflect a multisystem reduction and may be useful in identifying frailty. In addition, a demanding task such as fast walking or adding a cognitive distractor might enhance the sensitivity and specificity of frailty risk prediction and classification, and is recommended for frailty assessment using gait analysis.
Etiology of Valvular Heart Disease in the 21st Century
Authors: Boudoulas Konstantinos Dean , Borer Jeffrey S. , Boudoulas Harisios
Published: September 2013

A metamorphosis in the etiology of valvular heart disease (VHD) has occurred over the last 6 decades. In this review, the factors contributing to this metamorphosis, the common causes of VHD today, the relationship of valvular calcification to atherosclerosis and the interrelationship of VHD with other systems/organs are presented.
The Effect of Person-Centred Dementia Care to Prevent Agitation and Other Neuropsychiatric Symptoms and Enhance Quality of Life in Nursing Home Patients: A 10-Month Randomized Controlled Trial
Authors: Rokstad Anne Marie Mork , Røsvik Janne , Kirkevold Øyvind , Selbaek Geir , Saltyte Benth Jurate , Engedal Knut
Published: September 2013

Aims: We examined whether Dementia Care Mapping (DCM) or the VIPS practice model (VPM) is more effective than education of the nursing home staff about dementia (control group) in reducing agitation and other neuropsychiatric symptoms as well as in enhancing the quality of life among nursing home patients. Methods: A 10-month three-armed cluster-randomized controlled trial compared DCM and VPM with control. Of 624 nursing home patients with dementia, 446 completed follow-up assessments. The primary outcome was the change on the Brief Agitation Rating Scale (BARS). Secondary outcomes were changes on the 10-item version of the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Cornell Scale for Depression in Dementia (CSDD) and the Quality of Life in Late-Stage Dementia (QUALID) scale. Results: Changes in the BARS score did not differ significantly between the DCM and the control group or between the VPM and the control group after 10 months. Positive differences were found for changes in the secondary outcomes: the NPI-Q sum score as well as the subscales NPI-Q agitation and NPI-Q psychosis were in favour of both interventions versus control, the QUALID score was in favour of DCM versus control and the CSDD score was in favour of VPM versus control. Conclusions: This study failed to find a significant effect of both interventions on the primary outcome. Positive effects on the secondary outcomes indicate that the methods merit further investigation.
Validation of the Rowland Universal Dementia Assessment Scale for Multicultural Screening in Danish Memory Clinics
Authors: Nielsen T. Rune , Andersen Birgitte Bo , Gottrup Hanne , Lützhøft Jan H. , Høgh Peter , Waldemar Gunhild
Published: September 2013

Background/Aims: The Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive screening test that was developed to detect dementia in multicultural populations. The RUDAS has not previously been validated in multicultural populations outside of Australia. The aim of this study was to evaluate the diagnostic accuracy of the RUDAS in a multicultural sample of patients referred to Danish memory clinics. Methods: Data were collected from 137 consecutive patients (34 with an immigrant background) in three Danish memory clinics. All patients were given the RUDAS as a supplement to the standard diagnostic workup. Results: Diagnostic accuracy for the RUDAS [area under the curve (AUC) = 0.838] was similar to that of the Mini-Mental State Examination (MMSE; AUC = 0.840). The cutoff score with the best balance of sensitivity, specificity and accuracy was <24/30 for the RUDAS (sensitivity 0.69, specificity 0.80) and <25/30 for the MMSE (sensitivity 0.76, specificity 0.83). In contrast to the MMSE, regression analyses revealed that the RUDAS was unaffected by factors related to the patients' immigrant backgrounds. Conclusion: The RUDAS showed high specificity and proved to be less affected by cultural and linguistic factors than the MMSE, making it a particularly valuable tool when screening for cognitive impairment in elderly multicultural patient populations.
Delicate Balance of Bleeding and Thrombosis in End-Stage Liver Disease and Liver Transplantation
Authors: Saner Fuat Hakan , Gieseler Robert K. , Akız Hikmet , Canbay Ali , Görlinger Klaus
Published: September 2013

Liver transplantation in cirrhotic patients is accompanied by severe bleeding. Indeed, the first 100 recipients of liver allografts transplanted by Thomas E. Starzl died mainly by uncontrolled bleeding. Since then, much progress has been made as to the understanding of the pathophysiology and the treatment of hemostatic disorders in cirrhotic patients. The aim of this review is to provide a state-of-the-art overview on recent developments and treatment options for hemostatic disorder in cirrhotic patients. Patients with end-stage-liver disease (ESLD) do not suffer only from procoagulant deficiency; there is also a lack of natural anticoagulants (i.e. proteins C and S) and profibrinolytics. Conventional laboratory methods such as the determination of the international normalized ratio or the activated partial thromboplastin time cannot predict bleeding complications in these patients. Progressive diagnostic techniques reveal that cirrhotic patients have the same capacity to produce thrombin like healthy volunteers. Moreover, cirrhotic patients - and particularly those with primary biliary cirrhosis or primary sclerosing cholangitis - are at a higher risk for developing thrombosis as compared with healthy controls. Hemostatic alterations are common in cirrhotic patients; they involve both the pro- and the anticoagulant pathways. However, this is a very delicate balance, which may be shifted to either of these pathways by different treatments thereby causing bleeding or thrombosis, respectively.
An Emerging Role for Metabolomics in Nutrition Science
Authors: Astarita Giuseppe , Langridge James
Published: September 2013

Nutritional research is undergoing a remarkable transformation driven by new technological tools. Because of the complexity of the components present in food and how they may interact with the biochemical networks of living organisms, nutrition cannot be considered a reductionist discipline. More holistic approaches, which are capable of gathering comprehensive, high-throughput amounts of data, appear to best enhance our understanding of the role of food in health and disease. In this context, global metabolite analysis, or ‘metabolomics', is becoming an appealing research tool for nutrigenomics and nutrigenetics scientists. The purpose of the present review is to highlight some potential applications of metabolomics in nutrition research.
Aging Promotes Progression of IgA Nephropathy: A Systematic Review and Meta-Analysis
Authors: Duan Zhi-Yu , Cai Guang-Yan , Chen Yi-Zhi , Liang Shuang , Liu Shu-Wen , Wu Jie , Qiu Qiang , Lin Shu-Peng , Zhang Xue-Guang , Chen Xiang-Mei
Published: September 2013

Background: There has been considerable interest in whether old age is associated with IgA nephropathy (IgAN) progression, which is still controversial. Methods: We searched multiple databases for studies published from 1980 to 2012. The inclusion criteria were case-control, cohort studies published in any language. The included studies needed to have an older group. IgAN was proven by biopsy. Results: We included 9 studies with a total of 6,543 patients. The meta-analyses of other risk factors between the older group (>50 years old) and the non-older group (15-50 years old) found significant differences in the presence of hypertension, proteinuria, serum cholesterol levels and baseline renal function. In the overall analysis, compared to the non-older group, older age significantly increased the incidence of developing end-stage renal disease [ESRD; relative risk (RR) random model 1.95; 95% CI: 1.27-3.01]. In the subgroup analyses, we found the age limit and traditional risk factors of IgAN may be the sources of heterogeneity between studies. Moreover, the RR (2.56) of the Asian countries was much higher than the RR (1.11) of the European countries. Conclusions: This comprehensive review revealed that old age is a real risk factor for IgAN progression to ESRD. The incidence of ESRD in the older IgAN patients was 1.95 times higher than that in the non-older IgAN patients. Moreover, the risk of IgAN progression to ESRD of the older patients in Asia was higher than that of the older patients in Europe.
The Significance of α-Synuclein, Amyloid-β and Tau Pathologies in Parkinson's Disease Progression and Related Dementia
Authors: Compta Yaroslau , Parkkinen Laura , Kempster Peter , Selikhova Mariana , Lashley Tammaryn , Holton Janice L. , Lees Andrew J. , Revesz Tamas
Published: September 2013

Background: Dementia is one of the milestones of advanced Parkinson's disease (PD), with its neuropathological substrate still being a matter of debate, particularly regarding its potential mechanistic implications. Objective: The aim of this study was to review the relative importance of Lewy-related α-synuclein and Alzheimer's tau and amyloid-β (Aβ) pathologies in disease progression and dementia in PD. Methods: We reviewed studies conducted at the Queen Square Brain Bank, Institute of Neurology, University College London, using large PD cohorts. Results: Cortical Lewy- and Alzheimer-type pathologies are associated with milestones of poorer prognosis and with non-tremor predominance, which have been, in turn, linked to dementia. The combination of these pathologies is the most robust neuropathological substrate of PD-related dementia, with cortical Aβ burden determining a faster progression to dementia. Conclusion: The shared relevance of these pathologies in PD progression and dementia is in line with experimental data suggesting synergism between α-synuclein, tau and Aβ and with studies testing these proteins as disease biomarkers, hence favouring the eventual testing of therapeutic strategies targeting these proteins in PD.
Changes in the Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and Postpartum: Influences on Maternal and Fetal Outcomes
Authors: Duthie Leanne , Reynolds Rebecca M.
Published: September 2013

Overexposure of the developing fetus to glucocorticoids is hypothesised to be one of the key mechanisms linking early life development with later life disease. The maternal hypothalamic-pituitary-adrenal (HPA) axis undergoes dramatic changes during pregnancy and postpartum. Although cortisol levels rise threefold by the third trimester, the fetus is partially protected from high cortisol by activity of the enzyme 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2). Maternal HPA axis activity and activity of HSD11B2 may be modified by maternal stress and disease allowing greater transfer of glucocorticoids from mother to fetus. Here we review emerging data from human studies linking dysregulation of the maternal HPA axis to outcomes in both the mother and her offspring. For the offspring, greater glucocorticoid exposure is associated with lower birth weight and shorter gestation at delivery. In addition, evidence supports longer term consequences for the offspring including re-setting of the HPA axis and susceptibility to neurodevelopmental problems and cardiometabolic disease. For the mother, the changes in the HPA axis, particularly in the postpartum period, may increase vulnerability to mood disturbances. Further understanding of the changes in the HPA axis during pregnancy and the impact of these changes may ultimately allow early identification of those most at risk of future disease.
Effect of Temozolomide in Patients with Metastatic Bronchial Carcinoids
Authors: Crona Joakim , Fanola Irina , Lindholm Daniel P. , Antonodimitrakis Pantelis , Öberg Kjell , Eriksson Barbro , Granberg Dan
Published: September 2013

Introduction: Metastatic bronchial carcinoids are rare neoplasms, where efforts of medical treatment so far have been disappointing. A previous study from our center indicated that temozolomide might be of value. Materials and Methods: All patients with progressive metastatic bronchial carcinoid treated with temozolomide as monotherapy at our center between 2004 and 2010 (n = 31) were included in this retrospective study. 14 tumors were classified as typical and 15 as atypical carcinoids, whereas 2 tumors could not be classified. Temozolomide was given on 5 consecutive days every 4 weeks. Toxicity was evaluable in 28 of 31 patients, and 22 patients were evaluable by RECIST 1.1. Results: There were no complete responses. A partial response was seen in 3 patients (14%), stable disease in 11 (52%) and progressive disease in 7 patients (33%). Median progression-free survival was 5.3 months and median overall survival was 23.2 months from the start of temozolomide. Toxicities grade 3-4 were noted in 4 patients, thrombocytopenia (n = 3) and leukopenia (n = 1). Conclusion: Temozolomide as monotherapy shows activity in metastatic bronchial carcinoids. Regimens combining temozolomide with other agents (e.g. capecitabine and/or bevacizumab, everolimus, radiolabeled somatostatin analogues) should be further studied in these patients.
Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging
Authors: Doukky Rami , Hayes Kathleen , Frogge Nathan , Balakrishnan Gautam , Dontaraju Venkata Satish , Rangel Maria O. , Golzar Yasmeen , Garcia-Sayan Enrique , Hendel Robert C.
Published: September 2013

Background—

Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)–myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown.

Methods and Results—

A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 27±10 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1;
P
=0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3;
P
=0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7;
P
=0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4;
P
<0.001). Among the 688 subjects (45.5%) with MPI classified as inappropriate, an abnormal MPI failed to predict major adverse cardiac events, although it was associated with a high revascularization rate. Furthermore, appropriate MPI use provided incremental prognostic value beyond myocardial perfusion and ejection fraction data.

Conclusions—

When performed for appropriate indications, SPECT-MPI continues to demonstrate high prognostic value. However, inappropriate use lacks effectiveness for risk stratification, further emphasizing the need for optimal patient selection for cardiac testing.
Switching Strategy for Mechanical Thrombectomy of Acute Large Vessel Occlusion in the Anterior Circulation
Authors: Kang Dong-Hun , Kim Yong-Won , Hwang Yang-Ha , Park Jaechan , Hwang Jeong-Hyun , Kim Yong-Sun
Published: September 2013

Background and Purpose—

We introduce the concept of a switching strategy for mechanical thrombectomy with period-to-period analysis. In period 1, forced arterial suction thrombectomy with a Penumbra reperfusion catheter was performed, even in difficult cases; in period 2, forced arterial suction thrombectomy was initially performed, with switching to Solitaire in difficult cases.

Methods—

We analyzed 135 consecutive patients treated with mechanical thrombectomy with acute large vessel occlusion in the anterior circulation, 61 from period 1 and 74 from period 2. We defined difficult case for both periods as ≥3 failed attempts at recanalization.

Results—

Period 2 showed a trend for better angiographic outcome of Thrombolysis in Cerebral Infarction 2b-3 (73.8%, period 1 versus 85.1%, period 2;
P
=0.10). In interperiod subgroup analysis of difficult cases, switching significantly outperformed nonswitching in Thrombolysis in Cerebral Infarction 2b-3 recanalization (52.7% versus 82.9%;
P
=0.030). Differences in puncture-to-recanalization time, symptomatic intracranial hemorrhage incidence, and procedure-related complications were not statistically significant.

Conclusions—

A switching strategy using 2 mechanical thrombectomy techniques (forced arterial suction thrombectomy to Solitaire) may harbor better angiographic outcomes than a 1 technique only strategy (forced arterial suction thrombectomy).
Prospective Validation of the Computed Tomographic Angiography Spot Sign Score for Intracerebral Hemorrhage
Authors: Romero Javier M. , Brouwers H. Bart , Lu JingJing , Almandoz Josser E. Delgado , Kelly Hillary , Heit Jeremy , Goldstein Joshua , Rosand Jonathan , Gonzalez R. Gilberto
Published: September 2013

Background and Purpose—

Intracerebral hemorrhage (ICH) results in high mortality and morbidity for patients. Previous retrospective studies correlated the spot sign score (SSSc) with ICH expansion, mortality, and clinical outcome among ICH survivors. We performed a prospective study to validate the SSSc for the prediction of ICH expansion, mortality, and clinical outcome among survivors.

Methods—

We prospectively included consecutive patients with primary ICH presenting to a single institution for a 1.5-year period. All patients underwent baseline noncontrast computed tomography (CT) and multidetector CT angiography performed within 24 hours of admission and a follow-up noncontrast CT within 48 hours after the initial CT. The ICH volume was calculated on the noncontrast CT images using semiautomated software. The SSSc was calculated on the multidetector CT angiographic source images. We assessed in-hospital mortality and modified Rankin Scale at discharge and at 3 months among survivors. A multivariate logistic regression analysis was performed to determine independent predictors of hematoma expansion, in-hospital mortality, and poor clinical outcome.

Results—

A total of 131 patients met the inclusion criteria. Of the 131 patients, a spot sign was detected in 31 patients (24%). In a multivariate analysis, the SSSc predicted significant hematoma expansion (odds ratio, 3.1; 95% confidence interval, 1.77–5.39;
P
≤0.0001), in-hospital mortality (odds ratio, 4.1; 95% confidence interval, 2.11–7.94;
P
≤0.0001), and poor clinical outcome (odds ratio, 3; 95% confidence interval, 1.4–4.42;
P
=0.004). In addition, the SSSc was an accurate grading scale for ICH expansion, modified Rankin Scale at discharge, and in-hospital mortality.

Conclusions—

The SSSc demonstrated a strong stepwise correlation with hematoma expansion and clinical outcome in patients with primary ICH.
Population-Based Case–Control Study of White Matter Changes on Brain Imaging in Transient Ischemic Attack and Ischemic Stroke
Authors: Li Linxin , Simoni Michela , Küker Wilhelm , Schulz Ursula G. , Christie Sharon , Wilcock Gordon K. , Rothwell Peter M.
Published: September 2013

Background and Purpose—

White matter changes (WMC) are a common finding on brain imaging and are associated with an increased risk of ischemic stroke. They are most frequent in small vessel stroke; however, in the absence of comparisons with normal controls, it is uncertain whether WMC are also more frequent than expected in other stroke subtypes. Therefore, we compared WMC in pathogenic subtypes of ischemic stroke versus controls in a population-based study.

Methods—

We evaluated the presence and severity of WMC on computed tomography and on magnetic resonance brain imaging using modified Blennow/Fazekas scale and age-related white matter changes scale, respectively, in a population-based study of patients with incident transient ischemic attack or ischemic stroke (Oxford Vascular Study) and in a study of local controls (Oxford Project to Investigate Memory and Ageing) without history of transient ischemic attack or ischemic stroke, with stratification by stroke pathogenesis (Trial of Org10172 in Acute Stroke Treatment classification).

Results—

Among 1601 consecutive eligible patients with first-ever ischemic events, 1453 patients had computed tomography brain imaging, 562 had magnetic resonance imaging, and 414 patients had both. Compared with 313 controls (all with computed tomography and 131 with magnetic resonance imaging) and after adjustment for age, sex, diabetes mellitus, and hypertension, moderate/severe WMC (age-related white matter changes scale) were more frequent in patients with small vessel events (odds ratio, 3.51 [95% confidence interval, 2.13–5.76];
P
<0.0001) but not in large artery (odds ratio, 1.03 [95% confidence interval, 0.64–1.67]), cardioembolic (odds ratio, 0.87 [95% confidence interval, 0.56–1.34]), or undetermined (odds ratio, 0.90 [95% confidence interval, 0.62–1.30]) subtypes. Results were consistent for ischemic stroke and transient ischemic attack, for other scales, and for magnetic resonance imaging and computed tomography separately.

Conclusions—

In contrast to small vessel ischemic events, WMC were not independently associated with other pathogenic subtypes, suggesting that WMC are unlikely to be an independent risk factor for nonsmall vessel events.
Diego Rivera: Moscow Sketchbook
Authors: Roberts Jodi
Published: September 2013

Diego Rivera made the following sketches during a seven-to-eight-month stay in the Soviet Union between 1927 and 1928. A prominent member of the Partido Comunista de México (Communist Party of Mexico), Rivera traveled to Moscow to participate in the tenth-anniversary celebrations of the 1917 Revolution. Word of Rivera's dedication to muralism as a politically potent art form preceded his arrival, and he quickly became embroiled in debates about Soviet art's ideological aims and physical characteristics. He lectured on monumental painting at the Komakademiia (Communist Academy) and joined the Oktiabr' (October) group, a body of artists—many former Constructivists—working in varied media but united in their rejection of easel painting in favor of works intended for public display and mass audiences. Rivera also received a commission from Anatolli Lunacharsky, the first Soviet Commissar of Enlightenment, for a fresco cycle (ultimately unrealized) at the Red Army's headquarters. As Maria Gough argues in this issue, the group of drawings, long assumed to be from a single notebook, is likely an amalgamation of sketches created during two distinct events, the tenth-anniversary celebrations in November 1927 and the May Day festivities of the following year. Rivera's sketches capture his reaction to these officially mandated public demonstrations—spectacles so large in scale that they defined a new type of mass political event. In January 1928, Rivera met two young American scholars—Alfred H. Barr Jr. and Jere Abbott, the future director and associate director of the Museum of Modern Art, New York, respectively—who were on the Russian leg of a European tour designed as an education in contemporary artistic developments. The three met regularly, visiting exhibitions and the studios of Moscow-based artists. The fruits of this unlikely friendship between a radical art-world celebrity and two fledgling art historians were seen in Rivera's one-man show at MoMA in the winter of 1931–32, a blockbuster that decimated the young museum's existing attendance records. In support of the exhibition, Abby Aldrich Rockefeller, a founding trustee of the Museum, purchased the sketches to help defray the cost of the artist's stay in New York. She donated the works to MoMA in 1935.
Life cycle and behavioural traits of Dikerogammarus villosus (Sowinsky, 1894) (Amphipoda, Gammaridae) colonising an artificial fresh water basin in Tuscany (central Italy)
Authors: Rossano C. , di Cristina G. , Scapini F.
Published: September 2013

The water amphipod Dikerogammarus villosus (Sowinsky, 1894) has colonised many rivers and water basins in central Europe and is rapidly reaching southern Europe. It was found in northern Italy in 2006 and in central Italy in 2008. In this last area it has colonised the recent artificial basin of Bilancino (Mugello Valley, Florence), currently being the only and abundant amphipod species in the lake. This new population offered a good opportunity to study the life cycle and behaviour of such unpopular species (called killer shrimp because of its aggression), with the aim of better understanding the mechanisms of survival and diffusion of water gammarids. For about one year and a half, bimonthly samplings were carried out in different points of the lake to study the life cycle and identify the most suitable populations for behavioural experiments. On this species experiments were carried out in the natural context to verify sun and landscape orientation and in the laboratory to analyse the response to a black boundary, direct light and substrate slope. The populations from the different points had a comparable structure and development, even if subjected to variations linked to the local features of the lake’s bottom. The response to the black boundary (simulating a predator or a refuge) was not significant, while a significant reaction of avoidance of a direct artificial light and a significant preference for the basin bottom (downslope) were observed. No specific responses were identified where the behaviour was strictly linked to the environment colonised (orientation to the sun and natural landscape). A lack of fine-tuned adaptations was expected in this species that has colonised a variety of environments, confirming comparable results on the physiology of this species, such as adaptation to wide ranges of temperature, salinity and oxygen levels.
Patterns of genetic structuring and levels of differentiation in supralittoral talitrid amphipods: an overview
Authors: Pavesi L. , Ketmaier V.
Published: September 2013

Talitrids are the only family within the order Amphipoda to have colonised supralittoral and terrestrial environments. They live in a variety of settings, from sandy to rocky and pebble beaches, to river and lake banks, and to leaf litter and caves. A common feature is the absence of a planktonic larval stage to facilitate passive dispersal over long-distances. However, some species have broad distributions. Genetic studies over the past 25 years have tried to explain this apparent contradiction by assessing patterns of species genetic structuring on different geographical scales. Here, we review the molecular studies available to date and focus on the population genetics of talitrids. Most of these studies considered populations in the Mediterranean area, but also along the Atlantic coast and in Canary Island caves. From this review, the group emerges as a potential model to understand processes of dispersal and divergence in non-highly-vagile supralittoral organisms. At the same time, studies on these issues are still too restricted geographically: a worldwide scale including different regions would provide us with a better perspective on these problems.
On Austral-Antarctic stenothoids (Amphipoda), Part 3: Torometopa, Scaphodactylus, and two new genera
Authors: Krapp-Schickel Traudl
Published: September 2013

This is the third and last part of a revision of the basic genera in the amphipod family Stenothoidae sensu lato (see Krapp-Schickel & Koenemann, 2006 for an overview, Krapp-Schickel, 2009 for the first part, Krapp-Schickel, 2011a for the second). The genera Torometopa and Scaphodactylus are revised, some species redescribed, and two new genera erected.
Revision of the genus Hemitrachys Gorham, with discovery of a second species (Coleoptera: Cleridae: Clerinae)
Authors: YANG GAN-YAN , YANG XING-KE
Published: September 2013

The genus Hemitrachys Gorham, 1876 is revised and a new species Hemitrachys tubericollis n. sp. from China is described as the second species of this genus. Thirty-eight illustrations of habitus, genital and external characters are provided.
Systematics of interstitial encrusting bryozoans from southeastern Brazil
Authors: WINSTON JUDITH E. , VIEIRA LEANDRO M.
Published: September 2013

This paper describes 22 species of marine bryozoans found in the sand-grain-encrusting interstitial epifauna of the northeast coast of São Paulo state, Brazil: one new cyclostome, Disporella calcitrapa sp. nov., and 21 cheilostomes. Sixteen of the cheilostomes are new species, and three represent new genera. They are Ammatophora arenacea sp. nov., Discoporella gemmulifera sp. nov., Puellina caraguata sp. nov., Puellina tuba sp. nov., Rosulapelta rosetta gen. et sp. nov., Collarina spicata sp. nov., Hippothoa calcicola sp. nov., Trypostega ilhabelae sp. nov., Reptadeonella granulosa sp. nov., Drepanophora irregularis sp. nov., Allotherenia sabulosa gen. et sp. nov., Bryopesanser tilbrooki sp. nov., Psammocleidochasma tridentatum gen. et sp. nov., Celleporina abstrusa sp. nov., Hippoporella castellana sp. nov., and Hippoporella sabulonis sp. nov. Other species found in this habitat, Alderina smitti, Cymulopora uniserialis, Vibracellina laxibasis, Akatopora leucocypha, and Smittipora sawayai, have previously been described. The family Cymuloporidae fam. nov. is erected for Cymulopora and Crepis. The occurrence in this habitat of living colonies of bryozoans more characteristic of larger subtidal shell substrata indicates the potential importance of an interstitial refuge in maintaining and dispersing encrusting bryozoan populations along continental shelves where larger substrata are absent or rare.