bluuebunny/crossref_metadata_2025 huggingface dataset:
How Visual Body Perception Influences Somatosensory Plasticity
Authors: Kuehn Esther , Pleger Burkhard
Published: March 2018

The study of somatosensory plasticity offers unique insights into the neuronal mechanisms that underlie human adaptive and maladaptive plasticity. So far, little attention has been paid on the specific influence of visual body perception on somatosensory plasticity and learning in humans. Here, we review evidence on how visual body perception induces changes in the functional architecture of the somatosensory system and discuss the specific influence the social environment has on tactile plasticity and learning. We focus on studies that have been published in the areas of human cognitive and clinical neuroscience and refer to animal studies when appropriate. We discuss the therapeutic potential of socially mediated modulations of somatosensory plasticity and introduce specific paradigms to induce plastic changes under controlled conditions. This review offers a contribution to understanding the complex interactions between social perception and somatosensory learning by focusing on a novel research field: socially mediated sensory plasticity.
Multilayer Distributed Circuit Modeling for Galvanic Coupling Intrabody Communication
Authors: Chen Zhi Ying , Gao Yue Ming , Du Min
Published: March 2018

Characterization of the human body as a transmission medium for electrical signals is a necessity for using intrabody communication (IBC) technique into connecting wearable electronic sensors and devices. In this paper, we propose a novel multilayer distributed circuit model for galvanic-coupling type IBC, which is emphasized on the propagation characteristics in contrast with other IBC models. Based on the model, a program is written in MATLAB to investigate the propagation characteristics of a human body channel with the frequency of 10 MHz to 20 MHz and the distance of 5 cm to 10 cm. Finally, a galvanic coupling IBC measurement is implemented to verify the proposed model. The outcome proves that the model is valid and correct.
Characterization of the Catalytic Structure of Plant Phytase, Protein Tyrosine Phosphatase-Like Phytase, and Histidine Acid Phytases and Their Biotechnological Applications
Authors: Cangussu Alex Sander Rodrigues , Aires Almeida Deborah , Aguiar Raimundo Wagner de Souza , Bordignon-Junior Sidnei Emilio , Viana Kelvinson Fernandes , Barbosa Luiz Carlos Bertucci , Cangussu Edson Wagner da Silva , Brandi Igor Viana , Portella Augustus Caeser Franke , Santos Gil Rodrigues dos , Sobrinho Eliane Macedo , Lima William James Nogueira
Published: March 2018

Phytase plays a prominent role in monogastric animal nutrition due to its ability to improve phytic acid digestion in the gastrointestinal tract, releasing phosphorus and other micronutrients that are important for animal development. Moreover, phytase decreases the amounts of phytic acid and phosphate excreted in feces. Bioinformatics approaches can contribute to the understanding of the catalytic structure of phytase. Analysis of the catalytic structure can reveal enzymatic stability and the polarization and hydrophobicity of amino acids. One important aspect of this type of analysis is the estimation of the number of β-sheets and α-helices in the enzymatic structure. Fermentative processes or genetic engineering methods are employed for phytase production in transgenic plants or microorganisms. To this end, phytase genes are inserted in transgenic crops to improve the bioavailability of phosphorus. This promising technology aims to improve agricultural efficiency and productivity. Thus, the aim of this review is to present the characterization of the catalytic structure of plant and microbial phytases, phytase genes used in transgenic plants and microorganisms, and their biotechnological applications in animal nutrition, which do not impact negatively on environmental degradation.
Quantification of Dynamic Properties of Pile Using Ensemble Empirical Mode Decomposition
Authors: Xiao Feng , Chen Gang S. , Zatar Wael , Hulsey J. Leroy
Published: March 2018

This paper investigated dynamical interactions between pile and frozen ground by using the ensemble empirical mode decomposition (EEMD) method. Unlike the conventional empirical mode decomposition (EMD) method, EEMD is found to be able to separate the mode patterns of pile response signals of different scales without causing mode mixing. The identified dynamic properties using the EEMD method are more accurate than those obtained from conventional methods. EEMD‐based results can be used to reliably and accurately characterize pile‐frozen soil interactions and help designing infrastructure foundations under permafrost condition.
A Compact Coupled-Fed Loop Antenna for Mobile LTE Smartphones
Authors: Wang Ping , Shao Yu , Huang Dong , Basit Muhammad Abdul
Published: March 2018

A coupled-fed loop antenna with Octa-bands operation for long-term evolution (LTE) smartphones is proposed in this paper. The antenna occupies a nonground space of only 6.5 mm × 72 mm, and two wide-band operations can be achieved by exploiting the multimode characteristics of loop antenna and using high-pass matching circuits. In low band, the LTE700/GSM850/900 operation is achieved by the loop mode of 0.5 λ and matching chip capacitor which generates a dual-resonance mode at 0.74 GHz and 0.9 GHz. In high band, the 1 λ mode, the 1.5 λ mode, and the 2 λ mode of the entire loop are combined with the 0.5 λ mode of the left-side coupling loop to cover the DCS1800/PCS1900/UMTS 2100/LTE 2300/2500 operation bands. The measured average realized gains and efficiencies are approximately 1.56 dBi/2.38 dBi and 55.3%/63.6% in the two bands, and a good radiation pattern is achieved as well.
Rapid Screening and Quantitative Determination of Active Components in Qing-Hua-Yu-Re-Formula Using UHPLC-Q-TOF/MS and HPLC-UV
Authors: Shao Xin , Zhao Jie , Wang Xu , Tao Yi
Published: March 2018

Qing-Hua-Yu-Re-Formula (QHYRF), a new herbal preparation, has been extensively used for treating diabetic cardiomyopathy. However, the chemical constituents of QHYRF remain uninvestigated. In the present study, rapid ultrahigh-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) was used to qualitatively analyze the components of QHYRF. Qualitative detection was performed on a Kromasil C18 column through the gradient elution mode, using acetonitrile-water containing 0.1% formic acid. Twenty-seven compounds were identified or tentatively characterized, including 12 phenolic acids, nine monoterpene glycosides, two flavonoids, three iridoids, and one unknown compound. Among these, six compounds were confirmed by comparing with standards. A high-performance liquid chromatography (HPLC) method was developed to simultaneously determine the following six active components in QHYRF: danshensu, paeoniflorin, acteoside, lithospermic acid, salvianolic acid B, and salvianolic acid C. These HPLC chromatograms were monitored at 254, 280, and 320 nm. The method was well validated with respect to specificity, linearity, limit of detection, limit of quantification, precision, stability, and recovery. The HPLC-UV method was successfully applied to 10 batches of QHYRF.
Performance Evaluation of Hard Rock TBMs considering Operational and Rock Conditions
Authors: Zou Xiaoyang , Zheng Hui , Mi Yongzhen
Published: March 2018

This paper focuses on studying the correlations of the performance of hard rock tunnel boring machines (TBMs) with operational and rock conditions. Firstly, a rigid‐flexible coupled multibody dynamic model of an opening hard rock TBM is established for the analysis of its vibration. Then four performance indexes including mean vibration energy dissipation rate, dynamic specific energy (DSE), disc cutter wear rate, and load sharing coefficient are introduced and formulated, respectively, for evaluating the vibration level, excavation energy efficiency, cutter’s vulnerability to wear, and load transmission performance of cutterhead driving system of the TBM. Finally, numerical simulation results of the TBM tunneling performance evaluation are obtained and validated by on‐site vibration measurement and tunneling data collection. It is found that operational and rock conditions exert important impact on TBM vibration level, excavation energy efficiency, and structure damage. When the type of rock to be cut changes from soft to hard with operational parameters held constant, TBM performance evaluated by these three indexes deteriorates significantly, and both the decrease of excavation energy efficiency and the increase of cutter wear rate caused by TBM vibration are obvious. This study provides the foundation for a more comprehensive evaluation of TBM performance in actual tunneling process.
Training Nursing Skills: A Quantitative Study of Nursing Students’ Experiences before and after Clinical Practice
Authors: Solvik Elisabeth , Struksnes Solveig
Published: March 2018

Introduction. Requirements for Patient Safety suggest that students encounter patients well prepared. In clinical laboratory practice (CLP), the students simulate patient situations as a preparation for internship. Various CLP models have been tried out to meet the students’ prerequisites and learning strategies.Objectives. The purpose of this study was to try out two different learning sessions related to the bed bath procedure.Design and Methods. The study has a descriptive, quantitative design with elements from clinically controlled trials.Sample. The population of 160 first-year students was randomly divided into two classes.Questionnaires. Two questionnaires were answered with six-month intervals: Form 1 immediately after the first training session and Form 2 a short time after clinical practice.Findings. A majority of the nursing students reported that the exercises in the clinical lab were a good way to prepare for the practice, although most of them did not perceive that the procedure conducted at the university resembled how it is conducted in clinical practice. Age or level of discomfort related to organization of the skills training did not have impact on the students’ confidence in mastering bed bath in clinical practice. Students without previous experience were less confident to master the procedure in clinical practice, but the results evened out during the internship.Conclusions. The results from this study could indicate that the students’ age to a larger extent should be considered in the universities’ facilitation of nursing students’ clinical preparations, to improve the transition to “real life” as smoothly and meaningfully as possible to nursing students.
Mutational Profiling of Non-Small-Cell Lung Cancer Resistant to Osimertinib Using Next-Generation Sequencing in Chinese Patients
Authors: Nie Keke , Jiang Haiping , Zhang Chunling , Geng Chuanxin , Xu Xiajuan , Zhang Ling , Zhang Hao , Zhang Zhongfa , Lan Ketao , Ji Youxin
Published: March 2018

Purpose. To identify the somatic mutated genes for optimal targets of non-small-cell lung cancer after resistance to osimertinib treatment. Patients and Methods. Study patients all had advanced lung adenocarcinoma and acquired resistance to osimertinib as a second- or third-line treatment. These patients had harboring EGFR T790M mutation before osimertinib treatment, which was confirmed by Amplification Refractory Mutation System (ARMS) PCR or Next-Generation Sequencing (NGS). After resistance to osimertinib treatment, tumor tissue was collected by core needle biopsy. DNA was extracted from 15 × 5 um sliced section of formalin-fixed paraffin-embedded (FFPE) material and NGS was done. The genetic changes were analyzed. Results. A total of 9 Chinese patients were studied, 5 females and 4 males, age 51–89 years. After progression with osimertinib treatment, core needle biopsy was performed and next-generation sequencing was performed. Nine patients had harboring 62 point mutations, 2 altered gene copies, 2 amplifications, and 1 EML4-ALK gene fusion. No MET or HER2 amplification was found in this cohort study. Nine patients still maintained initial EGFR 19 del or L858R activating mutations, while 7 of them kept EGFR T790M mutations. Among the 7 patients, 5 had secondary EGFR C797S and/or C797G mutations, which all happened in the same allele with T790M mutation. All patients were treated with targets therapies, chemotherapy, or best supportive care (BSC) in accordance with NGS genetic results and patients’ performance status; 7 of them are still alive and 2 of them died of disease progression at last follow-up. Conclusions. EGFR C797S/G mutation and the same one presented on the same allele with EGFR T790M mutation were the most common mutation feature and played a key role in resistance to osimertinib in Chinese patients with NSCLC. Tumor cells losing T790M mutation and maintaining EGFR activating mutation might benefit from first-generation EGFR-TKI treatment.
Deformation Control in Rest‐to‐Rest Motion of Mechanisms with Flexible Links
Authors: Caracciolo Roberto , Richiedei Dario , Trevisani Alberto
Published: March 2018

This paper develops and validates experimentally a feedback strategy for the reduction of the link deformations in rest‐to‐rest motion of mechanisms with flexible links, named Delayed Reference Control (DRC). The technique takes advantage of the inertial coupling between rigid‐body motion and elastic motion to control the undesired link deformations by shifting in time the position reference through an action reference parameter. The action reference parameter is computed on the fly based on the sensed strains by solving analytically an optimization problem. An outer control loop is closed to compute the references for the position controllers of each actuator, which can be thought of as the inner control loop. The resulting multiloop architecture of the DRC is a relevant advantage over several traditional feedback controllers: DRC can be implemented by just adding an outer control loop to standard position controllers. A validation of the proposed control strategy is provided by applying the DRC to the real‐time control of a four‐bar linkage.
Past Results, Present Trends, and Future Challenges in Intrabody Communication
Authors: Naranjo-Hernández David , Callejón-Leblic Amparo , Lučev Vasić Željka , Seyedi MirHojjat , Gao Yue-Ming
Published: March 2018

Intrabody communication (IBC) is a wireless communication technology using the human body to develop body area networks (BANs) for remote and ubiquitous monitoring. IBC uses living tissues as a transmission medium, achieving power‐saving and miniaturized transceivers, making communications more robust against external interference and attacks on the privacy of transmitted data. Due to these advantages, IBC has been included as a third physical layer in the IEEE 802.15.6 standard for wireless body area networks (WBANs) designated as Human Body Communication (HBC). Further research is needed to compare both methods depending on the characteristics of IBC application. Challenges remain for an optimal deployment of IBC technology, such as the effect of long‐term use in the human body, communication optimization through more realistic models, the influence of both anthropometric characteristics and the subject’s movement on the transmission performance, standardization of communications, and development of small‐size and energy‐efficient prototypes with increased data rate. The purpose of this work is to provide an in‐depth overview of recent advances and future challenges in human body/intrabody communication for wireless communications and mobile computing.
Exercise Intervention Associated with Cognitive Improvement in Alzheimer’s Disease
Authors: Cui Meng Ying , Lin Yang , Sheng Ji Yao , Zhang Xuewen , Cui Ran Ji
Published: March 2018

Alzheimer’s disease (AD) is a progressive neurodegenerative disease with the syndrome of cognitive and functional decline. Pharmacotherapy has always been in a dominant position for the treatment of AD. However, in most cases, drug therapy is accompanied with clinical delays when older adults have suffered from cognitive decline in episodic memory, working memory, and executive function. On the other hand, accumulating evidence suggests that exercise intervention may ameliorate the progression of cognitive impairment in aging ones while the standard strategy is lacking based on different levels of cognitive decline especially in mild cognitive impairment (MCI) and AD. MCI is the preclinical stage of AD in which neurodegeneration may be reversed via neuroplasticity. Therefore, taking exercise intervention in the early stage of MCI and healthy aging at the risk of AD could slow down the process of cognitive impairment and provide a promising cost-effective nonpharmacological therapy to dementia.
Novel Mechanisms Modulating Palmitate-Induced Inflammatory Factors in Hypertrophied 3T3-L1 Adipocytes by AMPK
Authors: Morita Naru , Hosaka Toshio , Kitahara Atsuko , Murashima Toshitaka , Onuma Hirohisa , Sumitani Yoshikazu , Takahashi Kazuto , Tanaka Toshiaki , Kondo Takuma , Ishida Hitoshi
Published: March 2018

Objective. A growing body of evidence indicates that AMP-activated protein kinase (AMPK) contributes to not only energy metabolic homeostasis but also the inhibition of inflammatory responses. However, the underlying mechanisms remain unclear. To elucidate the role of AMPK, in this study, we observed the effects of AMPK activation on monocyte chemoattractant protein-1 (MCP-1) release in mature 3T3-L1 adipocytes.Methods. We observed signal transduction pathways regulating MCP-1, which increased in obese adipocytes, in anin vitromodel of hypertrophied 3T3-L1 adipocytes preloaded with palmitate.Results. Palmitate-preloaded cells exhibited significant increase in MCP-1 release and triglyceride (TG) deposition. Increased MCP-1 release and TG deposition were significantly decreased by an AMPK activator. In addition, the AMPK activator not only markedly diminished MCP-1 secretion but also augmented phosphorylation of nuclear factor-κB (NF-κB) and extracellular signal-regulated kinase (ERK) 1/2. In contrast, MCP-1 release suppression was abolished by the AMPK inhibitor compound C and the MEK inhibitor U0126.Conclusions. MCP-1 release from hypertrophied adipocytes is suppressed by AMPK activation through the NF-κB and ERK pathways. These findings provide evidence that AMPK plays a crucial role in ameliorating obesity-induced inflammation.
A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet-Rich Plasma
Authors: Kaminski Rafal , Kulinski Krzysztof , Kozar-Kaminska Katarzyna , Wielgus Monika , Langner Maciej , Wasko Marcin K. , Kowalczewski Jacek , Pomianowski Stanislaw
Published: March 2018

Objective. The present study aimed to investigate the effectiveness and safety of platelet-rich plasma (PRP) application in arthroscopic repair of complete vertical tear of meniscus located in the red-white zone.Methods. This single center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 37 patients with complete vertical meniscus tears. Patients received an intrarepair site injection of either PRP or sterile 0.9% saline during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the two groups. The secondary endpoints were changes in the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analog scale (VAS) in the two groups at 42 months.Results. After 18 weeks, the meniscus healing rate was significantly higher in the PRP-treated group than in the control group (85% versus 47%,P=0.048). Functional outcomes were significantly better 42 months after treatment than at baseline in both groups. The IKDC score, WOMAC, and KOOS were significantly better in the PRP-treated group than in the control group. No adverse events were reported during the study period.Conclusions. The findings of this study indicate that PRP augmentation in meniscus repair results in improvements in both meniscus healing and functional outcome.
Coupling Dynamic Behavior Characteristics of a Spacecraft Beam with Composite Laminated Structures and Large-Scale Motions
Authors: You Bindi , Gao Zhihui , Wen Jianmin , Sun Yiming , Hao Peibo , Liang Dong
Published: March 2018

A nonlinear dynamic modeling method for a spacecraft body composed of a laminated composite beam undergoing large rotation is proposed in this paper. To study the characteristics of a laminated composite beam attached to a spacecraft body for the dynamic systems, the deformation description of a laminated beam is established with the consideration of laying angles and laying layers, and the displacement-strain relations is acquired based on the global-local higher-order shear deformation theory. Accordingly, a nonlinear dynamic model of the spacecraft body composed of a laminated composite beam is deduced using Hamilton variational principle. And the complete coupling terms for the laminated material properties are considered unlike any other singular or unidirectional materials. Then, the dynamic behavior of the spacecraft system is analyzed by comparison of an orthogonal-symmetric, singular, and unidirectional laminated beam. The results show that the laminated composite structures have significant influences on the dynamics properties of spacecraft compared with conventional equivalent singular or unidirectional materials. Hence, the nonlinear model is well suitable for approaching the problem of coupling relationship between geometric nonlinearity and large rotation motions. These conclusions will have significant theory and engineering practice values for coupling dynamics properties of laminated beams.
Chemical Activation of the Hypoxia-Inducible Factor Reversibly Reduces Tendon Stem Cell Proliferation, Inhibits Their Differentiation, and Maintains Cell Undifferentiation
Authors: Menon Alessandra , Creo Pasquale , Piccoli Marco , Bergante Sonia , Conforti Erika , Banfi Giuseppe , Randelli Pietro , Anastasia Luigi
Published: March 2018

Adult stem cell-based therapeutic approaches for tissue regeneration have been proposed for several years. However, adult stem cells are usually limited in number and difficult to be expanded in vitro, and they usually tend to quickly lose their potency with passages, as they differentiate and become senescent. Culturing stem cells under reduced oxygen tensions (below 21%) has been proposed as a tool to increase cell proliferation, but many studies reported opposite effects. In particular, cell response to hypoxia seems to be very stem cell type specific. Nonetheless, it is clear that a major role in this process is played by the hypoxia inducible factor (HIF), the master regulator of cell response to oxygen deprivation, which affects cell metabolism and differentiation. Herein, we report that a chemical activation of HIF in human tendon stem cells reduces their proliferation and inhibits their differentiation in a reversible and dose-dependent manner. These results support the notion that hypoxia, by activating HIF, plays a crucial role in preserving stem cells in an undifferentiated state in the “hypoxic niches” present in the tissue in which they reside before migrating in more oxygenated areas to heal a damaged tissue.
Behavioral Pattern of Endemic Sri Lanka Grey Hornbill (Ocyceros gingalensis) within the Breeding and Nonbreeding Seasons
Authors: Wijerathne Iresha , Wickramasinghe Sriyani
Published: March 2018

The hornbills are among the most extraordinary looking birds in the world. Out of two species of hornbill, the Ocyceros gingalensis is the only endemic grey hornbill in Sri Lanka. This study was conducted in Mihintale Sanctuary which is comprised of secondary dry mixed evergreen forest patches and semiurbanized area from 2013 to 2015. Ad libitum focal animal sampling was used to construct an ethogram for the behavior of Sri Lanka grey hornbill (SLGh). The study recorded 35 behavioral events in 11 acts under 4 types of their activities. Courtship and mating activities were recorded within the study period. Food items were changed throughout the parental care period. Within this period chicks were offered sufficient food comprised of fruits and flesh. These revealed that the nesting of the SLGh in suburb areas is not good sign since it potentially indicates the loss of adequate breeding conditions in the forest. Conservation of SLGh depends on protection of trees and tree cavities as an important ecological niche.
Co-Loan Network of Chinese Banking System Based on Listed Companies’ Loan Data
Authors: Li Liang , Ma Qianting , He Jianmin , Sui Xin
Published: March 2018

Based on the loan data of Chinese listed companies from 2008 to 2016, this paper constructs a co-loan network of the Chinese banking system and analyzes the topological structures and corresponding evolvement characteristics from the perspective of complex network. Through the empirical studies, we find that the co-loan network always displays a core-periphery structure; for example, ten banks including four state banks and six large commercial banks are always in the core region of the Chinese banking system for nine consecutive years. Furthermore, the co-loan network is a small-world network lasting for nine years.
Effect of 4DryField® PH, a Novel Adhesion Barrier, on Recurrence of Intestinal Adhesions after Extensive Visceral Adhesiolysis
Authors: Blumhardt Gerhard , Haas Matthias , Polte Stefanie
Published: March 2018

Background. Adhesions occur after up to 97% of abdominal interventions causing chronic pain, infertility, and intestinal obstruction. Various concepts to prevent adhesions have been presented but mostly either have low efficacy or are not applicable in resective intestinal surgery or incomplete hemostasis. In this retrospective one-center clinical trial, the course of patients with extensive abdominal adhesiolysis and application of a recent starch-based formulation, 4DryField PH (4DF), is analyzed. Case Report. Five female patients (age 65–83 years) underwent extensive open adhesiolysis with application of 4DF gel for adhesion prevention, premixed extracorporeally with saline or Ringer’s solution (60–70 mL per 5 g 4DF) for homogeneous gel distribution on intestinal loops and in the peritoneal cavity. In addition, dry 4DF powder was dispersed on the greater omentum and subsequently transformed into a gel by dripping with saline or Ringer’s solution directly before abdominal closure. Patients were followed up for more than two years, except for one patient who died after nine months due to metastases. One patient with complex situation due to Gore-Tex mesh in the lower abdomen showed no adhesions at scheduled second-look operation but after six months had relaparotomy for adhesiolysis. All other patients have remained free of adhesions or adhesion-related symptoms during follow-up. Conclusion. Considering the extent and complexity of adhesions, treatment with 4DF gel for adhesion prevention after open adhesiolysis appears promising. Prospective randomized trials should further elaborate on this clinical concept.
Relapsing Malaria: A Case Report of Primaquine Resistance
Authors: Dijanic Christopher , Nickerson Jillian , Shakya Sunita , Dijanic Amanda , Fabbri Marilyn
Published: March 2018

Primaquine (an 8-aminoquinoline malarial therapy) is the only FDA-approved therapy to treat the hypnozoite stage of P. vivax. We think of relapse occurring because of parasitic resistance or poor compliance secondary to drug toxicities. However, in patients with repeated treatment failure, we must consider CYP-450 mutations affecting drug metabolism as an important cause of relapse. A 47-year-old man who travelled to a jungle in Venezuela was diagnosed with P. falciparum and P. vivax in July 2015. He was treated with seven rounds of primaquine-based therapy in the following year, all resulted in relapse without further exposure to endemic areas. On his eighth presentation, he was found to have CYP-4502D6 mutation that affected the metabolism and activation of primaquine. Thereafter, he was treated without relapse. Primaquine efficacy depends on many factors. Understanding the mechanism responsible for malaria relapse is paramount for successful treatment and reduction in morbidity and mortality. This case illustrates the importance of considering cytochrome mutations that affect drug efficacy in cases of relapsing malaria.
Postinfantile Giant Cell Hepatitis with Features of Acute Severe Autoimmune Hepatitis Probably Triggered by Diclofenac in a Patient with Primary Myelofibrosis
Authors: Arvaniti Pinelopi , Zachou Kalliopi , Koukoulis George K. , Dalekos George N.
Published: March 2018

Giant cell hepatitis (GCH) is commonly reported in neonatal and infantile liver diseases but rarely in adults where the term postinfantile GCH (PIGCH) is used. PIGCH is associated with many diseases, including drugs toxicity, viruses, and autoimmune liver diseases, with autoimmune hepatitis (AIH) being the most prevalent. We present a case of PIGCH in a 76-year-old female without known history of liver disease who suffered from an acute severe episode of hepatitis. After careful exclusion of other hepatitis causes by imaging, virological, immunological, and microbiological investigations, a diagnosis of acute severe AIH (AS-AIH) was established. The patient was started on corticosteroids but she did not respond and died 3 days later because of advanced acute liver failure. Postmortem liver biopsy showed typical PIGCH lesions. Physicians must keep this catastrophic entity in mind in cases of unexplained acute liver injury as, contrary to our case, prompt rescue therapy with corticosteroids may be life-saving.
Intestinal Immunomodulatory Cells (T Lymphocytes): A Bridge between Gut Microbiota and Diabetes
Authors: Li Qingwei , Gao Zezheng , Wang Han , Wu Haoran , Liu Yanwen , Yang Yingying , Han Lin , Wang Xinmiao , Zhao Linhua , Tong Xiaolin
Published: March 2018

Diabetes mellitus (DM) is one of the most familiar chronic diseases threatening human health. Recent studies have shown that the development of diabetes is closely related to an imbalance of the gut microbiota. Accordingly, there is increasing interest in how changes in the gut microbiota affect diabetes and its underlying mechanisms. Immunomodulatory cells play important roles in maintaining the normal functioning of the human immune system and in maintaining homeostasis. Intestinal immunomodulatory cells (IICs) are located in the intestinal mucosa and are regarded as an intermediary by which the gut microbiota affects physiological and pathological properties. Diabetes can be regulated by IICs, which act as a bridge linking the gut microbiota and DM. Understanding this bridge role of IICs may clarify the mechanisms by which the gut microbiota contributes to DM. Based on recent research, we summarize this process, thereby providing a basis for further studies of diabetes and other similar immune-related diseases.
Canagliflozin and Heart Failure in Type 2 Diabetes Mellitus
Authors: Rådholm Karin , Figtree Gemma , Perkovic Vlado , Solomon Scott D. , Mahaffey Kenneth W. , de Zeeuw Dick , Fulcher Greg , Barrett Terrance D. , Shaw Wayne , Desai Mehul , Matthews David R. , Neal Bruce
Published: March 2018

Background:

Canagliflozin is a sodium glucose cotransporter 2 inhibitor that reduces the risk of cardiovascular events. We report the effects on heart failure (HF) and cardiovascular death overall, in those with and without a baseline history of HF, and in other participant subgroups.

Methods:

The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) enrolled 10 142 participants with type 2 diabetes mellitus and high cardiovascular risk. Participants were randomly assigned to canagliflozin or placebo and followed for a mean of 188 weeks. The primary end point for these analyses was adjudicated cardiovascular death or hospitalized HF.

Results:

Participants with a history of HF at baseline (14.4%) were more frequently women, white, and hypertensive and had a history of prior cardiovascular disease (all
P
<0.001). Greater proportions of these patients were using therapies such as blockers of the renin angiotensin aldosterone system, diuretics, and β-blockers at baseline (all
P
<0.001). Overall, cardiovascular death or hospitalized HF was reduced in those treated with canagliflozin compared with placebo (16.3 versus 20.8 per 1000 patient-years; hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67–0.91), as was fatal or hospitalized HF (HR, 0.70; 95% CI, 0.55–0.89) and hospitalized HF alone (HR, 0.67; 95% CI, 0.52–0.87). The benefit on cardiovascular death or hospitalized HF may be greater in patients with a prior history of HF (HR, 0.61; 95% CI, 0.46–0.80) compared with those without HF at baseline (HR, 0.87; 95% CI, 0.72–1.06;
P
interaction =0.021). The effects of canagliflozin compared with placebo on other cardiovascular outcomes and key safety outcomes were similar in participants with and without HF at baseline (all interaction
P
values >0.130), except for a possibly reduced absolute rate of events attributable to osmotic diuresis among those with a prior history of HF (
P
=0.03).

Conclusions:

In patients with type 2 diabetes mellitus and an elevated risk of cardiovascular disease, canagliflozin reduced the risk of cardiovascular death or hospitalized HF across a broad range of different patient subgroups. Benefits may be greater in those with a history of HF at baseline.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT01032629 and NCT01989754.
Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome
Authors: Sörensen Nils Arne , Neumann Johannes Tobias , Ojeda Francisco , Schäfer Sarina , Magnussen Christina , Keller Till , Lackner Karl J. , Zeller Tanja , Karakas Mahir , Münzel Thomas , Blankenberg Stefan , Westermann Dirk , Schnabel Renate B.
Published: March 2018

Background

The atypical presentation of women with acute coronary syndrome (
ACS
) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.

Methods and Results

We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of
ACS
. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex‐specific differences in management of patients with
ACS
were ascertained and a 2‐year follow‐up was performed. Women were older than men (median 67 versus 61 years,
P
=0.001), had more often dyspnea (22% versus 18%,
P
=0.024), nausea or vomiting (26% versus 16%,
P
=0.001) and radiating chest pain (47% versus 40%,
P
=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex‐related differences in diagnostic performance in a “first contact” setting (medical history and symptoms) or after “complete triage” (including
ECG
and biomarkers). Women with
ACS
underwent coronary angiography (73.8% versus 84.3%,
P
<0.001) and revascularization (53.8% versus 70.1%,
P
<0.001) less frequently. Two‐year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.

Conclusions

In a large cohort of patients with suspected
ACS
, sex differences in clinical presentation did not impair diagnostic accuracy. Two‐year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in
ACS
management and prognosis.

Clinical Trial Registration

URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
02355457 (
BACC
),
NCT
03227159 (stenoCardia).
Clinical Outcomes After Cardiac Stress Testing Among US Patients Younger Than 65 Years
Authors: Kini Vinay , Dayoub Elias J. , Hess Paul L. , Marzec Lucas N. , Masoudi Frederick A. , Ho P. Michael , Groeneveld Peter W.
Published: March 2018

Background

Scientific statements have championed the measurement of clinical outcomes after cardiac stress testing to better define their value. Using contemporary national data, we sought to describe the characteristics of patients who experience outcomes after stress testing.

Methods and Results

Using administrative claims from a large national private insurer, we conducted an observational cohort study of patients without cardiovascular disease aged 25 to 64 years who underwent stress testing from 2006 to 2011 and had at least 1 year of membership in the insurance company before and after testing. We used Kaplan–Meier time‐to‐event analyses to determine rates of acute myocardial infarction (
AMI
), elective coronary revascularization, and coronary angiography without revascularization in the year following testing. We used logistic regression to determine factors associated with outcomes, and stratified the cohort into quintiles based on likelihood of experiencing
AMI
and/or revascularization to describe the characteristics of patients at highest and lowest risk. Among 553 027 patients who underwent stress testing (mean age 50 years, 49% women, 73% white), 0.8% were hospitalized for
AMI
, 1.8% underwent elective coronary revascularization, and 2.5% underwent coronary angiography without revascularization within 1 year. Patients who were older, male, and white were more likely to undergo subsequent revascularization. Patients in the lowest likelihood quintile were young (mean age 40 years), frequently women (84.7%), had a low incidence of coexisting conditions (5.2% with diabetes mellitus), and had a 0.5% rate of
AMI
and/or revascularization.

Conclusions

The proportion of US patients younger than 65 who had
AMI
and/or coronary revascularization after stress testing was low. Assessing risk of subsequent outcomes may be useful in improving patient referrals for stress testing.
Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation
Authors: Lanters Eva A. H. , Teuwen Christophe P. , Yaksh Ameeta , Kik Charles , van der Does Lisette J. M. E. , Mouws Elisabeth M. J. P. , Knops Paul , van Groningen Nicole J. , Hokken Thijmen , Bogers Ad J. J. C. , de Groot Natasja M. S.
Published: March 2018

Background

Early postoperative atrial fibrillation (
EP
o
AF
) is associated with thromboembolic events, prolonged hospitalization, and development of late Po
AF
(
LP
o
AF
). It is, however, unknown if
EP
o
AF
can be predicted by intraoperative
AF
inducibility. The aims of this study are therefore to explore (1) the value of intraoperative inducibility of
AF
for development of both
EP
o
AF
and
LP
o
AF
and (2) the predictive value of de novo
EP
o
AF
for recurrence of
LP
o
AF
.

Methods and Results

Patients (N=496, 75% male) undergoing cardiothoracic surgery for coronary and/or valvular heart disease were included.
AF
induction was attempted by atrial pacing, before extracorporeal circulation. All patients were on continuous rhythm monitoring until discharge to detect
EP
o
AF
. During a follow‐up period of 2 years,
LP
o
AF
was detected by
ECG
s and Holter recordings. Sustained
AF
was inducible in 56% of patients. There was no difference in patients with or without
AF
before surgery (
P
=0.159), or between different types of surgery (
P
=0.687). In patients without a history of
AF
, incidence of
EP
o
AF
and
LP
o
AF
was 37% and 2%, respectively.
EP
o
AF
recurred in 58% patients with preoperative
AF
, 53% developed
LP
o
AF
. There were no correlations between intraoperative inducibility and
EP
o
AF
or
LP
o
AF
(
P
>0.05).
EP
o
AF
was not correlated with
LP
o
AF
in patients without a history of
AF
(
P
=0.116), in contrast to patients with
AF
before surgery (
P
<0.001).

Conclusions

Intraoperative
AF
inducibility does not predict development of either
EP
o
AF
or
LP
o
AF
. In patients with
AF
before surgery,
EP
o
AF
is correlated with
LP
o
AF
recurrences. This correlation is absent in patients without
AF
before surgery.
Non–ST‐Segment–Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score–Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management
Authors: Bhatia Subir , Arora Shilpkumar , Bhatia Sravya M. , Al‐Hijji Mohammed , Reddy Yogesh N. V. , Patel Parshva , Rihal Charanjit S. , Gersh Bernard J. , Deshmukh Abhishek
Published: March 2018

Background

Chronic kidney disease (
CKD
) remains an independent predictor of cardiovascular morbidity and mortality.
CKD
complicates referral for percutaneous coronary intervention (
PCI
) in non–ST‐segment–elevation myocardial infarction (
NSTEMI
) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients.

Methods and Results

Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess
PCI
utilization and in‐hospital outcomes in
NSTEMI
admissions with
CKD
.
NSTEMI
admissions were identified by
International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM)
code 410.7.
CKD
admissions were identified by
ICD‐9‐CM
code 585. Propensity score–matched cohorts of patients with
NSTEMI
were matched for age, sex, comorbidities, race, median household income, primary payer status, and hospital characteristics. Of 4 488 795 hospitalizations for
NSTEMI
, 31% underwent
PCI
. Overall, 89% of admissions had no
CKD
. In addition, 32% of
NSTEMI
admissions with no
CKD
and 23%, 14%, and 22% with
CKD
stages 3, 4, and 5 underwent
PCI
, respectively. Hospitalized
NSTEMI
patients with
CKD
stages 4 and 5 had 41% and 20% less likelihood, respectively, of undergoing
PCI
compared with those with no
CKD
. Among hospitalized
NSTEMI
patients with no
CKD
or
CKD
stage 3, 4, or 5,
PCI
‐treated groups had 63%, 57%, 39%, and 59% lower likelihood, respectively, of all‐cause, in‐hospital mortality compared with propensity score–matched medically managed groups.

Conclusions

PCI
use decreased among hospitalized
NSTEMI
patients as
CKD
severity increased, and all‐cause, in‐hospital mortality was greater for
NSTEMI
patients admitted with more severe
CKD
regardless of treatment strategy.
Provider Specialty, Anticoagulation Prescription Patterns, and Stroke Risk in Atrial Fibrillation
Authors: O'Neal Wesley T. , Sandesara Pratik B. , Claxton J'Neka S. , MacLehose Richard F. , Chen Lin Y. , Bengtson Lindsay G. S. , Chamberlain Alanna M. , Norby Faye L. , Lutsey Pamela L. , Alonso Alvaro
Published: March 2018

Background

Differences in anticoagulation rates and direct oral anticoagulant use by provider specialty may identify an area of practice improvement to reduce future stroke events in patients with atrial fibrillation (
AF
).

Methods and Results

We examined anticoagulant prescription fills in 388 045 (mean age, 68±15 years; 59% male) patients with incident
AF
from the MarketScan databases between 2009 and 2014. Provider specialty and filled anticoagulant prescriptions around the time of
AF
diagnosis (3 months before through 6 months after) were obtained from outpatient services and pharmacy claims. We estimated the association of provider specialty (cardiology versus primary care) with filling oral anticoagulant prescriptions, adjusting for patient characteristics. The risk of stroke and bleeding events also was explored. A total of 235 739 patients (61%) had a cardiology provider claim, whereas 152 306 (39%) were exclusively managed by primary care. Patients seen by cardiology providers were more likely to fill anticoagulant prescriptions than those seen by primary care (39% versus 27%; relative risk, 1.39; 95% confidence interval [
CI
], 1.37–1.40). Differences were observed for direct oral anticoagulants (relative risk, 1.74; 95%
CI
, 1.71–1.78) and warfarin (relative risk, 1.24; 95%
CI
, 1.22–1.26). A reduced risk of stroke events was observed among those seen by cardiology providers (hazard ratio, 0.90; 95%
CI
, 0.86–0.94) compared with primary care, without an increased bleeding risk (hazard ratio, 1.03; 95%
CI
, 0.98–1.07).

Conclusions

Patients seen by an outpatient cardiology provider shortly after
AF
diagnosis were more likely to initiate oral anticoagulation and were at lower risk of future stroke events without a higher rate of bleeding. Early referral to cardiology specialists may increase initiation of anticoagulant therapies and improve outcomes in
AF
.
Cognitive Function Before and After Left Heart Catheterization
Authors: Scott David A. , Evered Lisbeth , Maruff Paul , MacIsaac Andrew , Maher Sarah , Silbert Brendan S.
Published: March 2018

Background

Hospital procedures have been associated with cognitive change in older patients. This study aimed to document the prevalence of mild cognitive impairment in individuals undergoing left heart catheterization (
LHC
) before the procedure and the incidence of cognitive decline to 3 months afterwards.

Methods and Results

We conducted a prospective, observational, clinical investigation of elderly participants undergoing elective
LHC
. Cognition was assessed using a battery of written tests and a computerized cognitive battery before the
LHC
and then at 3 months afterwards. The computerized tests were also administered at 24 hours (or discharge) and 7 days after
LHC
. A control group of 51 community participants was recruited to calculate cognitive decline using the Reliable Change Index. Of 437 participants, mild cognitive impairment was identified in 226 (51.7%) before the procedure. Computerized tests detected an incidence of cognitive decline of 10.0% at 24 hours and 7.5% at 7 days. At 3 months, written tests detected an incidence of cognitive decline of 13.1% and computerized tests detected an incidence of 8.5%. Cognitive decline at 3 months using written tests was associated with increasing age, whereas computerized tests showed cognitive decline was associated with baseline amnestic mild cognitive impairment, diabetes mellitus, and prior coronary stenting.

Conclusions

More than half the patients aged >60 years presenting for
LHC
have mild cognitive impairment.
LHC
is followed by cognitive decline in 8% to 13% of individuals at 3 months after the procedure. Subtle cognitive decline both before and after
LHC
is common and may have important clinical implications.

Clinical Trial Registration Information

URL
:
www.anzctr.org.au
. Unique identifier:
ACTRN
12607000051448.
Safety and Effectiveness of Direct Oral Anticoagulants Versus Vitamin K Antagonists: Pilot Implementation of a Near‐Real‐Time Monitoring Program in Italy
Authors: Mayer Flavia , Kirchmayer Ursula , Coletta Paola , Agabiti Nera , Belleudi Valeria , Cappai Giovanna , Di Martino Mirko , Schneeweiss Sebastian , Davoli Marina , Patorno Elisabetta
Published: March 2018

Background

Real‐time monitoring is used to the ends of postmarketing observational research on newly marketed drugs. We implemented a pilot near‐real‐time monitoring program on the test case of oral anticoagulants. Specifically, we evaluated the safety and effectiveness of direct oral anticoagulants compared to vitamin K antagonists in nonvalvular atrial fibrillation secondary prevention during 2013‐2015 in the Lazio Region, Italy.

Methods and Results

A cohort study was conducted using a sequential propensity‐score–matched new user parallel‐cohort design. Sequential analyses were performed using Cox models. Overall, 10 742 patients contributed to the analyses. Compared with vitamin K antagonists, direct oral anticoagulant use was associated with a reduction of all‐cause mortality (0.81; 95% confidence interval [
CI
] 0.66‐0.99), cardiovascular mortality (0.71; 95%
CI
0.54‐0.93), myocardial infarction (0.67; 95%
CI
0.43‐1.04), ischemic stroke (0.87; 95%
CI
0.52‐1.45), hemorrhagic stroke (0.25; 95%
CI
0.07‐0.88), and with a nonsignificant increase of gastrointestinal bleeding (1.26; 95%
CI
0.69‐2.30).

Conclusions

The present pilot study is a cornerstone to develop real‐time monitoring for new drugs in our region.