bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Cytopathology in Primary Bladder Amyloidosis
Authors: Toll Adam D. , Ali Syed Z.
Published: April 2013

Background: Amyloidosis results from the accumulation of unique extracellular proteins which are not able to be degraded via the usual mechanism of lysosomal proteolysis. Isolated collections of amyloid within the bladder are extremely uncommon, and a cytopathologic description in voided urine has not been described to date. Methods: A retrospective review was performed at a tertiary-care hospital, and 3 patients with isolated bladder amyloidosis and corresponding voided urine specimens were identified. The following clinical data were collected for each case: age, gender, treatment and follow-up information. Results: The patient age range was 76-84 years, with 2 males and 1 female. Amyloidosis was never clinically suspected. In 1 patient, a urinary amyloid manifested, which was thought to represent extraneous debris at the time of original diagnosis. Two patients never manifested signs of systemic amyloidosis or multiple myeloma, and the third was found to have a monoclonal gammopathy. Conclusions: Our results show the difficulty of diagnosing urinary amyloid in the absence of clinical suspicion. Further, the presence of urinary amyloid is unlikely in patients with bladder amyloidosis as the cohesive nature of the protein makes spontaneous shedding uncommon. Testing for systemic amyloidosis is warranted and if the disease is localized, a favorable outcome can be expected.
Is Isolated Aphasia a Typical Presentation of Presumed Cardioembolic Transient Ischemic Attack or Stroke?
Authors: Fennis Th.F.M. , Compter A. , van den Broek M.W.C. , Koudstaal P.J. , Algra A. , Koehler P.J.
Published: April 2013

Background: Previous studies have suggested that patients with a transient ischemic attack (TIA) or minor ischemic stroke and isolated aphasia should be carefully screened for a potential cardiac source of embolism. Most of these publications, however, were case reports or small-series. The purpose of this study was to assess the relationship between isolated aphasia and atrial fibrillation (AF) as the cause of presumed cardioembolic TIA or stroke within the setting of 2 large multicenter trials. Methods: The frequency of isolated aphasia was compared between patients with a TIA or minor ischemic stroke either with AF [European Atrial Fibrillation Trial (EAFT), n = 1,001] or without AF [Dutch TIA Trial (DTT), n = 3,150]. We analyzed data with univariable and multivariable logistic regression. Isolated aphasia was defined as aphasia without dysarthria, visual-field defects or motor or sensory deficits of the arm, leg or face. Because dysarthria can be difficult to detect in aphasic patients, a second analysis was done without excluding dysarthric patients. In a third analysis, we excluded patients with a symptomatic lacunar infarct from the DTT, as these patients were overrepresented due to the exclusion of patients with AF. Subgroup analysis was performed for patients presenting with TIA and minor stroke. Results: Of 4,151 patients, 210 (5.1%) had isolated aphasia, 109 from the EAFT and 101 from the DTT, crude odds ratio (OR) 3.69, 95% confidence interval (CI) 2.79-4.89. Patients with isolated aphasia were older (mean age 70.3 vs. 66.8 years, p < 0.01), more often female (OR 1.87, 95% CI 1.41-2.46), and more often had diabetes (OR 1.73, 95% CI 1.16-2.59) and hypercholesterolemia (OR 1.83, 95% CI 1.11-3.03) than those without aphasia. After simultaneous adjustment for age, sex, diabetes and hypercholesterolemia, patients with isolated aphasia still had AF more often than patients without isolated aphasia (adjusted OR 2.94, 95% CI 2.16-4.01). Both after inclusion of patients with dysarthria in the group of patients with isolated aphasia and after exclusion of patients with a symptomatic lacunar infarct, essentially the results remained the same. Patients presenting with isolated aphasia due to a TIA tended to have AF more often than patients with a minor ischemic stroke. Conclusions: Isolated aphasia is an independent sign of AF in patients with a TIA or minor ischemic stroke. Careful cardiac screening seems warranted in patients with isolated aphasia, as secondary prevention is different in patients with a cardiac source of embolism.
Body Fat Distribution as a Risk Factor for Cerebrovascular Disease: An MRI-Based Body Fat Quantification Study
Authors: Karcher Hanna-Sofia , Holzwarth Robert , Mueller Hans-Peter , Ludolph Albert C. , Huber Roman , Kassubek Jan , Pinkhardt Elmar H.
Published: April 2013

Background: While adiposity is a well-established risk factor for cardiovascular disease, the association between adiposity and cerebrovascular disease is not entirely understood. For example, common methods to quantify body fat volume such as body mass index, waist circumference and waist-to-hip ratio are not suitable to identify the complex distribution patterns of body fat and its relation to cerebrovascular pathology. In view of a better understanding of the association between fat distribution and cerebrovascular disorders, the aim of the study was to perform measurements of body fat distribution patterns and body fat volumes in correlation to arteriosclerosis of the brain-feeding arteries and white matter lesion load (WMLL). Methods: In this study we performed a magnetic resonance imaging (MRI)-based volumetric differential analysis of subcutaneous and visceral body fat distribution in 25 patients with MRI-proven hyperacute ischemic stroke. For the measurement of adipose tissue volume and tissue distribution automatic labeling analysis software was used. A correlation analysis of MRI volumetric measurements of subcutaneous and visceral body fat, atherosclerotic plaque load of the brain-feeding arteries measured by computed tomography angiography, and WMLL measured by MRI volumetry of the whole brain was performed. Results: The normalized total abdominal adipose tissue and the normalized subcutaneous abdominal adipose tissue showed no significant correlation with either WMLL or total plaque volume. In contrast, the normalized visceral adipose tissue showed a significant correlation with WMLL volume. Visceral adipose tissue as a percentage of total adipose tissue showed a significant correlation with WMLL. In particular, the percentage of visceral adipose tissue rather than total body fat volume strongly correlated with atherosclerosis and ischemic cerebral lesions. Furthermore, the volume of both soft and calcified plaques correlated significantly with WMLL. Conclusions: Our results contribute to existing studies about the association of different patterns of fat distribution with atherosclerosis of the brain-feeding arteries, in particular highlighting the importance of visceral adiposity as a risk factor for cerebrovascular disease. The percentage of visceral adipose tissue in total adipose tissue has the potential of a sensitive parameter and might become a relevant new epidemiological marker, showing highly significant correlations with well-established markers of cerebrovascular disease. In conclusion, the percentage of visceral adipose tissue by itself has to be regarded as a risk factor for both small vessel cerebrovascular disease and cerebral atherosclerosis of the large-to-medium-sized arteries.
Successful Therapy of Vulvodynia with Local Anesthetics: A Case Report
Authors: Weinschenk Stefan , Brocker Kerstin , Hotz Lorenz , Strowitzki Thomas , Joos Stefanie ,   for the HUNTER (Heidelberg University Neural Therapy Education and Research) Group
Published: April 2013

SummaryBackground: Vulvodynia often occurs with unexplained vulvar pain and hyperesthesia, sexual dysfunction, and psychological disability, lacking an organic or microbiological substrate. Case Report: A 25-year-old woman with generalized, unprovoked vulvodynia for 12 years was treated repeatedly with procaine 1% for 14 sessions after she had previously had numerous unsatisfying multidisciplinary treatments. We observed a decrease in pain scores on the visual analogue scale (VAS) from initially 8-9 to presently 0-2. Injection sites were: Head's zones and trigger points of the lower abdomen, regional hypogastric ganglia, bilateral maxillary sinus, and scars of the lower jaw. No major adverse events were observed. Injections to remote sites improved symptoms more strongly than local or regional therapy. After a 3-year follow-up the patient is free of symptoms. Conclusion: Therapy with local anesthetics (TLA, neural therapy) can be a useful additional therapy in complicated cases of vulvodynia. Further studies on the underlying mechanism of injections into remote foci (interference field, stoerfeld) and the effectiveness of TLA in chronic pain syndromes should be performed.
Neuronal Mechanisms and the Treatment of Motion Sickness
Authors: Schmäl F.
Published: April 2013

The aim of this review is to provide an overview of the physiological basis, clinical picture and treatment options for motion sickness. Motion sickness is a well-known nausea and vomiting syndrome in otherwise healthy people. The physical signs of motion sickness occur in both humans and animals during travel by sea, automobile or airplane and in space. Furthermore, some other special situations, such as simulators, the cinema and video games, have been described as causing pseudomotion sickness. Children between 2 and 12 years old are most susceptible to motion sickness, and women are more frequently affected than men. Predisposing factors include menstruation, pregnancy, migraines and possibly a side difference in the mass of otoconia in the vestibular organs. Therapy is directed towards decreasing conflicting sensory input, accelerating the process of adaptation and controlling nausea and vomiting. To control these vegetative symptoms, scopolamine and antihistamines are the most effective drugs.
Maternal Obesity and Pre-Pregnancy Folic Acid Supplementation
Authors: Farah Nadine , Kennedy Cormac , Turner Ciara , O'Dwyer Vicky , Kennelly Mairead M. , Turner Michael J.
Published: April 2013

Objective: The purpose of this nested cohort study was to compare the rate of pre-pregnancy supplementation in obese women with that of women with a normal BMI. Methods: Pregnant women were enrolled at their convenience in a large university hospital. Weight and height were measured in the first trimester and BMI categorised. Results: Of the 288 women, 35.1% were in the normal, 29.5% in the overweight and 35.4% in the obese BMI categories. Only 45.1% (n = 46) of the obese women took pre-pregnancy folic acid compared with 60.4% (n = 61) of women with a normal BMI (p < 0.03). The lower incidence of folic acid supplementation in obese women was associated with an unplanned pregnancy in 36.3% of women compared with 22.8% in the normal BMI category (p < 0.04). Conclusions: Obese women should take folate supplements whether they are planning to conceive or not.
Effects of Pamidronate and Calcitriol on the Set Point of the Parathyroid Gland in Postmenopausal Hemodialysis Patients with Secondary Hyperparathyroidism
Authors: Huang Chung-Yu , Zheng Cai-Mei , Wu Chia-Chao , Lo Lan , Lu Kuo-Cheng , Chu Pauling
Published: April 2013

Background/Aims: Secondary hyperparathyroidism may worsen after the administration of pamidronate in postmenopausal hemodialysis (HD) patients. The aim of this study was to evaluate the short-term effect of coadministration of calcitriol and pamidronate on dynamic parathyroid hormone (PTH) secretion. Methods: Fifteen postmenopausal women undergoing regular HD with serum intact PTH levels of >200 pg/ml were enrolled. The PTH-ionized calcium (iCa) curve was evaluated by the response to hypo- and hypercalcemia induced with 1 and 4 mEq/l of dialysate calcium, respectively. Parameters were compared after pamidronate was administered and after coadministration of pamidronate and calcitriol. Changes in serum levels of maximal serum PTH (PTHmax), basal PTH (PTHbase) and minimal PTH (PTHmin) were evaluated. Results: Pamidronate therapy resulted in a decrease in predialysis basal plasma iCa (p < 0.05) and an increase in PTHmax (p < 0.01), PTHbase (p < 0.01) and PTHmin (p < 0.01). The change in serum iCa and PTH was reversed after the coadministration of calcitriol and pamidronate. Conclusion: Our study demonstrated that pamidronate therapy is associated with a reduced plasma iCa and increased PTH secretion. These adverse effects may be reversed by calcitriol. These findings suggest that in considering pamidronate treatment in postmenopausal patients with osteoporosis receiving HD, it might be safer to add calcitriol to prevent the increased PTH secretion.
All-Trans-Retinoic Acid Attenuates Intestinal Injury in a Neonatal Rat Model of Necrotizing Enterocolitis
Authors: Ozdemir Ramazan , Yurttutan Sadık , Sari Fatma Nur , Oncel Mehmet Yekta , Erdeve Omer , Unverdi Hatice Germen , Uysal Bülent , Dilmen Ugur
Published: April 2013

Background: Ischemia/reperfusion-induced intestinal injury is mediated by reactive oxygen species and inflammatory mediators. Objectives: This study was designed to evaluate whether all-trans-retinoic acid (ATRA) administration can attenuate intestinal injury and to analyze the antioxidant and anti-inflammatory effects of ATRA in a neonatal rat model of necrotizing enterocolitis (NEC). Methods: Twenty-nine Wistar albino rat pups were randomly divided into 3 groups: group 1 = control, group 2 = NEC and saline, and group 3 = NEC and ATRA treatment. NEC was induced by hyperosmolar enteral formula feeding and exposure to hypoxia after cold stress at +4°C and oxygen. Pups in group 3 were injected intraperitoneally with ATRA (0.5 mg/kg body weight) once a day prior to each NEC procedure, beginning on postnatal day 1 and daily through postnatal day 4. The pups were killed on the 4th day and their intestinal tissues were harvested for biochemical and histopathological analysis. Results: Mucosal injury scores and intestinal malondialdehyde levels in group 2 were found to be significantly higher than other groups (p < 0.05). Intestinal superoxide dismutase and glutathione peroxidase activities in group 3 were significantly higher than group 2 (p = 0.04 and p = 0.04, respectively). Intestinal tissue tumor necrosis factor-α levels were significantly reduced with ATRA treatment in group 3 compared to group 2 (p < 0.001). Conclusions: It is likely that oxidative stress and inflammatory mediators contributed to the pathogenesis of NEC and that ATRA had a protective effect on intestinal injury through its anti-inflammatory and antioxidant properties.
Emergence of Methicillin-Resistant Staphylococcus aureus in the Maternity Hospital, Kuwait
Authors: Udo Edet E. , Al-Sweih Noura
Published: April 2013

Objective: To establish the relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Maternity Hospital, Kuwait. Materials and Methods: A total of 22 MRSA were isolated from 20 neonates and 1 mother in the Special Care Unit, Maternity Hospital, Kuwait. They were characterized using antibiogram, pulsed-field gel electrophoresis (PFGE), SCCmec typing, spa typing and multi locus sequence typing (MLST), and were screened for genes encoding Panton Valentine leukocidin (PVL) and capsular polysaccharide types 5 and 8. Results: The isolates were resistant to cadmium acetate (n = 22 or 100%), trimethoprim (n = 13 or 59.1%), gentamicin (n = 7 or 31.8%), ciprofloxacin (n = 5 or 22.7%), erythromycin and clindamycin (n = 2 or 9.1%), tetracycline (n = 2 or 9.1%) and fusidic acid (n = 2 or 9.1%). Eight isolates contained genes for PVL while 15 and 6 carried genes for types 5 and 8 capsular polysaccharide, respectively. Molecular typing distinguished 12 clones. Ten of these clones consisted of 20 isolates belonging to ST60-SCCmec-IV-t3935 (5 isolates), ST6-SCCmec-IV-t6269 (4 isolates), ST194-SCCmec-IV-t6892 (3 isolates), ST1-SCCmec-V-t2962 (2 isolates) and 1 isolate each of ST77-SCCmec-IV-t339, ST935-SCCmec-V-t1084, ST1317-SCCmec-V-t1548, ST9-SCCmec-V-t5801, ST627-SCCmec-IV-t1340 and ST2148-SCCmec-IV-t2810. Conclusion: The study demonstrated the emergence of MRSA including novel ST60 and ST194 clones at the Maternity Hospital in Kuwait.
Histopathologie und Leberbiopsie des hepatozellulären Karzinoms
Authors: Solaß Wiebke , Tannapfel Andrea
Published: April 2013

Hintergrund: Das hepatozelluläre Karzinom (HCC) ist der häufigste maligne Tumor der Leber. Die Differenzierung zwischen primären Lebertumoren und Metastasen kann jedoch trotz moderner bildgebender Diagnostik mitunter Schwierigkeiten bereiten, was wiederum oftmals zu einer Diskussion über die Indikation zur Leberbiopsie führt. Methode: Basis dieser Arbeit ist eine selektive Literaturübersicht zum Thema «HCC». Des Weiteren erfolgte die Einbeziehung publizierter Empfehlungen und Stellungnahmen nationaler und internationaler Fachgesellschaften bezüglich der Indikation zur Leberbiopsie. Die Schlussfolgerungen werden durch die Auswertung eigener Daten ergänzt. Ergebnisse: Histologisch müssen die unterschiedlichen Wachstumsformen des HCC unterschieden werden und eine Abgrenzung zu präkanzerösen Läsionen und einigen Sonderformen des HCC erfolgen. Es scheint also vernünftig, immer dann zu biopsieren, wenn Zweifel an der radiologischen Diagnostik oder am klinischen Verlauf bestehen. In der Biopsie soll auch juxtaläsionelles Gewebe entnommen werden, um eine häufige Leberzirrhose zu dokumentieren. Ist eine chirurgische Resektion geplant, so kann auf die Biopsie verzichtet werden. Schlussfolgerung: Die Leberbiopsie erlaubt die Diagnose eines HCC, wenn die histologischen und immunhistochemischen (CD34, Zytokeratin 7 und 19, Glypican 3) Parameter eindeutig sind.
Imaging in Hepatocellular Carcinoma: Guidelines and Future Prospects
Authors: Bartolozzi Carlo , Battaglia Valentina
Published: April 2013

Background: Non-invasive diagnosis of hepatocellular carcinoma (HCC) in cirrhosis is nowadays the option of choice, as reported by both Western and Eastern guidelines. Methods: Currently, the diagnosis is still focused on the detection of the typical, neoplastic, vascular pattern, characterized by lesion hypervascularization in the arterial phase and by wash-out in the late vascular phase, by means of multidetector computed tomography (MDCT) or magnetic resonance (MR) imaging. In cases of atypical nodules, Western international guidelines suggest, depending on the cases, to perform a second imaging examination, but not contrast-enhanced ultrasound (CEUS), or biopsy tissue sampling. On the contrary, Eastern guidelines have additionally included RES(reticuloendothelial system)-targeted ultrasound or MR examination or hepatobiliary MR imaging for these difficult cases. Results: On the basis of new findings regarding the histological changes occurring in the pathway towards nodular malignancy, new hepatospecific contrast agents are routinely applied in MR studies, allowing to explore cellular metabolic function also in atypical hypoperfused nodules. Conclusions: In the near future, hepatobiliary MR imaging with hepatocyte-selective contrast agents might be considered the best choice to classify preneoplastic, low-risk lesions or atypical nodules with a high potential of malignancy.
Anterior Segment Imaging and Treatment of a Case with Syndrome of Ectopia Lentis, Spontaneous Filtering Blebs, and Craniofacial Dysmorphism
Authors: Mansour Ahmad M. , Younis Mohammad H. , Dakroub Rola H.
Published: April 2013

Purpose: To report the ultrasound biomicroscopy (UBM) and surgical findings in a subject with a syndrome of ectopia lentis, spontaneous filtering blebs, and craniofacial dysmorphism (Traboulsi syndrome). Methods: Case report, using a 40-MHz UBM wide-field anterior segment scan and anterior segment optical coherence tomography (OCT). Results: A 16-year-old orphan girl presented with visual loss to the level of 6/60 (20/200) bilaterally. She had a central corneal opacification with retrocorneal fibrosis. The anterior chamber was flat with a very poorly dilating pupil. The lens was central in location. Perilimbal conjunctival blebs were bilateral with an intraocular pressure of 8 mm Hg. UBM and anterior segment OCT revealed chronic apposition of the iris to the cornea with angle closure, delineation of the bleb tract and rarefaction of the zonules. The girl had abnormal facial features (a beaked nose and long face) with normal chromosomal studies, negative fluorescent in situ hybridization study for velocardiofacial syndrome and an absence of signs suggesting Marfan syndrome. Under general anesthesia, attempts at deepening the anterior chamber with sodium hyaluronate 3% led to a spontaneous dislocation of the lens into the anterior chamber, facilitating its aspiration. Deepening of the angle was found after lens removal. Retrocorneal fibrosis persisted after surgery, but the bleb height decreased. Best corrected visual acuity did not improve from the preoperative level beyond 6/60 (20/200) because of central retrocorneal fibrosis. Conclusions: Early surgical removal of the lens is necessary in this syndrome to avoid irreversible corneal and trabecular meshwork damage in chronic apposition of the iris to the cornea. UBM can help in the delineation of the bleb tract and document resolution of angle closure after surgery.
Resektion und Lebertransplantation bei hepatozellulärem Karzinom
Authors: Farkas Stefan A. , Schlitt Hans Jürgen
Published: April 2013

Hintergrund: Kurative Therapieverfahren für das hepatozelluläre Karzinom (HCC) sind die Resektion und die Lebertransplantation. Grundlage für die Therapieentscheidung ist bisher die Klassifikation der Barcelona Clinic Liver Cancer Group (BCLC). Methode: Basis dieser Arbeit ist eine selektive Literaturübersicht zur Therapie des HCC. Leitlinien verschiedener Fachgesellschaften wurden einbezogen und aktuelle Arbeiten zu neuen chirurgischen Techniken besonders berücksichtigt. Ergebnisse: Primär resektable HCCs sollen reseziert werden. Für die Resektion kommen alle Patienten in adäquatem Allgemeinzustand ohne Zirrhose oder mit Child-A-Zirrhose ohne ausgeprägte portale Hypertension in Betracht. Hierbei ist von entscheidender Bedeutung, dass über die Möglichkeit der Resektabilität in einem ausgewiesenen Leberzentrum befunden wird. Auf die Leber beschränkte Rezidive können erneut operiert oder für eine Lebertransplantation gelistet werden. Techniken zur erweiterten Leberresektion und laparoskopische Verfahren finden zunehmend Anwendung und müssen weiter evaluiert werden. Schlussfolgerung: Neben der Resektion ist die Lebertransplantation inzwischen eine Standardtherapie für HCCs in Zirrhose. Innerhalb der Mailand-Kriterien können nach der Transplantation 5-Jahres-Überlebensraten von 70-90% erreicht werden. Allerdings erfordern der zunehmende Organmangel und die daraus resultierenden längeren Wartezeiten mit der Gefahr des Tumorprogresses ein Umdenken. So können Patienten, die für eine Transplantation infragekommen, nicht nur zum Bridging bis zur Transplantation reseziert werden, sondern auch, um eine biologische Stratifizierung durchzuführen. Unter engmaschigem Monitoring kann dann erst bei Auftreten eines Rezidivs eine «Rescue»-Transplantation durchgeführt werden. Jedoch werden auch Patienten mit fortgeschritteneren Tumoren, die nicht oder erst zu spät transplantiert werden können, zunehmend mit guten Ergebnissen reseziert. Somit könnten die Kriterien für eine Resektion im Rahmen der BCLC-Klassifikation erweitert werden.
Secondary Malignant Peritoneal Mesothelioma of the Greater Omentum after Therapy for Primary Pleural Mesothelioma
Authors: Gutzeit Andreas , Reischauer Carolin , Hergan Klaus , Kos Sebastian , Roos Justus E.
Published: April 2013

Mesothelioma is the most common malignant primary tumor of the pleura and usually associated with inhalation of asbestos fibers. In contrast, peritoneal mesothelioma is a rare entity whose pathomechanism is not yet fully understood. The coexistence of pleural mesothelioma with secondary involvement of the abdominal cavity has not been addressed in the literature. In this case report, we describe secondary malignant mesothelioma of the greater omentum. A 69-year-old man with histologically proven pleural mesothelioma on the right side and no past medical history of asbestos exposure received palliative treatment consisting of a talc pleurodesis. After a 6-month interval of stable disease, a local progressive tumor of the right pleura was seen on a CT scan. Eleven months later, during follow-up, the patient presented at our emergency department with a sudden onset of diffuse abdominal pain. Abdominal ultrasound revealed a mass within the greater omentum and the coexistence of free fluid. Subsequent abdominal CT scans demonstrated tumor infiltration from the right pleura by a transdiaphragmatic route into the abdomen, where diffuse infiltration of the greater omentum was observed. Aspiration of the ascites and the biopsy of the greater omentum confirmed the diagnosis of secondary malignant mesothelioma of the peritoneum. In conclusion, we present the extremely rare diagnosis of secondary malignant mesothelioma of the abdomen, which arose as a result of local progression from the right pleura into the abdomen.
Rhegmatogenous Retinal Detachment with a High Risk of Proliferative Vitreoretinopathy Treated with Episcleral Surgery and an Intravitreal Dexamethasone 0.7-mg Implant
Authors: Reibaldi Michele , Russo Andrea , Longo Antonio , Bonfiglio Vincenza , Uva Maurizio G. , Gagliano Caterina , Toro Mario D. , Avitabile Teresio
Published: April 2013

Purpose: To report a case of rhegmatogenous retinal detachment with a high risk of proliferative vitreoretinopathy (PVR) effectively treated with episcleral surgery and an intravitreal dexamethasone 0.7-mg implant. Methods: A 35-year-old Caucasian man with a macula-off rhegmatogenous subtotal retinal detachment that had persisted for 1 month in his myopic left eye presented several risk factors that could have led to the development of PVR after retinal detachment surgery. His best corrected visual acuity was hand motion. He received an intravitreal dexamethasone 0.7-mg implant (Ozurdex®) after episcleral surgery to prevent this complication. Results: At least 9 months after surgery, no sign of PVR or pucker has developed in the treated eye. Visual acuity improved to 0.2, the retina was attached and no complications were observed. Conclusion: Intravitreal dexamethasone 0.7-mg implant (Ozurdex) could be considered as off-label treatment following episcleral surgery to prevent PVR.
Molecular basis of coagulation factor V deficiency caused by the R1698W inter-domain mutation
Authors: Villoutreix Bruno , Lunghi Barbara , Livaja Ruzica , Bernardi Francesco , Dahlbäck Björn , Calzavarini Sara
Published: April 2013

Coagulation factor V (FV) deficiency is characterised by variable bleeding phenotypes and heterogeneous mutations. To add new insights into the FV genotype-phenotype relationship, we characterised the R1698W change in the A3 domain, at the poorly investigated interface with the A2 domain. The FV R1698W mutation was responsible for a markedly reduced expression level (10% of FV-WT) and specific activity in thrombin generation (0.39). Interestingly, the FVa1698W showed rapid activity decay upon activation due to increased dissociation rate between the heavy and light chains. The importance of the size and charge of the residue at position 1698 was investigated by three additional recombinant mutants, FVR1698A, FVR1698Q, and FVR1698E. FVR1698A and FVR1698Q expression (30 and 45% of FV-WT), specific activity (both 0.57) and stability were all reduced. Noticeably, FVR1698E showed normal activity and stability despite poor expression (10% of FV-WT). These data indicate the essential role of R1698 for normal biosynthetic process and support local flexibility for positively or negatively charged residues to produce stable and functional A3-A2 domain interactions. Their experimental alteration produces a gradient of FV defects, which help to interpret the wide spectrum of phenotypes in FV-deficient patients.
Long-term treatment of deep-vein thrombosis with low-molecular-weight heparin: An update of the evidence
Authors: Townshend Grace , Hull Russell
Published: April 2013

This article reviews updated evidence-based knowledge on long-term treatment of deep-vein thrombosis (DVT) with low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs). Eleven trials were identified comparing the two treatments in a broad spectrum of patients with DVT and with >100 study participants. Four comparative trials were identified in patients with cancer and DVT (in whom anticoagulation treatment is more complex and bleeding complications more frequent). In the 11 trials in broad patient populations, LMWHs were as effective as VKAs in preventing recurrent venous thromboembolism (VTE), and there were no consistent differences in the incidence of bleeding complications during long-term treatment. In patients with cancer, VTE recurrence was significantly reduced with LMWH versus VKA in two studies, while major bleeding complications did not differ between groups in any of the four trials. Current evidence-based European and American guidelines recommend LMWH over VKA for the long-term treatment of DVT in patients with cancer. LMWH and VKA are recommended over the new oral anticoagulant drugs, for which there are limited data on use in long-term treatment. Post-thrombotic syndrome (PTS), a common complication of DVT, causes considerable morbidity. Long-term use of tinzaparin reduced the risk of PTS compared with VKA in one trial, and a meta-analysis of nine studies in total demonstrated a consistently favourable effect of LMWHs versus VKA on PTS-related outcomes. Given the limited treatment options available for PTS, this suggests that LMWHs provide a useful therapeutic option in any patient particularly at risk of developing PTS.
Anticoagulation with dabigatran does not increase secondary intracerebral haemorrhage after thrombolysis in experimental cerebral ischaemia
Authors: Ploen Robert , Zorn Markus , Sun Li , Zhou Wei , Veltkamp Roland
Published: April 2013

Dabigatran etexilate (DE) has recently been introduced for stroke prevention in atrial fibrillation, but management of acute ischaemic stroke during therapy with DE is a challenge. Thrombolysis is contrain-dicated because of a presumed increased risk of intracerebral haemorrhagic complications. We studied in different ischaemia models whether DE increases secondary haemorrhage after thrombolysis. C57BL/6 mice were anticoagulated with high-dose DE or warfarin. After 2 hour (h) or 3 h transient filament MCAO, rt-PA was injected. At 24 h after MCAO, secondary haemorrhage was quantified using a macroscopic haemorrhage score and haemoglobin spectrophotometry. Post-ischaemic blood-brain-barrier (BBB) damage was assessed using Evans blue. To increase the validity of findings, the duration of anticoagulation was prolonged in mice (5 x DE over 2 days), and the effect of DE after thrombolysis was also examined in thromboembolic MCAO in rats. Pretreatment with warfarin resulted in significantly more secondary haemorrhage (mean haemorrhage score 2.6 ± 0.2) compared to non-anticoagulated animals (1.7 ± 0.3) and DE (9 mg/kg, 1.6 ± 0.3) in 2 h ischaemia. Also after a 3 h period of ischaemia, haemorrhage was more severe in animals anticoagulated with warfarin compared to 9 mg/kg DE and non-anticoagulated control. Prolonged or enteral dabigatran pretreatment led to identical results. Also, thrombolysis after thromboembolic MCAO in rats did not induce more severe bleeding in DE-treated animals. Mice pretreated with warfarin had higher BBB permeability and increased activation of matrix-metalloproteinase 9. In conclusion, DE does not increase the risk of secondary haemorrhage after thrombolysis in various rodent models of ischaemia and reperfusion. The implications of this finding for stroke patients have to be determined in the clinical setting.
Cytochrome P450 2B6 and 2C9 genotype polymorphism – a possible cause of prasugrel low responsiveness
Authors: Franken Cora , Kaiser Andreas , Krüger Jan , Overbeck Kristina , Mügge Andreas , Neubauer Horst
Published: April 2013

The cytochrome P450 (CYP) isoenzymes are essential for the metabolic activation of the prodrug prasugrel. Little is known about the impact of polymorphism of these isoenzymes on the prevalence of prasugrel low responsiveness (PLR) in patients with coronary artery disease. We investigated the frequency of PLR and the question whether PLR is associated with decreased/non-function polymorphisms of the CYP isoenzymes (2C9*2, 2C9*3, 2C19*2, 2C19*3, and 2B6*6). Our study included 355 patients who underwent percutaneous coronary stenting. The patients were initially treated with either prasugrel (n=90; 60/10 mg: loading/daily maintenance dose) or 600/75 mg clopidogrel hydrogensulfate (n=265) in combination with 500/100 mg acetylsalicylic acid (ASA). Platelet function was tested by impedance aggregometry 48 hours after taking the loading dose. Prasugrel achieved on the average significantly higher levels of platelet inhibition as compared to clopidogrel (mean 27.3 U vs 41.2 U). The frequencies of low response for prasugrel, clopidogrel and ASA were 9.8%, 35.1% and 14.9%, respectively. We identified only body mass index to be associated with PLR. PLR was not caused by a loss of ADP P2Y12-receptor function. Half of the patients with PLR were carriers of the reducedfunction allele CYP2B6*6, and 41.7% had the genetic variant CYP2C9*2. The allele CYP2C9*3 was detected in three patients with PLR (25%) and two patients with PLR (16.7%) carried the gene variant CYP2C19*2. In conclusion, the rate of low responders was significantly lower among patients treated with prasugrel than with clopidogrel. PLR are more often carriers of CYP2C9*2 (50% in PLR) than when compared to the prevalence described in literature. Also, there is a trend to an increased frequency of CYP2B6*6 in PLR. In conclusion, CYP2B6 and CYP2C9 polymorphisms seem to be associated with prasugrel low-response.
Single-dose TB-402 or rivaroxaban for the prevention of venous thromboembolism after total hip replacement
Authors: Gunn Sophie , Sonesson Elisabeth , Peerlinck Kathelijne , Vanassche Thomas , Vandenbriele Christophe , Ageno Walter , Glazer Steven , Prins Martin , Buller Harry , Tangelder Marco , Verhamme Peter
Published: April 2013

TB-402 is a long-acting monoclonal antibody that partially inhibits factor VIII. A single administration of TB-402 was effective and well-tolerated for the prevention of venous thromboembolism (VTE) after total knee replacement. In this study, the efficacy and safety of a single administration of TB-402 for the extended prophylaxis of VTE after total hip replacement (THR) was investigated. This was a phase II, randomised, active-controlled, double-blind study that included patients undergoing elective THR surgery. Patients were randomised to TB-402 25 mg or TB-402 50 mg, administered as a single intravenous administration 2–4 hours postoperatively, or to rivaroxaban 10 mg once daily for 35 days. The primary efficacy outcome was total VTE defined as symptomatic VTE and asymptomatic deep-vein thrombosis (DVT) detected by bilateral venography at day 35. The principal safety outcome was the incidence of major bleeding and clinically relevant non-major bleeding until day 35. Total VTE was similar in all groups: 5.3% (95%CI 2.9–9.6), 5.2% (95%CI 2.8–9.3) and 4.7% (95%CI 2.5–8.7) for TB-402 25 mg, TB-402 50 mg and rivaroxaban, respectively. All were asymptomatic DVTs. Major or clinically relevant non-major bleedings were observed in 5.8% (95%CI 3.3–9.9), 7.2% (95%CI 4.4–11.6) and 1.4% (95%CI 0.5–4.2) for TB-402 25 mg, TB-402 50 mg and rivaroxaban, respectively. In conclusion, TB-402, administered as a single postoperative dose, had a similar efficacy compared to rivaroxaban for the prevention of VTE after THR. The incidence of major and clinically relevant non-major bleeding was higher in the TB-402 groups than in the rivaroxaban group.
Regulation of Endothelial Cell Differentiation and Specification
Authors: Marcelo Kathrina L. , Goldie Lauren C. , Hirschi Karen K.
Published: April 2013

The circulatory system is the first organ system to develop in the vertebrate embryo and is critical throughout gestation for the delivery of oxygen and nutrients to, as well as removal of metabolic waste products from, growing tissues. Endothelial cells, which constitute the luminal layer of all blood and lymphatic vessels, emerge de novo from the mesoderm in a process known as vasculogenesis. The vascular plexus that is initially formed is then remodeled and refined via proliferation, migration, and sprouting of endothelial cells to form new vessels from preexisting ones during angiogenesis. Mural cells are also recruited by endothelial cells to form the surrounding vessel wall. During this vascular remodeling process, primordial endothelial cells are specialized to acquire arterial, venous, and blood-forming hemogenic phenotypes and functions. A subset of venous endothelium is also specialized to become lymphatic endothelium later in development. The specialization of all endothelial cell subtypes requires extrinsic signals and intrinsic regulatory events, which will be discussed in this review.
Monocyte-Directed RNAi Targeting CCR2 Improves Infarct Healing in Atherosclerosis-Prone Mice
Authors: Majmudar Maulik D. , Keliher Edmund J. , Heidt Timo , Leuschner Florian , Truelove Jessica , Sena Brena F. , Gorbatov Rostic , Iwamoto Yoshiko , Dutta Partha , Wojtkiewicz Gregory , Courties Gabriel , Sebas Matt , Borodovsky Anna , Fitzgerald Kevin , Nolte Marc W. , Dickneite Gerhard , Chen John W. , Anderson Daniel G. , Swirski Filip K. , Weissleder Ralph , Nahrendorf Matthias
Published: April 2013

Background—

Exaggerated and prolonged inflammation after myocardial infarction (MI) accelerates left ventricular remodeling. Inflammatory pathways may present a therapeutic target to prevent post-MI heart failure. However, the appropriate magnitude and timing of interventions are largely unknown, in part because noninvasive monitoring tools are lacking. Here, we used nanoparticle-facilitated silencing of CCR2, the chemokine receptor that governs inflammatory Ly-6C
high
monocyte subset traffic, to reduce infarct inflammation in apolipoprotein E–deficient (apoE
−/−
) mice after MI. We used dual-target positron emission tomography/magnetic resonance imaging of transglutaminase factor XIII (FXIII) and myeloperoxidase (MPO) activity to monitor how monocyte subset–targeted RNAi altered infarct inflammation and healing.

Methods and Results—

Flow cytometry, gene expression analysis, and histology revealed reduced monocyte numbers and enhanced resolution of inflammation in infarcted hearts of apoE
−/−
mice that were treated with nanoparticle-encapsulated siRNA. To follow extracellular matrix cross-linking noninvasively, we developed a fluorine-18–labeled positron emission tomography agent (
18
F-FXIII). Recruitment of MPO-rich inflammatory leukocytes was imaged with a molecular magnetic resonance imaging sensor of MPO activity (MPO-Gd). Positron emission tomography/magnetic resonance imaging detected anti-inflammatory effects of intravenous nanoparticle-facilitated siRNA therapy (75% decrease of MPO-Gd signal;
P
<0.05), whereas
18
F-FXIII positron emission tomography reflected unimpeded matrix cross-linking in the infarct. Silencing of CCR2 during the first week after MI improved ejection fraction on day 21 after MI from 29% to 35% (
P
<0.05).

Conclusion—

CCR2-targeted RNAi reduced recruitment of Ly-6C
high
monocytes, attenuated infarct inflammation, and curbed post-MI left ventricular remodeling.
God in Ghanaian Pentecostal Songs
Authors: Quayesi-Amakye Joseph
Published: April 2013

This essay is about implicit ideas of God in Ghanaian Pentecostal songs. It examines and discusses some selected songs or choruses sung by Ghanaian Pentecostal churches. Today these songs have ceased to be the prerogative of the Pentecostals; they are sung by all: Christian and non-Christian. The songs I examine in this paper reveal Ghanaian Pentecostal understanding and interpretation of the being and nature of God. The paper aims at demonstrating the naturalness of Ghanaian Pentecostal songs. It also reveals the synthesis of the Akan primal worldview and biblical understanding in the Ghanaian Pentecostal concept of God. Yet this paper demonstrates that Ghanaian Pentecostals show a clear discontinuity with the primal worldview when they subvert the mediatorial and salvific roles of the traditional deities and spirits with those of Christ and the Christian God.
Two new species of the genus Paramitraceras Pickard-Cambridge, 1905 (Opiliones: Laniatores: Stygnopsidae) from Chiapas, Mexico
Authors: CRUZ-LÓPEZ JESÚS A. , FRANCKE OSCAR F.
Published: April 2013

Paramitraceras pickardcambridgei sp. nov. and Paramitraceras tzotzil sp. nov. from Chiapas, Mexico are described based on specimens previously determined as Paramitraceras granulatum Pickard-Cambridge, 1905 by Goodnight and Goodnight. The male genitalia of the new species and P. granulatum are illustrated with scanning electronic micrographs (SEMs) or drawings derived from them. The importance of the ocular tubercle, cheliceral dentition and sexual dimor-phism, pedipalpal armature and male genitalia as taxonomic characters within the genus is discussed as well as differences and similarities between Paramitraceras Pickard-Cambridge, 1905 and its most similar genus, Sbordonia Šilhavý, 1977.
On some mites (Acari: Prostigmata) from the Interior Highlands: descriptions of the male, immature stages, and female reproductive system of Pseudocheylus americanus (Ewing, 1909) and some new state records for Arkansas
Authors: SKVARLA MICHAEL J. , FISHER J. RAY , DOWLING ASHLEY P.G.
Published: April 2013

The male and immature stages of Pseudocheylus americanus (Ewing, 1909) (Pseudocheylidae) are described and illustrated for the first time and the female is re-illustrated. The description of Pseudobonzia reticulata (Heryford, 1965) (Cunaxidae) is modified to include the presence of dorsal setae f2, which were not reported in the original description. In addition, Bonzia yunkeri Smiley, 1992 and Parabonzia bdelliformis (Atyeo, 1958) (Cunaxidae) are reported from the Ozark Mountains, Caeculus cremnicolus Enns, 1958 (Caeculidae) is reported from the Ozark and Ouachita Mountains, and Dasythyreus hirsutus Atyeo, 1961 (Dasythyreidae) is reported from Missouri and the Ouachita Mountains in Arkansas.
On the identity of Clistocoeloma balansae A. Milne-Edwards, 1873, and C. tectum (Rathbun, 1914), with description of a new species from the West Pacific (Crustacea: Decapoda: Sesarmidae)
Authors: LEE B. Y. , NG N. K. , NG PETER K.L.
Published: April 2013

The identity of the mangrove sesarmid crab Clistocoeloma balansae A. Milne-Edwards, 1873, is clarified on the basis of the types from New Caledonia, and fresh material from Vanuatu and the Philippines. Sesarma (Sesarma) tectum Rathbun, 1914, is shown to be a junior subjective synonym of C. balansae A. Milne-Edwards, 1873. A new species, C. melanesi-cum, superficially similar to C. balansae, is described from Vanuatu, New Caledonia, and, Solomon Islands.
The taxonomic status of Oligoryzomys brendae Massoia, 1998 (Rodentia, Cricetidae), with comments on the availability of this name
Authors: TETA PABLO , JAYAT J. PABLO , ORTIZ PABLO E. , D’ELÍA GUILLERMO
Published: April 2013

Oligoryzomys brendae was poorly described by Massoia in 1998 to include populations of the large form of Oligoryzomys that inhabits the Yungas and high altitudinal grasslands of northwestern Argentina, which were previously referred as O. longicaudatus, O. stolzmanni, O. destructor or Oligoryzomys sp. Contrary to some interpretations, we state that the name O. brendae is available, given that it fully accomplishes the requirements of the International Code of Zoological Nomen-clature. We also present morphologic and genetic evidence showing that this taxon represents a distinct species and pro-vide an emended diagnosis and re-description of it. In addition, the evidence at hand indicates that O. brendae is the only large-sized species of Oligoryzomys inhabiting northwestern Argentina.
The March 2009 Dust Event in Saudi Arabia: Precursor and Supportive Environment
Authors: Alharbi B. H. , Maghrabi A. , Tapper N.
Published: April 2013

A case study is presented of the environmental background for a massive Saudi Arabian dust storm event that took place on 10 and 11 March 2009. The dust storm was large enough to be clearly seen from outer space and caused a widespread heavy atmospheric dust load, very low visibility, total airport shutdown, and damage to vehicles and trees across northern and central parts of Saudi Arabia. The precursor and supportive environment for this dust storm outbreak are investigated, drawing upon routine synoptic data and satellite imagery. Analytical evidence is offered to suggest that this dust storm was triggered and sustained by a cold front passage coincident with the propagation of a preexisting intense upperlevel jet streak. The major plume of the 10 March 2009 dust storm originated from several rich dust source areas extending across two regions—the Qasim region and the Adibdibah and As-Summan Plateau region. The intensity and frequency of dust storms triggered from these active areas of dust emissions seem to be dominated by a response to the amount of precipitation during November and December.
Children’s Questions in Cross-Cultural Perspective
Authors: Gauvain Mary , Munroe Robert L. , Beebe Heidi
Published: April 2013

This study investigated language data collected in 1978-1979 from ninety-six 3- to 5-year-old children in four different non-Western cultures: Garifuna in Belize, Logoli in Kenya, Newars in Nepal, and Samoans in America Samoa. There were 24 children per culture; half of the children were 3 years of age, and half were 5 years of age. The study examined the use of information-seeking questions in everyday life situations and the proportion of explanation-seeking questions (why-questions) in these communities relative to those reported among Western samples. Results revealed that the number of information-seeking questions does not differ from those of Western samples, but the proportion of explanation-seeking questions was much lower than that reported for Western children. Implications of these findings are discussed.
Cultivating Our Roots and Extending Our Branches
Authors: McCarthy Henry
Published: April 2013

As a behavioral science and helping profession, rehabilitation must promote theory building and knowledge utilization through comprehensive and conscientious approaches. This article addresses notable failures to incorporate earlier and significant conceptual developments from rehabilitation into contemporary research. The identified gaps in scholarship acknowledgment concerned omissions of the groundbreaking work of several scholars who were shaped by Kurt Lewin’s mentorship and field theory. These authors advanced two fundamental principles: (a) the ecological perspective that behavior (including that associated with disability) can only be understood as the interaction of the person within an environmental context and (b) a strengths-based approach that rehabilitation assessments and interventions must tap into the assets of the person and the resources in the environment. The nexus and usefulness of these authors’ contributions have gone unrecognized in explanations of two relevant and popular psychosocial research agendas: (a) the new paradigm of disability and (b) the positive psychology movement. This article delineates these gaps in rehabilitation knowledge utilization, offers some interpretations for their occurrence, and recommends strategies to reduce the gaps. It also suggests how developments in theory or practice from rehabilitation research and philosophy could be better marketed to and utilized by our partners in other counseling/psychology specialties, disability studies, and the broader community interested in disability issues.