bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulated tissue fluidity steers zebrafish body elongation
Authors: Lawton Andrew K. , Nandi Amitabha , Stulberg Michael J. , Dray Nicolas , Sneddon Michael W. , Pontius William , Emonet Thierry , Holley Scott A.
Published: January 2013

The tailbud is the posterior leading edge of the growing vertebrate embryo and consists of motile progenitors of the axial skeleton, musculature and spinal cord. We measure the 3D cell flow field of the zebrafish tailbud and identify changes in tissue fluidity revealed by reductions in the coherence of cell motion without alteration of cell velocities. We find a directed posterior flow wherein the polarization between individual cell motion is high, reflecting ordered collective migration. At the posterior tip of the tailbud, this flow makes sharp bilateral turns facilitated by extensive cell mixing due to increased directional variability of individual cell motions. Inhibition of Wnt or Fgf signaling or cadherin 2 function reduces the coherence of the flow but has different consequences for trunk and tail extension. Modeling and additional data analyses suggest that the balance between the coherence and rate of cell flow determines whether body elongation is linear or whether congestion forms within the flow and the body axis becomes contorted.
X-ray Absorption Spectroscopy of an Unusual Plastocyanin from a Fern, Dryopteris crassirhizoma
Authors: Togashi Hiromi , Yano Junko , Yachandra Vittal K , Kohzuma Takamitsu
Published: January 2013

X-ray absorption spectroscopy (XAS) of a plastocyanin from a fern, Dryopteris crassirhizoma (DPc) was studied. The XAS of reduced CuIDPc demonstrated the retention of the four coordinated structure at pH 5.0. The EXAFS analyses of the reduced DPc demonstrated that the Cu-axial SMet95 ligand distance is much shorter than that in the oxidized form. This is the first report for the XAS and EXAFS of an unusual fern plastocyanin.
Light rhythm and diet differently influence facets of the metabolic syndrome in WOKW rats
Authors: Klöting Ingrid , Bahr Jeanette , Wilke Barbara , Lange Jörn
Published: January 2013

It has previously been shown that high-calorie diet alters the function of the mammalian circadian clock and that obesity has an influence on circadian organization of hormone secretion. That prompted us to test whether inbred Wistar Ottawa Karlsburg W (RT1u) (WOKW) rats developing facets of the metabolic syndrome show changes in their metabolic profiles under different feeding conditions (high-fat, high-sugar versus control diet) and under two different 12 h:12 h light–dark (LD) cycles. At the age of four weeks, these rats were divided into four groups. Groups 1 and 2 were kept under initial LD cycle (lights on at 05:00 h). Group 1 was fed with a normal rat diet while group 2 received a high-fat, high-sugar diet from 10 up to the age of 21 weeks. Groups 3 and 4 were kept under a shifted LD cycle (lights on at 11:00 h). Group 3 was given a normal diet while group 4 received a high-fat, high-sugar diet from an age like groups 1 and 2. Several metabolic traits were studied during the observation period of 21 weeks. The blood samples were obtained 2 h before lights off. Body weight gain ( P < 0.001), leptin ( P < 0.001), triglycerides ( P < 0.001) and cholesterol ( P < 0.05) were significantly reduced in group 4 versus group 2, but comparable between control groups (1 versus 3). The insulin concentrations were reduced in groups 3 and 4 versus groups 1 and 2 without effect of diet. In conclusion, the results provide evidence that light conditions influence diet induced changes in phenotypic traits like body weight gain, lipids as well as hormone levels (insulin and leptin) in WOKW rats.
A cross-sectional study of aggression levels in physicians and orthopaedic surgeons: impact on specialty selection and training?
Authors: Barlow T , Wight A , Barlow D
Published: January 2013

Objectives

To determine if current validated psychometric evaluations could determine a difference in basic behavioural characteristics between surgical and medical specialties.

Design

Cross-sectional study.

Setting

Two district general hospitals and one University teaching hospital in England, UK.

Participants

Internal medicine (16) and trauma and orthopaedic (20) consultants.

Main outcome measures

Aggression levels as assessed by the Buss and Warren questionnaire. The self-administered questionnaire assesses aggression in terms of physical, verbal, anger, hostility, indirect hostility and an overall assessment of aggression.

Results

All participants had aggression scores below the population average. We found a significant difference ( P < 0.01) in total level of aggression, with orthopaedic consultants scoring a mean of 61.1 (standard deviation [SD] 9.2) and physicians 51.3 (SD 9.5). When analysis of the five different subtypes of aggression was carried out, orthopaedic surgeons scored significantly higher in terms of verbal aggression ( P = 0.005), hostility ( P = 0.002) and indirect hostility ( P = 0.03).

Conclusion

This study joins a growing evidence base for aspects of behaviour indicative of a given specialty. Aggression is a relatively stable behavioural characteristic from adolescence, and as such this is the first study of its type to suggest that the differences in behavioural characteristics seen between specialties are inherent, rather than learned. It is unclear if the differences observed represent an attraction of that specialty to the personality type or is required for success within the given specialty. Whether this can be used in terms of selection into higher specialty training, or influence training within specialties, requires further work.
Friedman’s excess free energy and the McMillan–Mayer theory of solutions: Thermodynamics
Authors: Gómez-Estévez Juan Luis
Published: December 2012

In his version of the theory of multicomponent systems, Friedman used the analogy which exists between the virial expansion for the osmotic pressure obtained from the McMillan–Mayer (MM) theory of solutions in the grand canonical ensemble and the virial expansion for the pressure of a real gas. For the calculation of the thermodynamic properties of the solution, Friedman proposed a definition for the “excess free energy” that is a reminder of the ancient idea for the “osmotic work”. However, the precise meaning to be attached to his free energy is, within other reasons, not well defined because in osmotic equilibrium the solution is not a closed system and for a given process the total amount of solvent in the solution varies. In this paper, an analysis based on thermodynamics is presented in order to obtain the exact and precise definition for Friedman’s excess free energy and its use in the comparison with the experimental data.
Multiscale modeling of solvation in chemical and biological nanosystems and in nanoporous materials
Authors: Kovalenko Andriy
Published: January 2013

Statistical–mechanical, 3D-RISM-KH molecular theory of solvation (3D reference interaction site model with the Kovalenko–Hirata closure) is promising as an essential part of multiscale methodology for chemical and biomolecular nanosystems in solution. 3D-RISM-KH explains the molecular mechanisms of self-assembly and conformational stability of synthetic organic rosette nanotubes (RNTs), aggregation of prion proteins and β-sheet amyloid oligomers, protein-ligand binding, and function-related solvation properties of complexes as large as the Gloeobacter violaceus pentameric ligand-gated ion channel (GLIC) and GroEL/ES chaperone. Molecular mechanics/Poisson–Boltzmann (generalized Born) surface area [MM/PB(GB)SA] post-processing of molecular dynamics (MD) trajectories involving SA empirical nonpolar terms is replaced with MM/3D-RISM-KH statistical–mechanical evaluation of the solvation thermodynamics. 3D-RISM-KH has been coupled with multiple time-step (MTS) MD of the solute biomolecule driven by effective solvation forces, which are obtained analytically by converging the 3D-RISM-KH integral equations at outer time-steps and are calculated in between by using solvation force coordinate extrapolation (SFCE) in the subspace of previous solutions to 3D-RISM-KH. The procedure is stabilized by the optimized isokinetic Nosé–Hoover (OIN) chain thermostatting, which enables gigantic outer time-steps up to picoseconds to accurately calculate equilibrium properties. The multiscale OIN/SFCE/3D-RISM-KH algorithm is implemented in the Amber package and illustrated on a fully flexible model of alanine dipeptide in aqueous solution, exhibiting the computational rate of solvent sampling 20 times faster than standard MD with explicit solvent. Further substantial acceleration can be achieved with 3D-RISM-KH efficiently sampling essential events with rare statistics such as exchange and localization of solvent, ions, and ligands at binding sites and pockets of the biomolecule. 3D-RISM-KH was coupled with ab initio complete active space self-consistent field (CASSCF) and orbital-free embedding (OFE) Kohn–Sham (KS) density functional theory (DFT) quantum chemistry methods in an SCF description of electronic structure, optimized geometry, and chemical reactions in solution. The (OFE)KS-DFT/3D-RISM-KH multi-scale method is implemented in the Amsterdam Density Functional (ADF) package and extensively validated against experiment for solvation thermochemistry, photochemistry, conformational equilibria, and activation barriers of various nanosystems in solvents and ionic liquids (ILs). Finally, the replica RISM-KH-VM molecular theory for the solvation structure, thermodynamics, and electrochemistry of electrolyte solutions sorbed in nanoporous materials reveals the molecular mechanisms of sorption and supercapacitance in nanoporous carbon electrodes, which is drastically different from a planar electrical double layer.
The Role of Civil Society in Cambodia's Peace-building Process
Authors: Dosch Jörn
Published: January 2013

The aid dependence of Cambodian NGOs has resulted in a predominantly donor-driven peace-building process. Notwithstanding some crucial reconciliation initiatives that predate donor involvement and are rooted in local—often Buddhist—traditions, recent key initiatives in the area of transitional justice would not have happened without significant international funding and support.
Electrospun nylon nanofibers for polymer composites
Authors: Albañil-Sánchez Loyda , Cruz-Silva Rodolfo , Piza-Betancourt Jose Luis , Romo-Uribe Angel
Published: January 2013

Engineered polymer nanofibers are materials with high potential to form composite materials. Electrospinning is a technique that allows preparation of such fibers with a high degree of nanometric scale control. This study explores the preparation of polymer nanocomposites reinforced with nylon nanofibers through impregnation. The polymer matrix consists of water soluble polymers, and engineering polymers for structure and electronic applications such as polyvinylidine pyrrolidone, PP and poly-dimethyl siloxane, respectively. The procedure involves deposition of the electrospun nylon nanofibers on a substrate. Fiber orientation and morphology were studied using scanning electron microscopy and small-angle light scattering, and mechanical properties were studied under uniaxial tensile deformation. The results showed that preparation of nanocomposites using nylon nanofibers is feasible, and the nanofibers significantly improved the mechanical properties of the polymer matrix.
Examining Errors in Simple Spreadsheet Modeling from Different Research Perspectives
Authors: Kadijevich Djordje M.
Published: January 2013

By using a sample of 1st-year undergraduate business students, this study dealt with the development of simple (deterministic and non-optimization) spreadsheet models of income statements within an introductory course on business informatics. The study examined students' errors in doing this for business situations of their choice and found three kinds of errors: errors in selecting variables, errors in initializing variables, and errors in relating variables. This article describes these errors, discusses possible reasons for them from different research perspectives, and gives suggestions for further practice and research. These perspectives dealt with modeling with spreadsheets, spreadsheets as mindtools, and errors in operational spreadsheets. The article is primarily directed to teachers of modeling with spreadsheets, interested in taking a broader view of the subject.
Educational Transitions in the United States: Reflections on the American Dream
Authors: Crawford Paul T.
Published: January 2013

Education involves socialization so that individuals become productive members of society. At present, in the United States, educational transitions are primarily viewed in terms of their location in an outcomes-oriented process and framed as helping people achieve the American Dream, but in terms of the status quo national economic interest. But what about US residents who are unwilling to accommodate this particular worldview or its component ethos? Current conceptualizations of educational transitions in the United States favour economic efficiency and national security. However, new demographic realities will necessitate a revised notion of national security, one that is based on social inclusion. Consider, for example, the burgeoning Latino population in the United States. Will the current offer of education remain as valid in 2020 or 2050 when the nation has become a patchwork of minority populations? Individual choice at the moment of educational transition in the United States is increasingly framed as a zero-sum calculus: conform to the status quo or risk marginalization. The educational system is being co-opted by narratives associated with standard gross domestic product (GDP) metrics. The metrics used to guide and warrant educational policy and practice need to be widened so that educational assessment is based on the ‘context of human lives’. Despite an uneven record of cultural and ethnic injustice, the United States has narrative-based resources that support social inclusion. At the heart of the nation's orienting narrative is a quandary: how to balance a sense of manifest destiny with an understanding that our future is uncertain and sustainable only by joining many human capabilities?
Prevalence of white spot lesion formation during orthodontic treatment
Authors: Julien Katie C. , Buschang Peter H. , Campbell Phillip M.
Published: January 2013

Purpose:

To quantify the prevalence of white spot lesions (WSLs) on the anterior teeth and, secondarily, to evaluate risk factors and predictors.

Materials and Methods:

Digital photographs and records of 885 randomly chosen patients were evaluated before and after treatment. Chart information included gender, age, as well as banding and debanding dates. Fluorosis and oral hygiene before and after treatment were also evaluated. Preexisting and posttreatment WSLs were recorded and compared for all 12 anterior teeth. Risk ratios (RR) and absolute risk (AR) were calculated to determine the likelihood and risk of WSL formation.

Results:

Overall, 23.4% of the patients developed at least one WSL during their course of treatment. Maxillary anterior teeth were affected more than mandibular teeth. The maxillary laterals and canines and the mandibular canines were the most susceptible. There was no significant difference in WSLs between genders. Fluorosis, treatment time in excess of 36 months, poor pretreatment hygiene, hygiene changes during treatment, and preexisting WSLs were all significantly (P < .05) related to the development of WSLs. The highest risk of developing WSLs was associated with preexisting WSLs (RR = 3.40), followed by declines in oral hygiene during treatment (RR = 3.12) and poor pretreatment oral hygiene (RR = 2.83).

Conclusions:

Nearly 25% of the patients developed WSLs while in treatment, depending on fluorosis, treatment time, preexisting WSLs, and oral hygiene. Orthodontists need to be mindful of these risk factors when making treatment decisions.
Epigenetic Regulation of Adipogenesis by PHF2 Histone Demethylase
Authors: Okuno Yosuke , Ohtake Fumiaki , Igarashi Katsuhide , Kanno Jun , Matsumoto Takahiro , Takada Ichiro , Kato Shigeaki , Imai Yuuki
Published: December 2012

PHF2 is a JmjC family histone demethylase that removes the methyl group from H3K9me2 and works as a coactivator for several metabolism-related transcription factors. In this study, we examined the in vivo role of PHF2 in mice. We generated Phf2 floxed mice, systemic Phf2 null mice by crossing Phf2 floxed mice with CMV-Cre transgenic mice, and tamoxifen-inducible Phf2 knockout mice by crossing Phf2 floxed mice with Cre-ERT2 transgenic mice. Systemic Phf2 null mice had partial neonatal death and growth retardation and exhibited less adipose tissue and reduced adipocyte numbers compared with control littermates. Tamoxifen-induced conditional knockout of PHF2 resulted in impaired adipogenesis in stromal vascular cells from the adipose tissue of tamoxifen-inducible Phf2 knockout mice as well as of Phf2 knocked-down 3T3-L1 cells. PHF2 interacts with CEBPA and demethylates H3K9me2 in the promoters of CEBPA-regulated adipogenic genes. These findings suggest that PHF2 histone demethylase potentiates adipogenesis through interaction with CEBPA in vivo. Taken together, PHF2 may be a novel therapeutic target in the treatment of obesity and the metabolic syndrome.
Intracerebroventricular Administration of C-Type Natriuretic Peptide Suppresses Food Intake via Activation of the Melanocortin System in Mice
Authors: Yamada-Goto Nobuko , Katsuura Goro , Ebihara Ken , Inuzuka Megumi , Ochi Yukari , Yamashita Yui , Kusakabe Toru , Yasoda Akihiro , Satoh-Asahara Noriko , Ariyasu Hiroyuki , Hosoda Kiminori , Nakao Kazuwa
Published: December 2012

C-type natriuretic peptide (CNP) and its receptor are abundantly distributed in the brain, especially in the arcuate nucleus (ARC) of the hypothalamus associated with regulating energy homeostasis. To elucidate the possible involvement of CNP in energy regulation, we examined the effects of intracerebroventricular administration of CNP on food intake in mice. The intracerebroventricular administration of CNP-22 and CNP-53 significantly suppressed food intake on 4-h refeeding after 48-h fasting. Next, intracerebroventricular administration of CNP-22 and CNP-53 significantly decreased nocturnal food intake. The increment of food intake induced by neuropeptide Y and ghrelin was markedly suppressed by intracerebroventricular administration of CNP-22 and CNP-53. When SHU9119, an antagonist for melanocortin-3 and melanocortin-4 receptors, was coadministered with CNP-53, the suppressive effect of CNP-53 on refeeding after 48-h fasting was significantly attenuated by SHU9119. Immunohistochemical analysis revealed that intracerebroventricular administration of CNP-53 markedly increased the number of c-Fos–positive cells in the ARC, paraventricular nucleus, dorsomedial hypothalamus, ventromedial hypothalamic nucleus, and lateral hypothalamus. In particular, c-Fos–positive cells in the ARC after intracerebroventricular administration of CNP-53 were coexpressed with α-melanocyte–stimulating hormone immunoreactivity. These results indicated that intracerebroventricular administration of CNP induces an anorexigenic action, in part, via activation of the melanocortin system.
Sterol Regulatory Element-Binding Factor 2 (SREBF-2) Predicts 7-Year NAFLD Incidence and Severity of Liver Disease and Lipoprotein and Glucose Dysmetabolism
Authors: Musso Giovanni , Cassader Maurizio , Bo Simona , De Michieli Franco , Gambino Roberto
Published: December 2012

We prospectively assessed the impact of a sterol regulatory element-binding factor-2 (SREBF-2) polymorphism on the risk of developing nonalcoholic fatty liver disease (NAFLD) and on liver histology and lipoprotein and glucose metabolism in biopsy-proven NAFLD. In a population-based study, we followed 175 nonobese, nondiabetic participants without NAFLD or metabolic syndrome at baseline, characterized for the SREBF-2 rs133291 C/T polymorphism, dietary habits, physical activity, adipokines, C-reactive protein (CRP), and endothelial adhesion molecules. A comparable cohort of NAFLD patients underwent liver biopsy, an oral glucose tolerance test with minimal model analysis to yield glucose homeostasis parameters, and an oral fat tolerance test with measurement of plasma lipoproteins, adipokines, and cytokeratin-18 fragments. After 7 years, 27% of subjects developed NAFLD and 5% developed diabetes. SREBF-2 predicted incident NAFLD and diabetes and CRP and endothelial adhesion molecule changes. In biopsy-proven NAFLD patients, SREBF-2 predicted nonalcoholic steatohepatitis (odds ratio 2.92 [95% CI 2.08–4.18], P = 0.002) and the severity of tissue insulin resistance, β-cell dysfunction, and oral fat intolerance (characterized by higher postprandial lipemia, cholesterol enrichment of triglyceride-rich lipoproteins and oxidized LDLs, HDL cholesterol fall, adipokine imbalance, and postprandial apoptosis activation). An SREBF-2 polymorphism predisposes individuals to NAFLD and associated cardiometabolic abnormalities and affects liver histology and glucose and lipid metabolism in biopsy-proven NAFLD.
Evidence of a Causal Relationship Between Adiponectin Levels and Insulin Sensitivity
Authors: Gao He , Fall Tove , van Dam Rob M. , Flyvbjerg Allan , Zethelius Björn , Ingelsson Erik , Hägg Sara
Published: December 2012

The adipocyte-secreted protein adiponectin is associated with insulin sensitivity in observational studies. We aimed to evaluate whether this relationship is causal using a Mendelian randomization approach. In a sample of Swedish men aged 71 years (n = 942) from the Uppsala Longitudinal Study of Adult Men (ULSAM), insulin sensitivity (M/I ratio) was measured by the euglycemic insulin clamp. We used three genetic variants in the ADIPOQ locus as instrumental variables (IVs) to estimate the potential causal effect of adiponectin on insulin sensitivity and compared these with results from conventional linear regression. The three ADIPOQ variants, rs17300539, rs3774261, and rs6444175, were strongly associated with serum adiponectin levels (all P ≤ 5.3 × 10−9) and were also significantly associated with M/I ratio in the expected direction (all P ≤ 0.022). IV analysis confirmed that genetically determined adiponectin increased insulin sensitivity (β = 0.47–0.81, all P ≤ 0.014) comparable with observational estimates (β = 0.50, all Pdifference ≥ 0.136). Adjustment for BMI and waist circumference partly explained the association of both genetically determined and observed adiponectin levels with insulin sensitivity. The observed association between higher adiponectin levels and increased insulin sensitivity is likely to represent a causal relationship partly mediated by reduced adiposity.
Metabolic Signatures of Human Adipose Tissue Hypoxia in Obesity
Authors: Hodson Leanne , Humphreys Sandy M. , Karpe Fredrik , Frayn Keith N.
Published: December 2012

Adipose tissue (AT) hypoxia has been proposed as the cause of obesity-related AT dysfunction, moving the tissue toward a proinflammatory phenotype. In humans, AT oxygenation has been assessed by expression of hypoxia-sensitive genes or direct assessment of O2 tension; the obvious read out of hypoxia, effects on intermediary metabolism, has not been investigated. We used tissue-specific venous catheterization of subcutaneous abdominal AT in humans to investigate oxygen-related metabolic processes, searching for metabolic signatures relating to hypoxia in obesity. O2 delivery to AT was reduced in obesity (P < 0.05). However, O2 consumption was low (<30% of resting forearm skeletal muscle [SM], P < 0.001); this was not related to obesity. AT primarily oxidized glucose, as demonstrated by a respiratory quotient close to 1.0 (higher than SM, P < 0.05). AT was a net producer of lactate, but there was an inverse relationship in venous outflow between lactate-to-pyruvate ratio (a marker of cytosolic redox state) and BMI, suggesting that AT is glycolytic but obese AT is not hypoxic. Although delivery of O2 to the obese AT is reduced, O2 consumption is low, and metabolic signatures of human AT do not support the notion of a hypoxic state in obesity.
Alloantibody and Autoantibody Monitoring Predicts Islet Transplantation Outcome in Human Type 1 Diabetes
Authors: Piemonti Lorenzo , Everly Matthew J. , Maffi Paola , Scavini Marina , Poli Francesca , Nano Rita , Cardillo Massimo , Melzi Raffaella , Mercalli Alessia , Sordi Valeria , Lampasona Vito , Espadas de Arias Alejandro , Scalamogna Mario , Bosi Emanuele , Bonifacio Ezio , Secchi Antonio , Terasaki Paul I.
Published: December 2012

Long-term clinical outcome of islet transplantation is hampered by the rejection and recurrence of autoimmunity. Accurate monitoring may allow for early detection and treatment of these potentially compromising immune events. Islet transplant outcome was analyzed in 59 consecutive pancreatic islet recipients in whom baseline and de novo posttransplant autoantibodies (GAD antibody, insulinoma-associated protein 2 antigen, zinc transporter type 8 antigen) and donor-specific alloantibodies (DSA) were quantified. Thirty-nine recipients (66%) showed DSA or autoantibody increases (de novo expression or titer increase) after islet transplantation. Recipients who had a posttransplant antibody increase showed similar initial performance but significantly lower graft survival than patients without an increase (islet autoantibodies P < 0.001, DSA P < 0.001). Posttransplant DSA or autoantibody increases were associated with HLA-DR mismatches (P = 0.008), induction with antithymocyte globulin (P = 0.0001), and pretransplant panel reactive alloantibody >15% in either class I or class II (P = 0.024) as independent risk factors and with rapamycin as protective (P = 0.006) against antibody increases. DSA or autoantibody increases after islet transplantation are important prognostic markers, and their identification could potentially lead to improved islet cell transplant outcomes.
Relationship Between Markers of Insulin Resistance, Markers of Adiposity, HbA1c, and Cognitive Functions in a Middle-Aged Population–Based Sample: the MONA LISA Study
Authors: Sanz Caroline M. , Ruidavets Jean-Bernard , Bongard Vanina , Marquié Jean-Claude , Hanaire Hélène , Ferrières Jean , Andrieu Sandrine
Published: December 2012

OBJECTIVE

To determine the relationship between markers of insulin resistance (fasting insulin and homeostasis model assessment of insulin resistance), markers of adiposity (BMI, waist circumference, and body fat), HbA1c, and cognitive performances in a middle-aged population–based sample free of diabetes.

RESEARCH DESIGN AND METHODS

Our study sample consisted of 1,172 people aged 35–64 years (49% women), free of diabetes, and recruited between 2005 and 2007 in the MONA LISA survey. Cognitive functions (memory, attention, and processing speed) were evaluated by neuropsychological tests: word-list learning test, digit symbol substitution test (DSST), word fluency test, and Stroop Test. Multiple logistic regressions were used to estimate the relationship between cognitive performance and metabolic markers. We serially adjusted for age, sex, education, and occupational status (model A), additionally for income, smoking, alcohol consumption, sedentarity, and psychotropic substance use (model B), and finally, included variables linked to the metabolic syndrome (hypertension, dyslipidemia, vascular disease, and C-reactive protein) and depression (model C).

RESULTS

Elevated markers of adiposity were associated with poor cognitive performance in tests evaluating processing speed. The probability of being in the lowest quartile of each test was nearly doubled for participants in the upper quartile of BMI, compared with those in the lowest one [BMI, adjusted odds ratio (OR) 2.18, P = 0.003 (DSST), and OR 2.09, P = 0.005 (Stroop Test)]. High HbA1c was associated with poor cognitive performance in DSST (adjusted OR 1.75, P = 0.037). Waist circumference was linked to poor cognitive performance in men but not in women.

CONCLUSIONS

Poor cognitive performance is associated with adiposity and hyperglycemia in healthy middle-aged people.
Associations of Insulin Resistance With Cardiovascular Risk Factors and Inflammatory Cytokines in Normal-Weight Hispanic Women
Authors: Vella Chantal A. , Burgos Ximena , Ellis Carla J. , Zubia Raul Y. , Ontiveros Diana , Reyes Hector , Lozano Claudia
Published: December 2012

OBJECTIVE

To investigate the associations of markers of insulin resistance with cardiovascular disease risk factors and inflammation in young, normal-weight, Hispanic women.

RESEARCH DESIGN AND METHODS

Seventy-one normal-weight (BMI <25 kg/m2) Hispanic women (age, 20–39 years) participated in a fasting blood draw for glucose, insulin, lipids, and inflammatory markers; a glucose tolerance test; anthropometric and blood pressure measurements; body composition by dual-energy x-ray absorptiometry; and measurements of cardiorespiratory fitness via Vo2max and daily physical activity by accelerometer.

RESULTS

Six percent of participants had impaired fasting glucose, 14% had impaired glucose tolerance, and 48% had at least one cardiovascular disease risk factor. Homeostasis model assessment of insulin resistance (HOMA-IR) and fasting insulin were positively correlated with glucose, triglycerides, systolic blood pressure, and diastolic blood pressure, and were negatively correlated with adiponectin (P < 0.05). The 2-h insulin was positively correlated with diastolic blood pressure, triglycerides, and high-sensitivity C-reactive protein. HOMA-IR and fasting insulin remained significantly and positively related to glucose, triglycerides, and blood pressure after adjustment for body composition. The relationships between markers of insulin resistance and adiponectin and high-sensitivity C-reactive protein were attenuated after adjustment for body composition.

CONCLUSIONS

Surrogate markers of insulin resistance were associated with cardiovascular disease risk factors and inflammation in young, normal-weight, Hispanic women. Our findings suggest that HOMA-IR, fasting, and 2-h insulin may be important clinical markers for identifying young, normal-weight, Hispanic women who may be at risk for development of type 2 diabetes and cardiovascular disease. Our findings show the importance of early screening for prevention of type 2 diabetes and cardiovascular disease in this population.
Cholesterol Metabolism After Bariatric Surgery in Grade 3 Obesity
Authors: Benetti Alberto , Del Puppo Marina , Crosignani Andrea , Veronelli Annamaria , Masci Enzo , Frigè Francesca , Micheletto Giancarlo , Panizzo Valerio , Pontiroli Antonio E.
Published: December 2012

OBJECTIVE

Malabsorptive bariatric surgery (biliopancreatic diversion and biliointestinal bypass [BIBP]) reduces serum cholesterol levels more than restrictive surgery (adjustable gastric banding [AGB]), and this is thought to be due to greater weight loss. Our aim was to evaluate the changes of cholesterol metabolism induced by malabsorptive and restrictive surgery independent of weight loss.

RESEARCH DESIGN AND METHODS

In a nonrandomized, self-selected, unblinded, active-comparator, bicenter, 6-month study, glucose metabolism (blood glucose and serum insulin levels and homeostasis model assessment of insulin resistance [HOMA-IR] index) and cholesterol metabolism (absorption: serum campesterol and sitosterol levels; synthesis: serum lathosterol levels; catabolism: rate of appearance and serum concentrations of serum 7-α- and serum 27-OH-cholesterol after infusions of deuterated 7-α- and 27-OH-cholesterol in sequence) were assessed in grade 3 obesity subjects undergoing BIBP (n = 10) and AGB (n = 10). Evaluations were performed before and 6 months after surgery.

RESULTS

Subjects had similar values at baseline. Weight loss was similar in the two groups of subjects, and blood glucose, insulin levels, HOMA-IR, and triglycerides decreased in a similar way. In contrast, serum cholesterol, LDL cholesterol, non-HDL cholesterol, serum sitosterol, and campesterol levels decreased and lathosterol levels increased only in BIBP subjects, not in AGB subjects. A significant increase in 7-α-OH-cholesterol occurred only with BIBP; serum 27-OH-cholesterol decreased in both groups.

CONCLUSIONS

Malabsorptive surgery specifically affects cholesterol levels, independent of weight loss and independent of glucose metabolism and insulin resistance. Decreased sterol absorption leads to decreased cholesterol and LDL cholesterol levels, accompanied by enhanced cholesterol synthesis and enhanced cholesterol catabolism. Compared with AGB, BIBP provides greater cholesterol lowering.
The Association Between Hepatic Fat Content and Liver Injury in Obese Children and Adolescents
Authors: Santoro Nicola , Feldstein Ariel E. , Enoksson Erik , Pierpont Bridget , Kursawe Romy , Kim Grace , Caprio Sonia
Published: December 2012

OBJECTIVE

Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH) are highly prevalent in obese youth. Herein, we aimed to study the association between hepatic fat accumulation as assessed by magnetic resonance imaging and circulating levels of cytokeratin-18 (CK-18) fragments, a robust NASH biomarker, and to explore the impact on this association of ethnicity, insulin resistance, and single nucleotide polymorphisms (SNPs) associated with steatosis (rs738409 in the PNPLA3, rs1260326 in the GCKR) or NASH severity (rs2645424 in the FDFT1).

RESEARCH DESIGN AND METHODS

Two-hundred twenty-nine obese youths (87 Caucasians, 61 African Americans, and 81 Hispanics; mean age, 12.8 ± 2.9 years; mean BMI, 31.4 ± 7.4) underwent magnetic resonance imaging, oral glucose tolerance test, and CK-18 levels measurement; 12 subjects underwent liver biopsy.

RESULTS

African Americans showed lower CK-18 levels than Hispanics (P < 0.001) and Caucasians (P = 0.004). Hepatic fat content (HFF%) and whole body insulin sensitivity index (WBISI) modulated CK-18 levels in Caucasians and Hispanics (P = 0.02 and P = 0.011), but not in African Americans; in fact, CK-18 was associated with HFF% and WBISI in Caucasians (P = 0.0018 and P < 0.0001) and Hispanics (P < 0.0001 and P = 0.02), but not in African Americans (both P = 0.5). The PNPLA3 SNP showed association in Caucasians (P = 0.02) and Hispanics (P = 0.05), and FDFT1 SNP showed an association in Caucasians (P = 0.05) and Hispanics (P = 0.02), with the same trend in African Americans (P = 0.07).

CONCLUSIONS

African Americans have lower levels of CK-18 than Caucasians and Hispanics irrespective of HFF% and insulin resistance. Moreover, SNPs in the PNPLA3 and FDFT1 may drive the individual predisposition to development of hepatic injury.
Improvements in robot navigation through operator speech preferences
Authors: Cassenti Daniel N. , Kelley Troy D. , Yagoda Rosemarie E. , Avery Eric
Published: December 2012

The capability to use voice commands to control robots offer an intriguing possibility to increase the efficiency with which robotic operators may give commands. This study consists of two experiments that investigate how robot operators prefer to speak to robots in a search-and-find task and to evaluate which mode of speaking generates the greatest performance. Experiment 1 revealed that operators used selective exocentric references when available to direct a confederate acting as a robot. Experiment 2 revealed that with the same exocentric references operators showed improved performance while directing an actual robot as compared with egocentric-only commands. Experiment 2 also revealed that performing a dual task was less detrimental to performance when using exocentric commands as compared to egocentric commands. Suggestions for improvements to a robot control system that follow from these results include developing recognition of structural properties of an indoor environment and improving map incorporation.
Development and Validation of a Self-Report Lower-Extremity Lymphedema Screening Questionnaire in Women
Authors: Yost Kathleen J. , Cheville Andrea L. , Weaver Amy L. , Al Hilli Mariam , Dowdy Sean C.
Published: January 2013

Background

Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema.

Objective

The purpose of this study was to develop and assess the diagnostic accuracy of a screening questionnaire to detect lower-extremity lymphedema (LEL) among normal-weight women and women with obesity.

Design

This was a cross-sectional survey study.

Methods

The authors reviewed existing questionnaires assessing upper-extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists who specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail to 186 women with clinically confirmed LEL (n=116) or UEL (n=70). A total of 99 women (53.2% of 186) completed the mailed survey, and 28 women with lymphedema who were recruited directly in a lymphedema clinic waiting area also completed the survey. A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL and positive and negative likelihood ratios (LR+, LR−) were estimated for the entire sample and for subsamples defined by obesity (body mass index ≥30 versus <30 kg/m2), which may confound the accurate diagnosis of LEL.

Results

Questionnaires were completed by 127 women (LEL group, n=88; UEL group, n=39). A sum of 13 items (score range=0–52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively (LR+=7.1, LR−=0.05), and 94.8% and 76.5%, respectively (LR+=4.0, LR−=0.07), for participants who were obese.

Limitations

By enumerating a sample with a high prevalence of LEL, a spectrum bias may have been introduced, which may have affected the accuracy of the screening questionnaire.

Conclusions

The brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among women, including those with a body mass index of ≥30 kg/m2.
Cesarean Section without Urethral Catheterization: A Randomized Control Trial
Authors: Acharya S , Uprety DK , Pokharel HP , Amatya R , Rai R
Published: January 2013

Background Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay. Objective To determine the feasibility and safety of cesarean section without urethral catheterization. Methods A prospective, randomized controlled trial was carried out from April 2008 to March 2009, in the Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences. Among 150 patients who had undergone cesarean section 75 were catheterized and 75 were uncatheterized. Results First void discomfort was significantly associated with the use of indwelling catheter (OR 6.95, CI 95 %, 3.74 to 12.95; P< 0.001).Significant number of patients with indwelling catheter had signs and symptoms of urinary tract infection (OR 6,CI 95%, 2.59 to 13. 86; P < 0.001). Positive urinalysis for urinary tract infection was high in catheterized group (P <0.001). Hospital stay was shorter in patients without catheter (p < 0.05). None of the patients had bladder injury. There were no significant differences in duration of surgery and ambulation time between two groups of patients. Conclusions Cesarean section can be done safely without urethral catheterization with reduced morbidities. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 18-22 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7337
Antibiotic Usage and its Sensitivity Pattern in the NICU
Authors: Shrestha R , Shrestha JM , Gurung B
Published: January 2013

Background Sepsis is a major cause of mortality and morbidity in newborns affecting both developed and developing countries accounting a quarter around one million deaths per annum. Objective This study was aimed to assess the prevalence of neonatal sepsis, culture isolates, pattern, antibiotic sensitivity and drug prescribing pattern. Methods In present prospective study, 48 neonates admitted in pediatric ward from January to March 2011 of Dhulikhel Hospital were included. The gestation age, onset of sepsis, culture isolates, antibiotic sensitivity pattern and drug prescribing pattern were studied. Environmental air sampling of NICU (Neonatal Intensive Care Unit) was done by settle plate method for microbial examination. Result Among 48 neonates, 23 (47.92%) neonates were culture positive with predominant isolates of Klebsiella oxytoca 11(47.83%), Pseudomonas spp. 4(17.39%), Methicillin Resistant Staphylococcus Aureus (MRSA) 3(13.04%) and single case of Enterobacter spp. In environmental samples, K. oxytoca and Enterobacter spp. were isolated. Amikacin, Imepeneum and Ciprofloxacin were sensitive whereas Ampicillin in combination with Cloxacillin, Ampicillin, Aztreonam were resistant for Klebsiella. oxytoca. Amikacin, Ceftazidime and Imipenuem are sensitive to Enterobacter spp. The single or combinations of resistant antibiotics were found to be prescribed. Conclusion The emerging antibiotic resistances among the culture isolates and coherence with environmental samples were observed. Hence, special measures are imperative for reducing environmental contamination and the rational usage of antibiotics for preventing the infection and emerging antibiotic resistance. The study recommends need of the antibiotic policy to curb the present scenario. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 27-32 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7339
Perception About the Role of Anesthesia and Anesthesiologist Among the Paramedical Staffs: Perspective from a Medical College in Nepal
Authors: Bhattarai B , Kandel S , Adhikari N
Published: January 2013

Background Anesthesiologists and anesthesia has been considered behind the scene. The image and status of anesthesiologist in the eyes of the medical and lay communities has always been a problem. Objectives This study was designed to assess the knowledge about the role of anesthesiologist among the paramedical staffs at Kathmandu University Hospital. Methods This prospective questionnaire based study was done at Kathmandu University School of Medical Science, Dhulikhel Hospital for 2nd January 2011 to 30th Jan 2011 among the paramedical staffs working in different department of the hospital. Results There were 150 questionnaire distributed out of which 120 responded. Mean Age was 23.33 and most of the respondents were female with majority having education qualification equivalent to intermediate level. Only 49.20 said it to be a different specialty and 72.5% said anaesthesiologist work differently in the theatre where as 70% knew anaesthesiologist did something in the post-operative period too. Conclusion Anesthesiologists have duty to visit patient’s pre operatively and post operatively. The role inside the theatre and expanding role outside the theatre is poorly known. The awareness about the role of anesthesiologist in operation theatre, in intensive care unit, acute and chronic pain management and emergency care areas should be highlighted to all the staffs. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 51-54 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7344
Perceptions and Care Seeking Behavior of Obstetric Complication in Thailand
Authors: Sharma SK , Vong-Ek P
Published: January 2013

Background Importance of maternal health has been recognized over the last decade, however information about the perception of illness and healthcare behavior of obstetric complication is lacking. Objective This study assesses women’s knowledge, perception, and experience of obstetric complication and care-seeking behavior and explores the factors associated with the morbidity and the constraints hindering them from seeking timely care. Methods Twenty one in-depth interviews on the perceptions, experience and care seeking behavior related to pregnancy and delivery of Women at Kanchanaburi Demographic Surveillance site of Thailand were conducted. A structured guideline was first prepared in English and translated into Thai language. An interpreter was hired to interview women at the Thai-Myanmar border to translate Thai into local language. A moderator note-taker, and interpreter were present throughout the interview period and tape recorded the conversation. Results In-depth interview revealed that even though quality maternal health care was accessible to most of the women, obstetric complication was prevalent and they were not seeking appropriate care specifically in highland. Too early and too late marriage, frequent child bearing, poverty, hard work, poor nutrition and traditional practices were the reasons for complications. Poor transportation, lack of health insurance, inadequate training of health personnel, poor health facilities and the perception that the complications are normal for pregnant women were the main reasons for not seeking appropriate care. Conclusions Perceived reasons for complications among women living in Kanchanaburi, Thailand were early marriage, frequent childbearing, hard work, poor nutrition and traditional practices. The constraints hindering them from seeking care for the complications were perceived to be the lack of access to health personnel, health facilities, and proper transportation. These issues seemed to be related to poverty. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 63-70 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7347
Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations
Authors: Koutourousiou Maria , Gardner Paul A. , Fernandez-Miranda Juan C. , Paluzzi Alessandro , Wang Eric W. , Snyderman Carl H.
Published: January 2013

Object

Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique.

Methods

The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome.

Results

Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1–114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up.

Conclusions

Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.