bluuebunny/crossref_metadata_2025 huggingface dataset:
Clearance of Free Silica in Rat Lungs by Spraying with Chinese Herbal Kombucha
Authors: Fu Nai-fang , Luo Chang-hui , Wu Jun-cai , Zheng Yan-yan , Gan Yong-jin , Ling Jian-an , Liang Heng-qiu , Liang Dan-yu , Xie Jing , Chen Xiao-qin , Li Xian-jun , Pan Rui-hui , Chen Zuo-Xing , Jiang Sheng-jun
Published: August 2013

The effects of spraying with kombucha and Chinese herbal kombucha were compared with treatments with tetrandrine in a rat silicosis model. Silica dust (50 mg) was injected into the lungs of rats, which were then treated with one of the experimental treatments for a month. The rats were then killed and the effects of the treatments were evaluated by examining the extent and severity of the histopathological lesions in the animals’ lungs, measuring their organ coefficients and lung collagen contents, determining the dry and wet weights of their lungs, and measuring the free silica content of the dried lungs. In addition, lavage was performed on whole lungs taken from selected rats, and the numbers and types of cells in the lavage fluid were counted. The most effective treatment in terms of the ability to reduce lung collagen content and minimize the formation of pulmonary histopathological lesions was tetrandrine treatment, followed by Chinese herbal kombucha and non-Chinese herbal kombucha. However, the lavage fluid cell counts indicated that tetrandrine treatment had severe adverse effects on macrophage viability. This effect was much less pronounced for the kombucha and Chinese herbal kombucha treatments. Moreover, the free silica levels in the lungs of animals treated with Chinese herbal kombucha were significantly lower than those for any other silica-exposed group. These preliminary results indicate that spraying with Chinese herbal kombucha preparations can effectively promote the discharge of silica dust from lung tissues. Chinese herbal kombucha inhalation may thus be a useful new treatment for silicosis and other pneumoconiosis diseases.
Spontaneous Retroperitoneal Hemorrhage in a Patient with Prolymphocytic Transformation of Chronic Lymphocytic Leukemia
Authors: Davies Gwynivere A. , Lazo-Langner Alejandro , Shkrum Michael , Minuk Leonard
Published: August 2013

Prolymphocytic transformation of chronic lymphocytic leukemia is a rare but recognized entity. We present the case of a 76-year-old gentleman with a previous diagnosis of chronic lymphocytic leukemia who presented with fatigue, fever, and a white blood cell count of 500 000 with prolymphocytes on peripheral blood examination. Chlorambucil and dexamethasone were initiated. He developed progressive anemia during his admission with no clear cause on initial CT examination. Bilateral hip pain began several days later and he was unfortunately diagnosed with a large spontaneous retroperitoneal hemorrhage postmortem. This condition is rare and generally occurs in those receiving therapeutic anticoagulation or dialysis, with known bleeding disorders or vascular malformation, none of which were present in our patient. Pathology revealed marked leukemoid engorgement of the vessels of many organs with prolymphocytes. We discuss the potential etiologies and relationships between these critical diagnoses.
Transjugular Retrograde Obliteration prior to Liver Resection for Hepatocellular Carcinoma Associated with Hyperammonemia due to Spontaneous Portosystemic Shunt
Authors: Chikamori Fumio , Kuniyoshi Nobutoshi
Published: August 2013

A 67-year-old woman had hepatocellular carcinoma (HCC) measuring 3.7 cm at S8 of the liver with hyperammonemia due to a spontaneous giant mesocaval shunt. Admission laboratory data revealed albumin, 2.9 g/dL; total bilirubin, 1.3 mg/dL; plasma ammonia level (NH3), 152 g/dL; total bile acid (TBA) 108.5 μmoL/L; indocyanine green retention rate at 15 min (ICG15), 63%. Superior mesenteric arterial portography revealed a hepatofugal giant mesocaval shunt, and the portal vein was not visualized. Before surgery, transjugular retrograde obliteration (TJO) for the mesocaval shunt was attempted to normalize the portal blood flow. Via the right internal jugular vein, a 6 F occlusive balloon catheter was inserted superselectively into the mesocaval shunt. The mesocaval shunt was successfully embolized using absolute ethanol and a 50% glucose solution. Eleven days after TJO, NH3, TBA, and ICG15 decreased to 56, 44, and 33, respectively. Superior mesenteric arterial portography after TJO revealed a hepatopetal portal flow. Partial hepatectomy of S8 was performed 25 days after TJO. The subsequent clinical course showed no complications, and the woman was discharged on postoperative day 14. We conclude that the combined therapy of surgery and TJO is an effective means of treating HCC with hyperammonemia due to a spontaneous portosystemic shunt.
Optic Disc Swelling and Vision Loss in a Patient with Cystic Fibrosis and Diabetes
Authors: Iosfina Ioulia , Chuo Jean Y. , Godinho Derek V. , Wilcox Pearce G. , Kreisman Stuart H. , Quon Bradley S.
Published: August 2013

Advances in cystic fibrosis management have significantly improved life expectancy in these patients. However, we are now faced with a growing number of long-term extrapulmonary consequences of this disease, including ophthalmic complications of diabetes in cystic fibrosis patients. We present a unique report that documents a case of diabetic papillopathy progressing to nonarteritic anterior ischemic optic neuropathy resulting in vision loss in a patient with CF and diabetes. It highlights the potentially devastating consequences of longstanding diabetes in CF patients.
Experimental Investigations on Microcracks in Vibrational and Conventional Drilling of Cortical Bone
Authors: Wang Yu , Cao Meng , Zhao Yuanyuan , Zhou Gang , Liu Wenyong , Li Deyu
Published: August 2013

Bone drilling is widely used in orthopedic surgery. Microcracks will be generated in bone drilling, which may cause fatigue damages and stress fractures. Fresh bovine cortical bones were drilled via vibrational and conventional ways. Drilling operations were performed by a dynamic material testing machine, which can provide the vibration while maintaining uniform feed motion. The drill site and bone debris were observed through scanning electron microscope (SEM). The experimental results showed that fewer and shorter micro‐cracks were formed in vibrational drilling than those formed in conventional way. And the surface morphology of bone debris from two different drilling ways was also quite different. It is expected that vibrational drilling in orthopedic surgery operation could decrease the microdamage to the bone, which could lower the incidence of stress fracture and contribute to the postoperative recovery.
Nonleukemic Ureteral Granulocytic Sarcoma Presenting with Unilateral Urinary Obstruction and Hematuria
Authors: Acar Ömer , Esen Tarık , Tecimer Tülay , Çetiner Mustafa , Peker Önder , Musaoğlu Ahmet
Published: August 2013

Granulocytic sarcoma is an extramedullary tumor which is composed of myeloblasts and immature myeloid cells. It usually occurs in association with acute myeloid leukemia and most commonly involves skin, soft tissue, lymph nodes, bone, and periosteum. We report a case of isolated ureteral granulocytic sarcoma without hematologic manifestations. Our patient presented with bloody urine and left-sided lumbar pain. Preoperative clinical and radiologic features raised the suspicion of an upper urinary tract transitional cell carcinoma, and he was scheduled for nephroureterectomy. However, perioperative pathologic feedback and the unusual endoscopic appearance of the tumor altered our surgical strategy towards segmental ureterectomy and ureteroneocystostomy. Eventual pathologic diagnosis was granulocytic sarcoma of the ureter. Postoperative workup failed to demonstrate any sign of an accompanying hematologic disorder. He started receiving the chemotherapy protocol of acute myeloblastic leukemia. To our knowledge, this is the first documented case of nonleukemic ureteral granulocytic sarcoma which came to attention due to urologic complaints.
“Values That Vanish into Thin Air”: Nurses' Experience of Ethical Values in Their Daily Work
Authors: Bentzen Gro , Harsvik Anita , Brinchmann Berit Støre
Published: August 2013

The objective of this study was to examine how nurses experience ethical values as they are expressed in daily practice in a Norwegian hospital. A growing focus in Western healthcare on effectiveness, production, and retrenchment has an influence on professional nursing standards and nursing values. Lack of resources and subsequent ethically difficult prioritizations imply a strain on nurses. This study is qualitative. Data collection was carried out by conducting 4 focus group interviews. The data was analyzed using content analysis. The results are presented in two main themes: (1) values and reflection are important for the nurses; (2) time pressure and nursing frustrations in daily work. The results demonstrate that nurses believe the ethical values to be of crucial importance for the quality of nursing; however, the ethical values are often repressed in daily practice. This results in feeling of frustration, fatigue, and guilty conscience for the nurses. There is a need for changes in the system which could contribute to the development of a caring culture that would take care of both patients and nurses. In an endeavour to reach this goal, one could apply caritative leadership theory, which is grounded on the caritas motive, human love, and mercy.
Cellular Kinetics of Perivascular MSC Precursors
Authors: Chen William C. W. , Park Tea Soon , Murray Iain R. , Zimmerlin Ludovic , Lazzari Lorenza , Huard Johnny , Péault Bruno
Published: August 2013

Mesenchymal stem/stromal cells (MSCs) and MSC-like multipotent stem/progenitor cells have been widely investigated for regenerative medicine and deemed promising in clinical applications. In order to further improve MSC-based stem cell therapeutics, it is important to understand the cellular kinetics and functional roles of MSCs in the dynamic regenerative processes. However, due to the heterogeneous nature of typical MSC cultures, their native identity and anatomical localization in the body have remained unclear, making it difficult to decipher the existence of distinct cell subsets within the MSC entity. Recent studies have shown that several blood-vessel-derived precursor cell populations, purified by flow cytometry from multiple human organs, give rise tobona fideMSCs, suggesting that the vasculature serves as a systemic reservoir of MSC-like stem/progenitor cells. Using individually purified MSC-like precursor cell subsets, we and other researchers have been able to investigate the differential phenotypes and regenerative capacities of these contributing cellular constituents in the MSC pool. In this review, we will discuss the identification and characterization of perivascular MSC precursors, including pericytes and adventitial cells, and focus on their cellular kinetics: cell adhesion, migration, engraftment, homing, and intercellular cross-talk during tissue repair and regeneration.
Course of Irritability, Depression and Apathy in Huntington's Disease in Relation to Motor Symptoms during a Two-Year Follow-Up Period
Authors: van Duijn Erik , Reedeker Nanda , Giltay Erik J. , Eindhoven Daniëlle , Roos Raymund A.C. , van der Mast Rose C.
Published: August 2013

Background: Irritability, depression and apathy are frequently reported neuropsychiatric symptoms of Huntington's disease (HD). Objective: This study investigated the course of irritability, depression and apathy in HD during a 2-year follow-up period. Methods: In 121 HD mutation carriers the presence of irritability, depression and apathy was measured with the Problem Behaviours Assessment (PBA). Multivariate linear regression analysis was performed to assess their relationships with the change of the motor score of the Unified Huntington's Disease Rating Scale (UHDRS-m) in premotor symptomatic (n = 46) and motor symptomatic mutation carriers (n = 75). Results: The median depression score of all participants decreased (p = 0.002), whereas irritability and apathy scores did not change significantly. In the total group of mutation carriers, a borderline significant association was found between an increase in motor symptoms and an increase in irritability (p = 0.05), and a trend was found for the association between an increase in motor symptoms and a decrease in depression (p = 0.06). Only in the at baseline premotor symptomatic mutation carriers was an increase in motor symptoms significantly related to an increase in irritability (p = 0.02). Conclusion: An increase in motor symptoms in the at baseline premotor symptomatic mutation carriers is related to an increase in irritability, which may be an early and sensitive marker for disease progression.
Tractography-Guided Stimulation of Somatosensory Fibers for Thalamic Pain Relief
Authors: Hunsche Stefan , Sauner Dieter , Runge Matthias J.R. , Lenartz Doris , El Majdoub Faycal , Treuer Harald , Sturm Volker , Maarouf Mohammad
Published: August 2013

Background: The spinothalamocortical tract (STC) is seen as a neural tract responsible for or involved in the generation or transmission of thalamic pain. Either the thalamus itself or the posterior limb of the internal capsule (PLIC) are targets for deep brain stimulation (DBS) in patients with thalamic pain, but due to its low contrast, conventional MRI cannot visualize the STC directly. Objectives: To show the feasibility of integrating diffusion tensor imaging-based tractography into the stereotactic treatment planning for identification of an object-oriented lead trajectory that allows STC-DBS with multiple electrode contacts. Methods: Diffusion tensor imaging was performed in 4 patients with thalamic pain. The STC was modeled and integrated into the stereotactic treatment planning for DBS. DBS-lead implantation was done according to trajectory planning along the modeled STC at the level of the PLIC. Results: After implantation, electrode stimulation was possible over a length of more than 20 mm with a tractography-based trajectory along the PLIC part of the STC. After a follow-up of 12 months, pain relief of more than 40% was achieved in 3 of 4 patients with rating on a visual analogue scale. In 1 patient, stimulation failed to reach any long-lasting positive effects. Conclusions: Integrating tractography data into stereotactic planning of DBS in thalamic pain is technically feasible. It can be used to identify a lead trajectory that allows for multiple contact stimulation along the STC at the level of the PLIC. Due to long-lasting positive stimulation effect, tractography-guided stimulation of sensory fibers seems to be beneficial for thalamic pain relief.
Transient Global Amnesia Associated with Accidental High-Frequency Stimulation of the Right Hippocampus in Deep Brain Stimulation for Segmental Dystonia
Authors: Baezner Hansjörg , Blahak Christian , Capelle H. Holger , Schrader Christoph , Lütjens Götz , Krauss Joachim K.
Published: August 2013

We report on a 66-year-old woman with segmental dystonia treated with chronic bilateral deep brain stimulation of the globus pallidus internus, in whom accidental high-voltage, high-frequency stimulation induced an episode of transient global amnesia (TGA) via an electrode contact which was misplaced in the right hippocampus. A possible mechanism underlying this TGA episode may have been the inhibition of local neuronal activity or fiber activation by high current density via direct electrical stimulation of hippocampal structures. While a unifying etiology of TGA has not been proven so far, our case demonstrates a possible link between focal electrical stimulation of hippocampal structures and the full clinical picture of the syndrome.
Olfactory Bulb and Hypothalamic Acute-Phase Responses to Influenza Virus: Effects of Immunization
Authors: Zielinski Mark R. , Souza Gianne , Taishi Ping , Bohnet Stewart G. , Krueger James M.
Published: August 2013

Background: Within hours of intranasal challenge, mouse-adapted H1N1 A/Puerto Rico/8/34 (PR8) influenza genomic RNA is found in the olfactory bulb (OB) and OB pro-inflammatory cytokines are up-regulated. Severing the olfactory tract delays the acute-phase response (APR) and the APR is attenuated by immunization. Objectives: To determine if immunization affects OB localization of influenza or the molecular brain mechanisms regulating APR. Methods: Male mice were immunized with PR8 influenza, then OB viral RNA, APR, and influenza-related cytokine responses were determined after homologous viral challenge. Results: Immunization did not prevent influenza OB viral invasion within 24 h of viral challenge. However, it greatly attenuated OB viral RNA 6 days after viral challenge and the APR including hypothermia and body weight loss responses. Within the OB, 24 h after influenza challenge, prior immunization blocked virus-induced up-regulation of toll-like receptor 7 and interferon (IFN) γ mRNAs. At this time, hypothalamic (HT) growth hormone-releasing hormone receptor and tumor necrosis factor-α mRNAs were greatly enhanced in immunized but not in positive control mice. By 6 days after viral challenge, OB and HT mRNAs returned towards baseline values. In the lung, mRNA up-regulation was greater than that in the brain and maximized 6 days after challenge. Lung IFNγ mRNA decreased at 24 h but increased 6 days after challenge in the positive compared to negative controls. Immunization prevented the up-regulation of most of the flu-related mRNAs measured in lungs. Conclusion: Collectively, these data suggest a role for OB and HT involvement in immunization protection against influenza infection.
Successfully Treated Abdominal Pregnancy Causing Hemoperitoneum Using Combined Surgical and Systemic Methotrexate Therapy: A Case Report and Review of Cases Treated at Kyushu University Hospital
Authors: Yasutake Nobuko , Tsunematsu Ryosuke , Oishi Hiroko , Yahata Hideaki , Uchida Soko , Kobayashi Hiroaki , Kato Kiyoko
Published: August 2013

Abdominal pregnancy is a rare condition that accounts for only 1% of all ectopic pregnancies but results in high maternal morbidity and mortality. We present a case of abdominal pregnancy with massive peritoneal bleeding successfully treated using systemic methotrexate (MTX). A 34-year-old woman with amenorrhea for 8 weeks and a positive pregnancy test was referred for evaluation of ectopic pregnancy. Transvaginal ultrasonographic scan showed a gestational sac measuring 25 mm in diameter containing a viable embryo in the cul-de-sac and a considerable amount of free fluid in the patient's lower abdomen and pelvis. Laboratory parameters showed that her hemoglobin concentration was 5.8 g/dl and serum human chorionic gonadotropin concentration was 13,195 mIU/ml. Emergency surgery revealed an abdominal pregnancy in the cul-de-sac and a massive intra-abdominal hemorrhage. After a hemostasis procedure, the patient was successfully treated using systemic MTX. We also present the review of abdominal pregnancy cases treated using systemic MTX at our institution over 10 years. Systemic MTX treatment for abdominal pregnancy is safe and effective and makes it possible to avoid the risk of excessive bleeding by surgical resection of the implantation site.
Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis - A Review
Authors: Kenn K. , Gloeckl R. , Behr J.
Published: August 2013

Among the various types of interstitial lung diseases, idiopathic pulmonary fibrosis (IPF) is the most common disorder and has a poor prognosis and a limited response to pharmacological treatment. In patients with IPF, functional exercise tolerance and quality of life have been shown to be significantly decreased. Current IPF guidelines suggest only a weak recommendation for pulmonary rehabilitation (PR). However, PR is regarded as a reasonable choice for the majority of patients with IPF. This review will summarize all of the available studies that have investigated the effects of PR in patients with IPF so far. Although only a small number of studies have been published to date, most studies have found significant short-term improvements in functional exercise capacity, quality of life, and level of perceived dyspnea. Long-term improvements or maintenance strategies of PR in IPF patients have not been adequately investigated yet. Up to now there is still no sufficient evidence for the recommendation of PR in IPF. However, physical training seems to be the major component of all PR programs. The current review will discuss potential exercise training regimens for patients with IPF and suggest additional useful modalities of a specific multidisciplinary PR program for IPF patients. Based on the current literature and our own experience, this article will try to highlight the importance of PR as an additional, beneficial therapeutic option for patients with IPF.
A Case of Adult Type 1 Gaucher Disease Complicated by Temporal Intestinal Hemorrhage
Authors: Ito Junitsu , Saito Takafumi , Numakura Chikahiko , Iwaba Akiko , Sugahara Shinpei , Ishii Rika , Sato Chikako , Haga Hiroaki , Okumoto Kazuo , Nishise Yuko , Watanabe Hisayoshi , Ida Hiroyuki , Hayasaka Kiyoshi , Togashi Hitoshi , Kawata Sumio , Ueno Yoshiyuki
Published: August 2013

A 21-year-old man with a history of sudden rectal hemorrhage was referred to our hospital. Examination disclosed thrombocytopenia and hepatosplenomegaly. A liver biopsy specimen demonstrated Gaucher cells in Glisson's capsule. Additional investigations revealed a low level of leukocyte β-glucosidase activity and common mutations of the glucocerebrosidase gene, L444P/D409H. We diagnosed the patient with Gaucher disease type 1. He underwent enzyme replacement therapy. Thrombocytopenia and hepatosplenomegaly improved at a rate of approximately 50 and 20%, respectively, within 6 months. This case suggests that we must pay attention to adult Gaucher disease as a differential diagnosis for cryptogenic thrombocytopenia.
Heuchera lakelae (Saxifragaceae), a new species from the Sierra La Marta and Sierra Coahuilón, Coahuila and Nuevo León, Mexico
Authors: FOLK RYAN
Published: August 2013

Described herein is a new species from high-elevation limestone outcrops in the northern Sierra Madre Oriental, closely allied to Heuchera sanguinea, from which it is distinguished on the basis of 6 morphological characters (external flower surface color and indumentum, petal color, petal shape, stamen exsertion, and overall flower shape) as well restriction to high elevations and a geographical range restricted to the Sierra la Marta and Sierra Coahuilón.
Three decades to connect the sexes: Calatola microcarpa (Icacinaceae), a new species from the Southwestern Amazon
Authors: DE STEFANO RODRIGO DUNO , JANOVEC JOHN P. , CAN LILIA LORENA
Published: August 2013

A new species of Calatola (Icacinaceae), C. microcarpa, from the departments of Loreto and Madre de Dios, Peru, and the state of Acre, Brazil, is described and illustrated. The new taxon is well documented with staminate and pistillate flowers, and fruits. Its small leaves and fruit are similar to those found in Calatola laevigata and C. uxpanapensis. It is also compared with Calatola costaricensis, with which it sometimes grows sympatrically in Brazil and Peru. The conservation status of the new taxa is assessed against IUCN criteria.
The aphid genus Aphthargelia Hottes (Hemiptera: Aphididae), with one new species
Authors: JENSEN ANDREW S.
Published: August 2013

A new species of the previously monotypic aphid genus Aphthargelia is described and the genus reviewed. The new species, A. rumbleboredomia is heteroecious, alternating between host plants in Symphoricarpos and Aconogonon in the mountains of northwestern North America. Descriptive notes on A. symphoricarpi are given, along with diagnostic features for separating the two species of the genus. A key to related genera is presented, and biological information on both species of Aphthargelia is summarized.
A Possible Larva of Lepicerus inaequalis Motschulsky (Coleoptera: Myxophaga: Lepiceridae) from Panama
Authors: LAWRENCE JOHN F. , ŚLIPIŃSKI ADAM , BEUTEL ROLF G. , NEWTON ALFRED F.
Published: August 2013

A larva is described which is presumed to be that of Lepicerus inaequalis Motschulsky based on several probable first instars and one later instar collected a few miles from and in a similar habitat to adult specimens of this species. The association is additionally based on several features also occurring in other known myxophagan larvae. A key is provided comparing these larvae with those of the other three families of Myxophaga.
Causes and Predictability of the 2012 Great Plains Drought
Authors: Hoerling M. , Eischeid J. , Kumar A. , Leung R. , Mariotti A. , Mo K. , Schubert S. , Seager R.
Published: August 2013

Central Great Plains precipitation deficits during May–August 2012 were the most severe since at least 1895, eclipsing the Dust Bowl summers of 1934 and 1936. Drought developed suddenly in May, following near-normal precipitation during winter and early spring. Its proximate causes were a reduction in atmospheric moisture transport into the Great Plains from the Gulf of Mexico. Processes that generally provide air mass lift and condensation were mostly absent, including a lack of frontal cyclones in late spring followed by suppressed deep convection in the summer owing to large-scale subsidence and atmospheric stabilization.

Seasonal forecasts did not predict the summer 2012 central Great Plains drought development, which therefore arrived without early warning. Climate simulations and empirical analysis suggest that ocean surface temperatures together with changes in greenhouse gases did not induce a substantial reduction in sum mertime precipitation over the central Great Plains during 2012. Yet, diagnosis of the retrospective climate simulations also reveals a regime shift toward warmer and drier summertime Great Plains conditions during the recent decade, most probably due to natural decadal variability. As a consequence, the probability of the severe summer Great Plains drought occurring may have increased in the last decade compared to the 1980s and 1990s, and the so-called tail risk for severe drought may have been heightened in summer 2012. Such an extreme drought event was nonetheless still found to be a rare occurrence within the spread of 2012 climate model simulations. The implications of this study's findings for U.S. seasonal drought forecasting are discussed.
Hydrologic Implications of Different Large-Scale Meteorological Model Forcing Datasets in Mountainous Regions
Authors: Mizukami Naoki , P. Clark Martyn , G. Slater Andrew , D. Brekke Levi , M. Elsner Marketa , R. Arnold Jeffrey , Gangopadhyay Subhrendu
Published: August 2013

Process-based hydrologic models require extensive meteorological forcing data, including data on precipitation, temperature, shortwave and longwave radiation, humidity, surface pressure, and wind speed. Observations of precipitation and temperature are more common than other variables; consequently, radiation, humidity, pressure, and wind speed often must be either estimated using empirical relationships with precipitation and temperature or obtained from numerical weather prediction models. This study examines two climate forcing datasets using different methods to estimate radiative energy fluxes and humidity and investigates the effects of the choice of forcing data on hydrologic simulations over the mountainous upper Colorado River basin (293 472 km2). Comparisons of model simulations forced by two climate datasets illustrate that the methods used to estimate shortwave radiation impact hydrologic states and fluxes, particularly at high elevation (e.g., ~20% difference in runoff above 3000-m elevation), substantially altering the timing of snowmelt and runoff (~20 days difference) and the partitioning of precipitation between evapotranspiration and runoff. The different forcing datasets also exhibit differences in hydrologic sensitivity to interannual temperature at high elevation. The results suggest that the choice of forcing dataset is an important consideration when conducting climate impact assessments and the subsequent applications of these assessments for water resources planning and management.
Acute myocardial infarction in pregnancy following unlicensed use of methylenedioxymethamphetamine (‘ecstasy’)
Authors: Okunoye GO , Dutton P
Published: August 2013

Acute myocardial infarction is rare in pregnancy; however, the emerging trend towards advanced maternal age and the rising prevalence of obesity and diabetes suggest that more cases of myocardial infarction are likely to be encountered in pregnancy. However, there is scanty evidence on the risk of myocardial infarction with regard to socially misused substances in pregnancy. We describe the management of a case of acute myocardial infarction following unlicensed use of 3,4-methylenedioxymethamphetamine (‘Ecstasy’) in pregnancy. The case highlights a rare but serious risk associated with substance misuse in pregnancy.
Improvement in symptoms of peripheral arterial disease with sildenafil therapy
Authors: Turtle EJ , Drummond ID , Webb DJ
Published: August 2013

A 57-year-old man presented with symptoms of intermittent claudication and was diagnosed with peripheral arterial disease. He was advised to stop smoking and start a walking programme. He had a background history of hypercholesterolaemia and erectile dysfunction, for which he was taking simvastatin and phosphodiesterase type-5 inhibitor sildenafil, respectively. After starting his exercise programme, he noted that his walking distance was more than doubled on the mornings after taking sildenafil, and he has been using sildenafil primarily for shopping trips since that time. Although this single-patient self-experiment has the potential for placebo confounding, the patient was not led to expect this benefit, and there is evidence that reduced nitric oxide bioactivity plays an important role in the pathophysiology of peripheral arterial disease. Given the biological plausibility of this effect, we feel that a randomised, blinded and placebo-controlled clinical study is warranted to confirm the benefit of phosphodiesterase type-5 inhibitors in peripheral arterial disease.
Perceived tutor benefits of teaching near peers: insights from two near peer teaching programmes in South East Scotland
Authors: Qureshi ZU , Gibson KR , Ross MT , Maxwell S
Published: August 2013

Background and aims

There is little evidence about the benefits to junior doctors of participating in teaching, or how to train doctors as teachers. We explore (through South East Scotland based teaching programmes): (a) How prepared do junior doctors feel to teach? (b) What junior doctors consider to be the main challenges of teaching? (c) What motivates the junior doctors to continue teaching, and what is the perceived impact of teaching on their professional development?

Methods and results

‘Questionnaire 1’, distributed at ‘tutor training days’, explored (i) attitudes towards teaching and (ii) tutors’ preparedness to teach. ‘Questionnaire 2’, distributed after completion of a teaching programme, evaluated the tutor experience of teaching.

Results

Seventy-six per cent of tutors reported no previous teacher training; 10% were able to teach during allocated work hours. The strongest motivation for teaching was to help students with their learning and to develop teaching skills. Ninety one per cent of tutors felt more prepared to teach by the end of the programme. Tutors also improved their clinical skills from teaching.

Conclusions

There is a body of junior doctors, who see teaching as an important part of their career, developing both teaching and clinical skills in the tutor. If teaching is expected of foundation doctors, rotas ought to be more flexible to facilitate both teaching and teacher training.
Nineteenth century mortality at the Royal Hospital for Sick Children, Glasgow
Authors: Cullis PS , Young DG
Published: August 2013

Background and aims

Since Glasgow’s Royal Hospital for Sick Children opened in 1882, significant advances have been made in child health. Our aim was to investigate the hospital mortality that occurred in the last decade of the 19th century at Royal Hospital for Sick Children.

Methods and results

Hospital mortality records for the decades, 1890–1899, were collected from the Archives of the Royal Hospital for Sick Children. Data were extracted from the hospital inpatient records and the pathology records. In the decade 1890–1899, there were 731 hospital deaths. The main cause of death at that time in the 19th Century was infection, particularly of the respiratory tract. The age at which death occurred was analysed and the recorded cause were analysed as was the distance patients travelled to the hospital. The ratio of boys to girls and length of inpatient stay was similar to that seen in the hospital currently.

Conclusion

This study records the mortality in a children’s hospital in a large developing industrial city in the 19th century as experienced in a children’s hospital.
The epidemiology and management of adult poisonings admitted to the short-stay ward of a large Scottish emergency department
Authors: Teo AIC , Cooper JG
Published: August 2013

Background and aims

The emergency department of Aberdeen Royal Infirmary receives around 68,000 new adult admissions annually. All poisoning cases are admitted to a 14-bedded short-stay ward, except those admitted to intensive care or immediately discharged. This study aimed to analyse epidemiological trends and management of short-stay ward admissions for poisonings.

Method and results

Adult (>13 years) poisoning presentations admitted to the emergency department short-stay ward of Aberdeen Royal Infirmary from 1 January–31 December 2009 were retrospectively reviewed using patient discharge summaries. During 2009, there were 1062 poisoning cases, of which repeat episodes were responsible for 15%. The mean age of presentation was 33.9 years (SD 14.4) and there was a female preponderance (62%). Almost half of poisonings were polypharmacy, alcohol was involved in 40% of cases and overdoses most commonly involved paracetamol (43%). Management involved basic observations only (66%), N-acetylcysteine (24%), naloxone (4%) and activated charcoal (1%). Liaison psychiatry reviewed 84% presentations and admitted 9% to the psychiatric unit.

Conclusions

The short-stay ward is important for acute management of poisonings and the data gained from this study should help to direct patient services appropriately.
The role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in the management of patients with carcinoma of unknown primary
Authors: Deonarine P , Han S , Poon FW , de Wet C
Published: August 2013

Purpose

Carcinoma of unknown primary is one of the ten most frequent cancers worldwide. Its median survival time is less than 10 months. Detecting primary tumour locations and/or occult metastatic lesions may inform definitive treatment and improve patients’ prognosis. We aimed to determine: (1) the sensitivity, specificity and accuracy of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography; (2) its detection rate of primary tumour locations and occult metastases and (3) factors associated with improved survival times.

Methods

We retrospectively reviewed all cases in the West of Scotland for the period 1 December 2007 to 31 May 2011 that met all our selection criteria: (1) diagnosis of carcinoma of unknown primary; (2) a thorough but negative ‘work-up’ and (3) 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography report. Statistical methods included frequencies, Kaplan-Meier graphs and log-rank tests to compare survival times.

Results

18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected primary tumour sites in 19/51 (37.3%) and occult metastases in 28/51 (54.9%) of eligible patients. Its sensitivity, specificity and accuracy were 79.2%, 70.4% and 74.5%, respectively; 20/51 (39.2%) patients died during the study period with a median survival of 8.4 months (range 21.4, SD ± 6.2). The number of metastatic locations was strongly associated with survival ( p = 0.002), but detection of a primary tumour site ( p = 0.174) or histopathology ( p = 0.301) was not.

Conclusion

18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected occult metastatic sites in the majority and a primary cancer location in a substantial minority of patients. Our results were comparable with international literature and may indicate that 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography have an early role to improve the accuracy of cancer staging and to optimise carcinoma of unknown primary management.
Future (Un)Relatedness between Goddess and Christian Feminism and a Jewish Feminist – Past, Present and Future
Authors: Gur Klein Thalia
Published: August 2013

My purpose in this article is twofold. I wish to discuss the rift between Jewish feminists and Christian feminists and their Goddess peers, aiming to grapple with points of dispute, alienation and disparity. I equally aspire to find shared grounds; even where agreement is impossible, to raise a greater insight into Judaism beyond irreducible divides, and enhance mutual understanding and respect. By mutual respect I mean that not only shared grounds should build bridges; bridges should be built where homologous identity is missing. While leaving a space for disagreements, irreducible edges and differences; it is when divides are irreducible that mutual respect is most needed, though most difficult to find. Bridges over both shared and unshared grounds are the future of relations, as awareness of differences and open contention can widen reciprocal understanding of our separate worlds.
Internet-Based Physical Activity Interventions
Authors: Joseph Rodney P. , Durant Nefertiti H. , Benitez Tanya J. , Pekmezi Dorothy W.
Published: August 2013

This article provides a comprehensive review of Internet– and Website–based physical activity interventions targeting adult populations. Search procedures identified 72 unique Internet-based physical activity interventions published in peer-reviewed journals. Participants of the studies were predominately White, middle-aged (mean age = 43.3 years), and female (65.9%). Intervention durations ranged from 2 weeks to 13 months (median = 12 weeks). Forty-six of the studies were randomized controlled trials, 21 were randomized trials without a control condition, 2 were non–randomized controlled trials, and 3 used a single-group design. The majority of studies (n = 68) assessed outcomes immediately following the end of the intervention period, and 16 studies provided delayed postintervention assessments. Forty-four of the 72 studies (61.1%) reported significant increases in physical activity. Future directions for Internet-based physical activity interventions include increasing representation of minority and male populations in Internet-based efforts, conducting delayed postintervention follow-up assessments, and incorporating emerging technologies (ie, cellular and Smartphones) into Internet-based physical activity efforts.
Inflammatory myofibroblastic tumor with extensive involvement of the bladder in an adolescent: a case report
Authors: Yi Xin Lin , Lu Hao Yuan , Wu Yue Xian , Li Wen Hui , Meng Qing Gui , Cheng Ji Weng , Tang Yong , Liu Yu , Bai Xian Zhong
Published: August 2013

Inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear pathogenesis that shows a wide, highly variable spectrum of clinical behavior. We describe the case of a 17-year-old boy with a large IMT that infiltrated the bladder, ileocecal junction, peritoneum and pelvic retroperitoneal space. The tumor was associated with extensive toughening and thickening of the bladder, and, although it showed a tendency for invasive growth, it affected mainly the bladder and adjacent tissue. To the best of our knowledge, this case report is the first to describe an IMT involving the entire bladder and several adjacent pelviabdominal organs. The bladder wall was tough and could hardly be cut by scalpel. Levels of inflammatory response markers such as C-reactive protein fell after surgery.
Evaluating protocols and analytical methods for peptide adsorption experiments
Authors: Fears Kenan P , Petrovykh Dmitri Y , Clark Thomas D
Published: August 2013

This paper evaluates analytical techniques that are relevant for performing reliable quantitative analysis of peptide adsorption on surfaces. Two salient problems are addressed: determining the solution concentrations of model GG–X–GG, X5, and X10 oligopeptides (G = glycine, X = a natural amino acid), and quantitative analysis of these peptides following adsorption on surfaces. To establish a uniform methodology for measuring peptide concentrations in water across the entire GG–X–GG and Xn series, three methods were assessed: UV spectroscopy of peptides having a C-terminal tyrosine, the bicinchoninic acid (BCA) protein assay, and amino acid (AA) analysis. Due to shortcomings or caveats associated with each of the different methods, none were effective at measuring concentrations across the entire range of representative model peptides. In general, reliable measurements were within 30% of the nominal concentration based on the weight of as-received lyophilized peptide. In quantitative analysis of model peptides adsorbed on surfaces, X-ray photoelectron spectroscopy (XPS) data for a series of lysine-based peptides (GGKGG, K5, and K10) on Au substrates, and for controls incubated in buffer in the absence of peptides, suggested a significant presence of aliphatic carbon species. Detailed analysis indicated that this carbonaceous contamination adsorbed from the atmosphere after the peptide deposition. The inferred adventitious nature of the observed aliphatic carbon was supported by control experiments in which substrates were sputter-cleaned by Ar+ ions under ultra-high vacuum (UHV) then re-exposed to ambient air. In contrast to carbon contamination, no adventitious nitrogen species were detected on the controls; therefore, the relative surface densities of irreversibly-adsorbed peptides were calculated by normalizing the N/Au ratios by the average number of nitrogen atoms per residue.
X-ray and neutron investigation of self-assembled lipid layers on a titanium surface
Authors: Golub Maksym , Lott Dieter , Watkins Erik B , Garamus Vasyl , Luthringer Berengere , Stoermer Michael , Schreyer Andreas , Willumeit Regine
Published: August 2013

Titanium is the most widely preferred metal material for bone reconstruction in orthopedics and dentistry. To improve its biological performance, various coatings can be applied. In this investigation, a biomimetic coating on a model implant surface was studied in X-ray and neutron reflectivity experiments to probe the quality of this coating, which is only few nanometers thick. Titanium was deposited on polished silicon surfaces using a magnetron sputtering technique. To improve the lipid coating’s stability, a stronger van der Waals interaction was first created between the implant surface and the biomimetic coating by adding a phosphonic acid (n-octadecylphosphonic acid – OPA) monolayer onto the surfaces. Then, three monolayers of POPE (phospholipid 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-ethanolamine) were transferred using the Langmuir-Blodgett (LB) and Langmuir-Schaefer (LS) techniques. The analysis of X-ray and neutron specular reflectivity data shows that OPA molecules cover the model implant surface completely and that approximately 50% coverage of POPE can be achieved by LB and LS transfer.
Evaluating a community-based early childhood education and development program in Indonesia: study protocol for a pragmatic cluster randomized controlled trial with supplementary matched control group
Authors: Pradhan Menno , Brinkman Sally A , Beatty Amanda , Maika Amelia , Satriawan Elan , de Ree Joppe , Hasan Amer
Published: August 2013

Background

This paper presents the study protocol for a pragmatic cluster randomized controlled trial (RCT) with a supplementary matched control group. The aim of the trial is to evaluate a community-based early education and development program launched by the Government of Indonesia. The program was developed in collaboration with the World Bank with a total budget of US$127.7 million, and targets an estimated 738,000 children aged 0 to 6 years living in approximately 6,000 poor communities. The aim of the program is to increase access to early childhood services with the secondary aim of improving school readiness.

Methods/Design

The study is being conducted across nine districts. The baseline survey contained 310 villages, of which 100 were originally allocated to the intervention arm, 20 originally allocated to a 9-month delay staggered start, 100 originally allocated to an 18-month delay staggered start and 90 allocated to a matched control group (no intervention). The study consists of two cohorts, one comprising children aged 12 to 23 months and the other comprising children aged 48 to 59 months at baseline. The data collection instruments include child observations and task/game-based assessments as well as a questionnaire suite, village head questionnaire, service level questionnaires, household questionnaire, and child caretaker questionnaire. The baseline survey was conducted from March to April 2009, midline was conducted from April to August 2010 and endline conducted early 2013. The resultant participation rates at both the district and village levels were 90%. At the child level, the participation rate was 99.92%. The retention rate at the child level at midline was 99.67%.

Discussion

This protocol paper provides a detailed record of the trial design including a discussion regarding difficulties faced with compliance to the randomization, compliance to the dispersion schedule of community block grants, and procurement delays for baseline and midline data collections. Considering the execution of the program and the resultant threats to the study, we discuss our analytical plan and intentions for endline data collection.

Trials registration

Current Controlled Trials ISRCTN76061874
Steroids or pentoxifylline for alcoholic hepatitis (STOPAH): study protocol for a randomised controlled trial
Authors: Forrest Ewan , Mellor Jane , Stanton Louise , Bowers Megan , Ryder Priscilla , Austin Andrew , Day Christopher , Gleeson Dermot , O’Grady John , Masson Steven , McCune Anne , Patch David , Richardson Paul , Roderick Paul , Ryder Stephen , Wright Mark , Thursz Mark
Published: August 2013

Background

Alcoholic hepatitis is the most florid presentation of alcohol-related liver disease. In its severe form, defined by a Maddrey’s discriminant function (DF) ≥32, the 28-day mortality rate is approximately 35%. A number of potential treatments have been subjected to clinical trials, of which two, corticosteroids and pentoxifylline, may have therapeutic benefit. The role of corticosteroids is controversial as trial results have been inconsistent, whereas the role of pentoxifylline requires confirmation as only one previous placebo-controlled trial has been published.

Methods/design

STOPAH is a multicentre, double-blind, factorial (2 × 2) trial in which patients are randomised to one of four groups:

Group A: placebo / placebo

Group B: placebo / prednisolone

Group C: pentoxifylline / placebo

Group D: pentoxifylline / prednisolone

The trial aims to randomise 1,200 patients with severe alcoholic hepatitis, in order to provide sufficient power to determine whether either of the two interventions is effective. The primary endpoint of the study is mortality at 28 days, with secondary endpoints being mortality at 90 days and 1 year.

Discussion

STOPAH aims to be a definitive study to resolve controversy around the existing treatments for alcoholic hepatitis. Eligibility criteria are based on clinical parameters rather than liver biopsy, which are aligned with standard clinical practice in most hospitals. The use of a factorial design will allow two treatments to be evaluated in parallel, with efficient use of patient numbers to achieve high statistical power.

Trial registration

EudraCT reference number: 2009-013897-42

ISRCTN reference number: ISRCTN88782125