bluuebunny/crossref_metadata_2025 huggingface dataset:
PAIN DISTRIBUTION PATTERN IN GLUTEAL-RELATED LOW BACK PAIN: A PROPOSED PATHO-ANATOMICAL APPROACH USING GLUTEAL TRIANGLE
Authors: Bello Ajediran I. , Foli Margret A. , Adegoke Babatunde O. A.
Published: October 2011

Purpose: Different assessment strategies for radiating low back pain (LBP) abound across and within primary-contact disciplines yet physical diagnosis of the involved faulty anatomical structures remain difficult. This study investigated pattern of pain distribution in patients with gluteal-related low back pain. Methods: The study involved forty (40) participants with radiating low back pain who were referred for physiotherapy from two major referral clinical settings in Ghana. They were recruited into the cross-sectional survey through consecutive sampling technique. Using marker and transparent tracing sheet, gluteal triangle was outlined from the lumbar region, the involved gluteal region and the posterior part of the involved thigh. Pattern of pain distribution was noted and physically correlated with stereotype patterns of pressure points as gold standard. Data analysis involved mean, frequency distribution, percentage distributions and z-score. Alpha value was considered significant at p < 0.05. Results: The mean ages, year (SD) were 52.0 years (12.0) and 48 years (15) for male and female, respectively. Myofascial and piriformis syndromes were the most predominant presentations among the patients recording 13 (32.5%) and 10 (25%), respectively. Male group recorded 9 (22.5%) of pain originating from myofascial syndrome compared to 4 (10%) assessed in their female counterparts. There was no gender difference in the proportion of pattern of pain distribution among the participants. Conclusion: This study demonstrated different patterns of pain distribution and was found to be consistent with gold standard pressure point in the assessment of patients with radiating LBP, thus it can be included as complimentary diagnostic tool in clinical practice.
A NOTE ON STABILITY OF ERROR BOUNDS IN STATISTICAL LEARNING THEORY
Authors: LI MING , CAPONNETTO ANDREA
Published: October 2011

We consider a wide class of error bounds developed in the context of statistical learning theory which are expressed in terms of functionals of the regression function, for instance, its norm in a reproducing kernel Hilbert space or other functional space. These bounds are unstable in the sense that a small perturbation of the regression function can induce an arbitrary large increase of the relevant functional and make the error bound useless. Using a known result involving Fano inequality, we show how stability can be recovered.
THREE NON-ZERO SOLUTIONS FOR ELLIPTIC NEUMANN PROBLEMS
Authors: D'AGUÌ GIUSEPPINA , MOLICA BISCI GIOVANNI
Published: October 2011

In this note we obtain a multiplicity result for an eigenvalue Neumann problem. Precisely, a recent critical point result for differentiable functionals is exploited, in order to prove the existence of a determined open interval of positive eigenvalues for which the problem admits at least three non-zero weak solutions.
MOLECULAR DYNAMICS STUDY OF THE INTERFACE-STRUCTURE FORMATION OF A COPPER/SILVER BILAYER
Authors: XU Z. H. , YUAN L. , SHAN D. B. , GUO B. , DONG H. S. , LI X. Y.
Published: October 2011

The formation of the interface of a Cu/Ag bilayer during sputtering was studied with molecular dynamics simulations with EAM potential. The results show that the first deposited Ag layer grows on the Cu substrate by the layer mode, while the first deposited Cu layer grows on the Ag substrate by the island mode for both the (111) and (001) orientated growth. The film is epitaxial up to the coverage, reaching about 10 monolayers except for Cu growth on Ag (001). Ag atoms in the (001) orientated substrate diffuse into the Cu film for a longer distance compared to other cases. The interface is sharp and exhibits a (9 × 9) superstructure with hexagonal moiré pattern for both Ag growth on Cu (111) and Cu growth on Ag (111). The displacement of the superposed Cu atoms contributes to the corrugation of the interface for both cases. A c(10 × 2) superstructure forms when Ag grows on Cu (001). When Cu is deposited on Ag (001), partial dislocations are activated near the interface, and a great number of stacking faults form in the Cu film with the significantly curved interface.
MODELING OF FAILURE FEATURES FOR TiN COATINGS WITH DIFFERENT SUBSTRATE MATERIALS
Authors: WANG S. , LIN J. , BALINT D.
Published: October 2011

A set of continuum viscoplastic damage constitutive equations is presented in this paper. The equations are calibrated for a TiN coating material, and a number of substrate materials, and are implemented into the commercial finite element (FE) solver, ABAQUS, through the user-defined material subroutine, VUMAT, for FE simulation. An FE model has been created to simulate a load-bearing test. Studies are carried out to investigate failure features of the coating with variations in coating thickness for three different substrate materials: pure copper, a gear steel and a tool steel. It has been demonstrated that the proposed damage equations can be used to predict failure features of coatings, which are affected by the thickness of the coating and the stiffness of the substrate.
A CONJECTURE ON AVERAGE DISTANCE AND DIAMETER OF A GRAPH
Authors: WU BAOYINDURENG , LIU GUOJIE , AN XINHUI , YAN GUIYING , LIU XIAOPING
Published: October 2011

Using Ore's structural characterization on diameter-maximal graphs, we determine the extremal graphs with the minimum average distance among the graphs with given order and diameter, thereby solving a conjecture of Aouchiche and Hansen [Automated results and conjectures on average distance in graphs, in Graph Theory in Paris, eds. A. Bondy, J. Fonlupt, J.-L. Fouquet, J.-C. Fournier and J.-L. Ramírez Alfonsín, Trends in Mathematics, Vol. 6 (Birkhäuser Boston, Boston, 2007), pp. 21–36].
THE LINEAR GEODETIC NUMBER OF A GRAPH
Authors: SANTHAKUMARAN A. P. , JEBARAJ T. , CHANDRAN S. V. ULLAS
Published: October 2011

For a connected graph G of order n, an ordered set S = {u1, u2, …, uk} of vertices in G is a linear geodetic set of G if for each vertex x in G, there exists an index i, 1 ≤ i < k such that x lies on a ui - ui + 1 geodesic on G, and a linear geodetic set of minimum cardinality is the linear geodetic number gl(G). The linear geodetic numbers of certain standard graphs are obtained. It is shown that if G is a graph of order n and diameter d, then gl(G) ≤ n - d + 1 and this bound is sharp. For positive integers r, d and k ≥ 2 with r < d ≤ 2r, there exists a connected graph G with rad G = r, diam G = d and gl(G) = k. Also, for integers n, d and k with 2 ≤ d < n, 2 ≤ k ≤ n - d + 1, there exists a connected graph G of order n, diameter d and gl(G) = k. We characterize connected graphs G of order n with gl(G) = n and gl(G) = n - 1. It is shown that for each pair a, b of integers with 3 ≤ a ≤ b, there is a connected graph G with g(G) = a and gl(G) = b. We also discuss how the linear geodetic number of a graph is affected by adding a pendent edge to the graph.
BREAKING AND REPAIRING AN APPROXIMATE MESSAGE AUTHENTICATION SCHEME
Authors: TONIEN DONGVU , SAFAVI-NAINI REIHANEH , NICKOLAS PETER
Published: October 2011

Traditional hash functions are designed to protect against even the slightest modification of a message. Thus, one bit changed in a message would result in a totally different message digest when a hash function is applied. This feature is not suitable for applications whose message spaces admit a certain fuzziness, such as multimedia communications or biometric authentication applications. In these applications, approximate hash functions must be designed so that the distance between messages are proportionally reflected in the distance between message digests. Most of the previous designs of approximate hash functions employ traditional hash functions. In an ingenious approximate message authentication scheme for an N-ary alphabet recently proposed by Ge, Arce and Crescenzo, the approximate hash functions are based on the majority selection function. This scheme is suitable for N-ary messages with arbitrary alphabet size N. In this paper, we show a hidden property of the majority selection function, which allows us to successfully break this scheme. We show that an adversary, by observing just one message and digest pair, without any knowledge of the secret information, can generate N - 1 new valid message and digest pairs. In order to resist the attack, we propose some modifications to the original design. The corrected scheme is as efficient as the original scheme and it is secure against the attack. By a new combinatorial approach, we calculate explicitly the security parameters of the corrected scheme.
POST-MACROECONOMICS: LESSONS FROM THE CRISIS AND STRATEGIC DIRECTIONS AHEAD
Authors: MONGA CÉLESTIN
Published: October 2011

The global crisis has not invalidated everything about macroeconomics. However, it has highlighted some of mistakes of the discipline's dominant intellectual framework. Post-macroeconomic thinking recommended in this paper should not be understood as another metanarrative of the end of metanarratives. The use of the prefix post here suggests and emphasises much more than temporal posterity. Post-macroeconomics should follow from macroeconomics more than it follows after macroeconomics. The theorising of post-macroeconomics is therefore neither systematically oppositional, nor hegemonic. It does not advocate a "dialectic opposition" between macroeconomics and post-macroeconomics. Rather, it suggests that the latter builds on the former and goes beyond it.
SOME CAVEATS IN MODELLING TECHNICAL PROGRESS AND INVESTMENT: THE CASE OF CHINA
Authors: FELIPE JESUS , McCOMBIE JOHN
Published: October 2011

Since the early 1990s, the number of studies using neoclassical models to understand the Chinese economy has mushroomed. In this paper, we review two examples of estimation of the rate of technical progress and one attempt at modelling investment. We identify their shortcomings and the problems with the alleged policy implications. We show that econometric estimation of neoclassical models may result in apparently sensible results for misinformed reasons. We conclude that modelling the Chinese economy requires a deeper understanding of its inner workings as a transition and as a developing economy.
The interaction of Ca2+ with sarcomeric proteins: role in function and dysfunction of the heart
Authors: ter Keurs Hendrick E. D. J.
Published: October 2011

The hallmarks of the normal heartbeat are both rapid onset of contraction and rapid relaxation as well as an inotropic response to both increased end-diastolic volume and increased heart rate. At the microscopic level, Ca2+ plays a crucial role in normal cardiac contraction. This paper reviews the cycle of Ca2+ fluxes during the normal heartbeat, which underlie the coupling between excitation and contraction and permit a highly synchronized action of cardiac sarcomeres. Length dependence of the response of the regulatory sarcomeric proteins mediates the Frank-Starling Law of the heart. However, Ca2+ transport may go astray in heart disease such as in congestive heart failure, and both jeopardize systole and diastole and triggering arrhythmias. The interaction between weak and strong segments in nonuniform cardiac muscle allows partial preservation of force of contraction but may further lead to mechanoelectric feedback or reverse excitation-contraction coupling mediating an early diastolic Ca2+ transient caused by the rapid force decrease during the relaxation phase. These rapid force changes in nonuniform muscle may cause arrhythmogenic Ca2+ waves to propagate by the activation of neighboring sarcoplasmic reticulum by diffusing Ca2+ ions.
Interstitial volume modulates the conduction velocity-gap junction relationship
Authors: Veeraraghavan Rengasayee , Salama Mohamed E. , Poelzing Steven
Published: October 2011

Cardiac conduction through gap junctions is an important determinant of arrhythmia susceptibility. Yet, the relationship between degrees of Gj uncoupling and conduction velocity (θ) remains controversial. Conflicting results in similar experiments are normally attributed to experimental differences. We hypothesized that interstitial volume modulates conduction velocity and its dependence on Gj. Interstitial volume (VIS) was quantified histologically from guinea pig right ventricle. Optical mapping was used to quantify conduction velocity and anisotropy (ARθ). Albumin (4 g/l) decreased histologically assessed VIS, increased transverse θ by 71 ± 10%, and lowered ARθ. Furthermore, albumin did not change isolated cell size. Conversely, mannitol increased VIS, decreased transverse θ by 24 ± 4%, and increased ARθ. Mannitol also decreased cell width by 12%. Furthermore, mannitol was associated with spontaneous ventricular tachycardias in three of eight animals relative to zero of 15 during control. The θ-Gj relationship was assessed using the Gj uncoupler carbenoxolone (CBX). Whereas 13 μM CBX did not significantly affect θ during control, it slowed transverse θ by 38 ± 9% during mannitol (edema). These data suggest changes in VIS modulate θ, ARθ, and the θ-Gj relationship and thereby alter arrhythmia susceptibility. Therefore, VIS may underlie arrhythmia susceptibility, particularly in diseases associated with gap junction remodeling.
In VivoPositron Emission Tomography Imaging of Protease Activity by Generation of a Hydrophobic Product from a Noninhibitory Protease Substrate
Authors: Chuang Chih-Hung , Chuang Kuo-Hsiang , Wang Hsin-Ell , Roffler Steve R. , Shiea Jen-taie , Tzou Shey-Cherng , Cheng Ta-Chun , Kao Chien-Han , Wu Shih-Yen , Tseng Wei-Lung , Cheng Chiu-Min , Hou Ming-Feng , Wang Ju-Ming , Cheng Tian-Lu
Published: October 2011

Purpose: To develop an imaging technology for protease activities in patients that could help in prognosis prediction and in design of personalized, protease-based inhibitors and prodrugs for targeted therapy.

Experimental Design: Polyethylene glycol (PEG) was covalently attached to the N-terminus of a hydrophilic peptide substrate (GPLGVR) for matrix metalloproteinase (MMP) to increase hydrophilicity. PEG-peptide was then linked to a hydrophobic tetramethylrhodamine (TMR) domain and labeled with 18F to form a PEG-peptide-18F-TMR probe. Specific cleavage of the probe by MMP2 was tested in vitro by matrix-assisted laser desorption/ionization–time-of-flight (MALDI-TOF). In vivo imaging of MMP2-expressing tumors was evaluated by micro-PET.

Results: The hydrophobic TMR fragment (948 Da) was specifically generated by MMP2 enzymes and MMP-expressing HT1080 cells but not control MCF-7 cells. MMP-expressing HT1080 cells and tumors selectively accumulated the hydrolyzed, hydrophobic TMR fragment at sites of protease activity. Importantly, we found that 18F-labeled probe (18F-TMR) preferentially localized in HT1080 tumors but not control MCF-7 tumors as shown by micro-PET. Uptake of the probe in HT1080 tumors was 18.4 ± 1.9-fold greater than in the MCF-7 tumors 30 minutes after injection. These results suggest that the PEG-peptide-18F-TMR probe displays high selectivity for imaging MMP activity.

Conclusions: This strategy successfully images MMP expression in vivo and may be extended to other proteases to predict patient prognosis and to design personalized, protease-based inhibitors and prodrug-targeted therapies. Clin Cancer Res; 18(1); 238–47. ©2011 AACR.
Clinically Significant Urethral Stricture and/or Subclinical Urethral Stricture after High-Intensity Focused Ultrasound Correlates with Disease-Free Survival in Patients with Localized Prostate Cancer
Authors: Komura Kazumasa , Inamoto Teruo , Black Peter C. , Fujisue Yutaka , Katsuoka Yoji , Watsuji Toshikazu , Azuma Haruhito
Published: October 2011

Purpose: To assess the association between the development of a urethral stricture (US) and disease-free survival for patients with localized prostate cancer treated with high-intensity focused ultrasound (HIFU). Patients and Methods: Patients with clinical stage T1-T2N0M0 prostate cancer were eligible for treatment with HIFU. Treatment failure was defined according to the Phoenix criteria, and the disease-free survival rate (DFSR) was evaluated using this definition. Patients were divided into two subgroups according to whether or not they developed a US or a subclinical urethral stricture (SCUS) during follow-up. SCUS was defined as clinically insignificant bladder outlet obstruction requiring transient catheterization. Results: A total of 144 patients were included in the present study. The median follow-up time was 47 months (range 2–70). Grade 1–4 US occurred during follow-up in 28 (19.5%) patients and SCUS was found in 30 (20.8%). The 5-year DFSR by Kaplan-Meier estimation was 61.2% for the entire cohort, 78.2% for patients who developed a US/SCUS and 47.8% for those without US or SCUS (p < 0.001). On Cox regression analysis, development of US/SCUS proved to be an independent predictor of DFSR. Conclusions: Development of US/SCUS was identified as a predictor of favorable HIFU treatment outcome.
Role of Diffusion MRI and Apparent Diffusion Coefficient Measurement in the Diagnosis, Staging and Pathological Classification of Bladder Tumors
Authors: Dağgülli Mansur , Onur Mehmet Ruhi , Fırdolaş Fatih , Onur Rahmi , Kocakoç Ercan , Orhan İrfan
Published: October 2011

Objectives: Our aim was to investigate the role of simultaneous apparent diffusion coefficient (ADC) measurement and diffusion-weighted MRI (DWMRI) in the diagnosis and differentiation of bladder masses. Methods: Weexamined 45 patients presenting with hematuria by dynamic and diffusion MRI (at b100, b600, b1000 gradients) and cystoscopy. Thirty healthy volunteers without hematuria were also included in the study. Results from imaging techniques were compared to cystoscopic and histopathologic findings. The ADC values of benign and malignant bladder masses, and bladder tissue in healthy subjects were measured and compared with each other. Results: The mean ADC values of benign (n = 10) and malignant lesions (n = 35) were significantly lower than the mean ADC values of adjacent bladder walls and bladder walls of healthy subjects at all 3 gradients (p < 0.05). However, no significant difference was detected between benign and malignant lesions (p > 0.05). Mean ADC values of invasive tumors were significantly lower than superficial malignancies at b600 and b1000 gradients. The mean ADC values of transitional cell tumors were significantly higher than squamous cell tumors at b100 and b600 gradients. Conclusion: Simultaneous measurement ofADC and DWMRI provided useful information in the diagnosis, staging and histopathological classification of bladder tumors.
Stent Coated With Antibody Against Vascular Endothelial-Cadherin Captures Endothelial Progenitor Cells, Accelerates Re-Endothelialization, and Reduces Neointimal Formation
Authors: Lim Woo-Hyun , Seo Won-Woo , Choe WonSeok , Kang Chan-Koo , Park Jonghanne , Cho Hyun-Ju , Kyeong San , Hur Jin , Yang Han-Mo , Cho Hyun-Jai , Lee Yoon-Sik , Kim Hyo-Soo
Published: October 2011

Objective—

In contrast to CD34, vascular endothelial-cadherin (VE-cadherin) is exclusively expressed on the late endothelial progenitor cells (EPC) whereas not on the early or myeloid EPC. Thus, VE-cadherin could be an ideal target surface molecule to capture circulating late EPC. In the present study, we evaluated whether anti-VE–cadherin antibody-coated stents (VE-cad stents) might accelerate endothelial recovery and reduce neointimal formation through the ability of capturing EPC.

Methods and Results—

The stainless steel stents were coated with rabbit polyclonal anti-human VE-cadherin antibodies and exposed to EPC for 30 minutes in vitro. The number of EPC that adhered to the surface of VE-cad stents was significantly higher than bare metal stents (BMS) in vitro, which was obliterated by pretreatment of VE-cad stent with soluble VE-cadherin proteins. We deployed VE-cad stents and BMS in the rabbit right and left iliac arteries, respectively. At 48 hours after stent deployment in vivo, CD-31–positive endothelial cells adhered to VE-cad stent significantly more than to BMS. At 3 days, scanning electron microscopy showed that over 90% surface of VE-cad stents was covered with endothelial cells, which was significantly different from BMS. At 42 days, neointimal area that was filled with smooth muscle cells positive for actin or calponin was significantly smaller in VE-cad stents than in BMS by histological analysis (0.95±0.22 versus 1.34±0.43 mm
2
, respectively,
P
=0.02). Immuno-histochemical analysis revealed that infiltration of inflammatory cells was not significantly different between 2 stents.

Conclusion—

VE-cad stents captured EPC successfully in vitro, accelerated endothelial recovery on stent, and eventually reduced neointimal formation in vivo.
Nuclear Plakoglobin Is Essential for Differentiation of Cardiac Progenitor Cells to Adipocytes in Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Lombardi Raffaella , da Graca Cabreira-Hansen Maria , Bell Achim , Fromm Richard R. , Willerson James T. , Marian A.J.
Published: October 2011

Rationale:

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease of desmosome proteins characterized by fibroadipogenesis in the myocardium. We have implicated signaling properties of junction protein plakoglobin (PG) in the pathogenesis of ARVC.

Objective:

To delineate the pathogenic role of PG in adipogenesis in ARVC.

Methods and Results:

We generated mice overexpressing PG, either a wildtype (PG
WT
) or a truncated (PG
TR
), known to cause ARVC, in the heart; and PG null (PG
−/−
) embryos. PG
WT
and PG
TR
mice exhibited fibro-adiposis, cardiac dysfunction, and premature death. Subcellular protein fractionation and immunofluorescence showed nuclear localization of PG
WT
and PG
TR
and reduced membrane localization of PG
TR
. Coimmunoprecipitation showed reduced binding of PG
TR
but not PG
WT
to desmosome proteins DSP and DSG2. Transgene PG
WT
and PG
TR
were expressed in c-Kit
+
:Sca1
+
cardiac progenitor cells (CPCs) isolated from the hearts of PG
WT
and PG
TR
by fluorescence activated cell sorting. CPCs isolated from the transgenic hearts showed enhanced adipogenesis, increased levels of adipogenic factors KLF15, C/EBP-α and noncanonical Wnt5b, and reduced level of CTGF, an inhibitor of adipogenesis. Treatment with BIO activated the canonical Wnt signaling, reversed the proadipogenic transcriptional switch and prevented adipogenesis in a dose-dependent manner. Moreover, c-Kit
+
CPCs, isolated from PG
−/−
embryos, were resistant to adipogenesis, expressed high mRNA levels of CTGF and other canonical Wnt signaling targets.

Conclusions:

Nuclear PG provokes adipogenesis in c-Kit
+
CPCs by repressing the canonical Wnt signaling and inducing a proadipogenic gene expression. The findings suggest that adipocytes in ARVC, at least in part, originate from c-Kit
+
CPCs.
Plasmacytoid Dendritic Cells Protect Against Atherosclerosis by Tuning T-Cell Proliferation and Activity
Authors: Daissormont Isabelle T.M.N. , Christ Anette , Temmerman Lieve , Sampedro Millares Stefan , Seijkens Tom , Manca Marco , Rousch Mat , Poggi Marjorie , Boon Louis , van der Loos Chris , Daemen Mat , Lutgens Esther , Halvorsen Bente , Aukrust Pal , Janssen Edith , Biessen Erik A.L.
Published: October 2011

Rationale:

Unlike conventional dendritic cells, plasmacytoid DCs (PDC) are poor in antigen presentation and critical for type I interferon response. Though proposed to be present in human atherosclerotic lesions, their role in atherosclerosis remains elusive.

Objective:

To investigate the role of PDC in atherosclerosis.

Methods and Results:

We show that PDC are scarcely present in human atherosclerotic lesions and almost absent in mouse plaques. Surprisingly, PDC depletion by 120G8 mAb administration was seen to promote plaque T-cell accumulation and exacerbate lesion development and progression in LDLr
−/−
mice. PDC depletion was accompanied by increased CD4
+
T-cell proliferation, interferon-γ expression by splenic T cells, and plasma interferon-γ levels. Lymphoid tissue PDC from atherosclerotic mice showed increased indoleamine 2,3-dioxygenase (IDO) expression and IDO blockage abrogated the PDC suppressive effect on T-cell proliferation.

Conclusions:

Our data reveal a protective role for PDC in atherosclerosis, possibly by dampening T-cell proliferation and activity in peripheral lymphoid tissue, rendering PDC an interesting target for future therapeutic interventions.
Validation of the Essen Stroke Risk Score and the Stroke Prognosis Instrument II in Chinese Patients
Authors: Meng Xia , Wang Yilong , Zhao Xingquan , Wang Chunxue , Li Hao , Liu Liping , Zhou Yong , Xu Jie , Wang Yongjun
Published: October 2011

Background and Purpose—

Little was known about the predictive accuracy of the Essen Stroke Risk Score and the Stroke Prognostic Instrument II in Chinese patients with stroke.

Methods—

We evaluated the predictive accuracy of both Essen Stroke Risk Score and Stroke Prognostic Instrument II scores for both recurrent stroke and combined vascular events using data from a prospective cohort of 11 384 patients with acute ischemic stroke and transient ischemic attack admitted to 132 urban hospitals throughout China.

Results—

The cumulative 1-year event rates were 16% (95% CI, 15%–16%) for recurrent stroke and 18% (95% CI, 18%–19%) for combined vascular events. Both event rates were significantly higher in patients with transient ischemic attack and increased significantly from lower to higher Essen Stroke Risk Score and Stroke Prognostic Instrument II categories. Essen Stroke Risk Score and Stroke Prognostic Instrument II had similar predictive accuracies for each study outcome.

Conclusions—

In Chinese patients with ischemic stroke or transient ischemic attack, both Essen Stroke Risk Score and Stroke Prognostic Instrument II scores are equally able to stratify the risk of recurrent stroke and combined vascular events.
Evidence-Based Quality Indicators for Stroke Rehabilitation
Authors: Grube Maike M. , Dohle Christian , Djouchadar Diana , Rech Petra , Bienek Karen , Dietz-Fricke Ursula , Jöbges Michael , Kohler Martin , Missala Isabelle , Schönherr Bertram , Werner Cordula , Zeytountchian Helen , Wissel Jörg , Heuschmann Peter U.
Published: October 2011

Background and Purpose—

Previous stroke performance measures consider aspects of postacute treatment, but there are only few specific quality indicators or standards for poststroke rehabilitation. The purpose of this study was to develop a set of indicators for measuring the quality of postacute stroke rehabilitation in inpatient and outpatient facilities using a standardized evidence-based approach.

Methods—

Quality indicators were developed between January 2009 and February 2010 by an interdisciplinary board of healthcare professionals from rehabilitation centers cooperating in the Berlin Stroke Alliance. The Berlin Stroke Alliance is a regional network of >40 providers of acute treatment, rehabilitation, and aftercare aiming to improve stroke services within Berlin and Brandenburg. The indicators were developed according to published international recommendations and predefined methodological requirements. The applied standards included a systematic literature review, a rating of published evidence, an external peer review, and the evaluation in a pilot study before implementation.

Results—

Of an initial list of 33 indicators, 20 indicators were rated as being appropriate. After completion of the pilot phase, we agreed on a set of 18 indicators. The indicators measure processes (9 indicators), outcomes (5 indicators), and structures (4 indicators) in the following domains of stroke rehabilitation: completion of diagnostics; secondary prevention; cognition and affect; speech and swallowing; management of complications; sensorimotor functions and mobility; discharge status; and aftercare.

Conclusions—

Documentation of evidence-based quality indicators for stroke rehabilitation in clinical routine is feasible and can serve as a first step toward implementing standardized cross-institutional quality assurance programs for stroke rehabilitation.
Statin Use During Ischemic Stroke Hospitalization Is Strongly Associated With Improved Poststroke Survival
Authors: Flint Alexander C. , Kamel Hooman , Navi Babak B. , Rao Vivek A. , Faigeles Bonnie S. , Conell Carol , Klingman Jeff G. , Sidney Stephen , Hills Nancy K. , Sorel Michael , Cullen Sean P. , Johnston S. Claiborne
Published: October 2011

Background and Purpose—

Statins reduce infarct size in animal models of stroke and have been hypothesized to improve clinical outcomes after ischemic stroke. We examined the relationship between statin use before and during stroke hospitalization and poststroke survival.

Methods—

We analyzed records from 12 689 patients admitted with ischemic stroke to any of 17 hospitals in a large integrated healthcare delivery system between January 2000 and December 2007. We used multivariable survival analysis and grouped-treatment analysis, an instrumental variable method that uses treatment differences between facilities to avoid individual patient-level confounding.

Results—

Statin use before ischemic stroke hospitalization was associated with improved survival (hazard ratio, 0.85; 95% CI, 0.79–0.93;
P
<0.001), and use before and during hospitalization was associated with better rates of survival (hazard ratio, 0.59; 95% CI, 0.53–0.65;
P
<0.001). Patients taking a statin before their stroke who underwent statin withdrawal in the hospital had a substantially greater risk of death (hazard ratio, 2.5; 95% CI, 2.1–2.9;
P
<0.001). The benefit was greater for high-dose (>60 mg/day) statin use (hazard ratio, 0.43; 95% CI, 0.34–0.53;
P
<0.001) than for lower dose (<60 mg/day) statin use (hazard ratio, 0.60; 95% CI, 0.54–0.67;
P
<0.001; test for trend
P
<0.001), and earlier treatment in-hospital further improved survival. Grouped-treatment analysis showed that the association between statin use and survival cannot be explained by patient-level confounding.

Conclusions—

Statin use early in stroke hospitalization is strongly associated with improved poststroke survival, and statin withdrawal in the hospital, even for a brief period, is associated with worsened survival.
A Comparison of Acute Hemorrhagic Stroke Outcomes in 2 Populations
Authors: Zaganas Ioannis , Halpin Amy P. , Oleinik Alexandra , Alegakis Athanasios , Kotzamani Dimitra , Zafiris Spiros , Chlapoutaki Chryssanthi , Tsimoulis Dimitris , Giannakoudakis Emmanouil , Chochlidakis Nikolaos , Ntailiani Aikaterini , Valatsou Christina , Papadaki Efrosini , Vakis Antonios , Furie Karen L. , Greenberg Steven M. , Plaitakis Andreas
Published: October 2011

Background and Purpose—

Although corticosteroid use in acute hemorrhagic stroke is not widely adopted, management with intravenous dexamethasone has been standard of care at the University Hospital of Heraklion, Crete with observed outcomes superior to those reported in the literature. To explore this further, we conducted a retrospective, multivariable-adjusted 2-center study.

Methods—

We studied 391 acute hemorrhagic stroke cases admitted to the University Hospital of Heraklion, Crete between January 1997 and July 2010 and compared them with 510 acute hemorrhagic stroke cases admitted to Massachusetts General Hospital, Boston, from January 2003 to September 2009. Of the Cretan cases, 340 received a tapering scheme of intravenous dexamethasone, starting with 16 to 32 mg/day, whereas the Boston patients were managed without steroids.

Results—

The 2 cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0%, n=510;
P
<0.001) as was the 30-day mortality (Crete: 25.4%, n=307; Boston: 39.4%, n=510;
P
<0.001). Exclusion of patients on anticoagulants showed even greater differences (30-day mortality: Crete 20.8%; n=259; Boston 37.0%; n=359;
P
<0.001). The improved survival on Crete was observed 3 days after initiation of intravenous dexamethasone and was pronounced for deep-seated hemorrhages. After adjusting for acute hemorrhagic stroke volume/location, Glasgow Coma Scale, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet, and anticoagulant use, intravenous dexamethasone treatment was associated with better functional outcomes and significantly lower risk of death at 30 days (OR, 0.357; 95% CI, 0.174–0.732).

Conclusions—

This study suggests that intravenous dexamethasone improves outcome in acute hemorrhagic stroke and supports a randomized clinical trial using this approach.
Viscoelastic and viscoplastic behavior of a fully recycled carbon fiber-reinforced maleic anhydride grafted polypropylene modified polypropylene composite
Authors: Szpieg M , Giannadakis K , Asp LE
Published: October 2011

The effect of maleic anhydride grafted polypropylene (MAPP) coupling agents on properties of a new composite made of recycled carbon fibers and recycled polypropylene (rCF/[rPP + MAPP]) was studied experimentally. This new material presented significantly improved properties, compared to the previous generation, without the addition of MAPP (Giannadakis K, Szpieg M and Varna J. Mechanical performance of recycled carbon fibre/PP. Exp Mech 2010; published online.). This was mostly attributed to improvement of the fiber/matrix interface. The inelastic and time-dependent behavior of the MAPP modified composite material in tension was analyzed. A series of quasi-static tensile and creep tests were performed to identify the material model, which accounts for: (a) damage-related stiffness reduction, (b)development of stress and time-dependent irreversible strains described as viscoplasticity, (c) nonlinear viscoelastic behavior. The damage-related stiffness reduction was found to be less than 10%. Although damage-dependent stiffness was not the main source of nonlinearity, it was included in the inelastic material model. In creep tests, it was found that the time and stress dependence of viscoplastic strains follows a power law, which makes the determination of the parameters in the viscoplasticity model relatively simple. The viscoelastic response of the composite was found to be linear in the investigated stress domain. The material model was validated in constant stress rate tensile tests.
Pretreatment With Citrulline Improves Gut Barrier After Intestinal Obstruction in Mice
Authors: Batista Marina Andrade , Nicoli Jacques Robert , dos Santos Martins Flaviano , Nogueira Machado José Augusto , Esteves Arantes Rosa Maria , Pacífico Quirino Iara Eliza , Davisson Correia Maria Isabel Toulson , Cardoso Valbert Nascimento
Published: October 2011

Background: Citrulline has been shown to be an important marker of gut function, regulator of protein metabolism, and precursor of arginine. The authors assessed the effects of citrulline on gut barrier integrity and bacterial translocation (BT) in mice undergoing intestinal obstruction. Methods: Mice were divided into 3 groups: sham, intestinal obstruction (IO), and citrulline (CIT). The CIT group received a diet containing 0.6% citrulline; the IO and sham groups were fed a standard chow diet. On the eighth day of treatment, all animals received a diethylenetriamine pentaacetic acid (DTPA) solution labeled with 99mTechnetium (99mTc‐DTPA) by gavage for the intestinal permeability study. Terminal ileum was ligated except the sham group, which only underwent laparotomy. After 4, 8, and 18 hours, blood was collected to determine radioactivity. Samples of ileum were removed 18 hours after intestinal obstruction for histological analysis. In another set of animals, BT was evaluated. Animals received 108 CFU/mL of 99mTc–Escherichia coli by gavage; 90 minutes later, they underwent ileum ligation. Intestinal fluid and serum were collected to measure sIgA and cytokines. Results: The CIT group presented decreased intestinal permeability and BT when compared with the IO group (P < .05). Histopathology showed that citrulline preserved the ileum mucosa. The sIgA concentration was higher in the CIT group (P < .05). The IO group presented the highest levels of interferon‐γ (P < .05). Conclusions: Pretreatment with citrulline was able to preserve barrier integrity and also modulated the immune response that might have affected BT decrease.
Stimulatory Adrenocortical Effects of a Selective Estrogen Receptor Modulator in Ovariectomized Female Macaques
Authors: Wood Charles E. , Stavisky Ronda C. , Nowak Jette , Kaplan Jay R.
Published: October 2011

Here, we report the effects of estrogen and the selective estrogen receptor modulator (SERM) levormeloxifene on adrenocortical measures in ovariectomized female cynomolgus monkeys ( Macaca fascicularis). Animals were randomized into one of five treatment groups, each containing 23 to 26 animals: (1) placebo, (2) 0.016 mg/kg 17β-estradiol (E2), (3) 0.5 mg/kg levormeloxifene (L1), (4) 1.0 mg/kg levormeloxifene (L2), and (5) 5.0 mg/kg levormeloxifene (L3). Treatments were administered orally each day for 18 mo. All doses of levormeloxifene resulted in adrenal weights at least 50% greater than placebo ( p < .0001 for all). The target dose of levormeloxifene (L2) resulted in higher serum concentrations of cortisol (+63%), dehydroepiandrosterone-sulfate (+73%), and androstenedione (+37%) compared with the placebo group ( p < .05 for all). In contrast, E2 resulted in no significant differences in adrenal weight or adrenocortical steroids. Oral E2 and all SERM doses resulted in similar reductions in serum gonadotropins and at least threefold greater uterine weight versus placebo ( p < .0001 for all). Results indicate that the SERM levormeloxifene, in contrast to E2, may have robust stimulatory effects on adrenocortical hormones in a postmenopausal model. These findings warrant further investigation into long-term SERM effects on adrenocortical function.
Pediatric Otolaryngology in the United States
Authors: Tucker John A. , Reilly Brian K. , Tucker Sean T. , Reilly James S.
Published: October 2011

Chevalier Jackson and his disciples in pediatric bronchology and esophagology strove to conquer the 3 great illnesses of the early 20th century: lye ingestion with esophageal cicatrix formation, foreign‐body aspiration, and tuberculosis. Jackson’s successes and legacy were based on teaching through the use of clinical drawings and his improvements in instrumentation, which have saved generations of children. Clinical specialization and meticulous teamwork protected children’s airways from the ravages of diphtheria. Jackson observed the mechanics of respiratory pulmonary function and gained a better understanding of the causes of pulmonary wheezes. A recent biography, Swallow, tells of Jackson’s life and his important contributions to the care of all children.
Effects of Platelet-Rich Fibrin Matrix on Repair Integrity of At-Risk Rotator Cuff Tears
Authors: Bergeson Adam G. , Tashjian Robert Z. , Greis Patrick E. , Crim Julia , Stoddard Gregory J. , Burks Robert T.
Published: October 2011

Background: Increased age, larger tear size, and more advanced fatty degeneration of the rotator cuff musculature have been correlated with poorer healing rates after rotator cuff repair. Platelets are an endogenous source of growth factors present during rotator cuff healing.

Hypothesis: Augmentation of rotator cuff repairs with platelet-rich fibrin matrix (PRFM) may improve the biology of rotator cuff healing and thus improve functional outcome scores and retear rates after repair.

Study Design: Cohort study; Level of evidence, 3.

Methods: Rotator cuff tears at risk for retear were prospectively identified using an algorithm; points were assigned for age (50-59 years = 1; 60-69 years = 2; >70 years = 3), anterior-to-posterior tear size (2-2.9 cm = 0; 3-3.9 cm = 1; >4 cm = 2), and fatty atrophy (Goutallier score 0-2 = 0; Goutallier score 3-4 = 1). Three points were required for enrollment. Arthroscopic rotator cuff repair was performed with the addition of PRFM. Preoperative and 1-year postoperative magnetic resonance imaging (MRI) and functional outcome scores were obtained. Imaging and functional outcomes were compared with historical controls meeting the same enrollment criteria.

Results: Sixteen and 21 patients were enrolled in the PRFM and control groups, respectively. Mean age (65 ± 7 and 65 ± 9 years; P = .89), tear size (3.8 ± 1.1 and 3.9 ± 1.1 cm; P = .79), and median Goutallier scores (2 and 3; P = .18) were similar between the PRFM and control groups, respectively. Retear rates (56.2% vs 38.1%) were statistically significantly higher ( P = .024) in the PRFM group compared with controls. Functional outcome scores postoperatively were not significantly improved compared with controls. Complications included 2 infections in the PRFM group.

Conclusion: The augmentation of at-risk rotator cuff tears with PRFM did not result in improved retear rates or functional outcome scores compared with controls.
Synergistic fire retardancy in layered-silicate nanocomposite combined with low-melting phenysiloxane glass
Authors: Wu Guang Mei , Schartel Bernhard , Yu Dan , Kleemeier Malte , Hartwig Andreas
Published: October 2011

Tetraphenyl phosphonium-modified layered silicate (LS) and low-melting phenylsiloxane glass (G) are combined for more efficient halogen-free flame retardancy in epoxy resin (EP_LSG). Particularly, the peak heat release rate (PHRR) is decreased (by up to 60%), but levels off at additive concentrations ≥10 wt%. The performance of EP_LSG is compared to EP_LS and EP_G assuming an absolute and a relative flame retardancy effect, respectively, and based on the same amount of each filler and, alternatively, with EP_G containing the same overall amount of filler. EP_LSG behaves close to superposition but shows a strong tendency toward synergism due to a superior structural integrity of the fire residues. Apart from LS, adding G in particular is a promising approach when its content is ≤5 wt%, as is LSG for ≥10 wt%.
The Role of Medications in Predicting Activity Restriction Due to a Fear of Falling
Authors: Guthrie Dawn M. , Fletcher Paula C. , Berg Katherine , Williams Evelyn , Boumans Nicole , Hirdes John P.
Published: October 2011

Objectives: To examine the role of medication use and other factors in predicting activity restriction due to a fear of falling (AR/FF). Methods: Older adults were assessed twice with the interRAI Community Health Assessment and the Berg Balance Scale (BBS). The main outcome was limiting going outdoors due to an AR/FF. Medications were recorded by trained assessors. Results: Participants ( n = 441) had a mean age of 80.3 ( SD = 7.1) years, most were aged 65+ (96.8%) and 29.3% reported activity restriction. Taking nervous system active or cardiovascular medications was associated with AR/FF. In a multivariate model, the main predictors were having 3+ comorbid health conditions, lower (i.e., worse) scores on the BBS, having difficulty with climbing stairs, and having a visual impairment. Discussion: Modifiable risk factors, related to functional impairments, such as difficulties with balance and vision, appear to be more important predictors than medications.
Personality Prior to Disability Determines Adaptation
Authors: Boyce Christopher J. , Wood Alex M.
Published: October 2011

Personality traits prior to the onset of illness or disability may influence how well an individual psychologically adjusts after the illness or disability has occurred. Previous research has shown that after the onset of a disability, people initially experience sharp drops in life satisfaction, and the ability to regain lost life satisfaction is at best partial. However, such research has not investigated the role of individual differences in adaptation to disability. We suggest that predisability personality determines the speed and extent of adaptation. We analyzed measures of personality traits in a sample of 11,680 individuals, 307 of whom became disabled over a 4-year period. We show that although becoming disabled has a severe impact on life satisfaction, this effect is significantly moderated by predisability personality. After 4 years of disability, moderately agreeable individuals had levels of life satisfaction 0.32 standard deviations higher than those of moderately disagreeable individuals. Agreeable individuals adapt more quickly and fully to disability; disagreeable individuals may need additional support to adapt.
Cervical human papillomavirus infection in Mexican women with systemic lupus erythematosus or rheumatoid arthritis
Authors: Rojo-Contreras W , Olivas-Flores EM , Gamez-Nava JI , Montoya-Fuentes H , Trujillo-Hernandez B , Trujillo X , Suarez-Rincon AE , Baltazar-Rodriguez LM , Sanchez-Hernandez J , Ramirez-Flores M , Vazquez-Salcedo J , Rojo-Contreras J , Morales-Romero J , Gonzalez-Lopez L
Published: October 2011

Cervical human papillomavirus (HPV+) infection is associated with an increased risk of cervical dysplasia. Although the frequency of HPV+ in systemic lupus erythematosus (SLE) has been investigated in some races its prevalence in Hispanic women is still unknown. This cross-sectional study evaluated the prevalence of cervical HPV+ in Mexican women with SLE ( n = 34) or rheumatoid arthritis (RA) ( n = 43) and in healthy controls ( n = 146). These women were interviewed about risk factors for sexually transmitted infections and cervical cytology analysis was performed. HPV+ viral types were identified using PCR: HPV+ was observed in 14.7% of SLE, 27.9% of RA and 30.8% of controls. High-risk HPV types were observed in 11.7% of women with SLE, 27.9% of women with RA, and in 26% of the controls. High-risk viral types 58, 35 and 18 were the most frequently identified in SLE. Two women with SLE had a high-grade squamous intraepithelial lesion and one had cervical cancer. An association was observed between methotrexate utilization, longer duration of therapy with prednisone, and HPV+ in RA or SLE. Thus, there is a high prevalence of cervical HPV infection in Mexican women with SLE or RA, and physicians must be vigilant in preventing the development of cervical dysplasia.
Influence of cross-linking agent on thermomechanical properties and shape memory effect of styrene shape memory polymer
Authors: Zhang Dawei , Liu Yanju , Yu Kai , Leng Jinsong
Published: October 2011

The influence of cross-linking agent content on thermomechanical properties and shape recovery behavior of thermoset styrene shape memory polymer (SMP) was investigated in this article. The SMP was polymerized by free radical reaction, with styrene and butyl acrylate as comonomers and divinylbenzene as the cross-linking agent. When the cross-linking agent content is increased from 1 to 4 wt%, the storage modulus and the glass transition temperature ( Tg) of the SMP increased correspondingly. During the glass transition, while the value of damping peak decreased as a result of the addition of the cross-linking agent, the peak width increased, and the main relaxation activation energy increased by 48.6%. When the active temperature was higher than or equal to Tg, the SMP samples containing different weight percentages of the cross-linking agent could recover their original shape. At or above Tg, SMP with varied fractions of cross-linking agent could completely recover its original shape; the recovery rate of SMP increased with the increase in the contents of the cross-linking agent. Below Tg, SMP could not recover its original shape, but the recovery angle increased as the contents of cross-linking agent increased. These results were attributed to the increase of cross-linking densities as a result of the addition of cross-linking agent.