bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Involvement of Immune/Inflammatory Response Genes in Retinal Degeneration in DBA/2J Mice
Authors: Fan W. , Li X. , Wang W. , Mo J.S. , Kaplan H. , Cooper N.G.F.
Published: September 2017

Purpose

The DBA/2J (D2) mouse carries mutations in two of its genes, Tyrp1 and Gpnmb. These alterations result in the development of an immune response in the iris, leading to iris atrophy and pigment dispersion. The development of elevated intraocular pressure (IOP) in this model of glaucoma is considered to be a significant factor leading to the death of retinal ganglion cells (RGCs). Changes in gene expression in the retina have already been correlated with the appearance of elevated IOP in the D2 mouse. The purpose of the present study was to determine if any changes in gene expression occur prior to the development of IOP.

Methods

The IOP was measured monthly using a rebound tonometer in D2 and age-matched C57/BL6 (B6) mice (normal controls). D2 animals with normal IOP at 2 and 4 M were used. In addition, mice at the age of 6–7 M were included to look for any trends in gene expression that might develop during the progression of the disease. Separate RNA samples were prepared from each of three individual retinas for each age, and gene expression profiles were determined with the aid of mouse oligonucleotide arrays (Agilent). A subset of genes was examined with the aid of real-time PCR. Immunocytochemistry was used to visualize changes in the retina for some of the gene-products.

Results

Four hundred and thirteen oligonucleotide probes were differentially expressed in the retinas of 4 M versus 2 M old D2 mice. The most significantly up-regulated genes (181) were associated with immune responses including interferon signaling, the complement system and the antigen presentation pathway, whereas the down-regulated genes (232) were linked to pathways related to cell death and known neurological diseases/disorders. These particular changes were not revealed in the age-matched B6 mice. By 6 M, when IOP started to increase in many of the D2 mice, more robust changes of these same genes were observed. Changes in the levels of selected genes, representative of different functions/pathways, were validated with RT-PCR, and changes in glial responses were visualized in the retina with immunocytochemistry.

Conclusions

The results showed that the expression of genes related to the immune response and acute stress were altered independently of the development of elevated IOP, and indicated early involvement of the immune system in the onset of the disease. The later development of elevated IOP, observed in this animal model, was coincident with continued changes in expression of genes observed at earlier time points. Further studies are warranted to identify the roles of specific genes identified here with respect to the death of the RGCs.
Oxaliplatin-Induced Haemolytic Anaemia: A Case Report
Authors: Compostella A , Pasetto LM , Ghiotto C , Stefani M , Monfardini S
Published: September 2017

Oxaliplatin plus 5Fluorouracil (5FU) and leucovorin (LV) is the standard treatment of metastatic colorectal cancer (CRC). We describe a rare clinical case of acute renal failure probably oxaliplatin-related at one day from the end of the palliative treatment. A 36 year-old woman developed a stage I CRC. Five months later a liver lesion was detected and treated with FOLFOX4 schedule. Because of progression the patient underwent surgery and she repeated the Oxaliplatin-based therapy for more than one cycle. After many months of therapy, on the second day, the patient noticed urine discoloration. Immediate urinanalysis demonstrated haemoglobinuria. The patient's complete blood count exhibited signs consistent with acute hemolysis, neutrophilic leucocytosis, thrombocytopenia and acute renal failure. She was treated with blood transfusion and hemodialysis and she was managed conservatively with monitored intravenous hydration and loop diuretics. The patient gradually recovered and the results of successive hematological and biochemical tests confirmed the improvement of her condition but a cardiologic evaluation showed a iatrogenic depressed systolic function (ejection fraction of 40%).
Expression Levels of Thymidylate Synthase, Thymidylate Phosphorylase and Dihydropyrimidine Dehydrogenase in Head and Neck Squamous Cell Carcinoma: Preliminary Study
Authors: Aubry K. , Labourey J.L. , Bessède J.P. , Tubiana-Mathieu N. , Rigaud M.
Published: September 2017

Introduction

Pharyngo-laryngeal tumors classified as T3-4, N0-3, M0, are conventionally treated by mutilating surgery (total (pharyngo)-laryngectomy). Neo-adjuvant chemotherapy with 5-FU/platinum salt can be proposed in an attempt to preserve the larynx. The level of the response to chemotherapy ranges from 36 to 54% of cases. Thus, a large number of patients receive chemotherapy that is ineffective and not free from adverse effects. Three main enzymes are involved in the metabolism of 5-FU: thymidylate synthase (TS), thymidylate phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD). Several studies suggest that a high level of expression of these three genes correlates with a poor clinical response to 5-FU. The main purpose of our study was to look for a correlation between the levels of expression of the genes for sensitivity to 5-FU (TS, TP, DPD) within the tumor and the clinical response observed after three courses of chemotherapy combining 5-FU/platinum salt in patients presenting with advanced cancer of the pharyngolarynx.

Methods

This was a prospective genetic study that had required approval from the Ethics Committee. The main assessment criterion was based on the assessment of the clinical response by an ENT panendoscopy and a cervical CT scan, after three courses of chemotherapy. The expression of the genes was determined by quantitative RT-PCR, using total RNA extracted from tumor biopsies taken during the initial panendoscopy.

Results

The means calculated, in our study, for the three genes of interest (TS, TP, DPD) were lower in the responder group than those in the non-responder group.

Discussion

Our preliminary findings reveal trends that confirm the hypothesis that the lower the level of expression of the sensitivity genes, the better the clinical response to chemotherapy. They now form part of a larger study that is currently in progress.
Biological Markers Predictive of Invasive Recurrence in DCIS
Authors: Nofech-Mozes Sharon , Spayne Jacqueline , Rakovitch Eileen , Kahn Harriette J , Seth Arun , Pignol Jean-Phillippe , Lickley Lavina , Paszat Lawrence , Hanna Wedad
Published: September 2017

DCIS is a heterogeneous group of non-invasive cancers of the breast characterized by various degrees of differentiation and unpredictable propensity for transformation into invasive carcinoma. We examined the expression and prognostic value of 9 biological markers with a potential role in tumor progression in 133 patients with pure DCIS treated with breast conserving surgery alone, between 1982–2000. Histology was reviewed and immunohistochemical staining was performed. Pearson correlation coefficient was used to determine the associations between markers and histopathological features. Univariate and multivariate analysis examined associations between time to recurrence and clinico-pathologic features and biological markers.

Median age at diagnosis was 55 years (25–85). With a median follow up of 8.91 years, 41/133 patients recurred (21 as invasive recurrence). In this cohort 13.5% had low, 43% intermediate and 42% high nuclear grade. Comedo necrosis was found in 65% of cases. Expression of ER (62.4%), PR (55.6%), HER2/neu (31.6%), MIB1 (39.8%), p53 (22.6%), p21 (39.8%), Cyclin D1 (95.5%) calgranulin (20.5%), psoriasin (12%), was found in DCIS. HER2/neu was overexpressed in 45% that recurred as DCIS and 42.9% that recurred as invasive cancer, and only in 26.1% in cases that never recurred. On univariate analysis, HER2/neu overexpression was the only marker associated with an increased risk for any recurrence (p = 0.044). The hazard ratio for recurrence for HER2/neu positive DCIS was 1.927 (confidence interval 1.016–3.653) compared to HER2 negative DCIS. On multivariate analysis, HER2/neu overexpression remained the only independent variable significantly associated with any recurrence (p = 0.014) and with invasive recurrence (p = 0.044).

This data suggest that HER2/neu testing may become an important parameter in the management of DCIS and the treatment of cases with positive HER2/neu status could be modified accordingly, similar to the current approach for HER2/neu positive invasive disease.
Bone Marrow Micrometastases in Breast Cancer Patients: A Long-Term Follow-up Study
Authors: Molino Annamaria , Giovannini Monica , Micciolo Rocco , Auriemma Alessandra , Fiorio Elena , Santo Antonio , Cetto Gian Luigi
Published: September 2017

In 125 early breast cancer patients who underwent multiple bone marrow aspirates, there was no significant difference in terms of disease-free and overall survival after a median follow-up of 163 months between the patients with or without micrometastasis at the time of primary surgery. However, when the time-dependent evolution of the bone marrow aspirates was taken into account, some evidence for a longer disease-free and overall survival was found for the patients with negative bone marrow
Stumbling into the ‘kitchen island’: Becoming through intra-actions with objects and theories
Authors: Myhre Cecilie Ottersland , Myrvold Hanne Berit , Joramo Unn-Wenche , Thoresen Marianne
Published: September 2017

This article draws on new materialism, especially the work of Karen Barad, in order to explore curious encounters and intra-actions within the context of a Norwegian kindergarten. The article argues that intra-actions between both human and non-human agents can potentiate forms of learning as well as forms of knowledge that can be neither anticipated nor predicted. This acquisition of new learning and new knowledge applies to both the (re)searchers as well as in relation to teachers and children. The article, in illustrating these transformations, calls attention to the work and play of diffraction, affect and agency. It is argued that the movements and intermingling that occur between and through each constitute what Gilles Deleuze refers to as ‘becoming’. The article goes on to suggest that in becoming, including ‘becoming (re)searcher’, there are possibilities for resisting habitual and sedimented practices.
Contact simulation of soft micro/nano bioparticles for use in identification of mechanical properties and manipulation based on atomic force microscopy
Authors: Korayem MH , Khaksar H , Hefzabad RN , Taheri M
Published: September 2017

The aim of this paper is to develop and simulate elastic-perfectly plastic contact theories for proper determination and estimation of contact area in manipulation of micro/nano bioparticles. The nanoparticles studied in this paper are categorized into three different cancerous cell types, lowly (LNCaP) and highly metastatic human prostate cancer cells (CL-1, CL-2), two normal bladder cells (Hu609 and HCV29) and three cancerous bladder cells (Hu456, T24 and BC3726). First, Hertz elastic model, finite element, and Brake and Chang elastic-perfectly plastic models with two different elastic states were simulated for Hu609 and Hu456 cells, and the results were compared against each other. Then, material and geometry effects of particles during contact were taken into account. Additionally, contacts of micro/nanoparticle–substrate and micro/nanoparticle–atomic force microscope tip were studied. The results of contact simulations indicate a meaningful difference in distinct models. It can be inferred from the difference between Brake and Chang elastic-perfectly plastic models and Hertz theory that the latter is unable to describe the contact behaviour of very soft bioparticles. In most of previous studies, elastic contact theories such as Hertz and JKR have been used to calculate mechanical properties of soft particles manipulation; for the first time, however, two Brake and Chang theories have been used here to calculate the mechanical properties of bioparticles and to simulate the contact mechanics for use in biomanipulation based on the atomic force microscopy.
An exploratory study of Behavioural Specialist experiences of involving service users in the development of their positive behavioural support plans
Authors: Kruger Bethany , Northway Ruth
Published: September 2017

There is limited research that explores the experiences of how behavioural specialists actively involve people with a learning disability and challenging behaviour in the development of their positive behavioural support (PBS) plan. Accordingly, this exploratory research study aimed to explore this little understood area of practice.

Methods:

The study included semi-structured interviews comprised of nine Behavioural Specialists in three focus groups across two health boards. A descriptive thematic analysis study.

Findings:

Three major themes and 11 minor themes were identified illustrating how people with learning disabilities and behaviours that challenge were involved in developing their PBS plan. Significantly, the themes illustrated the complexity of truly involving service users in the process.

Conclusion:

Inclusion of people with a learning disability and behaviours that challenge in their PBS plan poses significant challenges. Person-centred care struggles to be truly embedded in the PBS model.
Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination
Authors: Blair Gordon W , Appleton Jason P , Law Zhe Kang , Doubal Fergus , Flaherty Katie , Dooley Richard , Shuler Kirsten , Richardson Carla , Hamilton Iona , Shi Yulu , Stringer Michael , Boyd Julia , Thrippleton Michael J , Sprigg Nikola , Bath Philip M , Wardlaw Joanna M
Published: September 2017

Rationale

The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stroke recurrence, cognitive impairment, or radiological progression after lacunar stroke.

Aim

LACI-1 will assess the tolerability, safety, and efficacy, by dose, of isosorbide mononitrate and cilostazol, alone and in combination, in patients with ischemic lacunar stroke.

Sample size

A sample of 60 provides 80+% power (significance 0.05) to detect a difference of 35% (90% versus 55%) between those reaching target dose on one versus both drugs.

Methods and design

LACI-1 is a phase IIa partial factorial, dose-escalation, prospective, randomized, open label, blinded endpoint trial. Participants are randomized to isosorbide mononitrate and/or cilostazol for 11 weeks with dose escalation to target as tolerated in two centers (Edinburgh, Nottingham). At three visits, tolerability, safety, blood pressure, pulse wave velocity, and platelet function are assessed, plus magnetic resonance imaging to assess cerebrovascular reactivity in a subgroup.

Study outcomes

Primary: proportion of patients completing study achieving target maximum dose.

Secondary

symptoms whilst taking medications; safety (hemorrhage, recurrent vascular events, falls); blood pressure, platelet function, arterial stiffness, and cerebrovascular reactivity.

Discussion

This study will inform the design of a larger phase III trial of isosorbide mononitrate and cilostazol in lacunar stroke, whilst providing data on the drugs’ effects on vascular and platelet function.

Trial registration

ISRCTN (ISRCTN12580546) and EudraCT (2015-001953-33).
Decision Support for Diabetes in Scotland: Implementation and Evaluation of a Clinical Decision Support System
Authors: Conway Nicholas , Adamson Karen A. , Cunningham Scott G. , Emslie Smith Alistair , Nyberg Peter , Smith Blair H. , Wales Ann , Wake Deborah J.
Published: September 2017

Background:

Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users’ reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014.

Methods:

Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year.

Results:

The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (–2.3 mmol/mol [–0.2%] versus –1.1 [–0.1%], P = .003).

Discussion and Conclusions:

The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications.
Ultra-short echo time magnetic resonance imaging for detection of pulmonary arteriovenous malformation recanalization after coil embolization: a case report and a phantom study
Authors: Hamamoto Kohei , Chiba Emiko , Matsuura Katsuhiko , Okochi Tomohisa , Tanno Keisuke , Tanaka Osamu
Published: September 2017

A pulmonary arteriovenous malformation (PAVM) is a direct connection between the pulmonary arteries and veins for which metallic coil transcatheter embolization is the standard of care. Detecting recanalization after PAVM treatment is crucial, but direct visualization with computed tomography or magnetic resonance imaging (MRI) is generally difficult. Here, we report a case of a recanalized PAVM that was directly detected with ultra-short echo time MRI. The detection of these signals in the coils was confirmed in a phantom study.
Utilization of Interspinous Devices Throughout the United States Over a Recent Decade: An Analysis of the Nationwide Inpatient Sample
Authors: Laratta Joseph L. , Reddy Hemant , Lombardi Joseph M. , Shillingford Jamal N. , Saifi Comron , Fischer Charla R. , Lehman Ronald A. , Lenke Lawrence G.
Published: September 2017

Study Design:

Retrospective database study.

Objectives:

Analysis of economic and demographic data concerning interspinous device (ID) placement throughout the United States to improve value-based care and health care utilization.

Methods:

The National Inpatient Sample (NIS) database was queried for patients who underwent insertion of an interspinous process spinal stabilization device (ICD-9-CM 84.80) between 2008 and 2014 across 44 states. Demographic and economic data were obtained which included the annual number of surgeries, age, sex, insurance type, location, and frequency of routine discharge. The NIS database represents a 20% sample of discharges from US hospitals, which is weighted to provide national estimates.

Results:

There was a 73% decrease in ID implanted from 2008 to 2014. The mean cost associated with insertion of the device increased 28% from $13 653 in 2008 to $17 515 in 2014. The mean length of stay (LOS) increased from 1.8 to 2.4 days. Patients aged 45 to 64 years increased from 14.1% to 34.3% while patients aged 65 to 84 years decreased from 74.4% to 60.6%. By region, 34% of ID placement occurred in the South followed by 19.7% that occured in the Northeast. When stratifying by median income for patient zip code, the procedure was performed more in cities designated as higher rather than lower income areas (74.2% and 19.5%, respectively).

Conclusions:

Throughout the United States, there was a progressive decline in the insertion of interspinous spacers by 73% over the study period. The total costs for the procedure increased by 28% while the aggregate national charges decreased by 55.6% between 2008 and 2014.
Psychological Assessment of Patients With Biotin-Thiamine-Responsive Basal Ganglia Disease
Authors: Alfadhel Majid , Al-Bluwi Amal
Published: September 2017

Biotin-thiamine-responsive basal ganglia disease is a devastating autosomal recessive inherited neurological disorder. We conducted a retrospective chart review of all patients with biotin-thiamine-responsive basal ganglia disease who underwent a formal psychological assessment. Six females and 3 males were included. Five patients (56%) had an average IQ, two patients (22%) had mild delay, and two (22%) had severe delay. A normal outcome was directly related to the time of diagnosis and initiation of treatment. Early diagnosis and immediate commencement of treatment were associated with a favorable outcome and vice versa. The most affected domain was visual motor integration, while understanding and mathematical problem-solving were the least affected. In summary, this is the first study discussing the psychological assessment of patients with biotin-thiamine-responsive basal ganglia disease. The results of this study alert clinicians to consider prompt initiation of biotin and thiamine in any patient presenting with neuroregression and a basal ganglia lesion on a brain magnetic resonance imaging.
Verification of Neonatal Tetanus Surveillance Systems in Katsina State, Nigeria
Authors: Nass Shafique Sani , Danawi Hadi , Cain Loretta , Sharma Monoj
Published: September 2017

Background:

The incidence and mortality rates of neonatal tetanus (NNT) remain underreported in Nigeria. The goal of the study was to compare the NNT prevalence and the mortality rates from the existing surveillance system and active surveillance of health facility records in 7 selected health facilities from 2010 to 2014 in Katsina State, Nigeria.

Methods:

The study is a retrospective record review using extracted data from NNT records and analyzed using descriptive statistics.

Results:

The prevalence of NNT and mortality rate were 336 cases and 3.4 deaths per 100 000 population, respectively, whereas the prevalence of NNT and mortality rate reported through the Integrated Disease Surveillance and Response (IDSR) system were 111 cases and 1.0 death per 100 000 population, respectively.

Conclusion:

The study shows underreporting of NNT in the existing IDSR system.

Implications:

Active surveillance is a good strategy for verifying underreporting of NNT in the surveillance system. The IDSR system should be strengthened with the capacity to detect events associated with a disease toward global elimination.
Changing Gender Role: Women’s Livelihoods, Conflict and Post-conflict Security in Nepal
Authors: K.C. Luna , Van Der Haar Gemma , Hilhorst Dorothea
Published: September 2017

This article examines how the Maoist conflict in Nepal affected women ex-combatants and non-combatants, looking at shifts in gender roles during and after the conflict particularly from the standpoint of current livelihood challenges. We argue changing gender roles largely depends upon everyday practice of gender division of labour and power as it evolved during and after the conflict. We also found the conflict had different and contradictory effects: Both categories of women experienced shift in gender roles, with women taking on tasks earlier reserved for men, but this effect was strongest amongst ex-combatants during conflict. In the aftermath of conflict, these changes were partly reversed and especially ex-combatant women faced severe livelihood challenges and returned to traditional gender roles. The article also considers how women experience state and non-state responses meant to improve their livelihoods security in the post-conflict setting. The article is based on in-depth fieldwork in Chitwan and Kathmandu districts of Nepal. It draws on interviews with women ex-combatants/non-combatants and key informant interviews.
Biological Sex, Gender, and Public Policy
Authors: van Anders Sari M. , Schudson Zach C. , Abed Emma C. , Beischel William J. , Dibble Emily R. , Gunther Olivia D. , Kutchko Val J. , Silver Elisabeth R.
Published: September 2017

Policy debates have focused on who can participate in or access single-sex activities or services. This article describes how science of the biology of sex is relevant to three major policy areas: parenting (including leaves), sports, and public spaces. We focus on what scientists know about sex and gender (and gender/sex, where gender and sex are intertwined), and the role of various biological factors, including hormones such as testosterone and estradiol as well as genetics, gonads, genitals, and more. The policies under debate often use “biological sex,” but this fails to account for scientific understandings of sex and gender, misrepresents sex as single-faceted and binary, and overlooks scientific consensus about the importance of gender and identity.
Nadler’s fixed point theorem in ν-generalized metric spaces
Authors: Suzuki Tomonari
Published: September 2017

We extend Nadler’s fixed point theorem to ν-generalized metric spaces. Through the proof of the above extension, we understand more deeply the mathematical structure of a ν-generalized metric space. In particular, we study the completeness of the space. We also improve Caristi’s and Subrahmanyam’s fixed point theorems in the space.
Coincidence theory for compact morphisms
Authors: O’Regan Donal
Published: September 2017

In this paper we present several coincidence type results for morphisms (fractions) in the sense of Gorniewicz and Granas.
The aetiology of the non-ossifying fibroma of the distal femur and its relationship to the surrounding soft tissues
Authors: Goldin A. , Muzykewicz D. A. , Dwek J. , Mubarak S. J.
Published: September 2017

Purpose

We aim to retrospectively evaluate patients with non-ossifying fibroma (NOF) of the distal femur by radiographs, CT and MRI, and to provide a theory describing the reasoning for the distal femur NOF's location and aetiology.

Methods

Charts of patients with NOFs between 2003 and 2014 were retrospectively reviewed. Inclusion criteria encompassed a diagnosis of NOF of the distal femur by imaging, and histologically, if available. Radiographs, CT and MRI were used to characterise the relationship of the NOF lesions with the surrounding soft tissues.

Results

The 68 NOFs from 60 patients were included. By radiograph, 41 (60.3%) of the 68 lesions appeared at the medial and 25 (36.7%) at the lateral aspect of the distal femur. In total, 41 lesions had CT scans, showing 22 NOFs (53.7%) attached to the origin of the medial gastrocnemius, 12 (29.3%) to the origin of the lateral gastrocnemius and four (9.8%) at the attachment of the adductor magnus. Of the CT scans, 93% identified the NOF's relationship with an adjoining tendon of the distal femur. Six had MRIs, all of which showed attachment at the medial gastrocnemius.

Conclusion

The study reveals a relationship between tendinous structures and NOFs. NOFs of the distal femur occur most commonly at the origin of the medial and lateral gastrocnemius. They may originate from the physis/metaphysis but they do not always attach to the physis, as we observe them ‘migrating’ as patients grow. More research is required to understand the exact aetiology of NOFs.
A UNIFIED DECISION FRAMEWORK FOR INVENTORY CLASSIFICATION THROUGH GRAPH THEORY
Authors: Mallick Bivash , Sarkar Bijan , Das Santanu
Published: September 2017

Conventionally, a traditional ABC analysis based on a single criterion of annual consumption cost is employed in industry to facilitate classification of inventory items. However, other criteria may be important in inventory classification such as lead time, item criticality, storage cost, etc. Hence, for situations like this many multiple criteria decision-making methods are available and the Analytic Hierarchy Process (AHP) is a popular one. The present article demonstrates a new approach by integrating Graph Theory (GT) and the Analytic Hierarchy Process (AHP) as a decision analysis tool for multi-criteria inventory classification. In this paper, 47 disposable items used in a respiratory therapy unit of a hospital were considered for a case study. Output of this hybrid method shows more precise results than that of either traditional ABC or the AHP classification methods. As the proposed decision analysis tool is a simple, logical, systematic and consistent method, it may be recommended for application in diverse industries handling multi-criteria inventory classification systems.https://doi.org/10.13033/ijahp.v9.i2.482
HOW TO WRITE A CONTRACT WITH THE AHP
Authors: Vargas Luis G
Published: September 2017

In this paper, we show how the Analytic Hierarchy Process could be used to develop a legal contract in the process of a negotiation.  We illustrate the process with a well-known case used routinely in negotiation courses to illustrate that the AHP is particularly well suited for this type of applications where most of the dimensions and criteria are intangibles, and the scales used to measure the gains and costs of parties involved in the negotiation do not always exist. https://doi.org/10.13033/ijahp.v9.i2.490
Evaluation of Lipoprotein(a) Electrophoretic and Immunoassay Methods in Discriminating Risk of Calcific Aortic Valve Disease and Incident Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Cao Jing , Steffen Brian T , Guan Weihua , Budoff Matthew , Michos Erin D , Kizer Jorge R , Post Wendy S , Tsai Michael Y
Published: September 2017

BACKGROUND

A number of lipoprotein(a) [Lp(a)] analytical techniques are available that quantify distinct particle components, yet their clinical efficacy has not been comprehensively evaluated. This study determined whether Lp(a) mass [Lp(a)-M], Lp(a) cholesterol content [Lp(a)-C], and particle concentration [Lp(a)-P] differentially discriminated risk of calcific aortic valve disease (CAVD) or incident coronary heart disease (CHD) among 4679 participants of the Multi-Ethnic Study of Atherosclerosis (MESA).

METHODS

Lp(a)-M, Lp(a)-C, and Lp(a)-P were measured in individuals without clinical evidence of CHD at baseline. Relative risk regression and Cox proportional analysis determined associations between Lp(a) and the presence of CAVD or 12-year risk of CHD, respectively. To control for the relatively high lower limits of quantification for Lp(a)-C and Lp(a)-P assays, the upper 25th and 15th percentiles were selected as analytical cutoff points.

RESULTS

Regardless of method or analytical cutoff, high Lp(a) concentrations were significantly associated with CAVD and CHD in MESA participants following adjustment for typical cardiovascular risk factors. Stratifying by race/ethnicity rendered most associations nonsignificant after correction for multiple comparisons, but Lp(a) remained associated with CAVD in whites irrespective of method (all P < 0.0001).

CONCLUSIONS

Associations of Lp(a)-C, Lp(a)-P, and Lp(a)-M with CAVD or incident CHD were similar in this entire MESA sample using a dichotomized statistical approach. However, the high lower limits of quantification and imprecision of the Lp(a)-C and Lp(a)-P assays limited their usefulness in our analyses and would likely do so in research and clinical settings.
Cardiovascular Biomarkers in Hypertensive Patients with Medical Treatment—Results from the Randomized TEAMSTA Protect I Trial
Authors: Jagodzinski Annika , Neumann Johannes Tobias , Ojeda Francisco , Sörensen Nils Arne , Wild Philipp , Münzel Thomas , Zeller Tanja , Westermann Dirk , Blankenberg Stefan
Published: September 2017

BACKGROUND

High blood pressure (BP) is associated with an increased rate of cardiovascular events and mortality. Cardiovascular biomarkers are able to predict long-term risk in the general population, particularly in diseased cohorts. We undertook an investigation of the effect of 2 different antihypertensive treatments on cardiovascular biomarkers in a randomized trial.

METHODS

The TEAMSTA study included 481 hypertensive patients. They were randomized to either 80-mg telmisartan + 5-mg amlodipine (TA) or 40-mg olmesartan + 12.5-mg hydrochlorothiazide (OH). The trial was performed as a prospective, randomized, double-blinded, controlled, single-center study. We measured BP, high-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity cardiac troponin T (hs-cTnT), B-type natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-proBNP) before randomization and after 6 months.

RESULTS

Individuals were randomized into 2 groups: 230 individuals to the OH-group and 251 to the TA-group. After 6 months of treatment, a reduction in BP (systolic/diastolic) was seen, from 135.2/85.2 mmHg to 122.5/75.7 mmHg with similar effects in both groups. hs-cTnT concentrations were measureable in 26.2% of the study population, while hs-cTnI was detected in 98.3%. hs-cTnI concentrations were significantly reduced from 4.6 to 4.2 ng/L in the overall population, from 4.7 to 4.4 ng/L in the OH-group, and from 4.6 to 4.0 ng/L in the TA-group (all P < 0.001). No significant changes of hs-cTnT were observed. BNP and NT-proBNP concentrations decreased from 15.0 to 12.4 ng/L (P < 0.001) and from 64.8 to 53.3 ng/L (P < 0.001), respectively, after 6 months.

CONCLUSIONS

The reduction in BP was associated with a decrease of high-sensitivity troponin I, BNP, and NT-proBNP concentrations, which might represent a cardiovascular risk reduction.

CLINICAL TRIAL REGISTRATION

EudraCT 2009-017010-68
Balance Evaluation of Prefrail and Frail Community-Dwelling Older Adults
Authors: Marques Larissa Tomasauskas , Rodrigues Natalia Camargo , Angeluni Emanuella Oliveira , dos Santos Pessanha Fernanda Pinheiro Amador , da Cruz Alves Natália Maira , Freire Júnior Renato Campos , Ferriolli Eduardo , de Abreu Daniela Cristina Carvalho
Published: September 2017

Background and Purpose:

With the increase in the percentage of the population in older adulthood, issues such as frailty syndrome need to be considered. The aim of the present study was to evaluate the ability of the Balance Evaluation Systems Test (BESTest) and center of pressure (COP) in their ability to discriminate between nonfrail, prefrail, and frail older adults. The proposed hypothesis is that frail older adults would show poorer performance in BESTest tasks and higher oscillation of COP on a force platform.

Methods:

Sixty older adults 65 years or older were divided into 3 groups of 20: group 1, nonfrail; group 2, prefrail; and group 3, frail. The prefrail and frail identifications were made by Fried's 5 frailty phenotype criteria. Balance was assessed using the BESTest and a force platform in 6 positions: (1) fixed platform with eyes open; (2) fixed platform with eyes closed; (3) unstable platform with foam, with eyes open; (4) unstable platform, with eyes closed; (5) semitandem with eyes open; and (6) semitandem with eyes closed.

Results:

Frail older adults had lower scores in all sections and in the total score of the BESTest, indicating worse performance in the tasks. However, on the force platform, the frail older adults did not show higher oscillations, having similar mean values when compared with the prefrail and nonfrail older adults, indicating similar behavior of COP.

Conclusion:

The BESTest seems to be more appropriate than a force plate for assessing postural control impairment and discriminating balance performance among frail, prefrail, and nonfrail older adults, providing information about different components of postural control rather than the force plate, which evaluates sensory orientation.
Sodium Dynamics in Pyramidal Neuron Dendritic Spines: Synaptically Evoked Entry Predominantly through AMPA Receptors and Removal by Diffusion
Authors: Miyazaki Kenichi , Ross William N.
Published: September 2017

Dendritic spines are key elements underlying synaptic integration and cellular plasticity, but many features of these important structures are not known or are controversial. We examined these properties using newly developed simultaneous sodium and calcium imaging with single-spine resolution in pyramidal neurons in rat hippocampal slices from either sex. Indicators for both ions were loaded through the somatic patch pipette, which also recorded electrical responses. Fluorescence changes were detected with a high-speed, low-noise CCD camera. Following subthreshold electrical stimulation, postsynaptic sodium entry is almost entirely through AMPA receptors with little contribution from entry through NMDA receptors or voltage-gated sodium channels. Sodium removal from the spine head is through rapid diffusion out to the dendrite through the spine neck with a half-removal time of ∼16 ms, which suggests the neck has low resistance. Peak [Na+]ichanges during single EPSPs are ∼5 mm. Stronger electrical stimulation evoked small plateau potentials that had significant longer-lasting localized [Na+]iincreases mediated through NMDA receptors.

SIGNIFICANCE STATEMENTDendritic spines, small structures that are difficult to investigate, are important elements in the fundamental processes of synaptic integration and plasticity. The main tool for examining these structures has been calcium imaging. However, the kinds of information that calcium imaging reveals is limited. We used newly developed, high-speed, simultaneous sodium and calcium imaging to examine ion dynamics in spines in hippocampal pyramidal neurons. We found that following single subthreshold synaptic activation most sodium entry was through AMPA receptors and not through NMDA receptors or through voltage-gated sodium channels and that the spine neck is not a significant resistance barrier. Most spine mechanisms are linear. However, regenerative NMDA conductances can be activated with stronger stimulation.
Ingesta de productos naturales o macrobióticos: una llamada de atención a la salud pública
Authors: Hernandez Rivera Patricia
Published: September 2017

Este trabajo aborda la importancia de prevenir el uso indiscriminado de productos naturales o macrobióticos, sus posibles efectos perjudiciales en la salud, así  concienciar a profesionales en el área de la salud sobre la importancia de incluir este tema durante la historia médica. Se analiza el incremento en el uso de productos naturales o macrobióticos, las ventajas de la etnomedicina como un resurgimiento de la industria farmacéutica y las desventajas que acarrea este tipo de productos. Las hierbas ofrecen una alternativa terapéutica como la creación de nuevos fármacos, aunque poseen efectos secundarios que podrían arriesgar la salud de los pacientes.
Calidad en la administración de medicamentos por sondas enterales de una unidad de cuidados intensivos de México
Authors: Méndez-Jiménez Ana Gabriela , Avalos García María Isabel , Priego-Álvarez Heberto Romeo
Published: September 2017

El objetivo principal de este trabajo es evaluar la calidad en la administración de medicamentos por sondas enterales por el personal de enfermería de una unidad de cuidados intensivos. Metodología: Estudio observacional, transversal y descriptivo. Se consideró el total de profesionales en enfermería (N=30) de un hospital de alta especialidad. Se estudió las variables conocimiento y cumplimiento. Para evaluar el conocimiento en la administración de fármacos por sondas enterales, se utilizó el instrumento de Amuriza “encuesta de administración de fármacos por sonda”. Para evaluar el cumplimiento, se empleó la cédula oficial de administración de medicamentos vía oral del Sistema Nacional de Indicadores de Calidad en Salud. Para obtener del nivel de calidad, se creó un índice ponderado general (IPG) a partir de la suma de los valores estimados obtenidos del porcentaje y la puntuación media del nivel de conocimiento y nivel de cumplimiento. Se analizó los datos a través del programa estadístico SSPS V.21.0. Resultados: El nivel de conocimiento promedio fue deficiente en los participantes, el nivel de cumplimiento fue intermedio en el 77%, el nivel de calidad ponderado fue de 5 puntos estimado como deficiente. Conclusiones: El resultado es contrario a lo establecido en los lineamientos de administración de fármacos por sondas, se sugiere adiestramiento y evaluación constante para la mejora continua. Es indispensable el bien saber y el bien hacer en las intervenciones de enfermería
Impact of Metastasectomy in the Multimodality Approach for BRAF V600E Metastatic Colorectal Cancer: The Mayo Clinic Experience
Authors: Johnson Benny , Jin Zhaohui , Truty Mark J. , Smoot Rory L. , Nagorney David M. , Kendrick Michael L. , Kipp Benjamin R. , Grothey Axel
Published: September 2017

Background

BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC.

Subjects, Materials, and Methods

Using prospective clinical and molecular data, patients with BRAF V600E mCRC were analyzed for clinical characteristics and survival. Statistical analyses utilized the Kaplan-Meier method, log-rank test, and Cox proportional hazard models.

Results

Fifty-two patients were identified between July 1, 2008, and January 4, 2016. Patient characteristics included median age 65 years, 61% female, Eastern Cooperative Oncology Group performance status ≤1, 71% with right-sided tumors, and 28% with liver-limited metastasis. In the first-line setting, 7% (4/52) received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI)/bevacizumab (BEV) and 81% were treated with doublet chemotherapy consisting of fluoropyrimidine, oxaliplatin, and BEV. Median overall survival (OS) for all 52 patients was 25 months with median progression-free survival (PFS) of 9.3 months. With median follow-up of 18.3 months, 21 patients underwent metastasectomy with longer OS (29.1 months vs. 22.7 months, hazard ratio [HR] = 0.33; confidence interval [CI], 0.12–0.78; p = .01) and PFS (13.6 months vs. 6.2 months, HR = 0.53, CI, 0.28–0.97; p = .03) compared with the non-metastasectomy cohort. In multivariate analysis, metastasectomy remained significant for improved survival outcomes (HR = 0.52; 95% CI, 0.07–1.02; p = .02). Median disease-free survival after metastasectomy was 9.7 months (95% CI, 5.5–19.5). Two patients remain disease-free at the time of last follow-up, with one patient without relapse for greater than 2 years (28.9 months).

Conclusion

Multimodality therapy incorporating metastasectomy for BRAF V600E mCRC should be considered and might be associated with improved overall survival in select patients.

Implications for Practice

BRAF V600E metastatic colorectal cancer (mCRC) represents an extremely difficult molecular subset of colorectal cancer to treat. To date, this subset remains refractory to standard chemotherapies, prompting extensive clinical investigation regarding novel treatment approaches and targeted modalities. While the use of metastasectomy for expanded RAS wild-type and RAS mutated mCRC has resulted in improved overall survival for select patients, utilization of metastasectomy in patients with BRAF V600E mCRC remains controversial. This article explores the authors' experience with BRAF V600E mCRC to ascertain whether a multidisciplinary approach incorporating metastasectomy for well-selected patients improves overall survival.
Die Hertzogprys vir drama: Griekse tragedie, Middeleeuse moraliteitspel of Negentiende-eeuse realiteit - die problematiek en uitdagings binne die drama-"industrie" en die invloed daarop by die toekenningsproses
Authors: Van Jaarsveld A
Published: September 2017

Die herbesinning oor die begrip "gemeenskap" in die eeu waarin ons leef, noodsaak tot ŉ groot mate ŉ herinterpretasie van ons posisie binne die kulturele en sosiale domeine in die samelewing. Met verwysing na die filosofie van die wetenskap, neem Pierre Bourdieu standpunt in tussen strukturalisme aan die een en ŉ meer subjektiewe benadering tot agente in die samelewing aan die ander kant. Dit beteken in feite dat hoewel mense skynbaar as subjektiewe onafhanklike agente optree, hulle tog ook beïnvloed word deur strukture binne hulle sosiale omgewing. Binne die literêre sisteem impliseer dit dus dat die skrywer of dramaturg en sy/haar teks nooit outonoom geëvalueer kan word nie. Ander belangrike rolspelers binne hierdie proses sou die leser, kritici, uitgewer en selfs die media ook insluit. 'n Duidelike transformasie by die toekenning van pryse is tans in werking. Daar is 'n gedurige dinamiese wisselwerking in die proses, tussen die uitgebreide meganika van nominasie en verkiesing, aanbieding en aanvaarding, borgskap, publisiteit en skandale. In hierdie artikel val die fokus op die bepaalde verhoudings tussen agente en reëls wat binne die veld bestaan. Voorts word die groter "kulturele veld" wat deur pryse blootgelê word, insluitend die belangstelling wat hulle genereer asook die kritieke vyandigheid wat hulle so toenemend ontlok, bekyk. Die afleiding wat gemaak kan word, is dat daar geen ontsnapping uit "die ekonomie van prestige" kan wees nie. Daar word indringend gekyk na die problematiek ten opsigte van die drama-toekennings teen die agtergrond van die drama-genre as deel van die groter literêre sisteem maar ook as onlosmaaklik deel van die groter teaterwetenskap. Die dramateks is dus terselfdertyd literêre teks en teateropvoering. Die drama as speel- en leesteks vereis binne die Hertzogprys-beoordelingsproses sonder twyfel 'n eiesoortige benadering waarsonder die drama-genre nooit sy regmatige plek binne die literêre sisteem sal verkry nie.