bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterising ‘near miss’ events in complex laparoscopic surgery through video analysis
Authors: Bonrath Esther M , Gordon Lauren E , Grantcharov Teodor P
Published: May 2015

Background

Root cause analyses of surgical complications are of high importance to ensure surgical quality, but specific details on technical causes often remain unclear. Identifying subclinical intraoperative incidents attributable to technical errors is essential for developing rescue mechanisms to prevent adverse outcomes.

Objective

Descriptive study to characterise intraoperative technical error-event patterns in successful laparoscopic procedures.

Methods

Events (injuries) identified during prior blinded analyses of 54 unedited recordings of bariatric laparoscopic procedures were subjected to a secondary review to determine the presumed underlying error mechanism. The recordings were obtained from one university-based bariatric collaborative programme, and represented consultant, fellow and shared trainee cases.

Results

Sixty-six events were identified in 38 recordings, while 16 videos showed no events. In 25 (66%) of the videos that showed events, additional measures such as haemostasis or suture repair were required. Common identified events were minor bleeding (n=39, 59%), thermal injury to non-target tissue (n=7, 11%), serosal tears (n=6, 9%). Common error mechanisms were ‘inadequate use of force/distance (too much)’ (n=20, 30%) and ‘inadequate visualisation’ during grasping/dissecting (n=6, 9%), ‘inadequate use of force/distance (too much)’ using an energy device (n=6, 9%), or during suturing (n=6, 9%). All events were recognised intraoperatively.

Conclusions

Analysis of successful operations allowed the identification of numerous error-event sequences. Reviewing injury mechanisms can enhance surgeons’ understanding of relevant errors. This error awareness may aid surgeons in preparing for cases, help avoid errors and mitigate their consequences. Thus, this approach may impact future surgical education and quality initiatives aimed at reducing surgical risks.
Practical application of equine learning theory, part 1
Authors: Pearson Gemma
Published: May 2015

Horses have played a major role in human history, from a food source when hunted and farmed, to aiding us through war and agriculture, before more recently being used for sport and recreation. Because the training of horses is based around tradition, people still use knowledge passed on through generations and frequently discuss ‘the art of horsemanship’ with very little science to back this up. This article, the first in a two‐part series, discusses how horses learn and how understanding this can be used to make working with horses easier and safer. This article uses case examples to explain operant conditioning and classical conditioning. The second article, to be published in a subsequent issue of In Practice, will consider habituation and shaping.
Immediate dispatch
Authors: Brown Richard
Published: May 2015

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.

In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Immediate dispatch?’, was submitted and discussed by Richard Brown. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘The mating game’, which was published in the April issue of In Practice, appears on page 263.

The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.
Comments on the dilemma in the April issue: ‘The mating game’
Authors: Mullan Siobhan
Published: May 2015

The dilemma in the April issue dealt with a valuable Suffolk tup, which was jointly owned by three farmers. Having already served the first two flocks, the tup appeared a bit off colour when it came to the last farm. The provisional diagnosis was acute bronchopneumonia with fever, for which the vet advised rest, antibiotics, anti‐inflammatories, as well as good hay and plenty of water. However, because his ewes had been synchronised, the farmer agreed to follow all the advice except resting the tup (IP, April 2015, vol 37, pp 206‐207). Gwen Rees empathised with the farmer's difficult predicament but suggested that the best option for the ram (as well as the ewes and the farm) was to find a different tup for the season. Although this would mean either using a substandard ram or paying a high price at such short notice, the two other owners might help with the cost or search. She added that if veterinary advice had been ignored an insurance company might not pay out in the event of the ram's death or infertility. It might also be necessary to remind the farmer of the Animal Welfare Act and perhaps even report the farmer for neglect if the ram died.
Whistleblowing in medicine and in Homer'sIliad
Authors: Rodulson Victoria , Marshall Robert , Bleakley Alan
Published: May 2015

‘Thinking with Homer’, or drawing creatively on themes and scenes from Homer'sIliadandOdyssey, can help us to better understand medical culture and practice. One current, pressing, issue is the role of the whistleblower, who recognises and exposes perceived poor practice or ethical transgressions that compromise patient care and safety. Once, whistleblowers were ostracised where medical culture closed ranks. However, in a new era of public accountability, medicine looks to formally embrace whistleblowing to the point that not reporting transgressions can now constitute a transgression of professionalism. Where medical students identify with the history and traditions of medical culture, they inevitably find themselves in situations of conflicting loyalties if they encounter senior clinicians behaving unprofessionally. What are the implications of facing these dilemmas for students in terms of role modelling and shaping of character as a doctor, and how might a study of Homer help with such dilemmas? We suggest that a close reading of an opening scene in Homer's theIliadcan help us to better appreciate such ethical dilemmas. We link this with the early Greek tradition ofparrhesiaor ‘truth telling’, where frankly speaking out against perceived injustice is encouraged as resistance to power and inappropriate use of authority. We encourage medical educators to openly discuss perceived ethical dilemmas with medical students, and medicine as a culture to examine its conscience in a transition from an authoritarian to an ‘open’ society, where whistleblowing becomes as acceptable and necessary as good hygiene on the wards.
Therapeutic use of methocarbamol in a demoiselle crane (Anthropoides virgo) with severe ataxia and lateroflexion of the neck
Authors: Done Lisa , Ialeggio Donna
Published: May 2015

After running at high speed into a fence, an adult, male demoiselle crane (Anthropoides virgo), estimated age 20 years, presented with ataxia, inability to stand and severe lateroflexion of the base of the neck. Therapy for severe shock along with other supportive care treatments provided improvement. After the crane was transferred to a stall six days post presentation, it repeatedly ran into the walls, resulting in the inability to stand. Despite sling support and ongoing corticosteroid therapy, euthanasia was considered. The caudal cervical area was very stiff, with markedly reduced lateral and dorsoventral range of motion. Treatment with intravenous methocarbamol, a centrally acting muscle relaxant, was initiated. Within several hours of the first methocarbamol injection, the caudal cervical area became palpably more flexible. After 54 days of hospitalisation and 30 days of methocarbamol treatment, the crane was normal without clinical evidence of ataxia or lateroflexion of the neck.
Assessment of donor heart viability during ex vivo heart perfusion
Authors: White Christopher W. , Ambrose Emma , Müller Alison , Li Yun , Le Hoa , Hiebert Brett , Arora Rakesh , Lee Trevor W. , Dixon Ian , Tian Ganghong , Nagendran Jayan , Hryshko Larry , Freed Darren
Published: May 2015

Ex vivo heart perfusion (EVHP) may facilitate resuscitation of discarded donor hearts and expand the donor pool; however, a reliable means of demonstrating organ viability prior to transplantation is required. Therefore, we sought to identify metabolic and functional parameters that predict myocardial performance during EVHP. To evaluate the parameters over a broad spectrum of organ function, we obtained hearts from 9 normal pigs and 37 donation after circulatory death pigs and perfused them ex vivo. Functional parameters obtained from a left ventricular conductance catheter, oxygen consumption, coronary vascular resistance, and lactate concentration were measured, and linear regression analyses were performed to identify which parameters best correlated with myocardial performance (cardiac index: mL·min–1·g–1). Functional parameters exhibited excellent correlation with myocardial performance and demonstrated high sensitivity and specificity for identifying hearts at risk of poor post-transplant function (ejection fraction: R2 = 0.80, sensitivity = 1.00, specificity = 0.85; stroke work: R2 = 0.76, sensitivity = 1.00, specificity = 0.77; minimum dP/dt: R2 = 0.74, sensitivity = 1.00, specificity = 0.54; tau: R2 = 0.51, sensitivity = 1.00, specificity = 0.92), whereas metabolic parameters were limited in their ability to predict myocardial performance (oxygen consumption: R2 = 0.28; coronary vascular resistance: R2 = 0.20; lactate concentration: R2 = 0.02). We concluded that evaluation of functional parameters provides the best assessment of myocardial performance during EVHP, which highlights the need for an EVHP device capable of assessing the donor heart in a physiologic working mode.
Comparative analysis of abundance–occupancy relationships for species at risk at both broad taxonomic and spatial scales
Authors: Roney Nancy E. , Kuparinen Anna , Hutchings Jeffrey A.
Published: May 2015

The abundance–occupancy relationship is one of the most well-examined relationships in ecology. At the species level, a positive association has been widely documented. However, until recently, research on the nature of this relationship at broad taxonomic and spatial scales has been limited. Here, we perform a comparative analysis of 12 taxonomic groups across a large spatial scale (Canada), using data on Canadian species at risk: amphibians, arthropods, birds, freshwater fishes, lichens, marine fishes, marine mammals, molluscs, mosses, reptiles, terrestrial mammals, and vascular plants. We find a significantly positive relationship in all taxonomic groups with the exception of freshwater fishes (negative association) and lichens (no association). In general, our work underscores the strength and breadth of this apparently fundamental relationship and provides insight into novel applications for large-scale population dynamics. Further development of species-independent abundance–occupancy relationships, or those of a similar nature, might well prove instrumental in serving as starting points for developing species-independent reference points and recovery strategies.
Population size and spatial ecology of Blanding’s Turtle (Emydoidea blandingii) in South March Highlands, Ottawa, Ontario, Canada
Authors: Hasler Caleb T. , Robinson Kevin , Stow Nick , Taylor Shawn R.
Published: May 2015

Between 2010 and 2011, an arterial road was constructed within provincially significant wetlands in the South March Highlands (SMH) located in Ottawa, Ontario, Canada. The wetlands and adjacent upland areas were determined to be sensitive habitat for Blanding’s Turtles (Emydoidea blandingii (Holbrook, 1838)) during the approval and permitting process, and a population study was required as part of the road construction project. The study consisted of a 4-year mark–recapture program and a movement study of radio-tagged adult turtles. General findings included the identification of 27 adult males and 55 females and a population estimate of 93 adults (95% Cl: 86–118). A 1:2.32 male to female sex bias was also found. Mean home-range size was 19.06 ha and tagged turtles moved, on average, more per observation in 2013 (191.40 m compared with 89.75 and 123.04 m in 2011 and 2012, respectively). Previously reported differences in movement patterns between males, females, and gravid females were not observed. The SMH Blanding’s Turtle population should be closely monitored because urban development continues in the area, which may further reduce the population size. Understanding the biology of imperiled populations across species’ ranges is necessary to promote conservation and adaptive wildlife management.
ACCELERATED SHARE REPURCHASE: PRICING AND EXECUTION STRATEGY
Authors: GUÉANT OLIVIER , PU JIANG , ROYER GUILLAUME
Published: May 2015

In this paper, we consider the optimal execution problem associated to accelerated share repurchase (ASR) contracts. When firms want to repurchase their own shares, they often enter such a contract with a bank. The bank buys the shares for the firm and is paid the average market price over the execution period, the length of the period being decided upon by the bank during the buying process. Mathematically, the problem is new and related to both option pricing (Asian and Bermudan options) and optimal execution. We provide a model, along with associated numerical methods, to determine the optimal stopping time and the optimal buying strategy of the bank.
Substituent effects on selectivity of coupled oxidation of iron tetraphenylporphyrins
Authors: Kakeya Kazuhisa , Shimizu Atsuko , Akasaka Kenta , Mizutani Tadashi
Published: May 2015

Coupled oxidation of iron tetraphenylporphyrins bearing either a OMe , Me , F , Cl , COOMe , CF 3 or CN group in the para-position of the phenyl groups gave tetraarylbiladien-ab-1-one and triarylbilindione. The ratios of the yields of the former to those of the latter were linearly correlated with the Hammett substituent constants σp+, with a positive slope (Δρ = 0.64). The Hammett plot of the oxidation rate vs. the substituent constant σp also showed a positive slope (ρ = 0.30). These substituent effects suggest that a nucleophilic step is included in the formation of bilindione. Coupled oxidation of an A3B type tetraarylporphyrin having an electron withdrawing nitro group in one of the phenyl groups indicated that the oxidation leading to biladienone occurred rather statistically in any of the meso-positions, while the oxidation leading to bilindione occurred preferentially in the meso-position bearing the 4-nitrophenyl group.
Hydrogen sulfide promotes calcium uptake in larval zebrafish
Authors: Kwong Raymond W. M. , Perry Steve F.
Published: May 2015

Hydrogen sulfide (H2S) can act as a signaling molecule for various ion channels and/or transporters; however, little is known about its potential involvement in Ca2+ balance. Using developing zebrafish ( Danio rerio) as an in vivo model system, the present study demonstrated that acute exposure to H2S donors increased Ca2+ influx at 4 days postfertilization, while chronic (3-day) exposure caused a rise in whole body Ca2+ levels. The mRNA expression of Ca2+-transport-related genes was unaffected by H2S exposure, suggesting that posttranscriptional modifications were responsible for the altered rates of Ca2+ uptake. Indeed, treatment of fish with the protein kinase A inhibitor H-89 abolished the H2S-mediated stimulation of Ca2+ influx, suggesting that H2S increased Ca2+ influx by activating cAMP-protein kinase A pathways. Cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) are two key enzymes in the endogenous synthesis of H2S. Using an antisense morpholino knockdown approach, we demonstrated that Ca2+ influx was reduced in CBS isoform b (CBSb)- but not in CSE-deficient fish. Interestingly, the reduction in Ca2+ influx in CBSb-deficient fish was observed only in fish that were acclimated to low-Ca2+ water (i.e., 25 μM Ca2+; control: 250 μM Ca2+). Similarly, mRNA expression of cbsb but not cse was increased in fish acclimated to low-Ca2+ water. Results from whole-mount immunohistochemistry further revealed that CBSb was expressed in Na+-K+-ATPase-rich cells, which are implicated in Ca2+ uptake in zebrafish larvae. Collectively, the present study suggests a novel role for H2S in promoting Ca2+ influx, particularly in a low-Ca2+ environment.
An Unusual Presentation of a Posterior Mediastinal Schwannoma Associated with Traumatic Hemothorax
Authors: Amin Ruchi , Waibel Brett H.
Published: May 2015

Schwannomas of the thoracic cavity are typically an asymptomatic, benign neurogenic neoplasm of the posterior mediastinum. In this case, we present a traumatic hemothorax as the initial presentation for a previously undiscovered mediastinal mass. The patient presented with shortness of breath and right-sided chest pain after being struck in the chest with a soccer ball. An operative exploration was pursued due to persistent hemothorax with hemodynamic instability despite resuscitation and adequate thoracostomy tube placement. The intraoperative etiology of bleeding was discovered to be traumatic fracture of a large hypervascular posterior mediastinal schwannoma. Surgical resection is the treatment of choice for these tumors. Specific serological markers do not exist for this tumor, and radiographic findings can be variable, so tissue diagnosis is of importance in differentiating benign from malignant schwannomas, as well as other posterior mediastinal tumors. However, most patients have excellent survival following complete resection.
Kytococcus schroeteriBacteremia in a Patient with Hairy Cell Leukemia: A Case Report and Review of the Literature
Authors: Amaraneni Akshay , Malik Devin , Jasra Sakshi , Chandana Sreenivasa R. , Garg Deepak
Published: May 2015

TheKytococcusgenus formerly belonged toMicrococcus. The first report of aKytococcus schroeteriinfection was in 2002 in a patient diagnosed with endocarditis. We report a case of central line associatedKytococcus schroeteribacteremia in a patient with underlying Hairy Cell Leukemia.Kytococcus schroeteriis an emerging infection in the neutropenic population and in patients with implanted artificial tissue. It is thought to be a commensal bacterium of the skin; however, attempts to culture the bacteria remain unsuccessful. There have been a total of 5 cases (including ours) ofK. schroeteribacteremia in patients with hematologic malignancies and neutropenia and only 18 documented cases in any population. Four of the cases of bacteria in neutropenic patients have been fatal, but early detection and treatment could make a difference in clinical outcomes.
CandidaBloodstream Infections in Italy: Changing Epidemiology during 16 Years of Surveillance
Authors: Caggiano Giuseppina , Coretti Caterina , Bartolomeo Nicola , Lovero Grazia , De Giglio Osvalda , Montagna Maria Teresa
Published: May 2015

Although considerable progress has been made in the management of patients with invasive fungal infections,Candidabloodstream infections are still widespread in hospital settings. Incidence rates vary geographically, often because of different patient populations. The aim of the present study was to describe the epidemiology of candidemia, to analyze the trend of species distribution, and to measure thein vitrosusceptibility to antifungal drugs in a university Italian hospital from 1998 to 2013. The antifungal susceptibility for allCandidaisolates was evaluated by broth microdilution assay (CLSI M27-A3 document). Of 394 episodes of candidemia, the average incidence was 3.06/10 000 admissions.C. albicansand non-albicans Candidaspecies caused 44.2% and 55.8% of the episodes, respectively.C. parapsilosis(62.2%) was the most common non-albicans.  C. albicanspredominated in almost all departments whereasC. parapsilosiswas found in adult and paediatric oncohaematology units (34.8% and 77.6%, resp.). Overall, mortality occurred in 111 (28.2%) patients. Death occurred most often in intensive care units (47.1%) and specialist surgeries (43.7%). Most of the isolates were susceptible to antifungal drugs, but there was an upward trend for azole (P<0.05). In conclusion, this study emphasizes the importance of monitoring local epidemiologic data and the diversity of patient groups affected.
Macrophage Activation Syndrome as Onset of Systemic Lupus Erythematosus: A Case Report and a Review of the Literature
Authors: Granata Guido , Didona Dario , Stifano Giuseppina , Feola Aldo , Granata Massimo
Published: May 2015

Macrophage activation syndrome (MAS) is a potentially fatal condition. It belongs to the hemophagocytic lymphohistiocytosis group of diseases. In adults, MAS is rarely associated with systemic lupus erythematosus, but it also arises as complication of several systemic autoimmune disorders, like ankylosing spondylitis, rheumatoid arthritis, and adult-onset Still’s disease. Several treatment options for MAS have been reported in the literature, including a therapeutic regimen of etoposide, dexamethasone, and cyclosporine. Here we report a case of 42-year-old woman in whom MAS occurred as onset of systemic lupus erythematosus.
Electrospinning Preparation of Timosaponin B‐II‐Loaded PLLA Nanofibers and Their Antitumor Recurrence Activities In Vivo
Authors: Huo Zhonghua , Qiu Yan , Chu Zhuling , Yin Peng , Lu Wenquan , Yan Yijia , Wan Na , Chen Zhilong
Published: May 2015

Poly(L‐lactic)‐acid (PLLA) as a drug carrier and a water‐soluble drug timosaponin B‐II (TB‐II) as a model drug were selected to prepare drug‐loaded nanofibers by electrospinning. The average diameters of pure PLLA nanofibers and TB‐II‐loaded nanofibers were 212.5 ± 68.5, 219.7 ± 57.8, 232.8 ± 66.9, and 232.9 ± 97.7 nm, respectively. DSC and XRD results demonstrated that TB‐II was well incorporated into the nanofibers in an amorphous state. FI‐TR spectroscopy indicated that TB‐II had good compatibility with PLLA. In vitro release studies showed that TB‐II was rapidly released from the nanofibers within 6 h, followed by a gradual release for long time. In vivo biosafety test revealed no noticeable toxicity of these TB‐II nanofibers. The TB‐II released from the nanofibers had obvious inhibition effect against human hepatocellular carcinoma SMMC 7721 cells both in vivo and in vitro. It was confirmed that the TB‐II‐loaded nanofibers were a sustained delivery system which could effectively inhibit the tumor growth and recurrence after surgery.
Synchronized Control for Five-Story Building under Earthquake Loads
Authors: Mesbahi Javad , Malek Alaeddin
Published: May 2015

Synchronized control is implemented for a five-story building under earthquake loads and its capabilities are investigated for protection of building under earthquake. In this regard, we appliedH2/LQGcontrol algorithm in form of synchronized control for structural vibration reduction. Simulation results of modeling indicated that not only the provided control is able to reduce the responses of vibrations for the structure, but also it is even capable of supplying the objectives of synchronized control at the same time. Numerical results for uncontrolled, traditionalH2/LQGcontrol and synchronized control coupled withH2/LQGalgorithm are presented. It is shown that for El Centro and Bam earthquakes the synchronized control is more efficient to reduce damage to the given structures.
Thoracic Aortic Injury: Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation
Authors: Lagios Konstantinos , Karaolanis Georgios , Perdikides Theodossios , Bazinas Theodoros , Kouris Nikolaos , Sfikas Spiros , Paxinos Odysseas
Published: May 2015

Iatrogenic aortic injuries are rare and well-recognized complications of a variety of procedures, including spinal surgery. The placement of pedicle screws is sometimes associated with devastating consequences. Aortic perforation with rapid hematoma formation and delayed aortic trauma leading to pseudoaneurysm formation have been described in the literature. A case describing a significant time interval between iatrogenic aortic injury and diagnosis in the absence of pseudoaneurysm formation is described in this paper and, according to our knowledge, is unique in the literature. The aortic injury was successfully treated, selecting the appropriate graft and, as a consequence, normal spinal cord blood flow was achieved.
Fairness Consideration of Scheduling for Real-Time Services in 4G Systems
Authors: Tarn Woei-Hwa , Chen Jenhui , Lee Chun-Liang
Published: May 2015

In order to achieve higher resource utilization, the call admission control (CAC) will allow the number of connections into the system more than the system capacity can offer. However, the fairness problem will occur when these connections are real-time services. To solve this problem, in this paper, we propose a fair scheduling algorithm named contribution-based scheduling algorithm (CSA) for real-time polling service (rtPS) or guarantee bit rate (GBR) in the uplink direction in the forth-generation (4G) systems. In CSA, a mobile subscriber (MS) gains its contribution credit value at the end of each transmission time interval (TTI), which is based on the contribution of MS to the radio resource scheduling. The base station (BS) schedules the bandwidth according to the credit value. Simulation results show that CSA achieves higher fairness in bandwidth allocation while connection drop rate and queuing delay are also guaranteed as compared to the roundrobin (RR) and early deadline first (EDF) mechanisms.
Assessment of Musculoskeletal Injuries from Domestic Violence in the Emergency Department
Authors: Giannakopoulos Georgios F. , Reijnders Udo J. L.
Published: May 2015

Domestic violence is one of the most common causes of nonfatal injury in women, with musculoskeletal injuries representing the second most prevalent manifestation of this form of violence. It is therefore of great importance that healthcare providers such as emergency department (ED) physicians and surgeons are able to recognize and assess these kinds of injuries. In this case report, a woman is described visiting an ED with injuries caused by a fall. Thanks to the knowledge and attention of the ED physician, the real cause of the injury was discovered. What appeared to be an unsuspicious accident was actually the result of intimate partner violence.
A Reliability-Based Approach to Nonrepairable Spare Part Forecasting in Aircraft Maintenance System
Authors: Kontrec Nataša Z. , Milovanović Gradimir V. , Panić Stefan R. , Milošević Hranislav
Published: May 2015

In recent times, spare parts inventory systems have been extensively researched, but most inventory models were not fully adequate due to the stochastic nature of inventory environment. This paper proposes an approach that supports decision making process in planning and controlling of spare parts in aircraft maintenance systems. Reliability characteristics of aircraft consumable parts were analyzed in order to substantiate this approach. Moreover, the proposed reliability model was used to evaluate characteristics of subassemblies and/or assemblies these parts belong to. Finally, an innovative approach for determining the total amount of parts required in inventory and underage costs, based on observing the total unit time as a stochastic process, is presented herein.
Segmentation of Bone with Region Based Active Contour Model in PD Weighted MR Images of Shoulder
Authors: Sezer Aysun , Sezer Hasan Basri , Albayrak Songul
Published: May 2015

Proton density (PD) weighted MR images present inhomogeneity problem, low signal to noise ratio (SNR) and cannot define bone borders clearly. Segmentation of PD weighted images is hampered with these properties of PD weighted images which even limit the visual inspection. The purpose of this study is to determine the effectiveness of segmentation of humeral head from axial PD MR images with active contour without edge (ACWE) model. We included 219 images from our original data set. We extended the use of speckle reducing anisotropic diffusion (SRAD) in PD MR images by estimation of standard deviation of noise (SDN) from ROI. To overcome the problem of initialization of the initial contour of these region based methods, the location of the initial contour was automatically determined with use of circular Hough transform. For comparison, signed pressure force (SPF), fuzzy C-means, and Gaussian mixture models were applied and segmentation results of all four methods were also compared with the manual segmentation results of an expert. Experimental results on our own database show promising results. This is the first study in the literature to segment normal and pathological humeral heads from PD weighted MR images.
Engineering Solutions to Enhance Traffic Safety Performance on Two-Lane Highways
Authors: Wu Lina , Chu Jiangwei , Ci Yusheng , Feng Shumin , Liu Xingwang
Published: May 2015

Improving two-lane highway traffic safety conditions is of practical importance to the traffic system, which has attracted significant research attention within the last decade. Many cost-effective and proactive solutions such as low-cost treatments and roadway safety monitoring programs have been developed to enhance traffic safety performance under prevailing conditions. This study presents research perspectives achieved from the Highway Safety Enhancement Project (HSEP) that assessed safety performance on two-lane highways in Beijing, China. Potential causal factors are identified based on proposed evaluation criteria, and primary countermeasures are developed against inferior driving conditions such as sharp curves, heavy gradients, continuous downgrades, poor sight distance, and poor clear zones. Six cost-effective engineering solutions were specifically implemented to improve two-lane highway safety conditions, including (1) traffic sign replacement, (2) repainting pavement markings, (3) roadside barrier installation, (4) intersection channelization, (5) drainage optimization, and (6) sight distance improvement. The effectiveness of these solutions was examined and evaluated based on Empirical Bayes (EB) models. The results indicate that the proposed engineering solutions effectively improved traffic safety performance by significantly reducing crash occurrence risks and crash severities.
The Leachate Release and Microstructure of the Sewage Sludge under the Anaerobic Fermentation
Authors: Dong Yiqie , Lu Haijun , Li Jixiang , Wang Changhong
Published: May 2015

Pollutant release, pore structure, and thermal effect of sewage sludge during anaerobic fermentation were investigated. Results showed that the pH value firstly declined and then increased during anaerobic fermentation. The BOD5and organics of sewage sludge declined, and the BOD5of samples which was originally neutral declined as much as 53.6%. The micropore of samples was relatively developed. The biggest adsorption amount was 69.2 cm3/g. The average pore size was enlarged about 16.0–19.8% under anaerobic fermentation. There existed endothermic valley during heating procedure of 0–200∘C because of the dehydration, and the mass loss was 60.9–72.5%. The endothermic valley of the sample fluctuated at the 14th day in the anaerobic fermentation. During the heating procedure of 200–600∘C, there existed exothermal peaks because of the oxidation and burning of the organics. The curve of sample which was originally neutral had comparatively large endothermic valley and exothermal peak.
AL Amyloidosis Complicated by Persistent Oral Bleeding
Authors: Marconcini Luiz Antonio Liarte , Stewart Forrest Marc , Sonntag Lisa , Stevens Emily , Burwick Nicholas
Published: May 2015

A case of amyloid light chain (AL) amyloidosis is presented here with uncontrolled bleeding after a nonsurgical dental procedure, most likely multifactorial in nature, and consequently treated with a multidisciplinary approach.
Inflammation Biomarkers of Advanced Disease in Nongingival Tissues of Chronic Periodontitis Patients
Authors: da Costa Thiago Alvares , Silva Marcelo José Barbosa , Alves Polyanna Miranda , Chica Javier Emílio Lazo , Barcelos Emilio Zorzo , Giani Max Antonio Alves , Garlet Gustavo Pompermaier , da Silva João Santana , Rodrigues Júnior Virmondes , Rodrigues Denise Bertulucci Rocha , Cardoso Cristina Ribeiro de Barros
Published: May 2015

Chronic periodontitis is a multifactorial inflammatory disease that affects supporting structures of the teeth. Although the gingival response is largely described, little is known about the immune changes in the alveolar bone and neighboring tissues that could indicate periodontal disease (PD) activity. Then, in this study we identified the ongoing inflammatory changes and novel biomarkers for periodontitis in the tissues directly affected by the destructive disease in PD patients. Samples were collected by osteotomy in 17 control subjects during extraction of third molars and 18 patients with advanced PD, in which alveoloplasty was necessary after extraction of teeth with previous extensive periodontal damage. Patients presented mononuclear cells infiltration in the connective tissue next to the bone and higher fibrosis area, along with increased accumulation of IL‐17+ and TRAP+ cells. The levels of TNF‐α and MMP‐2 mRNA were also elevated compared to controls and a positive and significant correlation was observed between TNF‐α and MMP‐2 mRNA expression, considering all samples evaluated. In conclusion, nongingival tissues neighboring large periodontal pockets present inflammatory markers that could predict ongoing bone resorption and disease spreading. Therefore, we suggested that the detailed evaluation of these regions could be of great importance to the assessment of disease progression.
Tracking and Functional Characterization of Epithelial–Mesenchymal Transition and Mesenchymal Tumor Cells during Prostate Cancer Metastasis
Authors: Ruscetti Marcus , Quach Bill , Dadashian Eman L. , Mulholland David J. , Wu Hong
Published: May 2015

The epithelial–mesenchymal transition (EMT) has been postulated as a mechanism by which cancer cells acquire the invasive and stem-like traits necessary for distant metastasis. However, direct in vivo evidence for the role of EMT in the formation of cancer stem–like cells (CSC) and the metastatic cascade remains lacking. Here we report the first isolation and characterization of mesenchymal-like and EMT tumor cells, which harbor both epithelial and mesenchymal characteristics, in an autochthonous murine model of prostate cancer. By crossing the established Pb-Cre+/−;PtenL/L;KrasG12D/+ prostate cancer model with a vimentin-GFP reporter strain, generating CPKV mice, we were able to isolate epithelial, EMT, and mesenchymal-like cancer cells based on expression of vimentin and EpCAM. CPKV mice (but not mice with Pten deletion alone) exhibited expansion of cells with EMT (EpCAM+/Vim-GFP+) and mesenchymal-like (EpCAM−/Vim-GFP+) characteristics at the primary tumor site and in circulation. These EMT and mesenchymal-like tumor cells displayed enhanced stemness and invasive character compared with epithelial tumor cells. Moreover, they displayed an enriched tumor-initiating capacity and could regenerate epithelial glandular structures in vivo, indicative of epithelia–mesenchyme plasticity. Interestingly, while mesenchymal-like tumor cells could persist in circulation and survive in the lung following intravenous injection, only epithelial and EMT tumor cells could form macrometastases. Our work extends the evidence that mesenchymal and epithelial states in cancer cells contribute differentially to their capacities for tumor initiation and metastatic seeding, respectively, and that EMT tumor cells exist with plasticity that can contribute to multiple stages of the metastatic cascade. Cancer Res; 75(13); 2749–59. ©2015 AACR.
A Novel Cinnamon-Related Natural Product with Pim-1 Inhibitory Activity Inhibits Leukemia and Skin Cancer
Authors: Kim Jong-Eun , Son Joe Eun , Jeong Hyein , Kim Dong Joon , Seo Sang Gwon , Lee Eunjung , Lim Tae Gyu , Kim Jong Rhan , Kimbung Yengo Raymond , Chen Hanyong , Bode Ann M. , Lee Ki Won , Dong Zigang
Published: May 2015

The Pim-1 kinase regulates cell survival, proliferation, and differentiation and is overexpressed frequently in many malignancies, including leukemia and skin cancer. In this study, we used kinase profiling analysis to demonstrate that 2′-hydroxycinnamicaldehyde (2′-HCA), a compound found in cinnamon, specifically inhibits Pim-1 activity. Cocrystallography studies determined the hydrogen bonding pattern between 2′-HCA and Pim-1. Notably, 2′-HCA binding altered the apo kinase structure in a manner that shielded the ligand from solvent, thereby acting as a gatekeeper loop. Biologically, 2′-HCA inhibited the growth of human erythroleukemia or squamous epidermoid carcinoma cells by inducing apoptosis. The compound was also effective as a chemopreventive agent against EGF-mediated neoplastic transformation. Finally, 2′-HCA potently suppressed the growth of mouse xenografts representing human leukemia or skin cancer. Overall, our results offered preclinical proof of concept for 2′-HCA as a potent anticancer principle arising from direct targeting of the Pim-1 kinase. Cancer Res; 75(13); 2716–28. ©2015 AACR.
A Monoclonal Antibody to ADAM17 Inhibits Tumor Growth by Inhibiting EGFR and Non–EGFR-Mediated Pathways
Authors: Rios-Doria Jonathan , Sabol Darrin , Chesebrough Jon , Stewart Dave , Xu Linda , Tammali Ravinder , Cheng Li , Du Qun , Schifferli Kevin , Rothstein Ray , Leow Ching Ching , Heidbrink-Thompson Jenny , Jin Xiaofang , Gao Changshou , Friedman Jay , Wilkinson Brandy , Damschroder Melissa , Pierce Andrew J. , Hollingsworth Robert E. , Tice David A. , Michelotti Emil F.
Published: May 2015

ADAM17 is the primary sheddase for HER pathway ligands. We report the discovery of a potent and specific ADAM17 inhibitory antibody, MEDI3622, which induces tumor regression or stasis in many EGFR-dependent tumor models. The inhibitory activity of MEDI3622 correlated with EGFR activity both in a series of tumor models across several indications as well in as a focused set of head and neck patient–derived xenograft models. The antitumor activity of MEDI3622 was superior to that of EGFR/HER pathway inhibitors in the OE21 esophageal model and the COLO205 colorectal model suggesting additional activity outside of the EGFR pathway. Combination of MEDI3622 and cetuximab in the OE21 model was additive and eradicated tumors. Proteomics analysis revealed novel ADAM17 substrates that function outside of the HER pathways and may contribute toward the antitumor activity of the monoclonal antibody. Mol Cancer Ther; 14(7); 1637–49. ©2015 AACR.
Noninvasive and Invasive Assessments of the Functional Significance of Intermediate Coronary Artery Stenosis: Is This a Matter of Right or Wrong?
Authors: Yongzhen Fan , Jeon Ki-Hyun , Doh Joon-Hyung , Koo Bon-Kwon
Published: May 2015

Coronary computed tomographic angiography (cCTA) has emerged in recent years as a noninvasive modality to evaluate coronary artery disease. Many studies have revealed the excellent diagnostic accuracy of cCTA when compared with invasive coronary angiography (ICA) or intravascular ultrasound (IVUS). It is generally accepted that the functional significance of coronary artery stenosis is important to make treatment decisions; however, cCTA, ICA, and IVUS are limited in the ability to determine the physiologic significance of coronary stenosis. The FIGURE-OUT study compared the noninvasive and invasive assessment of the functional significance of intermediate coronary artery stenosis.
Comprehensive Analysis of Large Sets of Age-Related Physiological Indicators Reveals Rapid Aging around the Age of 55 Years
Authors: Lixie Erin , Edgeworth Jameson , Shamir Lior
Published: May 2015

Background: While many studies show a correlation between chronological age and physiological indicators, the nature of this correlation is not fully understood. Objective: To perform a comprehensive analysis of the correlation between chronological age and age-related physiological indicators. Method: Physiological aging scores were deduced using principal component analysis from a large dataset of 1,227 variables measured in a cohort of 4,796 human subjects, and the correlation between the physiological aging scores and chronological age was assessed. Results: Physiological age does not progress linearly or exponentially with chronological age: a more rapid physiological change is observed around the age of 55 years, followed by a mild decline until around the age of 70 years. Conclusion: These findings provide evidence that the progression of physiological age is not linear with that of chronological age, and that periods of mild change in physiological age are separated by periods of more rapid aging.
Successful Management of a Unique Condition of Isolated Intracranial Mucormycosis in an Immunocompetent Child
Authors: Al Barbarawi Mohammed M. , Allouh Mohammed Z.
Published: May 2015

This report describes a unique case of isolated intracranial mucormycosis of a slowly progressive nature in a healthy immunocompetent child. A 4-year-old girl with a clear medical and surgical history presented with complaints of right side facial asymmetry and unsteady gait for a period of 10 months. Clinical and radiographic investigations revealed right-sided lower motor neuron facial palsy caused by an infiltrative lesion on the right cerebellopontine angle. Initial surgical debulking was performed, a biopsy was sent for histopathological examination, and a course of prophylactic antibiotic and antifungal drugs was prescribed. The pathological report confirmed the mucormycosis fungal infection, and intravenous amphotericin B was administered for 3 weeks. One month after admission, the patient left the hospital with complete recovery. Follow-ups after 4, 8 and 12 weeks revealed no sensory or motor neurological deficits. In conclusion, this is a unique case of mucormycosis with regard to the nature and location of the infection, along with the host being a healthy child. Initial surgical exploration is a very critical step in the early diagnosis and treatment of such rare conditions.
Molecular and Cytological Comparisons of Chromosomes 7el1, 7el2, 7Ee, and 7Ei Derived from Thinopyrum
Authors: Guo Jun , He Fang , Cai Jin-Jin , Wang Hong-Wei , Li An-Fei , Wang Hong-Gang , Kong Ling-Rang
Published: May 2015

Thinopyrum chromosomes 7el1, 7el2, 7Ee, and 7Ei, homoeologous to group 7 chromosomes of common wheat (Triticum aestivum), were determined to have many useful agronomical traits for wheat improvement. To analyze the genetic relationships among the 4 Thinopyrum 7E chromosomes, the conserved orthologous set markers, genomic in situ hybridization (GISH), and meiotic chromosome pairing were used in this study. The unweighted pair-group method with arithmetical averages (UPGMA) analysis indicated that 7el1, derived from T. ponticum, and 7Ei, derived from T. intermedium, were the most closely related. 7el2, derived from T. ponticum, was relatively distant from the 7el1-7Ei complex. While 7Ee, derived from T. elongatum, was more distantly related to 7el1, 7el2, and 7Ei. This is the first report showing that 7el1 and 7Ei may be similar, which could be explained by the similar chromosome signal distribution revealed by GISH as well as UPGMA analysis revealed by both molecular markers and the highest frequency of meiotic pairing. The newly developed genome-specific molecular markers may be useful for marker-assisted selection of Lr19, Bdv3, and Fhblop.
The Evaluation of Abnormal Voice Qualities in Patients with Amyotrophic Lateral Sclerosis
Authors: Tomik Jerzy , Tomik Barbara , Wiatr Maciej , Składzień Jacek , Stręk Paweł , Szczudlik Andrzej
Published: May 2015

Objective: Voice abnormalities are among the symptoms occurring in patients with amyotrophic lateral sclerosis (ALS). They are divergent and range from hoarseness, through the excessive adduction of false folds, up to the weakness of the vocal folds. The aim of the study was to analyze the phonatory function of the larynx in ALS patients. Methods: Seventeen patients with ALS were evaluated with subjective perceptual voice assessment (including the GRBAS scale), videolaryngostroboscopy including voice range and maximum phonation time (MPT), and objective acoustic voice analysis with IRIS software (including evaluation of jitter, shimmer, mean fundamental frequency, and noise-to-harmonics ratio (NHR)). Examinations were performed three times at 6-month intervals. Results: Hoarseness, roughness, and breathiness of voice were all found more frequently in the majority of these patients. Voice range, amplitude of vibration, mucosal wave, and glottal closure showed significant abnormalities with repeated examinations. MPT was shortened especially among women with ALS. Acoustic analysis of voice among men showed increased jitter value in the first examination only, while jitter, shimmer, and NHR in women with ALS were increased in all examinations. Conclusions: Analysis of voice qualities among patients with ALS allows for the detection of various abnormalities associated with the natural progression of the disease.
Treatment of Platelet Concentrates with the Mirasol Pathogen Inactivation System Modulates Platelet Oxidative Stress and NF-κB Activation
Authors: Johnson Lacey , Marks Denese
Published: May 2015

Background: Pathogen inactivation (PI) technologies for platelets aim to improve transfusion safety by preventing the replication of contaminating pathogens. However, as a consequence of treatment, aspects of the platelet storage lesion are amplified. Mirasol treatment also affects platelet signal transduction and apoptotic protein expression. The aim of this study was to examine the effect of Mirasol treatment on the generation of reactive oxygen species (ROS) and subsequent oxidative stress. Methods: Pooled platelet concentrates were prepared in platelet-additive solution (70% SSP+ / 30% plasma). ABO-matched platelets were pooled and split, and treated with the Mirasol system (TerumoBCT) or left untreated as a control. Platelet samples were tested on day 1, 5, and 7 post-collection. Results: Mirasol-treated platelets had increased formation of ROS by day 5 of storage. Oxidative damage, in the form of protein carbonylation, was higher in Mirasol-treated platelets, whilst no effect on nitrotyrosine formation or lipid peroxidation was detected. The NF-κB signaling pathway was also activated in Mirasol-treated platelets, with increased expression and phosphorylation of NF-κB p65 and IκBa. Conclusion: These data demonstrate that Mirasol-treated platelets produce more ROS and display protein alterations consistent with oxidative damage.
St. Gallen/Vienna 2015: A Brief Summary of the Consensus Discussion
Authors: Gnant Michael , Thomssen Christoph , Harbeck Nadia
Published: May 2015

The 2015 St. Gallen Consensus Conference on early breast cancer took place in Vienna, Austria, for the first time. After 3 days of high-level presentations by international panel members of clinical trials having been reported recently in the field, the traditional Saturday voting tried to translate the assembled knowledge into clinical treatment recommendations intended to guide clinical practice of breast cancer care for the ‘average' patient. This report summarizes the results of the 2015 international panel voting procedures with respect to locoregional and endocrine treatment, chemotherapy, targeted therapy, as well as adjuvant bisphosphonate use. This report is not aimed to replace the official St. Gallen consensus publication - some recommendations may even be altered in the final paper - but should serve as a preliminary rapid report of this important meeting.