bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicolegal Implications of Nosocomial Infections: A Case Report of Aspergillus Contamination during Cardiac Surgery
Authors: Tuchtan Lucile , Piercecchi‐Marti Marie‐Dominique , Dumon Henri , Métras Dominique , Léonetti Georges , Bartoli Christophe
Published: December 2016

Nosocomial infections have become a major issue of public health and lead to an increasing number of suits for damages. We present a rare case of Aspergillus contamination during cardiac surgery, describe the medicolegal investigation, and present the new system for compensation of bodily injury after nosocomial infection in France, based on the law of March 4, 2002 on patient rights and quality in the health system. This case demonstrates the limits of compensation for nosocomial infections on the grounds of national solidarity. The expert report requested by the regional commission for conciliation and compensation is of fundamental importance in enabling the commission to decide between fault and inherent risk of treatment.
Engineering Ashbya gossypii strains for de novo lipid production using industrial by‐products
Authors: Lozano‐Martínez Patricia , Buey Rubén M , Ledesma‐Amaro Rodrigo , Jiménez Alberto , Revuelta José Luis
Published: December 2016

Ashbya gossypii is a filamentous fungus that naturally overproduces riboflavin, and it is currently exploited for the industrial production of this vitamin. The utilization of A. gossypii for biotechnological applications presents important advantages such as the utilization of low‐cost culture media, inexpensive downstream processing and a wide range of molecular tools for genetic manipulation, thus making A. gossypii a valuable biotechnological chassis for metabolic engineering. A. gossypii has been shown to accumulate high levels of lipids in oil‐based culture media; however, the lipid biosynthesis capacity is rather limited when grown in sugar‐based culture media. In this study, by altering the fatty acyl‐CoA pool and manipulating the regulation of the main ∆9 desaturase gene, we have obtained A. gossypii strains with significantly increased (up to fourfold) de novo lipid biosynthesis using glucose as the only carbon source in the fermentation broth. Moreover, these strains were efficient biocatalysts for the conversion of carbohydrates from sugarcane molasses to biolipids, able to accumulate lipids up to 25% of its cell dry weight. Our results represent a proof of principle showing the promising potential of A. gossypii as a competitive microorganism for industrial biolipid production using cost‐effective feed stocks.
Hot Off the Press: Which Febrile Children With Sickle Cell Disease Need a Chest X‐Ray?
Authors: Morgenstern Justin , Heitz Corey , Milne William K.
Published: December 2016

This retrospective chart review examined the rate of acute chest syndrome (ACS) in febrile children (aged 3 months to 21 years) with sickle cell disease and used recursive partitioning to determine which clinical factors were predictive of a diagnosis of ACS. Over the course of 2 years, 697 children made 1,837 visits to one of two pediatric emergency departments. ACS was diagnosed in 185 (10%) of the visits.
Heavy alcohol use in adolescence is associated with altered cortical activity: a combined TMS–EEG study
Authors: Kaarre Outi , Kallioniemi Elisa , Könönen Mervi , Tolmunen Tommi , Kekkonen Virve , Kivimäki Petri , Heikkinen Noora , Ferreri Florinda , Laukkanen Eila , Määttä Sara
Published: December 2016

Long‐term alcohol use affects cognitive and neurophysiological functioning as well as structural brain development. Combining simultaneous electroencephalogram (EEG) recording with transcranial magnetic stimulation (TMS) enables direct, in vivo exploration of cortical excitability and assessment of effective and functional connectivity. In the central nervous system, the effects of alcohol are particularly mediated by alterations in gamma‐aminobutyric acid (GABA)ergic neurotransmission, and TMS‐evoked potentials (TEPs) N45 and N100 in EEG are known to reflect GABAergic function. However, no previous studies have examined the effects of long‐term alcohol use in adolescence on TEPs. In this study, a total of 27 young adults with heavy alcohol use in adolescence and 25 age‐matched, gender‐matched and education‐matched controls with little or no alcohol use participated in TMS–EEG measurements. The motor cortex (M1) was stimulated with an intensity of 90 percent of the resting motor threshold of the abductor pollicis brevis muscle. No significant differences were found in the resting motor threshold, TEP latencies or neuropsychological functioning between the groups. We observed an increase in the global mean field power in the time window of 54‐ to 75‐millisecond post‐TMS, as well as significant topographical differences in the P60 and N100 in those with a history of heavy drinking. Furthermore, there was a marked increase in the GABAergic N45 amplitude in alcohol users. These findings suggest that long‐term alcohol use in adolescence, even when not meeting the diagnostic criteria for a disorder, is associated with changes in connectivity and cortical excitability.
A comparison of two models of dental care for Aboriginal communities in New South Wales
Authors: Gwynne K , McCowen D , Cripps S , Lincoln M , Irving M , Blinkhorn A
Published: December 2016

Background

Aboriginal people, and particularly those in rural areas, continue to suffer very high levels of dental disease despite significant reductions in the wider Australian population in the past 30 years. Until recently, there has been a shortage of oral health clinicians and the majority have provided care in major cities. The NSW Government funded various models of care for rural and regional areas and vulnerable population groups including Aboriginal people. This study utilizes a comparative retrospective analysis to compare two models of oral health care for Aboriginal people including those living in rural NSW to inform future policy decisions.

Methods

Two models (Model A ‐ Fly in Fly out and Model B ‐ Collective impact) of public oral health care for Aboriginal patients in NSW were examined using publicly available descriptive information. Two years of funding and Dental Weighted Activity Units (DWAUs) data were analysed for the two different models and regression analysis was used to compare the trends of monthly time series of DWAUs.

Conclusions

Based on the standardized national weighted pricing for public dentistry, model B offers significantly more services for less financial resources.
Accounting Research: A Bibliometric Analysis
Authors: Merigó José M. , Yang Jian‐Bo
Published: December 2016

Bibliometrics is a fundamental field of information science that studies bibliographic material quantitatively. It is very useful for organising available knowledge within a specific scientific discipline. This study presents a bibliometric overview of accounting research using the Web of Science database, identifying the most relevant research in the field classified by papers, authors, journals, institutions and countries. The results show that the most influential journals are: The Journal of Accounting and Economics, Journal of Accounting Research, The Accounting Review and Accounting, Organizations and Society. It also shows that US institutions are the most influential worldwide. However, it is important to note that some very good research in this area, including a small number of papers and citations, may not show up in this study due to the specific characteristics of different subtopics.
Conscientious Objection to Vaccination
Authors: Clarke Steve , Giubilini Alberto , Walker Mary Jean
Published: December 2016

Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases (either for themselves or for their children); second, if so, to what constraints or requirements should conscientious objection (CO) to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease(s), its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible.
The Effect of Hierarchical Micro/Nanotextured Titanium Implants on Osseointegration Immediately After Tooth Extraction in Beagle Dogs
Authors: Fu Qian , Bellare Anuj , Cui Yajun , Cheng Bingkun , Xu Shanshan , Kong Liang
Published: December 2016

Background

Owing to simplify the operation and shorten the overall duration of treatment, immediate implantation earned much satisfactory from patients and dentists. The results of immediate implantation determined by osseointegration, we fabricated a micro/nanotextured titanium implants to improve osseointegration immediately after tooth extraction.

Purpose

The aim of this study was to investigate the effect of hierarchical micro/nanotextured titanium implant on osseointegration immediately after tooth extraction.

Material and Methods

The micro/nanotextured titanium implants were fabricated by etching with 0.5 wt% hydrofluoric (HF) acid followed by anodization in HF electrolytes. Implants with a machined surface as well as implants a microtextured surface prepared by 0.5 wt% HF etching served as control groups. The machined, microtextured, and micro/nanotextured implants were inserted into fresh sockets immediately after tooth extraction in beagle dogs. Twelve weeks after implantation, the animals were sacrificed for micro‐CT scanning, histological analysis and biomechanical test.

Results

The micro‐CT imaging revealed that the bone volume/total volume (BV/TV) and trabecular thickness (Tb.Th) in the micro/nanotextured group was significantly higher than that in the machined group and microtextured group, and the trabecular separation (Tb.Sp) in the micro/nanotextured group was significantly lower than that in the other groups. For the histological analysis, the bone‐to‐implant contact in the machined, micro and micro/nanotextured groups were 47.13 ± 6.2%, 54.29 ± 4.18%, and 63.38 ± 7.63%, respectively, and the differences significant. The maximum pull‐out force in the machined, micro, and micro/nanotextured groups were 216.58 ± 38.71 N, 259.42 ± 28.93 N, and 284.73 ± 47.09 N, respectively.

Conclusions

The results indicated that implants with a hierarchical micro/nanotextured can promote osseointegration immediately after tooth extraction.
Navigating the mesentery: part II. Vascular abnormalities and a review of the literature
Authors: Nesgaard J. M. , Stimec B. V. , Bakka A. O. , Edwin B. , Ignjatovic D. ,   the RCC study group
Published: December 2016

Aim

Vascular abnormalities present advantages and/or disadvantages for the patient undergoing surgery. The aims of this study were to define, classify and demonstrate the courses, and to assess the clinical value, of arterial and venous abnormalities in the central mesentery.

Method

We conducted a review of the anatomy of 340 patients planned for enrolment in the ‘Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic MDCT Angiography’ trial, 312 of whom were submitted to surgery. Vascular abnormalities were analysed in context with surgical notes and images. A meta‐analysis of the literature was performed.

Results

Arterial Abnormalities were found in 28 (8.2%) of the 340 patients and were classified into the following three groups based on anticipated surgical difficulty: group 1, accessory or replaced arteries to solid organs [14 (4.1%)]; group 2, arterial shunts [11 (3.2%)] between the coeliac trunk and the superior mesenteric artery, which resulted in bleeding in three patients; and group 3, common stem abnormalities [3 (0.9%)]. Two groups of superior mesenteric vein abnormalities were noted. The first included morphological abnormalities in a single vein [4 (1.2%)]: aneurysm [1 (0.3%)]; and ring variants of principal tributaries [3 (0.9%)]. The second included double superior mesenteric vein trunks [31 (9.1%)]: genuine bifid [10 (2.9%)]; and pseudo bifid [21 (6.2%)]. The meta‐analysis revealed 26 articles, including 10 series of anatomical dissections or angiographies [1970 cases with 205 (10.4%) arterial abnormalities] and 16 case reports, none of which described a clinical or surgical setting.

Conclusion

Vascular abnormalities occur frequently. Arterial abnormalities are a hazard when inadvertent injury occurs during surgery. Preoperative knowledge of a bifid superior mesenteric vein is useful.
Evolution of body weight parameters up to 3 years after solid organ transplantation: The prospective Swiss Transplant Cohort Study
Authors: Beckmann Sonja , Nikolic Nataša , Denhaerynck Kris , Binet Isabelle , Koller Michael , Boely Elsa , De Geest Sabina ,   the Psychosocial Interest Group, Swiss Transplant Cohort Study
Published: December 2016

Obesity and weight gain are serious concerns after solid organ transplantation (Tx); however, no unbiased comparison regarding body weight parameter evolution across organ groups has yet been performed. Using data from the prospective nationwide Swiss Transplant Cohort Study, we compared the evolution of weight parameters up to 3 years post‐Tx in 1359 adult kidney (58.3%), liver (21.7%), lung (11.6%), and heart (8.4%) recipients transplanted between May 2008 and May 2012. Changes in mean weight and body mass index (BMI) category were compared to reference values from 6 months post‐Tx. At 3 years post‐Tx, compared to other organ groups, liver Tx recipients showed the greatest weight gain (mean 4.8±10.4 kg), 57.4% gained >5% body weight, and they had the highest incidence of obesity (38.1%). After 3 years, based on their BMI categories at 6 months, normal weight and obese liver Tx patients, as well as underweight kidney, lung and heart Tx patients had the highest weight gains. Judged against international Tx patient data, the majority of our Swiss Tx recipients’ experienced lower post‐Tx weight gain. However, our findings show weight gain pattern differences, both within and across organ Tx groups that call for preventive measures.
Detection of cryptococcosis in liquid‐based sputum cytology
Authors: Sharma S. , Gupta N. , Behera D. , Rajwanshi A.
Published: December 2016

Sputum cytology is a simple non‐invasive technique which can lead to rapid diagnosis of many pulmonary lesions. Liquid‐based cytology (LBC) can further aid in the diagnosis by providing a cleaner background. There are only a few reports of detection of cryptococcus in sputum samples. We report a case of cryptococcosis diagnosed on sputum cytology aided with LBC.
Between florivory and herbivory: inefficacy of decision‐making by generalist floriphilic katydids
Authors: TAN MING KAI , TAN HUGH TIANG WAH
Published: December 2016

1. Florivory, which is less studied but as equally widespread as herbivory, can have effects on plant and floral trait adaptations, individual fitness, and community interactions. However, there are still knowledge gaps in our understanding of florivory, including the role of neural constraints and diet specialisation of florivores in floral resource utilisation.

2. According to the neural constraint hypothesis, a generalist flower‐visiting katydid is expected to have lower decision‐making efficacy in feeding when subjected to the presence of both capitula and leaves, compared to the presence of either one of the two resources.

3. In the present study, experiments using the katydid, Phaneroptera brevis, and the plant, whiteweed, Ageratum conyzoides, were carried out to examine the foraging behaviour of the katydid to test our hypothesis. The results confirmed the prediction of the neural constraint hypothesis.

4. The decision‐making efficacy was generally lowered when the katydid was presented with the choice for both the resource that is preferred (capitula) and less preferred (leaves). It was also shown that Phaneroptera brevis is floriphilic, as it prefers capitula to leaves.

5. In conclusion, the first evidence of neural constraint in florivory is provided and suggests that more can be explored into the effects of neural constraints and diet specialisation in floral resource utilisation.
IgG4‐related disease and lymphocyte‐variant hypereosinophilic syndrome: A comparative case series
Authors: Carruthers Mollie N. , Park Sujin , Slack Graham W. , Dalal Bakul I. , Skinnider Brian F. , Schaeffer David F. , Dutz Jan P. , Law Joanna K. , Donnellan Fergal , Marquez Vladimir , Seidman Michael , Wong Patrick C. , Mattman Andre , Chen Luke Y.C.
Published: December 2016

Objective

To compare the clinical and laboratory features of IgG4‐related disease (IgG4‐RD) and lymphocyte‐variant hypereosinophilic syndrome (L‐HES), two rare diseases that often present with lymphadenopathy, gastrointestinal symptoms, eosinophilia, and elevated immunoglobulins/IgE.

Method

Comparative case series of 31 patients with IgG4‐RD and 13 patients with L‐HES.

Results

Peripheral blood eosinophilia was present in eight of 31 patients with IgG4‐RD compared to 13 of 13 patients with L‐HES (median eosinophils 0.4 vs 7.0 giga/L, P=.001) and 12 of 20 patients with IgG4‐RD had increased serum IgE compared to eight of 13 patients with L‐HES, P=.930. Twenty‐seven of 30 patients with IgG4‐RD had elevated serum IgG4 compared to five of 12 patients with L‐HES (median IgG4 9.6 g/L vs 0.80 g/L, P=.002). Flow cytometry demonstrated an aberrant T‐cell phenotype in 7 of 23 patients with IgG4‐RD and 13 of 13 patients with L‐HES (P<.001). T‐cell clonality by PCR was positive in 12 of 23 patients with IgG4‐RD vs 10 of 13 patients with L‐HES (P=.143). Patients in both groups received corticosteroids as first‐line therapy. For refractory disease in IgG4‐RD, rituximab was the most common steroid‐sparing agent, whereas in L‐HES, it was pegylated interferon‐α‐2a.

Conclusion

The overlapping features of these two diseases with divergent treatment options demonstrate the importance of familiarity with both entities to optimize diagnosis and treatment.
Corporate Entrepreneurship: Partial Divestitures as a Real Option
Authors: Moschieri Caterina , Mair Johanna
Published: December 2016

Scholars in strategy and entrepreneurship have discussed the benefits and difficulties of keeping ventures inside the firm versus separating them through divestitures and the balance between control and autonomy. Using an in‐depth analysis of cases of partial divestitures, this study examines the organizational arrangement that arises from divestitures with a retained parent‐unit relationship. The emerging framework connects the parent‐unit relationship and its modifications along the divestiture's objective – specifically, the exploration carried out by the unit. Partial divestitures are designed as real options, for firms to manage corporate venturing, taking advantage of the flexibility that such arrangement may grant.
On The Odiousness of Greek Debt
Authors: Bantekas Ilias , Vivien Renaud
Published: December 2016

Unlike the popular narrative, which suggests that the Greek debt crisis was the result of lavish spending, this article demonstrates that the ‘crisis’ was generated by a transformation of purely private debt into public debt. This finding is supported by the preliminary report of the Greek Parliamentary Committee on the Truth of the Greek Debt, which clearly showed that the exponential increase of private debt in Greece risked the collapse of the private financial institutions exposed to it, namely Greek, French and German banks. This resulted in pressure on the Greek government to recapitalise and nationalise Greek banks through Eurozone and IMF funding. This funding, which came to be known as ‘bailout for Greece’ was nothing more than the rescue of private banks through EU taxpayers' money, only 5% of which went into the Greek economy. The article shows that the process by which the debt was transformed, as well as the post‐crisis bailout were odious, illegal and illegitimate and the ensuing debt itself was unsustainable and wholly against fundamental human rights.
On the ‘Rationalities’ of European Private Law–Between the Internal Market and Law's Discourse
Authors: Niglia Leone
Published: December 2016

On the basis of the deployment of the idiom of co‐production of knowledge and governance, the article I am commenting upon critically argues for overcoming the reification practices and for the ‘re‐politicisation’ of the European private law field. I note and discuss a dialectical tension between, on the one hand, the explanation based on ‘reification’ as the process of co‐production of knowledge and governance which de‐politicises and, on the other hand, the description of institutional settings themselves as instigating and producing reification—between theory and practice, ideology and discourse.
Oesophageal disorders in horses: Retrospective study of 39 cases
Authors: Bezdekova B. , Janalik P.
Published: December 2016

Oesophageal diseases are less frequently reported in equine veterinary practice in comparison with other alimentary pathologies. This paper describes the prevalence, age, breed and sex distribution, the duration of clinical presentation before admission, the diagnosis, aetiology, treatment course, complications, length of hospitalisation, and the short‐term and long‐term survival of 39 cases with equine oesophageal disorders at a referral clinic. Prevalence of oesophageal disorders was significantly higher in the group of horses up to 4 years of age in comparison with other age groups. The most common oesophageal disorder was simple obstruction represented by 22/39 cases (56.41%). The common complications of the oesophageal disorder were oesophagitis (16/39, 41.02%) and aspiration pneumonia (11/39, 28.20%); 31/39 (79.49%) of all oesophageal cases survived up to clinical discharge. Long‐term survival was 65.78% in this group of cases.
The World Health Organization 2016 classification of testicular non‐germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel
Authors: Idrees Muhammad T , Ulbright Thomas M , Oliva Esther , Young Robert H , Montironi Rodolfo , Egevad Lars , Berney Daniel , Srigley John R , Epstein Jonathan I , Tickoo Satish K ,   the Members of the International Society of Urological Pathology Testicular Tumour Panel
Published: December 2016

The World Health Organization (WHO) released a new tumour classification for the genitourinary system in early 2016 after consensus by pathologists with expertise in these organs. It utilized the framework of the 2004 classification, and incorporated the most up‐to‐date information concerning these tumours. In testicular tumours, the majority of the changes occurred in the nomenclature and classification of germ cell tumours; however, several modifications were also made for non‐germ cell tumours. Among sex cord–stromal tumours, sclerosing Sertoli cell tumour (SCT) is no longer recognized as a separate entity but as a morphological variant of SCT not otherwise specified (NOS), as CTNNB1 gene mutations have been noted in both neoplasms but not in the other forms of SCT. Similarly, the lipid cell variant is not separately classified, but is considered to be a morphological variant of SCT NOS. Large‐cell calcifying SCT is recognized as a distinct entity that occurs either sporadically or in association with Carney complex, with the latter patients having a distinct germline PRKAR1A gene mutation. Intratubular large‐cell hyalinizing Sertoli cell neoplasia is also accepted as a separate entity linked with Peutz–Jeghers syndrome. The subcategories of ‘mixed’ and ‘incompletely differentiated’ forms of sex cord/gonadal stromal tumours have been replaced by ‘mixed and unclassified sex cord–stromal tumours’. New entities introduced in the latest WHO revision include: myoid gonadal stromal tumour and ‘undifferentiated gonadal tissue’, a putative precursor lesion of gonadoblastoma, whereas juvenile xanthogranuloma and haemangioma are included in the miscellaneous category of tumours.
Broadband luminescent ferroelectric biocompatible Er:(Na,K)NbO3 nanofibers
Authors: Grishin Alexander M. , Markova Nadezhda P.
Published: December 2016

Dense homogeneous fabric composed from continuous bead‐free erbium‐doped sodium potassium niobate (Er:NKN) 100 μm long and 100‐200 nm in diameter nanofibers was sintered by sol‐gel calcination assisted electrospinning technique. X‐ray diffraction revealed preferential cube‐on‐cube [001]‐directional growth of fibers containing predominantly monoclinic Na0.35K0.65NbO3‐type phase and significantly less of tetragonal NbO2, cubic Er2O3, and monoclinic ErNbO4 phases. Er doping with the concentration of 2 at.% provides readily detectable room‐temperature broad‐band photoluminescence (PL) centered at λPL = 0.55 and 0.98 μm being pumped, respectively, with 532 and 785 nm lasers. Impedance spectroscopy and static electrical tests revealed ferroelectric properties, electric field induced resistance switching and strong rectification effect in nanoporous sandwich Au/Er:NKN/Pt capacitive cell. Memristor‐type current‐voltage (I‐V) characteristics originate from the electrochemical migration of oxygen vacancies at the n‐type NKN oxide/high work function Pt cathode junction interface.
Mucin 4 and matrix metalloproteinase 7 as novel salivary biomarkers for periodontitis
Authors: Lundmark Anna , Johannsen Gunnar , Eriksson Kaja , Kats Anna , Jansson Leif , Tervahartiala Taina , Rathnayake Nilminie , Åkerman Sigvard , Klinge Björn , Sorsa Timo , Yucel‐Lindberg Tülay
Published: December 2016

Aim

Periodontitis is a chronic inflammatory disease, characterized by irreversible destruction of tooth‐supporting tissue including alveolar bone. We recently reported mucin 4 (MUC4) and matrix metalloproteinase 7 (MMP7) as highly associated with periodontitis in gingival tissue biopsies. The aim of this study was to further investigate the levels of MUC4 and MMP7 in saliva and gingival crevicular fluid (GCF) samples of patients with periodontitis.

Materials and Methods

Saliva and GCF samples were collected from periodontitis patients and healthy controls. The levels of MUC4, MMP7, and total protein concentrations were analysed using ELISA or Bradford assay.

Results

MUC4 levels were significantly lower in saliva and GCF from periodontitis patients relative to healthy controls. MMP7 levels were significantly higher in saliva and GCF from periodontitis patients. Multivariate analysis revealed that MUC4 was significantly associated with periodontitis after adjusting for age and smoking habits and, moreover, that the combination of MUC4 and MMP7 accurately discriminated periodontitis from healthy controls.

Conclusions

MUC4 and MMP7 may be utilized as possible novel biomarkers for periodontitis.
Enhanced activation of eosinophils in peripheral blood and implications for eosinophilic esophagitis diagnosis
Authors: Botan Valéria , dos Santos Borges Tatiana Karla , Rocha Alves Érica Alessandra , Claudino Pereira Couto Shirley , Bender Kohnert Seidler Heinrich , Muniz‐Junqueira Maria Imaculada
Published: December 2016

Background and Aim

Eosinophils are markers of the eosinophilic esophagitis (EoE) disease, and this work aimed to assess whether activation of eosinophils could be a noninvasive test to contribute for EoE diagnosis.

Methods

The activation state of peripheral blood eosinophils in EoE patients and control subjects was assessed based on the morphological aspects of the eosinophil after adherence to slide. Cyclooxygenase‐2 and 5‐lipoxygenase expressions were evaluated by means of immunofluorescence microscopy to verify if and which eicosanoid pathway is triggered in eosinophils in blood in EoE.

Results

The eosinophils of patients with EoE were significantly more activated than those of control individuals. The lowest percentage of normal eosinophils for control subjects was 40%, while the highest percentage of eosinophils of normal aspect for patients with EoE was 32%. Considering 36% as a cutoff for normal eosinophils, this value differentiated all individuals with EoE from individuals without the disease with a sensitivity of 100%, considering the diagnosis of EoE as currently defined. Eosinophils of EoE patients showed higher expression of cyclooxygenase‐2 than those of control subjects.

Conclusions

The quantification of morphological changes in eosinophils is a feasible, easy, and reliable manner to identify EoE patients. Therefore, patients with symptoms of esophageal dysfunction showing higher than 36% activated eosinophils in peripheral blood could be a useful way to help definition and diagnostic criterion for EoE.
Screening Tool of Older Person's Prescriptions/Screening Tools to Alert Doctors to Right Treatment Medication Criteria Modified for U.S. Nursing Home Setting
Authors: Khodyakov Dmitry , Ochoa Aileen , Olivieri‐Mui Brianne L. , Bouwmeester Carla , Zarowitz Barbara J. , Patel Meenakshi , Ching Diana , Briesacher Becky
Published: December 2016

Objectives

To develop a set of prescribing indicators measurable with available data from electronic nursing home (NH) databases by adapting the European‐based 2014 Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tools to Alert Doctors to Right Treatment (START) criteria of potentially inappropriate and underused medications for the U.S. setting.

Design

A two‐stage expert panel process. In the first stage, the investigator team reviewed 114 criteria for compatibility and measurability. In the second stage, an online modified e‐Delphi (OMD) panel was convened to rate the validity of criteria, and two webinars were held to identify criteria with highest relevance to U.S. NHs.

Participants

Seventeen experts with recognized reputations in NH care participated in the e‐Delphi panel and 12 in the webinar.

Measurements

Compatibility and measurability were assessed by comparing criteria with U.S. terminology and setting standards and data elements in NH databases. Validity was rated using a 9‐point Likert‐type scale (1 = not valid at all, 9 = highly valid). Mean, median, interpercentile ranges, and agreement were determined for each criterion score. Relevance was determined by ranking the mean panel ratings on criteria that reached agreement; the webinar participants reviewed and approved half of the criteria with the highest mean values.

Results

Fifty‐three STOPP/START criteria were deemed to be compatible with the U.S. NH setting and measurable using data from electronic NH databases. E‐Delphi panelists rated 48 criteria as valid for U.S. NHs. Twenty‐four criteria were deemed to be most relevant, consisting of 22 measures of potentially inappropriate medications and two measures of underused medications.

Conclusion

This study created the first explicit criteria for assessing the quality of prescribing in U.S. NHs.
A Pilot Randomized Controlled Trial of the Effects of Chair Yoga on Pain and Physical Function Among Community‐Dwelling Older Adults With Lower Extremity Osteoarthritis
Authors: Park Juyoung , McCaffrey Ruth , Newman David , Liehr Patricia , Ouslander Joseph G.
Published: December 2016

Objectives

To determine effects of Sit ‘N’ Fit Chair Yoga, compared to a Health Education program (HEP), on pain and physical function in older adults with lower extremity osteoarthritis (OA) who could not participate in standing exercise.

Design

Two‐arm randomized controlled trial.

Setting

One HUD senior housing facility and one day senior center in south Florida.

Participants

Community‐dwelling older adults (N = 131) were randomly assigned to chair yoga (n = 66) or HEP (n = 65). Thirteen dropped after assignment but prior to the intervention; six dropped during the intervention; 106 of 112 completed at least 12 of 16 sessions (95% retention rate).

Interventions

Participants attended either chair yoga or HEP. Both interventions consisted of twice‐weekly 45‐minute sessions for 8 weeks.

Measurements

Primary: pain, pain interference; secondary: balance, gait speed, fatigue, functional ability measured at baseline, after 4 weeks of intervention, at the end of the 8‐week intervention, and post‐intervention (1 and 3 months).

Results

The chair yoga group showed greater reduction in pain interference during the intervention (P = .01), sustained through 3 months (P = .022). WOMAC pain (P = .048), gait speed (P = .024), and fatigue (P = .037) were improved in the yoga group during the intervention (P = .048) but improvements were not sustained post intervention. Chair yoga had no effect on balance.

Conclusion

An 8‐week chair yoga program was associated with reduction in pain, pain interference, and fatigue, and improvement in gait speed, but only the effects on pain interference were sustained 3 months post intervention. Chair yoga should be further explored as a nonpharmacologic intervention for older people with OA in the lower extremities.

Trial Registration: ClinicalTrials.gov: NCT02113410.
WHY PERCEIVED SIZE MATTERS FOR AGENCY TERMINATION
Authors: CORBETT JACK , HOWARD COSMO
Published: December 2016

Agency size is generally assumed to be positively correlated with survival: the bigger an agency, the less likely it is to be terminated. Yet, recent research finds a very small effect of size on survival. The reason, we argue, is that it only addresses size in terms of overall operating budget – what this article calls objective size. By contrast, we use an interpretive historicist approach to show how perceived size – the meanings and beliefs of key actors concerning an agency's size – affects termination. Drawing on a case study of Australia's independent aid agency, AusAID, which endured a tumultuous history of cuts, reorganizations and rebirths, culminating in termination, we show how perceptions of the agency's size mattered. These findings both support and extend recent research showing that adaptation and reputation are critical to the survival of government agencies.
Multiple Milia as an Isolated Skin Manifestation of Dominant Dystrophic Epidermolysis Bullosa: Evidence of Phenotypic Variability
Authors: Akaksa Eijiro , Nakano Hajime , Takagi Yuriko , Toyomaki Yuka , Sawamura Daisuke
Published: December 2016

We report a Japanese pedigree with dominant dystrophic epidermolysis bullosa (DDEB) harboring the p.G2251E mutation of COL7A1. The proband of this pedigree presented with multiple milia as an isolated skin manifestation without a history of blistering and subsequently developed generalized intractable blisters, suggesting that multiple milia could be a primary manifestation of DDEB. Her mother exhibited nail dystrophy and pruritic nodules and her elder sister was unaffected, despite having the same COL7A1 mutation. Inter‐ and intrafamilial clinical variability are often observed in DDEB, so we should be aware of this factor to provide appropriate genetic counselling.
Palmoplantar Keratoderma in Costello Syndrome Responsive to Acitretin
Authors: Marukian Nareh V. , Levinsohn Jonathan L. , Craiglow Brittany G. , Milstone Leonard M. , Choate Keith A.
Published: December 2016

Costello syndrome (CS) is a multisystem congenital disorder characterized by coarse facial features, cardiac defects, intellectual disability, and predisposition to malignancies. Dermatologic findings can include cutaneous papillomas, skin redundancy, acanthosis nigricans, and keratosis pilaris. Palmoplantar keratoderma (PPK) is present in approximately 76% of patients with CS, with disabling functional consequences in severe cases. We report a case of CS with severe PPK that improved dramatically with systemic administration of acitretin 0.3 mg/kg/day.
Sub‐Tenon's injection in equine cadaver eyes: MRI visualization of anesthetic fluid distribution and comparison of two different volumes
Authors: Stadler Silvia , Dennler Matthias , Hetzel Udo , Del Chicca Francesca , Hoey Sèamus , Spiess Bernhard M. , Voelter Katrin , Pot Simon A.
Published: December 2016

Objective

To compare the localization and distribution of two different anesthetic fluid volumes around equine cadaver eyes to determine an appropriate volume for a single sub‐Tenon's injection in horses.

Procedure

A single sub‐Tenon's injection of 2% lidocaine was performed in 10 equine cadaver heads (20 eyes) using two different volumes (7 mL on one side and 10 mL on the opposite side). The posterior circular distribution of the anesthetic was quantified in sagittal, dorsal, and transverse MRI (T2W‐TSE) sequences and evaluated independently by three board‐certified radiologists. The distribution of the two fluid volumes was compared via a paired Student's t‐test. The interobserver reliability was evaluated via a Kruskal–Wallis test.

Results

Extension of the injection fluid was observed along the dorsal and temporal quadrants of the globe within the subconjunctival space, the anterior and posterior sub‐Tenon's space, and into the muscle sheaths along the extraocular muscles. Accumulation of anesthetic fluid directly surrounding the optic nerve was detected in three of 20 cadaver eyes. Circular distribution of the 7 and 10 mL anesthetic volumes was not significantly different (P = 0.849). More retrograde leakage of the anesthetic was observed using the 10 mL volume. Evaluation of interobserver reliability revealed no significant differences between observers (P = 0.21–0.92).

Conclusions

Sub‐Tenon's anesthesia can have potential as an alternative to retrobulbar anesthesia for ophthalmic surgeries in equines. A 7‐ to 10‐mL injection volume should be appropriate based on the results of this study. The distribution of the anesthetic solution in live tissues, the clinical effects, and the potential for complications will have to be evaluated in vivo.
Rapid limb‐specific modulation of vestibular contributions to ankle muscle activity during locomotion
Authors: Forbes Patrick A. , Vlutters Mark , Dakin Christopher J. , van der Kooij Herman , Blouin Jean‐Sébastien , Schouten Alfred C.
Published: December 2016

Key points

The vestibular influence on human walking is phase‐dependent and modulated across both limbs with changes in locomotor velocity and cadence.

Using a split‐belt treadmill, we show that vestibular influence on locomotor activity is modulated independently in each limb.

The independent vestibular modulation of muscle activity from each limb occurs rapidly at the onset of split‐belt walking, over a shorter time course relative to the characteristic split‐belt error‐correction mechanisms (i.e. muscle activity and kinematics) associated with locomotor adaptation.

Together, the present results indicate that the nervous system rapidly modulates the vestibular influence of each limb separately through processes involving ongoing sensory feedback loops.

These findings help us understand how vestibular information is used to accommodate the variable and commonplace demands of locomotion, such as turning or navigating irregular terrain.

During walking, the vestibular influence on locomotor activity is phase‐dependent and modulated in both limbs with changes in velocity. It is unclear, however, whether this bilateral modulation is due to a coordinated mechanism between both limbs or instead through limb‐specific processes that remain masked by the symmetric nature of locomotion. Here, human subjects walked on a split‐belt treadmill with one belt moving at 0.4 m s−1 and the other moving at 0.8 m s−1 while exposed to an electrical vestibular stimulus. Muscle activity was recorded bilaterally around the ankles of each limb and used to compare vestibulo‐muscular coupling between velocity‐matched and unmatched tied‐belt walking. In general, response magnitudes decreased by ∼20–50% and occurred ∼13–20% earlier in the stride cycle at the higher belt velocity. This velocity‐dependent modulation of vestibular‐evoked muscle activity was retained during split‐belt walking and was similar, within each limb, to velocity‐matched tied‐belt walking. These results demonstrate that the vestibular influence on ankle muscles during locomotion can be adapted independently to each limb. Furthermore, modulation of vestibular‐evoked muscle responses occurred rapidly (∼13–34 strides) after onset of split‐belt walking. This rapid adaptation contrasted with the prolonged adaptation in step length symmetry (∼128 strides) as well as EMG magnitude and timing (∼40–100 and ∼20–70 strides, respectively). These results suggest that vestibular influence on ankle muscle control is adjusted rapidly in sensorimotor control loops as opposed to longer‐term error correction mechanisms commonly associated with split‐belt adaptation. Rapid limb‐specific sensorimotor feedback adaptation may be advantageous for asymmetric overground locomotion, such as navigating irregular terrain or turning.
N‐Cadherin, a novel and rapidly remodelling site involved in vasoregulation of small cerebral arteries
Authors: Sun Zhe , Li Min , Li Zhaohui , Hill Michael A. , Meininger Gerald A.
Published: December 2016

Key points

N‐cadherin formed punctate adherens junctions (AJ) along the borders between vascular smooth muscle cells (VSMCs) in the pressurized rat superior cerebellar artery.

The formation of N‐cadherin AJs in the vessel wall depends on the intraluminal pressure and was responsive to treatment with phenylephrine (PE) (10−5 m) and ACh (10−5 m).

N‐cadherin‐coated beads were able to induce clustering of N‐cadherin‐enhanced green fluorescent protein (EGFP) on the plasma membrane of isolated VSMCs, whereas treatment with PE (10−5 m) or sodium nitroprusside (10−5 m) induced a significant increase or decrease in the N‐cadherin‐EGFP clustering, respectively.

Application of pulling force (∼1 nN) to the N‐cadherin‐coated beads via an atomic force microscope induced a localized mechanical response from the VSMCs that opposed the pulling.

N‐cadherin is the major cell–cell adhesion molecule in vascular smooth muscle cells (VSMCs). We tested the hypothesis that N‐cadherin is part of a novel mechanosensory mechanism in VSMCs and plays an active role in both the arteriolar myogenic response and during changes in vascular tone induced by vasomotor agonists. Intact and pressurized rat superior cerebellar arteries were labelled for confocal immunofluorescence imaging. N‐cadherin formed punctate adherens junctions (AJ) along the borders between VSMCs. When the lumen pressure was raised from 50 to 90 mmHg, both the density and the average size of N‐cadherin AJs increased significantly. Similarly, arteriolar constriction with phenylephrine (PE) (10–5 m) induced a significant increase of N‐cadherin AJ density at 50 mmHg, whereas vasodilatation induced by ACh (10–5 m) was accompanied by a significant decrease in density and size of N‐cadherin AJs. An atomic force microscope (AFM) was employed to further examine the mechano‐responsive properties of N‐cadherin adhesion sites in isolated VSMCs. AFM probes with an attached N‐cadherin‐coated microbead (5 μm) induced a progressive clustering of N‐cadherin‐enhanced green fluorescent protein (EGFP) on the VSMC surface. Application of pulling force (∼1 nN) to the N‐cadherin‐coated‐beads with the AFM induced a localized mechanical response from the VSMCs that opposed the pulling. Treatment with PE (10–5 m) or sodium nitroprusside (10–5 m) induced a significant increase or decrease of the N‐cadherin‐EGFP clustering, respectively. These observations provide compelling evidence that N‐cadherin AJs are sensitive to pressure and vasomotor agonists in VSMCs and support a functional role of N‐cadherin AJs in vasomotor regulation.
Quantitative analysis of the Ca2+‐dependent regulation of delayed rectifier K+ current IKs in rabbit ventricular myocytes
Authors: Bartos Daniel C. , Morotti Stefano , Ginsburg Kenneth S. , Grandi Eleonora , Bers Donald M.
Published: December 2016

Key points

[Ca2+]i enhanced rabbit ventricular slowly activating delayed rectifier K+ current (IKs) by negatively shifting the voltage dependence of activation and slowing deactivation, similar to perfusion of isoproterenol.

Rabbit ventricular rapidly activating delayed rectifier K+ current (IKr) amplitude and voltage dependence were unaffected by high [Ca2+]i.

When measuring or simulating IKs during an action potential, IKs was not different during a physiological Ca2+ transient or when [Ca2+]i was buffered to 500 nm.

The slowly activating delayed rectifier K+ current (IKs) contributes to repolarization of the cardiac action potential (AP). Intracellular Ca2+ ([Ca2+]i) and β‐adrenergic receptor (β‐AR) stimulation modulate IKs amplitude and kinetics, but details of these important IKs regulators and their interaction are limited. We assessed the [Ca2+]i dependence of IKs in steady‐state conditions and with dynamically changing membrane potential and [Ca2+]i during an AP. IKs was recorded from freshly isolated rabbit ventricular myocytes using whole‐cell patch clamp. With intracellular pipette solutions that controlled free [Ca2+]i, we found that raising [Ca2+]i from 100 to 600 nm produced similar increases in IKs as did β‐AR activation, and the effects appeared additive. Both β‐AR activation and high [Ca2+]i increased maximally activated tail IKs, negatively shifted the voltage dependence of activation, and slowed deactivation kinetics. These data informed changes in our well‐established mathematical model of the rabbit myocyte. In both AP‐clamp experiments and simulations, IKs recorded during a normal physiological Ca2+ transient was similar to IKs measured with [Ca2+]i clamped at 500–600 nm. Thus, our study provides novel quantitative data as to how physiological [Ca2+]i regulates IKs amplitude and kinetics during the normal rabbit AP. Our results suggest that micromolar [Ca2+]i, in the submembrane or junctional cleft space, is not required to maximize [Ca2+]i‐dependent IKs activation during normal Ca2+ transients.

image
The human thymus perivascular space is a functional niche for viral-specific plasma cells
Authors: Nuñez Sarah , Moore Carolina , Gao Baoshan , Rogers Kortney , Hidalgo Yessia , del Nido Pedro J. , Restaino Susan , Naka Yoshifumi , Bhagat Govind , Madsen Joren C. , Bono María Rosa , Zorn Emmanuel
Published: December 2016

The human thymus perivascular space houses viral-specific plasma cells and memory B cells producing protective antibodies.
Case of coeliac disease presenting in the psychiatry ward
Authors: Oliveira-Maia Albino J , Andrade Isabel , Barahona-Corrêa J Bernardo
Published: December 2016

We describe a case of coeliac disease that was diagnosed in the psychiatry inpatient unit of a general hospital. The patient was admitted due to suicidal behaviours and developed an agitated catatonic state while in the inpatient psychiatry unit. An extensive diagnostic study allowed for the diagnosis of coeliac disease and while her state was unresponsive to antidepressants, anxiolytics, antipsychotics and electroconvulsive therapy, the patient improved significantly when a gluten-free diet was started. While it is well known that, occasionally, gluten sensitivity and coeliac disease can present as brain gluten sensitivity, such cases are typically characterised by motor and/or cognitive symptoms and by white matter abnormalities. Psychiatric presentations of these conditions have only rarely been reported.