bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Folic Acid Supplementation in Pregnant Women by Estimation of Serum Levels of Tetrahydrofolic Acid, Dihydrofolate Reductase, and Homocysteine
Authors: Naithani Manisha , Saxena Vartika , Mirza Anissa Atif , Kumari Ranjeeta , Sharma Kapil , Bharadwaj Jyoti
Published: March 2016

Background.Status of folic acid use in pregnant women of the hilly regions in North India was little known. This study was carried out to assess the folic acid use and estimate folate metabolites in pregnant women of this region.Materials and Methods. This cross-sectional study is comprised of 76 pregnant women, whose folic acid supplementation was assessed by a questionnaire and serum levels of homocysteine, tetrahydrofolic acid (THFA), and dihydrofolate reductase (DHFR) were estimated using Enzyme Linked Immunoassays.Results.The study data revealed awareness of folic acid use during pregnancy was present in 46.1% and 23.7% were taking folic acid supplements. The study depicted that there was no statistically significant difference between serum levels of THFA and DHFR in pregnant women with and without folic acid supplements (p=0.790). Hyperhomocysteinemia was present in 15.78% of the participants.Conclusion.Less awareness about folic acid supplementation and low use of folic acid by pregnant women were observed in this region. Sufficient dietary ingestion may suffice for the escalated requirements in pregnancy, but since this cannot be ensured, hence folic acid supplementation should be made as an integral part of education and reproductive health programs for its better metabolic use, growth, and development of fetus.
Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis
Authors: Li Cuilan , Tang Shiyan , Gao Xingcheng , Lin Wanping , Han Dong , Zhai Jinguo , Mo Xuetang , Zhou Lee Jaden Gil Yu Kang
Published: March 2016

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.
Infrared Thermographic Assessment of Cooling Effectiveness in Selected Dental Implant Systems
Authors: Kirstein Karol , Dobrzyński Maciej , Kosior Piotr , Chrószcz Aleksander , Dudek Krzysztof , Fita Katarzyna , Parulska Olga , Rybak Zbigniew , Skalec Aleksandra , Szklarz Magdalena , Janeczek Maciej
Published: March 2016

The excessive temperature fluctuations during dental implant site preparation may affect the process of bone-implant osseointegration. In the presented studies, we aimed to assess the quality of cooling during the use of 3 different dental implant systems (BEGO®, NEO BIOTECH®, and BIOMET 3i®). The swine rib was chosen as a study model. The preparation of dental implant site was performed with the use of 3 different speeds of rotation (800, 1,200, and 1,500 rpm) and three types of cooling: with saline solution at room temperature, with saline solution cooled down to 3°C, and without cooling. A statistically significant difference in temperature fluctuations was observed between BEGO and NEO BIOTECH dental systems when cooling with saline solution at 3°C was used (22.3°C versus 21.8°C). In case of all three evaluated dental implant systems, the highest temperature fluctuations occurred when pilot drills were used for implant site preparation. The critical temperature, defined in the available literature, was exceeded only in case of pilot drills (of all 3 systems) used at rotation speed of 1,500 rpm without cooling.
Colonic Interposition between the Liver and Diaphragm: “The Chilaiditi Sign”
Authors: Nair Nita , Takieddine Zeina , Tariq Hassan
Published: March 2016

A 90-year-old wheelchair bound male was brought to the emergency department with complaints of worsening abdominal pain over the last 2-3 days. The patient also had difficulty in passing urine. Abdominal examination revealed tenderness in the umbilical and hypogastric area without rebound tenderness or guarding. Computed tomography (CT) of the abdomen showed a loop of colon interpositioned between the liver and the right hemidiaphragm (the Chilaiditi sign), mimicking free air. Foley’s catheter was placed and the patient was managed conservatively. The patient clinically improved with improvement of the abdominal pain.
Expression Marker-Based Strategy to Improve Beef Quality
Authors: Cassar-Malek Isabelle , Picard Brigitte
Published: March 2016

For beef cattle research, a main objective is to control concomitantly the development of muscles and the qualities of beef cuts. Beef quality is a complex phenotype that is only detectable after slaughter and is highly variable. The beef industry is in need of tools to estimate beef quality of live cattle or online in abattoirs, with specific attention towards sensory attributes (tenderness, juiciness, flavour, and colour). Identification of relevant genetic and genomic markers is ongoing, especially for tenderness—a top priority quality attribute. In this paper, we describe the steps of an expression marker-based strategy to improve beef sensory quality, from the discovery of biomarkers that identify consistent beef and the biological functions governing beef tenderness to the integration of the knowledge into detection tests for desirable animals. These tools should soon be available for the management of sensory quality in the beef production chain for meeting market’s demands and assuring good quality standards.
Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution
Authors: Bourgi Ali , Ayoub Elias , Merhej Sleiman
Published: March 2016

Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT).Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years.Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans.Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured.
Postpartum Regression of a Presumed Cavernous Meningioma
Authors: Phang See Yung , Whitfield Peter
Published: March 2016

Meningiomas are known to be more common in females than males. They are also known in rare cases to grow in size during pregnancy, which can complicate its management. We describe a 31-year-old Caucasian woman who presented with blurring of her vision and diplopia during the third trimester of her pregnancy. Magnetic resonance imaging (MRI) showed a small left cavernous sinus meningioma. The patient was treated conservatively until her uncomplicated delivery. A postpartum MRI scan showed complete regression of the suspected meningioma. Currently the patient is contemplating a further pregnancy.
First Imported Case of Chikungunya Virus Infection in a Travelling Canadian Returning from the Caribbean
Authors: Therrien Christian , Jourdan Guillaume , Holloway Kimberly , Tremblay Cécile , Drebot Michael A.
Published: March 2016

This is the first Canadian case of Chikungunya virus (CHIKV) infection reported in a traveller returning from the Caribbean. Following multiple mosquito bites in Martinique Island in January 2014, the patient presented with high fever, headaches, arthralgia on both hands and feet, and a rash on the trunk upon his return to Canada. Initial serological testing for dengue virus infection was negative. Support therapy with nonsteroidal anti-inflammatory drugs was administered. The symptoms gradually improved 4 weeks after onset with residual arthralgia and morning joint stiffness. This clinical feature prompted the clinician to request CHIKV virus serology which was found to be positive for the presence of IgM and neutralizing antibodies. In 2014, over four hundred confirmed CHIKV infection cases were diagnosed in Canadian travellers returning from the Caribbean and Central America. Clinical suspicion of CHIKV or dengue virus infections should be considered in febrile patients with arthralgia returning from the recently CHIKV endemic countries of the Americas.
Improved Production ofAspergillus usamiiendo-β-1,4-Xylanase inPichia pastorisvia Combined Strategies
Authors: Wang Jianrong , Li Yangyuan , Liu Danni
Published: March 2016

A series of strategies were applied to improve expression level of recombinant endo-β-1,4-xylanase fromAspergillus usamii(A. usamii) inPichia pastoris(P. pastoris). Firstly, the endo-β-1,4-xylanase (xynB) gene fromA. usamiiwas optimized forP. pastorisand expressed inP. pastoris. The maximum xylanase activity of optimized (xynB-opt) gene was 33500 U/mL after methanol induction for 144 h in 50 L bioreactor, which was 59% higher than that by wild-type (xynB) gene. To further increase the expression ofxynB-opt, theVitreoscilla hemoglobin(VHb) gene was transformed to the recombinant strain containingxynB-opt. The results showed that recombinant strain harboring thexynB-optandVHb(named X33/xynB-opt-VHb) displayed higher biomass, cell viability, and xylanase activity. The maximum xylanase activity of X33/xynB-opt-VHbin 50 L bioreactor was 45225 U/mL, which was 35% and 115% higher than that by optimized (xynB-opt) gene and wild-type (xynB) gene. Finally, the induction temperature of X33/xynB-opt-VHbwas optimized in 50 L bioreactor. The maximum xylanase activity of X33/xynB-opt-VHbreached 58792 U/mL when the induction temperature was 22°C. The results presented here will greatly contribute to improving the production of recombinant proteins inP. pastoris.
Antineutrophil Cytoplasmic Antibody Induction due to Infection: A Patient with Infective Endocarditis and Chronic Hepatitis C
Authors: Kamar Fareed B. , Hawkins T. Lee-Ann
Published: March 2016

While antineutrophil cytoplasmic antibody (ANCA) is often used as a diagnostic marker for certain vasculitides, ANCA induction in the setting of infection is much less common. In the case of infective endocarditis, patients may present with multisystem disturbances resembling an autoimmune process, cases that may be rendered even trickier to diagnose in the face of a positive ANCA. Though not always straightforward, distinguishing an infective from an inflammatory process is pivotal in order to guide appropriate therapy. We describe an encounter with a 43-year-old male with chronically untreated hepatitis C virus infection who featured ANCA positivity while hospitalized with acute bacterial endocarditis. His case serves as a reminder of two of the few infections known to uncommonly generate ANCA positivity. We also summarize previously reported cases of ANCA positivity in the context of endocarditis and hepatitis C infections.
Review of 16S and ITS Direct Sequencing Results for Clinical Specimens Submitted to a Reference Laboratory
Authors: Payne Michael , Azana Robert , Hoang Linda M. N.
Published: March 2016

We evaluated the performance of 16S and internal transcribed spacer (ITS) region amplification and sequencing of rDNA from clinical specimens, for the respective detection and identification of bacterial and fungal pathogens. Direct rDNA amplification of 16S and ITS targets from clinical samples was performed over a 4-year period and reviewed. All specimens were from sterile sites and submitted to a reference laboratory for evaluation. Results of 16S and ITS were compared to histopathology, Gram and/or calcofluor stain microscopy results. A total of 277 16S tests were performed, with 64 (23%) positive for the presence of bacterial DNA. Identification of an organism was more likely in microscopy positive 16S samples 14/21 (67%), compared to 35/175 (20%) of microscopy negative samples. A total of 110 ITS tests were performed, with 14 (13%) positive. The yield of microscopy positive ITS samples, 9/44 (21%), was higher than microscopy negative samples 3/50 (6%). Given these findings, 16S and ITS are valuable options for culture negative specimens from sterile sites, particularly in the setting of positive microscopy findings. Where microscopy results are negative, the limited sensitivity of 16S and ITS in detecting and identifying an infectious agent needs to be considered.
Acetaminophen Use: An Unusual Cause of Drug-Induced Pulmonary Eosinophilia
Authors: Saint-Pierre Mathieu D. , Moran-Mendoza Onofre
Published: March 2016

Pulmonary eosinophilia (PE) can be found in very diverse pathological processes. Several medications have also been associated with this entity. Acetaminophen is a medication commonly used in multiple different drug formulations, many of which are available without a prescription. It has however been associated with pulmonary eosinophilia (eosinophilic pneumonia) in a few cases in Japan. We describe the case of a 68-year-old Caucasian female who presented with new persistent dry cough and dyspnea on exertion after she started using up to 4 grams of acetaminophen on a daily basis. Chest imaging revealed peripheral lower lung zone ground glass and reticular opacities, and increased eosinophils were present on bronchoalveolar lavage (BAL). The patient’s symptoms markedly improved upon acetaminophen cessation, and significantly decreased eosinophils were seen on repeat BAL. To our knowledge, this is the first case of likely acetaminophen-induced pulmonary eosinophilia reported outside Japan.
Evidence for Conversion of Methanol to Formaldehyde in Nonhuman Primate Brain
Authors: Zhai Rongwei , Zheng Na , Rizak Joshua , Hu Xintian
Published: March 2016

Many studies have reported that methanol toxicity to primates is mainly associated with its metabolites, formaldehyde (FA) and formic acid. While methanol metabolism and toxicology have been best studied in peripheral organs, little study has focused on the brain and no study has reported experimental evidence that demonstrates transformation of methanol into FA in the primate brain. In this study, three rhesus macaques were given a single intracerebroventricular injection of methanol to investigate whether a metabolic process of methanol to FA occurs in nonhuman primate brain. Levels of FA in cerebrospinal fluid (CSF) were then assessed at different time points. A significant increase of FA levels was found at the 18th hour following a methanol injection. Moreover, the FA level returned to a normal physiological level at the 30th hour after the injection. These findings provide direct evidence that methanol is oxidized to FA in nonhuman primate brain and that a portion of the FA generated is released out of the brain cells. This study suggests that FA is produced from methanol metabolic processes in the nonhuman primate brain and that FA may play a significant role in methanol neurotoxicology.
Influence of Sodium Bisulfite and Lithium Bromide Solutions on the Shape Fixation of Camel Guard Hairs in Slenderization Process
Authors: Xiao Xueliang , Hu Jinlian
Published: March 2016

Outstanding performance of natural camel hair has attracted much attention on the effective use of such specialty fiber to apparel textiles. In this paper, sodium bisulfide (SB) and lithium bromide (LB) solutions were used to process the camel guard hair before its slenderization. It is found that camel guard hair processed by SB solution shows the highest breaking elongation (~140%) due to the breakage of disulfide bonds (reflected by Raman spectra). LB ions result in the disruption of hair crystalline phase with slight benefit to the slenderization (determined by X-ray diffraction and differential scanning calorimetry). IR spectra indicate that hydrogen bonds of camel guard hair act as fixation switch in the programmed tensile test. It is discovered that guard hair reveals the best water-induced shape memory with 90% of stretching shape recovery, whereas the value remained to be 70% and 60% for hair processed by LB and SB solutions after breaking partial crystalline phase and disulfide cross-links separately (polymer net-points). The poorer shape memory of processed guard hair benefits its slenderization for more stable fixation of stretched length.
An Efficient Metal-Free Hydrophilic Carbon as a Counter Electrode for Dye-Sensitized Solar Cells
Authors: Kouhnavard Mojgan , Ahmad Ludin Norasikin , Vazifehkhah Ghaffari Babak , Sopian Kamaruzzaman , Abdul Karim Norshazlinah , Miyake Mikio
Published: March 2016

This study presents a new cost-effective metal-free counter electrode (CE) for dye-sensitized solar cells (DSSCs). CE was prepared by doctor blading a hydrophilic carbon (HC) particle on a fluorine-doped tin oxide substrate. Thereafter, HC CE was characterized using X-ray diffraction, profilometry, four-point probe testing, and cyclic voltammetry. A 2 µm thick HC CE revealed a comparable catalytic activity to that of the Pt electrode under the same experimental conditions. DSSC based on HC CE was analyzed and showedJscof 6.87 mA/cm2close to that of DSSC with Pt CE (7.0 mA/cm2). More importantly, DSSC based on HC CE yielded a power conversion efficiency (η) of 2.93% under AM 1.5 irradiation (100 mW/cm2), which was comparable to that of DSSC based on standard Pt CE. These findings suggest that HC CE could be a promising CE for low-cost DSSCs.
E-Index for Differentiating Complex Dynamic Traits
Authors: Qi Jiandong , Sun Jianfeng , Wang Jianxin
Published: March 2016

While it is a daunting challenge in current biology to understand how the underlying network of genes regulates complex dynamic traits, functional mapping, a tool for mapping quantitative trait loci (QTLs) and single nucleotide polymorphisms (SNPs), has been applied in a variety of cases to tackle this challenge. Though useful and powerful, functional mapping performs well only when one or more model parameters are clearly responsible for the developmental trajectory, typically being a logistic curve. Moreover, it does not work when the curves are more complex than that, especially when they are not monotonic. To overcome this inadaptability, we therefore propose a mathematical-biological concept and measurement,E-index (earliness-index), which cumulatively measures the earliness degree to which a variable (or a dynamic trait) increases or decreases its value. Theoretical proofs and simulation studies show thatE-index is more general than functional mapping and can be applied to any complex dynamic traits, including those with logistic curves and those with nonmonotonic curves. Meanwhile,E-index vector is proposed as well to capture more subtle differences of developmental patterns.
Paraneoplastic Cough and Renal Cell Carcinoma
Authors: Sullivan Stephen
Published: March 2016

A case of patient with intractable cough due to renal cell carcinoma is reported. The discussion reviews the literature regarding this unusual paraneoplastic manifestation of renal malignancy.
Application of Arterial Spin Labelling in the Assessment of Ocular Tissues
Authors: Vaghefi E. , Pontré B.
Published: March 2016

Arterial spin labelling (ASL) is a noninvasive magnetic resonance imaging (MRI) modality, capable of measuring blood perfusion without the use of a contrast agent. While ASL implementation for imaging the brain and monitoring cerebral blood flow has been reviewed in depth, the technique is yet to be widely used for ocular tissue imaging. The human retina is a very thin but highly stratified structure and it is also situated close to the surface of the body which is not ideal for MR imaging. Hence, the application of MR imaging and ASL in particular has been very challenging for ocular tissues and retina. That is despite the fact that almost all of retinal pathologies are accompanied by blood perfusion irregularities. In this review article, we have focused on the technical aspects of the ASL and their implications for its optimum adaptation for retinal blood perfusion monitoring. Retinal blood perfusion has been assessed through qualitative or invasive quantitative methods but the prospect of imaging flow using ASL would increase monitoring and assessment of retinal pathologies. The review provides details of ASL application in human ocular blood flow assessment.
Comparison of Guided and Unguided Ocriplasmin Injection for the Treatment of Vitreomacular Traction: A Preliminary Study
Authors: Mastropasqua Rodolfo , Di Antonio Luca , Ciciarelli Vincenzo , Aharrh-Gnama Agbeanda , Rispoli Marco , Carpineto Paolo
Published: March 2016

This retrospective quality control study aimed at comparing resolution in patients treated with intravitreal ocriplasmin (IVO) using two injection techniques, classical injection procedure (unguided) and targeted injection using a surgical microscope with a 30-gauge 1-inch needle (guided) for the treatment of focal VMT without macular hole. The two groups presented a statistically significant difference in terms of resolution of VMT within the first month following treatment: 1/7 for the unguided group versus 6/7 for the guided group (p=0.0291). The majority of the guided group presented an earlier resolution than the single resolved case in the unguided group. The results of this preliminary study indicate that the injection of ocriplasmin closer to the site of VMT results in the resolution in a higher number of cases and that this resolution occurs in a short time interval.
The Global Solutions and Moment Boundedness of Stochastic Multipantograph Equations
Authors: Tian Maosheng , Meng Xuejing , Chen Jihong , Tang Xiaoqi
Published: March 2016

We consider the existence of global solutions and their moment boundedness for stochastic multipantograph equations. By the idea of Lyapunov function, we impose some polynomial growth conditions on the coefficients of the equation which enables us to study the boundedness more applicably. Methods and techniques developed here have the potential to be applied in other unbounded delay stochastic differential equations.
Vena Cava Superior Syndrome Related to Right Heart Invasion of an Unresectable Hepatocellular Carcinoma
Authors: Maleux Geert , Budts Werner , Vandecaveye Vincent
Published: March 2016

A rare case of hepatocellular tumor extension in the right heart was reported. The patient presented with clinical signs of a vena cava superior syndrome. Computed tomography and transthoracic echocardiography demonstrated a large tumoral mass lesion extending from the left liver lobe into the inferior vena cava right atrium and right ventricle. The patient was treated with best supportive care.
Psychological Distress in Out-Patients Assessed for Chronic Pain Compared to Those with Rheumatoid Arthritis
Authors: Rice D. , Mehta S. , Shapiro A. , Pope J. , Harth M. , Morley-Forster P. , Sequeira K. , Teasell R.
Published: March 2016

Background. Patients diagnosed with chronic pain (CP) and rheumatoid arthritis (RA) represent two samples with overlapping symptoms, such as experiencing significant pain.Objectives. To compare the level of psychological distress among patients diagnosed CP attending a specialist pain clinic with those attending a specialist RA clinic.Measures. A cross-sectional study was conducted at an academic specialist chronic pain and rheumatology clinic.Participants. 330 participants included a CP group (n=167) and a RA group (n=163) completed a booklet of questionnaires regarding demographic characteristics, duration, and severity of their pain. Psychological and personality variables were compared between the CP and RA participants using a Multivariate Analysis of Covariance (MANCOVA).Results. Level of psychological distress based on the subscales of the DASS (depression, anxiety, and stress), PASS (escape avoidance, cognitive anxiety, fear of pain, and physiological anxiety), and PCS (rumination, magnification, and helplessness) was significantly higher in the CP group compared to the RA group. Categorization of individuals based on DASS severity resulted in significant differences in rates of depression and anxiety symptoms between groups, with a greater number of CP participants displaying more severe depressive and anxiety symptoms.Discussion and Conclusions. This study found greater levels of psychological distress among CP individuals referred to an academic pain clinic when compared to RA patients referred to an academic rheumatology clinic.
Medial Tibial Stress Syndrome: Muscles Located at the Site of Pain
Authors: Brown Ato Ampomah
Published: March 2016

Objective. The purpose of this study was to examine the relationship between the location of the MTSS pain (posteromedial border of tibia) and the muscles that originate from that site.Method. The study was conducted in the Department of Anatomy of the School of Medical Sciences, University of Cape Coast, and involved the use of 22 cadaveric legs (9 paired and 4 unpaired) from 11 males and 2 females.Findings. The structures that were thus observed to attach directly to the posteromedial border of the tibia were the soleus, the flexor digitorum longus, and the deep crural fascia. The soleus and flexor digitorum longus muscles were observed to attach directly to the posteromedial border of the tibia. The tibialis posterior muscle had no attachment to this site.Conclusion. The findings of this study suggest that if traction is the cause of MTSS then soleus and the flexor digitorum muscles and not the tibialis posterior muscle are the likely cause of MTSS.
Association between NSAIDs andClostridium difficile-Associated Diarrhea: A Systematic Review and Meta-Analysis
Authors: Permpalung Nitipong , Upala Sikarin , Sanguankeo Anawin , Sornprom Suthanya
Published: March 2016

Objective. Clostridium difficileinfection is a leading cause of nosocomial diarrhea in developed countries. Studies evaluating the associations of increased risk of community-acquired CDAD and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have yielded inconclusive results. We conducted a systematic review and meta-analysis to compare the odds of NSAID exposure in patients with CDAD versus patients without CDAD in both community-based and healthcare-associated settings.Methods.Relevant observational studies indexed in PubMed/MEDLINE and EMBASE up to February 2015 were analyzed and data were extracted from nine studies. Of these, eight studies were included in the meta-analysis.Results.A search of the databases resulted in 987 articles. The nine studies from which data were extracted involved over 39,000 subjects. The pooled odds ratio for history of NSAID use in participants with CDAD compared with controls was 1.41 (95% CI 1.06–1.87;p<0.01), indicating a significant increased odds of CDAD among patients exposed to NSAIDs.Conclusions.To the best of our knowledge, this is the first study of its nature to demonstrate the association between the use of NSAIDs and increased risk of CDAD. Further studies to evaluate if any specific types of NSAIDs can increase the risk of CDAD are warranted.
A Device for Respiratory Monitoring during Nutritive Sucking: Response to Neonatal Breathing Patterns
Authors: Rosi Andrea , Schena Emiliano , Massaroni Carlo , Tamilia Eleonora , Formica Domenico , Taffoni Fabrizio
Published: March 2016

The quantitative monitoring of breathing, sucking, and swallowing is required to predict newborns’ neurodevelopmental outcomes. In particular, the coordination of breathing timing with respect to sucking cycle is crucial. In this work, we present the characterization of a low-cost flowmeter designed for noninvasive recording of breathing pattern during bottle feeding. The transducer is designed to be integrated on a commercial feeding bottle also instrumented with a system for sucking monitoring. The flowmeter consists of two transistors (hot bodies) supplied at constant current, which are placed in a duct used to convey the inspiratory and expiratory flow coming from the newborn’s nostrils. The transducer design, its static calibration, and its response time are discussed. Moreover, a custom-made active lung simulator was used to perform a feasibility assessment of the proposed flowmeter for respiratory monitoring of neonatal respiratory patterns. The flowmeter has a discrimination threshold <0.5 L·min−1and a response time of347±12 ms. The breathing period estimated by the proposed transducer was compared with the one measured by a high performance flowmeter, used as reference: the mean absolute error was <11%. Results highlighted the ability of the device to track respiratory patterns at frequencies typical of neonatal breathing.
Usage of Cholesky Decomposition in order to Decrease the Nonlinear Complexities of Some Nonlinear and Diversification Models and Present a Model in Framework of Mean-Semivariance for Portfolio Performance Evaluation
Authors: Siaby-Serajehlo H. , Rostamy-Malkhalifeh M. , Hosseinzadeh Lotfi F. , Behzadi M. H.
Published: March 2016

In order to get efficiency frontier and performance evaluation of portfolio, nonlinear models and DEA nonlinear (diversification) models are mostly used. One of the most fundamental problems of usage of nonlinear and diversification models is their computational complexity. Therefore, in this paper, a method is presented in order to decrease nonlinear complexities and simplify calculations of nonlinear and diversification models used from variance and covariance matrix. For this purpose, we use a linear transformation which is obtained from the Cholesky decomposition of covariance matrix and eliminate linear correlation among financial assets. In the following, variance is an appropriate criterion for the risk when distribution of stock returns is to be normal and symmetric as such a thing does not occur in reality. On the other hand, investors of the financial markets do not have an equal reaction to positive and negative exchanges of the stocks and show more desirability towards the positive exchanges and higher sensitivity to the negative exchanges. Therefore, we present a diversification model in the mean-semivariance framework which is based on the desirability or sensitivity of investor to positive and negative exchanges, and rate of this desirability or sensitivity can be controlled by use of a coefficient.
An Example-Based Super-Resolution Algorithm for Selfie Images
Authors: William Jino Hans , Venkateswaran N. , Narayanan Srinath , Ramachandran Sandeep
Published: March 2016

A selfie is typically a self-portrait captured using the front camera of a smartphone. Most state-of-the-art smartphones are equipped with a high-resolution (HR) rear camera and a low-resolution (LR) front camera. As selfies are captured by front camera with limited pixel resolution, the fine details in it are explicitly missed. This paper aims to improve the resolution of selfies by exploiting the fine details in HR images captured by rear camera using an example-based super-resolution (SR) algorithm. HR images captured by rear camera carry significant fine details and are used as an exemplar to train an optimal matrix-value regression (MVR) operator. The MVR operator serves as an image-pair priori which learns the correspondence between the LR-HR patch-pairs and is effectively used to super-resolve LR selfie images. The proposed MVR algorithm avoids vectorization of image patch-pairs and preserves image-level information during both learning and recovering process. The proposed algorithm is evaluated for its efficiency and effectiveness both qualitatively and quantitatively with other state-of-the-art SR algorithms. The results validate that the proposed algorithm is efficient as it requires less than 3 seconds to super-resolve LR selfie and is effective as it preserves sharp details without introducing any counterfeit fine details.
Parietal Fast Sleep Spindle Density Decrease in Alzheimer’s Disease and Amnesic Mild Cognitive Impairment
Authors: Gorgoni Maurizio , Lauri Giulia , Truglia Ilaria , Cordone Susanna , Sarasso Simone , Scarpelli Serena , Mangiaruga Anastasia , D’Atri Aurora , Tempesta Daniela , Ferrara Michele , Marra Camillo , Rossini Paolo Maria , De Gennaro Luigi
Published: March 2016

Several studies have identified two types of sleep spindles: fast (13–15 Hz) centroparietal and slow (11–13 Hz) frontal spindles. Alterations in spindle activity have been observed in Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI). Only few studies have separately assessed fast and slow spindles in these patients showing a reduction of fast spindle count, but the possible local specificity of this phenomenon and its relation to cognitive decline severity are not clear. Moreover, fast and slow spindle density have never been assessed in AD/MCI. We have assessed fast and slow spindles in 15 AD patients, 15 amnesic MCI patients, and 15 healthy elderly controls (HC). Participants underwent baseline polysomnographic recording (19 cortical derivations). Spindles during nonrapid eye movements sleep were automatically detected, and spindle densities of the three groups were compared in the derivations where fast and slow spindles exhibited their maximum expression (parietal and frontal, resp.). AD and MCI patients showed a significant parietal fast spindle density decrease, positively correlated with Minimental State Examination scores. Our results suggest that AD-related changes in spindle density are specific for frequency and location, are related to cognitive decline severity, and may have an early onset in the pathology development.
Challenges in the Caesarean Section of a Severely Kyphotic Parturient
Authors: Chhetry Manisha , Banerjee Basudeb , Subedi Shanti , Gharti Chhetri Narayan Bahadur , Gupta Yogendra
Published: March 2016

Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.
Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study
Authors: Yan Marie , Elligsen Marion , Simor Andrew E. , Daneman Nick
Published: March 2016

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%), osteoarticular infections (28%), and bacteremia (21%). The most frequently prescribed antimicrobials were ceftriaxone (21%) and cefazolin (20%). Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.
Place of Colistin-Rifampicin Association in the Treatment of Multidrug-ResistantAcinetobacter BaumanniiMeningitis: A Case Study
Authors: Souhail Dahraoui , Bouchra Belefquih , Belarj Badia , Laila Rar , Mohammed Frikh , Nassirou Oumarou Mamane , Azeddine Ibrahimi , Haimeur Charki , Lemnouer Abdelhay , Elouennass Mostafa
Published: March 2016

Treatment ofAcinetobacter baumanniimeningitis is an important challenge due to the accumulation of resistance of this bacteria and low meningeal diffusion of several antimicrobial requiring use of an antimicrobial effective combination to eradicate these species. We report a case ofAcinetobacter baumanniimultidrug-resistant nosocomial meningitis which was successfully treated with intravenous and intrathecal colistin associated with rifampicin.
Evaluating Adult Cystic Fibrosis Care in BC: Disparities in Access to a Multidisciplinary Treatment Centre
Authors: Roberts James M. , Wilcox Pearce G. , Quon Bradley S.
Published: March 2016

Background. Cystic fibrosis (CF) care that is delivered through dedicated, multidisciplinary CF clinics is believed to be partly responsible for improvements in the length and quality of life of persons with CF. We hypothesized patients living farthest from a CF clinic would be seen less frequently than recommended, which would result in reduced access to guideline-recommended care and poorer health outcomes.Methods. We performed a retrospective chart review of 168 patients who accessed CF care primarily through the St. Paul’s Hospital Adult CF Clinic. Subjects were stratified into four geographical groups according to the estimated one-way travel time by automobile from their home address to the clinic (<45 mins, 45–150 mins, 150–360 mins, and >360 mins).Results. There were no significant differences in pulmonary function, nutritional status, CF-related complications, or access to guideline-recommended CF pulmonary therapies between the four groups. Compared to the reference (<45 mins) group, subjects in the two farthest groups (>150 mins) were less likely to be seen in the clinic quarterly as recommended by current CF care guidelines (p=0.002). Those in the farthest group (>360 mins) were at risk for more rapid decline in lung function compared to the reference group (FEV1% predicted annual change: −3.1%/year [95% CI −5.1 to −1.1] versus −0.9%/year [95% CI −1.6 to 0.1], resp.,p=0.04).Conclusions. Access to CF care is a challenge for individuals who live outside Metro Vancouver and has health policy implications. Further initiatives should be undertaken to ensure equitable care for people living with CF.
The Challenges of Living with Inflammatory Bowel Disease: Summary of a Summit on Patient and Healthcare Provider Perspectives
Authors: Bray Judith , Fernandes Aida , Nguyen Geoffrey C. , Otley Anthony R. , Heatherington Joan , Stretton Jennifer , Bollegala Natasha , Benchimol Eric I.
Published: March 2016

Canada has one of the highest rates of inflammatory bowel disease (IBD) and the disease represents a significant health, social, and economic burden. There is currently no cure for IBD, although earlier diagnosis and new therapies have improved the overall health outcomes and quality of life for patients. Crohn’s and Colitis Canada is Canada’s only national, volunteer-based charity dedicated to finding cures for IBD and improving the lives of those affected, through research, education, patient programs, advocacy, and increased awareness. On April 30, 2015, Crohn’s and Colitis Canada hosted the “Patient and Healthcare Professional Summit on the Burden of Disease in IBD” to obtain a deeper understanding of the unmet needs of IBD patients and their caregivers. Through personal vignettes, patients articulated a pressing need to increase understanding of the challenges faced by people suffering from IBD among both health care professionals and the general public, develop best practices for navigating life transitions and addressing the unique challenges faced by children with IBD, and provide equitable access to appropriate, effective, and affordable treatments. The recommendations that emerged from the summit will inform about efforts to increase public awareness, inform about advocacy strategies, and contribute to the development of research priorities.
Multiple Site Fracture of Both Rods in a Malleable Penile Implant
Authors: Pinheiro Marcelo Almeida , Barroso Filho Haroldo Brasil , Mesquita Francisco José Cabral , Teixeira de Souza Ivon , Guimarães Rafael Silva , Santos Everaldo Moura , Augusto da Silveira Rômulo , Regadas Rommel Prata , Macedo Geraldo Munguba
Published: March 2016

Penile prosthesis implant is the definitive treatment for refractory erectile dysfunction. Fracture of malleable prosthesis is rarely described due to its low incidence. We describe a case of multiple, bilateral fracture of a malleable penile implant, ten years after implantation. After the diagnosis, a review surgery was performed and the implants were replaced. No corporal rupture or urethral lesion was observed. Review of the literature shows few articles reporting penile implant fractures, and to our knowledge no other article has described multiple, bilateral fractures of a penile prosthesis.
A Case of Pyomyoma following Uterine Fibroid Embolization and a Review of the Literature
Authors: Obele Chika C. , Dunham Samantha , Bennett Genevieve , Pagan Johanna , Sung Lok Yun , Charles Hearns W.
Published: March 2016

Background.Since its introduction in 1996, uterine fibroid embolization (UFE) has become standard medical practice in the management of symptomatic uterine fibroids. An extremely rare complication, pyomyoma, has been reported only 5 times previously in the literature following UFE.Case.A 37-year-old woman underwent UFE for symptomatic leiomyomas of the uterus. Signs and symptoms of uterine infection ensued, beginning at 6 days following the procedure. Recurrent fevers and increasing leukocytosis despite the intravenous administration of appropriate antibiotics eventually necessitated surgical intervention on postprocedure day #18.Conclusion.An extremely rare complication of UFE is herein presented, pyomyoma, with a review of other reported cases. Commonalities are sought among these few reported cases with the hope of increasing diagnostic acumen in the detection of this disease.
Overdiagnosis in Mammographic Screening because of Competing Risk of Death
Authors: Falk Ragnhild Sorum , Hofvind Solveig
Published: March 2016

Background: Different definitions and estimates of overdiagnosis in mammographic screening reflect a substantial need to investigate and understand the complexity of the issue. This modeling study aims to estimate the number of overdiagnosed women, defined as those diagnosed with breast cancer who die from any cause within the lead-time period.

Methods: We used numbers from incidence and death statistics available online and published estimates of lead-time. Postulated cohorts of screened and not screened women ages 50 to 51 were followed for a period corresponding to 10 biennial screening exams during 20 years, and a further 10 years, to ages 78 to 79. The increase in breast cancer incidence because of screening was estimated based on lead-time. The proportion of women diagnosed with breast cancer who died within the lead-time period was assessed based on the differences in the cumulative number of breast cancer diagnosed in a nonscreened and screened cohort.

Results: The proportion of inevitable overdiagnosed women in a screened versus nonscreened cohort was 1.9% for England and Wales and 1.8% for Norway. Sensitivity analyses using various assumptions increased the estimates up to a maximum of 4%.

Conclusion: The proportion of women with breast cancer diagnosed after participation in a screening program who died within the estimated lead-time period was less than 4%. This inevitable proportion of overdiagnosis should be emphasized in the definition and communication of the issue.

Impact: The issue of overdiagnosis is complex and estimates should be interpreted with substantial care. Cancer Epidemiol Biomarkers Prev; 25(5); 759–65. ©2016 AACR.