bluuebunny/crossref_metadata_2025 huggingface dataset:
Synchronous Microscopic Epstein-Barr Virus–Positive Diffuse Large B-Cell Lymphoma of the Adrenal and Lymphoplasmacytic Lymphoma: De Novo Disease or Transformation?
Authors: Moonim Mufaddal T. , Nasir Alia , Hubbard Jonathan , Ketley Nicholas , Fields Paul
Published: December 2016

Lymphomas arising in the adrenal are rare, and to our knowledge, 2 cases of Epstein-Barr virus (EBV)–positive diffuse large B-cell lymphomas (DLBCL) in an adrenal pseudocyst have been reported. We report an incidental EBV-positive DLBCL arising in an adrenal pseudocyst in a 58-year-old man with a 7-year history of lymphoplasmacytic lymphoma (LPL). The DLBCL was present in the fibrinous exudate, while the LPL resided in the cyst wall. The patient underwent de-roofing of the same cyst 3 years previously; review of histology revealed foci of LPL in the cyst wall, but not of DLBCL. There have been reports of similar microscopic EBV-positive DLBCLs within enclosed cystic spaces. However, all these cases were incidental extranodal primary DLBCLs. Since residual LPL was present alongside DLBCL, with similar light chain restriction, we propose that this may represent transformation, rather than a de novo primary EBV-driven lymphoma.
Necitumumab for the treatment of squamous cell non-small cell lung cancer
Authors: Brinkmeyer Jessica K , Moore Donald C
Published: December 2016

Non-small cell lung cancer is the most common form of lung cancer, accounting for about 85% of all cases and is further subdivided into adenocarcinoma, squamous cell, and large cell carcinoma. Necitumumab (Portrazza™, Eli Lilly and Company) is an anti-epidermal growth factor receptor monoclonal antibody approved for the first-line treatment of squamous cell non-small cell lung cancer in combination with cisplatin and gemcitabine. The safety and efficacy of necitumumab has been evaluated in two-phase III clinical trials, one demonstrating a lack of efficacy in non-squamous non-small cell lung cancer and another demonstrating improvement in overall survival and progression-free survival in squamous cell non-small cell lung cancer. Necitumumab is associated with adverse events such as infusion reactions, hypomagnesemia, diarrhea, and dermatological toxicities. Although considered a safe and effective treatment option for squamous cell non-small cell lung cancer, the clinical utility of necitumumab may be limited due to the high cost of the drug as well as added toxicity when combined with cisplatin and gemcitabine. Several clinical trials are ongoing in order to further investigate the utilization of necitumumab.
Breadmaking performance and textural changes during storage of composite breads made from spelt wheat and different forms of amaranth grain
Authors: Filipčev Bojana , Bodroža-Solarov Marija , Pestorić Mladenka , Šimurina Olivera
Published: December 2016

The objectives of the present study were to assess the baking properties of composite spelt wheat–amaranth blends and to study the staling of composite breads during a six-day storage. Different forms of amaranth grains were added to spelt bread formulation: native amaranth flour and flour from popped amaranth, including their scalded and non-scalded variants. Native amaranth flour (both scalded and non-scalded) gave loaves with the highest volume and contributed to significantly softer crumb but not in comparison to the control bread. Crumb resilience did not show significant differences among the breads but there were differences in the crumb stress relaxation parameters which indicated certain influence on the crumb viscoelastic properties. During storage, all samples developed firmer and less elastic crumbs. Drying loss and staling degree significantly increased with increased storage time. The staling rate was the highest in the bread with non-scalded amaranth flours (native and flour from popped amaranth). The changes in the crumb textural and elastic properties caused by staling turned significant after six days of storage. In general, inclusion of different forms of amaranth flour did not alter the staling of breads and they exerted similar behaviour during storage.
The Influence of Planned Aggression on the Journey to Homicide: An Examination Across Typology Classifications
Authors: Corsaro Nicholas , Pizarro Jesenia M. , Shafer Jillian
Published: December 2016

We assessed the impact of planned aggression across homicide mobility types in Newark, New Jersey, from 1997 through 2007. Homicides where offenders traveled to victims’ resident/incident locales were more likely to involve aggressive intent, whereas homicides where victims traversed to offender/incident locales were less likely to involve planned aggression. Planned aggression was unrelated to geographically proximate (internal) homicides as well as geographically distinct (total mobility) homicides. Study findings show that routine activities and situational characteristics are not only important in explaining homicide patterns but also demonstrate that planned aggression meaningfully contributes to the routine activities and environmental criminology frameworks under specific geographic conditions.
Cor Triatriatum: A Review
Authors: Jha Ajay Kumar , Makhija Neeti
Published: December 2016

Cor triatriatum is a rare congenital cardiac anomaly defined by an abnormal septation within the atrium (left or right) leading to inflow obstruction to the respective ventricles. It exists either in isolated classical form or may be associated with simple to complex congenital cardiac anomalies. Several anatomical variants exist even in the classical form, and therefore, it may require multimodal diagnostic modalities to characterize and differentiate for better percutaneous interventional or surgical planning. It commonly presents in infancy but may remain undetected till death. Symptomatology typically mimics mitral and tricuspid stenosis in sinister and dexter varieties, respectively. However, features of systemic embolization, heart failure, atrial fibrillation, cyanosis, cardiac asthma, syncope, and sudden cardiac arrest have also been reported in the literature. Surgical correction under cardiopulmonary bypass is the preferred treatment. Nevertheless, balloon dilatation may be considered in anatomically compatible variants and in special circumstances, such as heart failure, pregnancy, or as a bridge to definitive treatment.
Getting Smart
Authors: Marinova Detelina , de Ruyter Ko , Huang Ming-Hui , Meuter Matthew L. , Challagalla Goutam
Published: December 2016

Smart technologies are rapidly transforming frontline employee-customer interactions. However, little academic research has tackled urgent, relevant questions regarding such technology-empowered frontline interactions. The current study conceptualizes (1) smart technology use in frontline employee-customer interactions, (2) smart technology–mediated learning mechanisms that elevate service effectiveness and efficiency performance to empower frontline interactions, and (3) stakeholder interaction goals as antecedents of smart technology–mediated learning. We propose that emerging smart technologies, which can substitute for or complement frontline employees’ (FLEs) efforts to deliver customized service over time, may help resolve the long-standing tension between service efficiency and effectiveness because they can learn or enable learning from and across customers, FLEs, and interactions. Drawing from pragmatic and deliberate learning theories, the authors conceptualize stakeholder learning mechanisms that mediate the effects of frontline interaction goals on FLEs’ and customers’ effectiveness and efficiency outcomes. This study concludes with implications for research and practice.
The Role of the Sales-Service Interface and Ambidexterity in the Evolving Organization
Authors: Rapp Adam A. , Bachrach Daniel G. , Flaherty Karen E. , Hughes Douglas E. , Sharma Arun , Voorhees Clay M.
Published: December 2016

Despite a long history of independent sales and service functions within organizations, customers are pressuring organizations to rethink their sales and service operations. Specifically, customers expect organizations to offer a “single face” of the firm rather than being forced to interact with multiple agents across both sales and service throughout their relationships. As firms attempt to meet these customer demands, they have countless options to integrate sales and service operations, but little is known about which strategies are most effective. This article attempts to shed new light into the challenges and potential benefits of sales-service integration, in an effort to spur research in this area and better inform this managerial challenge. Specifically, we formalize the concept of the sales-service interface, discuss how it relates to sales-service ambidexterity, and identify several opportunities for future research. Given the complexity of the sales-service interface, we contend that future researchers must view these issues through a multilevel lens and, as a result, we focus on identifying opportunities ideally suited for testing in a multilevel environment. The goal of this article is to provide a platform for researchers to tackle this challenging problem and generate new insights into how best to meet customer’s evolving demands.
Effect of deslorelin acetate treatment in oocyte recovery and in vitro embryo production in domestic cats
Authors: Ackermann Camila Louise , Trevisol Eduardo , Crocomo Leticia Ferrari , Rascado Tatiana da Silva , Volpato Rodrigo , Guaitolini Carlos Renato de Freitas , Lopes Carlize , Costa Talita de Almeida , Lopes Maria Denise
Published: December 2016

Objectives

The present study investigated the effect of contraceptive treatment with deslorelin acetate on in vitro embryo production and oocyte recovery in domestic queens.

Methods

Twenty-one mature domestic cats were used. Eleven queens (treated group) and one tom were kept in an experimental cattery, and 10 queens were privately owned (control group). When in interestrus or diestrus (day 0) a deslorelin acetate implant (Suprelorin, 4.7 mg/animal) was inserted into the subcutaneous tissue of the interscapular region in all queens in the treated group. After 6 months of treatment, all animals were ovariohysterectomized, and the ovaries were used for in vitro embryo production. Percentage of cleavage was determined 18 h after oocyte insemination and blastocyst formation was assessed on the eighth day of culture. The rate of cumulus-oocyte complexes (COCs) recovery was analyzed by an unpaired t-test. The cleavage and blastocyst rates were expressed as percentages and analyzed by Fisher’s exact test. All analyses were performed using GraphPad Prism v5.0, with P <0.05 set as the level of significance.

Results

In the treated group, we recovered 8.3 ± 1.15 grade I COCs per queen; the cleavage rate was 60% and the blastocyst rate was 36%. In the control group, we recovered 18.4 ± 3.21 grade I COCs per queen; the cleavage rate was 55.97% and the blastocyst rate was 34%. Forty percent of treated females did not produce any blastocysts. In the treated group, we observed a significant decrease in COC recovery. Although there was no significant difference in cleavage and blastocyst rates between groups, 40% of treated females did not produce any blastocysts.

Conclusions

Recovery of grade I COCs is negatively affected by deslorelin treatment in domestic cats. Regarding embryo production, new studies are still necessary to evaluate the success of this technique owing to the individual effect caused by deslorelin acetate.
Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record
Authors: Lekan Deborah A. , Wallace Debra C. , McCoy Thomas P. , Hu Jie , Silva Susan G. , Whitson Heather E.
Published: December 2016

Introduction:

Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes.

Purpose:

The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization.

Methods:

The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined.

Results:

The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77−2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]).

Discussion:

Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.
Cost–benefit analysis of telehealth in pre-hospital care
Authors: Langabeer James R , Champagne-Langabeer Tiffany , Alqusairi Diaa , Kim Junghyun , Jackson Adria , Persse David , Gonzalez Michael
Published: December 2016

Objective

There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative.

Methods

Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost–benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD).

Results

In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit).

Conclusion

Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS ‘treat and transport to ED’ model.
Mining and the living materiality of mountains in Andean societies
Authors: Salas Carreño Guillermo
Published: December 2016

This article explores indigenous Andean perspectives on the relationship between mining and mountains. It briefly elaborates on how, in Andean worlds, mountains are intentional agents that are crucial members of society. Paying central attention to the materiality of these beings, the article compares the different social logics at play in, on the one hand, contexts of underground mining and, on the other, those of the recent open-pit mines. Using ethnographic data from Cuzco and Ancash (Peru) as well as previous ethnographies of mining practices in Bolivia and Peru, the article analyses how underground mining involved indigenous workers and practices that engaged the mined earth-beings. In contrast, in recent open-pit mines, there are very few workers from the surrounding communities, and indigenous practices engaging earth-beings became invisible. Underground mining is assumed to damage and threaten the fertility of the mined earth-beings but it is not seen as endangering their existence. In contrast, recent open-pit mines are only made possible by destroying earth-beings and extracting metal from their corpses.
Using full immersive simulation to prepare trauma teams to work in a major trauma centre
Authors: Mercer Simon J
Published: December 2016

A reconfiguration of trauma services in the UK has led to the development of trauma networks with major trauma centres. This article describes the use of fully immersive simulation to train whole trauma teams in both a traditional simulation centre setting and ‘in situ’ in the clinical environment. Carefully designed scenarios that are driven by experienced faculty allow modern trauma management concepts, such as damage control resuscitation and massive transfusion to be explored within a hospital’s own organisational structure. Human factors specific to the trauma team can also be explored as part of a video-assisted debrief.
Effects of exendin-4 on the intrarenal renin-angiotensin system and interstitial fibrosis in unilateral ureteral obstruction mice: Exendin-4 and unilateral ureteral obstruction
Authors: Le Ying , Zheng Zongji , Xue Junyu , Cheng Mengling , Guan Meiping , Xue Yaoming
Published: December 2016

Objective:

The objective of this article is to investigate the renoprotecive effects of exendin-4 in a mouse model of unilateral ureteral obstruction (UUO) and explore the putative mechanisms.

Methods:

Male Balbc mice underwent sham operation or UUO surgery, and then received intraperitoneal injection of vehicle or exendin-4, respectively. After 14 days, mice were sacrificed and the left kidneys were collected and analyzed by histology, immunohistochemistry, Western blot, quantitative real-time reverse transcription polymerase chain reaction, radioimmunoassay and enzyme-linked immunosorbent assay.

Results:

As compared to the sham group, mice that underwent UUO surgery developed more severe tubular injury and interstitial fibrosis, as well as higher expression of fibronectin (FN), collagen-1 (Col-1) and α-smooth muscle actin (α-SMA). Also, we observed higher expression of angiotensin-converting enzyme (ACE) while lower expression of angiotensin-converting enzyme 2 (ACE2), higher levels of intrarenal angiotensin II (Ang II) while lower levels of intrarenal angiotensin-(1–7), and higher expression of transforming growth factor β1 (TGF-β1) and phosphorylation of Smad3 (p-Smad3) in the obstructed kidneys. Impressively, these pathologic changes were significantly attenuated in the mice group of UUO treated with exendin-4.

Conclusion:

Our present study indicates for the first time that exendin-4 exerts renoprotective effects in an experimental model of UUO, partly through regulating the balance of the intrarenal renin-angiotensin system and then inhibiting the Ang II-mediated TGF-β1/Smad3 signaling pathway.
Social Determinants and Teen Pregnancy Prevention: Exploring the Role of Nontraditional Partnerships
Authors: Fuller Taleria R. , White Carla P. , Chu Jocelyn , Dean Deborah , Clemmons Naomi , Chaparro Carmen , Thames Jessica L. , Henderson Anitra Belle , King Pebbles
Published: December 2016

Addressing the social determinants of health (SDOH) that influence teen pregnancy is paramount to eliminating disparities and achieving health equity. Expanding prevention efforts from purely individual behavior change to improving the social, political, economic, and built environments in which people live, learn, work, and play may better equip vulnerable youth to adopt and sustain healthy decisions. In 2010, the Centers for Disease Control and Prevention in partnership with the Office of Adolescent Health funded state- and community-based organizations to develop and implement the Teen Pregnancy Prevention Community-Wide Initiative. This effort approached teen pregnancy from an SDOH perspective, by identifying contextual factors that influence teen pregnancy and other adverse sexual health outcomes among vulnerable youth. Strategies included, but were not limited to, conducting a root cause analysis and establishing nontraditional partnerships to address determinants identified by community members. This article describes the value of an SDOH approach for achieving health equity, explains the integration of such an approach into community-level teen pregnancy prevention activities, and highlights two project partners’ efforts to establish and nurture nontraditional partnerships to address specific SDOH.
Formative Research: Using a Community-Based Participatory Research Approach to Develop an Oral Health Intervention for Migrant Mexican Families
Authors: Finlayson Tracy L. , Asgari Padideh , Hoffman Lisa , Palomo-Zerfas Ana , Gonzalez Martha , Stamm Nannette , Rocha Maria-Isabel , Nunez-Alvarez Arcela
Published: December 2016

Oral health is a leading unmet health need among migrant families. This article describes the 1-year, community-based participatory research (CBPR) approach employed to plan and develop a Líder Communitario (lay community health worker)–led educational intervention for Mexican migrant adult caregivers and their families in three underserved, remote communities in North San Diego County, California. Four partner organizations collaborated, reviewed existing oral health curricula, and sought extensive input on educational topics and research design from key informants, migrant caregivers, and Líderes Communitarios. Based on community stakeholder input, partners developed a logic model and drafted educational intervention materials. Key informants ( n = 28), including several members from two community advisory boards, ranked program priorities and intervention subgroup population via online survey. Three focus groups were conducted with Líderes Communitarios ( n = 22) and three with migrant families ( n = 30) regarding the oral health program’s design and content. Twelve Líderes Communitarios reviewed draft intervention materials during two focus groups to finalize the curriculum, and their recommended changes were incorporated. Formative research results indicated that community stakeholders preferred to focus on adult caregivers and their families. A 5-week educational intervention with hands on demonstrations and colorful visuals was developed, covering the following topics: bacteria and tooth decay, oral hygiene, nutrition, gum disease, and dental services. The CBPR process engaged multiple community stakeholders in all aspects of planning and developing the educational intervention.
Involvement of Recipient Transplant Coordinators in Transplant Outpatient Clinics in Japan
Authors: Hagiwara Kuniko , Seto Natsuko , Shimizu Yasuko , Takahara Shiro
Published: December 2016

Context:

Transplant recipients require long-term immunosuppressive therapy, so continued medical follow-up is necessary for long-term survival.

Objective:

To investigate the current role of recipient transplant coordinators (RTCs) in the outpatient care of organ transplant recipients in Japan.

Methods:

We sent a questionnaire survey to doctors in transplant facilities affiliated with the Japan Society for Transplantation probing attitudes on the role of RTCs in outpatient clinics. The questionnaire assessed responses using an ordinal scale of 5 ranks.

Results:

In total, 139 responses were obtained from 233 transplant facilities. Respondents were divided into 2 groups, doctors currently working with RTCs (group A) and doctors not currently working with RTCs (group B). Differences in response rates between groups were analyzed using the Mann-Whitney U test. The overall attendance rate of RTCs in outpatient clinics was only 45%. Of all items on transplant outpatient clinics, group A exhibited a significantly higher response rate of “strongly agree” for “The involvement of an RTC in outpatient work can be expected to help prevent complications in transplant patients” ( P < .01) and “The involvement of an RTC in outpatient work can be expected to help prevent or reduce drug-related side effects in transplant patients” ( P < .01). Those with the highest rate of “strongly agree” were “It is necessary for RTCs to provide outpatient follow-up for transplant patients alongside doctors” (82.1% vs 67.3%, P < .07).

Conclusion:

We suggest that Japanese RTCs must participate more frequently in posttransplant outpatient care.
A Randomized Controlled Trial of Assisted Intention Monitoring for the Rehabilitation of Executive Impairments Following Acquired Brain Injury
Authors: Gracey Fergus , Fish Jessica E. , Greenfield Eve , Bateman Andrew , Malley Donna , Hardy Gemma , Ingham Jessica , Evans Jonathan J. , Manly Tom
Published: December 2016

Background. Acquired brain injury (ABI) can impair executive function, impeding planning and attainment of intentions. Research shows promise for some goal-management rehabilitation interventions. However, evidence that alerts assist monitoring and completion of day-to-day intentions is limited. Objective. To examine the efficacy of brief goal-directed rehabilitation paired with periodic SMS text messages designed to enhance executive monitoring of intentions (assisted intention monitoring [AIM]). Methods. A randomized, double-blind, controlled trial was conducted. Following a baseline phase, 74 people with ABI and executive problems were randomized to receive AIM or control (information and games) for 3 weeks (phase 1) before crossing over to either AIM or no intervention (phase 2). The primary outcome was change in composite score of proportion of daily intentions achieved. A total of 59 people (71% male; 46% traumatic brain injury) completed all study phases. Results. Per protocol crossover analysis found a significant benefit of AIM for all intentions [ F(1, 56) = 4.28; P = .04; f = 0.28; 3.7% mean difference; 95% CI = 0.1%-7.4%] and all intentions excluding a proxy prospective memory task [ F(1, 55) = 4.79; P = .033; f = 0.28, medium effect size; 3% mean difference; 95% CI = 0.3%-5.6%] in the absence of significant changes on tests of executive functioning. Intention-to-treat analyses, comparing AIM against control at the end of phase 1 revealed no statistically significant differences in the attainment of intentions. Conclusion. Combining brief executive rehabilitation with alerts may be effective for some in improving achievement of daily intentions, but further evaluation of clinical effectiveness and mechanisms is required.
Generalizability of the Maximum Proportional Recovery Rule to Visuospatial Neglect Early Poststroke
Authors: Winters Caroline , van Wegen Erwin E. H. , Daffertshofer Andreas , Kwakkel Gert
Published: December 2016

Background and objective. Proportional recovery of upper-extremity motor function and aphasia after stroke may suggest common mechanisms for spontaneous neurobiological recovery. This study aimed to investigate if the proportional recovery rule also applies to visuospatial neglect (VSN) in right-hemispheric first-ever ischemic stroke patients and explored the possible common underlying mechanisms. Methods. Patients with upper-limb paresis and VSN were included. Recovery defined as the change in Letter Cancellation Test (LCT) score at ~8 days and 6 months poststroke. Potential recovery defined as LCTmax-LCTinitial = 20 − LCTinitial. Hierarchical clustering separated fitters and nonfitters of the prediction rule. A cutoff value on LCTmax-LCTinitial was determined. The change in LCT and Fugl-Meyer Assessment Upper Extremity was expressed as a percentage of the total possible score to investigate the communality of proportional recovery. Results. Out of 90 patients, 80 displayed proportional recovery of VSN (ie, “fitters,” 0.97; 95% CI = 0.82-1.12). All patients who did not follow the prediction rule for VSN (ie, ”nonfitters”) had ≥15 missing O’s at baseline and failed to show proportional recovery of the upper limb. Conclusions. This study shows that the proportional recovery rule also applies to patients with VSN poststroke. Patients who fail to show proportional recovery of VSN are the same patients who fail to show proportional recovery of the upper limb. These findings support the idea of common intrahemispheric mechanisms underlying spontaneous neurobiological recovery in the first months poststroke. Future studies should investigate the prognostic clinical and neurobiological markers of these subgroups.
The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors
Authors: Gascou Gregory , Ferrara Riccardo , Ambard Dominique , Sanchez Mathieu , Lobotesis Kyriakos , Jourdan Franck , Costalat Vincent
Published: December 2016

Background and purpose

Pore density (PD), surface metal coverage (SMC) and the number of wires are all different parameters which can influence the efficacy of a flow disruptor/diverter. Nevertheless, the relative importance of a parameter to induce intra-aneurysmal blood stasis is still poorly evaluated. Therefore, comparison between devices based on a unique value is not reliable. The aim of this study was to propose a new bench top parameter (the pressure reduction coefficient (PRC; ξ)) in order to assess the global haemodynamic effect of each flow diverter/disruptor to slow flow.

Methods

Eight devices were tested in vitro during three different flow conditions. For the eight devices, the PRC was computed at different volumetric flow rates to characterise flow reduction. Comparison was made with SMC, PD and the number of wires.

Results

The PRC obtained for flow disruptors was on average 1.5 times more efficient in reducing flow compared to flow diverters. PD (mm2) ranged from 24 to 38 for flow diverters and did not independently correlate with the PRC. The SMC of flow diverters ranged from 25% to 70%, and ranged from 20% to 100% for flow disruptors, without independent correlation to the PRC. The number of wires ranged from 48 to 96 for the flow diverters and did not correlate independently to the PRC.

Conclusion

There were no direct correlations between individual device characteristics and the PRC, suggesting a multifaceted and interrelating association of the overall design of each implant. Hence, the PRC could be used as a simple, reliable parameter to assess the overall capacity of flow disruptors/diverters to induce intra-aneurysmal blood stasis.
The transvenous pressure cooker technique: A treatment for brain arteriovenous malformations
Authors: Zhang Guang , Zhu Shiyi , Wu Pei , Xu Shancai , Shi Huaizhang
Published: December 2016

The treatment of brain arteriovenous malformations (AVMs) remains a significant challenge, especially hemorrhagic AVMs which are unsuitable for microsurgery or radiosurgery. We demonstrate an AVM located in the left basal ganglia area, supplied by slender arteries, and treated by the transvenous pressure cooker technique. Herein, we describe the procedure and outline the crucial points and indications for this technique.
Treatment of upper extremity venous aneurysms with a polytetrafluoroethylene-covered stent
Authors: Parizh David , Victory Jesse , Rizvi Syed Ali , Hingorani Anil , Ascher Enrico
Published: December 2016

Background

Venous aneurysms of the upper torso are uncommon in contrast to the abdomen and lower extremities. Mostly silent, they can cause significant morbidity. Large or symptomatic venous aneurysms are generally treated with open resection. To our knowledge, there are no documented cases of head and neck venous aneurysms treated by a hybrid endovascular and open approach.

Case Presentation

A 56-year-old female presented with the complaint of pain and increasing size of a supraclavicular mass. Imaging revealed a large saccular aneurysm of the subclavian vein with the presence of a large intramural thrombus on computed tomography scan with contrast. A covered stent was deployed in order to exclude the aneurysm from circulation. Three weeks later, the symptoms continued, and an aneurysmorrhaphy was performed to excise the stent and aneurysm resection.

Discussion

A combined endovascular and open approach to resection of symptomatic subclavian vein aneurysms is a viable method with minimal morbidity.
pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure
Authors: McNamee JJ , Gillies MA , Barrett NA , Agus AM , Beale R , Bentley A , Bodenham A , Brett SJ , Brodie D , Finney SJ , Gordon AJ , Griffiths M , Harrison D , Jackson C , McDowell C , McNally C , Perkins GD , Tunnicliffe W , Vuylsteke A , Walsh TS , Wise MP , Young D , McAuley DF
Published: December 2016

One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO2R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO2R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO2R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.
Determination of a threshold compromise value for the perfusion index by laser Doppler imaging after digital revascularization
Authors: Chu Y.-Y. , Yu D.-Y. , Chang C.-W. , Fang F. , Liao H.-T.
Published: December 2016

We have used laser Doppler imaging to monitor the microcirculation of replanted digits during the post-operative period in 103 patients who underwent either replantation after traumatic amputation or toe-to-finger reconstruction. The blood flow (perfusion unit) in each revascularized digit was compared with that of an unaffected digit. The perfusion index was defined as the perfusion value of a revascularized digit divided by the perfusion value of the neighbouring normal digit. The ideal threshold value of the perfusion index (0.397) was calculated by determining the receiver operating characteristic curve with optimal sensitivity and specificity. The corresponding Youden’s index was 0.828. We believe that by establishing a threshold, that laser Doppler imaging should provide a reliable and objective assessment for the development of perfusion compromise in revascularized digits.

Level of evidence: III
Genetic engineering approach to develop next-generation reagents for endotoxin quantification
Authors: Mizumura Hikaru , Ogura Norihiko , Aketagawa Jun , Aizawa Maki , Kobayashi Yuki , Kawabata Shun-ichiro , Oda Toshio
Published: December 2016

The bacterial endotoxin test, which uses amebocyte lysate reagents of horseshoe crab origin, is a sensitive, reproducible and simple assay to measure endotoxin concentration. To develop sustainable raw materials for lysate reagents that do not require horseshoe crabs, three recombinant protease zymogens (factor C, derived from mammalian cells; factor B; and the proclotting enzyme derived from insect cells) were prepared using a genetic engineering technique. Recombinant cascade reagents (RCRs) were then prepared to reconstruct the reaction cascade in the amebocyte lysate reagent. The protease activity of the RCR containing recombinant factor C was much greater than that of recombinant factor C alone, indicating the efficiency of signal amplification in the cascade. Compared with the RCR containing the insect cell-derived factor C, those containing mammalian cell-derived factor C, which features different glycosylation patterns, were less susceptible to interference by the injectable drug components. The standard curve of the RCR containing mammalian cell-derived recombinant factor C had a steeper slope than the curves for those containing natural lysate reagents, suggesting a greater sensitivity to endotoxin. The present study supports the future production of recombinant reagents that do not require the use of natural resources.
TLR ligands, but not modulators of histone modifiers, can induce the complex immune response pattern of endotoxin tolerance in mammary epithelial cells
Authors: Günther Juliane , Petzl Wolfram , Zerbe Holm , Schuberth Hans-Joachim , Seyfert Hans-Martin
Published: December 2016

Excessive stimulation of the TLR4 axis through LPS reduces the expression of some cytokine genes in immune cells, while stimulating the expression of immune defense genes during a subsequent bacterial infection. This endotoxin tolerance (ET) is mediated via epigenetic mechanisms. Priming the udder of cows with LPS was shown to induce ET in mammary epithelial cells (MEC), thereby protecting the udder against reinfection for some time. Seeking alternatives to LPS priming we tried to elicit ET by priming MEC with either lipopeptide (Pam2CSK4) via the TLR2/6 axis or inhibitors of histone-modifying enzymes. Pre-incubation of MEC with Pam2CSK4 enhanced baseline and induced expression of bactericidal (β-defensin; SLPI) and membrane protecting factors ( SAA3, TGM3), while reducing the expression of cytokine- and chemokine-encoding genes ( TNF, IL1β) after a subsequent pathogen challenge, the latter, however, not as efficiently as after LPS priming. Pre-treating MEC with various inhibitors of histone H3 modifiers (for demethylation, acetylation or deacetylation) all failed to induce any of the protective factors and only resulted in some dampening of cytokine gene expression after the re-challenge. Hence, triggering immune functions via the TLR axis, but not through those histone modifiers, induced the beneficial phenomenon of ET in MEC.
Best practices in the treatment of early cystic fibrosis lung disease
Authors: Proesmans Marijke
Published: December 2016

For many years, management of cystic fibrosis (CF) lung disease was focused on symptomatic treatment of chronic lung infection, which is characterized by cough and sputum production, leading to progressive lung damage. With increasing survival and better knowledge of the pathogenesis of CF lung disease, it has become clear that treatment has to start very early because lung damage occurs in young patients, often before obvious symptoms appear. The arrival of new cystic fibrosis transmembrane conductance-regulator (CFTR)-correcting therapies will bring more opportunities to prevent the disease, apart from only treating chronic lung infection.

In this review, a summary of the current knowledge of early CF lung disease is provided, based on animal model studies, as well as on data obtained from well structured follow-up programs after newborn screening (NBS). The most important clinical guidelines for treating young CF patients are also summarized.
Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis
Authors: Brown Elizabeth Timbrook , Mock Stephen , Dmochowski Roger , Reynolds W. Stuart , Milam Douglas , Kaufman Melissa R.
Published: December 2016

Background:

Urethroplasty is often successful for the treatment of male urethral stricture disease, but limited data exists on recurrence management. Our goal was to evaluate direct visual internal urethrotomy (DVIU) as a treatment option for isolated, recurrent strictures after urethroplasty.

Methods:

We retrospectively identified male patients who underwent urethroplasty from 1999 to 2013 and developed an isolated, recurrent stricture at the urethroplasty site treated with DVIU. Success was defined as lack of symptomatology and no subsequent intervention. Comparative analysis identified characteristics and stricture properties associated with success.

Results:

A total of 436 urethroplasties were performed in 401 patients at our institution between 1999 and 2013. Stricture recurrence was noted in 64 (16%) patients. Of these, 47 (73%) underwent a DVIU. A total of 37 patients met inclusion criteria and underwent 50 DVIU procedures at the urethroplasty site. A single DVIU was successful in 13 of 37 patients (35%). A total of 4 of 6 patients required a second DVIU (67%). Overall, 17 of 43 (40%) of the total DVIUs were successful after urethroplasty. Success did not differ by age, stricture length or location, surgical technique, radiation history, prior urethroplasty or DVIU, time to failure, or etiology.

Conclusions:

Post-urethroplasty DVIU for isolated, recurrent strictures may be offered as a minimally invasive treatment option. Approximately 40% of patients were spared further intervention.
Understanding disclosure behaviours in HIV-positive young people
Authors: Grainger Carrie
Published: December 2016

Disclosure of sero-status is part of living with HIV and involves a complex decision-making process. Disclosure is not a one-off event and can be viewed as a sequential process and, while affording opportunities for individuals to access appropriate physical and psychological support, it is also an important part of secondary prevention. It is, however, often fraught with emotional challenges, and there is a considerable amount of evidence demonstrating the barriers that individuals face to making a disclosure. Adolescents are one such group that face challenges over disclosing their HIV status. Many adolescents are choosing not to disclose their status, through fear of potentially adverse outcomes, such as rejection and stigma, which could amplify onward transmission rates. In order to better support young people through disclosure journeys, it is essential to understand the reasons and motivations behind why young people choose not to disclose their sero-status in order to develop interventions which may facilitate supporting young people through the disclosure process.
Futures Studies Serving the Development of Future Orientation in Hungary
Authors: Nováky Erzsébet , Hideg Éva , Tóthné Klára Szita
Published: December 2016

This article presents a case study of futures studies in Hungary. There had been two stages of development: the first had seen the vertical deepening and horizontal expansion of the field, whereas the second can be described as theoretical and methodological renewal as well as broadening relationships to the practice. International impacts and linkages have been important throughout, but local contextual factors and specific opportunities also played their role to place Hungarian futures studies on the global map of the discipline.
Social Time as a Multidimensional Category
Authors: Poli Roberto
Published: December 2016

The paper proposes to understand social time through the lens of two different multidimensional grids, one focused on the experience of time and therefore grounded in present perceptions and one focused on the interactions between the three temporal modes of past, present, and future.
Emerging role of checkpoint blockade therapy in lymphoma
Authors: Galanina Natalie , Kline Justin , Bishop Michael R.
Published: December 2016

Following the successful application of immune checkpoint blockade therapy (CBT) in refractory solid tumors, it has recently gained momentum as a promising modality in the treatment of relapsed lymphoma. This significant therapeutic advance stems from decades of research that elucidated the role of immune regulation pathways and the mechanisms by which tumors can engage these critical pathways to escape immune detection. To date, two main pathways, the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed death 1 (PD-1), have emerged as key targets of CBT demonstrating unprecedented activity particularly in heavily pretreated relapsed/refractory Hodgkin lymphoma and some forms of non-Hodgkin disease. Herein we provide a brief discussion of checkpoint blockade in the context of lymphoma biology with a specific focus on novel checkpoint inhibitors and their therapeutic activity. We discuss current clinical trials and the landscape of CBT to underscore both the remarkable progress and foreseeable limitations of this novel treatment strategy. In particular, we build upon state-of-the-art knowledge and clinical insights gained from the early trials to review potential approaches to how CBT may be integrated with other treatment modalities, including chemoimmunotherapy to improve patient outcomes in the future. Finally, as the role of CBT evolves to potentially become a cornerstone of therapy in refractory/relapsed lymphoma, we briefly emphasize the importance of predictive biomarkers in an effort to select appropriate patients who are most likely to derive benefit from CBT.
Effects of a smoking ban on clozapine plasma concentrations in a nonsecure psychiatric unit
Authors: Gee Siobhan H. , Taylor David M. , Shergill Sukhwinder S. , Flanagan Robert , MacCabe James H.
Published: December 2016

Background:

Tobacco smoke is known to affect plasma levels of some drugs, including the antipsychotic clozapine. The effects of suddenly stopping smoking on patients who take clozapine can be severe, as plasma concentrations are expected to rapidly rise, potentially leading to toxicity. A ban on smoking at South London and the Maudsley NHS Foundation Trust (SLaM) was implemented in 2014, and this was expected to affect the plasma concentrations of clozapine for inpatients at the time. This study aimed to determine whether plasma concentrations of clozapine were affected, and additionally, in line with observations from other authors, whether levels of reported violence would also be affected.

Methods:

The smoking habits of all patients at SLaM who smoked and were prescribed clozapine were recorded both before and after the ban. The Glasgow Antipsychotic Side Effect Scale for Clozapine (GASS-C) scale was used to evaluate side-effect burden. Clozapine doses and plasma concentrations were also collected.

Results:

In total, 31 patients were included in this study. The mean clozapine dose before the ban was 502 mg/day, and this did not change significantly after the ban. Similarly, there were no significant changes in clozapine or norclozapine plasma concentrations, or in GASS-C scores. There was no change in the amount of tobacco patients reported smoking before or after the ban. A modest but statistically significant reduction in violent incidences was observed.

Conclusions:

Our data suggest that a ban on smoking for patients taking clozapine on open wards at inpatient hospital sites had little impact on clozapine plasma concentrations, because patients continued to smoke tobacco if allowed to leave. Smoking bans may result in a reduction in violent incidences.
Clonazepam improves dopamine supersensitivity in a schizophrenia patient: a case report
Authors: Fukai Mina , Hirosawa Tetsu , Takahashi Tetsuya , Kaneda Reizo , Kikuchi Mitsuru , Minabe Yoshio
Published: December 2016

Dopamine supersensitivity is an important consideration for assessing treatment-resistant schizophrenia. The emergence of dopamine supersensitivity might be related to upregulation of dopamine D2 receptor, which engenders tolerance to antipsychotics, rebound psychosis, and tardive dyskinesia (TD). A 24-year-old man with a history of treatment-resistant schizophrenia was hospitalized for treatment of bone fracture sustained during a suicide attempt. After the operation, his clinical symptoms implied malignant catatonia. The patient discontinued antipsychotics without rebound psychosis under clonazepam treatment. His psychotic symptoms were controlled further with 24 mg/day aripiprazole without relapse or worsening. Clonazepam might be an effective option for the management of dopamine supersensitivity psychosis (DSP).