bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing Confidence in Uncertainty: Conflicting Roles of Trainees as They Become Educators in Veterinary and Human Medicine
Authors: Lygo-Baker Simon , Kokotailo Patricia K. , Young Karen M.
Published: November 2015

The important role of medical trainees (interns and residents) as teachers is increasingly recognized in veterinary and human medicine, but often is not supported through adult learning programs or other preparatory training methods. To develop appropriate teaching programs focused on effective clinical teaching, more understanding is needed about the support required for the trainee's teaching role. Following discussion among faculty members from education and veterinary and pediatric medicine, an experienced external observer and expert in higher education observed 28 incoming and outgoing veterinary and pediatric trainees in multiple clinical teaching settings over 10 weeks. Using an interpretative approach to analyze the data, we identified five dynamics that could serve as the foundation for a new program to support clinical teaching: (1) Novice–Expert, recognizing transitions between roles; (2) Collaboration–Individuality, recognizing the power of peer learning; (3) Confidence–Uncertainty, regarding the confidence to act; (4) Role–Interdisciplinarity, recognizing the ability to maintain a discrete role and yet synthesize knowledge and cope with complexity; and (5) Socialization–Identity, taking on different selves. Trainees in veterinary and human medicine appeared to have similar needs for support in teaching and would benefit from a variety of strategies: faculty should provide written guidelines and practical teaching tips; set clear expectations; establish sustained support strategies, including contact with an impartial educator; identify physical spaces in which to discuss teaching; provide continuous feedback; and facilitate peer observation across medical and veterinary clinical environments.
Final-Year Students' and Clinical instructors' Experience of Workplace-Based Assessments Used in a Small-Animal Primary-Veterinary-Care Clinical Rotation
Authors: Weijs Cynthia A. , Coe Jason B. , Hecker Kent G.
Published: November 2015

Final-year veterinary students must meet baseline clinical competency upon completion of their training for entry to practice. Workplace-based assessments (WBAs), widely used in human medical training to assess post-graduate students' professionalism and clinical performance, have recently been adopted in undergraduate veterinary clinical teaching environments. WBAs should support veterinary trainees' learning in a clinical teaching environment, though utility of WBAs within veterinary education may differ from that in medical training due to differences in context and in learners' stage of clinical development. We conducted focus groups with final-year veterinary students and clinical instructors following the implementation of three WBAs (Direct Observation of Procedural Skills [DOPS], the Mini-Clinical evaluation exercise [Mini-CEX], and the In-Training Evaluation Report [ITER]) during a small-animal primary-veterinary-care rotation. Students and clinical instructors viewed the DOPS and Mini-CEX as feasible and valuable learning and assessment tools that offered an overall opportunity for timely in-the-moment feedback. Instructors viewed the ITER as less feasible in the context of a service-oriented veterinary clinical teaching environment. Students believed the ITER had potential to be informative, although in its existing application the ITER had limited utility due to time constraints on instructors that prevented them from providing students with individualized and specific feedback. In service-oriented veterinary clinical teaching environments, successful implementation of WBAs requires balancing provision of feedback to students, time demands on clinical instructors, and flexibility of assessment tools.
Faculty Development for a New Curriculum: Implementing a Strategy for Veterinary Teachers within the Wider University Context
Authors: Warman Sheena , Pritchard Jane , Baillie Sarah
Published: November 2015

Faculty development in veterinary education is receiving increasing attention internationally and is considered of particular importance during periods of organizational or curricular change. This report outlines a faculty development strategy developed since October 2012 at the University of Bristol Veterinary School, in parallel with the development and implementation of a new curriculum. The aim of the strategy is to deliver accessible, contextual faculty development workshops for clinical and non-clinical staff involved in veterinary student training, thereby equipping staff with the skills and support to deliver high-quality teaching in a modern curriculum. In October 2014, these workshops became embedded within the new University of Bristol Continuing Professional Development scheme, Cultivating Research and Teaching Excellence. This scheme ensures that staff have a clear and structured route to achieving formal recognition of their teaching practice as well as access to a wide range of resources to further their overall professional development. The key challenges and constraints are discussed.
Ensuring That the Competent Are Truly Competent: An Overview of Common Methods and Procedures Used to Set Standards on High-Stakes Examinations
Authors: De Champlain André F.
Published: November 2015

Determining whether or not an examinee has met an adequate standard of performance constitutes a central task for licensure and certification bodies. Consequently, standard setting is a key activity for all certification and licensing testing programs. The purpose of this article is to provide an overview of methods that have been proposed for set a passing standard on an examination. First, the distinction between norm-referenced and criterion-referenced methods for setting a standard will be outlined. Then, both test-centered and examinee-centered methods for setting a passing standard will be explicated. The importance of factoring in the consequences of adopting a standard will also be illustrated via the Hofstee method. In the concluding section, important issues pertaining to the selection of panelists as well as the validation of the standard will be addressed briefly.
Professional and Veterinary Competencies: Addressing Human Relations and the Human–Animal Bond in Veterinary Medicine
Authors: Adams Cindy L. , Conlon Peter D. , Long Kendra C.
Published: November 2015

Purpose – The purpose of this study was to determine the nature and degree of coverage of human relations and the human– animal bond in veterinary curricula across North America. The attitudes and opinions of a cohort of veterinary students and alumni about human relations skills and human–animal bond training in the veterinary program was also investigated.

Method – Twenty veterinary schools across North America were contacted and data were collected regarding their coverage of human relations and the human–animal bond in the curriculum. A survey was developed to measure attitudes and opinions about this type of training. The survey was disseminated to students in years 1 to 4 and alumni from the Ontario Veterinary College (OVC). Data were analyzed descriptively.

Results – Based on availability of contact people, 20 schools in North America were contacted, and all participated in the study. Each of the veterinary schools surveyed has incorporated strategies for teaching human relations skills through required courses, electives, guest speakers, and/or community service programs. The overall participation rate for OVC students was 53%. Ninetynine percent of all students surveyed agreed that their ability to deal with people using effective human relations skills was a concern, and all students said they would like to receive more training in this area. There was a 41% participation rate for OVC alumni. Fifty-five percent of alumni said they had learned enough in the veterinary program to employ effective human relations skills in practice, yet 65% felt they had not received enough instruction in addressing the human–animal bond specifically.

Conclusions – It is apparent that veterinary schools recognize the need to prepare entry-level practitioners to deal with the human–animal bond and with human relations. It is also evident that students and practitioners value receiving information of this nature in the curriculum and desire further training. Specific learning objectives for veterinary curricula have been outlined based on findings from this study.
A Model Euthanasia Workshop: One Class’s Experience at Tufts University
Authors: Cohen-Salter Cynthia , Folmer-Brown Susan , Hogrefe Kimberly M. , Brosnahan Margaret
Published: November 2015

Performing euthanasia is likely one of the most challenging tasks a veterinarian faces. Four students at Tufts University School of Veterinary Medicine felt that they and their classmates needed additional training on this subject. They informally surveyed the classmates to determine what topics and formats the students desired. The findings were used to develop the Euthanasia Workshop at the university, a voluntary series of lectures and discussions on technical and emotional issues relating to euthanasia. The four students then informally surveyed 30 North American veterinary colleges to determine the scope of euthanasia training in other veterinary programs. They found that euthanasia, while often covered within other courses, is rarely taught as a standalone course.
Attitudes of Veterinary Medical Students and Medical Students Toward Collaborative Learning: An Experiment
Authors: Edwards Janine C. , Walsum Kim van , Sanders Charles W. , Fossum Theresa V. , Sadoski Mark , Bramson Rachel , Wiprud Robert M.
Published: November 2015

This study measured the attitudes of 55 medical students and 30 veterinary medical students as they participated in an experiment of collaborative teaching and learning about basic surgical skills. Two parallel forms of an attitude questionnaire were developed, with three subscales: confidence in one’s own surgical skill; collaboration with the other type of student; and inter - professional collaboration in general. These attitude scales were administered before and after an experiment involving the veterinary medical students teaching the medical students incision and exploratory laparoscopy in a laboratory setting using live rabbits. After the experiment, measures of the medical students’ attitudes had increased significantly on all three subscales. Measures of the veterinary students’ attitudes increased significantly on two subscales but declined on the subscale of intero-professional collaboration.
An Anatomist’s Comments on Learning and Teaching
Authors: Smallwood James E.
Published: November 2015

A Texas farm boy, who entered veterinary school in 1966 with the goal of becoming a “cow doctor” but instead has ended up teaching anatomy for more than 30 years, shares some of his personal philosophy and ideas about learning and teaching. The author claims no special expertise in teaching methodology, offers no “cutting-edge” techniques, and presents no particularly “novel” concepts on how to be a good teacher. He merely shares his personal, common-sense teaching philosophy, which is pretty much summarized in “Smallwood’s 12 or More Axioms of Learning and Teaching.” As a “parting shot,” the author comments briefly on teaching anatomy using the problem-based learning approach.
Mechanical Low Back Pain: Secular Trend and Intervention Topics of Randomized Controlled Trials
Authors: Castellini Greta , Gianola Silvia , Banfi Giuseppe , Bonovas Stefanos , Moja Lorenzo
Published: November 2015

Purpose: To evaluate the number of published randomized controlled trials (RCTs) focusing on mechanical low back pain (MLBP) rehabilitation, the secular (i.e., long-term) trend, and the distribution of interventions studied. Methods: All included RCTs were extracted from all Cochrane systematic reviews focusing on rehabilitation therapies for MLBP, and two independent reviewers screened and analyzed the information on interventions. Results: After removal of duplicates, the data set consisted of 196 RCTs published between 1961 and 2010. The number of RCTs published increased consistently over time: 2 trials (1% of the total) were published in 1961–1970, 10 (5%) in 1971–1980, 41 (21%) in 1981–1990, 68 (35%) in 1991–2000, and 75 (38%) in 2001–2010. The intervention of interest in the majority of RCTs was exercise therapy (115/399; 29%), followed by spinal manipulation therapies (60/399; 15%). Conclusion: The number of RCTs focusing on MLBP has risen over time; of all interventions studied, exercise therapy has attracted the most research interest.
A Roland Morris Disability Questionnaire Target Value to Distinguish between Functional and Dysfunctional States in People with Low Back Pain
Authors: Stratford Paul W. , Riddle Daniel L.
Published: November 2015

Purpose: To estimate a threshold Roland Morris Disability Questionnaire (RMQ) value that could be used to classify patients with low back pain (LBP) as functional or dysfunctional. Methods: In this secondary analysis of data from a study that estimated clinically important RMQ change scores, participants were adults with LBP attending one of three physical therapy clinics. Diagnostic test methodology and a reference standard of goals met were applied to estimate a threshold RMQ value that best distinguished between participants with a functional status and those whose status was dysfunctional. Results: Of 143 participants, 104 (73%) met their goals. An RMQ threshold value of 4/24 best distinguished between those who met their goals and those who did not. Sensitivity and specificity for a threshold score of 4 were 94% (95% CI, 88–98) and 69% (95% CI, 52–83), respectively. Conclusions: A threshold value of 4 RMQ points provided a reasonably accurate classification of patients. Further research is necessary to cross-validate this estimate and to examine the stability of the estimated value in people with diverse functional demands.
Leadership in Physical Therapy: Characteristics of Academics and Managers: A Brief Report
Authors: Desveaux Laura , Chan Zach , Brooks Dina
Published: November 2015

Purpose: To explore the characteristics of physical therapy leaders in academic and managerial roles. Methods: This quantitative, cross-sectional study used an online questionnaire administered via email to Canadian physical therapists recruited through the Canadian Physiotherapy Association and via additional emails targeted to academic and health care institutions. Individuals who met the inclusion criteria after completion of the questionnaire were asked to complete the Clifton StrengthsFinder, which was used to objectively assess the extent to which participants exhibited personality characteristics. We calculated frequencies for demographic characteristics and the 10 most prominent characteristics for participants in academic and managerial roles. Results: A total of 88 participants completed the questionnaire (52 managers, 36 academics). The most prevalent strengths among both academics and managers were the learner and achiever characteristics. Conclusions: Academics and managers in physical therapy share similar core characteristics, with slight variations in secondary characteristics.
Diminishing Effect Sizes with Repeated Exposure to Evidence-Based Practice Training in Entry-Level Health Professional Students: A Longitudinal Study
Authors: Lewis Lucy K. , Wong Sze C. , Wiles Louise K. M. , McEvoy Maureen P.
Published: November 2015

Purpose: To investigate the magnitude of change in outcomes after repeated exposure to evidence-based practice (EBP) training in entry-level health professional students. Method: Using an observational cross-sectional analytic design, the study tracked 78 students in physiotherapy, podiatry, health science, medical radiations, and human movement before and after two sequential EBP courses. The first EBP course was aimed at developing foundational knowledge of and skills in the five steps of EBP; the second was designed to teach students to apply these steps. Two EBP instruments were used to collect objective (actual knowledge) and self-reported (terminology, confidence, practice, relevance, sympathy) data. Participants completed both instruments before and after each course. Results: Effect sizes were larger after the first course than after the second for relevance (0.72 and 0.26, respectively), practice (1.23 and 0.43), terminology (2.73 and 0.84), and actual knowledge (1.92 and 1.45); effect sizes were larger after the second course for sympathy (0.03 and 0.14) and confidence (0.81 and 1.12). Conclusions: Knowledge and relevance changed most meaningfully (i.e., showed the largest effect size) for participants with minimal prior exposure to training. Changes in participants' confidence and attitudes may require a longer time frame and repeated training exposure.
Canadian Physiotherapy Assessment of Clinical Performance: Face and Content Validity
Authors: Mori Brenda , Norman Kathleen E. , Brooks Dina , Herold Jodi , Beaton Dorcas E.
Published: November 2015

Purpose: To investigate face and content validity of a draft measure to be used across Canada to assess physiotherapy students' performance in clinical education, through broad consultation with physiotherapy clinical instructors (CIs) across Canada. Methods: An online survey was used to collect input on the draft measure. In addition to demographics, the questionnaire included questions on the preferred rating scale, the items within the measure that should have their own rating scale, and general impressions. Results: Among the 259 CIs who completed the survey, a discrete rating scale with six anchors and 10 boxes or a continuous-line rating scale with six anchors was preferred. Respondents favoured using one rating scale for each key competency in the Expert role but considered a single rating scale sufficient for assessing the Scholarly Practitioner role. CIs agreed that the proposed measure would allow them to assess a student who was performing poorly or very well. The name Canadian Physiotherapy Assessment of Clinical Performance (ACP) received the most votes in the questionnaire. Conclusions: CIs' collective preferences on the design, organization, and naming of the measure they will use in evaluating students are reflected in the second draft of the ACP.
Public law and ordinary legal method: Revisiting Dicey’s approach to droit administratif
Authors: Walters Mark D
Published: November 2015

In this article, the author considers the basic character of public law in the common law tradition by returning to AV Dicey’s famous assertion that public law is ‘ordinary’ law. Dicey made this claim in the course of articulating a theory of the rule of law within the common law tradition, and he juxtaposed that theory with the idea of public law within the civil law tradition, using French droit administratif as his central target of attack. Dicey’s ideas have attracted considerable criticism and are now generally out of favour. However, once the idea of public law as ordinary is reconsidered in light of its genesis within the long history of common law discourse concerning law and state power, and once Dicey’s own evolving attitudes about French droit administratif are considered, the idea can be seen to offer important insights into the ideal of legality today. The core insight, in the end, is the simple idea that if the rule of law means anything, the law that rules must embrace the qualities that law ordinarily embraces – that public law is, in the end, the product of ordinary legal method.
Disgorgement: From property to contract
Authors: Sage Nicholas W
Published: November 2015

The article develops an understanding of the disgorgement remedy in private law by moving between the proprietary context, where the remedy has long been awarded, and the contractual context, where the remedy is relatively new and still controversial. The resulting account can explain the emerging common law on disgorgement for breach of contract, which has so far eluded explanation. The account also has broader implications for private law theory. First, it suggests that asking whether the plaintiff has a right ‘to a thing’ (the paradigmatic sort of property right) may obscure the remedial analysis. Instead, the analysis should attend to another, hitherto overlooked aspect of the plaintiff’s rights: their logical scope. Second, the account suggests that a purely ‘rights-based’ understanding of private law remedies cannot adequately explain disgorgement, because it elides the crucial role that the defendant’s wrongful action plays in the explanation for the remedy.
A novel surgical approach to the lumbar spine involving hemilateral split-off of the spinous process to preserve the multifidus muscle: technical note
Authors: Chatani Kenichi
Published: November 2015

In the conventional posterior approach to the lumbar spine, the lamina is exposed by stripping the paravertebral muscles from the spinous process, and the resulting paravertebral muscle damage can produce muscle atrophy and decreased muscle strength. The author developed a novel surgical approach to the lumbar spine in which the attachment of the paravertebral muscles to the spinous process is preserved. In the novel approach, the spinous process is split on the midline without stripping the attached muscles, and a hemilateral half of the spinous process is then resected at the base, exposing only the ipsilateral lamina. Before closing, the resected half is sutured and reattached to the remaining half of the spinous process. Thirty-eight patients with lumbar spinal canal stenosis (LSCS) undergoing unilateral partial laminectomy and bilateral decompression using this novel approach were analyzed. Postoperative changes in the multifidus muscle were evaluated by T2 signal intensity on MR images. MRI performed 1 year after the operation revealed no significant difference in the T2 signal intensity of the multifidus muscle between the approach and nonapproach sides. This result indicated that postoperative changes of the multifidus muscle on the approach side were slight. The clinical outcomes of unilateral partial laminectomy and bilateral decompression using this approach for LSCS were satisfactory. The novel approach can be a useful alternative to the conventional posterior lumbar approach.
Does immunotherapy increase the rate of radiation necrosis after radiosurgical treatment of brain metastases?
Authors: Colaco Rovel J. , Martin Pierre , Kluger Harriet M. , Yu James B. , Chiang Veronica L.
Published: November 2015

OBJECT

Radiation necrosis (RN), or its imaging equivalent, treatment-related imaging changes (TRIC), is an inflammatory reaction to high-dose radiation in the brain. The authors sought to investigate the hypothesis that immunotherapy increases the risk of developing RN/TRIC after stereotactic Gamma Knife (GK) radiosurgery for brain metastases.

METHODS

A total of 180 patients who underwent GK surgery for brain metastases between 2006 and 2012 were studied. The systemic therapy they received was classified as cytotoxic chemotherapy (CT), targeted therapy (TT), or immunotherapy (IT). The timing of systemic therapy in relation to GK treatment was also recorded. Logistic regression was used to calculate the odds of developing RN according to type of systemic therapy received.

RESULTS

The median follow-up time was 11.7 months. Of 180 patients, 39 (21.7%) developed RN/TRIC. RN/TRIC rates were 37.5% (12 of 32) in patients who received IT alone, 16.9% (14 of 83) in those who received CT only, and 25.0% (5 of 20) in those who received TT only. Median overall survival was significantly longer in patients who developed RN/TRIC (23.7 vs 9.9 months, respectively). The RN/TRIC rate was increased significantly in patients who received IT alone (OR 2.40 [95% CI 1.06–5.44]; p = 0.03), whereas receipt of any CT was associated with a lower risk of RN/TRIC (OR 0.38 [95% CI 0.18–0.78]; p = 0.01). The timing of development of RN/TRIC was not different between patients who received IT and those who received CT.

CONCLUSIONS

Patients who receive IT alone may have an increased rate of RN/TRIC compared with those who receive CT or TT alone after stereotactic radiosurgery, whereas receiving any CT may in fact be protective against RN/TRIC. As the use of immunotherapies increases, the rate of RN/TRIC may be expected to increase compared with rates in the chemotherapy era.
Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap
Authors: Rastatter Jeffrey C. , Walz Patrick C. , Alden Tord D.
Published: November 2015

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.
Hippocampal and cerebellar atrophy in patients with Cushing’s disease
Authors: Burkhardt Till , Lüdecke Daniel , Spies Lothar , Wittmann Linus , Westphal Manfred , Flitsch Jörg
Published: November 2015

OBJECT

Cushing’s disease (CD) may cause atrophy of different regions of the human brain, mostly affecting the hippocampus and the cerebellum. This study evaluates the use of 3-T MRI of newly diagnosed patients with CD to detect atrophic degeneration with voxel-based volumetry.

METHODS

Subjects with newly diagnosed, untreated CD were included and underwent 3-T MRI. Images were analyzed using a voxelwise statistical test to detect reduction of brain parenchyma. In addition, an atlas-based volumetric study for regions likely to be affected by CD was performed.

RESULTS

Nineteen patients with a mean disease duration of 24 months were included. Tumor markers included adre-nocorticotropic hormone (median 17.5 pmol/L), cortisol (949.4 nmol/L), and dehydroepiandrosterone sulfate (5.4 μmol/L). The following values are expressed as the mean ± SD. The voxelwise statistical test revealed clusters of significantly reduced gray matter in the hippocampus and cerebellum, with volumes of 2.90 ± 0.26 ml (right hippocampus), 2.89 ± 0.28 ml (left hippocampus), 41.95 ± 4.67 ml (right cerebellar hemisphere), and 42.11 ± 4.59 ml (left cerebellar hemisphere). Healthy control volunteers showed volumes of 3.22 ± 0.25 ml for the right hippocampus, 3.23 ± 0.25 ml for the left hippocampus, 50.87 ± 4.23 ml for the right cerebellar hemisphere, and 50.42 ± 3.97 ml for the left cerebellar hemisphere.

CONCLUSIONS

Patients with untreated CD show significant reduction of gray matter in the cerebellum and hippocampus. These changes can be analyzed and objectified with the quantitative voxel-based method described in this study.
Creutzfeldt-Jakob disease: updated diagnostic criteria, treatment algorithm, and the utility of brain biopsy
Authors: Manix Marc , Kalakoti Piyush , Henry Miriam , Thakur Jai , Menger Richard , Guthikonda Bharat , Nanda Anil
Published: November 2015

Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative condition with a rapid disease course and a mortality rate of 100%. Several forms of the disease have been described, and the most common is the sporadic type. The most challenging aspect of this disease is its diagnosis—the gold standard for definitive diagnosis is considered to be histopatho-logical confirmation—but newer tests are providing means for an antemortem diagnosis in ways less invasive than brain biopsy. Imaging studies, electroencephalography, and biomarkers are used in conjunction with the clinical picture to try to make the diagnosis of CJD without brain tissue samples, and all of these are reviewed in this article. The current diagnostic criteria are limited; test sensitivity and specificity varies with the genetics of the disease as well as the clinical stage. Physicians may be unsure of all diagnostic testing available, and may order outdated tests or prematurely request a brain biopsy when the diagnostic workup is incomplete. The authors review CJD, discuss the role of brain biopsy in this patient population, provide a diagnostic pathway for the patient presenting with rapidly progressive dementia, and propose newer diagnostic criteria.
Role of apolipoprotein E polymorphism as a prognostic marker in traumatic brain injury and neurodegenerative disease: a critical review
Authors: Maiti Tanmoy Kumar , Konar Subhas , Bir Shyamal , Kalakoti Piyush , Bollam Papireddy , Nanda Anil
Published: November 2015

OBJECT

The difference in course and outcome of several neurodegenerative conditions and traumatic injuries of the nervous system points toward a possible role of genetic and environmental factors as prognostic markers. Apolipoprotein E (Apo-E), a key player in lipid metabolism, is recognized as one of the most powerful genetic risk factors for dementia and other neurodegenerative diseases. In this article, the current understanding of APOE polymorphism in various neurological disorders is discussed.

METHODS

The English literature was searched for various studies describing the role of APOE polymorphism as a prognostic marker in neurodegenerative diseases and traumatic brain injury. The wide ethnic distribution of APOE polymorphism was discussed, and the recent meta-analyses of role of APOE polymorphism in multiple diseases were analyzed and summarized in tabular form.

RESULTS

Results from the review of literature revealed that the distribution of APOE is varied in different ethnic populations. APOE polymorphism plays a significant role in pathogenesis of neurodegeneration, particularly in Alzheimer’s disease. APOE ε4 is considered a marker for poor prognosis in various diseases, but APOE ε2 rather than APOE ε4 has been associated with cerebral amyloid angiopathy-related bleeding and sporadic Parkinson’s disease. The role of APOE polymorphism in various neurological diseases has not been conclusively elucidated.

CONCLUSIONS

Apo-E is a biomarker for various neurological and systemic diseases. Therefore, while analyzing the role of APOE polymorphism in neurological diseases, the interpretation should be done after adjusting all the confounding factors. A continuous quest to look for associations with various neurological diseases and wide knowledge of available literature are required to improve the understanding of the role of APOE polymorphism in these conditions and identify potential therapeutic targets.
Seven-Tesla MRI and neuroimaging biomarkers for Alzheimer’s disease
Authors: Ali Rohaid , Goubran Maged , Choudhri Omar , Zeineh Michael M.
Published: November 2015

The goal of this paper was to review the effectiveness of using 7-T MRI to study neuroimaging biomarkers for Alzheimer’s disease (AD). The authors reviewed the literature for articles published to date on the use of 7-T MRI to study AD. Thus far, there are 3 neuroimaging biomarkers for AD that have been studied using 7-T MRI in AD tissue: 1) neuroanatomical atrophy; 2) molecular characterization of hypointensities; and 3) microinfarcts.

Seven-Tesla MRI has had mixed results when used to study the 3 aforementioned neuroimaging biomarkers for AD.

First, in the detection of neuroanatomical atrophy, 7-T MRI has exciting potential. Historically, noninvasive imaging of neuroanatomical atrophy during AD has been limited by suboptimal resolution. However, now there is compelling evidence that the high resolution of 7-T MRI may help overcome this hurdle. Second, in detecting the characterization of hypointensities, 7-T MRI has had varied success. PET scans will most likely continue to lead in the noninvasive imaging of amyloid plaques; however, there is emerging evidence that 7-T MRI can accurately detect iron deposits within activated microglia, which may help shed light on the role of the immune system in AD pathogenesis. Finally, in the detection of microinfarcts, 7-T MRI may also play a promising role, which may help further elucidate the relationship between cerebrovascular health and AD progression.
Percutaneous irreversible electroporation (IRE) of prostate cancer: Contrast-enhanced ultrasound (CEUS) findings
Authors: Niessen C. , Jung E.M. , Beyer L. , Pregler B. , Dollinger M. , Haimerl M. , Scheer F. , Stroszczynski C. , Wiggermann P.
Published: November 2015

PURPOSE:

To evaluate the use of contrast-enhanced ultrasound (CEUS) after irreversible electroporation (IRE) of prostatic cancer tissue to assess the ablation status by depicting microvascularisation in the ablation area.

MATERIALS AND METHODS:

Retrospective evaluation of CEUS of 13 patients (mean age: 61.4 ± 7.5 years) with histologically confirmed prostatic cancer who underwent percutaneous IRE. In the course of clinical routine, the tumor lesions were documented before, immediately after, and 1 day after the ablationusing color-coded transabdominal and transrectal CEUS. The obtained image data (DICOM loops and images) were subsequently evaluated by 2 experienced radiologists and assessed with regard to micro vascularisation by means of a 5-point scale.

RESULTS:

CEUS images showed significantly reduced microcirculation of the lesions (mean 0.9 ± 0.6 cm (0.5–1.5 cm) after IRE. Microcirculation was reduced from 2.15 ± 0.56 prior to ablation to 0.65 ± 0.63 ( p <  0.001) immediately after the ablation and to 0.27 ± 0.44 one day after IRE ( p <  0.001).

CONCLUSION:

This study showed rapid and significant reduction of the microcirculation in the ablation area afterpercutaneous IRE of prostatic cancer tissue.
The interaction of human macrophage subsets with silicone as a biomaterial
Authors: Vijaya Bhaskar Thanga Bhuvanesh , Ma Nan , Lendlein Andreas , Roch Toralf
Published: November 2015

Silicones are widely used as biomaterials for medical devices such as extracorporeal equipments. However, there is often conflicting evidence about their supposed cell- and histocompatibility. Macrophages could mediate silicone-induced adverse responses such as foreign body reaction and fibrous encapsulation. The polarization behaviour of macrophages could determine the clinical outcome after implantation of biomaterials. Induction of classically activated macrophages (CAM) may induce and support uncontrolled inflammatory responses and undesired material degradation. In contrast, polarization into alternatively activated macrophages (AAM) is assumed to support healing processes and implant integration.

This study compared the interaction of non-polarized macrophages (M0), CAM, and AAM with commercially available tissue culture polystyrene (TCP) and a medical grade silicone-based biomaterial, regarding the secretion of inflammatory mediators such as cytokines and chemokines. Firstly, by using the Limulus amoebocyte lysate (LAL) test the silicone films were shown to be free of soluble endotoxins, which is the prerequisite to investigate their interaction with primary immune cells. Primary human monocyte-derived macrophages (M0) were polarized into CAM and AAM by addition of suitable differentiation factors. These macrophage subsets were incubated on the materials for 24 hours and their viability and cytokine secretion was assessed. In comparison to TCP, cell adhesion was lower on silicone after 24 hours for all three macrophage subsets. However, compared to TCP, silicone induced higher levels of certain inflammatory and chemotactic cytokines in M0, CAM, and AAM macrophage subsets.

Conclusively, it was shown that silicone has the ability to induce a pro-inflammatory state to different magnitudes dependent on the macrophage subsets. This priming of the macrophage phenotype by silicone could explain the incidence of severe foreign body complications observed in vivo.
Quantification of adherent platelets on polymer-based biomaterials. Comparison of colorimetric and microscopic assessment
Authors: Braune S. , Zhou S. , Groth B. , Jung F.
Published: November 2015

BACKGROUND:

Platelet adhesion to artificial surfaces is one of the most important indicators for the thrombogenicity of implant materials. Currently, a variety of enzyme activity-based colorimetric assays or microscopy-based techniques are commonly in use to assess this characteristic. Studies about how data of colorimetric assays correlate with the image-based quantification of adherent platelets are scarce. To address this question, the present study compared two colorimetric assays (lactate dehydrogenase (LDH) and acid phosphatase (ACP)) with an image-based quantification of the density of platelets adhering on polymer-based biomaterial surfaces.

MATERIALS AND METHODS:

Tri-sodium citrated whole blood was collected from apparently healthy subjects and platelet rich plasma (PRP) was prepared according to a standardized protocol. An in vitro static thrombogenicity test was applied to study platelet adhesion from PRP adjusted to 50,000 platelets per μL on three different polymers: medical grade polytetrafluoroethylene (PTFE), silicone and polyethylene terephthalate (PET). For the direct image-based approach, surface adherent platelets were fixed, fluorescently labelled and microscopically visualized. The image-based determination of platelet densities provided reference values for the comparison with data of the colorimetric assays. Correlation between standard platelet concentrations and ACP/LDH absorbance measurements were analysed to estimate accuracy and association of both parameters. ACP and LDH release from resting and ADP-stimulated platelets was studied to estimate how platelet activation influences colorimetric assay results.

RESULTS:

The density of adherent platelets ranged from 15,693 ± 2,487 platelets·mm–2 (PTFE) to 423 ± 99 platelets·mm–2 (silicone) and 4,621 ± 1,427 platelets·mm–2 (PET) and differed significantly between the three polymers (ANOVA: p <  0.05). Correlation coefficients between microscopic and colorimetric determination of platelet densities ranged between r = 0.93 (LDH, p <  0.001) and r = 0.94 (ACP, p <  0.001). ACP absorbance measurements of platelet standards with different concentrations corresponded well to an ideal linear regression, while LDH data either deceeded or exceeded the expected values. The LDH release during ADP-induced platelet activation was significantly higher compared to the release of ACP.

CONCLUSION:

For an adjusted platelet concentration of 50,000 platelets·μL−1, both colorimetric assays (ACP and LDH) allowed a similar accurate quantification of the mean platelet density compared to the microscopic evaluation. Better linearity of the assay standards, less variability of the results and a lower influence of platelet activation on the measurements mark the ACP assay as more suitable for the assessment of material surface adherent platelets compared to the LDH assay, particularly, if near physiological platelet concentrations are applied.
Long term follow-up after endovascular brachytherapy of femoro-popliteal arteries
Authors: Thalhammer Christoph , Alvarez Elena , Husmann Marc , Staub Daniel , Kaspar Mathias , Aschwanden Markus , Amann-Vesti Beatrice R.
Published: November 2015

To perform a long term follow-up after endovascular brachytherapy (EVBT) and balloon angioplasty (PTA) regarding vessel patency and diameter. EVBT had been successfully used to decrease restenosis in short term, but long term data are lacking. Participants of a randomized study comparing EVBT and balloon angioplasty alone were invited for follow-up examination ten years after intervention. Using a standardized protocol measurement of the patency and vessel diameter was performed of femoral and popliteal arteries. 44 patients were included, 21 had been treated with EVBT and 23 had received PTA alone. Target lesion patency was similar between the two groups (90.5% vs. 87.0%). Vessel diameter of the target lesion was significantly greater in the EVBT group (6.4 mm, range 3.9–9.9) compared to the controls (5.0 mm, range 3.1–7.4; p = 0.002). Ten years after EVBT of femoro-popliteal arteries vessel diameter is significantly increased whereas patency rate is not different compared to angioplasty alone.
Expression of nicotinic acetylcholine receptor subunits in HEp-2 cells for immunodetection of autoantibody specificities in sera from Myasthenia gravis patients
Authors: George S. , Noack M. , Vanek M. , Rentzsch J. , Röber N. , Conrad K. , Roggenbuck D. , Küpper J.-H.
Published: November 2015

Myasthenia gravis (MG) is an autoimmune disease characterized by the formation of pathogenic autoantibodies mostly targeting the nicotinic acetylcholine receptor (AChR). The AChR is composed of two alpha subunits and one subunit of each beta, delta and gamma (fetal AChR), or epsilon (adult AChR), respectively. Serological diagnostics is commonly done by radioimmunoassay (RIA). Here we used an indirect immunofluorescence assay with MG patient sera on transiently transfected HEp-2 cells expressing selected components of the AChR. Our data show that already 12 out of 13 MG patient sera showed autoantibody binding to HEp-2 cells transfected to express the alpha subunit solely. Interestingly, 11 out of 13 patient sera reacted positive with cells transfected to reconstitute the complete fetal AChR, but only 6 out of 13 sera showed positive signals with cells expressing the components of adult AChR. Moreover, there was no strict correlation of the serum concentration required to obtain clear-cut fluorescence signals to the antibody titer as measured by RIA. It will be an interesting topic to further investigate if the optimal serum dilution for indirect immunofluorescence as well as the autoantibody binding preferences to defined AChR subunits and to the adult versus the fetal receptor variant could provide additional predictive value in MG diagnostics.
The interaction of adipose-derived human mesenchymal stem cells and polyether ether ketone
Authors: Wang Weiwei , Kratz Karl , Behl Marc , Yan Wan , Liu Yue , Xu Xun , Baudis Stefan , Li Zhengdong , Kurtz Andreas , Lendlein Andreas , Ma Nan
Published: November 2015

Polyether ether ketone (PEEK) as a high-performance, thermoplastic implant material entered the field of medical applications due to its structural function and commercial availability. In bone tissue engineering, the combination of mesenchymal stem cells (MSCs) with PEEK implants may accelerate the bone formation and promote the osseointegration between the implant and the adjacent bone tissue. In this concept the question how PEEK influences the behaviour and functions of MSCs is of great interest. Here the cellular response of human adipose-derived MSCs to PEEK was evaluated and compared to tissue culture plate (TCP) as the reference material. Viability and morphology of cells were not altered when cultured on the PEEK film. The cells on PEEK presented a high proliferation activity in spite of a relatively lower initial cell adhesion rate. There was no significant difference on cell apoptosis and senescence between the cells on PEEK and TCP. The inflammatory cytokines and VEGF secreted by the cells on these two surfaces were at similar levels. The cells on PEEK showed up-regulated BMP2 and down-regulated BMP4 and BMP6 gene expression, whereas no conspicuous differences were observed in the committed osteoblast markers (BGLAP, COL1A1 and Runx2). With osteoinduction the cells on PEEK and TCP exhibited a similar osteogenic differentiation potential. Our results demonstrate the biofunctionality of PEEK for human MSC cultivation and differentiation. Its clinical benefits in bone tissue engineering may be achieved by combining MSCs with PEEK implants. These data may also provide useful information for further modification of PEEK with chemical or physical methods to regulate the cellular processes of MSCs and to consequently improve the efficacy of MSC-PEEK based therapies.
Evaluation of the diagnostic accuracy of CEUS in children with benign and malignant liver lesions and portal vein anomalies
Authors: Pschierer K. , Grothues D. , Rennert J. , da Silva N. Platz Batista , Schreyer A.G. , Melter M. , Stroszczysnski C. , Jung E.M.
Published: November 2015

OBJECTIVE:

Comparison of the diagnostic findings of MRI, CT and CEUS in children with benign and malignant and portal venous anomalies of the liver.

MATERIALS/METHODS:

Retrospective analysis of the diagnostic findings of CEUS, MRI and CT scans in 56 children (age 0–17 years) with a total of 60 benign and malignant liver lesions and anomalies of the portal vein/perfusion. All patients underwent CEUS using sulphur hexafluoride microbubbles and a multi-frequency probe (1–5 MHz, 6–9 MHz). Cine-loops were stored up to 3 minutes. MRI was performed in 38 lesions. CT was performed in 8 lesions.

RESULTS:

Out of the 56 patients 49 liver lesions (48 benign, 1 malignant), 9 anomalies of the portal vein/perfusion and 2 of the biliary system were detected. 16/49 lesions were analyzed histopathologically. Using CEUS, the characterization of the lesions was possible in 45 out of 49 cases. In 32 cases, CEUS provided the exact diagnosis. Only two benign lesions were falsely categorized as malignant. Findings of MRI and CEUS were concordant in 84% of cases ( n = 32/38). CEUS considered 1 benign lesion to be malignant. 2 lesions were not detectable and in 3 lesions no definite diagnosis was established using MRI. Findings of CT and CEUS were concordant in 5 of 8 cases. In 21 lesions CEUS as the only imaging modality was found to be sufficient for diagnostics.

CONCLUSION:

Despite the restricted indications for using CEUS in children, it offers a high diagnostic detection rate (93%) for characterization of liver lesions and portal vein anomalies.
Recommendations for contrast enhanced ultrasound (CEUS) in free tissue transplant monitoring
Authors: Prantl Lukas , Geis Sebastian , Lamby Philipp , Jung Ernst Michael
Published: November 2015

Complications rates after free flap transplantation still amount up to 5% . Consequently a reliable monitoring system is of high importance in plastic and reconstructive surgery. The following guidelines provide an overview of the current opportunities for free flap planning and monitoring with ultrasound and in particular with contrast enhanced ultrasound.