bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient safety competencies in undergraduate nursing students: a rapid evidence assessment
Authors: Bianchi Monica , Bressan Valentina , Cadorin Lucia , Pagnucci Nicola , Tolotti Angela , Valcarenghi Dario , Watson Roger , Bagnasco Annamaria , Sasso Loredana
Published: May 2016

Aims

To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students.

Background

Patient safety in nursing education is of key importance for health professional environments, settings and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety.

Design

Rapid Evidence Assessment.

Data Sources

MEDLINE, CINAHL, SCOPUS and ERIC were searched, yielding 500 citations published between 1 January 2004–30 September 2014.

Review methods

Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies.

Results

Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students'
overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication and facilitates adequate supervision and feedback.

Conclusion

Few studies describe the nursing students'
patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students'
patient safety competencies.
Acute Autonomic Engagement Assessed by Heart Rate Dynamics During Vagus Nerve Stimulation in Patients With Heart Failure in the ANTHEM‐HF Trial
Authors: NEARING BRUCE D. , LIBBUS IMAD , AMURTHUR BADRI , KENKNIGHT BRUCE H. , VERRIER RICHARD L.
Published: May 2016

Acute Heart Rate Dynamics During VNS

Background

Chronic vagus nerve stimulation (VNS) applied to produce biomimetic levels of parasympathetic activation is feasible, well tolerated, safe, improves left ventricular ejection fraction, NYHA class, heart rate variability, and baroreflex function, and reduces T‐wave alternans (TWA) in patients with chronic heart failure. However, the acute effects of VNS on beat‐to‐beat heart rate dynamics have not been systematically characterized in humans.

Methods and Results

We evaluated acute effects of VNS on R‐R‐interval dynamics during the VNS titration period in patients (n = 59) enrolled in ANTHEM‐HF trial by quantifying effects during continuous cyclic VNS (14‐seconds on‐time, 66‐seconds off‐time) adjusted to the maximum tolerable dose without excessive (<4 bpm) bradycardia during the 10‐week titration period. VNS elicited an immediate change in heart rate that was correlated to VNS current amplitude, pulse width, and frequency. Heart rate decreased more in the 28 patients with right‐sided stimulation (–2.22 ± 0.13 bpm) than in the 31 patients with left‐sided stimulation (–0.60 ± 0.08 bpm, P < 0.001). The linear correlation between stimulus intensity and lengthening of the R–R interval was stronger among the 28 patients with right‐sided VNS implantation (r = 0.88, P < 0.0001) than among the 31 patients with left‐sided VNS implantation (r = 0.49, P < 0.002). In all patients, the heart rate change elicited by VNS was significantly greater than the change during the same timing intervals in 10 randomly selected patients without stimulation (+0.08 ± 0.06 bpm, P < 0.001).

Conclusion

Instantaneous heart rate change during therapeutic levels of VNS in patients with heart failure indicates consistent modulation of the autonomic nervous system for both left‐ and right‐sided stimulation.
Reproductive biology of the stingrays, Myliobatis goodei and Myliobatis ridens (Chondrichthyes: Myliobatidae), in southern Brazil
Authors: Araújo P. R. V. , Oddone M. C. , Velasco G.
Published: May 2016

This study, carried out between spring 2012 and winter 2014, characterized the sexual development and reproductive cycle of Myliobatis goodei and Myliobatis ridens in the extreme south of Brazil to support future management and conservation plans. Ninety‐five specimens of M. goodei (24 males and 71 females) and 175 M. ridens (24 males and 151 females) were sampled. Female M. goodei attained disc‐width‐at‐50% maturity (WD50) at 683 mm. Uterine fecundity was four to five embryos. The largest male recorded, a mature individual, had a disc width of 650 mm. In M. ridens, WD50 was 662 mm. Uterine fecundity varied from one to eight embryos. The largest male on record was a maturing 590 mm WD individual. The hepato‐somatic index was higher in autumn in females of M. goodei, and in the summer in M. ridens. The gonado‐somatic index and the largest vitellogenic follicle diameter were higher in spring in both species. Pregnant females of both species were recorded during spring, although for M. ridens, these females also occurred in summer. Embryos had WD of 61–218 and 40–236 mm for M. goodei and M. ridens, respectively. The incidence of pregnant females in southern Brazil in spring–summer coincides with the small‐scale beach artisanal fisheries season peak, when M. goodei and M. ridens suffer fishing mortality, while using the coastal shallow areas in the warmer periods (spring–summer) to give birth.
REGIONAL GROWTH, INNOVATION, AND LATENT NONLINEAR EFFECTS
Authors: Sanso‐Navarro Marcos , Vera‐Cabello María
Published: May 2016

This paper studies the link between knowledge, innovation, and growth in European regions using nonparametric methods. Our findings suggest that knowledge inputs and the share of innovative firms have a heterogeneous and nonlinear relationship with growth. This evidence has been exploited to examine the consequences of alternative policies using a counterfactual estimation setup, the results of which imply that increasing the formal knowledge base may be optimal in most regions. Less knowledge and innovation intensive regions will also benefit from a higher innovation potential and from a trustworthy and entrepreneurial economic environment.
Constipation prophylaxis in children undergoing orthopedic surgery: A quasi‐experimental study
Authors: Mantegazzi Laila Sara , Seliner Brigitte , Imhof Lorenz
Published: May 2016

Purpose

This study evaluated the effectiveness of constipation prophylaxis administered with the support of an advanced practice nurse.

Design

A quasi‐experimental study with a historical control group of 112 pediatric (age 1–18) orthopedic patients and an intervention group of 59 patients was conducted in a surgical ward in Switzerland.

Results

The implementation of a standardized constipation prophylaxis led to an absolute risk reduction (27%) of constipation. Fisher's exact test showed a significant difference in the prevalence of constipation in the two samples, p = .001.

Practice Implications

Constipation prophylaxis is a necessity in pediatric orthopedics.
Elevated levels of circulating CDH5 and FABP1 in association with human drug‐induced liver injury
Authors: Mikus Maria , Drobin Kimi , Gry Marcus , Bachmann Julie , Lindberg Johan , Yimer Getnet , Aklillu Eleni , Makonnen Eyasu , Aderaye Getachew , Roach James , Fier Ian , Kampf Caroline , Göpfert Jens , Perazzo Hugo , Poynard Thierry , Stephens Camilla , Andrade Raúl J. , Lucena M Isabel , Arber Nadir , Uhlén Mathias , Watkins Paul B. , Schwenk Jochen M. , Nilsson Peter , Schuppe‐Koistinen Ina
Published: May 2016

Background & Aims

The occurrence of drug‐induced liver injury (DILI) is a major issue in all phases of drug development. To identify novel biomarker candidates associated with DILI, we utilised an affinity proteomics strategy, where antibody suspension bead arrays were applied to profile plasma and serum samples from human DILI cases and controls.

Methods

An initial screening was performed using 4594 randomly selected antibodies, representing 3450 human proteins. Resulting candidate proteins together with proposed DILI biomarker candidates generated a DILI array of 251 proteins for subsequent target analysis and verifications. In total, 1196 samples from 241 individuals across four independent cohorts were profiled: healthy volunteers receiving acetaminophen, patients with human immunodeficiency virus and/or tuberculosis receiving treatment, DILI cases originating from a wide spectrum of drugs, and healthy volunteers receiving heparins.

Results

We observed elevated levels of cadherin 5, type 2 (CDH5) and fatty acid‐binding protein 1 (FABP1) in DILI cases. In the two longitudinal cohorts, CDH5 was elevated already at baseline. FABP1 was elevated after treatment initiation and seemed to respond more rapidly than alanine aminotransferase (ALT). The elevations were verified in the DILI cases treated with various drugs. In the heparin cohort, CDH5 was stable over time whereas FABP1 was elevated.

Conclusions

These results suggest that CDH5 may have value as a susceptibility marker for DILI. FABP1 was identified as a biomarker candidate with superior characteristics regarding tissue distribution and kinetics compared to ALT but likely with limited predictive value for the development of severe DILI. Further studies are needed to determine the clinical utility of the proposed markers.
Divergent trophic responses to biogeographic and environmental gradients
Authors: Matias Miguel G. , Pereira Cátia Lúcio , Raposeiro Pedro Miguel , Gonçalves Vítor , Cruz Ana Mafalda , Costa Ana Cristina , Araújo Miguel Bastos
Published: May 2016

Following environmental changes, communities disassemble and reassemble in seemingly unpredictable ways. Whether species respond to such changes individualistically or collectively (e.g. as functional groups) is still unclear. To address this question, we used an extensive new dataset for the lake communities in the Azores' archipelago to test whether: 1) individual species respond concordantly within trophic groups; 2) trophic groups respond concordantly to biogeographic and environmental gradients. Spatial concordance in individual species distributions within trophic groups was always greater than expected by chance. In contrast, trophic groups varied non‐concordantly along biogeographic and environmental gradients revealing idiosyncratic responses to them. Whether communities respond individualistically to environmental gradients thus depends on the functional resolution of the data. Our study challenges the view that modelling environmental change effects on biodiversity always requires an individualist approach. Instead, it finds support for the longstanding idea that communities might be modelled as a cohort if the functional resolution is appropriate.
Using triage for environmental remediation in Antarctica
Authors: Raymond Tania C. , Snape Ian
Published: May 2016

Remediation of sites impacted by human activity in Antarctica is a difficult and resource intensive process. With increasing activity and climate change, the extent of damage from human activities is expected to increase and it will not be feasible to protect the environment entirely. We recommend a triage process be used to provide informed and transparent management decisions for comprehensive and adequate environmental remediation in Antarctica. We provide examples that demonstrate realistic outcomes where we have avoided tying up resources on disturbed sites that will recover naturally, are stable, or too damaged to recover, and that also incorporate feasible operational practices. Not all disturbed sites will be remediated and many of those that are, are unlikely to be returned to pristine condition. The decisions around remediation are not based solely on the desired environmental outcome. In the absence of effective legal obligation, we recognize that financial, social, policy, health and safety, technological confidence, and operational feasibility are part of the decision‐making process.
Aspects of Authentic Spoken German: Awareness and Recognition of Elision in the German Classroom
Authors: Lightfoot Douglas
Published: May 2016

This work discusses the importance of spoken German in classroom instruction. The paper examines the nature of natural spoken language as opposed to written language. We find a general consensus that the prevailing language measure (whether pertaining to written or spoken language) in instructional settings more often typifies the rules associated with a written variety to the relative exclusion of norms associated with natural spoken language. A discussion of authentic spoken language and pragmatics in the classroom follows. The principle linguistic notion examined is elision (dropping certain sounds), but we also look at assimilation (sounds becoming more alike) due to its high frequency of occurrence with elision. The article then presents suggestions for classroom instruction on awareness and recognition of spoken language, along with the contexts in which spoken language occurs.
Cultivating Early Trajectories of Participation A Blended Learning Environment for Business German
Authors: Neville David O.
Published: May 2016

The essay forwards suggestions for developing a blended learning environment to insert genre‐based language for specific purposes (LSP) subject matter into the undergraduate second language development curriculum. Specifically, the essay will highlight: (1) the development of an overarching narrative for structuring the LSP subject matter; (2) the formulation of performance objectives for the modules that will deliver the subject matter; (3) the development of a learning strategy for the modules, including their alignment with the existing program curriculum and the use of bimonthly face‐to‐face labs; and (4) the development and implementation of instructional materials, including the creation of study aids and open educational digital resources.
Progressive multifocal leukoencephalopathy after liver transplantation can have favorable or unfavorable outcome
Authors: Dumortier J. , Guillaud O. , Bosch A. , Coppéré B. , Petiot P. , Roggerone S. , Vukusic S. , Boillot O.
Published: May 2016

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC polyomavirus (JCPyV) in immunocompromised patients, including solid organ transplant recipients. We report 2 cases of PML late after liver transplantation (144 and 204 months) and review the few other published cases. The clinical course of PML is characterized by a rapid progressive neurological decline coinciding with the presence of white matter lesions on magnetic resonance images. No direct antiviral therapy is available against the JCPyV. The prognosis is therefore extremely poor. Restoration of the immune response achieved by tapering or ending the immunosuppressive therapy is the basis of treatment in transplanted patients. One of our patients is alive 3 years after diagnosis after total withdrawal of immunosuppressive therapy. The other presented severe rejection when tapering immunosuppression and died 26 months after diagnosis.
Effect of deploying community health assistants on appropriate treatment for diarrhoea, malaria and pneumonia: quasi‐experimental study in two districts of Zambia
Authors: Biemba Godfrey , Yeboah‐Antwi Kojo , Vosburg Kathryn Bradford , Prust Margaret L. , Keller Brett , Worku Yekoyesew , Zulu Happy , White Emily , Hamer Davidson H.
Published: May 2016

Objective

A critical shortage of human resources for health in Zambia remains a great challenge. In response, the Zambian Ministry of Health developed a national community health assistant (CHA) programme, aiming to create a well‐trained and motivated community‐based health workforce. This study assessed whether CHAs increased treatment rates for diarrhoea, confirmed malaria or pneumonia in the first programme year.

Methods

This study used a quasi‐experimental difference‐in‐difference design, comparing changes in the catchment areas of health posts with CHAs to those without. Baseline and end line household surveys were conducted to measure the proportion of children under 5 years treated for diarrhoea, malaria or pneumonia in the 2 weeks before the survey and immunisation rates and malaria rapid diagnostic test rates.

Results

We surveyed 2330 women with children under five from the intervention area and 2314 from comparison areas at baseline and end line. Treatment for diarrhoea, malaria or pneumonia increased by 18.0% (P < 0.01) and 23.5% (P < 0.01) in the intervention and comparison groups, respectively, but DID analysis was not significant (P = 0.27). The proportion of fully immunised children grew by 7.5% in the intervention, but shrank by 7.5% in the comparison group (DID: 0.14; 95% CI 0.12–0.16, P < 0.01).

Conclusion

Although we observed no significant difference between the intervention and comparison groups in the DID estimates for the primary outcome, there were significant increases after one year in treatment for all three diseases in the intervention group from baseline to end line and in the proportion of fully immunised children.
Listeria monocytogenes septicemia in an immunocompromised dog
Authors: Pritchard Jessica C. , Jacob Megan E. , Ward Todd J. , Parsons Cameron T. , Kathariou Sophia , Wood Michael W.
Published: May 2016

An 11‐year‐old, male castrated, Boston Terrier was presented to the North Carolina State University College of Veterinary Medicine Small Animal Emergency Service with a 2‐day history of progressive ataxia, left‐sided head tilt, and anorexia. The dog had previously been diagnosed with chronic lymphoid leukemia and suspected immune‐mediated destruction of his bone marrow precursor cells, possibly due to therapy with immunosuppressive dosages of prednisone and azathioprine. During the physical examination, abnormal findings included an increased body temperature and horizontal nystagmus. Diagnostic investigations included a computed tomography (CT) scan, which confirmed bilateral otitis media, and a blood culture, which was positive for Listeria monocytogenes serotype 4b (epidemic clone 1). Upon treatment with ampicillin/sulbactam, enrofloxacin, and minocycline, the dog became normothermic and the neurologic signs improved. L monocytogenes serotype 4b (epidemic clone 1) has been associated with outbreaks of human listeriosis originating from food contamination. Although rare case reports of Listeria spp. infection in dogs exist, an actual infection with the epidemic clone 1 strain has never before been reported in a dog. It should be included in the differential diagnoses in immunocompromised dogs with clinical signs of septicemia.
Workplace Democracy and Civic Engagement in Vermont Food Cooperatives
Authors: Reuge Cecile , Mares Teresa
Published: May 2016

This article argues that the efforts of worker‐run governance bodies are integral for securing worker citizenship at consumer cooperatives; however, are not immune to challenges associated with forging worker solidarity across racial and ethnic lines. Using a mixed methods approach that includes focus groups, individual interviews, and textual and policy analyses, this study looks at the impact of unions on the social, political, and civil rights of workers in two unionized food cooperatives in Vermont. It was concluded that unions provided critical opportunities for civic engagement and workplace democracy although more work was needed in the area of inclusion.
Load Sharing Among Collateral Ligaments, Articular Surfaces, and the Tibial Post in Constrained Condylar Knee Arthroplasty
Authors: Wang Xiaonan , Malik Aamer , Bartel Donald L. , Wright Timothy M. , Padgett Douglas E.
Published: May 2016

The normal knee joint maintains stable motion during activities of daily living. After total knee arthroplasty (TKA), stability is achieved by the conformity of the bearing surfaces of the implant components, ligaments, and constraint structures incorporated in the implant design. The large, rectangular tibial post in constrained condylar knee (CCK) arthroplasty, often used in revision surgery, provides added stability, but increases susceptibility to polyethylene wear as it contacts the intercondylar box on the femoral component. We examined coronal plane stability to understand the relative contributions of the mechanisms that act to stabilize the CCK knee under varus–valgus loading, namely, load distribution between the medial and lateral condyles, contact of the tibial post with the femoral intercondylar box, and elongation of the collateral ligaments. A robot testing system was used to determine the joint stability in human cadaveric knees as described by the moment versus angular rotation behavior under varus–valgus moments at 0 deg, 30 deg, and 90 deg of flexion. The angular rotation of the CCK knee in response to the physiological moments was limited to ≤1.5 deg. The primary stabilizing mechanism was the redistribution of the contact force on the bearing surfaces. Contact between the tibial post and the femoral box provided a secondary stabilizing mechanism after lift-off of a condyle had occurred. Collateral ligaments provide limited stability because little ligament elongation occurred under such small angular rotations. Compressive loads applied across the knee joint, such as would occur with the application of muscle forces, enhanced the ability of the bearing surfaces to provide resisting internal varus–valgus moment and, thus, reduced the exposure of the tibial post to the external varus–valgus loads. Our results suggest that the CCK stability can be refined by considering both the geometry of the bearing surfaces and the contacting geometry between the tibial post and femoral box.
A Study on Friction Stir Welding of Dissimilar Thin Sheets of Aluminum Alloys AA 5052–AA 6061
Authors: Doley Jyoti K. , Kore Sachin D.
Published: May 2016

Friction stir welding (FSW) of AA 5052 H32 to AA 6061 T6 blanks was obtained for each thicknesses of 1 mm and 1.5 mm. Successful welds were obtained at constant tool spindle speed of 1500 rpm and two tool traverse speeds of 63 mm/min and 98 mm/min. For both thicknesses, weld produced at 63 mm/min speed gives more ductility than the weld produced at 98 mm/min. Elongation prior failure of 1.5 mm thick tailor welded blank (TWB) was found to be 47% more than that of 1 mm thickness weld. Microhardness measurement of the dissimilar welds showed lower values at heat-affected zones (HAZ) on both the sides of weld line, whereas lowest hardness value was obtained at HAZ of AA 5052. Optical microscope and energy dispersive spectroscopy (EDS) analyses on the stir zone (SZ) suggest dynamic recrystallization and finer grain size with uniform mixing at the center of SZ. Intermetallic compounds are formed during welding which plays detrimental role in the fracture strength of the joint.
Integral Modeling of a Twin-Screw Compressor
Authors: Van Erdeweghe Sarah , De Schutter Joris , Van den Bulck Eric
Published: May 2016

In this paper, an integral methodology for the modeling of a twin-screw compressor is presented. Starting from a known rotor profile, all the algorithms to calculate the second rotor profile, the size of the control volume, and the compressor's performance are presented. The proposed modeling approach can be applied in an optimization procedure to find the optimal rotor profiles for a given application, with corresponding working conditions. Furthermore, based on the modeling results and substantiated with measurements on different compressor types, a similarity law for positive displacement compressors seems to exist. The existence of a similarity law has large application potential as it could be used to predict the performance of a positive displacement compressor in other than the (lab) tested working conditions. Further investigation of the similarity law for positive displacement compressors is therefore proposed as a key topic for future research.
Electrical and optical properties of SrTiO3 nanopowders: Effect of different dopants Ba and Ag
Authors: Ghasemifard Mahdi , Ghamari Misagh , Iziy Meysam
Published: May 2016

Using strontium–titanium salts precursor, nanopowders (STO-based-NPs) were successfully synthesized by controlled gel-combustion method. Citric and nitric acids in an optimum ratio were used as the fuel and oxidizer agents, respectively. After heat treatment at 850[Formula: see text]C, the crystalline structure of the products was investigated by X-ray diffraction. The effects of Ba and Ag dopants on particle size distribution were discussed by transmission electron microscopy (TEM). The optical and dielectric parameters such as energy band gap [Formula: see text], real and imaginary parts of refractive index, dielectric function and energy loss function of nanopowders have been investigated by UV–Vis and FTIR spectra. The band gap of SrTiO3 increased with increasing Ba, Ag and Ba–Ag. Different atomic radii of dopants are responsible for changing optical and dielectric parameters due to the altered orbital configuration of the lattice structure.
EFFECTS OF FOOTWEAR VARIATIONS ON THREE-DIMENSIONAL KINEMATICS AND TIBIAL ACCELERATIONS OF SPECIFIC MOVEMENTS IN AMERICAN FOOTBALL
Authors: SINCLAIR J , ROONEY E , NAEMI R , ATKINS S , CHOCKALINGAM N
Published: May 2016

American football is associated with a high rate of non-contact chronic injuries. Players are able to select from both high and low cut footwear. The aim of the current investigation was to examine the influence of high and low cut American football specific footwear on tibial accelerations and three-dimensional (3D) kinematics during three sport specific movements. Twelve male American football players performed three movements, run, cut and vertical jump whilst wearing both low and high cut footwear. 3D kinematics of the lower extremities were measured using an eight-camera motion analysis system alongside tibial acceleration parameters which were obtained using a shank mounted accelerometer. Tibial acceleration and 3D kinematic differences between the different footwear were examined using either repeated measures or Friedman’s ANOVA. Tibial accelerations were significantly greater in the low cut footwear in comparison to the high cut footwear for the run and cut movements. In addition, peak ankle eversion and tibial internal rotation parameters were shown to be significantly greater in the low cut footwear in the running and cutting movement conditions. The current study indicates that the utilization of low cut American football footwear for training/performance may place American footballers at increased risk from chronic injuries.
Synthesis and Characterization of Chloridobis(dimethylglyoximato)4-(2-ferrocenylvinyl)pyridinecobalt(III): A New Heterobinuclear Cobaloxime
Authors: Pizarro Sebastián , Saá Guillermo , Gajardo Francisco , Delgadillo Alvaro
Published: May 2016

The synthesis of a new heterobinuclear cobaloxime with 4-(2-ferrocenylvinyl)pyridine, fcvpy, is reported. The complex [CoCl(dmgH)2(fcvpy)], where dmgH2is dimethylglyoxime and dmgH is dimethylglyoximato, has been characterized by1H-NMR, UV-Vis, cyclic voltammetry, and elemental analysis. The cyclic voltammogram of this complex shows a fc/fc+reversible wave at +0.58 V versus Ag/AgCl, one irreversible wave,Epc= −0.54 V versus Ag/AgCl, assigned to the reduction of Co(III) to Co(II), and two quasireversible processes at −1.02 V and −1.10 V versus Ag/AgCl associated with the reduction of Co(II). The complex showed ferrocene-ligand charge transfer bands at 334 nm and 505 nm. TDDFT/B3LYP/6-31G(d) calculations support this assignation.
A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System
Authors: Almalki Mohammad , Al-Tawayjri Ibrahim , Al-Anazi Ahmed , Mahmoud Sami , Al-Mohrej Ahmad
Published: May 2016

Introduction. Illness anxiety disorder (IAD) entails a preoccupation with having a serious, undiagnosed illness in which somatic symptoms are, if present, mild in intensity (American Psychiatric Association, 2013).Case Report. This is a case of seventy-three-year-old Saudi man who started visiting the primary health care center around twenty-five years ago. With concerns of having cancer, the patient continuously visited the hospital, costing over $170,000. Throughout this period, the patient has been exposed to extensive unnecessary imaging studies and laboratory tests that have effects on his life in all aspects with such concerns. Five years ago, a family doctor has put an end to that by directing the patient to the right path. The doctor made several actions; most importantly, he directed the patient to a cognitive behavioral therapy which significantly improved a range of hypochondriacal beliefs and attitudes. This patient’s case demonstrates the fundamental importance of a proper health system that limits such patients from abusing the health system and depleting the medical resources. Moreover, this case emphasizes the important role of the family physician who can be the first physician to encounter such patients. Thus, proper understanding of the nature of such disorder is a key element for better diagnosis and management.
Short-Spindled Cell Haemangioblastoma with CD34 Expression: New Histopathological Variant or Just a Stochastic Cytological Singularity?
Authors: Salazar Miguel Fdo. , Escalante Abril Paola Andrea , Velasco Vales María Verónica , Martínez Ruiz Celene , Gómez Apo Erick , Chávez Macías Laura G.
Published: May 2016

Haemangioblastomas are neoplasms of uncertain histogenesis with cellular and reticular variants advocated in current lore. Herein we describe an intriguing cerebellar specimen with unusual traits including spindle cell morphology and CD34 positivity. A thirty-nine-year old man had an infratentorial tumour discovered incidentally and resected three times. In all the instances, histopathological diagnosis was haemangioblastoma; nonetheless, he had neither physical stigmata nor family history of von Hippel-Lindau disease. By histology, the lesion was composed of areas of conventional stromal cells admixed with territories populated by short-spindled cells packed in lobules, sometimes giving the appearance ofgomitoli. Immunoperoxidase-coupled reactions confirmed the expression of inhibin A, neuron-specific enolase (NSE), PS100, and CD57 but also revealed focal immunolabeling for CD34, CD99, and FXIIIa. This case highlights the potential phenotypical diversity that can be found within these neoplasms. Rather than uncertain histogenesis, it may in fact reflect multiple lines of differentiation—histomimesis—prone to adopt unusual morpho- and immunophenotypes in a subset of haemangioblastomas.
Shock Wave Speed and Transient Response of PE Pipe with Steel-Mesh Reinforcement
Authors: Wan Wuyi , Mao Xinwei
Published: May 2016

A steel mesh can improve the tensile strength and stability of a polyethylene (PE) pipe in a water supply pipeline system. However, it can also cause more severe water hammer hazard due to increasing wave speed. In order to analyze the influence of the steel mesh on the shock wave speed and transient response processes, an improved wave speed formula is proposed by incorporating the equivalent elastic modulus. A field measurement validates the wave speed formula. Moreover, the transient wave propagation and extreme pressures are simulated and compared by the method of characteristics (MOC) for reinforced PE pipes with various steel-mesh densities. Results show that a steel mesh can significantly increase the shock wave speed in a PE pipe and thus can cause severe peak pressure and hydraulic surges in a water supply pipeline system. The proposed wave speed formula can more reasonably evaluate the wave speed and improve the transient simulation of steel-mesh-reinforced PE pipes.
Ulam-Hyers Stability for MKC Mappings via Fixed Point Theory
Authors: Hassan Anisa Mukhtar , Karapınar Erdal , Alsulami Hamed H.
Published: May 2016

We consider some extension of MKC mappings in the framework of complete dislocated metric spaces. Besides the theoretical results, we also consider some illustrative examples. Further, we state and prove that our main results improved the related results in the frame of generalized Ulam-Hyers stability theory.
Biomarker Analyses of Clinical Outcomes in Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib with or without Erlotinib in the SEARCH Trial
Authors: Zhu Andrew X. , Kang Yoon-Koo , Rosmorduc Olivier , Evans T.R. Jeffry , Santoro Armando , Ross Paul , Gane Edward , Vogel Arndt , Jeffers Michael , Meinhardt Gerold , Peña Carol E.A.
Published: May 2016

Purpose: Sorafenib is the current standard therapy for advanced hepatocellular carcinoma, but validated biomarkers predicting clinical outcomes are lacking. This study aimed to identify biomarkers predicting prognosis and/or response to sorafenib, with or without erlotinib, in hepatocellular carcinoma patients from the phase III SEARCH trial.

Experimental Design: A total of 720 patients were randomized to receive oral sorafenib 400 mg twice daily plus erlotinib 150 mg once daily or placebo. Fifteen growth factors relevant to the treatment regimen and/or to hepatocellular carcinoma were measured in baseline plasma samples.

Results: Baseline plasma biomarkers were measured in 494 (69%) patients (sorafenib plus erlotinib, n = 243; sorafenib plus placebo, n = 251). Treatment arm–independent analyses showed that elevated hepatocyte growth factor [HGF; HR, 1.687 (high vs. low expression); endpoint multiplicity adjusted (e-adj) P = 0.0001] and elevated plasma VEGFA (HR, 1.386; e-adj P = 0.0377) were significantly associated with poor overall survival (OS) in multivariate analyses, and low plasma KIT [HR, 0.75 (high vs. low); P = 0.0233; e-adj P = 0.2793] tended to correlate with poorer OS. High plasma VEGFC independently correlated with longer TTP (HR, 0.633; e-adj P = 0.0010) and trended toward associating with improved disease control rate (univariate: OR, 2.047; P = 0.030; e-adj P = 0.420). In 67% of evaluable patients (339/494), a multimarker signature of HGF, VEGFA, KIT, EPGN, and VEGFC correlated with improved median OS in multivariate analysis (HR, 0.150; P < 0.00001). No biomarker predicted efficacy from erlotinib.

Conclusions: Baseline plasma HGF, VEGFA, KIT, and VEGFC correlated with clinical outcomes in hepatocellular carcinoma patients treated with sorafenib with or without erlotinib. These biomarkers plus EPGN constituted a multimarker signature for improved OS. Clin Cancer Res; 22(19); 4870–9. ©2016 AACR.
Protection against HPV-16–Associated Tumors Requires the Activation of CD8+ Effector Memory T Cells and the Control of Myeloid-Derived Suppressor Cells
Authors: Diniz Mariana O. , Sales Natiely S. , Silva Jamile R. , Ferreira Luís Carlos S.
Published: May 2016

Active anticancer immunotherapeutic approaches have been shown to induce cellular or humoral immune responses in patients, but, thus far, the observed outcomes did not ensure their recommendation for clinical use. The induction of tumor-specific CD8+ T cells, although required for the clearance of most solid tumors, was shown to be insufficient for the development of a successful immunotherapeutic approach. The suppressive immune environment triggered by tumors, including the expansion of myeloid-derived suppressor cells (MDSC), is detrimental to the development of antitumor immune responses and precludes the generation of more promising clinical outcomes. In this work, we characterized the CD8+ T-cell population specifically involved in the control of tumor growth and the role of MDSCs after administration of an antitumor therapeutic DNA vaccine targeting human papillomavirus type 16 (HPV-16)-associated tumors. Activation of cytotoxic high-avidity CD8+ T cells with an effector memory phenotype was found in mice grafted with tumor cells expressing the HPV-16 oncoproteins. In addition, MDSC antibody depletion further enhanced the immunotherapeutic effects of the vaccine, resulting in the complete eradication of tumor cells. Collectively, the current results indicate that the simultaneous control of MDSCs and activation of high-avidity tumor-specific effector memory CD8+ T cells are key features for tumor protection by immunotherapeutic approaches and deserve further testing under clinical conditions. Mol Cancer Ther; 15(8); 1920–30. ©2016 AACR.
Adipose-Derived Stromal Cells from Lipomas: Isolation, Characterisation and Review of the Literature
Authors: Tremp Mathias , Menzi Nadia , Tchang Laurent , di Summa Pietro G. , Schaefer Dirk J. , Kalbermatten Daniel F.
Published: May 2016

Objective: The aim of this study was to characterize adipose-derived stromal cells (ADSCs) from patients diagnosed with multiple symmetric lipomatosis (MSL) in order to obtain potentially new insights into the pathophysiology, pathogenesis and treatment of this disease. Methods: Cells from the stromal vascular fraction were analysed by the colony-forming efficiency assay and flow cytometry using standard markers. Moreover, the power of adipogenic plasticity was evaluated. Finally, a literature review was performed from 1982 to 2015 using the US National Institutes of Health's PubMed database. Results: Three European-descent patients diagnosed with either MSL type I or II could be identified for analysis. The resulting mean colony-forming efficiency assay was 14.3 ± 5%. Flow-cytometric analysis of the ADSCs revealed high levels of CD34 (70 ± 9%), CD45 (37 ± 13%) and CD73 (55.8 ± 14%), whereas low levels of CD31 (16.8 ± 14%) and CD105 (5.8 ± 0.7%) were detected. Furthermore, ADSCs showed a strong adipogenic potential, which is in line with the literature review. The stem cell pool in lipoma shows several alterations in biological activities, such as proliferation, apoptosis and stemness. Conclusions: ADSCs from lipoma may be interesting in the application of regenerative medicine. We discuss possible molecular treatment options to regulate their activities at the source of the MSL.
Urine Ethyl Glucuronide Unraveling the Reality of Abstinence Monitoring in a Routine Outpatient Setting: A Cross-Sectional Comparison with Ethanol, Self Report and Clinical Judgment
Authors: Barrio Pablo , Teixidor Lidia , Rico Naira , Bruguera Pol , Ortega Lluisa , Bedini José Luis , Gual Antoni
Published: May 2016

Aims: To test the screening performance of urinary ethyl glucuronide (EtG) under routine clinical conditions in a sample of alcohol-dependent outpatients, comparing it against urinary ethanol, self reports and clinical judgment. Methods: A cross-sectional study under routine conditions was conducted in February 2015, where 613 consecutive urinary samples, provided by 188 outpatients with alcohol use disorders, were analyzed for ethanol and EtG (cut-off level = 500 ng/ml). Clinical variables such as the presence of aversive medication, comorbidities and clinician judgment were also collected. The discrepancy between the number of alcohol and EtG positives was recorded. A logistic regression analysis including clinical variables was conducted to assess for predictors of EtG positivity. Results: Urinary alcohol yielded 9 positives (1.5% of all urine samples) belonging to 8 patients. EtG yielded 136 positives (22% of all urine samples) belonging to 74 patients. Of these, 93.4% (127 of 136) were negative for alcohol. All urinary alcohol positives resulted in EtG positives. The clinician judged 48 samples from 26 patients as belonging to not abstinent patients and 550 samples from 178 patients as belonging to abstinent patients. She was unsure in 15 samples from 15 patients. When comparing it against EtG as the gold standard, the area under the curve was 0.592. Self reports were extremely unreliable in this study, with only 5 patients reporting drinking in a total of 6 urine samples. In the logistic regression model, only aversive medications (OR 2.1, 95% CI 1.3-3.3) and clinician judgment (OR 2, 95% CI 1.4-2.9) resulted in significant effects. Conclusions: EtG performed largely better than ethanol for urine screening in alcohol outpatients, detecting an extra 20.4% (125 out of 613) of positives. It means that for each alcohol-positive sample, there were 15 EtG-positive samples. Although better than ethanol, clinician judgment was also not performed efficiently. If routinely implemented in the screening of alcohol outpatients, EtG might bring relevant changes that merit further research.
Immunohistochemical Expression and Serum Levels of CD44 as Prognostic Indicators in Patients with Non-Small Cell Lung Cancer
Authors: Shinohara Shinji , Hanagiri Takeshi , Taira Akihiro , Takenaka Masaru , Oka Soichi , Chikaishi Yasuhiro , Uramoto Hidetaka , So Tomoko , Yamada Sohsuke , Tanaka Fumihiro
Published: May 2016

Background/Objectives: CD44 is often expressed in various types of tumor cells and involved in a number of biological behaviors of malignancy. The present study focused on the clinical significance of the expression of CD44st and CD44v6 in non-small cell lung cancer (NSCLC). Methods: The cohort consisted of 261 consecutive patients who had undergone complete resection of NSCLC. CD44 expression was evaluated in surgical specimens by immunohistochemical staining. Serum CD44 levels were determined using a sandwich ELISA (enzyme-linked immunosorbent assay). Results: In the immunohistochemical analysis, significant correlations were observed between CD44 expression and clinicopathological factors such as the T factor, N factor, pathological stage, and histological type. The 5-year survival rates according to CD44v6 expression were 65.8 and 80.6% in the higher and lower expression groups, respectively (p = 0.0053). According to ELISA, the group with higher expression of serum CD44v6 also showed a significantly more unfavorable prognosis than the lower expression group (p = 0.014). According to multivariate analysis using these significant variables, serum CD44v6 level was found to be an independent prognostic factor (p = 0.048). Conclusions: CD44v6 overexpression and higher serum CD44v6 levels were found to be significantly unfavorable prognostic factors.
Fecal Human Neutrophil Peptide Levels Correlate with Intestinal Inflammation in Ulcerative Colitis
Authors: Kanmura Shuji , Hamamoto Hitomi , Morinaga Yuko , Oda Kohei , Fujita Toshihiro , Arima Shiho , Nasu Yuichiro , Sasaki Fumisato , Hashimoto Shinichi , Taguchi Hiroki , Setoyama Hitoshi , Ido Akio
Published: May 2016

Background/Aim: Fecal markers have recently been found to provide convenient and noninvasive assessment of intestinal inflammation in inflammatory bowel disease (IBD). In this study, we examined the clinical significance of fecal human neutrophil peptides (F-HNP) in the evaluation of IBD disease activity. Methods: This study enrolled 70 patients with IBD, consisting of 45 patients with ulcerative colitis (UC), 25 patients with Crohn's disease (CD), and 11 non-IBD controls. Stools samples were evaluated for the association between F-HNP concentration and disease and endoscopic activity in each group and the correlation between F-HNP and fecal calprotectin (F-CP) concentrations. Results: Median F-HNP levels were as follows: UC: 25.6 ng/ml; CD: 20.1 ng/ml; and non-IBD controls: 4.9 ng/ml. F-HNP levels were significantly higher in each IBD group, especially in the UC group, than in the control group. In the UC group, both F-HNP and F-CP levels were significantly higher during active disease compared to the remission phase. Both markers were significantly correlated with the Mayo endoscopic score, although the correlation was stronger for F-HNP than for F-CP (r = 0.66 vs. r = 0.54). Conclusion: F-HNP is a noninvasive marker that is useful for evaluating UC endoscopic activity.
Clinical Characteristics of Overhydration in Patients with Idiopathic Edema
Authors: Ham Young Rok , Kim Hae Ri , Jeon Hong Jae , Kim Yoo Hyung , Jeon Jae Woong , Chung Sarah , Choi Dae Eun , Na Ki Ryang , Lee Kang Wook
Published: May 2016

Background: Idiopathic edema (IE) is a common clinical syndrome. Designing treatment plans for IE is problematic because of the difficulty in assessing volume status. We aimed to evaluate volume status, measured by bioimpedance spectroscopy (BIS), and investigated clinical parameters associated with volume overload (VO) in patients with IE. Methods: Patients with IE were defined as those with symptomatic edema and without abnormal renal function or any other apparent cause of edema. A total of 124 patients were included. Overhydration (OH) and extracellular water (ECW) were calculated using BIS. Relative hydration status (ΔHS) was defined as OH/ECW. Patients were classified into 2 groups: overhydrated group (OG; ΔHS ≥7%) and non-OG (NOG; ΔHS <7). Simple and multiple logistic regression analyses were used to assess the influence of several variables on the incidence of VO. Results: Of 124 patients, 37 (29.8%) were in the OG. The proportion of men in the OG was higher than that in the NOG (p = 0.020). Patients in the OG showed more frequent pretibial pitting edema (PTPE, p < 0.001) and had lower hemoglobin (p = 0.008) and serum albumin levels (p < 0.001). The multivariate analysis showed that the presence of PTPE (OR 10.62, 95% CI 1.98-57.1), low serum albumin level (OR 0.01, 95% CI 0.00-0.25) and lower fat tissue index (OR 0.78, 95% CI 0.63-0.97) were independent risk factors for the presence of VO. Conclusions: BIS helps to identify volume status and body composition in patients with IE.
Potassium: From Physiology to Clinical Implications
Authors: Zacchia Miriam , Abategiovanni Maria Luisa , Stratigis Spiros , Capasso Giovambattista
Published: May 2016

Background: Potassium (K+) is the major intracellular cation, with 98% of the total pool being located in the cells at a concentration of 140-150 mmol/l, and only 2% in the extracellular fluid, where it ranges between 3.5 and 5 mmol/l. A fine regulation of the intracellular-extracellular gradient is crucial for life, as it is the main determinant of membrane voltage; in fact, acute changes of K+ plasma levels may have fatal consequences. Summary: An integrated system including an ‘internal' and ‘external' control prevents significant fluctuations of plasma levels in conditions of K+ loading and depletion. The internal control regulates the intra-extracellular shift, a temporary mechanism able to maintain a constant K+ plasma concentration without changing the total amount of body K+. The external control is responsible for the excretion of the ingested K+, and it has the kidney as the major player. The kidney excretes nearly 90% of the daily intake. Along the proximal tubule and the thick ascending limb on Henle's loop, the amount of K+ reabsorption is quite fixed (about 80-90%); conversely, the distal nephron has the ability to adjust K+ excretion in accordance with homeostatic needs. The present review analyzes: (1) the main molecular mechanisms mediating K+ reabsorption and secretion along the nephron; (2) the pathophysiology of the principal K+ derangements due to renal dysfunction, and (3) the effect of ingested K+ on blood pressure and renal electrolyte handling. Key Messages: Maintaining plasma K+ levels in a tight range is crucial for life; thus, multiple factors are implicated in K+ homeostasis, including kidney function. Recent studies have suggested that K+ plasma levels, in turn, affect renal salt absorption in animal models; this effect may underlie the reduction of blood pressure observed in hypertensive subjects under K+ supplementation.