bluuebunny/crossref_metadata_2025 huggingface dataset:
Podoplanin expression in oral leukoplakia: prognostic value and clinicopathological implications
Authors: Kreppel M , Kreppel B , Drebber U , Wedemayer I , Rothamel D , Zöller JE , Scheer M
Published: March 2012

Oral Diseases(2012)18, 692–699

Objectives: Current clinicopathological parameters cannot predict the risk of malignant transformation in oral leukoplakia sufficiently. Recent studies have shown that podoplanin is expressed in oral cancer and precancerous lesions. The aim of our study was to assess whether podoplanin expression in pretreatment biopsies could serve as a biomarker to predict the risk of malignant transformation in patients with oral leukoplakia.

Materials and Methods: In this retrospective study, podoplanin expression was analysed in 60 patients with previously untreated oral leukoplakia by immunohistochemistry. We investigated the associations between podoplanin expression and various clinicopathological variables including oral cancer‐free survival (OCFS) and the SIN‐classification.

Results: The chi‐square‐test revealed that high expression of podoplanin in pretreatment biopsies was associated with malignant transformation (P = 0.003) and increasing SIN‐classification (P = 0.009). In univariate analysis, podoplanin expression in oral leukoplakia had a significant impact on OCFS (P = 0.009). The 5‐year OCFS rate decreased from 100% for patients with no podoplanin expression to 41.7% for patients with the highest level of podoplanin expression.

Conclusion: Although podoplanin expression and the SIN‐classification served as factors to predict malignant transformation in patients with oral leukoplakia in univariate analysis, no significant impact was found for both factors in multivariate analysis.
Plasma Separation by Centrifugation and Subsequent Plasma Filtration: Impact on Survival in a Pig Model of Sepsis
Authors: Sauer Martin , Altrichter Jens , Mencke Thomas , Klöhr Sven , Thomsen Maren , Kreutzer Hans J. , Nöldge‐Schomburg Gabriele , Mitzner Steffen R.
Published: March 2012

The impact on survival of a combination of plasma separation by centrifugation and subsequent plasma filtration was tested in a bacterial sepsis model in pigs. In this animal study 19 pigs were included. Groups II and III received an intravenous lethal dose of live Staphylococcus aureus over 1 h; group I received saline (non‐septic control—NC). Groups I and II were treated by an extracorporeal circuit consisting of online centrifugation and subsequent plasma filtration (group II: treated group—TG) for 4 h; group III had no specific treatment (septic control, SC). The observation time was 7 days. All animals of group I (NC) and group II (TG) survived, while all animals of group III (SC) died during the observation time. Extracorporeal therapy with online centrifugation and plasma filtration significantly improved survival in a pig model of sepsis. Further studies with this approach are encouraged.
Ubiquitous equatorial accretion disc winds in black hole soft states
Authors: Ponti G. , Fender R. P. , Begelman M. C. , Dunn R. J. H. , Neilsen J. , Coriat M.
Published: March 2012

High-resolution spectra of Galactic black holes (GBHs) reveal the presence of highly ionized absorbers. In one GBH, accreting close to the Eddington limit for more than a decade, a powerful accretion disc wind is observed to be present in softer X-ray states and it has been suggested that it can carry away enough mass and energy to quench the radio jet. Here we report that these winds, which may have mass outflow rates of the order of the inner accretion rate or higher, are a ubiquitous component of the jet-free soft states of all GBHs. We furthermore demonstrate that these winds have an equatorial geometry with opening angles of few tens of degrees, and so are only observed in sources in which the disc is inclined at a large angle to the line of sight. The decrease in Fe xxv/Fe xxvi line ratio with Compton temperature, observed in the soft state, suggests a link between higher wind ionization and harder spectral shapes. Although the physical interaction between the wind, accretion flow and jet is still not fully understood, the mass flux and power of these winds and their presence ubiquitously during the soft X-ray states suggest they are fundamental components of the accretion phenomenon.
Return to Play Guidelines Cannot Solve the Football‐Related Concussion Problem
Authors: Johnson L. Syd M.
Published: March 2012

BACKGROUND: High school football players are the single largest cohort of athletes playing tackle football, and account for the majority of sport‐related concussions. Return to play guidelines (RTPs) have emerged as the preferred approach for addressing the problem of sport‐related concussion in youth athletes.

METHODS: This article reviews evidence of the risks and effects of football‐related concussion and subconcussive brain trauma, as well as the effectiveness of RTPs as a preventative measure. Literature review utilized PubMed and Google Scholar, using combinations of the search terms “football,”“sports,”“concussion,”“Chronic Traumatic Encephalopathy,”“athlete,”“youth,” and “pediatric.” Literature review emphasized medical journals and primary neuroscientific research on sport‐related concussion and concussion recovery, particularly in youth athletes.

RESULTS: Sport‐related concussion is a significant problem among student athletes. Student athletes are more vulnerable to concussion, and at risk of neurocognitive deficits lasting a year or more, with serious effects on academic and athletic performance. RTPs do little to address the problem of sport‐related concussion or the chronic damage caused by subconcussive brain trauma.

CONCLUSIONS: Emphasizing RTPs as the solution to the concussion problem in tackle football risks neglecting genuine reforms that would prevent concussions. More effective concussion prevention is needed. Eliminating tackling from school football for youth under 16 is recommended to reduce concussions. Additional modifications to football are recommended to enhance safety and reduce brain trauma at all levels of play.
Dietary hyperthyroidism in dogs
Authors: Köhler B. , Stengel C. , Neiger R.
Published: March 2012

Objectives:Evaluation of dogs with elevated plasma thyroxine concentration fed raw food before and after changing the diet.

Method:Between 2006 and 2011 all dogs presented with an elevated plasma thyroxine concentration and a dietary history of feeding raw food were included. Thyroxine (reference interval: 19·3 to 51·5 nmol/L) and in many cases also thyroid‐stimulating hormone concentrations (reference interval: <0·30 ng/mL) were measured initially and after changing the diet.

Results:Twelve dogs were presented with a median age of five years. The median plasma thyroxine concentration was 156·1 (range of 79·7 to 391·9) nmol/L; in six dogs, thyroid‐stimulating hormone concentration was measured and was <0·03 ng/mL in five dogs and 0·05 ng/mL in one dog. Six dogs showed clinical signs such as weight loss, aggressiveness, tachycardia, panting and restlessness while six dogs had no clinical signs. After changing the diet eight dogs were examined: thyroxine concentration normalised in all dogs and clinical signs resolved.

ClinicalSignificance:Dietary hyperthyroidism can be seen in dogs on a raw meat diet or fed fresh or dried gullets. Increased plasma thyroxine concentration in a dog, either with or without signs of hyperthyroidism, should prompt the veterinarian to obtain a thorough dietary history.
Determination of Absolute Threshold and Just Noticeable Difference in the Sensory Perception of Pungency
Authors: Orellana‐Escobedo L. , Ornelas‐Paz J.J. , Olivas G.I. , Guerrero‐Beltran J.A. , Jimenez‐Castro J. , Sepulveda D.R.
Published: March 2012

Abstract:  Absolute threshold and just noticeable difference (JND) were determined for the perception of pungency using chili pepper in aqueous solutions. Absolute threshold and JND were determined using 2 alternative forced‐choice sensory tests tests. High‐performance liquid chromatography technique was used to determine capsaicinoids concentration in samples used for sensory analysis. Sensory absolute threshold was 0.050  mg capsaicinoids/kg sample. Five JND values were determined using 5 reference solutions with different capsaicinoids concentration. JND values changed proportionally as capsaicinoids concentration of the reference sample solutions changed. Weber fraction remained stable for the first 4 reference capsaicinoid solutions (0.05, 0.11, 0.13, and 0.17 mg/kg) but changed when the most concentrated reference capsaicinoids solution was used (0.23 mg/kg). Quantification limit for instrumental analysis was 1.512 mg/kg capsaicinoids. Sensory methods employed in this study proved to be more sensitive than instrumental methods.

Practical Application:  A better understanding of the process involved in the sensory perception of pungency is currently required because “hot” foods are becoming more popular in western cuisine. Absolute thresholds and differential thresholds are useful tools in the formulation and development of new food products. These parameters may help in defining how much chili pepper is required in a formulated product to ensure a perceptible level of pungency, as well as in deciding how much more chili pepper is required in a product to produce a perceptible increase in its pungency.
Effect of Mannoproteins on the Growth, Gastrointestinal Viability, and Adherence to Caco‐2 Cells of Lactic Acid Bacteria
Authors: Ganan M. , Carrascosa A.V. , de Pascual‐Teresa S. , Martinez‐Rodriguez A.J.
Published: March 2012

Abstract:  Yeast cell wall (YCW) preparations and yeast mannoprotein extracts have been effective against some enteropathogenic bacteria as Campylobacter jejuni, Escherichia coli, and Salmonella, and they can affect the population of beneficial lactic acid bacteria (LAB). In this work, we studied the effect of a mannoprotein extract on five strains of LAB. This extract was metabolised by the bacteria, enhancing their survival in simulated gastrointestinal juice, and increasing the adherence of Lactobacillus plantarum, L. salivarius, and Enterococcus faecium to Caco‐2 cells. Yeast mannoproteins are promising naturally occurring compounds that could be used to enhance LAB intestinal populations and control pathogens.

Practical Application:  Mannoproteins could be used to enhance the population of beneficial lactic acid bacteria, improving their growth, gastrointestinal viability and adherence to epithelial intestinal cells.
Exploitation of a turbot (Scophthalmus maximusL.) immune‐related expressed sequence tag (EST) database for microsatellite screening and validation
Authors: NAVAJAS‐PÉREZ R. , ROBLES F. , MOLINA‐LUZÓN M. J. , De La HERRÁN R. , ÁLVAREZ‐DIOS J. A. , PARDO B. G. , VERA M. , BOUZA C. , MARTÍNEZ P.
Published: March 2012

In this study, we identified and characterized 160 microsatellite loci from an expressed sequence tag (EST) database generated from immune‐related organs of turbot (Scophthalmus maximus). A final set of 83 new polymorphic microsatellites were validated after the analysis of 40 individuals of Atlantic origin including both wild and farmed individuals. The allele number and the expected heterozygosity ranged from 2 to 18 and from 0.021 to 0.951, respectively. Evidences of null alleles at moderate–high frequencies were detected at six loci using population data. None of the analysed loci showed deviations from Mendelian segregation after the analysis of five full‐sib families including approximately 92 individuals/family. The markers are used to consolidate the turbot genetic map, and because they are mostly EST‐derived, they will be very useful for comparative genomic studies within flatfishes and with model fish species. Using anin silicoapproach, we detected significant homologies of microsatellite sequences with the EST databases of the flatfish species with highest genomic resources (Senegalese sole, Atlantic halibut, bastard halibut) in 31% of these turbot markers. The conservation of these microsatellites within Pleuronectiformes will pave the way for anchoring genetic maps of different species and identifying genomic regions related to productive traits.
Impact of clinical pharmacists in a warrior transition battalion at a military hospital
Authors: Hopper Ashley , Berry-Cabán Cristóbal S
Published: March 2012

Objective

Military treatment facilities across the USA began implementing Warriors in Transition Battalions (WTB), which provide enhanced health care and support to wounded soldiers in need of medical evaluation, treatment and rehabilitation. With the implementation of WTB, clinical pharmacists have begun to play a role in the management of these patients. The objective of this study was to examine the impact of clinical pharmacists' interventions in a WTB by evaluating drug-related interventions recommendations and to determine the acceptance rate of these interventions by primary care providers.

Methods

A retrospective chart review of all soldiers referred to and seen by clinical pharmacists in the WTB registered at Womack Army Medical Center in Fort Bragg, NC, USA, was performed using the Composite Health Care System (CHCS) database. Data were collected for all patients between 1 March and 30 November 2009. Provider acceptance was determined from eligible pharmacist interventions. Clinical pharmacist-initiated medications or laboratory draws were not eligible for provider acceptance.

Key findings

Fifty patients were seen by a clinical pharmacist in the WTB; the mean age was 33.4 years and 84% were males. A total of 216 recommendations were documented. The most common intervention was drug addition (36%) followed by drug deletion (18%). The primary reason for consultation was medication therapy management (56%); pain management was the second most common reason for consultation (28%). Of the 216 recommendations examined, 181 (84%) were eligible for provider acceptance. Providers accepted 142 (78%) out of 181 pharmacist recommendations.

Conclusions

A majority of pharmacist recommendations were accepted. Clinical pharmacist presence in the WTB is a valuable resource in terms of optimizing medication therapy.
Factor XIII Val34Leu mutation accelerates the development of fibrosis in patients with chronic hepatitis B and C
Authors: Dik Kathelijne , de Bruijne Joep , Takkenberg R. Bart , Roelofs Joris J. , Tempelmans Marjan J. , Dijkgraaf Marcel G. W. , Gelderblom Huub C. , Reesink Henk W. , Meijers Joost C. M. , Jansen Peter L. , Levi Marcel
Published: March 2012

Aim:  There is considerable variation in liver fibrosis stage and progression to cirrhosis among patients with chronic hepatitis B (CHB) or C (CHC). Coagulation pathway activity due to genetic variations could influence the rate of fibrosis. We investigated thrombotic risk factors and their association with the extent and progression of fibrosis in CHB or CHC patients.

Methods:  In total, 194 patients with CHB (n = 88) or CHC (n = 106) were included. Data on demographic and laboratory findings were collected. Liver biopsies were evaluated according to the Ishak classification system. Fibrosis progression rate (FPR), defined as ratio of fibrosis score to duration of infection, was determined for 131 patients. Prevalence of factor V Leiden, prothrombin G20210A, plasminogen activator inhibitor type‐1 (PAI‐1) 4G/5G and factor XIIIA Val34Leu mutations was evaluated.

Results:  Heterozygosity for factor V Leiden, prothrombin G20210A, PAI‐1 4G/5G and factor XIIIA Val34Leu mutations was present in 3.1%, 2.1%, 49% and 28% of the patients, respectively. Factor XIII Val34Leu mutation was a risk for enhanced FPR (odds ratio 4.7; P = 0.01). In patients with both factor XIII Val34Leu and PAI‐1 4G/5G mutations the risk of an accelerated FPR was further increased (odds ratio 5.0; P = 0.02). Mutations of the other thrombotic genes were not significantly associated with fibrosis stage and FPR.

Conclusion:  Our data show that factor XIII Val34Leu mutation alone or in combination with PAI‐1 4G/5G mutation is a risk factor for an increased rate of liver fibrosis development in patients with CHB or CHC.
jPopGen Suite: population genetic analysis of DNA polymorphism from nucleotide sequences with errors
Authors: Liu Xiaoming
Published: March 2012

1. Next‐generation sequencing (NGS) is being increasingly used in ecological and evolutionary studies. Though promising, NGS is known to be error‐prone. Sequencing error can cause significant bias for population genetic analysis of a sequence sample.

2. We present jPopGen Suite, an integrated tool for population genetic analysis of DNA polymorphisms from nucleotide sequences. It is specially designed for data with a non‐negligible error rate, although it serves well for ‘error‐free’ data. It implements several methods for estimating the population mutation rate, population growth rate and conducting neutrality tests.

3. jPopGen Suite facilitates the population genetic analysis of NGS data in various applications and is freely available for non‐commercial users at http://sites.google.com/site/jpopgen/.
The relationship between compulsive exercise and emotion regulation in adolescents
Authors: Goodwin Huw , Haycraft Emma , Meyer Caroline
Published: March 2012

Objective. Compulsive exercise is suggested to be a strategy to regulate emotions. This suggestion has never been studied in adolescents. Therefore, this study examined the cross‐sectional association between emotion regulation and compulsive exercise attitudes in adolescents.

Design. A cross‐sectional design was employed for this study.

Method. A sample of 1,630 adolescent boys and girls completed self‐report measures of compulsive exercise, emotion regulation, and disordered eating attitudes, as part of ongoing research into exercise and eating attitudes in adolescents.

Results. Compulsive exercise was significantly associated with emotion regulation, after controlling for disordered eating attitudes. Among boys, compulsive exercise was associated with internal functional, internal dysfunctional, and external functional emotion regulation strategies. In girls, internal functional and internal dysfunctional emotion regulation strategies predicted compulsive exercise.

Conclusions. Adolescents’ compulsivity towards exercise is positively associated with different emotion regulation strategies. More work is needed to identify whether emotion regulation strategies longitudinally predict compulsive exercise.
Effects of Target Size on Foreign Object Damage in Gas-Turbine Grade Silicon Nitrides by Steel Ball Projectiles
Authors: Choi Sung R. , Rácz Zsolt
Published: March 2012

Foreign object damage (FOD) phenomena of two gas-turbine grade silicon nitrides (AS800 and SN282) were assessed at ambient temperature applying impact velocities from 20 to 300 m/s using 1.59-mm diameter hardened steel ball projectiles. Targets in a flexural configuration with two different sizes (thicknesses) of 1 and 2 mm were ballistic-impacted under a fully supported condition. The severity of impact damage, as well as the degree of post-impact strength degradation, increased with increasing impact velocity, increased with decreasing target size, and was greater in SN282 than in AS800 silicon nitride. The critical impact velocity where targets fractured catastrophically decreased with decreasing target size and was lower in SN282 than in AS800. Overall, FOD by steel projectiles was significantly less than that by silicon-nitride ceramic counterparts, due to much decreased Hertzian contact stresses. A correlation of backside cracking velocity versus target size was made based on a simplified elastic foundation analysis.
Characterization and comparison of silicon nitride films deposited using two novel processes
Authors: Sharma Vivek , Bailey Adam , Dauksher Bill , Tracy Clarence , Bowden Stuart , O’Brien Barry
Published: March 2012

Hydrogenated silicon nitride films (SiNx:H) deposited using a PECVD process enhance the performance of crystalline silicon solar cells by functioning as an efficient antireflection coating and passivating layer. In this paper, we compared two SiNx:H novel deposition processes using two different PECVD tools—one nontraditional in process regime and the other nontraditional in type—to determine their suitability to solar cell fabrication. The parameter space was explored by employing a design of experiment methodology followed by material characterization using variable angle spectroscopic ellipsometry, reflectance, FTIR, RBS and elastic recoil detection. The thickness and reflectance of Si-rich films changed dramatically after annealing. Further, FTIR results showed that the Si–H bond peak present at 2160 cm−1 in such films disappeared after a typical Al firing step. Therefore, the optimized films were deposited with a lower SiH4/NH3 ratio to minimize the changes in the film properties after annealing.
Dimethyl Sulfoxide and Ethanol Elicit Increased Amyloid Biogenesis and Amyloid-Integrated Biofilm Formation in Escherichia coli
Authors: Lim Ji Youn , May Janine M. , Cegelski Lynette
Published: March 2012

Escherichia colidirects the assembly of functional amyloid fibers termed “curli” that mediate adhesion and biofilm formation. We discovered thatE. coliexhibits a tunable and selective increase in curli protein expression and fiber assembly in response to moderate concentrations of dimethyl sulfoxide (DMSO) and ethanol. Furthermore, the molecular alterations resulted in dramatic functional phenotypes associated with community behavior, including (i) cellular agglutination in broth, (ii) altered colony morphology, and (iii) increased biofilm formation. Solid-state nuclear magnetic resonance (NMR) spectra of intact pellicles formed in the presence of [13C2]DMSO confirmed that DMSO was not being transformed and utilized directly for metabolism. Collectively, the chemically induced phenotypes emphasize the plasticity ofE. coli's response to environmental stimuli to enhance amyloid production and amyloid-integrated biofilm formation. The data also support our developing model of the extracellular matrix as an organized assembly of polymeric components, including amyloid fibers, in which composition relates to bacterial physiology and community function.
The Trypanosomatid-Specific N Terminus of RPA2 Is Required for RNA Polymerase I Assembly, Localization, and Function
Authors: Daniels Jan-Peter , Gull Keith , Wickstead Bill
Published: March 2012

African trypanosomes are the only organisms known to use RNA polymerase I (pol I) to transcribe protein-coding genes. These genes include
VSG
, which is essential for immune evasion and is transcribed from an extranucleolar expression site body (ESB). Several trypanosome pol I subunits vary compared to their homologues elsewhere, and the question arises as to how these variations relate to pol I function. A clear example is the N-terminal extension found on the second-largest subunit of pol I, RPA2. Here, we identify an essential role for this region. RPA2 truncation leads to nuclear exclusion and a growth defect which phenocopies single-allele knockout. The N terminus is not a general nuclear localization signal (NLS), however, and it fails to accumulate unrelated proteins in the nucleus. An ectopic NLS is sufficient to reinstate nuclear localization of truncated RPA2, but it does not restore function. Moreover, NLS-tagged, truncated RPA2 has a different subnuclear distribution to full-length protein and is unable to build stable pol I complexes. We conclude that the RPA2 N-terminal extension does not have a role exclusive to the expression of protein-coding genes, but it is essential for all pol I functions in trypanosomes because it directs trypanosomatid-specific interactions with RPA1.
Family-based behavioural intervention programme for obese children: a feasibility study
Authors: Teder Marie , Mörelius Evalotte , Bolme Per , Nordwall Maria , Ekberg Joakim , Timpka Toomas
Published: March 2012

Objectives

To assess a 2-year family-based behavioural intervention programme against child obesity.

Design

Single-group pre- and post-intervention feasibility study.

Setting

Swedish paediatric outpatient care.

Participants

26 obese children aged 8.3–12.0 years and their parents who had consented to actively participate in a 2-year intervention.

Interventions

25 paediatric outpatient group sessions over a 2-year period with parallel groups for children and parents. The basis for the programme was a manual containing instructions for tutor-supervised group sessions with obese children and their parents.

Primary and secondary outcome measures

The primary outcome measure was change in standardised body mass index between baseline and after 36 months. The secondary outcome measures were change in the waist:height ratio, metabolic parameters and programme adherence. The participants were examined at baseline and after 3, 12 and 24 months of therapy and at follow-up 12 months after completion of the programme.

Results

The primary outcome measure, standardised body mass index, declined from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) (p<0.001) at follow-up 12 months after completion of the programme. There was no change in the waist:height ratio. Biomedical markers of blood glucose metabolism and lipid status remained in the normal range. 96% of the families completed the programme.

Conclusions

This feasibility study of a 2-year family-based behavioural intervention programme in paediatric outpatient care showed promising results with regard to further weight gain and programme adherence. These findings must be confirmed in a randomised controlled trial with longer follow-up before the intervention programme can be implemented on a larger scale.
Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005
Authors: Suzuki Etsuji , Kashima Saori , Kawachi Ichiro , Subramanian S V
Published: March 2012

Objectives

To examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan.

Design

Observational study of the vital statistics and the census data.

Setting

Japan.

Participants

Entire population aged 25 years or older and less than 65 years in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005. The total number of decedents was 984 022 and 532 223 in men and women, respectively.

Main outcome measures

For each sex, ORs and 95% CIs for mortality were estimated by using multilevel logistic regression models with ‘cells’ (cross-tabulated by age and occupation) at level 1, 8 years at level 2 and 47 prefectures at level 3. The prefecture-level variance was used as an estimate of geographic inequalities of mortality.

Results

Adjusting for age and time-trends, compared with production process and related workers, ORs ranged from 0.97 (95% CI 0.96 to 0.98) among administrative and managerial workers to 2.22 (95% CI 2.19 to 2.24) among service workers in men. By contrast, in women, the lowest odds for mortality was observed among production process and related workers (reference), while the highest OR was 12.22 (95% CI 11.40 to 13.10) among security workers. The degree of occupational inequality increased in both sexes. Higher occupational groups did not experience reductions in mortality throughout the period and was overtaken by lower occupational groups in the early 1990s, among men. Conditional on individual age and occupation, overall geographic inequalities of mortality were relatively small in both sexes; the ORs ranged from 0.87 (Okinawa) to 1.13 (Aomori) for men and from 0.84 (Kanagawa) to 1.11 (Kagoshima) for women, even though there is a suggestion of increasing inequalities across prefectures since 1995 in both sexes.

Conclusions

The present findings suggest that both social and geographic inequalities in all-cause mortality have increased in Japan during the last 3 decades.
A method for early evaluation of a recently introduced technology by deriving a comparative group from existing clinical data: a case study in external support of the Marfan aortic root
Authors: Treasure Tom , Crowe Sonya , Chan K M John , Ranasinghe Aaron , Attia Rizwan , Lees Belinda , Utley Martin , Golesworthy Tal , Pepper John
Published: March 2012

Objective

During the early phase of evaluation of a new intervention, data exist for present practice. The authors propose a method of constructing a fair comparator group using these data. In this case study, the authors use the example of external aortic root support, a novel alternative to aortic root replacement.

Design

A matched comparison group, of similar age, aortic size and aortic valve function to those having the novel intervention, was constructed, by minimization, from among patients having conventional aortic root replacement in other hospitals during the same time frame.

Setting

Three cardiac surgical units in England.

Patients

The first 20 patients, aged 16–58 years with aortic root diameters of 40–54 mm, having external support surgery were compared with 20 patients, aged 18–63 years and aortic root diameters of 38–58 mm, who had conventional aortic root replacement, between May 2004 and December 2009.

Interventions

A pliant external mesh sleeve, customised by computer-aided design, encloses the whole of the ascending aorta. The comparator group had conventional aortic root replacement, 16 valve-sparing and four with composite valved grafts.

Main outcome measures

Duration of cardiopulmonary bypass (CPB), myocardial ischaemic time, blood loss and transfusion of blood, platelets and clotting factors.

Results

Comparing total root replacement and customised aortic root support surgery: CPB (median (range)) was 134 (52–316) versus 0 (0–20) min; myocardial ischaemia 114 (41–250) versus 0 (0–0) min; 4 h blood loss was 218 (85–735) versus 50 (25–400) ml; and 9/18 had blood transfusion, 9/18 platelets and 12/18 fresh frozen plasma after root replacement versus 1/20, 0/20 and 0/20, respectively, for the novel surgery.

Conclusions

Avoidance or large reductions in CPB, myocardial ischaemia and blood product usage were achieved with the novel surgery. These data are of use in decision analysis and health economic evaluation and are available early in evaluation before randomised trial data are available.
Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes
Authors: Mamede Sílvia , Splinter Ted A W , van Gog Tamara , Rikers Remy M J P , Schmidt Henk G
Published: March 2012

Background

Flaws in clinical reasoning are present in most diagnostic errors and occur even when physicians have enough knowledge to solve the problem. Deliberate reflection has been shown to improve diagnoses. The sources of faulty reasoning and how reflection counteracts them remain largely unknown.

Objective

To explore the causes of faulty reasoning and the mechanisms through which reflection neutralises them by investigating the influence of salient distracting clinical features on diagnostic decision-making.

Design and setting

In a prior study, 34 internal medicine residents and 50 medical students of the Erasmus Medical Centre, Rotterdam, diagnosed four clinical cases by means of non-analytical reasoning and four by reflective reasoning. In the secondary analysis of the data presented here, five internists independently evaluated the diagnoses and examined the nature of the diagnostic errors in relation to case features that gave rise to these errors.

Main outcomes

Frequency of incorrect diagnoses caused by salient distracting features made through reflective and non-analytical reasoning.

Results

Among residents, reflective reasoning (Mean diagnostic accuracy score (M)=2.09, 95% CI 1.77 to 2.40) led to a significantly higher number of correct diagnoses than non-analytical reasoning (M=1.71, 95% CI 1.37 to 2.04; p=0.03). This higher diagnostic accuracy was associated with fewer incorrect diagnoses triggered by salient distracting clinical features (M=0.47, 95% CI 0.26 to 0.68) compared with non-analytical reasoning (M=0.85, 95% CI 0.59 to 1.11; p=0.02). Students did not benefit from reflection to improve diagnoses.

Conclusion

Salient features in a case tend to attract physicians' attention and may misdirect diagnostic reasoning when they turn out to be unrelated to the problem, causing errors. Reflection helps by enabling physicians to overcome the influence of distracting features. The lack of effect for students suggests that this is only possible when there is enough knowledge to recognise which features discriminate between alternative diagnoses.
Tibetan plateau earthquake: altitude challenges to medical rescue work
Authors: Xu Tengda , Wang Zhenhua , Li Tao , Pei Veronica , Wen Liping , Wan Lidong , Wang Yuxuan , Yu Xuezhong
Published: March 2012

Background

Rescue efforts for earthquakes in remote plateau regions require large numbers of professional personnel to be transported from various lowland regions for relief work. Unacclimatised rescuers to high-altitude regions commonly suffer acute mountain sickness (AMS), which makes relief efforts inefficient and potentially dangerous.

Methods

In this study, the AMS symptoms of 78 unacclimatised rescue workers for the Yushu earthquake from Beijing were recorded using the Lake Louise AMS self-report questionnaire. Heart rate and blood oxygen were recorded at rest before departure, during rest and during activity.

Results

After ascending, resting heart rate increased from mean 75.87 bpm to 87.45 bpm and resting SpO2decreased from an average of 98.51% to 90.35% (both p<0.001). The mean Lake Louise AMS Score for participants was 3.1 (95% CI 2.6 to 3.6). 29 members (37.2%) met the diagnosis criteria for AMS. 16 members (20.5%) were evacuated early due to acute AMS (AMS score ≥5).Rhodiolawas offered on a voluntary basis as a prophylactic measure but shown to be ineffective.

Conclusion

Given the ineffectiveness of prophylactic measures and the urgency of such disaster situations, it is unrealistic to mobilise rescue teams from lowland regions for immediate relief efforts. A local disaster plan specific to plateau earthquakes needs to be developed with local personnel for timely and efficient relief.
Implementation of an evidence based guideline reduces blood tests and length of stay for the limping child in a paediatric emergency department
Authors: McCanny Peter J , McCoy Siobhan , Grant Tim , Walsh Sean , O'Sullivan Ronan
Published: March 2012

Introduction

Acute non-traumatic limp is a common reason for children to present to the emergency department (ED). There is a wide differential diagnosis for these patients, and there are certain serious conditions which cannot be missed. An evidence based guideline for the ‘limping child’ was designed and the impact of guideline implementation on a number of specific, predefined quantitative outcomes was assessed.

Methods

An initial retrospective chart review over 3 months was carried out for all patients presenting with acute non-traumatic limp. Following guideline introduction and implementation, information was gathered prospectively for a further 3 month period. Data outcomes between the two patient groups were then compared.

Results

110 patients met the criteria for inclusion: 56 pre-guideline and 54 post-guideline implementation. Baseline characteristics and diagnosis breakdown were similar in both groups. The rate of laboratory investigations was significantly reduced following guideline implementation (68% of patients pre-guideline, vs 48% post-guideline; (χ2), p=0.03). The number of x-rays carried out was similar in each group (74 pre- vs 67 post-guideline, mean 1.32 vs 1.28; (χ2), p=0.53). Length of time spent in the ED was significantly reduced following guideline implementation (median time 150 min pre- vs 82.5 min post-guideline; (χ2), p=0.04). No cases of serious pathology were missed using the guideline.

Conclusion

Implementation of an evidence based clinical practice guideline for the limping child in a paediatric ED reduced the overall time patients spent in the ED, reduced the need for unnecessary laboratory investigations and ensured that appropriate investigations were carried out on an individual patient basis.
Use of the human dive reflex for the management of supraventricular tachycardia: a review of the literature
Authors: Smith Gavin , Morgans Amee , Taylor David McD , Cameron Peter
Published: March 2012

Background

The human dive reflex (HDR), a physiological phenomenon similar to the bradycardia reflex used by marine mammals during prolonged submersion, can be employed in managing paroxysmal supraventricular tachycardia (PSVT). This review aims to identify a standardised HDR technique for haemodynamically stable PSVT, to determine the effectiveness of the HDR and to define its usefulness in the prehospital setting.

Methods

A review of the Medline, EMBASE and CINAHL databases was conducted. Articles were included if they described the use of the HDR to revert PSVT in the prehospital or emergency medical setting, the nature of the effectiveness of the HDR for PSVT or historically significant developments of HDR techniques for PSVT reversion. Articles not available in English or describing the use of HDR in animal studies only were excluded.

Results

211 articles were identified, of which 21 were found to be relevant. These included 10 studies of HDR effectiveness in PSVT and three physiological studies of HDR effect. No standardised model of performance exists for the HDR. Elements of performance include: a cold stimulus applied to the entire face, a specific temperature of the cold stimulus, application duration, breath holding during HDR and posture assumed to perform the procedure. There are also safety and logistics issues with using the HDR in prehospital care.

Conclusions

The HDR represents an effective method of terminating PSVT in the hospital emergency department. Its usefulness in prehospital care requires further evaluation of the elements of the manoeuvre to determine appropriateness to this setting.
Nuclear survivin is associated with cell proliferative advantage in uterine cervical carcinomas during radiation therapy
Authors: Chaopotong Pattama , Kajita Sabine , Hashimura Miki , Saegusa Makoto
Published: March 2012

Background

Although the anticancer effects of radiation therapy for patients with uterine cervical squamous cell carcinoma (U-SCC) are widely acknowledged, little is known about the resultant morphological alterations in tumour tissue kinetics.

Aims

To make a detailed assessment of possible roles of survivin expression in apoptosis and cell proliferation in U-SCC during radiation therapy.

Methods

181 biopsy specimens from 55 consecutive U-SCCs of patients receiving radiation therapy were studied using a combined morphological (apoptosis) and immunohistochemical (MIB-1 and survivin) approach. The intracellular distribution of various splice variants of thesurvivingene was also examined.

Results

Tumour cell proliferation, determined as MIB-1 labelling indices (LIs), as well as nuclear survivin (N-Surv) LIs, were inversely correlated with irradiation dosage, in contrast to relatively minor changes in apoptotic indices, suggesting a shift in tumour tissue kinetics towards a relative predominance of cell deletion. In addition, the low N-Sur LI category showed significant stepwise decrease in MIB-1 LIs during therapy, in contrast to no changes in the high category. Exogenous overexpression of three variants of thesurvivingene resulted in different expression patterns, showing cytoplasmic staining with or without dot formation for survivin and survivin-2B and distinct nuclear accumulation for survivin-deled exon 3 (∆Ex3).

Conclusions

Results showed that nuclear survivin, including survivin itself and the survivin-∆Ex3 splice variants, may participate in modulation of altered cell kinetics of U-SCC during radiation therapy.
NEUTRINO EMISSION FROM DARK MATTER ANNIHILATION/DECAY IN LIGHT OF COSMIC e± AND $\bar{p}$ DATA
Authors: LIU JIE , YUAN QIANG , BI XIAOJUN , LI HONG , ZHANG XINMIN
Published: March 2012

A self-consistent global fitting method based on the Markov Chain Monte Carlo technique to study the dark matter (DM) property associated with the cosmic ray electron/positron excesses was developed in our previous work. In this work we further improve the previous study to include the hadronic branching ratio of DM annihilation/decay. The PAMELA [Formula: see text] data are employed to constrain the hadronic branching ratio. We find that the 95% (2σ) upper limits of the quark branching ratio allowed by the PAMELA [Formula: see text] data is ~0.032 for DM annihilation and ~0.044 for DM decay, respectively. This result shows that the DM coupling to pure leptons is indeed favored by the current data. Based on the global fitting results, we further study the neutrino emission from DM in the galactic center. Our predicted neutrino flux is some smaller than previous works since the constraint from γ-rays is involved. However, it is still capable to be detected by the forthcoming neutrino detector such as IceCube. The improved points of the present study compared with previous works include: (1) the DM parameters, both the particle physical ones and astrophysical ones, are derived in a global fitting way, (2) constraints from various species of data sets, including γ-rays and antiprotons are included, and (3) the expectation of neutrino emission is fully self-consistent.
THE FROBENIUS VECTOR OF A FREE AFFINE SEMIGROUP
Authors: ASSI ABDALLAH
Published: March 2012

We give a formula for the Frobenius vector of a free affine simplicial semigroup. This generalizes to the affine case a well known formula for free numerical semigroups.
NILPOTENT ELEMENTS AND NIL-ARMENDARIZ PROPERTY OF MONOID RINGS
Authors: HABIBI M. , MOUSSAVI A.
Published: March 2012

Antoine [Nilpotent elements and Armendariz rings, J. Algebra 319(8) (2008) 3128–3140] studied the structure of the set of nilpotent elements in Armendariz rings and introduced nil-Armendariz rings. For a monoid M, we introduce nil-Armendariz rings relative to M, which is a generalization of nil-Armendariz rings and we investigate their properties. This condition is strongly connected to the question of whether or not a monoid ring R[M] over a nil ring R is nil, which is related to a question of Amitsur [Algebras over infinite fields, Proc. Amer. Math. Soc.7 (1956) 35–48]. This is true for any 2-primal ring R and u.p.-monoid M. If the set of nilpotent elements of a ring R forms an ideal, then R is nil-Armendariz relative to any u.p.-monoid M. Also, for any monoid M with an element of infinite order, M-Armendariz rings are nil M-Armendariz. When R is a 2-primal ring, then R[x] and R[x, x-1] are nil-Armendariz relative to any u.p.-monoid M, and we have nil (R[M]) = nil (R)[M].
SUBGROUP NORMALITY DEGREES OF FINITE GROUPS II
Authors: FARROKHI D. G. M. , SAEEDI F.
Published: March 2012

Let [Formula: see text] be the set of all subgroup normality degrees of a given finite group G and [Formula: see text] be the union over all [Formula: see text], where G ranges over all finite groups. It is shown that [Formula: see text] and structural results are given for finite groups G with [Formula: see text]. Also it is proved that G is solvable if [Formula: see text] or [Formula: see text], in which [Formula: see text].
Terminal sialic acids are an important determinant of pulmonary endothelial barrier integrity
Authors: Cioffi Donna L. , Pandey Subha , Alvarez Diego F. , Cioffi Eugene A.
Published: March 2012

The surface of vascular endothelium bears a glycocalyx comprised, in part, of a complex mixture of oligosaccharide chains attached to cell-surface proteins and membrane lipids. Importantly, understanding of the structure and function of the endothelial glycocalyx is poorly understood. Preliminary studies have demonstrated structural differences in the glycocalyx of pulmonary artery endothelial cells compared with pulmonary microvascular endothelial cells. Herein we begin to probe in more detail structural and functional attributes of endothelial cell-surface carbohydrates. In this study we focus on the expression and function of sialic acids in pulmonary endothelium. We observed that, although pulmonary microvascular endothelial cells express similar amounts of total sialic acids as pulmonary artery endothelial cells, the nature of the sialic acid linkages differs between the two cell types such that pulmonary artery endothelial cells express both α( 2 , 3 )- and α( 2 , 6 )-linked sialic acids on the surface (i.e., surficially), whereas microvascular endothelial cells principally express α( 2 , 3 )-linked sialic acids. To determine whether sialic acids play a role in endothelial barrier function, cells were treated with neuraminidases to hydrolyze sialic acid moieties. Disruption of cell-cell and cell-matrix adhesions was observed following neuraminidase treatment, suggesting that terminal sialic acids promote endothelial barrier integrity. When we measured transendothelial resistance, differential responses of pulmonary artery and microvascular endothelial cells to neuraminidase from Clostridium perfringens suggest that the molecular architecture of the sialic acid glycomes differs between these two cell types. Collectively our observations reveal critical structural and functional differences of terminally linked sialic acids on the pulmonary endothelium.
Interplay of macrophages and T cells in the lung vasculature
Authors: Gerasimovskaya Evgenia , Kratzer Adelheid , Sidiakova Asya , Salys Jonas , Zamora Martin , Taraseviciene-Stewart Laimute
Published: March 2012

In severe pulmonary arterial hypertension (PAH), vascular lesions are composed of phenotypically altered vascular and inflammatory cells that form clusters or tumorlets. Because macrophages are found in increased numbers in intravascular and perivascular space in human PAH, here we address the question whether macrophages play a role in pulmonary vascular remodeling and whether accumulation of macrophages in the lung vasculature could be compromised by the immune system. We used the mouse macrophage cell line RAW 264.7 because these cells are resistant to apoptosis, have high proliferative capacity, and resemble cells in the plexiform lesions that tend to pile up instead of maintaining a monolayer. Cells were characterized by immunocytochemistry with cell surface markers ( Lycopersicon Esculentum Lectin, CD117, CD133, FVIII, CD31, VEGFR-2, and S100). Activated, but not quiescent, T cells were able to suppress RAW 264.7 cell proliferative and migration activity in vitro. The carboxyfluorescein diacetate-labeled RAW 264.7 cells were injected into the naïve Sprague Dawley (SD) rat and athymic nude rat. Twelve days later, cells were found in the lung vasculature of athymic nude rats that lack functional T cells, contributing to vascular remodeling. No labeled RAW 264.7 cells were detected in the lungs of immune-competent SD rats. Our data demonstrate that T cells can inhibit in vitro migration and in vivo accumulation of macrophage-like cells.
Time-resolved surface-enhanced resonance Raman spectro-electrochemistry of heme proteins
Authors: Grosserueschkamp Marc , Nowak Christoph , Knoll Wolfgang , Naumann Renate L. C.
Published: March 2012

Heme proteins such as cytochrome c (cc) play a fundamental role in many biological processes. Surface-enhanced resonance Raman spectroscopy (SERRS) combined with electrochemical methods is an ideal tool to study the redox processes of heme proteins. In this context we designed a new measuring cell allowing for simultaneous electrochemical manipulation and high sensitive SERRS measurements of heme proteins. The measuring cell is based on an inverted rotating disc electrode for excitation by using a confocal Raman microscope. Furthermore, we developed a SER(R)S-active silver modified silver substrate for spectro-electrochemical applications. For this purpose silver nanoparticles (AgNPs) were adsorbed on top of a planar silver surface. The substrate was optimized for an excitation wavelength of 413 nm corresponding to the resonance frequency of heme structures. An enhancement factor of 105was achieved. The high performance of the new measuring cell in combination with the new silver substrate was demonstrated using cc as a reference system.