bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of the most common cutaneous neoplasms in dogs and evaluation of breed and age distributions for selected neoplasms
Authors: Villamil J. Armando , Henry Carolyn J. , Bryan Jeffrey N. , Ellersieck Mark , Schultz Loren , Tyler Jeff W. , Hahn Allen W.
Published: October 2011

Objective—To identify the most common cutaneous neoplasms in dogs and evaluate breed and age distributions for selected neoplasms.

Design—Retrospective epidemiological study.

Sample—Records available through the Veterinary Medical Database of dogs examined at veterinary teaching hospitals in North America between 1964 and 2002.

Procedures—Information on tumor type and patient breed and age was collected. Incidence and odds ratios with 95% confidence intervals were calculated.

Results—Records of 1,139,616 dogs were reviewed. Cutaneous neoplasms were diagnosed in 25,996 of these dogs; records for the remaining 1,113,620 dogs did not indicate that cutaneous neoplasms had been diagnosed, and these dogs were considered controls. The most frequent age range for dogs with cutaneous neoplasms was 10 to 15 years. Lipoma, adenoma, and mast cell tumor were the most common skin tumor types.

Conclusions and Clinical Relevance—Results supported previously reported data regarding cutaneous neoplasia in dogs but provided updated information on the most common skin tumors and on age and breed distributions.
Clinical characteristics, treatment, and outcome of dogs with presumed primary hepatic lymphoma: 18 cases (1992–2008)
Authors: Dank Gillian , Rassnick Kenneth M. , Kristal Orna , Rodriguez Carlos O. , Clifford Craig A. , Ward Rebecca , Mallett Courtney L. , Gieger Tracy , Segev Gilad
Published: October 2011

Objective—To determine outcome of dogs with presumed primary hepatic lymphoma treated with various multiagent, doxorubicin-based chemotherapeutic protocols and identify factors associated with prognosis.

Design—Retrospective case series.

Animals—18 dogs with presumed primary hepatic lymphoma.

Procedures—Medical records were reviewed for information on signalment, treatment, and outcome.

Results—8 dogs had a complete remission (CR), with a median remission duration of 120 days. Dogs with leukocytosis, neutrophilia, hypoalbuminemia, hyperbilirubinemia, or a combination of hypoalbuminemia and hyperbilirubinemia were less likely to achieve a CR. Overall median survival time (MST) was 63 days (range, 2 to 402 days). In a multivariate analysis, response to treatment and serum albumin concentration were associated with MST. Dogs that did not achieve a CR had a significantly shorter MST than did dogs that did achieve a CR (13 vs 283 days, respectively). Dogs with serum albumin concentration < 2.5 g/dL at the time treatment was initiated had a significantly shorter MST than did dogs with serum albumin concentration within reference limits (10 vs 128 days, respectively). There was also a positive correlation between serum albumin concentration and survival time (r = 0.74).

Conclusions and Clinical Relevance—Results suggested that dogs with primary hepatic lymphoma that underwent chemotherapy had a poor prognosis, with a low response rate. Dogs that responded to treatment had a better prognosis, and dogs with hypoalbuminemia had a poorer prognosis.
Vaginal resection and anastomosis for treatment of vestibulovaginal stenosis in 4 dogs with recurrent urinary tract infections
Authors: Kieves Nina R. , Novo Roberto E. , Martin Robert B.
Published: October 2011

Case Description—4 dogs were evaluated because of recurrent urinary tract infections.

Clinical Findings—All dogs had recurrent urinary tract infections and similar clinical signs; 3 dogs had urinary incontinence. Digital vaginal examination revealed vestibulovaginal stenosis in all dogs, which was confirmed by results of contrast vaginourethrography. From image measurements, the vestibulovaginal ratio (ratio of the height of the vestibulovaginal junction to the maximum height of the vagina on a lateral vaginourethrogram) was calculated for each dog. Three dogs had severe stenosis (vestibulovaginal ratio, < 0.20; severe stenosis is defined as a vestibulovaginal ratio < 0.20), whereas the fourth dog had moderate stenosis (vestibulovaginal ratio, 0.24; ratio range for moderate stenosis is 0.20 to 0.25).

Treatment and Outcome—All dogs were anesthetized for surgical correction of the vestibulovaginal stenosis. Vaginal resection and anastomosis of the stenosis was performed in all 4 dogs, with 1 dog also undergoing episioplasty. Complete resolution of clinical signs was apparent in 3 dogs; 1 dog had postoperative complications including pollakiuria and stranguria, which resulted in rectal and vaginal prolapse. This dog underwent ovariohysterectomy, after which clinical signs resolved. All dogs had resolution of urinary tract infections at the time of follow-up (6 to 8 months after surgery).

Clinical Relevance—Resection and anastomosis may resolve recurrent urinary tract infections in dogs with severe or moderate vestibulovaginal stenosis. Episiotomy was not necessary for success of surgical treatment, and overall, that procedure increased morbidity, the severity of intraoperative hemorrhage, and duration of surgery.
Diagnosis and management of lymphoma in a green iguana (Iguana iguana)
Authors: Folland Douglas W. , Johnston Matthew S. , Thamm Douglas H. , Reavill Drury
Published: October 2011

Case Description—A 2-year-old female green iguana was examined for anorexia and swelling and pain on palpation in the cranial cervical area.

Clinical Findings—Marked soft tissue swelling in the cranial cervical area with corresponding cystic swellings in the pharynx were noted. The iguana was considered to be 50% under the expected body weight, given diet and husbandry conditions. The WBC count was markedly elevated, characterized by heterophilia and lymphocytosis. Surgical exploration of the cranial cervical area and histologic and microbial testing identified lymphoma with secondary infection as the cause of the swelling.

Treatment and Outcome—The tumor was initially treated with a single 10-Gy fraction of radiation directed at the masses in the neck. A vascular access port was placed in the ventral abdominal vein, and a canine chemotherapy protocol was modified for use in the iguana. During the course of treatment, the protocol was modified twice. At 1,008 days from the initiation of treatment, the iguana appeared to be in remission.

Clinical Relevance—To our knowledge, this is the first reported use of radiation with doxorubicin, vincristine, cyclophosphamide, and prednisone to successfully manage lymphoma in a reptile. A vascular access port was used effectively for drug administration for an extended period. The doxorubicin, vincristine, cyclophosphamide, and prednisone protocol appeared to be safe and effective in this iguana for the management of lymphoma.
Sliding wear behaviour of diamond-like carbon (DLC) coatings deposited on plasma nitrided steels
Authors: Tillmann Wolfgang , Momeni Siavash , Hoffmann Fabian
Published: September 2011

A hydrogen-free DLC (diamond-like carbon) coating was deposited with a bias voltage of 150 V on various high and low alloy tool steels to study the effect of the pre-treatment of the steel substrate on the wear behaviour of the DLC coating in sliding contact with uncoated counterparts. The morphology and mechanical properties of the DLC coating as well as the effect of plasma nitriding on the surface roughness and the hardness of the steels were studied in order to perform a correlation with the results of tribology tests. It could be concluded from the results that the plasma nitriding of the high alloy tool steel X210CrW12 leads to a significant decrease in the wear and friction coefficient of the DLC coating. Furthermore, it was found that plasma nitriding of the steel results in a decrease in the wear of uncoated counterparts as well. Finally, the wear mechanisms and failure of DLC coatings deposited on various steels were compared with each other and discussed analytically.
China's Port Reform and Development
Authors: Guan Changqian , Yahalom Shmuel
Published: October 2011

Driven by globalization and the Chinese export-oriented economy, ports in China have experienced exponential growth in the past decade. The Chinese port industry has gone through several stages of reform, from a central-control system with inadequate investment and poor efficiency to a large-scale and highly competitive system with various types of public–private partnerships. Today, the Chinese port industry is characterized by rapid growth, large-scale foreign investment, and liberalization of port policy. Of the top 10 container ports in the world, six are in China. This accomplishment is largely because of port reforms; in recent years, corporatization and joint venture have become the hallmark of port development in China. This study reviewed the evolution of China's port reform and policy changes supported by port statistics, examined a brief case study of port development in Shanghai, China, and analyzed policy changes in port governance, legal framework, and funding mechanisms. The analysis integrated key milestones in policy change and port development. Port reform has become an enabler of China's economic development and international trade. The unique model of port governance and administration provides an effective tool for macrocontrol at the national level and private-sector investment in cargo-handling systems and management expertise. Whether the port reform will take the next step toward more private sector involvement and what type of public–private partnership will form remain to be seen.
Geographic Information Systems for Estimating Coastal Maritime Risk
Authors: Dobbins James P. , Jenkins Lindsay M.
Published: October 2011

The U.S. Maritime Administration made a strong commitment to short-sea shipping in 2010 in America's Marine Highway Program. There are few statistics about coastal vessel traffic, however, and even less is known about casualty rates in those waters because of the absence of trip data and the relatively poor quality of casualty data. Geographic information systems (GIS) are unique tools that enable greater visualization and understanding of complex problems. A methodology was used to adapt a GIS-based highway planning traffic assignment model for use in maritime risk assessment. The planning model routed 12 years of vessel entrance and clearance data through an international waterway network to estimate the number of trips traversing network links by any number of metrics, including year, ship type, flag of registry, and draft. The risk methodology deployed a 100-mi2 mesh (10 mi × 10 mi) over the entire United States and coastal waters to estimate the highest casualty rate (casualties per million vessel trips) and casualty frequency locations.
Schedule Design and Container Routing in Liner Shipping
Authors: Wang Shuaian , Meng Qiang
Published: October 2011

A liner shipping company seeks to provide liner services with shorter transit time compared with the benchmark of market-level transit time because of the ever-increasing competition. When the itineraries of its liner service routes are determined, the liner shipping company designs the schedules of the liner routes such that the wait time at transshipment ports is minimized. As a result of transshipment, multiple paths are available for delivering containers from the origin port to the destination port. Therefore, the medium-term (3 to 6 months) schedule design problem and the operational-level container-routing problem must be investigated simultaneously. The schedule design and container-routing problems were formulated by minimization of the sum of the total transshipment cost and penalty cost associated with longer transit time than the market-level transit time, minus the bonus for shorter transit time. The formulation is nonlinear, noncontinuous, and nonconvex. A genetic local search approach was developed to find good solutions to the problem. The proposed solution method was applied to optimize the Asia–Europe–Oceania liner shipping services of a global liner company.
Integrated Bay Allocation and Yard Crane Scheduling Problem for Transshipment Containers
Authors: Lee Der-Horng , Jin Jian Gang , Chen Jiang Hang
Published: October 2011

The integrated problem for bay allocation and yard crane scheduling in transshipment container terminals was addressed. Unlike space allocation under the entire yard overview and slot assignment within a yard bay, the bay allocation problem focuses on a block and aims to allocate bay resource to fleets of transshipment containers in a more efficient way. The receiving operation and retrieving operation in the storage yards were considered simultaneously to achieve a more efficient operation of yard crane. The bay allocation and the yard crane scheduling were integrated as a whole process. A mixed integer programming model was developed for the problem formulation with the objective of minimizing total costs, including yard crane cost and delay cost. Considering the high complexity of the problem, a simulated annealing heuristic algorithm was developed to obtain near-optimal solutions. Numerical experiments were also conducted to test the efficiency of the proposed algorithm.
Energy Inefficiency of Marine Transportation
Authors: Stewart Richard D.
Published: October 2011

Policy makers at all levels of government use reports that analyze transportation data for planning, regulation, modeling, and budgeting. The value of a report's analysis is dependent on proper methodology and accurate data. Concerns about the accuracy of transportation data have been raised. A published analysis that represented the energy efficiency of marine transportation compared with other modes of transportation was assessed. The analysis was based on the best available data supplied by a government agency. The methodology, data, and data collection processes used in the case study and other related reports were examined. Recommendations were made for new maritime data collection processes along with changes in data analysis methodology.
Development of Sobriety Tests for the Marine Environment
Authors: Fiorentino Dary D. , Dietel Bergetta M. , Jimenez Dulcemonica D.
Published: October 2011

Six seated tests were evaluated in the laboratory to determine whether they would be feasible for use on the water as sobriety tests to measure impairment from alcohol at blood alcohol concentrations (BACs) of >0.08%. The standardized field sobriety tests (SFSTs) currently used at roadside are not suitable for the marine environment; marine law enforcement officers are left with insufficient methods to assess impairment on the water. One hundred fifty-seven participants were randomly assigned to a BAC group: 0.00%, 0.04%, 0.08%, and 0.12%. Six tests were administered to the participants by experienced law enforcement officers. Neither the testers nor the participants were privy to the participants' BACs. A variable called BAC status (N = 138) was obtained by dividing the average BAC into two groups: BAC < 0.08% and BAC ≥ 0.08%. A combination of four tests—horizontal gaze nystagmus (HGN), finger to nose (FTN), palm pat (PP), and hand coordination (HC)—correctly classified 82% of the BACs ≥0.08% and 67% of the BACs <0.08%, for an overall percentage correct of 72%. Four individual tests also predicted BAC status: HGN, FTN, PP, and HC. Four tests in combination and individually discriminated BAC status, although the overall percentages of accuracy, sensitivity, and specificity of the tests were below what was typically reported in literature on the roadside SFSTs. With the proper refinements, the four tests may assist marine officers with assessments of alcohol-related impairment in recreational boaters.
Hub-and-Spoke Networks to Increase the Scope of Container-on-Barge Transport
Authors: Konings Rob , Maras Vladislav
Published: October 2011

Container-on-barge transport has developed successfully in Europe during the past two decades, but this transport business primarily focused on maritime container flows and has therefore developed as a typical hinterland transport system. Accessibility and sustainability present a great challenge to increase the container-on-barge market share within as well as outside hinterland corridors. The latter implies the development of intermodal barge transport of cargo that has no direct relation with the seaport, which would be a completely new market for container-on-barge transport. A new type of container-on-barge-services, that is, hub-and-spoke services, can pave the way to open up this continental freight market for container-on-barge transport. A cost model is used to demonstrate the potential performance of such barge services compared with traditional services. The results of the analysis indicate that the most promising strategy to develop hub-and-spoke services is that the well-developed hinterland barge services become a part of the hub-and-spoke network. In this way, the continental cargo flows can be bundled with maritime cargo flows. The effectiveness of hub-and-spoke services, however, depends on several conditions, in particular, the network configuration (i.e., transport volumes, sailing distances, quality of waterways) as well as the type and performance of container exchange in the hub.
Transportation Rate Analysis of Waterborne Trip Movements on Gulf Intracoastal Waterway West
Authors: Protopapas Annie , Kruse C. James , Olson Leslie E.
Published: October 2011

The limitations of and the alternative methodologies for field data collection used to estimate transportation rates from origin to destination—including transfer and handling fees—for 40 commodity movements on the Gulf Intracoastal Waterway West and alternative rail or truck land routings were studied. The study was intended to be a small-scale scoping exercise for the research team to benchmark more extensive efforts required to conduct future work for the U.S. Army Corps of Engineers (USACE). The study was originally intended to be based on field-collected data, but the researchers encountered stiff resistance from terminal operators when requesting cost information as well as substantial inaccuracies with the contact and ownership information contained in the trip data files and Port Series Reports of the USACE Waterborne Commerce Statistics Center. Therefore, it was necessary to use the Barge Costing Model (BCM) and the researchers' experience to develop transportation rates for most of the movements. The study found that no off-river origin or destination sites were associated with any of the movements. Barge shipment was found to be the least-cost alternative for every movement and, in most cases (38 of the 40 movements), the least-cost and most practical land-only transportation alternative to barge was rail. Detailed rate sheets for each of the 40 commodity movements were developed. The study concluded that in future research efforts, it will be vital to include barge operators in the data collection effort to verify the BCM and the researchers' assumptions.
Is Neurodegenerative Disease a Long-Latency Response to Early-Life Genotoxin Exposure?
Authors: Kisby Glen E. , Spencer Peter S.
Published: September 2011

Western Pacific amyotrophic lateral sclerosis and parkinsonism-dementia complex, a disappearing neurodegenerative disease linked to use of the neurotoxic cycad plant for food and/or medicine, is intensively studied because the neuropathology (tauopathy) is similar to that of Alzheimer’s disease. Cycads contain neurotoxic and genotoxic principles, notably cycasin and methylazoxymethanol, the latter sharing chemical relations with nitrosamines, which are derived from nitrates and nitrites in preserved meats and fertilizers, and also used in the rubber and leather industries. This review includes new data that influence understanding of the neurobiological actions of cycad and related genotoxins and the putative mechanisms by which they might trigger neurodegenerative disease.
Modeling Evacuate versus Shelter-in-Place Decisions in Wildfires
Authors: Cova Thomas J. , Dennison Philip E. , Drews Frank A.
Published: September 2011

Improving community resiliency to wildfire is a challenging problem in the face of ongoing development in fire-prone regions. Evacuation and shelter-in-place are the primary options for reducing wildfire casualties, but it can be difficult to determine which option offers the most protection in urgent scenarios. Although guidelines and policies have been proposed to inform this decision, a formal approach to evaluating protective options would help advance protective-action theory. We present an optimization model based on the premise that protecting a community can be viewed as assigning threatened households to one of three actions: evacuation, shelter-in-refuge, or shelter-in-home. While evacuation generally offers the highest level of life protection, it can place residents at greater risk when little time is available. This leads to complex trade-offs involving expected fire intensity, available time, and the quality and accessibility of in-place shelter. An application of the model is presented to illustrate a range of issues that can arise across scenarios.
Edge effects on growth and biomass partitioning of an Amazonian understory herb (Heliconia acuminata; Heliconiaceae)
Authors: Bruna Emilio M. , de Andrade Ana Segalin
Published: October 2011

• Premise: After deforestation, environmental changes in the remaining forest fragments are often most intense near the forest edge, but few studies have evaluated plant growth or plasticity of plant growth in response to edge effects.

• Methods: In a 2‐year common garden experiment, we compared biomass allocation and growth of Heliconia acuminata with identical genotypes grown in 50 × 35 m common gardens on a 25‐year‐old edge and in a forest interior site.

• Key results: Genetically identical plants transplanted to the forest edge and understory exhibited different patterns of growth and biomass allocation. However, individuals with identical genotypes in the same garden often had very different responses. Plants on forest edges also had higher growth rates and increased biomass at the end of the experiment, almost certainly due to the increased light on the forest edge.

• Conclusions: With over 70000 km of forest edge created annually in the Brazilian Amazon, phenotypic plasticity may play an important role in mediating plant responses to these novel environmental conditions.
Strong phylogenetic effects on floral scent variation of oil‐secreting orchids in South Africa
Authors: Steiner Kim E. , Kaiser Roman , Dötterl Stefan
Published: October 2011

• Premise of the study: Evolution involves the interplay between natural selection and phylogenetic constraint. This is particularly evident among the flowering plants where form and diversity of flowers attest to the importance of both pollinator‐mediated selection and phylogenetic constraint. Although this has been studied mostly using visible floral characters, invisible volatile chemicals emitted by the flowers should be subject to these same evolutionary forces. Unfortunately, most analyses of floral volatiles have over‐emphasized the importance of natural selection and underplayed phylogenetic constraint without quantifying their respective roles in the evolution and composition of floral scents.

• Methods: We used multivariate analyses to test the relative importance of pollinators vs. phylogeny in determining the composition of floral scents among oil‐secreting orchids in southern Africa. Floral scents of 42 oil‐secreting taxa/ecotypes distributed among 12 subclades in the tribe Diseae were sampled using headspace adsorption and gas chromatography‐mass spectroscopy.

• Key results: We identified 257 scent compounds distributed over nine different compound classes, with the majority of scents dominated by aliphatic or benzenoid compounds. The only significant predictor of floral scent among these orchids above the species level was phylogeny. Nevertheless, in two of the clades there were differences in scent profiles at the species and ecotype level that corresponded to different pollinators and were thus suggestive of pollinator‐mediated selection.

• Conclusions: Scent variation was greater than expected and phylogeny was more important than pollinator‐mediated selection in predicting the composition of floral scents of oil‐secreting orchids, despite the specialized nature of the pollinator reward system.
Neuropeptide Release Augments Serum Albumin Loss and Reduces Ultrafiltration in Peritoneal Dialysis
Authors: Cavallini Nicola , Delbro Dick , Tobin Gunnar , Braide Magnus
Published: October 2011

♦Background

The triggers of the acute local inflammatory response to peritoneal dialysis (PD) fluid exposure remain unknown. In the present study, we investigated the effects of neurogenic inflammation and mast cell degranulation on water and solute transport in experimental PD.

♦Methods

Single 2-hour dwells in rats with PD catheters were studied. Histamine and the neuropeptides substance P and calcitonin gene–related peptide (CGRP) were measured in PD fluid samples by ELISA. Radiolabeled albumin (125I and 131I respectively) was used as an intraperitoneal (IP) and intravascular tracer. Glucose and urea concentrations were measured in plasma and PD fluid. The effects of varying the volume and osmolarity of a lactate-buffered PD fluid were compared and related to the effects of pharmacologic intervention.

♦Results

Application of 20 mL 3.9% glucose PD fluid induced an IP histamine release during the first 30 minutes, blockable by the mast cell stabilizer doxantrazole and the substance P neurokinin-1 receptor (NK1R)–blocker span-tide. Histamine release was also inhibited at a reduced PD volume (14 mL), but was not affected by normalizing the PD fluid osmolarity. Blockade of NK1R also reduced plasma albumin leakage to the peritoneal cavity. Inhibition of CGRP receptors by CGRP8-37 improved osmotic (transcapillary) and net ultrafiltration and reduced the dialysate urea concentration. Neuropeptide release was not clearly related to activation of the TrpV1 receptor, the classic trigger of neurogenic inflammation.

♦Conclusions

Neuropeptide release exaggerated albumin loss and reduced ultrafiltration in this rat PD model. Intervention aimed at the neuropeptide action substantially improved PD efficiency.
Comparing Cardiac Surgery in Peritoneal Dialysis and Hemodialysis Patients: Perioperative Outcomes and Two-Year Survival
Authors: Kumar Victoria A. , Ananthakrishnan Shubha , Rasgon Scott A. , Yan Eric , Burchette Raoul , Dewar Karen
Published: October 2011

♦Background

We sought to compare perioperative outcomes and 2-year survival in a cohort of peritoneal dialysis (PD) patients compared with matched hemodialysis (HD) patients who underwent cardiothoracic surgery at our institution.

♦Methods

We obtained a list of all dialysis-dependent patients who underwent cardiac surgery (coronary artery bypass grafting, valve replacement, or both) at our center between 1994 and 2008. All patients undergoing PD at the time of surgery were included in our analysis. Two HD patients matched for age, diabetes status, and Charleston comorbidity score were obtained for each PD patient.

♦Results

The analysis included 36 PD patients and 72 HD patients. Mean age, sex, diabetes status, cardiac unit stay, hospital stay, and operative mortality did not differ by dialysis modality. The incidence of 1 or more postoperative complications (infection, prolonged intubation, death) was higher for HD patients (50% vs. 28% for PD patients, p = 0.046). After surgery, 2 PD patients required conversion to HD. The 2-year survival was 69% for PD patients and 66% for HD patients ( p = 0.73).

♦Conclusions

Our findings suggest that, compared with HD patients, PD patients who require cardiac surgery do not experience more early complications or a lesser 2-year survival and that 2-year survival for dialysis patients after cardiac surgery is acceptable.
Cost-Effectiveness Analysis of the Spanish Renal Replacement Therapy Program
Authors: Villa Guillermo , Fernández–Ortiz Lucía , Cuervo Jesús , Rebollo Pablo , Selgas Rafael , González Teresa , Arrieta Javier
Published: October 2011

♦Background

We undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios.

♦Methods

A Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4).

♦Results

The incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, -€83 150, -€354 977, and -€235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY.

♦Conclusions

Scenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.
The Role of Tumor Necrosis Factor-α Promoter Genetic Variation in Takayasu Arteritis Susceptibility and Medical Treatment
Authors: LV NAQIANG , DANG AIMIN , ZHU XILIN , LIU YING , LIU YIWEN , ZHENG DEYU , HUI RUTAI , LIU GUOZHANG
Published: October 2011

Objective.

Tumor necrosis factor-α (TNF-α) is a multifunctional proinflammatory cytokine that influences the pathogenesis of Takayasu arteritis (TA). There is still no evidence of the relationship between TNF-α gene promoter polymorphisms and TA. We examined whether variations in the TNF-α promoter region may lead to TA susceptibility and disease progression.

Methods.

Five TNF-α gene promoter polymorphisms (−238G/A, −308G/A, −857C/T, −863C/A, and −1031C/T) were analyzed in 110 Chinese Han patients with TA, with a control group of 362 unrelated healthy individuals. Genotypes of TNF-α gene promoter polymorphisms were identified by direct sequencing. TNF-α plasma concentrations were determined by ELISA.

Results.

Our results indicated that the frequency of the −863A allele was significantly lower in the patients with TA than in the controls (18.2% vs 25.7%; p = 0.011), but the significance was lost after Bonferroni correction (pc= 0.055). The frequency of −863CA/AA genotypes was significantly lower in the patients with refractory TA than in those with the 863CC genotype (22.4% vs 44.2%; pc< 0.01). The frequency of the GGCCT haplotype was significantly higher in patients than in the controls, while the frequencies of GGCAT and GGCCC haplotypes were significantly lower in patients than in controls. The plasma TNF-α concentrations were significantly lower in the subjects carrying the −863A allele than in those without. Patients with active TA had a significant increase in plasma levels of TNF-α compared with remission patients and the control group.

Conclusion.

Polymorphisms of the TNF-α promoter are not associated with TA in the Chinese Han population. The A allele of the −863C/A polymorphism is associated with decreased TNF-α expression, which might affect medical treatment.
Effects of Changing from Oral to Subcutaneous Methotrexate on Red Blood Cell Methotrexate Polyglutamate Concentrations and Disease Activity in Patients with Rheumatoid Arthritis
Authors: STAMP LISA K. , BARCLAY MURRAY L. , O’DONNELL JOHN L. , ZHANG MEI , DRAKE JILL , FRAMPTON CHRISTOPHER , CHAPMAN PETER T.
Published: October 2011

Objective.

To determine the effects of changing from oral to subcutaneous (SC) methotrexate (MTX) in patients with rheumatoid arthritis (RA) on red blood cell MTX polyglutamate (RBC MTXGlun) concentrations, disease activity, and adverse effects.

Methods.

Thirty patients were changed from oral to SC MTX. Trough RBC MTXGlun concentrations were measured for 24 weeks and concentrations fitted to a first-order accumulation model. Disease activity was assessed by 28-joint Disease Activity Score (DAS28).

Results.

MTXGlu3, MTXGlu4, and MTXGlu5 concentrations, but not MTXGlu1 and MTXGlu2, increased significantly over 24 weeks, reaching 90% of new steady-state concentrations by about 40 weeks. A decrease in DAS28 was associated with increased RBC MTXGlu5 (p = 0.035) and RBC MTXGlu3–5 (p = 0.032). No change in adverse effect frequency occurred.

Conclusion.

Changing to SC MTX results in increased long-chain MTXGlun. However, it takes at least 6 months for RBC steady-state concentrations to be achieved. Increased long-chain MTXGlun concentrations were significantly associated with reduced disease activity.
The Influence of the Definition of Patient Global Assessment in Assessment of Disease Activity According to the Disease Activity Score (DAS28) in Rheumatoid Arthritis
Authors: DOUGADOS MAXIME , RIPERT MAHAUT , HILLIQUIN PASCAL , FARDELLONE PATRICE , BROCQ OLIVIER , BRAULT YVES , LOGEART ISABELLE
Published: October 2011

Objective.

Patient global assessment (PGA) is one of the 4 items included in the Disease Activity Score (DAS28) for evaluation of activity of rheumatoid arthritis (RA). We studied the influence of the use of 3 different techniques of PGA on the assessment of disease activity.

Methods.

We evaluated 3 different DAS28 according to the technique of PGA in 108 patients with active RA before and after 12 weeks of etanercept therapy.

Results.

The reliability (intraclass coefficient of correlation) between screening and baseline was very high and similar for the 3 DAS28. The percentage of patients in the different states of disease (from remission to higher disease activity) and the sensitivity to change across the 3 DAS28 scales were very similar.

Conclusion.

The different techniques of collection of PGA to be included in the DAS calculation yield similar results. However, an accepted, unequivocal technique should be encouraged in order to reduce heterogeneity in scoring DAS among patients with RA.
A Nonsynonymous Functional Variant of the ITGAM Gene Is Not Involved in Biopsy-proven Giant Cell Arteritis
Authors: CARMONA F. DAVID , SERRANO AURORA , RODRÍGUEZ-RODRÍGUEZ LUIS , CASTAÑEDA SANTOS , MIRANDA-FILLOY JOSÉ A. , MORADO INMACULADA C. , NARVÁEZ JAVIER , SOLANS ROSER , SOPEÑA BERNARDO , MARÍ-ALFONSO BEGOÑA , UNZURRUNZAGA AINHOA , ORTEGO-CENTENO NORBERTO , BLANCO RICARDO , DE MIGUEL EUGENIO , HIDALGO-CONDE ANA , MARTÍN JAVIER , GONZÁLEZ-GAY MIGUEL A.
Published: October 2011

Objective.

To investigate whether a functional integrin alpha M (ITGAM) variant is involved in susceptibility to and clinical manifestations of giant cell arteritis (GCA).

Methods.

A Spanish cohort of 437 white patients with biopsy-proven GCA and 1388 healthy controls were genotyped using the TaqMan allele discrimination technology.

Results.

No association was observed between ITGAM rs1143679 and GCA (p = 0.80, OR 0.97). Similarly, subphenotype analyses did not yield significant differences between the case subgroups and the control set or between GCA patients with or without the main specific features of GCA.

Conclusion.

Our results suggest that the ITGAM rs1143679 variant does not play an important role in the pathophysiology of GCA.
Le corps masculin : une production culturelle ?
Authors: Schneider Monique
Published: October 2011

Monique Schneider a pour objectif une critique féministe des positions freudiennes sur la virilité. Voulant poser l’anatomie comme destin, Freud ne retient du corps masculin que l’un de ses emblèmes : le pénis, symbolisant la verticalité. Monique Schneider précise qu’il a oublié, au passage, une partie, les testicules, fantasmée, en tant qu’elle transite par le signifiant « les œufs », comme associée à un risque de fracture. Et c’est alors qu’elle affirme que deux fonctions potentiellement masculines sont séparées : le pouvoir politique et la fécondité, à laquelle se vouent les prolétaires. Elle cite en référence F. Héritier, anthropologue, qui souligne l’importance du thème de la fécondité comme marqueur de la différence sexuelle. Fécondité corrélée, dans le rêve très célèbre, celui du « grand exploit », à un phénomène d’accouchement.
Le cœur des hommes
Authors: Lahlou-Laforêt Khadija
Published: October 2011

Le travail du psychiatre de liaison dans un service de cardiologie permet d’aborder la question de l’identité masculine chez des hommes atteints par une pathologie cardiaque. Trois cas cliniques rapportés suggèrent un renforcement de l’identité masculine chez des hommes jeunes confrontés à un tel risque, et un affaiblissement de cette identité lorsque l’atteinte cardiaque survient chez un homme plus âgé.
Virilité et masculinité des hommes handicapés
Authors: Ancet Pierre
Published: October 2011

À partir d’un travail clinique récent avec Marcel Nuss sur la virilité avec des hommes atteints d’un handicap l’auteur s’interroge sur les liens entre virilité et masculinité. Est interrogée l’identité sexuelle comme part de l’identité socialement construite dans un dispositif de sexualité. La clinique de l’homme handicapé physique, supposé dépourvu de virilité vient éclairer la clinique du masculin en général. Ne peut-on jouer un rôle masculin (par exemple dans la fonction paternelle, dans la sexualité ou au travail) sans posséder les attributs stéréotypés de la virilité ?
« Suis-je un homme avec toi ? » : L'illusion conjugale à l'épreuve du handicap physique
Authors: Coopman Anne-Laurence , Janssen Christophe
Published: October 2011

David est tétraplégique. Dans un premier temps, il refuse l’aide psychologique qui lui est proposée. Les auteurs examinent en quoi cette atteinte brutale du corps se répercute sur le fonctionnement psychique et porte atteinte au narcissisme. C’est plusieurs mois plus tard qu’il viendra en consultation non pas pour les difficultés inhérentes à son handicap mais bien pour les questions qu’il se pose par rapport à son couple. Les auteurs se proposent d’envisager le handicap, à la lumière de ce cas clinique, comme un redoublement dans le corps de difficultés psychiques préalables à l’événement traumatique. Une forme de dépendance réelle conduirait la personne à faire l’expérience dans la réalité de ce qui, jusque-là, s’actualisait à bas bruit, guidé par le fantasme. À travers l’histoire de David, mais aussi par quelques explorations théoriques, les auteurs s’intéressent au processus en jeu dans le lien de couple et à la perturbation de l’illusion conjugale que provoque l’atteinte du corps.
Tatouages et masculinités chez les étudiants en sport de Karukéra. Le tégument comme affirmation d'une puissance physique et sexuelle ?
Authors: Saint-Clément Steeve , Héas Stéphane
Published: October 2011

En Guadeloupe, le décryptage des marques corporelles volontaires auprès de sept étudiants en Sciences et Techniques des Activités Physiques et Sportives indique l’importance notamment d’un bestiaire. Ces marques participent peut-être de manière voilée à un ancrage tutélaire proche d’une sotériologie. Mais ces tatouages mettent surtout en relief un soi esthétisé, visible et lisible par la marque.
L'Homme déformé chez Bacon
Authors: Reynier Gérard
Published: October 2011

Le corps de l’homme est ici présenté dans une de ses incarnations singulières : la déformation corporelle chez Bacon. Au-delà des discours consensuels, l’omniprésence de la déformation sera interrogée selon ses deux registres plastique et analytique. Si le premier vise le dévoilement des forces agitant la matière vivante perceptibles dans les sensations affectant la chair, le deuxième concerne le reflet distordu de l’image réfléchie interrogeant le miroir dont il est issu. Miroirs déformants qui conduisent vers celui, singulier, de Bacon révélant une identité aux prises avec le mouvement de l’informe.
Le corps dans les subcultures sombres. Représentations et mises en jeu sensorielles
Authors: Rigaut Philippe
Published: October 2011

Les imaginaires sombres se développent désormais à travers une scène artistique ouverte à différents modes d’expression et à une forte dimension communautaire. Cette subculture véhicule des esthétiques, mais aussi des conduites de vie, marquées par un jeu de proximité entre subversion culturelle et perversion. L’auteur pose un regard sociologique sur les esthétiques sombres dans lesquelles le corps est mis à l’épreuve, comme représentation mais aussi comme performance constituant un motif majeur, en lien à une éthique de l’ambivalence des sentiments et des sensations.
Critically Ill Patients With H1N1 Influenza A Undergoing Extracorporeal Membrane Oxygenation
Authors: Bibro Christopher , Lasich Christine , Rickman Frank , Foley Nichole E. , Kunugiyama Sujen K. , Moore Ember , O’Brien Amy , Sherman Natalie , Schulman Christine S.
Published: October 2011

The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis. Among the 15 patients with H1N1 influenza A treated with ECMO, 4 patients received the therapy simultaneously. The role of ECMO in supporting patients with severe respiratory failure due to H1N1 influenza is described, followed by discussions of the nursing care challenges for each body system. Variations from standards of care, operational considerations regarding staff workload, institutional burden, and emotional wear and tear of the therapy on patients, patients’ family members, and the entire health care team are also addressed. Areas for improvement for providing care of the critically ill patient requiring ECMO are highlighted in the conclusion.
Aspiration Prevention Protocol: Decreasing Postoperative Pneumonia in Heart Surgery Patients
Authors: Starks Bobbie , Harbert Christy
Published: October 2011

Background

Postoperative pneumonia contributes to morbidity and mortality in patients who have open heart surgery.

Objectives

To determine if measures to reduce aspiration in patients after cardiothoracic surgery would decrease the occurrence of postoperative pneumonia.

Methods

All patients undergoing cardiothoracic surgery from April 2008 through October 2008 were prospectively enrolled in the study. An aspiration prevention protocol was developed and implemented in a 24-bed intensive care unit. The protocol incorporated a bedside swallowing evaluation by a speech therapist and progressive oral intake.

Results

In the 6 months before development and implementation of the protocol, postoperative pneumonia developed in 11% of patients. After implementation of the protocol, no patients had postoperative pneumonia (P < .01).

Conclusions

Implementing an aspiration prevention protocol was effective in reducing the occurrence of postoperative pneumonia in patients who had cardiothoracic surgery.
Enhancing Leadership Orientation Through Simulation
Authors: Radovich Patricia , Palaganas Janice , Kiemeney Jennifer , Strother Bradley , Bruneau Brenda , Hamilton Lori
Published: October 2011

Many novice managers feel unprepared to handle some of the situations that occur as a daily part of their job. It is important to provide an environment through which novice managers can receive training and develop skills in effective communication in complex nursing environments. Simulation-based training can provide a safe, interactive way for new managers to develop their communication and leadership skills. This type of training allows novice managers to increase their confidence and improve their job satisfaction and their management skills.
Neuroinflammation and Endoplasmic Reticulum Stress Are Coregulated by Crocin To Prevent Demyelination and Neurodegeneration
Authors: Deslauriers André M. , Afkhami-Goli Amir , Paul Amber M. , Bhat Rakesh K. , Acharjee Shaona , Ellestad Kristofor K. , Noorbakhsh Farshid , Michalak Marek , Power Christopher
Published: October 2011

Endoplasmic reticulum (ER) stress is a homeostatic mechanism, which is used by cells to adapt to intercellular and intracellular changes. Moreover, ER stress is closely linked to inflammatory pathways. We hypothesized that ER stress is an integral component of neuroinflammation and contributes to the development of neurological diseases. In autopsied brain specimens from multiple sclerosis (MS) and non-MS patients, XBP-1 spliced variant (XBP-1/s) was increased in MS brains (p < 0.05) and was correlated with the expression of the human endogenous retrovirus-W envelope transcript, which encodes the glycoprotein, Syncytin-1 (p < 0.05). In primary human fetal astrocytes transfected with a Syncytin-1–expressing plasmid, XBP-1/s, BiP, and NOS2 were induced, which was suppressed by crocin treatment (p < 0.05). Crocin also protected oligodendrocytes exposed to cytotoxic supernatants derived from Syncytin-1–expressing astrocytes (p < 0.05) and NO-mediated oligodendrocytotoxicity (p < 0.05). During experimental autoimmune encephalomyelitis (EAE), the transcript levels of the ER stress genes XBP-1/s, BiP, PERK, and CHOP were increased in diseased spinal cords compared with healthy littermates (p < 0.05), although CHOP expression was not involved in the EAE disease phenotype. Daily treatment with crocin starting on day 7 post-EAE induction suppressed ER stress and inflammatory gene expression in spinal cords (p < 0.05), which was accompanied by preserved myelination and axonal density, together with reduced T cell infiltration and macrophage activation. EAE-associated neurobehavioral deficits were also ameliorated by crocin treatment (p < 0.05). These findings underscored the convergent roles of pathogenic ER stress and immune pathways in neuroinflammatory disease and point to potential therapeutic applications for crocin.
IL-17 Boosts Proinflammatory Outcome of Antiviral Response in Human Cells
Authors: Ryzhakov Grigory , Lai Cheryl Chuk-ke , Blazek Katrina , To Ken-win , Hussell Tracy , Udalova Irina
Published: October 2011

Excessive inflammation during bacterial and viral infections is destructive to the host and involves elevated production of proinflammatory cytokines. It is especially deleterious in organs with space constraints such as lung and the CNS. Indeed, a number of viruses that infect lungs, such as avian influenza virus, SARS-associated coronavirus, and respiratory syncytial virus, elicit a very high level of proinflammatory cytokines; however, it is unclear what triggers their production. In this study, we show that IL-17 commonly produced during viral infection specifically augments a proinflammatory response by directly synergizing with antiviral signaling. Costimulation of primary human fibroblasts with IL-17 greatly enhanced respiratory syncytial virus-induced or synthetic dsRNA-based viral mimic polyinosinic:polycytidylic acid-induced expression of proinflammatory genes without affecting expression of IFN-β–stimulated or IFN-stimulated genes. Knockdown of expression of known mediators of the antiviral signaling pathway revealed that the IL-17–poly(I:C) synergy depends on the presence of the transcriptional factors RelA and IFN regulatory factor 3 and IκB kinases. Moreover, this synergy was blocked by an IκB kinase inhibitor, BAY 11-7082. These findings shed light on the molecular mechanisms behind IL-17–dependent immunopathology observed in viral infections.