bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of ultrasound for non‐trauma patients in the emergency department
Authors: Lokuge Amaali , Mitra Biswadev , Bystrzycki Adam
Published: April 2013

Objective

In the past decade, there has been substantial knowledge translation in the use of ultrasound (US) by critical care physicians to aid diagnosis of the non‐trauma patient. This study aimed to determine emergency doctors' level of training in ultrasonography, pattern of US use in regular practice and barriers to US use for the non‐trauma patient presenting to an emergency department.

Method

A survey on the use of US in non‐trauma patients was conducted, targeting all emergency physicians and emergency medicine trainees in a single adult tertiary referral centre.

Results

The response rate was 92.7% with 38 completed surveys analysed. A course in non‐trauma US had been completed by 58% of respondents. The most common non‐trauma formal US training was in vascular access (82%, 95% confidence interval [CI] 66.8–90.6), detection of abdominal aortic aneurysm (79%, 95% CI 63.7–88.9) and pericardial fluid (84%, 95% CI 69.6–92.6). Upon completion of formal training, US was used significantly more frequently for obtaining vascular access (odds ratio [OR] 12.0), detection of abdominal aortic aneurysms (OR 4.3) and detection of pericardial fluid (OR 15.5). Most doctors felt the greatest barriers to the use of US in the non‐trauma patient were the lack of teaching, confidence in findings, experienced supervisors and time.

Conclusions

Among ED personnel, use of US to diagnose several non‐traumatic conditions was low, but specific training was associated with significantly more US use. Increased training and availability of US‐experienced supervisors might further improve utility of this important adjunct to the practice of emergency medicine.
Effect of climate change on the occurrence of overwintered moths of orchards in South Korea
Authors: Jung Myung‐Pyo , Kim Kwang‐Ho , Lee Sang‐Guei , Park Hong‐Hyun
Published: April 2013

According to the Intergovernmental Panel on Climate Change (IPCC), the global mean surface temperature increased by 0.74°C between 1906 and 2005, and is expected to continue rising. In Korea, the temperature increased rapidly by 1.8°C between 1912 and 2010. The effect of global warming are expected to cause phenological changes in exothermic organisms such as insect pests which are highly dependent on temperature. In present study, we estimated the emergence time of three lepidopteran pests (Carposina sasakii, Grapholita molesta, and Phyllonorycter ringoniella) in apple orchards during 2000, 2020s, 2050s, and 2090s, by means of Representative Concentration Pathway (RCP) 8.5 climate change scenario. In comparison with 2000, the emergence of C. sasakii is predicted to occur 5.5 ± 0.49 days earlier in 2020s, 14.9 ± 0.40 days earlier in 2050s, and 40.0 ± 0.75 days earlier in 2090s; the emergence of G. molesta is predicted to occur 8.2 ± 0.36 days earlier in 2020s, 16.9 ± 0.40 days earlier in 2050s, and 49.7 ± 0.61 days earlier in 2090s; and the emergence of P. ringoniella is predicted to occur 9.0 ± 0.34 days earlier in 2020s, 20.5 ± 0.58 days earlier in 2050s, and 52.5 ± 0.63 days earlier in 2090s. The number of generations a year is expected to increase by 0.5–2.8 generations in 2050s, 1.3–6.7 in 2090s. Our predictions provide basic data for the development of insect pest management strategies in spring under conditions of global warming.
Green Tea Formulations with Vitamin C and Xylitol on Enhanced Intestinal Transport of Green Tea Catechins
Authors: Chung Jae‐Hwan , Kim Sol , Lee Sang‐Jun , Chung Jin‐Oh , Oh Yu‐Jin , Shim Soon‐Mi
Published: April 2013

The effect of green tea formulated with vitamin C and xylitol on intestinal cell transport of gallated and nongallated catechin was studied. The transport of catechins from both apical to basolateral and basolateral to apical directions was measured. The effect of vitamin C (4, 10, 20 ppm), xylitol (11, 27.5, 55 ppm), and combinations of both on the intestinal transport rate of catechins was examined. The efflux value (Pb→a/Pa→b) of (–)‐epigallocatechin (EGC), (–)‐epigallocatechin gallate (EGCG), (–)‐epicatechin (EC), and (–)‐epicatechin gallate (ECG) was 0.26, 0.22, 1.22, and 0.17, respectively, indicating that EC appeared to be less absorbed compared with other catechins. The addition of xylitol (11, 27.5, 55 ppm) and vitamin C (4, 10, 20 ppm) and in combination enhanced transport rate of nongallated catechins such as EC and EGC. For EC, vitamin C was revealed to be the most effective on intestinal transport, implying the inhibition of the efflux transport mechanism of EC. Intestinal transport of gallated catechins significantly increased from catechins formulated with vitamin C and xylitol in a dose‐dependent manner compared to the catechin‐only formulation. Results provide a potential strategy to enhance the delivery and bioavailability of catechins in humans by modulating green tea formulation with vitamin C and xylitol.
Pelvic floor muscle training improves quality of life of women with urinary incontinence: a prospective study
Authors: Fan Hiu Lan , Chan Symphorosa Shing Chee , Law Tracy Sze Man , Cheung Rachel Yau Kar , Chung Tony Kwok Hung
Published: April 2013

Background

Women suffering from urinary incontinence have impaired quality of life (QoL). Pelvic floor muscle training (PFMT) has been recommended to be the first‐line treatment for them.

Aims

This study evaluated the role of (PFMT) in women with urinary incontinence.

Materials and Methods

All women suffering from urinary incontinence without pelvic organ prolapse who attended the urogynaecology unit of a university hospital from January 2009 to June 2010 were recruited. Urinary symptoms and impact on QoL were assessed using the Chinese validated Urogenital Distress Inventory short form (UDI‐6) and Incontinence Impact Questionnaire short form (IIQ‐7) before and after PFMT. Urodynamic studies (UDS) were used to differentiate the diagnoses of urinary incontinence.

Results

Three hundred and seventy‐two women, aged 52.3 ± 10.8 years and practised PFMT for 9.9 ± 7.3 months, completed the study. Over 65% recorded improvement in both UDI‐6 and IIQ‐7. Stratified for urodynamic diagnosis, stress incontinence group and those who had no UDS abnormality had significant improvement in their urinary symptoms and QoL after PFMT. UDI‐6 and IIQ‐7 also improved significantly after PFMT in groups where the clinical presentation was stress incontinence, overactive bladder symptoms or mixed urinary incontinence. Age was not associated with a significant difference in the response to PFMT.

Conclusions

Pelvic floor muscle training appears to be an effective first‐line intervention for improving urinary symptoms and QoL of women presenting with urinary incontinence. Future studies on long‐term effectiveness and cost‐effectiveness are also required.
Predictors of intergroup concern for disaster victims of the Japan earthquake
Authors: Sun Shaojing , Zagefka Hanna , Goodwin Robin
Published: April 2013

The study examined the relationships between out‐group perception, perceived intergroup conflict, emotions, and concern for out‐group victims in the context of the Japanese earthquake of 2011. Six hundred and eighty‐six participants in China completed a questionnaire immediately after the earthquake. Results showed that the image of Japan and historical conflicts between the two nations significantly predicted intergroup emotions. A positive image of Japan enhanced Chinese respondents' perceived competence of the Japanese people, which, however, appeared to mitigate concern for the victims. Positive emotions increased participants' concern for Japanese victims. Implications of the research findings are discussed with reference to research on intergroup relations and help following disasters.
A double‐blind, placebo‐controlled study of adjunctive calcitonin nasal spray in acute refractory mania
Authors: Vik Astrid , Ravindran Arun , Shiah I‐Shin , Wong Hubert , Walji Nazlin , Lam Raymond W , Yatham Lakshmi N
Published: April 2013

Objectives

Calcitonin, a neuropeptide, has been shown in preliminary double‐blind trials to reduce agitation in patients with acute mania. Given that it has effects similar to those of lithium and anticonvulsants on modulation of second‐messenger signaling pathways and stabilization of neuronal membranes, this study examined the efficacy of calcitonin nasal spray in treating acute manic symptoms in patients with treatment‐resistant mania using a double‐blind, placebo‐controlled design.

Methods

A total of 46 hospitalized patients experiencing either a manic or a mixed episode, who were refractory to treatment with adequate doses of either a mood stabilizer or an antipsychotic, or a mood stabilizer/antipsychotic combination, and had a score of ≥16 on the Young Mania Rating Scale (YMRS), were randomized to receive adjunctive nasal calcitonin 200 IU (n = 24) or saline (n = 22) spray for three weeks. The primary efficacy measure was the change in YMRS scores using the last observation carried forward (LOCF) method.

Results

The clinical and demographic characteristics were similar between the groups. Patients had a mean YMRS score of 26 in the placebo group and a mean score of 25 in the calcitonin group. There were no significant differences in YMRS scores or percentage responders at three weeks between patients who received calcitonin and those who received placebo. There were also no significant differences in change scores on any other scales. Few patients experienced any adverse events.

Conclusions

This study does not support the use of nasal calcitonin in the treatment of treatment‐resistant mania.
C9ORF72 expansion in a family with bipolar disorder
Authors: Meisler Miriam H , Grant Adrienne E , Jones Julie M , Lenk Guy M , He Fang , Todd Peter K , Kamali Masoud , Albin Roger L , Lieberman Andrew P , Langenecker Scott A , McInnis Melvin G
Published: April 2013

Objective

To investigate the role in bipolar disorder of the C9ORF72 hexanucleotide repeat expansion responsible for frontotemporal lobe dementia and amyotrophic lateral sclerosis.

Methods

Eighty‐nine subjects from a previously described panel of individuals with bipolar disorder ascertained for genetic studies were screened to detect expansion of the C9ORF72 repeat. One two‐generation family with bipolar disorder and an expanded repeat was characterized in depth using molecular diagnostics, imaging, histopathology, and neurological and neuropsychological evaluation.

Results

One proband, with the typical clinical presentation of bipolar disorder, carried an expanded C9ORF72 allele of heterogeneous length between 14 and 20 kilobases (kb) as assessed by Southern blot. The expanded allele was inherited from a parent with atypical, late onset clinical features of bipolar disorder, who subsequently progressed to frontotemporal lobe dementia. The expansion in peripheral blood of the parent ranged from 8.5 to 20 kb. Cultured lymphoblastoid cells from this parent exhibited a homogeneous expansion of only 8.5 kb.

Conclusions

The disease course in the two generations described here demonstrates that expansion of the C9ORF72 may be associated with a form of bipolar disorder that presents clinically with classic phenomenology and progression to neurodegenerative disease. The frequency in our bipolar disorder cohort was only 1%, indicating that C9ORF72 is not a major contributor to bipolar disorder. DNA from cultured cells may be biased towards shorter repeats and nonrepresentative of the endogenous C9ORF72 expansion.
Development of a new chewing function questionnaire for assessment of a self‐perceived chewing function
Authors: Peršić Sanja , Palac Antonija , Bunjevac Tomislav , Čelebić Asja
Published: April 2013

Objective

To develop a new unidimensional questionnaire for patients' self‐assessment of their chewing function (chewing function questionnaire: CFQ) and to test its psychometric properties.

Methods

A focus group of 7 dentists and 15 prosthodontic patients generated a pool of 30 relevant items. A 5‐point Likert scale (0–4) was used. A focus group reduced some redundant items, and 21 items remained for pilot testing after which additional four items were eliminated. Then, the 17‐item questionnaire was tested on a larger sample (200 participants). Factor analysis was obtained to investigate the dimensionality of the questionnaire. Finally the 10 items remained, and the CFQ was unidimensional. To test the psychometric properties, the CFQ was administrated to 224 individuals: 100 patients were already removable denture wearers (RDWs), 24 patients needed a removable prosthodontic treatment, and 100 individuals had natural teeth (NT group). Discriminative validity was tested between the RDWs and the NT groups. Convergent validity and internal consistency were tested on 200 subjects. The internal consistency was assessed by calculating the Cronbach's alpha coefficient and the average interitem correlation. The test–retest reliability was tested on 60 subjects. Responsiveness was tested on 24 patients who received new removable prosthodontic treatment.

Results

The initial factor analysis revealed that the items had been grouped in three different dimensions. By eliminating items with complexities greater than one, additional six questions were eliminated. One more item with the lowest correlation was further eliminated. The final questionnaire included 10 items. Discriminative validity showed significant differences between the NT group and the RDWs, as predicted (P < 0.001). Convergent validity was confirmed by the Spearman's rank correlation. A significant positive association (P < 0.001) was found between the CFQ and one general question about chewing difficulties, as well as between the CFQ and five items from the OHIP49 related to chewing. The test–retest reliability showed high intraclass correlation and no significant differences between the two administrations of the CFQ (P > 0.05). The internal consistency showed satisfactory Cronbach's alpha values (0.916 for all subjects, 0.742 for the NT group, and 0.852 for the RDWs). Responsiveness was confirmed by a significant difference between the baseline and the follow‐up score (P < 0.001) and a high effect size (0.95).

Conclusions

The developed CFQ provides an assessment instrument of the hypothetical construct invoked to explain the chewing function. Psychometric properties are satisfactory demonstrating that the instrument is suitable for the assessment of a self‐perceived chewing function.
Molecular and clinical characterization of Angelman syndrome in Chinese patients
Authors: Bai J.‐L. , Qu Y.‐J. , Jin Y.‐W. , Wang H. , Yang Y.‐L. , Jiang Y.‐W. , Yang X.‐Y. , Zou L.‐P. , Song F.
Published: April 2013

Angelman syndrome (AS) is a neurobehavioral disorder caused by lack of function of the maternal copy of the ubiquitin‐protein ligase E3A (UBE3A) gene. In our study, 49 unrelated patients with classic AS phenotypes were confirmed by methylation‐specific PCR (MS‐PCR) analysis, short tandem repeat linkage analysis, and mutation screening of the UBE3A gene. Among the Chinese AS patients, 83.7% (41/49) had deletions on maternal chromosome 15q11.2‐13. Paternal uniparental disomy, imprinting defects, and UBE3A gene mutations each accounted for 4.1% (2/49). Two AS patients were confirmed by MS‐PCR analysis, but the pathogenic mechanism was unknown because their parents' samples were unavailable. Of the two described UBE3A gene mutations, that is, p.Pro400His (c.1199C>A) and p.Asp563Gly (c.1688A>G), the latter has not been reported previously. Mutation transmission analysis showed that the p.Pro400His and p.Asp563Gly mutations originated from asymptomatic mothers. The patients with the maternal deletion showed AS clinical manifestations that were consistent with other studies. However, the incidence of microcephaly (36.7%, 11/30) was lower than that in the Caucasian population (approximately 80%), but similar to that of the Japanese population (34.5%). Our study demonstrated that the occurrence of microcephaly in AS may vary among different populations.
Robust Fitting on Poorly Sampled Data for Surface Light Field Rendering and Image Relighting
Authors: Vanhoey K. , Sauvage B. , Génevaux O. , Larue F. , Dischler J.‐M.
Published: April 2013

Two‐dimensional (2D) parametric colour functions are widely used in Image‐Based Rendering and Image Relighting. They make it possible to express the colour of a point depending on a continuous directional parameter: the viewing or the incident light direction. Producing such functions from acquired data is promising but difficult. Indeed, an intensive acquisition process resulting in dense and uniform sampling is not always possible. Conversely, a simpler acquisition process results in sparse, scattered and noisy data on which parametric functions can hardly be fitted without introducing artefacts. Within this context, we present two contributions. The first one is a robust least‐squares‐based method for fitting 2D parametric colour functions on sparse and scattered data. Our method works for any amount and distribution of acquired data, as well as for any function expressed as a linear combination of basis functions. We tested our fitting for both image‐based rendering (surface light fields) and image relighting using polynomials and spherical harmonics. The second one is a statistical analysis to measure the robustness of any fitting method. This measure assesses a trade‐off between precision of the fitting and stability with respect to input sampling conditions. This analysis along with visual results confirm that our fitting method is robust and reduces reconstruction artefacts for poorly sampled data while preserving the precision for a dense and uniform sampling.
Rotating titanium brush for plaque removal from rough titanium surfaces – an in vitro study
Authors: John Gordon , Becker Jürgen , Schwarz Frank
Published: April 2013

Objectives

The purpose of this study was the evaluation of the effectiveness of plaque removing of a new rotating brush made of titanium in comparison with the cleaning procedure with steel curettes.

Materials and methods

Plaque was collected by six volunteers for 48 h. A total of 60 samples were randomly designated to two groups: the test group TiBrush and the control group with steel curettes. The residual plaque area (RPA) and the treatment time were determined as parameters. Scanning electron microscopy (SEM) was performed for detecting possible damages of the treatment procedures.

Results

The mean RPA within the TiBrush group (8.57 ± 4.85%) was significant lower than in the control group (28.99 ± 5.51%), while the mean treatment time was also significant lower in the TiBrush group (176.7 ± 15.2 sec) in comparison with the steel curettes (303.5 ± 11.5 sec). The outcomes of SEM analysis showed no surface alteration after TiBrush treatment.

Conclusions

Within the limits of this study, this investigation concludes that TiBrush seems to be more effective in plaque removing capacity, while being gentler to the implant surface than the processing with steel curettes. These promising results could hold out an improvement of conventional periimplantitis treatment. Further studies are needed to prove these outcomes.
Efficacy of Mitomycin C for postoperative endoscopic sinus surgery: a systematic review and meta‐analysis
Authors: Numthavaj P. , Tanjararak K. , Roongpuvapaht B. , McEvoy M. , Attia J. , Thakkinstian A.
Published: April 2013

Background

Mitomycin C has recently been used to prevent nasal synechiae and sinus ostium stenosis after endoscopic sinus surgery.

Objective of review

To compare nasal synechiae rate between topical Mitomycin C and saline or no treatment.

Type of review

Systematic review and meta‐analysis.

Data sources

MEDLINE, SCOPUS, and Cochrane Register of Controlled Trials databases were used to identify studies up to January 2013.

Evaluation method

Data were independently extracted by two reviewers (PN and KT). Studies which compared topical Mitomycin C with control where the outcomes of interest were nasal synechiae or sinus ostium stenosis were included. Baseline study characteristics, quality of study, numbers of patients between treatment and control groups, outcomes, and adverse events were extracted. A multivariate meta‐analysis was separately applied for each outcome (nasal synechiae and maxillary sinus ostium stenosis).

Results

Among 11 included studies, most studies used Mitomycin C dose of 0.4–0.5 mg/mL 1–5 mL in the middle meatus for 5 min duration. Eight studies reported synechiae with 281 and 281 nasal cavities received Mitomycin C and saline, respectively. For outcome of nasal synechiae, a multivariate meta‐analysis suggested that Mitomycin C was associated with a 66% (RR = 0.34, 95% CI: 0.18–0.65) lower risk of nasal synechiae with moderate heterogeneity (I2 = 43%, 95% CI: 0–77%). Subgroup analyses by age and history of revision could reduce the degree of heterogeneity. Mitomycin C benefits were found in subgroups of age ≤ 40 years (RR = 0.27, 95% CI: 0.05–1.50) and patients without any history of revision (RR = 0.19, 95% CI: 0.06–0.58). Five studies with 134 and 140 nasal cavities for Mitomycin C and saline were included in pooling of maxillary sinus ostium stenosis. Mitomycin C was associated with 74% (RR = 0.26, 95% CI: 0.12–0.54) lower risk of maxillary sinus ostium stenosis when compared with saline with low heterogeneity (I2 = 5%, 95% CI: 0–85%). There was no evidence of publication bias for both poolings.

Conclusion

Applying Mitomycin C topically after endoscopic sinus surgery could reduce the risk of nasal synechiae and maxillary sinus ostium stenosis in short term by 66% and 74%, respectively. The treatment effects may be more beneficial in patients aged 40 years or younger or in patients without history of revision. However, our results were based on pooling trials with questionable methodological quality. Further trials with good research methodology and long‐term follow‐up should be conducted to confirm our results.
Recognition of goblet cells upon endocytoscopy indicates the presence of gastric intestinal metaplasia
Authors: Chiu Philip Wai Yan , Ng Enders Kwok Wai , To Kai Fai , Teoh Anthony Yuen Bun , Lam Candice Chuen Hing , Chan Francis Ka Leung , Sung Joseph Jao Yiu , Lau James Yun Wong
Published: April 2013

Background

Gastric intestinal metaplasia (IM) is considered precancerous and is difficult to differentiate upon endoscopy. Endocytoscopy enables observation at a cellular level for focused biopsy. The present study examined the use of endocytoscopy for recognition of gastric IM.

Patients and Methods

Patients with a history of gastric IM were recruited. We first carried out narrow band imaging (NBI) endoscopy to look for suspicious areas of gastric IM. A prototype endocytoscope with a magnification of 450× was used to re‐examine these areas. Areas examined were biopsied for histological comparison. Presence of goblet cells was considered as representative of IM upon endocytoscopy.

Results

Twenty patients were recruited with NBI demonstrating 102 suspicious lesions of gastric IM. Mean age of patients was 53.9 ± 7.6 years. Upon histology, 72 biopsies were confirmed as gastric IM, 15 showed IM and low‐grade dysplasia, whereas 15were diagnosed as chronic gastritis. Endocytoscopy image quality was significantly better for areas of IM as compared to gastritis (P < 0.05; OR 21.7 [95% CI 4.5–105.9]). The presence of goblet cells upon endocytoscopy achieved a diagnostic accuracy of 0.86 for gastric IM. Receiver operator characteristics curve achieved an area under curve of 0.8 with the presence of goblet cells under endocytoscopy as compared to 0.64 for NBI alone.

Conclusions

Presence of goblet cells upon endocytoscopy indicates a diagnosis of gastric IM. Image quality of endocytoscopy, however, is suboptimal. Further developments in endocytoscopy should focus on image quality and staining methods to enhance differentiation between IM, dysplasia and early gastric cancer.
Classification of Left Ventricular Diastolic Function Using American Society of Echocardiography Guidelines: Agreement among Echocardiographers
Authors: Chapman Carrie B. , Ewer Steven M. , Kelly Annie F. , Jacobson Kurt M. , Leal Miguel A. , Rahko Peter S.
Published: April 2013

Guidelines for assessing diastolic function by echocardiography are continually being updated. Our ability to use available guidelines effectively has not been completely investigated. Six trained echocardiographers were asked to interpret 105 echocardiograms using current American Society of Echocardiography (ASE) algorithms for interpretation of diastolic grade and estimation of left atrial (LA) pressure. Diastolic grade was categorized as normal, mild, moderate, or severe dysfunction. The presence or absence of elevated LA pressure was determined using a second ASE algorithm. As a reference comparison for level of agreement, left ventricular ejection fraction was visually determined. By the ASE algorithm, 29 subjects (28%) met all measurement criteria in their assigned grade and 57 subjects (55%) met all or all but one criterion of their assigned grade. Of the 45 subjects (43%) for whom the guidelines disagreed by more than 1 criterion, the readers debated between normal and moderate dysfunction in 22% or mild and moderate diastolic dysfunction in 31%. Percent inter‐reader agreement and kappa values were 76% (0.7) for determining diastolic grade, 84% (0.67) for determining elevated LA pressure, and 84% (0.67) for estimation of ejection fraction, the reference standard. For all subjects, if multiple echocardiographic criteria failed to fit into the proposed guidelines, agreement fell to 66% (0.58) for determining diastolic grade and 74% (0.48) for determining LA pressure. There is reasonable agreement estimating diastolic grade and LA pressure using current guidelines. Further refinements in the definition of mild and moderate dysfunction may improve agreement.
Double‐Chambered Right Ventricle with Pulmonary Valve Endocarditis
Authors: Chaurasia Ajay S. , Nawale Jaywant M. , Yemul Madhusudan A.
Published: April 2013

We describe a rare case of pulmonary valve endocarditis associated with a double‐chambered right ventricle in an adolescent male highlighting the two‐dimensional and three‐dimensional transthoracic echocardiographic findings. He was managed with aggressive antibiotic therapy followed by surgery. The echocardiographic findings were confirmed during surgery.
Postextrasystolic Potentiation in Low‐Gradient, Severe Aortic Stenosis: A Poor Man's Stress Echo?
Authors: Bhave Nicole M. , Patel Amit R. , Shah Atman P. , Lang Roberto M.
Published: April 2013

An elderly man with dyspnea and syncope was found to have severe aortic stenosis (AS) by the continuity equation, despite a transaortic gradient that was only moderately elevated, in the setting of severe left ventricular dysfunction. The transaortic gradient increased during postextrasystolic beats, suggesting that his that his AS was truly severe; this was confirmed by dobutamine echocardiography. He underwent transcatheter aortic‐valve replacement (TAVR), with subsequent improvement in left ventricular systolic function. The diagnostic and prognostic significance of postextrasystolic potentiation, with associated increase in aortic stenosis gradient, deserves renewed attention in the TAVR era.
A New View of an Unusual Pacemaker Complication: Role of Three‐Dimensional Transthoracic Echocardiography
Authors: Miglioranza Marcelo Haertel , Becker Derly , Jiménez‐Nácher José‐Julio , Moya José Luis , Golfin Covadonga Fernandez , Zamorano José Luis
Published: April 2013

Tricuspid regurgitation (TR) produced by endocavitary leads (EL) from permanent pacemakers and implantable cardiac defibrillators is a well‐known complication of this procedure. The EL may damage or interfere with tricuspid valve function causing mechanical interference of the valve leaflets leading to incomplete valve closure. It is important to recognize this mechanical complication because it could be corrected by repositioning the lead. In this case report we demonstrate how three‐dimensional transthoracic echocardiography permits to obtaining an en face view, which allows simultaneous visualization of the 3 moving leaflets during the cardiac cycle, their attachment to the tricuspid annulus and the pattern of leaflet coaptation. Thus, we propose three‐dimensional transthoracic echocardiography as the tool of choice to evaluate TR related to EL, to evaluate the necessity of repositioning the lead if severe regurgitation or tricuspid valve malfunction are demonstrated.
Lipoprotein lipase in aortic valve stenosis is associated with lipid retention and remodelling
Authors: Mahmut Ablajan , Boulanger Marie‐Chloé , Fournier Dominique , Couture Christian , Trahan Sylvain , Pagé Sylvain , Arsenault Benoît , Després Jean‐Pierre , Pibarot Philippe , Mathieu Patrick
Published: April 2013

Background

Calcific aortic valve disease (CAVD) is a chronic disorder characterized by a fibrocalcific remodelling. It is suspected that lipid retention within the aortic valve may be one important mechanism participating to aortic valve remodelling. Lipoprotein lipase (LPL) is implicated in lipid metabolism and may play a role in lipid retention within the aortic valve.

Methods

In 57 patients, CAVD were analysed for the expression of LPL by q‐PCR and immunohistochemistry. Expression of oxidized‐LDL (ox‐LDL) and decorin was also documented. In addition, a complete blood profile, including the size of LDL and high‐density lipoprotein (HDL) particles, were performed to find associations between the blood lipid profile and expression of ox‐LDL and LPL within CAVD.

Results

Immunohistochemistry studies revealed that LPL was expressed in stenotic aortic valves as a diffuse staining and also in dense cellular areas where macrophages were abundant. Expression of LPL co‐localized with decorin and ox‐LDL. In turn, valves with higher amount of ox‐LDL had elevated number of LPL transcripts. In addition, we documented that the small, dense HDL phenotype was associated with an elevated amount of ox‐LDL and LPL transcripts within CAVD. Furthermore, expression of LPL was associated with several indices of fibrocalcific remodelling of the aortic valve.

Conclusion

Expression of LPL within CAVD is related to the amount of ox‐LDL, which is, in turn, associated with the small, dense HDL phenotype. Lipid retention associated with smaller HDL particles may participate in the expression of LPL, whereby a fibrocalcific remodelling of the aortic valve is promoted.
Baseline comorbidities in a skin cancer prevention trial in Bangladesh
Authors: Argos Maria , Rahman Mahfuzar , Parvez Faruque , Dignam James , Islam Tariqul , Quasem Iftekhar , K. Hore Samar , T. Haider Ahmed , Hossain Zahid , I. Patwary Tazul , Rakibuz‐Zaman Muhammad , Sarwar Golam , La Porte Paul , Harjes Judith , Anton Kristen , Kibriya Muhammad G. , Jasmine Farzana , Khan Rashed , Kamal Mohammed , Shea Christopher R. , Yunus Muhammad , Baron John A. , Ahsan Habibul
Published: April 2013

Background

Epidemiologic research suggests that increased cancer risk due to chronic arsenic exposure persists for several decades even after the exposure has terminated. Observational studies suggest that antioxidants exert a protective effect on arsenical skin lesions and cancers among those chronically exposed to arsenic through drinking water. This study reports on the design, methods and baseline analyses from the Bangladesh Vitamin E and Selenium Trial (BEST), a population‐based chemoprevention study conducted among adults in Bangladesh with visible arsenic toxicity.

Materials and methods

Bangladesh Vitamin E and Selenium Trial is a 2×2 full factorial, double‐blind, randomized controlled trial of 7000 adults having manifest arsenical skin lesions evaluating the efficacy of 6‐year supplementation with alpha‐tocopherol (100 mg daily) and L‐selenomethionine (200 μg daily) for the prevention of nonmelanoma skin cancer.

Results

In cross‐sectional analyses, we observed significant associations of skin lesion severity with male gender (female prevalence odds ratio (POR) = 0·87; 95% CI = 0·79–0·96), older age (aged 36–45 years, POR = 1·27; 95% CI = 1·13–1·42; aged 46–55 years, POR = 1·44; 95% CI = 1·27–1·64 and aged 56–65 years, POR = 1·50; 95% CI = 1·26–1·78 compared with aged 25–35 years), hypertension (POR = 1·29; 95% CI = 1·08–1·55), diabetes (POR = 2·13; 95% CI = 1·32–3·46), asthma (POR = 1·55; 95% CI = 1·03–2·32) and peptic ulcer disease (POR = 1·20; 95% CI = 1·07–1·35).

Conclusions

We report novel associations between arsenical skin lesions with several common chronic diseases. With the rapidly increasing burden of preventable cancers in developing countries, efficient and feasible chemoprevention study designs and approaches, such as employed in BEST, may prove both timely and potentially beneficial in conceiving cancer chemoprevention trials in Bangladesh and beyond.
Financial, nonfinancial and editors' conflicts of interest in high‐impact biomedical journals
Authors: Bosch Xavier , Pericas Juan M. , Hernández Cristina , Doti Pamela
Published: April 2013

Purpose

To assess financial, nonfinancial and editors' conflicts of interest (COI) disclosure policies among the most influential biomedical journals publishing original research.

Materials and methods

We conducted a cross‐sectional study of 399 high‐impact biomedical journals in 27 biomedical categories of the Journal Citation Reports (JCR) in December 2011. Information relevant to COI and requirements for disclosures that was publicly available on journal websites was collected.

Results

While financial COI disclosures were required by 358 (89·7%) and nonfinancial by 280 (70·2%) journals, 155 (38·8%) required editors' disclosures. Journals in the first decile of the JCR classification scored significantly higher than those in the second decile for all disclosure policies. Ninety (22·6%) journals were published by Elsevier and 59 (14·8%) by Wiley‐Blackwell, with Elsevier scoring significantly better in financial disclosure policies (P = 0·022). Clinical journals scored significantly higher than basic journals for all disclosure policies. No differences were observed between open‐access (n = 25) and nonopen‐access (n = 374) journals for any type of disclosure. Somewhat incoherently, authors' disclosure statements were included in some published manuscript in 57·1% of journals without any COI disclosure policies.

Conclusions

Authors' financial COI disclosures were required by about 90% of high‐impact clinical and basic journals publishing original research. Unlike recent studies showing a significantly lower prevalence of nonfinancial compared with financial disclosures, the former were required by about 70% of journals, suggesting that editors are increasingly concerned about nonfinancial competing interests. Only 40% of journals required disclosure of editors' COI, in conflict with the recommendations of the most influential editors' associations.
Practising case‐based learning in oral medicine for dental students in China
Authors: Du G.‐F. , Li C.‐Z. , Shang S.‐H. , Xu X.‐Y. , Chen H.‐Z. , Zhou G.
Published: April 2013

Introduction

Teacher‐centred education dominates dental education in China. Student‐centred education has recently been introduced in the School of Stomatology, Wuhan University, and the effectiveness of such methods needs to be tested. The purpose of this study is to compare the learning outcomes of case‐based learning (CBL) and lecture‐based education (LBE) in an oral medicine curriculum.

Materials and methods

We chose oral leukoplakia as the learning subject for dental students. Forty fourth‐year dental students participated in the study. First, they were presented to basic knowledge of oral leukoplakia and related oral mucosal diseases. Then, they were divided into a CBL group (n = 20) and an LBE group (n = 20) by random numbers. The groups experienced the remaining course in separate groups. All students answered a questionnaire on their satisfaction with the education and the same standardised written test to analyse their learning outcomes.

Results

Both CBL and LBE courses were well accepted by students according to the satisfactory scores of the questionnaire. The test scores of the CBL group (90.00 ± 6.69) were significantly higher (P < 0.01) than those of the LBE group (83.00 ± 6.77). The percentage of high test score (test score ≥ 85) of the CBL group (85%) was also significantly higher (P < 0.01) than that of the LBE group (45%).

Conclusions

In this example, CBL was found to be more effective than LBE to teach dental students. These findings suggest that CBL should be added in our future oral medicine curriculum for dental students.
Increased neuronal firing in resting and sleep in areas of the macaque medial prefrontal cortex
Authors: Gabbott Paul L. , Rolls Edmund T.
Published: April 2013

The medial prefrontal cortex (mPFC) of humans and macaques is an integral part of the default mode network and is a brain region that shows increased activation in the resting state. A previous paper from our laboratory reported significantly increased firing rates of neurons in the macaque subgenual cingulate cortex,Brodmann area (BA) 25, during disengagement from a task and also during slow wave sleep [E.T. Rollset al. (2003)J. Neurophysiology,90, 134–142]. Here we report the finding that there are neurons in other areas of mPFCthat also increase their firing rates during disengagement from a task, drowsiness and eye‐closure. During the neurophysiological recording of single mPFCcells (n = 249) inBAs 9, 10, 13 m, 14c, 24b and especially pregenual area 32, populations of neurons were identified whose firing rates altered significantly with eye‐closure compared with eye‐opening. Three types of neuron were identified: Type 1 cells (28.1% of the total population) significantly increased (mean + 329%;P ≪ 0.01) their average firing rate with eye‐closure, from 3.1 spikes/s when awake to 10.2 spikes/s when asleep; Type 2 cells (6.0%) significantly decreased (mean −68%;P < 0.05) their firing rate on eye‐closure; and Type 3 cells (65.9%) were unaffected. Thus, in many areas of mPFC, implicated in the anterior default mode network, there is a substantial population of neurons that significantly increase their firing rates during periods of eye‐closure. Such neurons may be part of an interconnected network of distributed brain regions that are more active during periods of relaxed wakefulness than during attention‐demanding tasks.
The delta subfamily of glutamate receptors: characterization of receptor chimeras and mutants
Authors: Orth Angela , Tapken Daniel , Hollmann Michael
Published: April 2013

The delta receptors, GluD1 and GluD2, are regarded as a subfamily of the ionotropic glutamate receptors solely because of sequence homology. While they play important roles in cerebellar function and high‐frequency hearing and appear to serve structural functions at synapses, ligand‐gated ion channel function has not been observed. However, we have previously shown that GluD2 can form functional ion channels when grafted with the ligand binding domain of a kainate receptor. In this study, we characterized this chimera as well as additional rat delta receptor chimeras and point mutants in more detail. We found that the kainate receptor ligand binding domain renders GluD1 functional as well, and GluD2 becomes a functional ion channel also when provided with an AMPA receptor ligand binding domain. Point mutations indicate that the GluD2 ion pore operates similarly but not identically to that of AMPA (α‐amino‐3‐hydroxy‐5‐methylisoxazole‐4‐propionic acid) and kainate receptors. GluD2 mutated at a conserved arginine within the linker region connecting the ligand binding domain to the ion pore domain displays spontaneous currents that occur in the absence of agonists and are inhibited by agonist application – a behavior reminiscent of that of the previously characterized lurcher mutant. Using our chimeric approach, we provide evidence that this inhibition of spontaneous currents by agonists may be caused by desensitization. Our results show that delta receptors have functional gating machineries and ion permeation pathways similar but not identical to those of AMPA and kainate receptors, while the key differences seem to be located within the ligand binding domain.
Effect of D‐cycloserine in conjunction with fear extinction training on extracellular signal‐regulated kinase activation in the medial prefrontal cortex and amygdala in rat
Authors: Gupta Subhash C. , Hillman Brandon G. , Prakash Anand , Ugale Rajesh R. , Stairs Dustin J. , Dravid Shashank M.
Published: April 2013

D‐cycloserine (DCS) is currently under clinical trials for a number of neuropsychiatric conditions and has been found to augment fear extinction in rodents and exposure therapy in humans. However, the molecular mechanism of DCS action in these multiple modalities remains unclear. Here, we describe the effect of DCS administration, alone or in conjunction with extinction training, on neuronal activity (c‐fos) and neuronal plasticity [phospho‐extracellular signal‐regulated kinase (pERK)] markers using immunohistochemistry. We found that intraperitoneal administration of DCS in untrained young rats (24–28 days old) increased c‐fos‐ and pERK‐stained neurons in both the prelimbic and infralimbic division of the medial prefrontal cortex (mPFC) and reduced pERK levels in the lateral nucleus of the central amygdala. Moreover, DCS administration significantly increased GluA1, GluN1, GluN2A, and GluN2B expression in the mPFC. In a separate set of animals, we found that DCS facilitated fear extinction and increased pERK levels in the infralimbic prefrontal cortex, prelimbic prefrontal cortex intercalated cells and lateral nucleus of the central amygdala, compared with saline control. In the synaptoneurosomal preparation, we found that extinction training increased iGluR protein expression in the mPFC, compared with context animals. No significant difference in protein expression was observed between extinction‐saline and extinction‐DCS groups in the mPFC. In contrast, in the amygdala DCS, the conjunction with extinction training led to an increase in iGluR subunit expression, compared with the extinction‐saline group. Our data suggest that the efficacy of DCS in neuropsychiatric disorders may be partly due to its ability to affect neuronal activity and signaling in the mPFC and amygdala subnuclei.
Incidence, causes and outcomes of lameness cases in a working military horse population: A field study
Authors: Putnam J. R. C. , Holmes L. M. , Green M. J. , Freeman S. L.
Published: April 2013

Reasons for performing study

Lameness is a common problem in the horse. Despite this, information on the incidence of lameness in horses in theUKis restricted to studies of lameness in performance horses, racehorses or referral hospital populations.

Objectives

To determine the overall incidence and common causes of lameness in a working horse population and incidence, duration and outcome of conditions observed.

Study design

Prospective questionnaire study.

Methods

Questionnaires were used to record lameness episodes in 294 horses in an equine military establishment. Information recorded included age, years of service, type of work, causal lesion, time taken to return to work and outcome. Lameness problems could be reported by any staff involved in the horses' care and were diagnosed by a veterinary surgeon or qualified farrier. Trends between lame and nonlame populations were compared using Chi‐square analysis. Lameness diagnoses were grouped and analysed by disease category.

Results

Completed questionnaires for 273 horses were analysed. The mean monthly incidence of lameness was 2.1%, equivalent to an annual rate of 25.4 cases per 100 horses per annum, with a mean of 1.2 lameness episodes per horse in the lame population. Horse age and duration of service were not significantly different between lame and nonlame populations. The most common diagnoses were cellulitis (18.6%), skin wounds (16.3%) and foot/shoeing problems (11.6%) and 88% of cases had returned to previous levels of work by the conclusion of the study.

Conclusions

This initial field study showed that lameness is a common occurrence in this working military horse population and the majority of cases make a full return to work. The most common causes of lameness identified in this study and outcomes of these conditions differ from existing literature.

Potential relevance

This study highlights the need for further studies of lameness in the wider horse population.
Effects of moisture control, addition of glucose, inoculation of lactic acid bacteria and crushing process on the fermentation quality of rice grain silage
Authors: Inoue Hidehiko , Tohno Masanori , Kobayashi Hisami , Matsuo Morinobu , Kojima Yoichiro , Ibuki Toshihiko , Uegaki Ryuichi
Published: April 2013

To identify the best ensiling process and moisture content for rice grain silage, we determined the effects of additive (i.e. no additive, glucose additive or lactic acid bacteria [LAB] inoculation), crushing process (non‐crushing or crushing) and moisture control (none [13.6%], 20.0, 27.5, 35.0, 42.5 or 50.0% moisture content [in fresh matter, FM]) on rough rice and brown rice. Forage rice harvested at the fully ripe stage was ensiled in small‐scale experiments, and the silage was stored for 60 days. Regardless of the use of additives or LAB inoculation, the pH values tended to decrease with increasing moisture content. LAB inoculation and crushing resulted in low pH values, low butyric acid contents, low ethanol contents and high lactic acid contents, and the lactic acid content increased to more than 2.0% in FM at moisture contents of 27.5% and higher. The parameters of fermentation quality (pH, lactic acid, butyric acid, volatile basic nitrogen and ethanol content) were affected by not only the main effect of additive, crushing process and moisture control but also two‐way or three‐way interaction effects. LAB inoculation and crushing improved the lactic acid fermentation under lower moisture conditions, that is, 27.5% moisture content. In both rough rice and brown rice, we suggest that the appropriate pretreatment is the combined use of LAB inoculation, crushing process and controlling 27.5% moisture content.