bluuebunny/crossref_metadata_2025 huggingface dataset:
Independent Role of Left Ventricular Global Longitudinal Strain in Predicting Prognosis of Chronic Heart Failure Patients
Authors: Iacoviello Massimo , Puzzovivo Agata , Guida Pietro , Forleo Cinzia , Monitillo Francesco , Catanzaro Raffaella , Lattarulo Maria Silvia , Antoncecchi Valeria , Favale Stefano
Published: March 2013

Aims

To evaluate the independent prognostic role of two‐dimensional (2D) strain measures reflecting global longitudinal left ventricular (LV) systolic function in outpatients affected by chronic heart failure (CHF).

Methods and results

Global longitudinal LV systolic strain (GLS) was assessed in 308 outpatients affected by CHF, by analyzing standard views with 2D speckle tracking technique. During a mean follow‐up of 26 ± 13 months 37 patients died (29 due to cardiovascular causes), 10 patients underwent heart transplantation, and 75 patients experienced at least 1 episode of hospitalization due to acute decompensated heart failure (ADHF). Thirty‐one patients without a history of major ventricular arrhythmic events experienced the occurrence of ventricular fibrillation and/or tachycardia or sudden death was observed. Multivariate Cox regression analysis showed that GLS was significantly associated with all‐cause mortality (HR: 1.15; 95%CI: 1.02–1.30; P: 0.026), cardiovascular death (HR: 1.20; 95%CI: 1.04–1.39; P: 0.011), cardiovascular death or heart transplantation (HR: 1.24; 95%CI: 1.09–1.41; P: 0.001), ADHF‐related hospitalizations (HR: 1.15; 95%CI: 1.05–1.25; P: 0.003), and arrhythmic events (HR: 1.17; 95%CI: 1.03–1.33; P: 0.018).

Conclusions

Quantifying LV longitudinal systolic function in CHF outpatients on the basis of 2D speckle tracking analysis provides a new parameter that independently predicts patient outcome, thus, strengthening its possible role in current clinical practice.
Giant Right Atrium Due to Congenital Dysplastic Tricuspid Valve in an Elderly Female Patient
Authors: Shankarappa Ravindranath Khandenahally , Papaiah Srinivas , Karur Satish , Math Ravi S. , Nanjappa Manjunath Cholenahally
Published: March 2013

Isolated tricuspid valve disease is rare. We report the case of a 65‐year‐old female patient who presented with right heart failure. Initial echocardiographic evaluation revealed a giant right atrium (RA) with severe tricuspid inflow obstruction with regurgitation. A comprehensive two‐ and three‐dimensional echocardiographic evaluation revealed a dysplastic tricuspid valve resulting in the inflow obstruction and regurgitation. Rheumatic and carcinoid etiologies were ruled out by relevant tests. It is very rare for dysplastic tricuspid valve to present in late adulthood. The classic echocardiographic findings are discussed followed by a brief review of the literature.
Left Ventricular Dyssynchrony Predicts Clinical Response to CRT – A Long‐Term Follow‐Up Single‐Center Prospective Observational Cohort Study
Authors: Prinz Christian , Lehmann Roman , Schwarz Maria , Prinz Eva‐Maria , Bitter Thomas , Vogt Jürgen , van Buuren Frank , Bogunovic Nikola , Lamp Barbara , Horstkotte Dieter , Faber Lothar
Published: March 2013

Background

Until now, there is no consensus regarding the definition of a clinical response to cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) and systolic left ventricular (LV) dysfunction. The aim of this study was to evaluate if echocardiography is predictive for an objective improvement in exercise capacity during long‐term follow‐up of CRT.

Methods

Each patient underwent echocardiography and spiroergometry both at baseline and at last follow‐up. Left ventricular dyssynchrony (LVD) before CRT was defined by tissue Doppler imaging (TDI) as intra‐LV delay ≥40 msec (septal‐lateral or anterior‐posterior). Clinical response to CRT was defined as increase of peakVO2 or as increase of maximal workload >10% as compared to baseline.

Results

Mean follow‐up was 69 ± 37 months. From the 238 consecutive patients included in the study, 141 (59%) were classified as clinical responders and 97 (41%) as nonresponders. Baseline data of responders and nonresponders were comparable. However, clinical responders showed more often LVD (64%) than nonresponders (42%, P = 0.004). On multivariate regression analysis, nonischemic origin of CHF (β‐coefficient in the final model 0.1, P = 0.04) and LVD at baseline (β‐coefficient in the final model 0.2, P < 0.001) were independently associated with clinical response during long‐term follow‐up. Patients with LVD at baseline had significant more often an improvement of left ventricular ejection fraction >10% (P = 0.02) and a reduction of left ventricular end‐diastolic diameter (LVEDD) >10% (P < 0.01) than patients without LVD at baseline.

Conclusions

LVD at baseline as assessed by a straightforward echocardiographic approach predicts the long‐term clinical response to CRT and is associated with a more pronounced reverse LV remodeling.
Patients With Severe Aortic Stenosis and Reduced Ejection Fraction: Earlier Recovery of Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation Compared With Surgical Valve Replacement
Authors: Bauer Fabrice , Coutant Véronique , Bernard Mathieu , Stepowski Dimitri , Tron Christophe , Cribier Alain , Bessou Jean‐Paul , Eltchaninoff Hélène
Published: March 2013

Background

Only 50% of patients with aortic stenosis (AS) and low ejection fraction (EF) improve their contractility after surgical aortic valve replacement (AVR). Long‐term prognosis of these patients is strongly correlated to EF recovery after the surgery. The aim of this study was to compare the postoperative left ventricular function recovery in patients with severe AS and reduced EF after AVR and transcatheter aortic valve implantation (TAVI).

Methods and Results

Twenty‐one patients undergoing AVR for severe AS (<1 cm²) and reduced EF (<45%) were echocardiographically compared with 31 patients treated with TAVI by conventional and two‐dimensional (2D) strain method. TAVI patients were older (83 ± 6 vs. 74 ± 13 years, P < 0.001), had more comorbidities (Euroscore 26 ± 15% vs. 16 ± 12%, P < 0.001) and no differences in ischemic heart disease (16.1% vs. 9.5%, P = 0.39). EF was similar in both groups at baseline. Aortic valve area significantly increased (P = 0.01) while pressure gradient decreased (P = 0.009) after both procedures but TAVI was associated with a better EF recovery compared with AVR at day 7. Regional function assessed by radial 2D strain increased in TAVI group but was transiently deteriorated in AVR patients (P < 0.05). Longitudinal as well as circumferential 2D strain progressively increased at follow‐up in both groups (P < 0.05). EF was similar in both groups at 3‐month follow‐up.

Conclusion

In patients with severe AS and reduced EF, TAVI is associated with faster and better recovery of LV function compared with AVR.
The Diagnostic Utility of Transthoracic Echocardiography for the Diagnosis of Infective Endocarditis in the Real World of the Italian Registry on Infective Endocarditis
Authors: Cecchi Enrico , Chirillo Fabio , Faggiano Pompilio , Imazio Massimo , Cecconi Moreno , Moreo Antonella , Cialfi Alessandro , Rinaldi Mauro , Ponte Stefano Del , Squeri Angelo , Gaddi Oscar , Enia Francesco , Ferro Silvia , Costanzo Piera , Zuppiroli Alfredo , Bergandi Gianluigi , Bologna Flavio , Ciampani Nino , De Rosa Francescogiuseppe , Belli Riccardo ,   for the Italian Registry on Infective Endocarditis (RIEI) Investigators
Published: March 2013

Background

The choice of the imaging modality (transthoracic [TTE] vs. transesophageal echocardiography [TEE]) for the diagnosis of infective endocarditis (IE) depends on different variables. Aim of the present study is to provide updated data on the diagnostic sensitivity and the clinical usefulness of TTE vs. TEE from the Italian Registry on IE (RIEI).

Methods

The RIEI has enrolled consecutive cases of IE in every participating centre, evaluating diagnostic and therapeutic data from a real world practice perspective.

Results

From July 2007 to October 2010, 658 consecutive cases with definite IE according to Duke criteria have been enrolled in the RIEI (483 males). The following diagnostic echocardiographic exams were performed: 616 TTE (94%) and 476 TEE (72%). A positive TTE was recorded in 399 cases (65%), an uncertain TTE in 108 cases (17%), and a negative TTE in 109 cases (18%). For TEE, a positive study was reported in 451 cases (95%), uncertain in 13 cases (2.7%), and negative in 12 cases (2.5%) (P < 0.001). This difference is not evident in patients with tricuspid valve IE or i.v. drug addiction, and in Streptococcus bovis or Streptococcus viridans IE. TTE was significantly more performed before the admission and earlier than TEE during admission (P = 0.000). TTE was mainly responsible for the initial diagnosis in 59%. TEE contributed to changing the therapeutic approach in 42%.

Conclusions

In the real world, TTE is performed earlier and more commonly, and it is the major echocardiographic tool for the initial diagnosis. TEE confirms its superior diagnostic sensitivity in most cases, although it is relatively underused.
Insight and suicidality in first‐episode psychosis: understanding the influence of suicidal history on insight dimensions at first presentation
Authors: López‐Moríñigo Javier D. , Wiffen Benjamin , O'Connor Jennifer , Dutta Rina , Di Forti Marta , Murray Robin M. , David Anthony S.
Published: March 2013

Aim

Lack of insight is a cardinal feature of psychosis with crucial implications for outcome. Concerns have been raised regarding a link between insight and suicidality. This study aimed to test the relationship between suicidal behaviour preceding first‐episode psychosis (FEP) and insight dimensions at treatment onset.

Methods

A total of 112 FEP inpatients were recruited. Suicidal events prior to admission were recorded. Insight was assessed multidimensionally with the Schedule for the Assessment of Insight – Expanded version shortly after admission. Suicidal and non‐suicidal patients were compared regarding scores on ‘total insight’ and three insight domains: ‘awareness of mental illness’, ‘relabeling of psychotic experiences as abnormal’ and ‘compliance’. This analysis was also adjusted for a set of sociodemographic, clinical, neurocognitive and psychopathological variables.

Results

Bivariate analyses demonstrated a direct association between previous suicidality and all insight domains. However, these associations did not survive multivariable regression models, which demonstrated gender (female), shorter duration of untreated psychosis (DUP) and psychopathological symptoms – depression and disorganization – to mediate the influence of suicidal history on insight, and therefore to underlie the latter.

Conclusions

Insight dimensions in FEP patients are influenced by having suicidal antecedents through some mediating variables such as gender, DUP and depression. Further prospective studies are needed to clarify the potential implications of these findings on the management of insight in FEP. As suicidal history is associated with greater levels of both depression and insight at first presentation, these three variables might be useful in predicting further suicidal events.
Improving vocational outcomes of service users in an Early Intervention in Psychosis service
Authors: Dudley Robert , Nicholson Marsha , Stott Pauline , Spoors George
Published: March 2013

Aim

People with psychotic symptoms have poor social and occupational functioning. The aim of this research was to improve the engagement in meaningful education, training or employment for young people with psychosis. This was undertaken by introducing a vocational specialist into the early intervention service to implement the individual placement and support (IPS) model.

Methods

Two early intervention services provided information about the vocational status of their service users 6 and 1 months prior to the introduction of the vocational specialist into one of the services. Data were collected again 12 months following the intervention and then 6 months following the end of the intervention.

Results

Unemployment was high in both services during the baseline period (approximately 75% in both), but in the service receiving the intervention this reduced to 62% whereas it remained high in the service that did not introduce the vocational specialist. Following the withdrawal of the vocational specialist the improvement was lost.

Conclusions

To enable people in first‐episode services to live meaningful and valued lives occupational functioning needs to be considered a key performance indicator. Services can improve outcome by implementing and maintaining the IPS model.
Dynamics of the continent‐wide spread of a Drosophila defensive symbiont
Authors: Cockburn Sarah N. , Haselkorn Tamara S. , Hamilton Phineas T. , Landzberg Elizabeth , Jaenike John , Perlman Steve J.
Published: March 2013

Facultative symbionts can represent important sources of adaptation for their insect hosts and thus have the potential for rapid spread. Drosophila neotestacea harbours a heritable symbiont, Spiroplasma, that confers protection against parasitic nematodes. We previously found a cline in Spiroplasma prevalence across central Canada, ending abruptly at the Rocky Mountains. Resampling these populations 9 years later revealed that Spiroplasma had increased substantially across the region, resembling a Fisherian wave of advance. Associations between Spiroplasma infection and host mitochondrial DNA indicate that the increase was due to local increase of Spiroplasma‐infected flies. Finally, we detected Spiroplasma west of the Rocky Mountains for the first time and showed that defence against nematodes occurs in flies with a western genetic background. Because nematode infection is common throughout D. neotestacea's range, we expect Spiroplasma to spread to the Pacific coast.
X‐linked markers in the Duchenne muscular dystrophy gene associated with oral clefts
Authors: Patel Poorav J. , Beaty Terri H. , Ruczinski Ingo , Murray Jeffrey C. , Marazita Mary L. , Munger Ronald G. , Hetmanski Jacqueline B. , Wu Tao , Murray Tanda , Rose Margaret , Redett Richard J. , Jin Sheng C. , Lie Rolv T. , Wu‐Chou Yah‐Huei , Wang Hong , Ye Xiaoqian , Yeow Vincent , Chong Samuel , Jee Sun H. , Shi Bing , Scott Alan F.
Published: March 2013

As part of an international consortium, case–parent trios were collected for a genome‐wide association study of isolated, non‐syndromic oral clefts, including cleft lip (CL), cleft palate (CP), and cleft lip and palate (CLP). Non‐syndromic oral clefts have a complex and heterogeneous etiology. Risk is influenced by genes and environmental factors, and differs markedly by gender. Family‐based association tests (FBAT) were used on 14,486 single nucleotide polymorphisms (SNPs) spanning the X chromosome, stratified by type of cleft and racial group. Significant results, even after multiple‐comparisons correction, were obtained for the Duchenne muscular dystrophy (DMD) gene, the largest single gene in the human genome, among CL/P (i.e. both CL and CLP combined) trios. When stratified into groups of European and Asian ancestry, stronger signals were obtained for Asian subjects. Although conventional sliding‐window haplotype analysis showed no increase in significance, selected combinations of the 25 most significant SNPs in the DMD gene identified four SNPs together that attained genome‐wide significance among Asian CL/P trios, raising the possibility of interaction between distant SNPs within the DMD gene.
Platelet transfusion in thrombocytopenic horses
Authors: Dunkel B.
Published: March 2013

Platelet transfusions might be indicated in horses with thrombocytopenia. The need for a transfusion cannot be determined by platelet numbers alone, as primary or co‐existing disease processes, platelet function and age of the recipient also need to be considered. In patients with no co‐morbidities, relevant bleeding is uncommonly observed with platelet counts >10 x 109/l and a therapeutic approach with initiation of treatment when signs of bleeding are observed might be justified.
Pulmonary and hepatic eosinophilic granulomas and epistaxis in a horse suggestive of multi‐systemic eosinophilic epitheliotropic disease
Authors: Horan E. M. , Metcalfe L. V. A. , de Swarte M. , Cahalan S. D. , Katz L. M.
Published: March 2013

Multi‐systemic eosinophilic epitheliotropic disease (MEED) is a relatively uncommon disease characterised by eosinophilic infiltration of more than one organ system, with the skin and gastrointestinal tract most commonly affected. This case report describes a gelding that presented for weight loss, increased respiratory rate and effort and chronic intermittent epistaxis. Duringpost mortemexamination diffuse eosinophilic granulomatous lesions were identified in the lung and liver, leading to a diagnosis ofMEED. Veno‐occlusive pulmonary remodelling was also discovered, believed to be the cause of the chronic epistaxis and a result of the pulmonary fibrosis and eosinophilic granulomas.
Maxillectomy and mandibulectomy in the horse: Indications and necessity of post operative adjunct therapy
Authors: Witte S.
Published: March 2013

See also article by Cousty and Tricaud
Effect of simvastatin on the antihypertensive activity of losartan in hypertensive hypercholesterolemic animals and patients: Role of nitric oxide, oxidative stress, and high‐sensitivity C‐reactive protein
Authors: Abdel‐Zaher Ahmed O. , Elkoussi Alaa Eldin A. , Abudahab Lotfy H. , Elbakry Mohammed H. , Elsayed Elsayed Abu‐Elwafa
Published: March 2013

This study investigated whether simvastatin has antihypertensive activity and can enhance the antihypertensive effect of losartan in hypertensive hypercholesterolemic animals and patients. Hypertension and hypercholesterolemia were induced in rats by L‐NAME and cholesterol‐enriched diet, respectively. In these animals, repeated administration of simvastatin decreased the systolic blood pressure, enhanced its progressive reductions induced by repeated administration of losartan, and corrected the compromised lipid profile. Concomitantly, repeated administration of simvastatin, losartan, or simvastatin in combination with losartan to these animals increased nitric oxide (NO) production and decreased the elevated serum malondialdehyde (MDA) and high‐sensitivity C‐reactive protein (hs‐CRP) levels. Effects of combined treatment were greater than those of simvastatin or losartan alone. In hypertensive hypercholesterolemic patients, repeated administration of losartan decreased systolic and diastolic blood pressure, increased NO production, and decreased the elevated serum MDA and hs‐CRP levels. Addition of simvastatin to losartan therapy enhanced these effects and corrected the compromised lipid profile. Simvastatin inhibited the contractile responses of isolated aortic rings induced by angiotensin II and enhanced the inhibitory effect of losartan on this preparation. l‐arginine and acetylcholine enhanced, while L‐NAME inhibited the effects of simvastatin, losartan, and their combination on these contractile responses. Thus, simvastatin exerts antihypertensive effect in hypertensive hypercholesterolemic animals and enhances the antihypertensive effect of losartan in hypertensive hypercholesterolemic animals and patients. Besides, its cholesterol‐lowering effect, the ability of simvastatin to ameliorate endothelial dysfunction through increasing NO bioavailability and through suppression of oxidative stress and vascular inflammation may play an important role in these effects.
Community assembly processes shape an altitudinal gradient of forest biodiversity
Authors: Mori Akira S , Shiono Takayuki , Koide Dai , Kitagawa Ryo , Ota Aino T , Mizumachi Eri
Published: March 2013

Aim

Spatial patterns in biodiversity along environmental gradients are a central theme in ecology. However, the ways in which local assembly processes control changes in species turnover (β‐diversity) along broader gradients have been less well documented. In this study, we aimed to elucidate factors and processes governing the altitudinal gradients in the β‐diversity of woody plants and ground‐dwelling oribatid mites.

Location

Shiretoko National Park in Hokkaido, Japan.

Methods

The diversity of plants and oribatids was investigated in seven plots (each containing 10 subplots) at different altitudes, and the β‐diversity of the two organism groups was calculated for each altitude. The dependence of β‐diversity on the size of the species pool (γ‐diversity) is an issue of long‐standing importance. We therefore used null modelling, which randomly shuffles individuals among subplots while preserving the γ‐diversity, the relative abundance of each species per plot and the number of individuals per subplot. This approach enabled us to estimate how much the observed β‐diversity deviates from the expected β‐diversity under stochastic assembly processes. Environmental data were collected to evaluate the possible effects of habitat condition/heterogeneity on community processes.

Results

In plants, deterministic processes dominated in the low‐productivity, high‐altitude stands because of the finer‐scale niche partitioning seen among small individuals within less‐stratified stands. In the structurally developed, low‐altitude stands, the community structure was more strongly affected by stochasticity, probably resulting from one‐sided competition such that the canopy trees intercept the majority of light, a primary resource for plants, and therefore the small understorey individuals had limited access to light. Among the oribatids, the altitudinal gradient of β‐diversity was less evident than among the studied plants. However, this nonlinearity does not support the notion that local assembly processes contribute little to the spatial pattern of β‐diversity. Indeed, local‐scale environmental heterogeneity favoured a more deterministic assembly of oribatids at a given altitude.

Main conclusion

The biogeographical patterns of β‐diversity are not independent of community processes and, in reality, are shaped by local stochastic/deterministic factors that change within a landscape.
Reply to Sumberg et al.
Authors: Kassam Amir , Brammer Hugh
Published: March 2013

We reassert our claim made in an earlier Commentary that Conservation Agriculture (CA) and the System of Rice Intensification (SRI) are providing considerable environmental and socio‐economic benefits to large and growing numbers of practising farmers. CA helps to reduce soil degradation, increase and sustain yields, and sequester carbon. SRI practices reduce water use and methane emissions, and provided a world record rice yield of 21.16 tons/ha (dry weight) in Bihar state, India in 2011–12. We repeat our invitation for geographers to carry out field research on CA and SRI to provide a better understanding of how these practices relate to specific physical, socio‐political and economic environments.
Efficacy and safety in sitagliptin therapy for diabetes complicated by non‐alcoholic fatty liver disease
Authors: Arase Yasuji , Kawamura Yusuke , Seko Yuya , Kobayashi Mariko , Suzuki Fumitaka , Suzuki Yoshiyuki , Akuta Norio , Kobayashi Masahiro , Sezaki Hitomi , Saito Satoshi , Hosaka Tetsuya , Ikeda Kenji , Kumada Hiromitsu , Ohmoto‐Sekine Yuki , Hsieh Shiun Dong , Amakawa Kazuhisa , Ogawa Kyoko , Matsumoto Naoki , Iwao Akiko , Tsuji Hiroshi , Hara Shigeko , Mori Yasumichi , Okubo Minoru , Sone Hirohito , Kobayashi Tetsuro
Published: March 2013

Aim

The aim of this case–control study was to assess the efficacy and safety of dipeptidyl peptidase‐4 inhibitor (sitagliptin) for type 2 diabetes mellitus (T2DM) with non‐alcoholic fatty liver disease (NAFLD).

Methods

Twenty NAFLD patients with T2DM treated by sitagliptin were retrospectively enrolled as the sitagliptin group. These patients were given sitagliptin between January 2010 and July 2011. Another 20 NAFLD patients with T2DM treated only with diet and exercise for 48 weeks were selected as the control group. Serum levels of fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured before and 12, 24, 36 and 48 weeks after the initiation of treatment.

Results

In the sitagliptin group, average HbA1c levels decreased approximately 0.7% at 48 weeks after the initiation of sitagliptin. Next, average FPG levels decreased approximately 15 mg/dL at 48 weeks after the initiation of sitagliptin. The serum levels of HbA1c and FPG in the sitagliptin group decreased with statistical significance compared to those in the control group (P < 0.05). All the patients could take sitagliptin of 50 mg/day without reduction necessitated by sitagliptin‐related side‐effects. There were no significant changes of average AST and ALT levels during follow up of 48 weeks in both sitagliptin and control groups.

Conclusion

Our results indicate sitagliptin is effective and safe for the treatment of T2DM complicated with NAFLD.
Testing common assumptions in studies of songbird nest success
Authors: Streby Henry M. , Andersen David E.
Published: March 2013

We studied Ovenbird Seiurus aurocapilla and Golden‐winged Warbler Vermivora chrysoptera populations in northern Minnesota, USA, to test two common assumptions in studies of songbird nest success: (1) that the condition of an empty nest on or near its expected fledge date is an indicator of nest fate; and (2) that the presence of a fledgling or family group within a territory confirms a successful nest in that territory. We monitored the condition of nests and used radiotelemetry to monitor juveniles through the expected fledging date and early post‐fledging period. Of nests that contained nestlings 1–2 days before the expected fledge date, fates were misidentified using nest condition alone for 9.5% of Ovenbird nests, but those misidentifications were made in both directions (succeeded or failed), yielding only a small bias in estimated nest success. However, 20% of Golden‐winged Warbler nests were misidentified as successful using nest condition during the final visit interval, biasing the nest success estimate upward by 21–28% depending on the treatment of uncertain nest fates. Fledgling Ovenbirds from 58% of nests travelled beyond their natal territory within 24 h, rising to 98% after 5 days, and those fledglings travelled up to 390 m from nests within 10 days of fledging. Fledgling Golden‐winged Warblers from 13% of nests travelled beyond their natal territory within 24 h, rising to 85% after 5 days, and those fledglings travelled up to 510 m from nests within 10 days of fledging. We conclude that nest condition and fledgling presence can be misleading indicators of nest fate, probably commonly biasing nest success estimates upward, and we recommend that these assumptions should be tested in additional species.
Effects of edible coatings on some quality parameters of Chinese water chestnut (Eleocharis tuberosa) during storage
Authors: Peng Yong , Li Yunfei , Yin Lu
Published: March 2013

The effects of chitosan and shellac edible coating on the texture, quality attributes and internal changes of Chinese water chestnut (Eleocharis tuberosa) were investigated. Changes in weight loss, respiration rate, cell membrane permeability, oxidase activity and texture profile analysis (TPA) were recorded periodically for 45 days since harvest. Results showed that weight loss, cell membrane permeability and decay rate increased, however, peroxidase (POD), hardness and quality parameters decreased during cold storage. Application of chitosan and shellac coating was determined to give the better results in terms of these analysed parameters compared with the control. Particularly, shellac coating was more effective in reducing weight loss and respiration rate, as well as in maintaining the quality of Chinese water chestnut than chitosan coating.
Inflammatory Markers and Their Association with Post Stroke Cognitive Decline
Authors: Narasimhalu Kaavya , Lee Jasinda , Leong Yi-Lin , Ma Lu , De Silva Deidre A. , Wong Meng-Cheong , Chang Hui-Meng , Chen Christopher
Published: March 2013

Background

Population-based studies have demonstrated the association of inflammation and cognitive impairment. However, few studies to date have examined this association in ischemic stroke patients.

Aims

The study aims to determine the association between inflammatory markers and cognitive impairment.

Methods

Ischemic stroke patients with baseline neuropsychological assessments at three-months poststroke were followed up with annual neuropsychological assessments for up to five-years. Inflammatory markers (C-reactive protein, interleukin 1β, interleukin 6, interleukin 8, interleukin 10, interleukin 12, and tumor necrosis factor-α) were assayed, and logistic regression analyses were performed to determine associations between inflammatory markers and both baseline cognitive status and subsequent cognitive decline.

Results

There were 243 ischemic stroke patients in the study. In multivariable ordinal logistic regression analysis, age, education, ethnicity, stroke subtype, and interleukin 8 (OR 1·23 CI 1·05–1·44) levels were independently associated with baseline cognitive status. In multivariable logistic regression analyses, age, gender, recurrent strokes, and interleukin 12 (OR 25·02 CI 3·73 to 168·03) were independent predictors of subsequent cognitive decline.

Conclusions

Following ischemic stroke, higher serum interleukin 8 is independently associated with baseline cognitive impairment while higher serum interleukin 12 is associated with subsequent cognitive decline.
Age- and Gender-Specific Time Trend in Risk of Death of Patients Admitted with Aneurysmal Subarachnoid Hemorrhage in the Netherlands
Authors: Nieuwkamp Dennis J. , Vaartjes Ilonca , Algra Ale , Bots Michiel L. , Rinkel Gabriël J. E.
Published: March 2013

Background and aim

In a meta-analysis of population-based studies, case-fatality rates of subarachnoid hemorrhage have decreased worldwide by 17% between 1973 and 2002. However, age- and gender-specific decreases could not be determined. Because >10% of patients with subarachnoid hemorrhage die before reaching the hospital, this suggests that the prognosis for hospitalized subarachnoid hemorrhage patients has improved even more. We assessed age- and gender-specific time trends of the risk of death for hospitalized subarachnoid hemorrhage patients.

Methods

From the Dutch hospital discharge register (nationwide coverage), we identified 9403 patients admitted with subarachnoid hemorrhage in the Netherlands between 1997 and 2006. Changes in risk of death within this time frame and influence of age and gender were quantified with Poisson regression.

Results

The overall 30-day risk of death was 34·0% (95% confidence interval 33·1↔35·0%). After adjustment for age and gender, the annual decrease was 1·6% (95% confidence interval 0·5↔2·6%), which confers to a decrease of 13·4% (95% confidence interval4·8↔21·2%) in the study period. The one-year risk of death decreased 2·0% per year (95% confidence interval1·1↔2·9%). The decrease in risk of death was mainly found in the period 2003–2005, was not found for patients ≥65 years and was statistically significant for men, but not for women.

Conclusions

The decrease in risk of death for patients admitted in the Netherlands with subarachnoid hemorrhage is overall considerable, but unevenly distributed over age and gender. Further research should focus on reasons for improved survival (improved diagnostics, improved treatment) and reasons why improvement has not occurred for women and for patients in older age categories.
Long-term Mortality in Patients with Coexisting Potential Causes of Ischemic Stroke
Authors: Kim Young Dae , Cha Myoung-Jin , Kim Jinkwon , Lee Dong Hyun , Lee Hye Sun , Nam Chung Mo , Nam Hyo Suk , Heo Ji Hoe
Published: March 2013

Background

Multiple potential causes of stroke may coexist in ischemic stroke patients, which may affect long-term outcome.

Aim

We investigated whether there are differences in long-term mortality among stroke patients with coexisting potential causes.

Methods

We evaluated the long-term all-cause mortality and stroke or cardiovascular mortality of ischemic stroke patients with multiple potential stroke mechanisms, large artery atherosclerosis, cardioembolism, small vessel occlusion, and negative evaluation admitted to a single center between January 1996 and December 2008. Mortality data were obtained from a National Death Certificate system.

Results

Total 3533 patients were included in this study: 286 multiple potential mechanisms (138 large artery atherosclerosis + cardioembolism, 105 small vessel occlusion + large artery atherosclerosis, 43 small vessel occlusion + cardioembolism), 1045 large artery atherosclerosis, 701 cardioembolism, 606 small vessel occlusion, and 895 negative evaluation. During a mean follow-up of 3·9 years, as referenced to small vessel occlusion mortality rate, the adjusted mortality hazard ratio was 4·387 (95% confidence interval 3·157–6·096) for large artery atherosclerosis + cardioembolism group, 3·903 (95% confidence interval 3·032–5·024) for cardioembolism group, and 2·121 (95% confidence interval 1·655–2·717) for large artery atherosclerosis. The risk of long-term ischemic stroke mortality or cardiovascular mortality also showed comparable findings: highest in the large artery atherosclerosis + cardioembolism, followed by cardioembolism, and large artery atherosclerosis groups. However, the outcome of small vessel occlusion + large artery atherosclerosis or small vessel occlusion + cardioembolism group was not significantly different from that of small vessel occlusion.

Conclusions

Coexisting potential causes of ischemic stroke impact on long-term mortality. Identification of coexisting potential causes may help to predict stroke outcomes and to guide planning secondary prevention strategies.
The China Stroke Secondary Prevention Trial (CSSPT) Protocol: A Double-Blinded, Randomized, Controlled Trial of Combined Folic Acid and B Vitamins for Secondary Prevention of Stroke
Authors: Liu Xuedong , Shi Ming , Xia Feng , Han Junliang , Liu Zhirong , Wang Bo , Yang Fang , Li Li , Wu Songdi , Wang Ling , Liu Nan , Lv Yali , Zhao Gang
Published: March 2013

Rationale

Epidemiological studies suggest that elevated homocysteine is linked to stroke and heart disease. However, the results of lowering homocysteine levels in reducing the risk of stroke recurrence are controversial.

Aims

The study aims to evaluate whether homocysteine-lowering therapy with folic acid and vitamins B6 and B12 reduces recurrent stroke events and other combined incidence of recurrent vascular events and vascular death in ischemic stroke patients of low folate regions.

Design

This is a multicenter, randomized, double-blinded, placebo-controlled trial. Patients ( n = 8000, α = 0·05, β = 0·10) within one-month of ischemic stroke (large-artery atherosclerosis or small-vessel occlusion) or hypertensive intracerebral haemorrhage with plasma homocysteine level ⩾15 μmol/l will be enrolled. Eligible patients will be randomized by a web-based, random allocation system to receive multivitamins (folic acid 0·8 mg, vitamin B610 mg, and vitamin B12 500 μg) or matching placebo daily with a median follow-up of three-years.

Study Outcomes

Patients will be evaluated at six monthly intervals. The primary outcome event is the composite event ‘stroke, myocardial infarction, or death from any vascular cause’, whichever occurs first. Secondary outcome measures include nonvascular death, transient ischemic attack, depression, dementia, unstable angina, revascularization procedures of the coronary, and cerebral and peripheral circulations.

Discussion

This is the first multicenter randomized trial of secondary prevention for ischemic stroke in a Chinese population with a higher homocysteine level but without folate food fortification.
Alike but not alike: Welfare state and unemployment policies in Southern Europe. Italy and Portugal compared
Authors: Baglioni Simone , Mota Luis F. Oliveira
Published: March 2013

Although Italy and Portugal are considered to be part of the same welfare state family – the Southern European one – analysis of a key component of the welfare state, namely, unemployment policies and regulations, reveals a different evaluation. A comparative analysis of a series of specific indicators of Italian and Portuguese unemployment regimes shows that they represent two different models. Portugal appears to be a more inclusive system, closer to continental or Northern European countries than it is to Italy, or at least representing a hybrid system that combines characteristics of continental European welfare states with characteristics that are more typical of Southern European welfare states. Italy, on the contrary, is much more clearly a Southern European welfare state.
Pedicled full‐thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn
Authors: Zhao Jing‐Chun , Xian Chun‐Jing , Yu Jia‐Ao , Shi Kai
Published: March 2013

Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full‐thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad‐spectrum antibiotics to reduce infection, a pedicled full‐thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required.
Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review
Authors: Ousey Karen , Edward Karen‐Leigh , Lui Steve
Published: March 2013

The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post‐surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery.
Cost‐effectiveness of using Polyheal compared with surgery in the management of chronic wounds with exposed bones and/or tendons due to trauma in France, Germany and the UK
Authors: Guest Julian F , Sladkevicius Erikas , Panca Monica
Published: March 2013

The objective of this study was to assess the cost‐effectiveness of Polyheal compared with surgery in treating chronic wounds with exposed bones and/or tendons (EB&T) due to trauma in France, Germany and the UK, from the perspective of the payers. Decision models were constructed depicting the management of chronic wounds with EB&T and spanned the period up to healing or up to 1 year. The models considered the decision by a plastic surgeon to treat these wounds with Polyheal or surgery and was used to estimate the relative cost‐effectiveness of Polyheal at 2010/2011 prices. Using Polyheal instead of surgery is expected to increase the probability of healing from 0·93 to 0·98 and lead to a total health‐care cost of €7984, €7517 and €8860 per patient in France, Germany and the UK, respectively. Management with surgery is expected to lead to a total health‐care cost of €12 300, €18 137 and €11 330 per patient in France, Germany and the UK, respectively. Hence, initial treatment with Polyheal instead of surgery is expected to lead to a 5% improvement in the probability of healing and a substantial decrease in health‐care costs of 35%, 59% and 22% in France, Germany and the UK, respectively. Within the models' limitations, Polyheal potentially affords the public health‐care system in France, Germany and the UK a cost‐effective treatment for chronic wounds with EB&T due to trauma, when compared with surgery. However, this will be dependent on Polyheal's healing rate in clinical practice when it becomes routinely available.
A conceptual approach to density‐dependent management of zoo animals kept in herds
Authors: Müller D. W. H. , Hammer S. , Hammer C. , Hatt J.‐M. , Clauss M.
Published: March 2013

Successful management of herds of captive wildlife (small populations) requires monitoring of herd size over years. In many zoos, herd size is documented in the course of annual inventories without considering other epidemiological parameters. Here, the concept of the ‘anti‐clockwise cycle’ of the relation between mortality and population size is introduced for herd management. Four different phases of this cycle can be distinguished: (I) herd size increases while mortality decreases; (II) herd size and mortality increase; (III) herd size decreases and mortality still increases; (IV) herd size and mortality decrease. Consequently, a herd can still prosper in size (I, II) while an increase in mortality rates (II) already indicates that it is heading towards collapse (III). All four phases of the cycle of herd development could be observed in 28 small, closed ruminant breeding groups at the Al Wabra Wildlife Preservation, Qatar. Applications of the concept presented here to evaluate herd development in captivity may help to stabilize or even increase the size of a herd in care, which is particularly important for breeding herds of threatened species. The ‘anti‐clockwise cycle’ shows that a simple monitoring of the herd size in numbers is not enough to evaluate the sustainability and quality of the herd.
Measuring quality of life in patients with psoriasis using the Arabic version for Morocco of the Dermatology Life Quality Index
Authors: Khoudri Ibtissam , Lamchahab Fatima Z. , Ismaili Nadia , Senouci Karima , Hassam Badredine , Abouqal Redouane
Published: March 2013

Background  Psoriasis has been demonstrated to have substantial impacts on dermatology‐related functional limitations and health‐related quality of life (HRQL). This study evaluated the HRQL in Moroccan psoriatics using the Arabic version of the Dermatology Life Quality Index (DLQI) and examined the psychometric properties of the questionnaire.

Materials and methods  The Moroccan Arabic version of the DLQI was developed and approved by the author of the questionnaire. The DLQI was administered to inpatient and outpatient adult psoriatics. Some participants completed the DLQI for a second time. Demographic and clinical characteristics were collected. Reliability of the DLQI was tested using Cronbach’s coefficient alpha and intraclass correlation coefficient (ICC). Factor structure was tested by explanatory and confirmatory factor analysis. Construct validity was tested by known‐groups comparison using the generalized linear model to assess factors influencing patients’ HRQL.

Results  A total of 176 psoriatics completed the questionnaire. The mean age was 36 ± 14 years. The mean Psoriasis Area and Severity Index (PASI) score was 11.8 ± 7.9. The mean DLQI score was 12.7 ± 5.9 (the higher the score the greater the impairment of HRQL). Cronbach’s alpha coefficient was 0.84. ICC was 0.97. The principal component analysis confirmed the bidimensional structure of the questionnaire. Factors associated with poorer HRQL were higher PASI (P < 0.001), pustular and erythrodermal clinical forms (P < 0.001), and older age (P = 0.001).

Conclusions  The Arabic version for Morocco of the DLQI is reliable and valid. Severity of the psoriasis, older age, and severe clinical forms influence the HRQL of patients.
Meta‐analysis of vitamin D receptor polymorphisms and psoriasis risk
Authors: Stefanic Mario , Rucevic Ivana , Barisic‐Drusko Vladimira
Published: March 2013

Background

Vitamin D receptor (VDR) gene polymorphisms have been studied as candidate variants that affect psoriasis risk. However, results have been conflicting.

Methods

We reviewed studies on VDR polymorphisms and psoriasis risk published to October 1, 2011, and quantitatively summarized associations of the most widely studied variants (FokI, TaqI, ApaI, BsmI) using meta‐analysis. Associations were measured using random‐effect odds ratios (ORs) combined with 95% confidence intervals (CIs).

Results

Eleven eligible studies, encompassing 1106 cases and 1209 controls, were retrieved from electronic databases and included in this review. The results were heterogeneous, which may be partly explained by small sample bias, the phenomenon of winner's curse, and differences among populations. For FokI and ApaI polymorphisms, we did not find any evidence of association. A borderline allelic association was found for the BsmI B variant after exclusion of the earliest significant report (OR = 0.81, 95% CI 0.68–0.98; P = 0.04, inconsistency index [I 2] = 12.7%). Among Caucasian subjects, the TaqI t allele was nominally associated with psoriasis risk (OR = 0.77, 95% CI 0.64–0.97; P = 0.012, I 2 = 0), with homozygous carriers (tt vs. TT, OR = 0.59, 95% CI 0.39–0.90; P = 0.01, I 2 = 0) and recessive model (tt vs. Tt + TT, OR = 0.66, 95% CI 0.44–0.98; P = 0.04, I 2 = 0) as protective factors. None of these associations persisted after adjustment for multiple comparisons. No publication bias was detected in this meta‐analysis.

Conclusions

No genetic variant examined in the VDR gene showed a robust and reproducible association with risk for psoriasis. Any association that may exist is likely to be weak and potentially restricted to specific populations.