bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence for bulk superconductivity in pure bismuth single crystals at ambient pressure
Authors: Prakash Om , Kumar Anil , Thamizhavel A. , Ramakrishnan S.
Published: December 2016

Going cold with Bismuth

Many elemental metals, such as lead and aluminum, become superconducting at low temperatures. Bismuth, a semimetal with very low carrier density, stays nonsuperconducting down to 10 mK. Prakash
et al.
performed tricky magnetization measurements to show that pure bulk bismuth does undergo the superconducting transition at a tiny temperature of about 0.5 mK (see the Perspective by Behnia). Because bismuth does not fit neatly into the standard picture of superconductivity, further theoretical work is necessary to explain the findings.

Science
, this issue p.
52
; see also p.
26
Complete Genome Sequence of a Variant
Pyrrhula pyrrhula polyomavirus 1
Strain Isolated from White-Headed Munia (
Lonchura maja
)
Authors: Marton Szilvia , Erdélyi Károly , Dán Ádám , Bányai Krisztián , Fehér Enikő
Published: December 2016

A novel variant of finch polyomavirus has been identified and sequenced from a diseased white-headed munia (
Lonchura maja
).
Draft Genome Sequence of a Urinary Isolate of Lactobacillus crispatus
Authors: Price Travis K. , Shaheen Majed , Kalesinskas Laurynas , Malki Kema , Hilt Evann E. , Putonti Catherine , Wolfe Alan J.
Published: December 2016

While
Lactobacillus crispatus
contributes to the stability of normal vaginal microbiota, its role in urinary health remains unclear. As part of an on-going attempt to characterize the female urinary microbiota, we report the genome sequence of an
L. crispatus
strain isolated from a woman displaying no lower urinary tract symptoms.
Complete Genome Sequence of a Burkholderia mallei Isolate Originating from a Glanderous Horse from the Kingdom of Bahrain
Authors: Elschner Mandy C. , Thomas Prasad , Melzer Falk
Published: December 2016

Burkholderia mallei
is a zoonotic agent causing glanders, a notifiable disease in equines. During the past decades glanders emerged, and the Kingdom of Bahrain reported outbreaks to the World Organization of Animal Health in 2010 and 2011. This paper presents the complete genome sequence of the
Burkholderia mallei
strain 11RR2811 Bahrain1.
Complete Genome Sequence of Bacteroides ovatus V975
Authors: Wegmann Udo , Goesmann Alexander , Carding Simon R.
Published: December 2016

The complete genome sequence of
Bacteroides ovatus
V975 was determined. The genome consists of a single circular chromosome of 6,475,296 bp containing five rRNA operons, 68 tRNA genes, and 4,959 coding genes.
Comfrey herbal remedy causing second-degree heart block: do not be outfoxed by digitalis
Authors: Vithayathil Mathew Kurian , Edwards Matthew
Published: December 2016

A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. She had no previous medical or cardiac history, with the patient stating that she tried a herbal remedy of boiled comfrey leaves for insomnia 18 hours before arrival to the department. Her ECG showed multiple abnormalities, including bradycardia, second-degree atrioventricular node block, Mobitz Type 2, a shortened QT interval, downsloping ST depression and presence of U waves. After viewing the images of comfrey and foxglove, it highlighted the possibility of mistaken ingestion ofDigitalis, containing the organic forms of cardiac glycosides, such as digoxin and digitoxin. Raised serum digoxin levels confirmed this. The patient was haemodynamically stable, and given digoxin-binding antibodies. After 5 days of cardiac monitoring, her ECG returned to normal rhythm, and she was discharged home.
Muscle mania: the quest for the perfect body
Authors: Hameed Maira , Sahu Ajay , Johnson Maria B
Published: December 2016

We describe the case of a young man with repeated hospital presentations for a variety of symptoms related to excessive bodybuilding and associated behaviours. He presented to our department (radiology) with right arm pain and loss of function. Ultrasound showed complete triceps rupture, rare in young patients and multiple cystic areas within the muscles of the arm. MRI revealed these to be multiple proteinaceous lesions within the muscle bellies and the possibility of self-innoculation was raised by the reporting radiologist. The patient subsequently admitted to injecting coconut oil to improve muscle contour lost secondary to injury. A review of his hospital presentations was then made and revealed further concerning practices performed by the patient to enhance his muscular appearance.
Advance care planning in patients with incurable cancer: study protocol for a randomised controlled trial
Authors: Johnson Stephanie , Clayton Josephine , Butow Phyllis N , Silvester William , Detering Karen , Hall Jane , Kiely Belinda E , Cebon Jonathon , Clarke Stephen , Bell Melanie L , Stockler Martin , Beale Phillip , Tattersall Martin H N
Published: December 2016

Introduction

There is limited evidence documenting the effectiveness of Advance Care Planning (ACP) in cancer care. The present randomised trial is designed to evaluate whether the administration of formal ACP improves compliance with patients' end-of-life (EOL) wishes and patient and family satisfaction with care.

Methods and analysis

A randomised control trial in eight oncology centres across New South Wales and Victoria, Australia, is designed to assess the efficacy of a formal ACP intervention for patients with cancer. Patients with incurable cancer and an expected survival of 3–12 months, plus a nominated family member or friend will be randomised to receive either standard care or standard care plus a formal ACP intervention. The project sample size is 210 patient–family/friend dyads. The primary outcome measure is family/friend-reported: (1) discussion with the patient about their EOL wishes and (2) perception that the patient's EOL wishes were met. Secondary outcome measures include: documentation of and compliance with patient preferences for medical intervention at the EOL; the family/friend's perception of the quality of the patient's EOL care; the impact of death on surviving family; patient–family and patient–healthcare provider communication about EOL care; patient and family/friend satisfaction with care; quality of life of patient and family/friend subsequent to trial entry, the patient's strength of preferences for quality of life and length of life; the costs of care subsequent to trial entry and place of death.

Ethics and dissemination

Ethical approval was received from the Sydney Local Health District (RPA Zone) Human Research Ethical Committee, Australia (Protocol number X13-0064). Study results will be submitted for publication in peer-reviewed journals and presented at national and international conferences.

Trial registration number

Pre-results;ACTRN12613001288718.
Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: TOPIC feasibility study protocol
Authors: Yeung Joyce , Melody Teresa , Kerr Amy , Naidu Babu , Middleton Lee , Tryposkiadis Kostas , Daniels Jane , Gao Fang
Published: December 2016

Introduction

Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral ligament disruption, intercostal nerve trauma and wound movement during respiration combine to produce an acute, severe postoperative pain insult and persistent chronic pain many months after surgery is common. Three recent systematic reviews conclude that unilateral continuous paravertebral blockade (PVB) provides analgesia at least equivalent to thoracic epidural blockade (TEB) in the postoperative period, has a lower failure rate, and symptom relief that lasted months. Crucially, PVB may reduce the development of subsequent chronic pain by intercostal nerve protection or decreased nociceptive input. The overall aim is to determine in patients who undergo thoracotomy whether perioperative PVB results in reducing chronic post-thoracotomy pain (CPTP) compared with TEB. This pilot study will evaluate feasibility of a substantive trial.

Methods and analysis

TOPIC is a randomised controlled trial comparing the effectiveness of TEB and PVB in reducing CPTP. This is a pilot study to evaluate feasibility of a substantive trial and study processes in 2 adult thoracic centres, Heart of England NHS Foundation Trust (HEFT) and University Hospital of South Manchester NHS Foundation Trust (UHSM). The primary objective is to establish the number of patients randomised as a proportion of those eligible. Secondary objectives include evaluation of study processes. Analyses of feasibility and patient-reported outcomes will primarily take the form of simple descriptive statistics and where appropriate, point estimates of effects sizes and associated 95% CIs.

Ethics and dissemination

The study has obtained ethical approval from NHS Research Ethics Committee (REC number 14/EM/1280). Dissemination plan includes: informing patients and health professionals; engaging multidisciplinary professionals to support a proposal of a definitive trial and submission for a full HTA application dependent on the success of the study.

Trial registration number

ISRCTN45041624; Pre-results.
Safety and efficacy of stereotactic body radiation therapy combined with S-1 simultaneously followed by sequential S-1 as an initial treatment for locally advanced pancreatic cancer (SILAPANC) trial: study design and rationale of a phase II clinical trial
Authors: Zhu Xiaofei , Ju Xiaoping , Cao Fei , Fang Fang , Qing Shuiwang , Shen Yuxin , Jia Zhen , Cao Yangsen , Zhang Huojun
Published: December 2016

Introduction

Upfront surgeries are not beneficial to most patients with pancreatic cancer. Therefore, more emphasis has been placed chemoradiotherapy in locally advanced pancreatic cancer recently. Gemcitabine-based regimens or FOLFIRINOX (a chemotherapy regimen including leucovorin, 5-FU, irinotecan, oxaliplatin) has been proven as a standard chemotherapy in pancreatic cancer. However, severe toxicities may prevent the completion of chemotherapy. S-1 has showed better objective response rates, similar overall survival rates and progression-free survival rates compared with gemcitabine, revealing that S-1 may be a potential candidate in treating pancreatic cancer, especially for patients refractory to gemcitabine. Additionally, stereotactic body radiation therapy with Cyberknife could provide better efficacy than conventional radiotherapy in pancreatic cancer. Therefore, Cyberknife with S-1 simultaneously followed by sequential S-1 as an initial treatment may bring about favourable outcomes but needs further studies.

Methods and analysis

The S-1 as an initial treatment for locally advanced pancreatic cancer (SILAPANC) trial is a prospective, single-centre, one armed ongoing study. 190 eligible patients are required to initially receive Cyberknife with 1 cycle of S-1 simultaneously. After the concurrent chemoradiotherapy, 2 or 3 cycles of S-1 are sequentially given. Doses and fractions depend on the locations and volumes of tumours and the adjacent organs at risk. S-1 is taken orally, 2 times a day, at a dose of 80 mg/m2for 28 days, followed by a 14-day interval. The primary objectives are overall survival and 1-year, 2-year, 3-year, 4-year and 5-year overall survival rates. The secondary objectives are cancer-specific survival, progression-free survival, time to progression, local control rates, clinical benefit rates, radiation-induced acute and late toxicities, adverse effects of chemotherapy and quality of life of patients. Besides, variables most predictive of prognosis would be identified via multivariate methods.

Ethics and dissemination

Approvals have been granted by the Changhai Hospital Ethics Committee (CHEC-2016-032-01). The results will be disseminated in peer-reviewed journals and at conferences.

Trial registration number

NCT02704143; Pre-results.
Short-term effects of announcing revised lower risk national drinking guidelines on related awareness and knowledge: a trend analysis of monthly survey data in England
Authors: Holmes John , Brown Jamie , Meier Petra , Beard Emma , Michie Susan , Buykx Penny
Published: December 2016

Objectives

To evaluate short-term effects of publishing revised lower risk national drinking guidelines on related awareness and knowledge. To examine where drinkers heard about guidelines over the same period.

Design

Trend analysis of the Alcohol Toolkit Study, a monthly repeat cross-sectional national survey.

Setting

England, November 2015 to May 2016.

Participants

A total of 11 845 adults (18+) living in private households in England.

Intervention

Publication of revised national drinking guidelines in January 2016 which reduced the male guideline by approximately one-third to 14 units per week.

Measurements

Whether drinkers (1) had heard of drinking guidelines (awareness), (2) stated the guideline was above, exactly or below 14 units (knowledge) and (3) reported seeing the stated guideline number of units in the last month in each of 11 locations (exposure). Sociodemographics: sex, age (18–34, 35–64, 65+), social grade (AB, C1C2, DE). Alcohol consumption derived from graduated frequency questions: low risk (<14 units/week), increasing/high risk (14+ units/week).

Results

Following publication of the guidelines, the proportion of drinkers aware of guidelines did not increase from its baseline level of 85.1% (CI 82.7% to 87.1%). However, the proportion of male drinkers saying the guideline was 14 units or less increased from 22.6% (CI 18.9% to 26.7%) in December to 43.3% (CI 38.9% to 47.8%) in January and was at 35.6% (CI 31.6% to 39.9%) in May. Last month exposure to the guidelines was below 25% in all locations except television/radio where exposure increased from 33% (CI 28.8% to 36.2%) in December to 65% (CI 61.2% to 68.3%) in January. Awareness and knowledge of guidelines was lowest in social grade DE and this gap remained after publication.

Conclusions

Publication of new or revised lower risk drinking guidelines can improve drinkers’ knowledge of these guidelines within all sociodemographic groups; however, in the absence of sustained promotional activity, positive effects may not be maintained and social inequalities in awareness and knowledge of guidelines are likely to persist.
The episode, the PTAC, cost, and the neurointerventionalist
Authors: Hirsch Joshua A , Rosenkrantz Andrew B , Liu Raymond W , Manchikanti Laxmaiah , Nicola Gregory N
Published: December 2016

Episodic care forms a payment methodology of increasing relevance to neurointerventional specialists and other providers. Episodic care payment models are currently recognized in both payment paths described by the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA): the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. Understanding the cost of care, as well as how such costs are shaped in the context of episodic care, will be critical to success in both of these paths.
The work environment of junior doctors: their perspectives and coping strategies
Authors: Pan Tzong-Yang , Fan Howard S , Owen Cathy A
Published: December 2016

Objective

This study explores the associations between psychological distress in junior doctors and their work environment and how they cope with work stressors.

Methods

A cross-sectional survey designed by Health Education and Training Institute was delivered in 2014 to over 1900 junior doctors across 15 hospital networks through Australian Capital Territory and New South Wales. Psychological distress was evaluated using the Kessler Psychological Distress Scale-10 (K10). Numerous variables were assessed for associations with psychological distress to identify the strongest relationships and the coping strategies used. Potential associations between work demands, coping strategies and psychological distress were explored.

Results

540 responses were analysed. 414 (81%) thought their workload was reasonable, 376 (75%) were enjoying their current job and 446 (82.6%) were content with their work life. However, 85 (15.7%) reported that they would not study medicine if given their time again, and 146 (27%) reported workplace bullying. The mean K10 score was 17.2 (σ=6.3) and the prevalence of elevated psychological distress was between 63% and 80% higher than the general community. Variables most strongly associated with distress were: being discontented with workload, lack of enjoyment from current job, taking time off work and having experienced workplace bullying. There was a preference to use social activities as a method of coping but at higher levels of psychological distress there is a greater proportion who took time off work.

Conclusions

Psychologically distressed junior doctors need recognition, support and treatment. Future interventions should focus on improving work environment, job satisfaction, provision of supports, use of healthy coping strategies and improving work-related relationships. This could potentially reduce levels of psychological distress in junior doctors, optimise delivery of healthcare to patients and maximise workforce potential.
Wavelength-tunable superresolution imaging with a ferrite superlens
Authors: Wang Xiaohua , Liu Youwen , Feng Yuncai , Dong Daxing
Published: December 2016

We theoretically propose a system capable of wavelength-tunable sub-diffraction-limited imaging by a single planar magnetic superlens, which is made of [Formula: see text]-negative ferrite material (MNM) slab. Our theoretical and numerical simulation results demonstrate that the working wavelength of this planar superlens can be well tuned with the external magnetic field since the permeability of ferrite material LuBiIG is adjusted by the applied magnetic field. The resolution of the magnetic superlens with 300 [Formula: see text]m thickness LuBiIG film is smaller than [Formula: see text]/20, and the resolution is higher with thinner film. It may provide a potential way to design a wavelength-tunable magnetic superlens with the single layer of ferrite thin film material.
This Submission is for Special Issue on Underwater Acoustics: Perfectly Matched Layer Technique for Parabolic Equation Models in Ocean Acoustics
Authors: Xu Chuan-Xiu , Piao Sheng-Chun , Yang Shi-E , Zhang Hai-Gang , Li Li
Published: December 2016

In ocean waveguides, the ocean bottom is usually approximated as a half-space. Thus, there exist no reflection waves at the half-space bottom and condition of radiation at infinity should be satisfied. In numerical solutions like parabolic equation methods, the depth domain has to be truncated, which can generate reflection waves from the truncated ocean bottom. To reduce the effect of reflection waves and to simulate an unbounded ocean bottom accurately, an artificial absorbing layer (ABL) was used. As was demonstrated, an ABL meets well the demand of accuracy in sound field calculation. However, both the sea-bottom layer and the artificial absorbing layer are needed to be set quite thick by using an ABL technique. Fortunately, a PML with several wavelengths can keep similar calculation accuracy with an ABL with dozens of wavelengths. In this paper, perfectly matched layer (PML) techniques for three parabolic equation (PE) models RAM, RAMS and a three-dimensional PE model in underwater acoustics are presented. A key technique of PML “complex coordinate stretching” is used to truncate unbounded domains and to simulate infinity radiation conditions instead of the ABL in those models. The numerical results illustrate that the PML technique is of higher efficiency than the ABL technique at truncating the infinity domain with minimal spurious reflections in PE models.
Radon surveys and monitoring at active volcanoes: learning from Vesuvius, Stromboli, La Soufrière and Villarrica
Authors: Cigolini C. , Laiolo M. , Coppola D. , Trovato C. , Borgogno G.
Published: December 2016

Understanding the behaviour of fluids in hydrothermal systems is a key factor in volcano monitoring. Measuring gas emissions in volcanic areas is strategic for detecting and interpreting precursory signals of variations in volcanic activity. The role of radon as a potential precursor of earthquakes has been extensively debated. However, radon anomalies appear to be better suited to forecast eruptive episodes as we know the loci of volcanic eruptions and we can follow the evolution of volcanic activity. Radon mapping is an effective tool in assessing diffuse and concentrated degassing at the surface. We hereby summarize the in-soil radon emissions collected worldwide and further discuss a collection of data on our key targets. These are closed-conduit and open-conduit volcanoes: Vesuvius (Italy) and La Soufrière (Guadeloupe, Lesser Antilles), Stromboli (Italy) and Villarrica (Chile), respectively. In all the above volcanoes, faults and fracture systems control radon degassing. Automatic and real-time measurements help us to detect major changes in volcanic activity. We present and discuss the radon time series associated with the last effusive eruption at Stromboli. Spectral analyses reveal diurnal and semi-diurnal cycles being probably modulated by atmospheric variations. Multiple linear regression (MLR) analyses have been performed by filtering the radon signals from the effects of local environmental parameters. The residuals do not show particular variations or precursory peaks as the gases have been released from this open-conduit volcano before the onset of the effusive phase (7 August 2014).

It is finally emphasized that radon is not the sole precursor, and we should also rely on other geochemical and geophysical parameters. In this perspective, we propose a methodological procedure that can contribute to improving volcano surveillance in an attempt to mitigate volcanic risk.
Significant annual and sub-annual cycles in indoor radon concentrations: seasonal variation and correction
Authors: Crockett Robin G. M. , Groves-Kirkby Christopher J. , Denman Antony R. , Phillips Paul S.
Published: December 2016

The majority of radon measurements in the built environment are made over sub-year periods and are then generally seasonally corrected (i.e. scaled by an appropriate seasonal correction factor (SCF)) to estimate the annual average radon concentration. SCFs are statistically derived and assume an underlying annual cycle, reflecting the widely observed seasonal variation in indoor radon concentrations. In the UK, Public Health England has pioneered the calculation and use of a national SCF set using an annual sinusoidal model for variations in radon concentration and averaging across the entire country.

To test the validity of that model, a 4 year record of weekly radon data from four houses in Brixworth (Northamptonshire, UK) was analysed in conjunction with corresponding weather data for the period from a nearby weather station. The radon data showed a statistically significant annual cycle comprising both annual sinusoidal and second harmonic (i.e. 6 month period) terms.

Two sets of SCFs were calculated: first, using a conventional annual sinusoidal model that explained 21.2% of the variance in the radon data; and, secondly, a second harmonic term was included in the model that explained 24.6% of the variance. This represents an improvement of 3.4 percentage points (15.9%) and, thus, will result in better SCFs.
UMH
Authors: Ziabari Amir Kavyan , Sun Yifan , Ma Yenai , Schaa Dana , Abellán José L. , Ubal Rafael , Kim John , Joshi Ajay , Kaeli David
Published: December 2016

In this article, we describe how to ease memory management between a Central Processing Unit (CPU) and one or multiple discrete Graphic Processing Units (GPUs) by architecting a novel hardware-based Unified Memory Hierarchy (UMH). Adopting UMH, a GPU accesses the CPU memory only if it does not find its required data in the directories associated with its high-bandwidth memory, or the NMOESI coherency protocol limits the access to that data. Using UMH with NMOESI improves performance of a CPU-multiGPU system by at least 1.92 × in comparison to alternative software-based approaches. It also allows the CPU to access GPUs modified data by at least 13 × faster.
Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training
Authors: Thompson Christopher , Wylie Lee J. , Blackwell Jamie R. , Fulford Jonathan , Black Matthew I. , Kelly James , McDonagh Sinead T. J. , Carter James , Bailey Stephen J. , Vanhatalo Anni , Jones Andrew M.
Published: December 2016

We hypothesized that 4 wk of dietary nitrate supplementation would enhance exercise performance and muscle metabolic adaptations to sprint interval training (SIT). Thirty-six recreationally active subjects, matched on key variables at baseline, completed a series of exercise tests before and following a 4-wk period in which they were allocated to one of the following groups: 1) SIT and [Formula: see text]-depleted beetroot juice as a placebo (SIT+PL); 2) SIT and [Formula: see text]-rich beetroot juice (~13 mmol [Formula: see text]/day; SIT+BR); or 3) no training and [Formula: see text]-rich beetroot juice (NT+BR). During moderate-intensity exercise, pulmonary oxygen uptake was reduced by 4% following 4 wk of SIT+BR and NT+BR ( P < 0.05) but not SIT+PL. The peak work rate attained during incremental exercise increased more in SIT+BR than in SIT+PL ( P < 0.05) or NT+BR ( P < 0.001). The reduction in muscle and blood [lactate] and the increase in muscle pH from preintervention to postintervention were greater at 3 min of severe-intensity exercise in SIT+BR compared with SIT+PL and NT+BR ( P < 0.05). However, the change in severe-intensity exercise performance was not different between SIT+BR and SIT+PL ( P > 0.05). The relative proportion of type IIx muscle fibers in the vastus lateralis muscle was reduced in SIT+BR only ( P < 0.05). These findings suggest that BR supplementation may enhance some aspects of the physiological adaptations to SIT.

NEW & NOTEWORTHY We investigated the influence of nitrate-rich and nitrate-depleted beetroot juice on the muscle metabolic and physiological adaptations to 4 wk of sprint interval training. Compared with placebo, dietary nitrate supplementation reduced the O2 cost of submaximal exercise, resulted in greater improvement in incremental (but not severe-intensity) exercise performance, and augmented some muscle metabolic adaptations to training. Nitrate supplementation may facilitate some of the physiological responses to sprint interval training.
Aerobic Exercise and Cancer-Related Fatigue in Adults: A Reexamination Using the IVhet Model for Meta-analysis
Authors: Kelley George A. , Kelley Kristi S.
Published: December 2016

Background: Although the results of a recent meta-analysis using the traditional random effects model yielded a statistically significant standardized mean difference (SMD) reduction in cancer-related fatigue (CRF) as a result of aerobic exercise, a recently developed inverse heterogeneity (IVhet) model has been shown to be more valid than the traditional random effects model. The purpose of this study was to compare these previous meta-analytic results using the IVhet model.

Methods: Using data from a previous meta-analysis that included 36 SMD effect sizes (ES) representing 2,830 adults (1,426 exercise, 1,404 control), results were pooled using the IVhet model. Absolute and relative differences between the IVhet and random effects results for CRF were also calculated as well as influence analysis with each SMD ES deleted from the IVhet model. Nonoverlapping 95% confidence intervals (CI) were considered statistically significant.

Results: A statistically nonsignificant reduction in CRF fatigue was found as a result of aerobic exercise using the IVhet model (SMD, −0.08; 95% CI, −0.31–0.14; P = 0.46). The IVhet model yielded a SMD ES that was 0.14 (63.6%) smaller than the random effects model. With each study deleted from the IVhet model once, results remained statistically nonsignificant with SMD ESs ranging from −0.11 (95% CI, −0.33–0.11) to −0.06 (95% CI, −0.28–0.16).

Conclusions: Insufficient evidence currently exists to support the use of aerobic exercise for reducing CRF in adults.

Impact: Additional studies are needed to determine the certainty of aerobic exercise on CRF in adults. Cancer Epidemiol Biomarkers Prev; 26(2); 281–3. ©2016 AACR.
2q33.1q34 Deletion in a Girl with Brain Anomalies and Anorectal Malformation
Authors: Ronzoni Luisa , Novelli Antonio , Brisighelli Giulia , Peron Angela , Triulzi Fabio , Bianchi Vera , Leva Ernesto , Bedeschi Maria F.
Published: December 2016

2q33 deletions are considered to constitute a distinct clinical entity (Glass syndrome or 2q33 microdeletion syndrome) with a characteristic phenotype. Most patients have moderate to severe developmental delay, speech delay, a particular behavioural phenotype, feeding problems, growth restriction, a typical facial appearance, thin and sparse hair, tooth abnormalities, and skeletal anomalies. Here, we report on a patient with a 2q33.1q34 deletion spanning 8.3 Mb of genomic DNA. Although her clinical features are very reminiscent of the 2q33 microdeletion syndrome, she also presented with brain and anorectal malformations. Based on the present and published patients with 2q33 deletions, we suggest that the critical region for the Glass syndrome may be larger than initially proposed. Moreover, we suggest that brain abnormalities might be an additional feature of the 2q33 microdeletion syndrome, but that anorectal malformation is likely not a key marker.
Delayed Nephrology Consultation and High Mortality on Acute Kidney Injury: A Meta-Analysis
Authors: Soares Débora M. , Pessanha José F. , Sharma Aashish , Brocca Alessandra , Ronco Claudio
Published: December 2016

Background: Acute kidney injury (AKI) is a complex syndrome associated with substantial morbidity, mortality and costs. Despite advancements in diagnosis and care practice, AKI remains a disorder usually under/late-recognized with high mortality. One of the hidden reasons for poor outcome might be delayed nephrology consultation, with the involvement of the specialist only in severe stages of AKI when renal replacement therapy (RRT) is required. Methods: We searched PubMed, EMBASE and Cochrane central register for related work on the subject. Six studies were identified for the meta-analysis, correlating time of nephrology consultation and mortality in AKI. Results: We found that delayed nephrology consultation is associated with higher mortality in AKI, with an OR 0.79 (95% CI 0.48-1.10, p < 0.05). Conclusion: Delayed nephrology consultation contributes to higher mortality in AKI. The early involvement of nephrologist may present an advantage in terms of early recognition, prevention and effective treatment of AKI. An early involvement of multidisciplinary task force may contribute to better treatment, before the preventable complications of AKI occur or an emergency RRT is required.
The Relationship between Socioeconomic Status and Narrative Abilities in a Group of Italian Normally Developing Children
Authors: Mozzanica Francesco , Ambrogi Federico , Salvadorini Renata , Sai Elena , Pozzoli Raffaella , Barillari Maria Rosaria , Scarponi Letizia , Schindler Antonio
Published: December 2016

Objective: Only limited and conflicting information is available regarding the relationship between socioeconomic status (SES) and narrative abilities. Besides, the role fathers' SES plays in the development of their children's narrative abilities has never been investigated. The aim of this study was to analyze the relationship between fathers' and mothers' SES and narrative abilities of their children assessed with the Italian version of the Bus Story Test (I-BST). Subjects and Methods: A total of 505 normally developing Italian children were enrolled in the study. Information regarding parents' educational level and employment was collected for each child. Narrative abilities were evaluated using the I-BST. The relationships between parents' employment, educational level, and I-BST scores were analyzed by univariate and multivariate regression analysis. Results: In univariate analysis, both fathers' and mothers' education and employment were associated with most I-BST subscale scores, especially when higher educational and employment levels were contrasted with the lowest educational and employment levels. In multiple regression analysis, significant associations were found only between the fathers' working status and educational level and I-BST subscale scores. Conclusions: Parental education and employment might impact narrative abilities of children. When both fathers' and mothers' SES variables are considered together, only fathers' education and working status seemed to be associated with I-BST scores.
Locoregional Therapies of Cholangiocarcinoma
Authors: Sommer Christof M. , Kauczor Hans U. , Pereira Philippe L.
Published: December 2016

Background: Cholangiocarcinoma (CC) is the second most primary liver malignancy with increasing incidence in Western countries. Currently, surgical R0 resection is regarded as the only potentially curative treatment. The results of systemic chemotherapy and best supportive care (BSC) in patients with metastatic disease are often disappointing in regard to toxicity, oncologic efficacy, and overall survival. In current practice, the use of different locoregional therapies is increasingly more accepted. Methods: A review of the literature on locoregional therapies for intrahepatic cholangiocarcinoma (ICC) was undertaken. Results: There are no prospective randomized controlled trials. For localized ICC, either primary or recurrent, radiofrequency ablation (RFA) is by far the most commonly used thermal ablation modality. Thereby, a systematic review and meta-analysis reports major complication in 3.8% as well as 1-, 3-, and 5-year overall survival rates of 82, 47, and 24%, respectively. In selected patients (e.g. with a tumor diameter of ≤3 cm), oncologic efficacy and survival after RFA are comparable with surgical resection. For diffuse ICC, different transarterial therapies, either chemotherapy-based (hepatic artery infusion (HAI), transarterial chemoembolization (TACE)) or radiotherapy-based (transarterial radioembolization (TARE)), show extremely promising results. With regard to controlled trials (transarterial therapy versus systemic chemotherapy, BSC or no treatment), tumor control is virtually always better for transarterial therapies and very often accompanied by a dramatic survival benefit and improvement of quality of life. Of note, the latter is the case not only for patients without extrahepatic metastatic disease but also for those with liver-dominant extrahepatic metastatic disease. There are other locoregional therapies such as microwave ablation, irreversible electroporation, and chemosaturation; however, the current data support their use only in controlled trials or as last-line therapy. Conclusion: Dedicated locoregional therapies are commonly used for primary and recurrent ICC as well as liver-only and liver-dominant extrahepatic metastatic disease. Currently, the best evidence and most promising results are available for RFA, HAI, TACE, and TARE. In cohort studies, the overall survival rates are similar to those obtained with surgery or systemic therapies. Prospective randomized controlled trials are warranted to compare safety and efficacy between different surgical, interventional, and systemic therapies, as well as their combinations.
Critical Care Nephrology: A Multidisciplinary Approach
Authors: Rizo-Topete Lilia , Ronco Claudio
Published: December 2016

Acute kidney injury (AKI) is a serious medical condition affecting millions of people. Patients in intensive care unit (ICU) who develop AKI have increased morbidity and mortality, prolonged length of stay in ICU and hospital and increased costs, especially when they require renal replacement therapy. In the latter case, morbidity and mortality increase further. In order to meet the needs of the critically ill patients, a multidisciplinary care team is required, combining the efforts of physicians and nurses from different disciplines as well as nephrologists and intensivists. A personalized patient management is strongly recommended as proposed by the recent criteria of precision medicine. Early identification of patients at risk and timely intervention in case of AKI diagnosis can be obtained by integrating the role of nephrologist in the ICU practice. An innovative model of organization by introducing the nephrology rapid response team is advocated to manage critically ill patients with kidney problems in order to make early diagnosis and interventions, to reduce progression toward CKD and improve renal recovery. The routine adoption of AKI biomarkers together with such a collegial teamwork may represent the pathway toward success.
Screening of Bioactive Ingredients in Ligusticum Chuanxiong Hort for Protection against Myocardial Ischemia
Authors: Liu Xu , Li Xiuzhong , Ji Songgang , Cui Xiaobo , Li Mingchun
Published: December 2016

Background/Aims: To study the spectrum-effect relationship and effective components of Ligusticum Chuanxiong Hort. (LCH) on the protection of canine myocardial ischemia. Methods: Fingerprint spectrum of LCH extracts was developed using high performance liquid chromatography (HPLC), and a canine model of acute myocardial ischemia was established by ligating the coronary artery. Bivariate correlation analysis and multivariate regression analysis were used to correlate the pharmacodynamics of LCH extract and its common peaks in HPLC. Results: The bioactive components of LCH were ligustrazine, ferulic acid, cnidilide and ligustilide. Ligustrazine and ferulic acid could significantly reduce serum lactic acid in canine model of acute myocardial ischemia, while ligustilide could significantly reduce the elevation of serum free fatty acid. Conclusions: The spectrum-effect relationship study shows that the effective components of LCH are ligustrazine, ferulic acid, cnidilide and ligustilide, which have protective effect on myocardial ischemia.
MiR-181a Targets PHLPP2 to Augment AKT Signaling and Regulate Proliferation and Apoptosis in Human Keloid Fibroblasts
Authors: Rang Zhen , Wang Zong-yang , Pang Qiu-yu , Wang You-wei , Yang Ge , Cui Fan
Published: December 2016

Background/Aims: Keloids are fibrous overgrowths induced by cutaneous injury. MicroRNAs (miRNAs) have recently emerged as post-transcriptional gene repressors and participants in a diverse array of pathophysiological processes leading to skin disease. The purpose of the current study was to explore the precise functions of miR-181a in human keloid development and the underlying mechanisms. Methods: A miRNA microarray analysis was performed to compare expression profiles between keloid and normal skin tissues. Quantitative real-time PCR was conducted to estimate miR-181a expression. Cell proliferation was determined using the cell counting kit-8 (CCK-8) and 5-ethynyl-2-deoxyuridine (EdU) assays, and cell cycle and apoptosis were detected with flow cytometry. Direct targets of miR-181a were identified using the luciferase reporter assay. Results: miR-181a was significantly upregulated in human keloid tissues and fibroblasts, compared with their control counterparts. Overexpression of miR-181a enhanced keloid fibroblast DNA synthesis and proliferation and inhibited apoptosis, whereas miR-181a suppression triggered the opposite effects. Moreover, miR-181a suppressed the expression of PH domain leucine-rich repeat protein phosphatase 2 (PHLPP2) through direct interactions with its 3′UTR region and subsequently enhanced AKT activation. Overexpression of PHLPP2 without its 3′UTR attenuated the effects of miR-181a on cell proliferation and apoptosis in keloid fibroblast cells. Furthermore, miR-181a mimics increased normal skin fibroblast proliferation. Conclusions: Our results highlight a novel pathway mediated by miR-181a, which may be effectively used as a therapeutic target for treatment of keloids.
Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus
Authors: Yahagi Kazuyuki , Kolodgie Frank D. , Lutter Christoph , Mori Hiroyoshi , Romero Maria E. , Finn Aloke V. , Virmani Renu
Published: December 2016

The continuing increase in the prevalence of diabetes mellitus in the general population is predicted to result in a higher incidence of cardiovascular disease. Although the mechanisms of diabetes mellitus–associated progression of atherosclerosis are not fully understood, at clinical and pathological levels, there is an appreciation of increased disease burden and higher levels of arterial calcification in these subjects. Plaques within the coronary arteries of patients with diabetes mellitus generally exhibit larger necrotic cores and significantly greater inflammation consisting mainly of macrophages and T lymphocytes relative to patients without diabetes mellitus. Moreover, there is a higher incidence of healed plaque ruptures and positive remodeling in hearts from subjects with type 1 diabetes mellitus and type 2 diabetes mellitus, suggesting a more active atherogenic process. Lesion calcification in the coronary, carotid, and other arterial beds is also more extensive. Although the role of coronary artery calcification in identifying cardiovascular disease and predicting its outcome is undeniable, our understanding of how key hormonal and physiological alterations associated with diabetes mellitus such as insulin resistance and hyperglycemia influence the process of vascular calcification continues to grow. Important drivers of atherosclerotic calcification in diabetes mellitus include oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased inflammatory cytokine production, and release of osteoprogenitor cells from the marrow into the circulation. Our review will focus on the pathophysiology of type 1 diabetes mellitus– and type 2 diabetes mellitus–associated vascular disease with particular focus on coronary and carotid atherosclerotic calcification.
Tracking Monocyte Recruitment and Macrophage Accumulation in Atherosclerotic Plaque Progression Using a Novel hCD68GFP/ApoE
−/−
Reporter Mouse—Brief Report
Authors: McNeill Eileen , Iqbal Asif J. , Jones Daniel , Patel Jyoti , Coutinho Patricia , Taylor Lewis , Greaves David R. , Channon Keith M.
Published: December 2016

Objective—

To create a model of atherosclerosis using green fluorescent protein (GFP)–targeted monocytes/macrophages, allowing analysis of both endogenous GFP
+
and adoptively transferred GFP
+
myeloid cells in arterial inflammation.

Approach and Results—

hCD68GFP reporter mice were crossed with ApoE
−/−
mice. Expression of GFP was localized to macrophages in atherosclerotic plaques and in angiotensin II–induced aortic aneurysms and correlated with galectin 3 and mCD68 expression. Flow cytometry confirmed GFP
+
expression in CD11b
+
/CD64
+
, CD11c
+
/MHC-II
HI
, and CD11b
+
/F4/80
+
myeloid cells. Adoptive transfer of GFP
+
monocytes demonstrated monocyte recruitment to both adventitia and atherosclerotic plaque, throughout the aortic root, within 72 hours. We demonstrated the biological utility of hCD68GFP monocytes by comparing the recruitment of wild-type and CCR2
−/−
monocytes to sites of inflammation.

Conclusions—

hCD68GFP/ApoE
−/−
mice provide a new approach to study macrophage accumulation in atherosclerotic plaque progression and to identify cells recruited from adoptively transferred monocytes.
Contraction of Blood Clots Is Impaired in Acute Ischemic Stroke
Authors: Tutwiler Valerie , Peshkova Alina D. , Andrianova Izabella A. , Khasanova Dina R. , Weisel John W. , Litvinov Rustem I.
Published: December 2016

Objective—

Obstructive thrombi or thrombotic emboli are the pathogenic basis of ischemic stroke. In vitro blood clots and in vivo thrombi can undergo platelet-driven contraction (retraction), resulting in volume shrinkage. Clot contraction can potentially reduce vessel occlusion and improve blood flow past emboli or thrombi. The aim of this work was to examine a potential pathogenic role of clot contraction in ischemic stroke.

Approach and Results—

We used a novel automated method that enabled us to quantify time of initiation and extent and rate of clot contraction in vitro. The main finding is that clot contraction from the blood of stroke patients was reduced compared with healthy subjects. Reduced clot contraction correlated with a lower platelet count and their dysfunction, higher levels of fibrinogen and hematocrit, leukocytosis, and other changes in blood composition that may affect platelet function and properties of blood clots. Platelets from stroke patents were spontaneously activated and displayed reduced responsiveness to additional stimulation. Clinical correlations with respect to severity and stroke pathogenesis suggest that the impaired clot contraction has the potential to be a pathogenic factor in ischemic stroke.

Conclusions—

The changeable ability of clots and thrombi to shrink in volume may be a novel unappreciated mechanism that aggravates or alleviates the course and outcomes of ischemic stroke. The clinical importance of clot or thrombus transformations in vivo and the diagnostic and prognostic value of this blood test for clot contraction need further exploration.
Incidence, Risk Factors, and Outcome of Life-Threatening Ventricular Arrhythmias in Giant Cell Myocarditis
Authors: Ekström Kaj , Lehtonen Jukka , Kandolin Riina , Räisänen-Sokolowski Anne , Salmenkivi Kaisa , Kupari Markku
Published: December 2016

Background—

Ventricular tachyarrhythmias are characteristic of giant cell myocarditis, but their true incidence, predictors, and outcome are unknown.

Methods and Results—

Our work involved 51 patients with giant cell myocarditis (35 women) aged 52±12 years. Their medical records were reviewed for history, results of laboratory and imaging studies, and occurrence of serious cardiac events, including life-threatening ventricular tachyarrhythmias. Sudden cardiac death (fatal or aborted) was the primary end point of our analyses, whereas the composite of sudden cardiac death and ventricular tachycardia requiring treatment constituted the secondary end point. Giant cell myocarditis presented as nonfatal ventricular tachyarrhythmia in 10 patients and as a fatal cardiac arrest in 1 patient. Overall, 14 of 50 patients suffered a sudden cardiac death during follow-up, with a cumulative incidence of 22% at 1 year and 26% at 5 years from presentation. The composite incidence of sudden cardiac death or ventricular tachycardia was 41% at 1 year and 55% at 5 years. The incidence of arrhythmias was associated with high plasma concentrations of troponin-T and N-terminal brain natriuretic propeptide, as well as with moderate-to-severe fibrosis on myocardial biopsy and history of ventricular tachyarrhythmias at presentation (
P
<0.05 for all). An intracardiac cardioverter defibrillator was implanted in 31 patients, of whom 17 had altogether 114 appropriate antiarrhythmic therapies by the device and none suffered an arrhythmic death.

Conclusions—

In giant cell myocarditis, the risk of life-threatening ventricular arrhythmias exceeds 50% at 5 years from admission, being related to the presenting clinical manifestation and markers of myocardial injury and scarring.