bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Value of CA 15.3 Kinetics for Metastatic Breast Cancer
Authors: De La Lande B. , Hacene K. , Floiras J.-L. , Alatrakchi N. , Pichon M.-F.
Published: January 2018

Up to 80% of breast cancer patients developing metastases have high levels of CA 15.3. We studied the prognostic implications of CA 15.3 kinetics in 119 patients before and at first metastasis by univariate and multivariate statistics. At first metastasis, CA 15.3 was elevated in 82.4% of patients, with a lead time (median 162 days) in 42.0% of them. Kaplan-Meier analysis showed overall survival (median 1477 days) to be significantly related to estrogen receptor (ER) and progesterone receptor (PgR) status (p=0.0001) and tumor size (p=0.025). The interval between diagnosis and first abnormal CA 15.3 (p=0.0001), the CA 15.3 concentration (p=0.013), and the presence or absence of a lead time (p=0.001) also had prognostic value. ER and PgR status (p=0.0005 and p=0.0103, respectively), metastasis-free interval (p=0.0003), existence of a CA 15.3 lead time (p=0.0028), and days from diagnosis to first abnormal CA 15.3 (p=0.0055) entered in the Cox model. After first metastasis (median survival 573 days), ER and PgR status (p=0.0001 and p=0.0004, respectively), existence of a lead time for CA 15.3 (p=0.0138), and the concentration of first abnormal CA 15.3 (p=0.0145) had individual prognostic value. In the Cox model ER status (p=0.0001), nodal status (p=0.0191), existence of a lead time for CA 15.3 (p=0.0033), days from diagnosis to first abnormal CA 15.3 (p=0.0132), and concentration of first abnormal CA 15.3 (p=0.0320) were found to be independent prognostic variables. Compared to a matched historical control group that was not monitored by CA 15.3 assaying (n=140), the study group had a significantly longer survival after the first metastasis (p=0.0005). In conclusion, the kinetics of CA 15.3 before the first metastasis is of prognostic value. When associated with 18-fluorodeoxyglucose imaging, serial CA 15.3 assays may help to implement early treatment of metastases.
Serum Tumor Necrosis Factor-alpha and Interleukin-2 Concentrations in Newly Diagnosed ERBB2 (HER2/neu) Positive Breast Cancer Patients
Authors: Saglam Sezer , Suzme Rafi , Gurdol Figen
Published: January 2018

Aim

Cytokines have been associated with symptoms and adverse outcomes in breast cancer. Overexpression of ERBB2 (c-erb-b2; formerly HER2/neu), which is a member of the epidermal growth receptor family, is associated with involvement of lymph nodes, large tumor size, high grade, steroid receptor negativity, aneuploidy, high proliferation rate, and low overall survival in breast cancer. The aim of the study was to examine whether ERBB2 amplification has any effect on circulating levels of tumor necrosis factor-alpha (TNF-α) and interleukin-2 (IL-2) in breast cancer patients.

Material and methods

Fifty patients with primary breast carcinoma, classified as either ERBB2 (+) or (-) by the fluorescence in situ hybridization (FISH) technique, were included in the study. Cytokines were studied by ELISA according to the procedure described in the commercial kit.

Results

IL-2 levels were found significantly higher in ERBB2+ patients than in controls (p<0.05). A significant negative correlation existed between ERBB2 positivity and estrogen receptor status (p=0.004). Plasma TNF-α and IL-2 levels were positively correlated in ERBB2+ breast cancer patients (p<0.01).

Conclusion

The increase in IL-2 concentrations observed in our study suggests an activation of T cells by ERBB2 peptides.
Evaluation of Cell-free DNA in Urine as a Marker for Bladder Cancer Diagnosis
Authors: Zancan Matelda , Galdi Francesca , Di Tonno Fulvio , Mazzariol Chiara , Orlando Claudio , Malentacchi Francesca , Agostini Marco , Maran Michela , Del Bianco Paola , Fabricio Aline S.C. , Murer Bruno , Pianon Carlo , Gion Massimo
Published: January 2018

The diagnosis and follow-up of bladder cancer are mainly based on cystoscopy, an invasive method which could be negative in case of flat malignancies such as carcinoma in situ. Other noninvasive diagnostic methods have not yet given satisfactory results. There is a need for a reliable yet noninvasive method for the detection of bladder cancer. Our aim was to investigate whether cell-free DNA quantified in urine (ucf-DNA) could be a useful marker for the diagnosis of bladder cancer.

A standard urine test was performed in 150 naturally voided morning urine samples that were processed to obtain a quantitative evaluation of ucf-DNA. Leukocyturia and/or bacteriuria were found in 18 subjects, who were excluded from the study. Statistical analysis was performed on 45 bladder cancer patients and 87 healthy subjects. Ucf-DNA was extracted from urine samples by a spin column-based method and quantified using four different methods: GeneQuant Pro (Amersham Biosciences, Pittsburg, PA, USA), Quant-iT™ DNA high-sensitivity assay kit (Invitrogen, Carlsbad, CA, USA), Real-Time PCR (Applied Biosystems, Foster City, CA, USA), and NanoDrop 1000 (NanoDrop Technologies, Houston, TX, USA). Median free DNA quantification did not differ statistically between bladder cancer patients and healthy subjects.

A receiver-operating characteristic (ROC) curve was developed to evaluate the diagnostic performance of ucf-DNA quantification for each method. The area under the ROC curve was 0.578 for GeneQuant Pro, 0.573 for the Quant-iT™ DNA high-sensitivity assay kit, 0.507 for Real-Time PCR, and 0.551 for NanoDrop 1000, which indicated that ucf-DNA quantification by these methods is not able to discriminate between the presence and absence of bladder cancer. No association was found between ucf-DNA quantification and tumor size or tumor focality.

In conclusion, ucf-DNA isolated by a spin column-based method and quantified by GeneQuant Pro, Quant-iT™ DNA high-sensitivity assay kit, Real-Time PCR or NanoDrop 1000 does not seem to be a reliable marker for the diagnosis of bladder cancer.
Downregulation of ABCD1 in Human Renal Cell Carcinoma
Authors: Hour Tzyh-Chyuan , Kuo Yi-Zih , Liu Guang-Yaw , Kang Wang-Yi , Huang Chao-Yuan , Tsai Yu-Chieh , Wu Wen-Jeng , Huang Shu-Pin , Pu Yeong-Shiau
Published: January 2018

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. Delayed diagnosis may result in progression and metastasis. Markers for early detection of RCC are lacking. The ATP-binding cassette transporter D1 (ABCD1) is located in the human peroxisome membrane. Its mutation causes X-linked adrenoleukodystrophy (X-ALD), a peroxisomal disorder affecting lipid storage. The role of ABCD1 in human renal tumorigenesis was unclear. In this study, three pairs of RCC tissues were examined by cDNA microarray and data suggested that ABCD1 mRNA is downregulated. Downregulation of ABCD1 expression was confirmed by real-time PCR. ABCD1 expression was also downregulated in four renal cancer cell lines compared to immortalized benign renal tubular cells. ABCD1 mRNA and protein expression levels assessed by immunohistochemistry in the RCC tissues were similar between genders, tumor grades, and tumor stages. Immunohisto-chemical assays also showed that ABCD1 expression was significantly higher in normal than in cancerous tissues (p<0.001). ABCD1 downregulation may be involved in human renal tumorigenesis.
Osteopontin-Igm as a Marker for the Diagnosis of Hepatocellular Carcinoma
Authors: Biasiolo Alessandra , Tono Natascia , Beneduce Luca , Zuin Jessica , Fassina Giorgio , Meo Sabrina , Paccagnella Daniela , Mazzucco Mauro , Farinati Fabio , Giacomin Anna , Vanin Veronica , Aldinio Maria Teresa , Miola Emanuela , Donà Silvio , Matteucci Claudia , Sorrentino Roberta , Rasi Guido , Gatta Angelo , Pontisso Patrizia
Published: January 2018

Introduction

Biomarkers for early hepatocellular carcinoma (HCC) detection are still a clinical need. Recent data indicate that cancer-associated antigens lead to the formation of circulating IgM-linked immune complexes as the result of natural IgM production by the innate immune response. The SCCA-IgM immune complex has already been described for primary liver cancer detection. Osteopontin (OPN) is a member of the SIBLING family of proteins recently shown to be related to tumorigenesis, progression and metastasis in various cancer types.

Aim

To evaluate the serum levels of the OPN-IgM complex in comparison to the SCCA-IgM complex in patients with HCC.

Patients

A total of 256 patients were analyzed including 151 patients with HCC (M/F 115/36; mean age ± SD: 67 ± 12 years) and 106 patients with cirrhosis (M/F 68/38; mean age ± SD: 62 ± 12 years). HCC, tested before any therapeutic approach, was mainly of viral etiology (58% HCV, 11% HBV), while alcohol abuse (22%) was the main risk factor for the remaining cases. A similar distribution was found in patients with cirrhosis (46% HCV, 15% HBV, 38% alcohol).

Methods

Serum levels of OPN-IgM were measured using a homemade ELISA assay with a polyclonal anti-human OPN antibody (Biodesign Int, USA). SCCA-IgM was detected in serum using an ELISA assay kit (Hepa-IC, Xeptagen).

Results

OPN-IgM was positive in 64/151 (42%) patients with HCC and in 45/106 (42%) patients with cirrhosis (specificity 58%), while the reference biomarker SCCA-IgM showed 35% sensitivity (49/139) and 71 % specificity. When patients were stratified on the basis of etiology, the sensitivity values for OPN-IgM and SCCA-IgM were 51% vs 44% in HCV patients, and 36% vs 23% in the other patients, while the specificity was lower for OPN-IgM (55% vs 69% in HCV patients; 62% vs 72% in the other patients). Combination of the two biomarkers resulted in an increase in sensitivity to 63% for viral etiology and to 40% for nonviral etiology.

Conclusion

Different IgM-linked biomarkers are detectable in primary liver cancer. OPN-IgM and SCCA-IgM showed a similar behavior, while the combination of these biomarkers increased the diagnostic performance for primary liver cancer.
Circulating Survivin-IGM is a Novel Candidate Biomarker of Cirrhosis and Increases with Child Score in Patients Affected by Liver Diseases
Authors: Matteucci Claudia , Sorrentino Roberta , Ettorre Giuseppe M. , Bellis Lia , Antenucci Anna , Beneduce Luca , Santoro Roberto , Vennarecci Giovanni , Zuin Jessica , Biasiolo Alessandra , Pontisso Patrizia , Pierimarchi Pasquale , Puoti Claudio , Rasi Guido
Published: January 2018

Background

Survivin, also known as BIRC5, is the smallest member of the mammalian IAP family and is a well recognized inhibitor of apoptosis with an important role in cell-cycle regulation. It is detected in fetal and neoplastic adult tissue, but not in normal tissues. Survivin acts on cancer promotion not only by the inhibition of apoptosis but also by acceleration of the proliferative activity of cancer cells and several papers have suggested the involvement of this protein in hepatocarcino-genesis. It has been reported that the detection of HCC biomarkers circulating as IgM immune complexes (ICs) improved the diagnosis and prognosis of HCC. The aim of this study was to compare the expression of survivin as an IgM immune complex in serum from healthy controls and of patients with cirrhosis and patients with HCC to identify a novel biomarker for the monitoring of liver diseases.

Methods

Serum levels of survivin-IgM from 1 97 individuals, including 39 healthy subjects, 94 patients with cirrhosis and 64 with HCC, were measured by ELISA and the relationship with clinical parameters was evaluated.

Results

Survivin-IgM was almost undetectable in sera from healthy subjects, high in patients with cirrhosis, and moderately lower in patients with HCC. The survivin-IgM assay was positive in 62 of 94 patients with cirrhosis (66%) and in 28 of 64 patients with HCC (43.7%) using a cut-off of 264.89 AU/mL (specificity of 94%). Statistical analysis showed that IC values were significantly different between groups (cirrhosis versus healthy control group, p<0.001; HCC versus cirrhosis group, p<0.001). Circulating survivin-IgM ICs in patients with HCC were lower than in patients with cirrhosis; in fact, the statistical significance in comparison with healthy subjects was lost. On the other hand, the concentration of circulating survivin-IgM ICs was found to increase with progression of Child score.

Conclusions

The high expression of survivin-IgM in sera from patients with cirrhosis and the values of sensitivity indicate that survivin-IgM could be a novel candidate biomarker for cirrhotic disease. Furthermore, the increase in ICs with the progression of Child score seems to promote the survivin-IgM immune complex as marker of liver failure. Survivin-IgM was found to be lower in sera from HCC patients. Follow-up studies are in progress to monitor patients with cirrhosis and to validate the association of the downregulation of this marker with progression towards hepatocellular carcinoma.
A nighttime image enhancement method based on Retinex and guided filter for object recognition of apple harvesting robot
Authors: Wei Ji , Zhijie Qian , Bo Xu , Dean Zhao
Published: January 2018

In order to improve the working efficiency of robot promptly picking ripe apples, the harvesting robot must have the ability of continuous recognition and operation at night. Nighttime apple image has many dark spaces and shadows with low resolution, and therefore, a Retinex algorithm based on guided filter is presented to enhance nighttime image in this article. According to color feature of image, the illumination component is estimated by using guided filter which can be applied as an edge-preserving smoothing operator. And the reflection component with image itself characteristics is obtained by employing single-scale Retinex algorithm. After gamma correction, these two components of image are synthesized into a new enhanced nighttime apple image. Fifty nighttime images acquired under fluorescent lighting are selected to make experiment. Experimental results show that the image enhancement performance indexes processed by the proposed algorithm, such as average gray value, standard deviation, information entropy, average gradient, and segmentation error are superior to those of histogram equalization algorithms and Retinex algorithm based on bilateral filter. In addition, compared with the Retinex algorithm based on bilateral filter, the proposed algorithm has an average reduction of 74.56% in running time with better real-time and higher efficiency. So it can realize the continuous operation of apple harvesting robot at night.
The effects of ethnicity, musicianship, and tone language experience on pitch perception
Authors: Zheng Yi , Samuel Arthur G
Published: January 2018

Language and music are intertwined: music training can facilitate language abilities, and language experiences can also help with some music tasks. Possible language–music transfer effects are explored in two experiments in this study. In Experiment 1, we tested native Mandarin, Korean, and English speakers on a pitch discrimination task with two types of sounds: speech sounds and fundamental frequency (F0) patterns derived from speech sounds. To control for factors that might influence participants’ performance, we included cognitive ability tasks testing memory and intelligence. In addition, two music skill tasks were used to examine general transfer effects from language to music. Prior studies showing that tone language speakers have an advantage on pitch tasks have been taken as support for three alternative hypotheses: specific transfer effects, general transfer effects, and an ethnicity effect. In Experiment 1, musicians outperformed non-musicians on both speech and F0 sounds, suggesting a music-to-language transfer effect. Korean and Mandarin speakers performed similarly, and they both outperformed English speakers, providing some evidence for an ethnicity effect. Alternatively, this could be due to population selection bias. In Experiment 2, we recruited Chinese Americans approximating the native English speakers’ language background to further test the ethnicity effect. Chinese Americans, regardless of their tone language experiences, performed similarly to their non–Asian American counterparts in all tasks. Therefore, although this study provides additional evidence of transfer effects across music and language, it casts doubt on the contribution of ethnicity to differences observed in pitch perception and general music abilities.
Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1)
Authors: Charidimou Andreas , Shams Sara , Romero Jose R , Ding Jie , Veltkamp Roland , Horstmann Solveig , Eiriksdottir Gudny , van Buchem Mark A , Gudnason Vilmundur , Himali Jayandra J , Gurol M Edip , Viswanathan Anand , Imaizumi Toshio , Vernooij Meike W , Seshadri Sudha , Greenberg Steven M , Benavente Oscar R , Launer Lenore J , Shoamanesh Ashkan ,   for The International META-MICROBLEEDS Initiative
Published: January 2018

Background

Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, “high risk” elderly populations, and healthy individuals in population-based studies.

Methods

Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations.

Results

We identified 31 cohorts ( n = 20,368): 19 ischemic stroke/TIA ( n = 7672), 4 memory clinic ( n = 1957), 3 high risk elderly ( n = 1458) and 5 population-based cohorts ( n = 11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58–2.89 and adj-HR: 2.09; 95% CI: 1.71–2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68–8.08 and adj-HR: 3.93; 95% CI: 2.71–5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24–1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00–1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity.

Conclusions

Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.
Understanding players' transition from youth to senior professional football environments: A coach perspective
Authors: Røynesdal Øystein , Toering Tynke , Gustafsson Henrik
Published: January 2018

The aim of this study was to explore: (a) sociocultural features of a first team environment perceived to influence a player's progression, (b) the ways in which young players should manage these features and (c) how coaches operate to assist young players during specific phases in the youth-to-senior transition. Semi-structured interviews with eight elite development coaches in English Premier League football clubs generated two higher order categories: fitting in with standards of first team environment (e.g. handling social dynamics in the first team group) and facilitating shared perception of transition across key stakeholders (e.g. communicating with first team staff). Together, these findings indicate the need for young players to navigate between conforming, adapting to and breaking with specific features of the first team environment to successfully progress in the youth-to-senior transition to professional football.
Fatigue life prediction of wind turbine rotor blade composites considering the combined effects of stress amplitude and mean stress
Authors: Gao Jianxiong , An Zongwen , Kou Haixia
Published: January 2018

To predict fatigue life of wind turbine rotor blade composites under random loads, the combined effects of stress amplitude and mean stress are considered. First, the generalized σ–N curved surface is introduced to characterize the fatigue properties of composites under constant amplitude cyclic load. Then, a modified Miner’s rule is developed to reveal the evolution process of fatigue damage under variable amplitude cyclic loads. Finally, a fatigue life prediction model is presented based on the total probability formula and the modified Miner’s rule, which can reflect the combined effects of stress amplitude and mean stress on fatigue life. The experimental data of wind turbine rotor blade composites are used to illustrate the specific process of the proposed method; the results indicate that the prediction values of the developed method are reasonable and effective.
Characteristics of adolescents requiring intensive care in the United Kingdom: A retrospective cohort study
Authors: Wood Dora , Goodwin Sarah , Pappachan John , Davis Peter , Parslow Roger , Harrison David , Ramnarayan Padmanabhan
Published: January 2018

Objectives

To describe the case mix, resource use and outcomes for adolescents admitted to intensive care units in the UK.

Methods

Analysis of national prospectively collected data for all adolescents aged 12–19 years admitted to UK adult or paediatric intensive care units.

Results

There were 37,320 admissions of adolescents during the eight–year study period. Excluding elective surgery, respiratory diagnoses were the most common reason for paediatric intensive care unit (PICU) admission, with trauma and intoxication the most common reasons for adult intensive care unit (AICU) admission. Intensive care unit mortality was 6.0% and 5.7% for those admitted to PICUs and AICUs, respectively.

Conclusions

Mortality is similar among adolescents admitted to AICUs and PICUs; however, these rates have not been corrected for severity of acute illness or underlying burden of chronic illness, which may be different between AICUs and PICUs. Services planned for the majority of AICU and PICU patients may not be optimal for critically ill adolescents treated in UK intensive care units, who may need special consideration.
The impact of idiosyncratic risk of banking sector on oil, stock market, and fiscal indicators of Sultanate of Oman
Authors: Al Shubiri Faris Nasif , Jamil Syed Ahsan
Published: January 2018

Idiosyncratic risk (IDR) is defined in general as the uncertainties of return to investors from an investment portfolio leading to diversification or hedging to mitigate and avoid such risks. This article aims to analyze the IDR of banking sector on oil (OI), stock market indicator (SMI), and fiscal indicator (FI) of Sultanate of Oman. This article examines the IDR of six banking sectors listed in Muscat Security Market (MSM), from 2009 to 2015. Financial modeling is used to determine the IDR of banking sector treated as an independent variable. This study uses three main critical dependent variables, OI, SMI, and FI. The ordinary least squares regression results depicted that there is a statistically significant impact on all of SMIs in MSM 30 share price and its market capitalization with direction of oil exports as OI being significant, as well as total expenditure as percentage of gross domestic product is significant as FI at different significant levels 1%, 5%, and 10%. The findings of the research indicated a weak investor’s protection mechanism and strongly recommend heightened government focus on stressing the importance of having a formal system based on stability, safety, transparency, and supervision of the implementation of contracts so as to protect small investors, eventually leading to increased investments in stocks. Facilitation and encouragement to foreign direct investment will also lead to increase in the performance of fiscal management indicators and improve the export prices of oil, giving a boost to the economic and financial system of the nation.
Stacking Chairs: Local Sense and Global Nonsense
Authors: Scott-Samuel Nicholas E. , Ashida Hiroshi , Lovell P. George , Meese Tim S. , Schwarzkopf D. Samuel
Published: January 2018

We report a confusing stimulus which demonstrates the power of local interpretation of three-dimensional structure to disrupt a coherent global perception.
Effectiveness of paliperidone long-acting injection in clinical practice
Authors: Deslandes Paul Nicholas , Ward Elan Haf , Norris Kathryn , Sewell Robert David
Published: January 2018

Background:

The efficacy of the long-acting injectable formulation of the antipsychotic paliperidone (paliperidone palmitate) has been investigated in randomized controlled trials. Due to the nature of study designs, these may not be representative of usual clinical practice. The aim of this study was to assess the clinical effectiveness of the long-acting injectable antipsychotic paliperidone palmitate using treatment continuation at 1 year as an outcome.

Methods:

Patients were initiated on paliperidone palmitate prior to December 2014 in a single health board in Wales (UK). Demographic factors that may have influenced outcome, including diagnosis, age at initiation, sex, inpatient or outpatient status on initiation, were analysed to assess whether they influenced patient outcome. For patients completing 1 year of treatment, inpatient stay in the 12 months prior to and following paliperidone palmitate initiation was compared.

Results:

Data were available for 64 patients; 41 had a diagnosis of schizophrenia and 7 had previously received clozapine. Continuation rates at 6 and 12 months were 69% and 63% respectively. Treatment continuation was not associated with demographic factors. For continuers, mean inpatient stay pre- and post-initiation was 83.2 ± 105.3 and 73.5 ± 103.3 days respectively ( p = 0.61). The most common reason for discontinuation was lack of effect ( n = 9).

Conclusions:

The proportion of patients remaining on treatment was comparable to that reported in other naturalistic studies. Prescribing for indications outside the product licence was relatively common, but did not appear to influence outcome, although the number of patients in each group was small. Treatment continuation at 6 months appeared to be a predictor of longer-term outcome.
Diagnostic accuracy of functional, imaging and biochemical tests for patients presenting with chest pain to the emergency department: A systematic review and meta-analysis
Authors: Iannaccone Mario , Gili Sebastiano , De Filippo Ovidio , D’Amico Salvatore , Gagliardi Marco , Bertaina Maurizio , Mazzilli Silvia , Rettegno Sara , Bongiovanni Federica , Gatti Paolo , Ugo Fabrizio , Boccuzzi Giacomo G , Colangelo Salvatore , Prato Silvia , Moretti Claudio , D’Amico Maurizio , Noussan Patrizia , Garbo Roberto , Hildick-Smith David , Gaita Fiorenzo , D’Ascenzo Fabrizio
Published: January 2018

Background:

Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined.

Methods:

Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included.

Results:

Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79–0.94) and 0.84 (0.74–0.9) vs 0.89 (0.78–0.94) and 0.83 (0.70–0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81–0.98) and specificity 0.90 (0.93–0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77–0.91) and specificity 0.92 (0.83–0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy.

Conclusions:

Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.
Absolute lymphocyte and neutrophil counts in neonatal ischemic brain injury
Authors: Povroznik Jessica M , Engler-Chiurazzi Elizabeth B , Nanavati Tania , Pergami Paola
Published: January 2018

Objectives:

This study aimed to identify differences in absolute neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio between neonates with two forms of ischemic brain injury, hypoxic-ischemic encephalopathy, and acute ischemic stroke, compared to controls. We also aimed to determine whether this neutrophil/lymphocyte response pattern is associated with disease severity or is a consequence of the effects of total-body cooling, an approved treatment for moderate-to-severe hypoxic-ischemic encephalopathy.

Methods:

A retrospective chart review of 101 neonates with hypoxic-ischemic encephalopathy + total-body cooling (n = 26), hypoxic-ischemic encephalopathy (n = 12), acute ischemic stroke (n = 15), and transient tachypnea of the newborn (n = 48) was conducted; transient tachypnea of the newborn neonates were used as the control group. Absolute neutrophil count and absolute lymphocyte count at three time-intervals (0–12, 12–36, and 36–60 h after birth) were collected, and neutrophil-to-lymphocyte ratio was calculated.

Results:

Hypoxic-ischemic encephalopathy + total-body cooling neonates demonstrated significant time-interval-dependent changes in absolute lymphocyte count and neutrophil-to-lymphocyte ratio levels compared to transient tachypnea of the newborn and acute ischemic stroke patients. Pooled analysis of absolute lymphocyte count for neonates with acute ischemic stroke and hypoxic-ischemic encephalopathy (not hypoxic-ischemic encephalopathy + total-body cooling) revealed that absolute lymphocyte count changes occurring at 0–12 h are likely due to disease progression, rather than total-body cooling treatment.

Conclusion:

These data suggest that the neutrophil/lymphocyte response is modulated following neonatal ischemic brain injury, representing a possible target for therapeutic intervention. However, initial severity of hypoxic-ischemic encephalopathy among these patients could also account for the observed changes in the immune response to injury. Thus, additional work to clarify the contributions of cooling therapy and disease severity to neutrophil/lymphocyte response following hypoxic-ischemic encephalopathy in neonates is warranted.
Idiopathic intracranial hypertension as a presenting sign of adrenal insufficiency
Authors: Shenouda Sandra , Al-Farawi Khaled , Dolan Jenna , Flesher Susan L
Published: January 2018

Idiopathic intracranial hypertension is a diagnosis of exclusion defined by elevated intracranial pressure without mass lesions or hydrocephalus. Causes of idiopathic intracranial hypertension include obesity, vitamin derangements, antibiotics, corticosteroids, and autoimmune disorders. Cushing’s disease and Addison’s disease have been associated with idiopathic intracranial hypertension. Secondary adrenal insufficiency following withdrawal of inhaled corticosteroids has been found to be a relatively common phenomenon. This case describes an 11-year-old boy who was previously on inhaled corticosteroids for severe asthma who presented with secondary adrenal insufficiency after withdrawal of steroids. The adrenal insufficiency presented as idiopathic intracranial hypertension. We described the hospital course and process of diagnosis for this child with secondary adrenal insufficiency following withdrawal of inhaled corticosteroids. The association between the discontinuation of this patient’s corticosteroids and his onset of headache suggests secondary adrenal insufficiency as the most likely cause of his idiopathic intracranial hypertension. The gradual improvement in his symptoms after steroid replacement further supports this. Due to the significant prevalence of children using inhaled corticosteroids, it is important for clinicians to be aware of the potential for the withdrawal of these drugs to induce hypothalamic–pituitary–adrenal axis suppression.
Comparative outcomes of radiofrequency ablation for Barrett's oesophagus with different baseline histology
Authors: Tan Wei Keith , Rattan Arti , O’Donovan Maria , Nuckcheddy Tara , Alias Bincy , Sujendran Vijay , di Pietro Massimiliano
Published: January 2018

Background

Radiofrequency ablation (RFA) is currently recommended for dysplastic Barrett's oesophagus (BO); however, there are limited data on treatment response when stratified by baseline histology.

Objective

The objective of this article is to evaluate RFA outcomes and durability for BO with different baseline histology.

Methods

Patients treated with RFA between 2007 and 2017 at a single institution were retrospectively included. Outcome measures were: (a) complete remission of dysplasia (CRD) and intestinal metaplasia (CRIM) at 18 months, (b) complication rate and (c) durability of CRD and CRIM.

Results

A total of 148 patients underwent RFA, of whom 113 completed the treatment protocol (21 low‐grade dysplasia (LGD), 46 high‐grade dysplasia (HGD) and 46 intramucosal carcinoma (IMC)). CRD and CRIM were achieved in 94.7% and 78.8% of patients, respectively. When stratified by baseline histology, there was no significant difference in CRD between groups (LGD, 95.2%; HGD, 95.7%; and IMC, 93.5%; p = 0.89). Similarly, there was no significant difference in CRIM between groups (LGD, 71.4%; HGD, 76.1% and IMC, 87.0%; p = 0.39). CRD and CRIM durability at 24 months for LGD, HGD and IMC were 100%, 97.7% and 100% (log rank p = 0.31), and 100%, 89.0% and 95.5%, respectively (log rank p = 0.62).

Conclusion

Baseline histology is not a predictor of RFA response. Once CRD and CRIM are achieved, these effects are durable over time.
Congenital absence of the portal vein in a cat
Authors: Holloway Andrew , Groot Louise , van der Schaaf Klaartje
Published: January 2018

Case summary

A 9-month-old female neutered domestic shorthair cat presented with a history of episodic ptyalism, lethargy and abnormal behaviour. The clinical signs together with elevated pre- and post-prandial bile acid concentrations were consistent with hepatic encephalopathy (HE). In the absence of a portosystemic shunt (PSS) on abdominal ultrasound, medical management of HE was established with a protein-restricted diet and lactulose and the neurological signs resolved. Following an episode of acute vomiting and haemorrhagic diarrhoea at 19 months of age abdominal ultrasonography was repeated. The portal vein could not be demonstrated ultrasonographically; instead, portal vein tributaries were tortuous and communicated with the caudal vena cava (CdVC) at the level of the left kidney. CT angiography (CTA) confirmed the absence of the portal vein. CTA demonstrated the tortuous terminations of the portal tributaries, and several systemic veins, draining into the CdVC via a large-diameter paracaval vessel at the level of the left kidney. Gastrointestinal signs were stabilised and medical management for HE of a protein-restricted diet and lactulose was re-established.

Relevance and novel information

Congenital absence of the portal vein has not been described previously in the cat and should be considered in cats presenting with signs suggestive of a PSS and HE. The portal vein in the cat can be demonstrated using ultrasound, but complex congenital vascular malformations of the portal or systemic abdominal veins should be characterised using CTA and further distinguished from other vascular anomalies that may present with similar ultrasonographic features.
Race and Stratification in College Enrollment Over Time
Authors: Baker Rachel , Klasik Daniel , Reardon Sean F.
Published: January 2018

We measure college enrollment selectivity gaps by race-ethnicity using a novel method that is sensitive to both the level (2- vs. 4-year) and selectivity of the college in which students enroll. We find that overall Hispanic–White and Black–White enrollment selectivity gaps closed in the United States between 1986 and 2014. This overall closing of gaps appears to be related to the closing of high school graduation gaps. However, this contraction was driven almost entirely by students at the margin between no college and college enrolling in non-degree-granting programs. Among students who enrolled in degree-granting schools, Black students have enrolled at increasingly less selective institutions than White students, whereas Hispanic–White gaps remained relatively unchanged over the nearly 30 years of our study. These gaps are concerning because of their implications for long-term economic inequality.
Satisfaction With Health Care Among Patients Navigated for Preventive Cancer Screening
Authors: Hermann Emilia A , Ashburner Jeffrey M , Atlas Steven J , Chang Yuchiao , Percac-Lima Sanja
Published: January 2018

Background:

Patient navigation (PN) programs can improve cancer screening in underserved populations. PN may advance quality and equity of care by supporting individuals at increased risk of not receiving recommended care.

Objective:

To evaluate patient satisfaction with medical care and PN for cancer screening.

Methods:

We conducted a telephone survey of patients enrolled in a randomized control trial evaluating the impact of PN for cancer screening to assess their satisfaction with overall medical care and the PN program. We measured patient satisfaction with medical care using the Patient Satisfaction Questionnaire-18 and evaluated patient satisfaction with PN in the navigated group using the Patient Satisfaction with Interpersonal Relationships with Navigator questionnaire.

Key Results:

Satisfaction surveys were completed by 114 navigated and 108 non-navigated patients (33% response rate). Patients who received PN had higher satisfaction scores with overall medical care (71.0 vs 66.8; P < .001).

Conclusions:

Our findings show that patients at high risk of nonadherence with comprehensive cancer screening were satisfied with PN and suggest that PN could positively influence patient satisfaction with overall medical care.
Unravelling stakeholder participation under conditions of neoliberal biodiversity governance in Catalonia, Spain
Authors: Maestre-Andrés Sara , Calvet-Mir Laura , Apostolopoulou Evangelia
Published: January 2018

The restructuring of biodiversity governance in Europe during the last two decades has been, inter alia, based on the argument that effective conservation hinges on consensual decision-making involving all relevant stakeholders. This has given rise to various network-based forms of governance and participatory arrangements in protected areas reinforcing the involvement of business and non-state actors, particularly through the creation of profitable public–private partnerships. Even though this shift has been framed as promoting stakeholder and public participation, in practice it has often hampered democratic decision-making and community empowerment. In this paper, we investigate the restructuring of biodiversity governance through the establishment of participatory arrangements in the governance of the natural park of Sant Llorenç del Munt i l’Obac, a place whose history has been linked with the emergence of one of the first environmental movements in Catalonia (Spain). We pay particular attention to the role of participatory arrangements in transforming power relationships and in promoting a neoliberal mode of biodiversity governance. We find that governance restructuring under the rhetoric of promoting stakeholder participation has in practice led to the exclusion of key social actors from the management of the natural park and favoured the inclusion of actors with mainly economic motivations further embedding a neoliberal agenda in the governance of the park and ultimately disempowering local community.
Revisiting Caste in the Philosophy of Swami Vivekananda
Authors: Singh Mayengbam Nandakishwor
Published: January 2018

Caste still continues to be the most intriguing, yet fascinating, phenomenon which has not ceased to fascinate hordes of thinkers and intellectuals. Scholarships, amidst all those that abhor caste, appear to be overwhelming in the contemporary discourses. In the light of some theories which profess deep abomination against the caste system in India, Vivekananda’s own elucidation on caste no longer necessitates to be placed into oblivion, even if most of the literatures on caste today appear not to take cognizance of it. Swami Vivekananda’s interpretation of caste presents itself as a powerful defence of the caste system in India. Vivekananda does not bluntly promote the goodness of caste, for Vivekananda’s defence of caste is precisely located on certain philosophical underpinnings which are largely bolstered by the historical trajectory of India related to caste. While reflecting on the brighter side of caste system, Vivekananda unravels the unique cultural and historical narratives of India. This article seeks to examine Vivekananda’s own viewpoints on the question of caste in India, both in its original pristine form and in its modern caste practices. It further attempts to explore how far Vivekananda’s statement on the inherent merits of caste system clashes with some of the rival theories.
Reduce Inequalities: Dalits in Punjab Seek Development with Dignity
Authors: Kumar Sanjeev
Published: January 2018

This article argues for Dalit activists and rights-based groups, who are voicing the concerns of Dalits’ development in Punjab. Their emergence and achievement in securing Panchayat (common) land-rights in the Malwa region are the strongest expressions of the rising educated class of Dalits, who share common experiences of caste-based oppression, memories of humiliation and ages’ old forced socio-economic marginalization. They are striving for equality in political, social and economic domains.
A scoring system to predict the elevation of mean pulmonary arterial pressure in idiopathic pulmonary fibrosis
Authors: Furukawa Taiki , Kondoh Yasuhiro , Taniguchi Hiroyuki , Yagi Mitsuaki , Matsuda Toshiaki , Kimura Tomoki , Kataoka Kensuke , Johkoh Takeshi , Ando Masahiko , Hashimoto Naozumi , Sakamoto Koji , Hasegawa Yoshinori
Published: January 2018

Elevated mean pulmonary arterial pressure (MPAP; ≥21 mmHg) is sometimes seen in patients with idiopathic pulmonary fibrosis (IPF) and has an adverse impact upon survival. Although early diagnosis is crucial, there is no established screening tool that uses a combination of noninvasive examinations.

We retrospectively analysed IPF patients at initial evaluation from April 2007 to July 2015 and, using logistic regression analysis, created a screening tool to identify elevated MPAP. Internal validation was also assessed for external validity using a bootstrap method.

Using right-heart catheterisation (RHC), elevation of MPAP was determined to be present in 55 out of 273 patients. Multivariate models demonstrated that % predicted diffusing capacity of the lung for carbon monoxide (DLCO) <50%, ratio of pulmonary artery diameter to aorta diameter (PA/Ao) on computed tomography (CT) ≥0.9 and arterial oxygen tension (PaO2) <80 Torr were independent predictors. When we assigned a single point to each variable, the prevalence of elevation of MPAP with a score of zero, one, two or three points was 6.7%, 16.0%, 29.1% and 65.4%, respectively. The area under curve (AUC) for the receiver operating characteristic (ROC) curve was good at 0.757 (95% CI 0.682–0.833).

A simple clinical scoring system consisting of % predictedDLCO, PA/Ao ratio on CT andPaO2can easily predict elevation of MPAP in patients with IPF.
Trends in mortality from idiopathic pulmonary fibrosis in the European Union: an observational study of the WHO mortality database from 2001–2013
Authors: Marshall Dominic C. , Salciccioli Justin D. , Shea Barry S. , Akuthota Praveen
Published: January 2018

Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias and is characterised by progressive accumulation of scar tissue in the lungs. The objective of this study was to describe the current mortality rates due to IPF in Europe, based on the World Health Organization (WHO) mortality database.

We used country-level data for IPF mortality, identified in the WHO mortality database using International Classification of Diseases 10th Edition (ICD-10) codes, for the period 2001–2013. Joinpoint analysis was performed to describe trends throughout the observation period.

The median mortality was 3.75 per 100 000 (interquartile range (IQR) 1.37–5.30) and 1.50 per 100 000 (IQR 0.65–2.02) for males and females, respectively. IPF mortality increased in the majority of the European Union (EU) countries with the exceptions of Denmark, Croatia, Austria and Romania. There was a significant disparity in rates across Europe, in the range 0.41–12.1 per 100 000 for men and 0.24–5.63 per 100 000 for women. The most notable increases were observed in the United Kingdom and Finland. Rates were also substantially higher in males, with sex disparity increasing across the period.

The reported IPF mortality appears to be increasing across the EU; however, there is substantial variation in mortality trends and overall reported mortality rates between countries.
Hyperpolarized carbon-13 magnetic resonance spectroscopic imaging: a clinical tool for studying tumour metabolism
Authors: Zaccagna Fulvio , Grist James T , Deen Surrin S , Woitek Ramona , Lechermann Laura MT , McLean Mary A , Basu Bristi , Gallagher Ferdia A
Published: January 2018

Glucose metabolism in tumours is reprogrammed away from oxidative metabolism, even in the presence of oxygen. Non-invasive imaging techniques can probe these alterations in cancer metabolism providing tools to detect tumours and their response to therapy. Although Positron Emission Tomography with (18F)2-fluoro-2-deoxy-D-glucose (18F-FDG PET) is an established clinical tool to probe cancer metabolism, it has poor spatial resolution and soft tissue contrast, utilizes ionizing radiation and only probes glucose uptake and phosphorylation and not further downstream metabolism. Magnetic Resonance Spectroscopy (MRS) has the capability to non-invasively detect and distinguish molecules within tissue but has low sensitivity and can only detect selected nuclei. Dynamic Nuclear Polarization (DNP) is a technique which greatly increases the signal-to-noise ratio (SNR) achieved with MR by significantly increasing nuclear spin polarization and this method has now been translated into human imaging. This review provides a brief overview of this process, also termed Hyperpolarized Carbon-13 Magnetic Resonance Spectroscopic Imaging (HP 13C-MRSI), its applications in preclinical imaging, an outline of the current human trials that are ongoing, as well as future potential applications in oncology.