bluuebunny/crossref_metadata_2025 huggingface dataset:
Crushing Stones: Mechanical, Intracorporeal and Extracorporeal Lithotripsy in the Clearance of Common Bile Duct Lithiasis
Authors: Liguory Claude , Lefebevre Jean Francois , Bonnel Didier , Vitale Gary C
Published: April 2016

Mechanical, intracorporeal and extracorporeal lithotripsy were used in the treatment of common bile duct lithiasis in a series of 80 patients in whom initial extraction attempts with the Dormia basket and balloon catheter failed. Mechanical lithotripsy was performed in 74 cases and was successful in 38 (51.3%). Among the 36 patients with failure of mechanical lithotripsy, five had an initial attempt at stone dissolution w1th methyl terr-butyl ether (MTBE) infused through a nasobiliary stent. This was successful in four cases; the stones did not disappear completely - however, they were smaller and easier to extract. Of the remaining 32 patients who failed mechanical lithotripsy, two underwent success[, l surgical stone extraction with no further attempts at nonoperative treatment and 30 underwent complementary shock wave lithotripsy. Extracorporeal lithotripsy was used in 19 of these patients. The intracorporeal lithotripsy group of21 patients comprised 11 with failed mechanical lithotripsy, six in whom no ocher treatment was attempted and four in whom extracorporeal lithotripsy had failed. Extracorporeal lithotripsy was successful in 15 cases (79%) and intracorporeal lithotripsy in 19 (90%). There were four treatment failures, with one patient death due to cholangitis and respiratory failure. In summary, mechanical lithotripsy is an effective and safe treatment modality but has a high failure rate. Extracorporeal lithotripsy is useful and should he attempted where available, but is not always successful. Intracorporeal lithotripsy is very efficient but requires either the transpapillary route, which is technically difficult, or the transhepatic route which carries associated complications.
The 'Difficult' Colonic Polyp
Authors: Williams Christopher B
Published: April 2016

With improved instrumentation and endoscopic technique coupled with the pre-injection of an adrenaline/sclerosant mixture, nearly all pedunculated polyps can be rapidly and relatively easily removed. Only a few very large broad-based or sessile polyps require referral to the surgeon; even some of these can be managed endoscopically if the patient is unfit or unwilling for surgery, but willing to undergo multiple repeat endoscopies.
Mast Cells as Targets for the Therapy of Inflammatory Bowel Disease
Authors: Bissonnette EY , Benyon RC , Befus AD
Published: April 2016

The etiology and pathogenesis of inflammatory bowel disease (IBD) is poorly understood. However, numerous studies have demonstrated that immunological and inflammatory responses are activated during this disease. A better understanding of these events will help identify appropriate therapeutic interventions. Mast cell hyperplasia is a prominent feature of inflamed intestinal tissue in IBD. Intestinal mast cells are heterogeneous and at least two populations are present in the human intestine. The authors' objective is to explore mast cell properties, activation and mediators that are involved in the induction, maintenance and perpetuation of inflammatory lesions in the intestine. Although some therapies used in IBD can modulate mast cell activities, whether these actions are important in the beneficial effects of the drugs is unknown. Future drug development targeted to the inhibition of mast cells might be of therapeutic value. However, a cascade of different cellular events are involved in IBD development. The complexity of the disease raises difficulties in the development of therapies. Multiple drugs, selective for different phases of the disease or acting on different cells, might be most appropriate, rather than a single, all-encompassing therapeutic agent.
Pharmacological and Pharmacodynamic Implications of Nonsteroidal Anti-Inflammatory Drug Therapy in Elderly Arthritic Patients
Authors: Buchanan W Watson
Published: April 2016

There is growing evidence chat elderly patients may be more likely to develop adverse drug reactions to nonsteroidal anti-inflammatory drug/analgesic therapy. This may be due to the physiological changes which accompany ageing as well as multiple drug therapies commonly used in the elderly. The elderly may also be more prone to gastrointestinal adverse side effects. There is no satisfactory definition of the elderly. Although age 65 is widely accepted as a chronological definition, many elderly persons remain healthy until the age of 75, and furthermore, healthy elderly subjects differ little from healthy young persons. lt is with the frail elderly, ie, those with multiple diseases and multiple drug therapies, that problems of medication occur. Physiological changes, which include reduced muscle mass, total body water and albumin levels, as well as effects on renal and hepatic function, affect pharmacokinetic factors, including absorption, distribution, biotransformation and renal clearance. Assessment of the multiple disease states and resultant organ failure in elderly subjects is therefore necessary.
Esophageal Variceal Ligation
Authors: Goff John S
Published: April 2016

Endoscopic sclerotherapy is an effective method for treating and eradicating acutely bleeding varices in repeated sessions; however, it is not ideal because of numerous serious complications. Endoscopic variceal ligation, developed to circumvent some of the side effects of sclerotherapy, controls actively bleeding varices in about 90% of cases. Of 146 patients treated with endoscopic variceal ligation, variceal eradication was achieved in 80% of surviving patients in a mean of 5.5 treatment sessions. Recurrent bleeding developed in 39%. Complications were very rare. It is concluded that endoscopic variceal ligation is at least as effective as sclerotherapy but associated with fewer complications.
Quality of Life after Liver Transplantation
Authors: Grant David , Evans David , Hearn Margaret , Duff John , Ghent Cameron , Wall William
Published: April 2016

The results of liver transplantation are now well established in terms of graft and patient survival, but there is surprisingly little data on the quality of life attained. The authors mailed questionnaires to 32 consecutive adult liver recipients to assess their quality of life. Thirty-one patients (14 males, 17 females) with a mean age of 37 years (range 16 to 55), responded (97%). The mean time since transplantation was 19 months (range three to 50). Eighty percent of the respondents functioned at normal or near normal levels as measured by the Karnofsky Performance Index. Sixty-five per cent (20 patients) indicated they were currently able to live and function as they did before they became ill with liver disease. The respondents' scores were similar to normative scores on all of the following measures: life satisfaction, well being, and general affect (Campbell); and material well being, personal growth, marital relations, family relations and friendships (Evans). It is concluded that liver transplantation restores physical, mental and social well being in most patients with endstage liver disease.
Short Bowel Syndrome: Intestinal Adaptation and Medical Therapy
Authors: Buie WD , Thurston OG , Fedorak Richard N
Published: April 2016

Short bowel syndrome is a clinical entity, a consequence of significant loss of intestinal surface area, and manifests a variable picture of diarrhea, steatorrhea, malabsorprion and weight loss. Previously high mortality rates have been reduced by the early use of parenteral nutrition and have subsequently resulted in increased survival and prevalence of the condition. Ultimate patient survival is dependent on the intrinsic adaptive ability of residual intestine and this, in turn, is dependent upon length, type, functional state and the presence or absence of an ileocecal valve. The mechanisms of intestinal adaptation are not entirely understood; however, they can be grouped into three broad categories: luminal nutrition, hormonal factors, and pancreaticobiliary secretion. Medical treatment of short bowel syndrome remains supportive and centres around the control of three pathophysiological defects: decreased intestinal transit time, gastric hypersecretion, and reduced functional mucosal surface area.
Dysplasia in Ulcerative Colitis
Authors: Riddell RH
Published: April 2016

Patients at highest risk for developing cancer in ulcerative colitis are those with ‘extensive’ or total involvement of the large bowel who have had the disease for at least seven years. Dysplasia is used as a marker bur has many problems including those of sampling, reproducibility and management. The risk in patients with colitis is unclear particularly in those with left-sided or distal ulcerative colitis. In countries at high risk from colorectal cancer about 4 to 6% of the population can be expected to develop this disease. It is assumed that surveillance will reduce the mortality from colorectal cancer, although the evidence that this is happening is very limited. Cancers which are resected but from which the patient survives are an acceptable outcome, although less so in theory, as survival is to a certain extent fortuitous. Many surveillance studies include patients who have both developed and died from carcinoma. Surveillance also assumes that cancers can be detected before they have become lethal, or that a marker such as the presence of dysplasia precedes all carcinomas for a long enough period of time to be detectable. Considerable question has been raised as to whether dysplasia is both endoscopically detectable and morphologically identifiable. Surveillance is based on the principle that carcinoma arises from a cancerous lesion, and that the identification of dysplasia and excision of the large bowel in these patients prevents subsequent death from disseminated carcinoma. Conversely, patients with quiescent disease and no dysplasia could be followed and not subjected to unnecessary colectomy. There is currently no ‘best’ way of managing patients with colitis who are at risk for developing carcinoma. Routine follow-up of patients relies heavily on colonoscopy with multiple biopsies. Controversy continues regarding the management of dysplastic biopsies because there are relatively few data regarding the likelihood of an underlying invasive carcinoma on which to base a rational decision. The notion that all patients must be managed on an individual basis, guarantees that data remain difficult to obtain. The presence of a dysplasia-associated lesion or mass are high risk factors for carcinoma. Dysplasia is frequently confined to small areas of the mucosa causing major sampling problems for the endoscopist both in detection and if confirmation by re-endoscopy is proposed. The finding of aneuploidy as a marker for both dysplasia and carcinoma may prove useful in the detection of patients at greatest risk.
Submucosal Esophageal Hematoma Following Sclerotherapy: A Rare Complication
Authors: Singh Ram , Chawla YK , Kaur Upjeet , Malik Neelam , Dilawari JB
Published: April 2016

A cirrhotic patient who developed an intramural hematoma of the esophagus as a complication of esophageal variceal sclerotherapy is reported. The hematoma resolved spontaneously within two weeks without any residual complications such as esophageal stricture.
Campylobacter Jejuni and Thrombotic Thrombocytopenic Purpura
Authors: Jaeschke Roman , Irvine E Jan , Moore Jane , Kelton John
Published: April 2016

Gastrointestinal bacterial infections could be associated with multisystem complication due to the thrombotic phenomena. This paper reports the association of Campylobacterjejuniinfection and thrombotic thrombocytopenic purpura, and describes a new test for diagnosing thrombocytopenic purpura.
Fluticasone Propionate in Inflammatory Bowel Disease
Authors: Carpani de Kaski Marta , Hodgson Humphery JF
Published: April 2016

Although effective for both acute and often long term treatment of inflammatory bowel disease, systemically absorbed corticosteroids have a high incidence of side effects. This article briefly reviews the pharmacokinetics of corticosteroids and the strategics available for reducing systemic side effects. In particular, fluitcasone propionate is a fluorinated glucocorticoid, in which systemic side effects are absent or minimal due to its relatively low absorption and rapid first pass metabolism In an open trial in 12 patients with mild and moderately active Crohn's disease, administration of 20 mg fluitcasone propionate orally was associated with a significant fall in the Crohn's disease activity index and improvement in other parameters of inflammation, without change in either plasma cortisol levels or responsiveness to adrenocorticotropic hormone, suggesting that this drug is a promising therapy for Crohn's disease meriting evaluation against conventional corticosteroids.
Gallbladder Stones: Oral Dissolution Therapy
Authors: Thistle Johnson L
Published: April 2016

Chenodiol is noninvasive, safe and moderately expensive. Because of diarrhea, the need for aminotransferase monitoring, the long duration of therapy required, and the minority of patients who are appropriate candidates, it has had limited use. Ursodiol is generally preferred because it has minimal side effects. Patients with increased surgical risk, mild to moderate symptoms, and gallstones which are either floatable with oral radiopaque contrast media or radiolucent by computed tomography scan in a nonobstructed gallbladder arc appropriate candidates for oral bile acid therapy. Silent stones should not be treated under most circumstances.
Villous Adenoma of Papilla of Vater
Authors: Choudhury SR , Malik AK , Chawla Y , Wig JD
Published: April 2016

Biliary obstruction due to a benign villous adenoma of the ampulla of Vater treated by transduodenal local excision and sphincteroplasty is reported. Local surgical resection enabled a submucosal resection of the adenoma.
Esophageal Carcinoma: Clinical TNM Staging with Endosonography and Computed Tomography
Authors: Tio TL , Hartog Jager FCA Den , Coene PPLO
Published: April 2016

The prognosis of esophageal carcinoma has remained poor despite improvement of diagnostic modalities. Endosonography and computed tomography were performed for preoperative TNM staging (clinical TNM) of esophageal carcinoma. Endosonography was superior to computed tomography for diagnosing early stages and nonresectability of carcinoma. Endosonography was also superior to computed tomography in diagnosing regional lymph node metastases. For diagnosing nonmetastatic lymph nodes, however, computed tomography was superior. Endosonography was superior for diagnosing celiac lymph node metastases but less accurate in detecting liver involvement. Endosonography was accurate for clinical TNM staging of esophageal carcinoma. The possibility of performing cytology and biopsy will further enhance the diagnostic value of endosonography.
Carcinogenesis in Ulcerative Colitis: Is Surveillance Worthwhile?
Authors: Axon ATR
Published: April 2016

Observations that dysplastic epithelium predicts neoplastic change in the coli tic bowel have led to the adoption of surveillance policies in ulcerative colitis patients, usually involving colonoscopy irrespective of symptomatology. Few satisfactory prospective studies of surveillance have been carried out. The present data suggest that patients should be screened at 10 years and investigated when symptomatic. Annual clinical review with five-yearly colonoscopic examination may be more reasonable, lead to better compliance, detect the occasional early cancer, and reduce the colonoscopic load.
Premalignant Lesions of the Colon
Authors: Haggitt Rodger C
Published: April 2016

Cancer of the colon and rectum is the second most common cancer in men and women in North America. Early diagnosis results in detection of early stage tumours with a high probability of cure. Several studies document the efficacy of screening for the early detection of colorectal cancer; however, its incidence is so high chat screening the entire older adult population is not feasible. Thus, attempts have been made to focus screening on patients at higher than average risk for colorectal carcinoma; these include patients with predisposing conditions or premalignant lesions of the colon. Common predisposing conditions include previous resection of an adenoma or carcinoma, a family history of colorectal carcinoma, and ulcerative colitis of more than IO years' duration. The most important premalignant lesion is the colonic adenoma. Such lesions must be removed in their entirety and examined histologically to exclude the presence of carcinoma. Approximately 51 % of patients with colonic adenomas removed by endoscopic polypectomy will be found to have a carcinoma within the polyp. If a pedunculated adenoma containing invasive carcinoma can be removed with a clear stalk margin, the risk of nodal metastasis is very low, probably less than 2%. In contrast, sessile lesions containing carcinoma already show invasion into the submucosa of the underlying bowel wall with a significant risk of nodal metastasis. Segmental colonic resection is rarely necessary for management of the patient with carcinoma arising in a pedunculated adenoma, but it is often justified for the patient with carcinoma in a sessile lesion. Dysplasia arising in ulcerative colitis is another important premalignant lesion that can be detected by colonoscopy with biopsy. The presence of high grade dysplasia in a patient with longstanding ulcerative colitis is an indication for colectomy.
Helicobacter (Campylobacter) pylori and Acid Peptic Diseases
Authors: Kradjen Sigmund , Sherman Philip
Published: April 2016

Helicobacter pylori is a spiral-shaped Gram-negative bacteria implicated as a cause of histological gastritis, contributing to peptic ulcer disease and perhaps playing a role in gastric cancer in humans. The organism is found worldwide; the prevalence of infection increases with age; and colonization probably persists for life. Diagnostic approaches chat have been used include tissue stains, culture of stomach biopsy specimens, labelled-urea breath tests and serology. It is too early to advocate treatment for all infected individuals; the benefits and risks have yet to be carefully studied and assessed.
Aortoenteric Fistula Assocaited with Acute Myocardial Infarcation
Authors: Fingerote Robert J , Thomson Alan BR
Published: April 2016

A 64-year-old male with a prior abdominal aortic graft for lower limb ischemia presented with melena and myocardial infarction. Despite aggressive investigation, an aortoenteric fistula was not diagnosed until after massive gastrointestinal hemorrhage. The patient's myocardial infarction may have heen precipitated by hypotension induced by hemorrhage through the aortoenteric fistula. Patients with prior abdominal aortic graft surgery presenting with gastrointestinal bleeding, abdominal pain or occult sepsis need to be aggressively investigated to determine whether an aortoenteric fistula is present. Laparotomy should be done in such patients if no cause for these symptoms can be determined.
Endoscopic Drainage of Pancreatic Pseudocysts
Authors: Liguory Claude , Lefebvre Jean Francois , Vitale Gary C
Published: April 2016

Endoscopic drainage of pancreatic pseudocysts was attempted in 17 patients over an eight year period. There were nine cysts located in the head of the pancreas, six in the body and two in the tail. Endoscopic retrograde cholangiopancreatography was performed in all cases and the pancreatic duct satisfactorily opacified in 16 of the 17 patients. This study identified a communication with the pancreatic duct in seven cases. There were two cases in which multiple cysts were present; in each, one cyst was drained endoscopically and the others surgically. Endoscopic drainage of the cyst was immediately possible in 16 of 17 cases (94%). Late follow-up (mean 26 months) documented cyst disappearance in 11 cases (69%). None of the five patients with persistent cysts has required secondary surgical intervention, and the cysts are asymptomatic and stable or decreasing in size by serial scanning. There was one case (6%) in which a pseudocyst recurred following initial resolution. There were two complications (12%) requiring surgical intervention: gastrointestinal perforation with peritonitis in one patient and hemorrhage at the cyst margin from an arterial bleeder in another. There were no deaths at 30 days, but in one case a recurrent acute necrotizing pancrearitis occurred 36 days following endoscopic drainage and the patient died. This death was felt to be unrelated to the endoscopic procedure. In conclusion, internal drainage of pancreatic pseudocysts by endoscopic means can be proposed as an alternative to surgical drainage when the cyst can be identified as bulging into the stomach or duodenum. Immediate drainage is usually effective with a minimal long term recurrence rate.
Pitfalls in the Histological Diagnosis of Inflammatory Bowel Disease on Colorectal Biopsies
Authors: Malatjalian DA
Published: April 2016

Histopathological examination of appropriate colorectal biopsy specimens allows accurate identification of chronic inflammatory bowel disease in the majority of cases. Pitfalls, however, appear because overlapping histological features occur among the various forms of colitis or because a specific form of colitis may exhibit incomplete expression of its characteristic features. Pitfalls can be minimized if the histological findings are considered in the context of all other clinical and investigative data.
Giardiasis in Endoscopy Patients: A Comparison of Diagnostic Techniques
Authors: Watson Doone R , Sutherland Lloyd , Befus A Dean
Published: April 2016

The results of a study comparing techniques for diagnosis of giardiasis during endoscopy are presented. Methods of diagnosis included examination of duodenal biopsy impression smears, culture of both biopsies and aspirates, and examination of preserved aspirate. Giardiasis was diagnosed in three of 80 patients; in each case the impression smear was positive. Cultures of duodenal biopsies were positive in two patients; in the third patient a biopsy was not available. The preserved aspirate was positive in only one patient, while the aspirate cultures were never positive. It is proposed that during diagnostic endoscopy, routine submission of a duodenal biopsy impression smear from patients with unexplained small bowel diarrhea or abdominal discomfort is appropriate.
Carcinogenesis in Chronic Ulcerative Colitis: Flow Cytometry
Authors: Ahnen DJ , McHugh JB , Bozdech JM , Warren GH
Published: April 2016

Flow cytometry is a conceptually straightforward quantitative method that can be used to determine the DNA content (and many other parameters) of individual cells. It has been used in chronic ulcerative colitis to evaluate the presence of aneuploidy as a marker of colon cancer risk. In this paper, the basic principles of flow cytometry are reviewed, the current status of published studies using flow cytometric analysis of DNA content in chronic ulcerative colitis outlined, conclusions from the research are proposed and future research needs identified. Overall, aneuploidy correlates with the current best markers of cancer risk in ulcerative colitis, ie, dysplasia and established cancer. Whether aneuplo1dy will be useful for the prospective identification of individuals at increased risk for colon cancer deserves rigorous evaluation. An important technical issue of potential variability in interpretation of near diploid peaks is emphasized.
Extending the Impact of RAC1b Overexpression to Follicular Thyroid Carcinomas
Authors: Faria Márcia , Capinha Liliana , Simões-Pereira Joana , Bugalho Maria João , Silva Ana Luísa
Published: April 2016

RAC1b is a hyperactive variant of the small GTPase RAC1 known to be a relevant molecular player in different cancers. Previous studies from our group lead to the evidence that its overexpression in papillary thyroid carcinoma (PTC) is associated with an unfavorable prognosis. In the present study, we intended to extend the analysis of RAC1b expression to thyroid follicular neoplasms and to seek for clinical correlations. RAC1b expression levels were determined by RT-qPCR in thyroid follicular tumor samples comprising 23 follicular thyroid carcinomas (FTCs) and 33 follicular thyroid adenomas (FTAs). RAC1b was found to be overexpressed in 33% of carcinomas while no RAC1b overexpression was documented among follicular adenomas. Patients with a diagnosis of FTC were divided into two groups based on longitudinal evolution and final outcome. RAC1b overexpression was significantly associated with both the presence of distant metastases (P= 0.01) and poorer clinical outcome (P= 0.01) suggesting that, similarly to that previously found in PTCs, RAC1b overexpression in FTCs is also associated with worse outcomes. Furthermore, the absence of RAC1b overexpression in follicular adenomas hints its potential as a molecular marker likely to contribute, in conjunction with other putative markers, to the preoperative differential diagnosis of thyroid follicular lesions.
Confluent and Reticulated Papillomatosis of Gougerot-Carteaud on Black Skin: Two Observations
Authors: Ahogo Kouadio Celestin , Gbery Patrice Ildevert , Bamba Vagamon , Kouassi Yao Isidore , Ecra Elidje Joseph , Kouassi Kouame Alesandre , Allou Ange Sylvain
Published: April 2016

Confluent and reticulated papillomatosis of Goujerot-Carteaud is a rare and benign skin disease characterized by flat papules taking a reticulated appearance. It is a skin disease of unknown etiology and nosology that is always discussed. This disease preferentially involves the chest and interscapular regions. It is a condition probably underdiagnosed in black skin because it generally simulates a pigmented tinea versicolor. This pathology withstands antifungal treatment but has a particular sensitivity to cyclines thus constituting a distinguishing criterion, useful for diagnosis which should be evoked in front of these reticulated confluent papules.
Effect of Opioid on Adult Hippocampal Neurogenesis
Authors: Zhang Yue , Loh Horace H. , Law Ping-Yee
Published: April 2016

During the past decade, the study of the mechanisms and functional implications of adult neurogenesis has significantly progressed. Many studies focus on the factors that regulate proliferation and fate determination of adult neural stem/progenitor cells, including addictive drugs such as opioid. Here, we review the most recent works on opiate drugs’ effect on different developmental stages of adult hippocampal neurogenesis, as well as the possible underlying mechanisms. We conclude that opiate drugs in general cause a loss of newly born neural progenitors in the subgranular zone of dentate gyrus, by either modulating proliferation or interfering with differentiation and maturation. We also discuss the consequent impact of regulation of adult neurogenesis in animal’s opioid addiction behavior. We further look into the future directions in studying the convergence between the adult neurogenesis field and opioid addiction field, since the adult-born granular cells were shown to play a role in neuroplasticity and may help to reduce the vulnerability to drug craving and relapse.
Organization Learning Oriented Approach with Application to Discrete Flight Control
Authors: Yu Lin , Wang Shixing , Zheng Yongan
Published: April 2016

In nature and society, there exist many learning modes; thus, in this paper the goal is to incorporate features from the social organizations to improve the learning of intelligent systems. Inspired by future prediction, in the high level, the discrete dynamics is further written into the equivalent prediction model which can provide the bridge from now to the future. In the low level, the efficiency could be improved in way of group learning. The philosophy is integrated into discrete neural flight control where the cascade dynamics is written into the prediction form and the minimal-learning-parameter technique is designed for parameter learning. The effectiveness of the proposed method is verified with simulation.
Organotypic Cultures as a Model to Study Adult Neurogenesis in CNS Disorders
Authors: Cavaliere Fabio , Benito-Muñoz Monica , Matute Carlos
Published: April 2016

Neural regeneration resides in certain specific regions of adult CNS. Adult neurogenesis occurs throughout life, especially from the subgranular zone of hippocampus and the subventricular zone, and can be modulated in physiological and pathological conditions. Numerous techniques and animal models have been developed to demonstrate and observe neural regeneration but, in order to study the molecular and cellular mechanisms and to characterize multiple types of cell populations involved in the activation of neurogenesis and gliogenesis, investigators have to turn to in vitro models. Organotypic cultures best recapitulate the 3D organization of the CNS and can be explored taking advantage of many techniques. Here, we review the use of organotypic cultures as a reliable and well defined method to study the mechanisms of neurogenesis under normal and pathological conditions. As an example, we will focus on the possibilities these cultures offer to study the pathophysiology of diseases like Alzheimer disease, Parkinson’s disease, and cerebral ischemia.
The Canadian Registry for Pulmonary Fibrosis: Design and Rationale of a National Pulmonary Fibrosis Registry
Authors: Ryerson Christopher J. , Tan Benjamin , Fell Charlene D. , Manganas Hélène , Shapera Shane , Mittoo Shikha , Sadatsafavi Mohsen , To Teresa , Gershon Andrea , Fisher Jolene H. , Johannson Kerri A. , Hambly Nathan , Khalil Nasreen , Marras Theodore K. , Morisset Julie , Wilcox Pearce G. , Halayko Andrew J. , Khan Mohammad Adil , Kolb Martin
Published: April 2016

Background. The relative rarity and diversity of fibrotic interstitial lung disease (ILD) have made it challenging to study these diseases in single-centre cohorts. Here we describe formation of a multicentre Canadian registry that is needed to describe the outcomes of fibrotic ILD and to enable detailed healthcare utilization analyses that will be the cornerstone for future healthcare planning.Methods. The Canadian Registry for Pulmonary Fibrosis (CARE-PF) is a prospective cohort anticipated to consist of at least 2,800 patients with fibrotic ILD. CARE-PF will be used to (1) describe the natural history of fibrotic ILD, specifically determining the incidence and outcomes of acute exacerbations of ILD subtypes and (2) determine the impact of ILD and acute exacerbations of ILD on health services use and healthcare costs in the Canadian population. Consecutive patients with fibrotic ILD will be recruited from five Canadian ILD centres over a period of five years. Patients will be followed up as clinically indicated and will complete standardized questionnaires at each clinic visit. Prespecified outcomes and health services use will be measured based on self-report and linkage to provincial health administrative databases.Conclusion. CARE-PF will be among the largest prospective multicentre ILD registries in the world, providing detailed data on the natural history of fibrotic ILD and the healthcare resources used by these patients. As the largest and most comprehensive cohort of Canadian ILD patients, CARE-PF establishes a network for future clinical research and early phase clinical trials and provides a platform for translational and basic science research.
Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine
Authors: Hering Kathrin , Bresch Anke , Lobsien Donald , Mueller Wolf , Kortmann Rolf-Dieter , Seidel Clemens
Published: April 2016

Background Context.Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up.Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation.Study Design. Case report.Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine.Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms.Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.
Total Hip Arthroplasty Using a Polished Tapered Cemented Stem in Hereditary Multiple Exostosis
Authors: Kanda Akio , Kaneko Kazuo , Obayashi Osamu , Mogami Atsuhiko
Published: April 2016

A 61-year-old Japanese man underwent right total hip arthroplasty for hereditary multiple exostosis. At first presentation, he had suffered from coxalgia for a long time. On radiographic images, there was a gigantic femoral head, increased shaft angle, and large diameter of the femoral neck. He had also developed coxarthrosis and severe pain of the hip joint. The transformation of the proximal femur bone causes difficulty in setting a cementless total hip prosthesis. Therefore, total hip arthroplasty using a cemented polished tapered stem was performed via a direct lateral approach. Using a cemented polished tapered stem allowed us to deal with the femoral bone transformation and bone substance defectiveness due to exostosis and also minimized the invasiveness of the operation.
Estrogen Modulates Expression of Tight Junction Proteins in Rat Vagina
Authors: Oh Kyung-Jin , Lee Hyun-Suk , Ahn Kyuyoun , Park Kwangsung
Published: April 2016

Background. The objectives of this study were to investigate the localization of tight junctions and the modulation of zonula occludens- (ZO-) 1, occludin and claudin-1 expression by estrogen in castrated female rat vagina. Female Sprague-Dawley rats (230–240 g,n=45) were divided into three groups and subjected to a sham operation (control group,n=15), bilateral ovariectomy (Ovx group,n=15), or bilateral ovariectomy followed by daily subcutaneous injection of 17β-estradiol (50 μg/kg/day, Ovx + Est group,n=15). The cellular localization and expression of ZO-1, occludin, and claudin-1 were determined in each group by immunohistochemistry and western blot.Results. Expression of ZO-1 was diffuse in all groups, with the highest intensity in the superficial epithelium in the control group. Occludin was localized in the intermediate and basal epithelium. Claudin-1 was most intense in the superficial layer of the vaginal epithelium in the control group. Expression of ZO-1, occludin, and claudin-1 was significantly decreased after ovariectomy and was restored to the level of the control after estrogen replacement.Conclusions. Tight junctions are distinctly localized in rat vagina, and estrogen modulates the expression of tight junctions. Further researches are needed to clarify the functional role of tight junctions in vaginal lubrication.
Impact of Heart Transplantation on Cheyne-Stokes Respiration in a Child
Authors: Al-Saleh Suhail , Kantor Paul F. , Narang Indra
Published: April 2016

Sleep disordered breathing is well described in adults with heart failure but not in pediatric population. We describe a 13-year-old Caucasian male with severe heart failure related to dilated cardiomyopathy who demonstrated polysomnographic features of Cheyne-Stokes respiration, which completely resolved following cardiac transplantation. Cheyne-Stokes respiration in children with advanced heart failure and its resolution after heart transplant can be observed similar to adults.
Free Transverse Vibration Analysis of Axially Functionally Graded Tapered Euler-Bernoulli Beams through Spline Finite Point Method
Authors: Liu Peng , Lin Kun , Liu Hongjun , Qin Rong
Published: April 2016

A new model for the free transverse vibration of axially functionally graded (FG) tapered Euler-Bernoulli beams is developed through the spline finite point method (SFPM) by investigating the effects of the variation of cross-sectional and material properties along the longitudinal directions. In the proposed method, the beam is discretized with a set of uniformly scattered spline nodes along the beam axis instead of meshes, and the displacement field is approximated by the particularly constructed cubic B-spline interpolation functions with good adaptability for various boundary conditions. Unlike traditional discretization and modeling methods, the global structural stiffness and mass matrices for beams of the proposed model are directly generated after spline discretization without needing element meshes, generation, and assembling. The proposed method shows the distinguished features of high modeling efficiency, low computational cost, and convenience for boundary condition treatment. The performance of the proposed method is verified through numerical examples available in the published literature. All results demonstrate that the proposed method can analyze the free vibration of axially FG tapered Euler-Bernoulli beams with various boundary conditions. Moreover, high accuracy and efficiency can be achieved.
27.12 MHz Radiofrequency Ablation for Benign Cutaneous Lesions
Authors: Kim Dong Hyun , Hyun Dong Ju , Piquette Raymonde , Beaumont Clément , Germain Lucie , Larouche Danielle
Published: April 2016

As surgical and/or ablative modalities, radiofrequency (RF) has been known to produce good clinical outcomes in dermatology. Recently, 27.12 MHz RF has been introduced and has several advantages over conventional 4 or 6 MHz in terms of the precise ablation and lesser pain perception. We aimed to evaluate the clinical efficacy and safety of 27.12 MHz RF for the treatment of benign cutaneous lesions. Twenty female patient subjects were enrolled. Digital photography and a USB microscope camera were used to monitor the clinical results before one session of treatment with 27.12 MHz RF and after 1 and 3 weeks. Treated lesions included telangiectasias, cherry and spider angiomas, skin tags, seborrheic keratoses, lentigo, milium, dilated pore, acne, piercing hole, and one case of neurofibroma. For vascular lesions, clinical results were excellent for 33.3%, good for 44.4%, moderate for 11.1%, and poor for 11.1%. For nonvascular lesions (epidermal lesions and other benign cutaneous lesions), clinical results were excellent for 48.3%, good for 45.2%, moderate for 3.2%, and poor for 3.2%. No serious adverse events were observed. Mild adverse events reported were slight erythema, scale, and crust. The 27.12 MHz RF treatment of benign vascular and nonvascular lesions appears safe and effective after 3 weeks of follow-up.
Incidence and Predictors of Catheterization-Related Cerebral Infarction on Diffusion-Weighted Magnetic Resonance Imaging
Authors: Morita Yusuke , Kato Takao , Okano Mitsumasa , Suu Kanae , Kimura Masahiro , Minamino-Muta Eri , Nakane Eisaku , Izumi Toshiaki , Miyamoto Shoichi , Haruna Tetsuya , Ueyama Koji , Inoko Moriaki
Published: April 2016

Introduction. The aim of this study was to examine the incidence and risk factors of catheterization-related CI in the contemporary era, using diffusion-weighted magnetic resonance imaging.Methods. We retrospectively analyzed consecutive 84 patients who underwent MRI (magnetic resonance imaging) after2.81±2.4days(mean±SD)of catheterization via aortic arch. We categorized the patients by the presence or absence of acute CI determined by diffusion-weighted MRI and analyzed the incidence and predictors.Results. Of 84 patients that underwent MRI after catheterization, acute CI was determined in 27 (32.1%) patients. In univariate analysis, dyslipidemia, age, coronary artery disease, antiplatelet agents, number of catheters used, urgent settings, and interventional procedures were significantly different. Multivariate analysis revealed dyslipidemia (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.41–16.03;p=0.01), higher age (OR, 1.09; 95% CI, 1.007–1.19;p=0.03), and the number of catheters used (OR, 2.21; 95% CI, 1.21–4.36;p=0.01) as independent predictors of the incidence of catheterization-related acute CI.Conclusions. Dyslipidemia, higher age, and number of catheters used were independent predictors for acute CI after catheterization. These findings imply that managing dyslipidemia and comprehensive planning to minimize the numbers of catheters are important.
Advances of Targeted Therapy in Treatment of Unresectable Metastatic Colorectal Cancer
Authors: Lee Suk-young , Oh Sang Cheul
Published: April 2016

Despite being one of the most frequently diagnosed cancers worldwide, prognosis of metastatic colorectal cancer (CRC) was poor. Development and introduction of biologic agents in treatment of patients with metastatic CRC have brought improved outcomes. Monoclonal antibodies directing epidermal growth factor receptors and vascular endothelial growth factor are main biologic agents currently used in treatment of metastatic CRC. Encouraged by results from many clinical trials demonstrating efficacy of those monoclonal antibodies, the combination therapy with those targeted agents and conventional chemotherapeutic agents has been established as the standard therapy for patients with metastatic CRC. However, emergency of resistance to those target agents has limited the efficacy of treatment, and strategies to overcome the resistance are now being investigated by newly developed biological techniques clarifying how to acquire resistance. Here, we introduce mechanisms of action of the biologic agents currently used for treatment of metastatic CRC and several landmark historical clinical studies which have changed the main stream of treatment. The mechanism of resistance to those agents, one of serious problems in treatment metastatic CRC, and ongoing clinical trials to overcome the limitations and improve treatment outcomes will also be presented in this review.
Concurrent Training Decreases Cortisol but Not Zinc Concentrations: Effects of Distinct Exercise Protocols
Authors: Rosa Guilherme , Fortes Marcos de Sá Rego , Mello Danielli B. de
Published: April 2016

Objectives. To investigate the effects of distinct concurrent training (CT) protocols on zinc and cortisol concentrations and test the correlation between these blood variables.Methods. Samples of serum zinc and cortisol were assessed from 10 male subjects (27.1±4.8years old; BMI25.38±0.09) before and immediately after each study session: control (CS = no exercises), concurrent training 1 (CT1 = indoor cycling + strength training), and concurrent training 2 (CT2 = strength training + indoor cycle) with five days of interval between each.Results. There were no significant changes in zinc concentrations after the CS (Δ% = 8.45;p=0.07), CT1 (Δ% = 4.77;p=0.49), and CT2 (Δ% = −2.90;p=0.12) sessions. Cortisol levels showed significant decrease after CS (Δ% = −6.02;p=0.00), CT1 (Δ% = −26.32;p=0.02), and CT2 (Δ% = −33.57;p=0.05) sessions. There was a significant correlation between the variables only at CS (zinc post versus cortisol pre:r=0.82and cortisol post:r=0.82).Conclusions. CT decreases cortisol concentrations regardless of the sequence performed. No changes were found in zinc concentrations after the study sessions. The reduction in serum cortisol concentrations appear to occur by a mechanism independent of the zinc status.
Adaptive Flutter Suppression for a Fighter Wing via Recurrent Neural Networks over a Wide Transonic Range
Authors: Liu Haojie , Zhao Yonghui , Hu Haiyan
Published: April 2016

The paper presents a digital adaptive controller of recurrent neural networks for the active flutter suppression of a wing structure over a wide transonic range. The basic idea behind the controller is as follows. At first, the parameters of recurrent neural networks, such as the number of neurons and the learning rate, are initially determined so as to suppress the flutter under a specific flight condition in the transonic regime. Then, the controller automatically adjusts itself for a new flight condition by updating the synaptic weights of networks online via the real-time recurrent learning algorithm. Hence, the controller is able to suppress the aeroelastic instability of the wing structure over a range of flight conditions in the transonic regime. To demonstrate the effectiveness and robustness of the controller, the aeroservoelastic model of a typical fighter wing with a tip missile was established and a single-input/single-output controller was synthesized. Numerical simulations of the open/closed-loop aeroservoelastic simulations were made to demonstrate the efficacy of the adaptive controller with respect to the change of flight parameters in the transonic regime.
Splenorenal Manifestations ofBartonella henselaeInfection in a Pediatric Patient
Authors: Rising Taylor , Fulton Nicholas , Vasavada Pauravi
Published: April 2016

Bartonella henselaeis a bacterium which can cause a wide range of clinical manifestations, ranging from fever of unknown origin to a potentially fatal endocarditis. We report a case ofBartonella henselaeinfection in a pediatric-aged patient following a scratch from a kitten. The patient initially presented with a prolonged fever of unknown origin which was unresponsive to antibiotic treatment. The patient was hospitalized with worsening fevers and night sweat. Subsequent ultrasound imaging demonstrated multiple hypoechoic foci within the spleen. A contrast-enhanced CT of the abdomen and pelvis was also obtained which showed hypoattenuating lesions in the spleen and bilateral kidneys.Bartonella henselaeIgG and IgM titers were positive, consistent with an acuteBartonella henselaeinfection. The patient was discharged with a course of oral rifampin and trimethoprim-sulfamethoxazole, and all symptoms had resolved following two weeks of therapy.
Encephalopathy Associated with Autoimmune Thyroid Disease: A Potentially Reversible Condition
Authors: Correia Inês , Marques Inês B. , Ferreira Rogério , Sousa Lívia
Published: April 2016

Autoimmune thyroid disease may occasionally associate with unspecific neurological symptoms, which are more commonly insidious, include cognitive or behavioural symptoms, and may associate with tremor, myoclonus, or ataxia. We report a 61-year-old female patient who presented with chronic headache, insidious mood, and cognitive disturbance which evolved in a few months to dementia associated with exuberant limb myoclonus. Diagnostic workup revealed high anti-thyroid peroxidase antibody titers and an inflammatory CSF profile, and it was negative for other possible etiologies. Treatment with steroids induced significant improvement. The diagnosis of encephalopathy associated with autoimmune thyroid disease is still controversial given the fact that the clinical presentation and diagnostic workup are unspecific, the pathophysiology is still undetermined, and the diagnosis is mostly of exclusion. No direct correlation is found between anti-thyroid antibody titers and clinical presentation, and it is currently speculated that other still unrecognized antibodies may be responsible for this clinical entity. It is extremely important to recognize this entity because it is potentially treatable with immunotherapies. It is also increasingly recognized that clinical improvement with first-line treatment with steroids may be absent or incomplete, and other immunotherapies as immunosuppressants, intravenous immunoglobulin, or plasma exchange must be attempted in the clinical suspicion of EEAT.