bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of Coagulation and Fibrinolysis after Off-Pump Coronary Artery Bypass Grafting with or without Endotracheal General Anesthesia
Authors: Yachi Tsuyoshi , Watanabe Go , Tomita Shigeyuki
Published: January 2019

Objective

In this study, we measured the activity of coagulation and fibrinolysis and clarified the presence of certain differences between off-pump coronary artery bypass grafting (OPCAB) cases and awake off-pump coronary artery bypass grafting (AOCAB) cases to evaluate whether AOCAB is actually safe from the viewpoint of coagulability.

Methods

8 underwent OPCAB and 6 underwent AOCAB. The following factors inducing coagulation and fibrinolysis were measured for upto 5 days after the operation: platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degeneration products, D-dimer, thrombin-antithrombin III complex (TAT), α2-plasmin inhibitor-plasmin complex, prothrombin fragment 1, 2 (F1+2), thrombomodulin, β-thromboglobulin (β-TG), and platelet factor-4.

Results

At 5 days after the operation, fibrin degeneration products, D-dimer, α2–plasmin inhibitor-plasmin complex, and F1 + 2 levels of the OPCAB group were significantly higher compared with their baseline values and those of the AOCAB group. At 5 days after the operation, thrombin-antithrombin III complex levels of the OPCAB group were significantly higher than those of the AOCAB group. Fibrinogen levels of the OPCAB group were significantly higher than their baseline values at 3 days after the operation (POD3) and 5 days after the operation (POD5).

Conclusions

In this study, the hypercoagulable state at POD5 was suggested in the patients in the OPCAB group, but not in those in the AOCAB group. Further study is necessary to confirm these results, and future studies would evaluate the potential benefit of AOCAB procedure from the viewpoint of perioperative coagulability.
Mitral Re-Repair and Right Coronary Fistula Closure Advantage of Minimally Invasive Approach
Authors: Giordano Vincenzo , Grandjean Jan G.
Published: January 2019

A 51-year-old man developed severe mitral regurgitation 10 years after previous mitral valve repair; the echocardiographic images showed a remarkable eccentric jet toward posterior wall of left atrium associated with a high degree of pulmonary vein retrograde flow. The coronary arteriography pointed out no pathologic lesions but a coronary fistula from the proximal right coronary to the right atrium. The standard approach was avoided, and a right anterolateral minithoracotomy was chosen, providing an excellent view. Under cardiopulmonary bypass and mild hypothermia, the mitral valve was re-repaired, and a new ring was implanted. After aortic cross-clamp release, the right coronary fistula was closed through the right atrium. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. In such a high-risk reintervention and concomitant procedure, we think that this different approach may represent a feasible and reliable alternative.
Acute Kidney Injury after Transcatheter Aortic Valve Implantation: Incidence, Risk Factors, and Prognostic Effects
Authors: Alassar Aiman , Roy David , Abdulkareem Nada , Valencia Oswaldo , Brecker Stephen , Jahangiri Marjan
Published: January 2019

Objective

Acute kidney injury (AKI) is a common complication after surgical aortic valve replacement and is associated with increased mortality. Transcatheter aortic valve implantation (TAVI) is now considered the criterion standard treatment of patients with severe symptomatic aortic stenosis ineligible for surgery. The aim of this study was to establish the incidence, risk factors, and prognostic consequences of AKI after TAVI and at 1-year follow-up in a single center.

Methods

Between December 2007 and March 2011, a total of 79 patients with severe aortic stenosis who underwent 81 TAVI procedures with the Medtronic CoreValve System or the Edwards SAPIEN heart valve were included. Baseline characteristics and procedural complications were recorded. Acute kidney injury was defined according to the Valve Academic Research Consortium criteria (modified risk, injury, failure, loss, and end-stage kidney disease criteria).

Results

The mean age was 84 (78–87) years; 49 were men. After TAVI, 10 patients (12.3%) developed AKI, which had completely resolved in 9 patients before hospital discharge. Nine patients (10%) had mild AKI (stage 1) and only one patient (10%) experienced moderate AKI (stage 2) according to Valve Academic Research Consortium definitions. The predictive factors of AKI were diabetes (odds ratio, 6.722; P = 0.004) and preoperative creatinine level greater than 104 μmol/L (odds ratio, 1.024; P = 0.02). Thirteen patients (16.4%) died within 1 year after TAVI. Three of the nonsurvivors (3.7%) developed AKI postoperatively. Acute kidney injury was, however, not a predictive factor of 1-year mortality after TAVI.

Conclusions

Acute kidney injury occurred in 12.3% of the patients after TAVI and persisted in only one patient before hospital discharge. Diabetes and preoperative creatinine level were found to be the main predictive factors of AKI after TAVI. Acute kidney injury was not associated with increased 1-year mortality.
Evaluation of a Novel Cryoablation System: In vitro Testing of Heat Capacity and Freezing Temperatures
Authors: Weimar Timo , Lee Anson M. , Ray Shuddhadeb , Schuessler Richard B. , Damiano Ralph J.
Published: January 2019

Objective

Cryoablation has been used to ablate cardiac tissue for decades and has been shown to be able to replace incisions in the surgical treatment of atrial fibrillation. This in vitro study evaluates the performance of a novel cryoprobe and compares it with existing commercially available devices.

Methods

A new malleable 10-cm aluminum cryoprobe was compared with a rigid 3.5-cm copper linear probe using in vitro testing to evaluate performances under different thermal loads and with different tissue thicknesses. Radial dimensions of ice formation were measured in each water bath by a high-precision laser 2 minutes after the onset of cooling. Probe-surface temperatures were recorded by thermocouples. Tissue temperature was measured at depths of 4 mm and 5 mm from the probe-tissue interface. Time to reach a tissue temperature of −20°C was recorded.

Results

Ice formation increased significantly with lower water-bath temperatures (P < 0.001). Width and depth of ice formation were significantly less for the rigid linear probe (P < 0.012 and P < 0.001, respectively). There was no difference between the probes in the maximal negative temperature reached under different thermal loads or at different tissue depths. The malleable probe achieved significantly lower temperatures at the proximal compared with the distal end (–61.7°C vs −55.0°C, respectively; P < 0.001). A tissue temperature of −20°C was reached earlier at 4 mm than at 5 mm (P < 0.001) and was achieved significantly faster with the 3011 Maze Linear probe (P < 0.021).

Conclusions

The new malleable probe achieved rapid freezing to clinically relevant levels in up to 5-mm–thick tissue. Both probes maintained their performance under a wide range of thermal loads.
Intraoperative Fluorescence Imaging after Transit-Time Flow Measurement during Coronary Artery Bypass Grafting
Authors: Kuroyanagi Satoshi , Asai Tohru , Suzuki Tomoaki
Published: January 2019

Objective

This report describes the complementary use of transit-time flow measurement (TTFM) and intraoperative fluorescence imaging (IFI) during off-pump coronary artery bypass grafting (OPCAB) and compares their results with those of subsequent coronary angiography.

Methods

The subjects were 159 OPCAB patients, with a total of 435 grafts at a single center between April 2009 and November 2011. During surgery, all grafts were assessed initially by both TTFM and IFI. Transit-time flow measurement was used for screening grafts for possible revision, then IFI was applied to check patency. For IFI, indocyanine green was injected into the superior vena cava, then the presence and timing of fluorescent enhancement were monitored in coronary and graft vessels.

Results

Twelve grafts were revised after poor TTFM scores. Despite some poor TTFM scores even after revision, subsequent IFI showed that all grafts were enhanced. However, two grafts showed delayed enhancement. In one internal thoracic artery (ITA), delay was caused by competitive flow from a mildly stenotic native coronary artery. The other delayed-enhancement ITA was revised. Reanastomosis was constructed with shorter ITA at the larger lumen size. After about 1 week, all patients underwent coronary angiography (plain angiography for 31, computed tomography angiography for 128). These demonstrated that all 385 arterial grafts, and 48 out of 50 venous grafts, were patent.

Conclusions

Our OPCAB series using TTFM and IFI achieve extremely high graft patency in the early graft assessments. “Delayed enhancement” of one ITA in comparison with the other suggested either native competitive flow or a bypass graft problem.
Role of Preoperative Femoral Artery Color Doppler Echocardiography in Minimally Invasive Cardiac Surgery
Authors: Ceresa Fabrizio , Sansone Fabrizio , Patanè Francesco
Published: January 2019

Objective

Minimally invasive cardiac surgery (MICS) through a right thoracotomy has been developed in the past decades, leading to a significant improvement of postoperative outcome. The risk for complications during peripheral cannulation should be considered. We report our experience of preoperative evaluation by color Doppler echocardiography for patients scheduled for MICS.

Methods

Between January 2009 and December 2011, a total of 155 patients were operated on for mitral valve disease or patent foramen ovale. One hundred thirteen patients were approached by MICS through the fourth intercostal space, and arterial cannulation was peripheral (femoral artery). One hundred nineteen patients scheduled for MICS were screened by ultrasound evaluation before the induction of anesthesia, by means of a vascular linear probe. Three parameters were considered: longitudinal axis, transverse axis, and atherosclerotic disease (AD).

Results

Peripheral arterial cannulation of vessels greater than 7 mm is safe because we experienced no complications in 69 patients. In case of diameters 6.5 to 7 mm, peripheral cannulation should be avoided in case of presence of calcifications; in fact, three patients in our series with AD had vascular injuries; 25 patients without femoral artery AD had no complications. Cannulation was avoided in six patients with widespread AD. In case of diameters less than 6.5 mm, peripheral cannulation was avoided.

Conclusions

Peripheral cannulation is safe when a careful preoperative evaluation is performed. The diameters of the femoral vessels are predictors of complications in case of absence of other contraindications.
Thoracoscopic Resection and Re-resection of an Anterior Chest Wall Chondrosarcoma
Authors: Hennon Mark W. , Demmy Todd L.
Published: January 2019

The limits of thoracoscopic resections are expanding, with improved instruments for manipulating and dividing tissues such as the bone. We encountered a patient with a primary chest wall tumor that had exposure characteristics similar to our limited, but promising, experience with en bloc rib resections for primary lung cancer. A 71-year-old female patient presented with a symptomatic right meningocele, at which time a 7.7-cm left anterior mediastinal mass bulging through the second interspace was detected. With the patient in the lateral decubitus position, a modified three-incision approach similar to that for a video-assisted thorascopic surgery (VATS) lobectomy was performed but angled slightly different to expose the anterior chest wall. Using this approach, the mass was excised intact en bloc, with ribs 2 and 3 (9.5-cm total specimen with 6-cm longest rib). No chest wall reconstruction was necessary. The patient did well and had her chest tube removed on postoperative day (POD) 1, was discharged with minimal pain on POD 3, and was pain free on POD 14. Because a microscopic focus of chondrosarcoma was found at the second rib intramedullary margin on the final pathologic review, she returned for VATS re-resection of an additional 5 cm of rib on POD 43 using the same incisions, and her postoperative recovery was replicated. The operative times were 160 and 90 minutes, and blood loss was 400 and 100 mL, respectively. This case demonstrates that if traditional surgical values of exposure and oncologic safety can be replicated using enhanced instrumentation, it is reasonable to attempt more complex operations thoracoscopically. Even though ribs were removed, pain control was similar to other VATS operations.
Novel Mitral Repair Device for the Treatment of Severe Mitral Regurgitation: Preclinical Ovine Acute and Chronic Implantation Model
Authors: Hill Arthur C. , Lesh Michael D. , Khairkhahan Alexander
Published: January 2019

Objective

A project is now underway to implement a novel percutaneous mitral repair system for severe mitral regurgitation (MR). The initial phase of the project consists of proof-of-concept by testing device characteristics using open surgical implantation. When surgical proof-of-concept of the intended percutaneous design is completed, a second phase of the project will consist of in vivo testing of the percutaneous transseptal system. The device is currently being designed to fold into a 17F catheter system and to unfold within the left atrium where attachment is accomplished using a reversible anchoring system. The purpose of this study was to show functionality of the device in elimination of MR using the open surgical method.

Methods

We have performed surgical prototype device implantation in 5 acute and 7 chronic sheep preparations. We created a P2-flail model of severe (4+) MR in the 12 sheep. Via a minimally invasive left thoracotomy incision and open repair on cardiopulmonary bypass, the device was implanted to determine efficacy of elimination of severe MR. Implantation was considered successful if 4+ regurgitation was converted to 1+ MR or lower. Left ventriculography and epicardial 2-dimensional/3-dimensional echocardiography were used to assess repair; serial 2-dimensional/3-dimensional transthoracic echocardiography was used to assess long-term mitral repair status.

Results

Twelve sheep had surgical creation of severe (4+) MR by cutting all chordae to the P2 scallop of the mitral valve; this preparation was tested and was found to produce 100% acute fatality without repair of the mitral valve. Five sheep had acute implantation of the device with elimination of regurgitation in 5/5 sheep. Seven sheep had chronic (1–7 month) implantation of the device. The device was tested in the chronic model for clinical status, residual regurgitation, thrombosis, and histopathology. All sheep had mitigation of MR and survived to the intended date of death.

Conclusions

Proof-of-concept of a novel percutaneous mitral repair device has been completed using an ovine P2-flail severe MR model. The device has characteristics that will allow its use in posterior leaflet degenerative disease and functional/secondary MR. Open, minimally invasive, and robotic surgical implantation of the device can also be developed as an alternative to the percutaneous approach.
Robotic Application of a Novel Dual-Energy Device for Left Atrial Ablation: Intraoperative and Early Postoperative Results
Authors: Balkhy Husam H. , Vloka Margot E. , Chapman Peter D. , Peters Christopher C.
Published: January 2019

Objective

Recent trials show that in patients with atrial fibrillation (AF), pulmonary vein isolation performed with bipolar surgical ablation clamps using small bilateral thoracotomies is more effective than pulmonary vein isolation using standard catheter ablation. This improved efficacy comes with higher invasiveness including difficulty in execution and potentially more acute complications. Monopolar “loop” devices overcome these drawbacks but at the potential cost of decreased efficacy. Technology that has bipolar effectiveness but with improved access and safety profiles, capable of being deployed endoscopically on a beating heart, would be desirable. We evaluated an ablation system that may have all of these characteristics.

Methods

Between May 2012 and May 2013, 30 patients were treated surgically for AF using a right-sided endoscopic approach with robotic assistance. In each patient, a “box” ablation lesion set was created around all pulmonary veins with a new linear suction-applied dual-mode (monopolar and bipolar) radiofrequency (RF) ablation device that was looped around the pulmonary veins. Temperature-controlled RF was applied for 60 seconds, with a set temperature of 70°C, first in the bipolar mode and then in a separate RF ablation for 60 seconds at 70°C in the monopolar mode. Acute effectiveness of the procedure was assessed using conduction block testing and by attempting to induce sustained AF with rapid atrial pacing. The left atrial appendage (LAA) was occluded in all patients with multiple ENDOLOOP snares using a left video-assisted thoracoscopic surgery approach under transesophageal echocardiography guidance, after which the tip of the LAA was incised to empty the LAA of blood. All patients were seen clinically at 30, 90, and 180 days with routine electrocardiography monitoring: at 6 months, 24-hour Holter monitoring was performed.

Results

Acute conduction block was achieved in 93% the of patients, and sustained AF could not be induced by rapid atrial pacing after the surgical ablation procedure in 90% of the patients. At 3- and 6-month follow-up, 88% and 81% of the patients, respectively, were in sinus rhythm. Of 16 the patients seen at 12-month follow-up, 14 (88%) were in sinus rhythm with 44% still on antiarrhythmic medications.

Conclusions

The newly introduced bipolar/monopolar RF ablation device can be easily positioned using a right endoscopic approach. Robotic assistance enables effective fat removal for accurate and easy placement of the device around the pulmonary veins. With the use of this approach, the device is safe and effective in electrically isolating the pulmonary veins.
Technique of Aortic Root Reconstruction Using a New Model of Dacron Graft with Prefabricated Coronary Branches
Authors: Calcaterra Domenico , Farivar Robert S. , Parekh Kalpaj R. , Bashir Mohammad , Karam Karam , Turek Joseph W.
Published: January 2019

Aortic root reconstruction is a demanding surgical procedure still associated with a significant morbidity. Arguably, the most demanding aspect of the operation is reestablishing continuity between the prosthetic graft replacing the aortic root and the coronary arteries. With the objective of simplifying the possible challenges of coronary reimplantation, we designed a new model of aortic root graft with prefabricated coronary branches. We used this technique in 8 patients (6 males, 2 females; mean age, 54 years). There were 6 modified Bentall procedures and 2 valve-sparing root replacements with the “reimplantation” technique. There was no mortality or morbidity related to the use of this new prosthetic graft. Our purpose was to report in detail the technique of aortic root reconstruction using this new graft with prefabricated coronary branches. The use of this graft may simplify the procedure and offer a valuable tool for aortic root reconstruction in cases where the reimplantation of the coronary buttons may represent a technical challenge.
Sites of memory in the Irish landscape? Approaching ogham stones through memory studies
Authors: Künzler Sarah
Published: January 2019

The nexus between landscape, identity formation(s) and cultural memory has long been of interest to archaeology, cultural geography and various disciplines in the humanities. This article suggests that in medieval and early modern Irish texts, the depiction of monuments addresses precisely this complex relationship. On the basis of close readings of textual evidence and a critical engagement with Pierre Nora’s idea of lieux de mémoire, it will be argued that the cognitive interplay between literary-imagined and archaeological-material monuments enabled the medieval Irish literati to situate themselves within the world they inhabited both spatially and culturally. The article thus contributes substantially to our understanding of the material aspects of social remembrance and advocates the potential benefits of including the extremely rich Irish textual and archaeological sources into broader, interdisciplinary discussions.
The FLUENT study design: investigating immune cell subset and neurofilament changes in patients with relapsing multiple sclerosis treated with fingolimod
Authors: Cohen Jeffrey A , Bar-Or Amit , Cree Bruce A C , Mao-Draayer Yang , Han May H , Singer Barry , Jannu Ann , Kolodny Scott , Meng Xiangyi , Winger Ryan C
Published: January 2019

Background

Fingolimod is a sphingosine 1-phosphate receptor modulator for the treatment of patients with relapsing forms of multiple sclerosis (RMS). Fingolimod sequesters lymphocytes within lymphoid tissue thereby reducing the counts of circulating lymphocytes. However, fingolimod’s effects on the innate and adaptive components of the immune system are incompletely understood.

Objective

The FLUENT study will investigate temporal changes in circulating immune cell subsets in patients with RMS treated with fingolimod. Secondary objectives include examining the association between anti-John Cunningham virus (JCV) antibody status/index and phenotypic changes in innate and T and B cell subsets in patients on fingolimod therapy, and the association between serum neurofilament levels and clinical outcomes.

Methods

FLUENT is a prospective, multicenter, two-cohort, nonrandomized, open-label Phase IV study. Cohort 1 will include fingolimod-naïve patients and Cohort 2 will include patients who have received fingolimod 0.5 mg/day continuously for ≥2 years. Changes in the cellular components of the innate and adaptive immune system will be characterized over 12 months.

Results

The study is ongoing.

Conclusion

FLUENT may provide evidence for the use of immunologic profiling in predicting efficacy and risk of infection in patients with RMS treated with fingolimod.
Association Between Work-Related Factors and Diet: A Review of the Literature
Authors: Tanaka Rie , Tsuji Mayumi , Tsuchiya Takuto , Kawamoto Toshihiro
Published: January 2019

The quality of workers’ dietary intake could be influenced by their working conditions. This review aimed to summarize the published literature examining the association between work-related factors, such as work hours, shift work, physical strain, mental strain, job strain, support, and diet quality. The literature search, conducted in PubMed, was limited to articles published from 2000 to 2017, written in English, available online, and among workers employed in high-income countries. The search resulted in 16 articles that met the criteria. Although there was some evidence of unhealthy diet among shift workers, data on the diet quality in association with other work-related factors, such as number of hours worked, physical, mental, and job strain, and worksite support were scarce. Further studies are need for purposes better defining the association between work-related factors and quality of workers’ diet.
Influence of Self-reported Fatigue and Sex on Baseline Concussion Assessment Scores
Authors: Combs Patricia R. , Ford Cassie B. , Campbell Kody R. , Carneiro Kevin A. , Mihalik Jason P.
Published: January 2019

Background:

Baseline concussion assessments are advocated to provide an objective preinjury point of comparison for determining the extent of postconcussion neurological deficits and to assist with return-to-activity decision making. Many factors, including testing environment, proctor availability, and testing group size, can influence test accuracy and validity; however, it is unknown how self-reported fatigue affects test scores.

Purpose:

To investigate the influence of self-reported fatigue and patient sex on baseline concussion assessment scores.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Participants included 494 healthy Division I college student-athletes (221 women, 273 men; mean ± SD age, 20.0 ± 1.3 years). During preseason baseline testing, participants were asked to rate their fatigue on a scale from 0 to 100 based on how they normally feel and function each day (0, completely exhausted; 100, completely awake and alert). Each participant then completed a multimodal baseline concussion assessment, including a graded symptom checklist (number of symptoms endorsed and total symptom severity score), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and CNS Vital Signs computerized neurocognitive testing. Multiple linear regressions tested whether self-reported fatigue and sex predicted baseline concussion examination scores.

Results:

Athletes with higher self-reported fatigue levels (ß = –0.014, P < .01) and female athletes (ß = –0.216, P < .01) reported more total symptoms. Being male (ß = 0.856, P < .01) increased the likelihood of endorsing zero symptoms versus any symptoms by a factor of 2.40. Women also had significantly higher SAC scores (ß = 0.569, P < .001), BESS scores (ß = –2.747, P < .001), and CNS Vital Signs summary scores (ß = 4.506, P < .001). SAC, BESS, and CNS Vital Signs scores were not predicted by fatigue level ( P > .05).

Conclusion:

Female athletes and fatigued athletes endorsed more symptoms and higher symptom severity at baseline. Using total symptom endorsement and total symptom severity scores as part of the postinjury management is a common practice. The current data suggest that levels of reported exhaustion can influence concussion assessment scores meant to represent a healthy baseline and likely would interfere with postinjury assessment scores.
Relevant information and the Mental Capacity Act
Authors: Sorinmade Oluwatoyin A
Published: January 2019

Implicit in the assertion that an individual has consented to/has capacity to decide, is the concept that the individual has understood that which needed to be understood, retained the same and used/weighed this information as part of their decision-making process and thereafter communicated their wishes in whatever way possible. What invariably underpins the decision-making process is the information available to the individual (relevant information) and how this information is influenced by the functioning of their mind/brain. Consent given without an individual having processed the information relevant to the decision at hand is arguably invalid. This paper seeks to draw attention to the underpinning role of “what the patient needs to know” – (relevant information) in the correct determination of an individual's decisional capacity.
Cytogenetic complexity in chronic lymphocytic leukemia: definitions, associations, and clinical impact
Authors: Baliakas Panagiotis , Jeromin Sabine , Iskas Michalis , Puiggros Anna , Plevova Karla , Nguyen-Khac Florence , Davis Zadie , Rigolin Gian Matteo , Visentin Andrea , Xochelli Aliki , Delgado Julio , Baran-Marszak Fanny , Stalika Evangelia , Abrisqueta Pau , Durechova Kristina , Papaioannou George , Eclache Virginie , Dimou Maria , Iliakis Theodoros , Collado Rosa , Doubek Michael , Calasanz M. Jose , Ruiz-Xiville Neus , Moreno Carolina , Jarosova Marie , Leeksma Alexander C. , Panayiotidis Panayiotis , Podgornik Helena , Cymbalista Florence , Anagnostopoulos Achilles , Trentin Livio , Stavroyianni Niki , Davi Fred , Ghia Paolo , Kater Arnon P. , Cuneo Antonio , Pospisilova Sarka , Espinet Blanca , Athanasiadou Anastasia , Oscier David , Haferlach Claudia , Stamatopoulos Kostas
Published: January 2019

Recent evidence suggests that complex karyotype (CK) defined by the presence of ≥3 chromosomal aberrations (structural and/or numerical) identified by using chromosome-banding analysis (CBA) may be relevant for treatment decision-making in chronic lymphocytic leukemia (CLL). However, many challenges toward the routine clinical application of CBA remain. In a retrospective study of 5290 patients with available CBA data, we explored both clinicobiological associations and the clinical impact of CK in CLL. We found that patients with ≥5 abnormalities, defined as high-CK, exhibit uniformly dismal clinical outcomes, independently of clinical stage, TP53 aberrations (deletion of chromosome 17p and/or TP53 mutations [TP53abs]), and the expression of somatically hypermutated (M-CLL) or unmutated immunoglobulin heavy variable genes. Thus, they contrasted with CK cases with 3 or 4 aberrations (low-CK and intermediate-CK, respectively) who followed aggressive disease courses only in the presence of TP53abs. At the other end of the spectrum, patients with CK and +12,+19 displayed an exceptionally indolent profile. Building upon CK, TP53abs, and immunoglobulin heavy variable gene somatic hypermutation status, we propose a novel hierarchical model in which patients with high-CK exhibit the worst prognosis, whereas those with mutated CLL lacking CK or TP53abs, as well as CK with +12,+19, show the longest overall survival. Thus, CK should not be axiomatically considered unfavorable in CLL, representing a heterogeneous group with variable clinical behavior. High-CK with ≥5 chromosomal aberrations emerges as prognostically adverse, independent of other biomarkers. Prospective clinical validation is warranted before ultimately incorporating high-CK in risk stratification of CLL.
Clinical features of Sjögren's syndrome patients with autoantibodies against interferons
Authors: Burbelo Peter D. , Browne Sarah , Holland Steve M. , Iadarola Michael J. , Alevizos Ilias
Published: January 2019

Background

Sjögren's syndrome (SS) is an autoimmune disease characterized by immune attack on the salivary and lacrimal glands. Given the known cytokine activation and type I interferon gene expression signature found in SS, we hypothesized that anticytokine autoantibodies might be detectable by Luciferase immunoprecipitation systems in some SS patients and correlate with clinical symptoms.

Results

Luciferase immunoprecipitation systems was used to screen for serum anti‐cytokine autoantibodies in 57 primary SS patients and 25 healthy volunteers. Autoantibodies were detected against GMCSF, interferon‐γ, ‐α and, ‐ω in one, two, two and six patients with SS, respectively. None of the healthy volunteers showed anticytokine autoantibodies and none of the SS or control subjects showed autoantibodies against interferon‐λ. One 51‐year old female SS subject with the highest anti‐interferon‐α and ‐ω autoantibody levels had stable autoantibody levels over the course of a year. In vitro functional testing of serum autoantibodies from this subject demonstrated partially neutralizing activity for interferon‐α signaling. Clinical information on this individual revealed a low focus score and high levels of unstimulated salivary flow, suggesting the possibility that interferon‐α autoantibody neutralizing activity may have contributed to the milder sicca symptoms.

Conclusion

Overall, these findings demonstrate that a subset of SS patients (16%) harbor autoantibodies against GMCSF, interferon‐γ, interferon‐ω, and interferon‐α. These data support the observation that high levels of interferon‐α autoantibodies may attenuate disease symptoms in SS.
Objective knowledge, subjective knowledge, and prior experience of organic cotton apparel
Authors: Han Tae-Im
Published: January 2019

The purpose of this research is to examine the relationships between objective knowledge, subjective knowledge, and prior experience of organic cotton apparel and their effects on purchase behaviors. The sample of the present study consisted of Millennial consumers living in the United States. Multiple regression and cluster analysis were used to assess the relationship among variables. Objective and subjective knowledge related to organic cotton apparel had a weak relationship suggesting they are distinct measures of knowledge. Direct experience, indirect experience, and education level were significant predictors of subjective knowledge, however, they had insignificant effects on objective knowledge. Furthermore, consumers who are willing to pay more for organic cotton and willing to search actively for organic cotton apparel displayed a higher level of subjective knowledge and had more experience with the product. Objective knowledge was found to have a limited relationship with pro-environmental behaviors. The current study examined distinct types of knowledge associated with organic cotton apparel and their relationship to pro-environmental behaviors which provides a sound basis for better understanding consumers’ organic apparel purchase. It is widely accepted that product knowledge affects consumer behaviors, however, how product knowledge is measured varies extensively across consumer research. The findings offer a valid explanation for the contradictory findings in previous research in terms of the effect of product knowledge on purchase behaviors.
The Transcoding of the Codex Xolotl in Don Fernando de Alva Ixtlilxochitl’s Historia de la nación chichimeca
Authors: García Loaeza Pablo
Published: January 2019

This article considers the interplay among interpretation, intent, and ingenuity involved in don Fernando de Alva Ixtlilxochitl’s transcoding of the Codex Xolotl in the first part of his definitive work, the Historia de la nación chichimeca, by way of his earlier Sumaria relación de todas las cosas de la Nueva España. Scholars tend to focus on Alva Ixtlilxochitl’s role as a more or less reliable intermediary through whom the Codex Xolotl’s information has been transmitted. However, in order to better understand his contribution to Mexican ethnohistory, it is important to acknowledge him as a diligent researcher who was also an exceptional writer and storyteller.
Between theLofand the Liberators: Mapuche Authority in Chile’s Guerra a Muerte(1819–1825)
Authors: Zarley Jesse
Published: January 2019

This article examines the actions of Francisco Mariluán and Venancio Coñuepan, two rival caciques of the Mapuche indigenous people, during Chile’s independence wars to understand how indigenous leaders defended their sovereignty and shaped the transition from colony to nation in Spanish South America. Between 1819 and 1825, lands in southern Chile and western Río de la Plata that were controlled by the Mapuche became the stage for a civil war between Spanish royalists and Chilean patriots known as the guerra a muerte (war to the death). Mariluán and Coñuepan supported different sides in the conflict, but they expressed their support through diplomatic practices rooted in material and ritual reciprocities of negotiation, letter writing, and gift giving. By centering how Mariluán and Coñuepan imposed interethnic ritual negotiations (parlamentos) and diplomatic protocols on Chilean leaders, the article argues for the importance of indigenous practices of reciprocity and definitions of authority on the former frontiers of the Spanish Empire. These reciprocities governed interethnic encounters and changed the character of the conflict into a Mapuche war.
An Ishihara-style test of animal colour vision
Authors: Cheney Karen L. , Green Naomi F. , Vibert Alexander P. , Vorobyev Misha , Marshall N. Justin , Osorio Daniel C. , Endler John A.
Published: January 2019

Colour vision mediates ecologically relevant tasks for many animals, such as mate choice, foraging and predator avoidance. However, our understanding of animal colour perception is largely derived from human psychophysics, and behavioural tests of non-human animals are required to understand how colour signals are perceived. Here, we introduce a novel test of colour vision in animals inspired by the Ishihara colour charts, which are widely used to identify human colour deficiencies. In our method, distractor dots have a fixed chromaticity (hue and saturation) but vary in luminance. Animals can be trained to find single target dots that differ from distractor dots in chromaticity. We provide MATLAB code for creating these stimuli, which can be modified for use with different animals. We demonstrate the success of this method with triggerfish, Rhinecanthus aculeatus, which quickly learnt to select target dots that differed from distractor dots, and highlight behavioural parameters that can be measured, including success of finding the target dot, time to detection and error rate. We calculated discrimination thresholds by testing whether target colours that were of increasing colour distances (ΔS) from distractor dots could be detected, and calculated discrimination thresholds in different directions of colour space. At least for some colours, thresholds indicated better discrimination than expected from the receptor noise limited (RNL) model assuming 5% Weber fraction for the long-wavelength cone. This methodology could be used with other animals to address questions such as luminance thresholds, sensory bias, effects of sensory noise, colour categorization and saliency.
The Causal Effect of Competition on Prices and Quality: Evidence from a Field Experiment
Authors: Busso Matias , Galiani Sebastian
Published: January 2019

This paper provides experimental evidence on the effect of increased competition on prices and quality in the retail sector. We randomized the entry of 61 firms into 72 markets serving the beneficiaries of a conditional cash transfer program in the Dominican Republic. Six months after the intervention, entry into the market led to reductions in prices ranging from 2 to 6 percent and to a statistically significant improvement in self-reported service quality. Prices dropped more in areas where the number of entrants was larger. Competition seems to have driven part of the clientele away from incumbent retailers. (JEL C93, I38, L11, L15, L81, O14)
Are Credit Markets Still Local? Evidence from Bank Branch Closings
Authors: Nguyen Hoai-Luu Q.
Published: January 2019

This paper studies whether distance shapes credit allocation by estimating the impact of bank branch closings during the 2000s on local access to credit. To generate plausibly exogenous variation in the incidence of closings, I use an instrument based on within-county, tract-level variation in exposure to post-merger branch consolidation. Closings lead to a persistent decline in local small business lending. Annual originations fall by $453,000 after a closing, off a baseline of $4.7 million, and remain depressed for up to six years. The effects are very localized, dissipating within six miles, and are especially severe during the financial crisis. (JEL G21, G34, L22, R12, R32)
Employment Adjustment and Part-Time Work: Lessons from the United States and the United Kingdom
Authors: Borowczyk-Martins Daniel , LalÉ Etienne
Published: January 2019

We document that fluctuations in part-time employment play a major role in movements in hours per worker during cyclical swings in the labor market. Building on this result, we develop a stock-flow framework to describe the dynamics of part-time employment. The evolution of part-time employment is predominantly explained by cyclical changes in transitions between full-time and part-time employment. Those transitions occur overwhelmingly at the same employer, entail sizable changes in individual working hours and are associated with an increase in involuntary part-time work. Our findings provide a novel understanding of the cyclical dynamics of labor adjustment on the intensive margin. (JEL E24, E32, J22, J23)
Temporal horns subependymomas: A report of two cases of an intraventricular neoplasm in an atypical location
Authors: Ordones Monique Beraldo , Novaes Ana Cristhina Ribeiro , Lancellotti Carmen Lúcia Penteado , do Amaral Lázaro Luís Faria
Published: January 2019

Slow-growing intraventricular masses are sometimes imaging findings in asymptomatic patients. The neuroimaging characteristics frequently help making the correct diagnosis and the treatment decision. Subependymomas usually present as single lesions poorly vascularized, without invasion into adjacent brain parenchyma or cerebrospinal fluid dissemination. Ependymoma is considered the main differential diagnosis. We report two cases of this tumour who share the unusual location: The temporal horns. The lack of enhancement (or heterogeneous when present) and advanced neuroimaging techniques can be very useful in differentiating them from other lesions.
Gastric lipomas: a case series and review of a rare tumor
Authors: Sullivan Ian W , Hota Partha , Dass Chandra
Published: January 2019

The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between −80 and −120. A single lipoma measuring −50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.
Identifying stroke therapeutics from preclinical models: A protocol for a novel application of network meta-analysis
Authors: Lalu Manoj M. , Fergusson Dean A. , Cheng Wei , Avey Marc T. , Corbett Dale , Dowlatshahi Dar , Macleod Malcolm R. , Sena Emily S. , Moher David , Shorr Risa , McCann Sarah K. , Gray Laura J. , Hill Michael D. , O'Connor Annette , Thayer Kristina , Haggar Fatima , Dobriyal Aditi , Chung Hee Sahng , Welton Nicky J. , Hutton Brian
Published: January 2019

Introduction: Globally, stroke is the second leading cause of death. Despite the burden of illness and death, few acute interventions are available to patients with ischemic stroke. Over 1,000 potential neuroprotective therapeutics have been evaluated in preclinical models. It is important to use robust evidence synthesis methods to appropriately assess which therapies should be translated to the clinical setting for evaluation in human studies. This protocol details planned methods to conduct a systematic review to identify and appraise eligible studies and to use a network meta-analysis to synthesize available evidence to answer the following questions: in preclinical in vivo models of focal ischemic stroke, what are the relative benefits of competing therapies tested in combination with the gold standard treatment alteplase in (i) reducing cerebral infarction size, and (ii) improving neurobehavioural outcomes?

Methods: We will search Ovid Medline and Embase for articles on the effects of combination therapies with alteplase. Controlled comparison studies of preclinical in vivo models of experimentally induced focal ischemia testing the efficacy of therapies with alteplase versus alteplase alone will be identified. Outcomes to be extracted include infarct size (primary outcome) and neurobehavioural measures. Risk of bias and construct validity will be assessed using tools appropriate for preclinical studies. Here we describe steps undertaken to perform preclinical network meta-analysis to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. This will be a novel use of this evidence synthesis approach in stroke medicine to assess pre-clinical therapeutics. Combining all evidence to simultaneously compare mutliple therapuetics tested preclinically may provide a rationale for the clinical translation of therapeutics for patients with ischemic stroke. 

Dissemination: Review findings will be submitted to a peer-reviewed journal and presented at relevant scientific meetings to promote knowledge transfer.

Registration: PROSPERO number to be submitted following peer review.
Studies on Biological Test of Formulated Diets Supplementation of Vitamin E for the Broodstock of Females Blue Swimming Crab, Portunus pelagicus (Linnaeus, 1758)
Authors: Efrizal Efrizal , Zakaria Indra Junaidi , Rusnam Rusnam , Suryati Suryati , Yolanda Nofa
Published: January 2019

Background: Currently, great progress in the artificial propagation of commercially important   portunid crabs of the genus Portunus has been achieved, and various methods have been adopted in mass-scale hatchery activities. This study analyzed the biological testing of formulated diets with different dose supplementations of vitamin E for the broodstock of female blue swimming crabs, P. pelagicus (Linnaeus, 1758)

Methods: Female crab samples were collected from the coastal region of Padang, West Sumatra. The method used in this study was completely randomized design, with four treatment regimens (n=5 crabs each) of dietary vitamin E (0, 300, 600, and 900 IU/kg formulated diets).

Results: The results show that the supplementation of vitamin E in the formulated diet had a significant effect (P <0.05) on the absolute weight growth, carapace length and carapace width.

Conclusions: Supplementation of vitamin E on in formulated diet causes broodstock blue swimming crab molting, with a percentage value of 40–80% on day 20 and 20% on day 30, with a 100% survival rate.
Cryo-EM insight into the structure of MTOR complex 1 and its interactions with Rheb and substrates
Authors: Chao Luke H. , Avruch Joseph
Published: January 2019

The mechanistic target of rapamycin (MTOR) is a giant protein kinase that, together with the accessory proteins Raptor and mLst8, forms a complex of over 1 MDa known as MTOR complex 1 (MTORC1). MTORC1, through its protein kinase activity, controls the accretion of cell mass through the regulation of gene transcription, mRNA translation, and protein turnover. MTORC1 is activated in an interdependent manner by insulin/growth factors and nutrients, especially amino acids, and is inhibited by stressors such as hypoxia and by the drug rapamycin. The action of insulin/growth factors converges on the small GTPase Rheb, which binds directly to the MTOR polypeptide in MTORC1 and, in its GTP-bound state, initiates kinase activation. Biochemical studies established that MTORC1 exists as a dimer of the MTOR/Raptor/mLst8 trimer, and progressive refinements in cryo-electron microscopy (cryo-EM) have enabled an increasingly clear picture of the architecture of MTORC1, culminating in a deep understanding of how MTORC1 interacts with and phosphorylates its best-known substrates—the eIF-4E binding protein/4E-BP, the p70 S6 kinase/S6K1B, and PRAS40/AKT1S1—and how this is inhibited by rapamycin. Most recently, Rheb-GTP has been shown to bind to MTORC1 in a cooperative manner at an allosteric site remote from the kinase domain that twists the latter into a catalytically competent configuration. Herein, we review the recent cryo-EM and associated biochemical studies of MTORC1 and seek to integrate these new results with the known physiology of MTORC1 regulation and signaling.