bluuebunny/crossref_metadata_2025 huggingface dataset:
The natural history of autoimmune Addison’s disease with a non-classical presentation: a case report and review of literature
Authors: Manso Jacopo , Pezzani Raffaele , Scarpa Riccardo , Gallo Nicoletta , Betterle Corrado
Published: February 2018

Autoimmune Addison’s disease (AAD) is the most frequent cause of adrenocortical insufficiency. The natural history of AAD usually comprises five consecutive stages with the first stage characterized by the increase of plasma renin consistent with the impairment of pars glomerulosa, which is usually the first affected layer of the adrenal cortex. We describe a 19-year-old female with Hashimoto’s thyroiditis (HT) who underwent an autoantibody screening due to having the personal and family history of other autoimmune diseases in the absence of relevant clinical manifestations. She was positive for adrenal cortex autoantibodies (ACA) and steroid 21-hydroxylase autoantibodies (21-OH Ab) at high titers. She had increased basal levels of ACTH with normal basal cortisol not responding to ACTH stimulation, reduced levels of dehydroepiandrosterone-sulfate but normal levels of orthostatic renin and aldosterone. This scenario was consistent with a subclinical AAD presenting with first impairments in pars fasciculata and reticularis and conserved pars glomerulosa function. Only subsequently, progressive deficiency in pars glomerulosa function has become evident. Review of the literature showed that there was only one case, reported to date, with a similar atypical natural history of AAD. The strategies for screening for ACA/21-OH Ab in patients with HT are discussed.
The preparation and antibacterial activity of cellulose/ZnO composite: a review
Authors: Zhao Si-Wei , Guo Chong-Rui , Hu Ying-Zhu , Guo Yuan-Ru , Pan Qing-Jiang
Published: February 2018

The infectious diseases caused by various bacteria pose serious threat to human health. To solve this problem, antibacterial agents have been widely used in people’s daily life to deactivate or kill these bacteria. Among the antibacterial agents, ZnO is one of the most promising metal oxide antibacterial agents due to its non-toxic nature and safe properties. To expand its application, many composites of ZnO have been widely studied. Cellulose, as one of the most abundant biopolymers, has many merits like biodegradability, biocompatibility and low cost. Thus, many studies focus on synthesized cellulose/ZnO. The synthetic strategy includes both chemical and physical methods. Many of them have been shown that cellulose/ZnO composites have excellent antibacterial activity and are environment-friendly and have many applications for example food packing, antibacterial fibers and so on. This review mainly discusses the preparation methods of cellulose/ZnO and their effect on the morphology and properties.
Photochemical Transformation of some 3-benzyloxy-2-(benzo[b]thiophen-2-yl)-4Hchromen-4-ones: A Remote Substituent Effect
Authors: Dalal Aarti , Khanna Radhika , Kamboj Ramesh C.
Published: February 2018

The effect on photochemical transformations of the substituents present remotely from the reaction site in 3-benzyloxy-2-(benzo[b]thiophen-2-yl)-4H-chromen-4-ones has been determined. The structure(s) of the substrates and photoproducts were established by spectroscopic techniques (UV, IR, and NMR). The substituents had profound effects on product yield and distribution. Electron withdrawing groups (EWGs) on the benzenoid moiety of the chromenone nucleus increased the yield of the photoproducts whereas electron donating groups (EDGs) decreased the yield. These results may be attributed to “state switching” of the substituents during excitation.
Dynamic Changes of Secondary Metabolites and Antioxidant Activity ofLigustrum lucidumDuring Fruit Growth
Authors: Guo Xiuchun , Xia Zhaoyang , Song Miaomiao , Li Changqin , Wang Jinmei , Kang Wenyi
Published: February 2018

There are a number of secondary metabolites having medicinal values inLigustri Lucidi Fructus. In this study, the target analytes salidroside, ligustroflavone, specnuezhenide, oleuropein, oleanolic acid and ursolic acid were chosen, aiming to establish a method to investigate the content of six compounds during eight growth stages ofLigustri Lucidi Fructus. Even though the results indicated that the contents of six compounds in different growth periods reached their maximum value, they displayed a downward trend. The antioxidant activity of the analyzed samples also decreased along with the growth period. The relationship between the content of six secondary metabolites and the activity has been elucidated. Hence, this research provides a theoretical basis for guiding efficient use ofLigustri Lucidi Fructus.
Effect of Ti and Ta on Oxidation Kinetic of Chromia Forming Ni-Base Superalloys in Ar-O2-Based Atmosphere
Authors: Nowak Wojciech J. , Wierzba Bartek , Sieniawski Jan
Published: February 2018

In the present study, two commercially available Ni-base superalloys, namely Rene 80 which contains Ti and IN 792 containing Ti and Ta, were investigated during isothermal oxidation at 1,050°C in Ar–20% O2 gas up to 50 h. It was found that IN 792 showed a slightly lower oxidation rate as compared to Rene 80. Also differences in oxide scale microstructures and thicknesses were found. Both alloys formed qualitatively similar oxide scales consisting of outer TiO2 on top of a Cr2O3 scale and internally oxidized Al2O3. The IN 792 formed a thinner oxide scale in general as well as a thinner outer TiO2 scale. Also the depth of the internally oxidized Al2O3 precipitates is smaller in case of IN 792. These findings were correlated with the formation of TiTaO4, which in turn hampered outer Ti and inward oxygen flux.
A Thermodynamic Study of the Reduction of a Limonitic Laterite Ore by Methane
Authors: Pickles C. A. , Anthony W.
Published: February 2018

The recovery of nickel from the oxidic nickeliferous laterite ores is receiving increasing attention due to the difficulty of recovering this metal from the sulphide ore deposits. One possible solution is to selectively reduce the nickel oxide in the ore, which could then be upgraded by, for example, magnetic concentration. In this article, a thermodynamic study was performed on the reduction of a limonitic laterite ore by methane. Methane was selected as the reducing agent as it has a lower environmental impact than carbon due to the reduced carbon dioxide emissions. The effects of temperatures and methane additions on the nickel recovery and nickel grade were investigated. High recoveries of over 95 % were predicted, but the grades were limited to about 2.5 % due to the formation of magnetite. The thermodynamic simulations for reduction by methane were in agreement with the experimental results in the literature for other reducing agents, reflecting the fact that the nickel oxide in the limonitic ore is relatively unstable. Thus, high recoveries could be achieved irrespective of the reducing agent involved.
Multi-Terminal High Voltage Direct Current Transmission System with DC Resonant Semiconductor Breakers
Authors: Kinjo Ryota , Matayoshi Hidehito , Ludin Gul Ahmad , Howlader Abdul Motin , Urasaki Naomitsu , Senjyu Tomonobu
Published: February 2018

In consideration of the natural environment and depletion of energy resources, the widespread use of electric power system is expected in which the power is generated from sources of renewables such as wind and solar. When these plants are introduced in large scale, the use of broad land is required. Due to low transmission losses and small stability problems, multi-terminal high voltage direct current (MTDC) transmission becomes advantageous as long-distance power transmission system. Since DC current does not incorporate a zero cross point, therefore it’s blocking is difficult. This paper proposes a DC resonant semiconductor breaker which enables rapid fault clearance for self-excited HVDC transmission. This circuit breaker is connected as a semiconductor switch, in parallel with a group of capacitors, and resistors in the DC transmission line. The capacitor is charged to a higher voltage from the DC transmission line. For generating reverse current to allow the zero cross point in the transmission line, the semiconductor switch turns on to open the circuit breaker. After blocking, the inductance of the line is demagnetized by the resistor and fault clearing is achieved. The system except fault point can continue its normal operation.
Spline approximation, Part 1: Basic methodology
Authors: Ezhov Nikolaj , Neitzel Frank , Petrovic Svetozar
Published: February 2018

In engineering geodesy point clouds derived from terrestrial laser scanning or from photogrammetric approaches are almost never used as final results. For further processing and analysis a curve or surface approximation with a continuous mathematical function is required. In this paper the approximation of 2D curves by means of splines is treated. Splines offer quite flexible and elegant solutions for interpolation or approximation of “irregularly” distributed data. Depending on the problem they can be expressed as a function or as a set of equations that depend on some parameter. Many different types of splines can be used for spline approximation and all of them have certain advantages and disadvantages depending on the approximation problem. In a series of three articles spline approximation is presented from a geodetic point of view. In this paper (Part 1) the basic methodology of spline approximation is demonstrated using splines constructed from ordinary polynomials and splines constructed from truncated polynomials. In the forthcoming Part 2 the notion of B-spline will be explained in a unique way, namely by using the concept of convex combinations. The numerical stability of all spline approximation approaches as well as the utilization of splines for deformation detection will be investigated on numerical examples in Part 3.
Social Media and Crisis Communications: A Survey of Local Governments in Florida
Authors: Neely Stephen R. , Collins Matthew
Published: February 2018

Social media platforms are increasingly being used by public agencies and emergency managers to communicate with the public in times of crisis. However, while the adoption of these technologies has been well documented at the federal level, little is known empirically about the extent to which social media are being utilized for emergency management communications by local agencies, and less still is known about how rates of adoption vary based on the organizational and demographic characteristics of local municipalities. This exploratory study provides an empirical analysis of social media use by local municipalities in the State of Florida and examines the organizational and demographic factors related to social media adoption for emergency and crisis communications. The study suggests that social media are still underutilized by local agencies in many regards. Findings also indicate that larger municipalities which serve younger, more highly educated populations are more likely to adopt social media for crisis communications, while agencies representing traditionally under-served populations are less likely to utilize social media for these same purposes. The implications of these findings are discussed, particularly the role of higher education in preparing public administrators and emergency managers for careers in a networked society.
Approaches mothers of first graders use to deal with perceived reading difficulties
Authors: Sedláčková Jana
Published: February 2018

This study aims to enhance our understanding of how mothers of first graders cope with the perceived reading difficulties of their children. Their different perceptions stem from the reading aspirations the mothers have for their children. The study uses data obtained from in-depth semi-structured interviews with 10 mothers, conducted at the end of the second half of the 2015/2016 school year. The data analysis revealed that the differences in the mothers’ perceptions of their children’s reading difficulties are reflected in a wide variety of micro-actions aimed at solving them. Three different approaches can be identified: a)inspector mothers, who are most concerned about their child’s reading errors and their primary focus is on operationally correcting these errors; b)promoter mothers, who are primarily worried about their child’s potential or existing lack of interest in reading and who manage all reading activities so as to motivate the child (or prevent demotivation), e.g., through turn-taking in reading or in ensuring a regular supply of books; c)educator mothers, who fear most that their child will not understand the text and who show willingness and enthusiasm in explaining and creating various opportunities for reading literacy development, both as part of homework activities and leisure reading. They also engage in holistic attempts to prevent reading failures, and motivate their children to read through the act of reading. The conclusions of the study are explained in the context of self-determination theory and a discussion of the impact of parents’ socioeconomic status on their involvement or engagement in their children’s education.
Primary teachers go beyond the Slovak civic education curriculum
Authors: Danišková Zuzana , Lukšík Ivan
Published: February 2018

A number of studies have pointed to the low level of civic participation among young people. On the other hand, there is a section of the youth population that is politically involved in and supportive of extremist and anti-system political movements. Public discussions have suggested that this may be linked to inadequacies in citizenship education. However, as the Slovak case shows, the causes of this are deeper, have historic roots and are reflected in the fact that citizenship education has been pushed to the margins of the curriculum and is narrowly interpreted. Citizenship education is not just about the nature of the curriculum but also about broader extra-curricular activities and about the direct, or implicit, instruction provided by teachers. The empirical research presented here shows that primary school teachers go beyond the narrow framework of the national social studies syllabus and implicitly teach citizenship education in line with their own civic orientations.
On the fine Simpson moduli spaces of 1-dimensional sheaves supported on plane quartics
Authors: Iena Oleksandr
Published: February 2018

A parametrization of the fine Simpson moduli spaces of 1-dimensional sheaves supported on plane quartics is given: we describe the gluing of the Brill-Noether loci described by Drézet and Maican, provide a common parameter space for these loci, and show that the Simpson moduli space M = M
4m ± 1(ℙ2) is a blow-down of a blow-up of a projective bundle over a smooth moduli space of Kronecker modules. Two different proofs of this statement are given.
Evaluation of integrals with hypergeometric and logarithmic functions
Authors: Sofo Anthony
Published: February 2018

We provide an explicit analytical representation for a number of logarithmic integrals in terms of the Lerch transcendent function and other special functions. The integrals in question will be associated with both alternating harmonic numbers and harmonic numbers with positive terms. A few examples of integrals will be given an identity in terms of some special functions including the Riemann zeta function. In general none of these integrals can be solved by any currently available mathematical package.
Pattern of alcohol consumption by young people from North Eastern Portugal
Authors: Gonçalves Isabel Amorim , Carvalho Amâncio António de Sousa
Published: February 2018

Alcohol is the most used psychoactive substance among adolescents, is an important public health problem and a major risk factor for the health of this group. This study is regarding to the pattern of alcohol consumption by adolescents. Descriptive, correlational and cross-sectional study, with a sample of 378 adolescents, which are attending three high schools, in north-eastern Portugal. In the data collection we used a questionnaire. Data was analysed using SPSS. The prevalence of alcohol is 86.8%. The mean score of Alcohol Use Disorders Identification Test (AUDIT) was 3.53±4.525 points. The vast majority of participants were located in the non-excessive alcohol consumption area (91.3%). The pattern of alcohol consumption differs significantly between gender (Wald: p ≤ 0,004) and the religious practice (Wald: p ≤ 0,027), with greater percentage of boys and students who did not practice any religion in excessive consumers. The prevalence of alcohol consumers is high. The proportion of young people with excessive consumption in our sample is lower than in other studies, but shows that there is a group of adolescents in excessive consumption. It found a relationship between consumption pattern, gender and religious practice. These results justify the development of public health interventions.
Structure and optical properties of TiO2 thin films deposited by ALD method
Authors: Szindler Marek , Szindler Magdalena M. , Boryło Paulina , Jung Tymoteusz
Published: February 2018

This paper presents the results of study on titanium dioxide thin films prepared by atomic layer deposition method on a silicon substrate. The changes of surface morphology have been observed in topographic images performed with the atomic force microscope (AFM) and scanning electron microscope (SEM). Obtained roughness parameters have been calculated with XEI Park Systems software. Qualitative studies of chemical composition were also performed using the energy dispersive spectrometer (EDS). The structure of titanium dioxide was investigated by X-ray crystallography. A variety of crystalline TiO2 was also confirmed by using the Raman spectrometer. The optical reflection spectra have been measured with UV-Vis spectrophotometry.
Exercise-induced hypoalgesia in women with varying levels of menstrual pain
Authors: Travers Mervyn , Moss Penny , Gibson William , Hince Dana , Yorke Sheree , Chung Connie , Langford Rebecca , Tan Esther Ee Woon , Ng Jolene , Palsson Thorvaldur Skuli
Published: February 2018

Background and aims:

Exercise-induced hypoalgesia (EIH) is a well-established phenomenon in pain-free individuals that describes a decrease in pain sensitivity after an acute bout of exercise. The EIH response has been demonstrated to be sub-optimal in the presence of persisting pain. Menstrual pain is a common recurrent painful problem with many women experiencing high levels of pain each cycle. However, the EIH response has not been examined in a cohort of women with high levels of menstrual pain. This research aimed to examine whether EIH manifests differently in women with varying levels of menstrual pain. The primary hypothesis was that women with high levels of menstrual pain would demonstrate compromised EIH. Secondary aims were to explore relationships between EIH and emotional state, sleep quality, body mass index (BMI) or physical activity levels.

Methods:

Pressure pain thresholds (PPT) were measured in 64 participants using a digital handheld algometer before and after a submaximal isometric-handgrip exercise. EIH index was compared between low (VAS 0–3), moderate (VAS 4–7) and high (VAS 8–10) pain groups, using a linear mixed model analysis with participant as a random effect, and site, menstrual pain category and the interaction between the two, as fixed effects.

Results:

EIH was consistently induced in all groups. However, there was no statistically significant difference between the pain groups for EIH index (p=0.835) or for any co-variates (p>0.05).

Conclusions:

EIH was not found to differ between women who report regular low, moderate or high levels of menstrual pain, when measured at a point in their menstrual cycle when they are pain free.

Implications:

This study provides insight that EIH does not vary in women with differing levels of menstrual pain when they are not currently experiencing pain. The current findings indicate that, although menstrual pain can involve regular episodes of high pain levels, it may not be associated with the same central nervous system dysfunctions as seen in sustained chronic pain conditions.
Automatic detection of fused tungsten carbides for the characterization of welding process
Authors: Rosenberger Maik , Zhang Chen , Günther Karsten , Bergmann Jean P. , Notni Gunther
Published: February 2018

This paper represents an imaged-based method for the quantitative characterization of the dissolution behaviour of fused
tungsten carbide in the welding process. For the metallographic investigations based on microscopic images, a hybrid image
segmentation procedure for the detection of hard phases is proposed to quantify their amount and distribution in the
matrix material. With the help of this tool, the dependence of hard phase characteristic on the welding parameters was
investigated.
The alkaline earth-palladium-germanides Sr3Pd4Ge4 and BaPdGe
Authors: Stein Sebastian , Matar Samir F. , Schmolke Kai Heinz , Kösters Jutta , Pöttgen Rainer
Published: February 2018

The germanides Sr3Pd4Ge4 and BaPdGe were obtained from high-temperature reactions in sealed niobium ampoules and their structures have been determined from single-crystal X-ray diffraction data: a=444.2(1), b=438.1(1), c=2472.2(7) pm, space group Immm, U3Ni4Si4 type, wR2=0.0471, 576 unique reflections, 25 parameters for Sr3Pd4Ge4 and a=677.09(8), space group P213, LaIrSi type, wR2=0.0322, 409 unique reflections, nine parameters for BaPdGe. Both germanides have pronounced three-dimensional [Pd4Ge4]
δ− and [PdGe]
δ− polyanionic networks with Pd–Ge bonding interactions. This is confirmed by the density functional theory (DFT)-based electronic structure investigations, the trends of charge transfer and crystal orbital overlap population (COOP) analyses.
Single-Leg Roman Chair Hold Is More Effective Than the Nordic Hamstring Curl in Improving Hamstring Strength-Endurance in Gaelic Footballers With Previous Hamstring Injury
Authors: Macdonald Ben , O'Neill John , Pollock Noel , Van Hooren Bas
Published: February 2018

Macdonald, B, O'Neill, J, Pollock, N, and Van Hooren, B. Single-leg Roman chair hold is more effective than the Nordic hamstring curl in improving hamstring strength-endurance in Gaelic footballers with previous hamstring injury. J Strength Cond Res 33(12): 3302–3308, 2019—Poor hamstring strength-endurance is a risk factor for hamstring injuries. This study investigated the effectiveness of the single-leg Roman hold and Nordic hamstring curl in improving hamstring strength-endurance. Twelve Gaelic footballers (mean ± SD age, height, and mass were 25.17 ± 3.46 years, 179.25 ± 5.88 cm, 85.75 ± 4.75 kg, respectively) with a history of hamstring injury were randomized into 2 groups that performed 6 weeks of either Nordic hamstring curl or single-leg Roman chair hold training. The single-leg hamstring bridge (SLHB) was measured before and after intervention. The Roman chair group showed a very likely moderate magnitude improvement on SLHB performance for both legs (23.7% for the previously injured leg [90% confidence interval 9.6–39.6%] and 16.9% for the noninjured leg [6.2–28.8%]). The Nordic curl group showed a likely trivial change in SLHB performance for the noninjured leg (−2.1% [−6.7 to 2.6%]) and an unclear, but possibly trivial change for the previously injured leg (0.3% [−5.6 to 6.6%]). The Roman chair group improved very likely more with a moderate magnitude in both the noninjured (19.5% [8.0–32.2%]) and the previously injured leg (23.3% [8.5–40.0%]) compared with the Nordic curl group. This study demonstrated that 6-week single-leg Roman chair training substantially improved SLHB performance, suggesting that it may be an efficacious strategy to mitigate hamstring (re-) injury risk. Conversely, 6-week Nordic curl training did not substantially improve SLHB performance, suggesting this may not be the intervention of choice for modifying this risk factor.
Evaluating Physical Workload by Position During Match in Elite Bandy
Authors: Blomqvist Sven , Ervasti Per-Eric , Elcadi Guilherme H.
Published: February 2018

Blomqvist, S, Ervasti, PE, and Elcadi, GH. Evaluating physical workload by position during match in elite bandy. J Strength Cond Res 32(9): 2616–2622, 2018—To improve current understandings of physical workload (WL) in elite bandy, 10 bandy players were monitored for heart rate (HR) during 13 matches over 1 championship season. Participants were divided into 5 subgroups according to playing position—libero, defender, halves, midfielder, and forward. Heart rate measurements were analyzed with 2 different methods to compute physical WL—(a) percentage of total time spent in different HR zones (HRres) and (b) WL based on the Edwards method. Also determined was the time spent at HR levels above the lactate threshold (LT). A one-way analysis of variance was used for analysis. For WL, according to the Edwards method, significant differences (p = 0.05) were shown between the groups with defenders presenting the highest scores, and forwards and liberos the lowest. A significant difference (p = 0.05) was found between liberos and halves and the other positions as to how much time they spent in zone 70–80% of HRres. In 91–100% of HRres, there was a distinct difference between defenders and the other positions and also forwards differed significantly from liberos, defenders, and halves (p = 0.05). The libero spent only 1% of the time over the LT, whereas the midfielder spent approximately 27% of the time over the LT. Overall, defenders showed the greatest WL during a match and liberos the lowest. The practical implications of these findings can help coaches and trainers design training methods specific to each position and individualized training sessions for each player in elite bandy.
Maternal and Early Postnatal Immune Activation Produce Dissociable Effects on Neurotransmission in mPFC–Amygdala Circuits
Authors: Li Yan , Missig Galen , Finger Beate C. , Landino Samantha M. , Alexander Abigail J. , Mokler Emery L. , Robbins James O. , Manasian Yunona , Kim Woori , Kim Kwang-Soo , McDougle Christopher J. , Carlezon William A. , Bolshakov Vadim Y.
Published: February 2018

Inflammatory processes may be involved in the pathophysiology of neuropsychiatric illnesses including autism spectrum disorder (ASD). Evidence from studies in rodents indicates that immune activation during early development can produce core features of ASD (social interaction deficits, dysregulation of communication, increases in stereotyped behaviors, and anxiety), although the neural mechanisms of these effects are not thoroughly understood. We treated timed-pregnant mice with polyinosinic:polycytidylic acid (Poly I:C), which simulates a viral infection, or vehicle on gestational day 12.5 to produce maternal immune activation (MIA). Male offspring received either vehicle or lipopolysaccharide, which simulates a bacterial infection, on postnatal day 9 to produce postnatal immune activation (PIA). We then used optogenetics to address the possibility that early developmental immune activation causes persistent alterations in the flow of signals within the mPFC to basolateral amygdala (BLA) pathway, a circuit implicated in ASD. We found that our MIA regimen produced increases in synaptic strength in glutamatergic projections from the mPFC to the BLA. In contrast, our PIA regimen produced decreases in feedforward GABAergic inhibitory postsynaptic responses resulting from activation of local circuit interneurons in the BLA by mPFC-originating fibers. Both effects were seen together when the regimens were combined. Changes in the balance between excitation and inhibition were differentially translated into the modified spike output of BLA neurons. Our findings raise the possibility that prenatal and postnatal immune activation may affect different cellular targets within brain circuits that regulate some of the core behavioral signs of conditions such as ASD.

SIGNIFICANCE STATEMENTImmune system activation during prenatal and early postnatal development may contribute to the development of autism spectrum disorder (ASD). Combining optogenetic approaches and behavioral assays that reflect core features of ASD (anxiety, decreased social interactions), we uncovered mechanisms by which the ASD-associated behavioral impairments induced by immune activation could be mediated at the level of interactions within brain circuits implicated in control of emotion and motivation (mPFC and BLA, specifically). Here, we present evidence that prenatal and postnatal immune activation can have different cellular targets in the brain, providing support to the notion that the etiology of ASD may be linked to the excitation/inhibition imbalance in the brain affecting the signal flow within relevant behavior-driving neural microcircuits.
Combination immune checkpoint inhibitor therapy nivolumab and ipilimumab associated with multiple endocrinopathies
Authors: Gunawan Florence , George Elizabeth , Roberts Adam
Published: February 2018

Immune checkpoint inhibitors are the mainstay of treatment for advanced melanoma, and their use is being increasingly implicated in the development of autoimmune endocrinopathies. We present a case of a 52-year-old man with metastatic melanoma on combination nivolumab and ipilumimab therapy who developed concurrent hypophysitis, type 1 diabetes mellitus (T1DM) and diabetes insipidus. He presented prior to third cycle of combination treatment with a headache, myalgias and fatigue. Biochemistry and MRI pituitary confirmed anterior pituitary dysfunction with a TSH: 0.02 mU/L (0.5–5.5 mU/L), fT4: 5.2 pmol/L (11–22 pmol/L), fT3: 4.0 pmol/L (3.2–6.4 pmol/L), cortisol (12:00 h): <9 nmol/L (74–286 nmol/L), FSH: 0.7 IU/L (1.5–9.7 IU/L), LH: <0.1 IU/L (1.8–9.2 IU/L), PRL: 1 mIU/L (90–400 mIU/L), SHBG: 34 nmol/L (19–764 nmol/L) and total testosterone: <0.4 nmol/L (9.9–27.8 nmol/L). High-dose dexamethasone (8 mg) was administered followed by hydrocortisone, thyroxine and topical testosterone replacement. Two weeks post administration of the third cycle, he became unwell with lethargy, weight loss and nocturia. Central diabetes insipidus was diagnosed on the basis of symptoms and sodium of 149 mmol/L (135–145 mmol/L). Desmopressin nasal spray was instituted with symptom resolution and normalization of serum sodium. Three weeks later, he presented again polyuric and polydipsic. His capillary glucose was 20.8 mmol/L (ketones of 2.4 mmol), low C-peptide 0.05 nmol/L (0.4–1.5 nmol/L) and HbA1c of 7.7%. T1DM was suspected, and he was commenced on an insulin infusion with rapid symptom resolution. Insulin antibodies glutamic acid decarboxylase (GAD), insulin antibody-2 (IA-2) and zinc transporter-8 (ZnT8) were negative. A follow-up MRI pituitary revealed findings consistent with recovering autoimmune hypophysitis. Immunotherapy was discontinued based on the extent of these autoimmune endocrinopathies.

Learning points:

The most effective regime for treatment of metastatic melanoma is combination immunotherapy with nivolumab and ipilumimab, and this therapy is associated with a high incidence of autoimmune endocrinopathies.

Given the high prevalence of immune-related adverse events, the threshold for functional testing should be low.

Traditional antibody testing may not be reliable to identify early-onset endocrinopathy.

Routine screening pathways have yet to be adequately validated through clinical trials.
El desarrollo del sector asegurador y el crecimiento económico: un análisis empírico para 47 países
Authors: Sabater Castro Anelena
Published: February 2018

Este estudio examina el efecto del desarrollo del mercado asegurador –tanto del segmento de vida como de no vida[1]– sobre el crecimiento económico, así como las condiciones (grado de desarrollo financiero, nivel de ingresos y entorno institucional) que afectan el nexo de ambas variables. Para ello se utiliza el método generalizado de momentos (GMM), con un modelo dinámico de datos de panel para 47 países, entre 1990 y 2014. Los resultados revelan que existe un impacto positivo del desarrollo del mercado de seguros sobre el crecimiento económico. Además, la relación entre el desarrollo del mercado asegurador y el crecimiento económico se ve aminorada en un entorno institucional relativamente más sólido. Por otra parte, los resultados sugieren que el impacto positivo del desarrollo del mercado de seguros en el crecimiento económico se mitiga en los países de ingresos altos.[1] Existen dos grandes categorías de seguros: vida y no vida. Los seguros de vida se caracterizan porque el pago de la cantidad pactada (suma asegurada) depende del fallecimiento o supervivencia del asegurado. Los seguros generales o de no vida cubren riesgos que puedan ocasionar daños a los bienes o derechos del asegurado, etc.
Cost-Effectiveness of Supplemental Donor Milk Versus Formula for Very Low Birth Weight Infants
Authors: Trang Susan , Zupancic John A.F. , Unger Sharon , Kiss Alex , Bando Nicole , Wong Sabrina , Gibbins Sharyn , O’Connor Deborah L. ,   on behalf of the GTA DoMINO Feeding Group
Published: February 2018

OBJECTIVES:

To determine the cost-effectiveness of supplemental donor human milk (DHM) versus preterm formula (PTF) for very low birth weight (VLBW, <1500 g) infants from a societal perspective to 18 months’ corrected age.

METHODS:

This prospective cost-effectiveness analysis of 363 VLBW infants was conducted for a randomized control trial. Infants recruited from October 2010 to December 2012 were fed DHM or PTF whenever mother’s milk was unavailable. Formal health care costs for initial hospitalization and readmissions were obtained from standardized cost-accounting systems and physician fees. Informal and nonhealth care sector costs (eg, caregiver transportation, labor market earnings) were calculated from parent reports.

RESULTS:

Mean infant birth weight was 996 (SD, 272) grams. Incidence of necrotizing enterocolitis (NEC) differed between groups (all stages 3.9% DHM, 11.0% PTF; P = .01). Costs to 18 months did not differ with a mean (95% confidence interval) of 217 624 (197 697–237 551) and 217 245 (196 494–237 995) 2015 Canadian dollars in the DHM and PTF groups. Postdischarge costs were lower in the DHM (46 440 [40 648–52 233]) than PTF group (55 102 [48 269–61 934]) (P = .04), driven by parent lost wages. DHM cost an additional $5328 per case of averted NEC.

CONCLUSIONS:

In a high mother’s milk use setting, total costs from a societal perspective to 18 months of providing supplemental DHM versus PTF to VLBW infants did not differ, although postdischarge costs were lower in the DHM group. Although supplemental DHM was not cost-saving, it reduced NEC supporting its use over PTF.
Epidemiological situation of measles in Romania, Italy, and Hungary: On what threats should we focus nowadays?
Authors: Orosz László , Gáspár Gábor , Rózsa Ágnes , Rákos Nóra , Sziveri Szilárd , Bosnyákovits Tünde
Published: February 2018

Although the prevalence of wild-type measles virus infection has decreased by >90% in Europe, the disease is still not eliminated and has even reemerged with recurrent outbreaks in different countries, including Romania and Italy. Minor outbreaks of Romanian origin were reported from Hungary as well. In Romania, an outbreak has been ongoing since February 2016. As of October 2017, 9,670 measles cases and 35 deaths were registered in the country. The three most affected counties are located next to the Hungarian border. In Italy, until the end of August 2017, 4,477 cases were reported to the surveillance system. The outbreak affected most of the Italian administrative regions. Until October 2017, three minor measles outbreaks were also detected in Hungary. All of these outbreaks were derived from Romanian cases. Although in these countries, there are vaccination programs running, the spread of the disease raises the possibility of secondary vaccine failure.
Relation to intramuscular connective tissue properties to CT-values in longissimus thoracis muscle of Hungarian simmental cattle
Authors: Holló G. , Húth B. , Egri E. , Holló I. , Anton I.
Published: February 2018

Intramuscular connective tissue plays an important role in determining meat tenderness. The objective of the research was to compare the collagen/hydroxyproline content and X-ray Computed Tomographic (CT) connective tissue proportion of longissimus thoracis (LT) muscle in Hungarian Simmental bulls and cows. Animals (n=24) were slaughtered at similar live weight (bulls: 530.6+44.7 kg, cows: 527.3+53.5 kg) under standard commercial conditions in Hungary. After 24 h chilling, LT samples were taken from the right half carcass at the 12th rib. CT examinations were carried out with a 16-slice CT system (slice thickness: 5 mm). Samples were scanned at different user-selectable tube voltages e.g. low: 80 kV and high: 140 kV. CT value at LT muscle area of each mixed scan (80 and 140 kV) was determined. Volumetric connective tissue content was measured (above 200 CT value) as well. Following CT, the hydroxyproline/collagen content and intramuscular fat content of LT were determined. Cows had lower carcass weight (247 kg vs 295 kg), EU conformation score (3.5 vs 5.5), and fatness score (4.2 vs 5.9) than bulls (P<0.01). Bulls had higher LT area, but intramuscular fat content was similar for bulls (2.8±1.9) and cows (2.7±2.0). On the other hand, bulls had lower CT intramuscular connective tissue proportion in LT compared to cows (0.4±0.2% vs 0.7±0.3% P<0.01). The same tendency could be observed for the collagen content (0.5±0.2% vs 0.7±0.1% P<0.01). Correlation between the CT connective tissue proportion of LT and collagen content was r=0.8 (P=0.000). There was a weak positive correlation between slaughter age and CT connective tissue as well as collagen content of LT (r=0.3–0.4, P<0.05). In conclusion, intramuscular connective tissue proportion in LT increased with slaughter age, and older cows had higher collagen and connective tissue proportion than bulls. Mixed CT scans can be used for the analysis of intramuscular connective tissue content.
Lipoxins Regulate the Early Growth Response–1 Network and Reverse Diabetic Kidney Disease
Authors: Brennan Eoin P. , Mohan Muthukumar , McClelland Aaron , Tikellis Christos , Ziemann Mark , Kaspi Antony , Gray Stephen P. , Pickering Raelene , Tan Sih Min , Ali-Shah Syed Tasadaque , Guiry Patrick J. , El-Osta Assam , Jandeleit-Dahm Karin , Cooper Mark E. , Godson Catherine , Kantharidis Phillip
Published: February 2018

Background The failure of spontaneous resolution underlies chronic inflammatory conditions, including microvascular complications of diabetes such as diabetic kidney disease. The identification of endogenously generated molecules that promote the physiologic resolution of inflammation suggests that these bioactions may have therapeutic potential in the context of chronic inflammation. Lipoxins (LXs) are lipid mediators that promote the resolution of inflammation.

Methods We investigated the potential of LXA4 and a synthetic LX analog (Benzo-LXA4) as therapeutics in a murine model of diabetic kidney disease, ApoE−/− mice treated with streptozotocin.

Results Intraperitoneal injection of LXs attenuated the development of diabetes-induced albuminuria, mesangial expansion, and collagen deposition. Notably, LXs administered 10 weeks after disease onset also attenuated established kidney disease, with evidence of preserved kidney function. Kidney transcriptome profiling defined a diabetic signature (725 genes; false discovery rate P≤0.05). Comparison of this murine gene signature with that of human diabetic kidney disease identified shared renal proinflammatory/profibrotic signals (TNF-α, IL-1β, NF-κB). In diabetic mice, we identified 20 and 51 transcripts regulated by LXA4 and Benzo-LXA4, respectively, and pathway analysis identified established (TGF-β1, PDGF, TNF-α, NF-κB) and novel (early growth response–1 [EGR-1]) networks activated in diabetes and regulated by LXs. In cultured human renal epithelial cells, treatment with LXs attenuated TNF-α–driven Egr-1 activation, and Egr-1 depletion prevented cellular responses to TGF-β1 and TNF-α.

Conclusions These data demonstrate that LXs can reverse established diabetic complications and support a therapeutic paradigm to promote the resolution of inflammation.
Therapy for acute/subacute musculoskeletal pain: results of the ATUSA (Analgesic Treatment Using a Systemic Algorithm) observational study
Authors: Karateev A E , Alekseeva L I , Tsurgan A V , Gontarenko N V
Published: February 2018

Aim. To evaluate the efficiency of therapy for acute/subacute musculoskeletal pain (MSP) by applying an individualized pathogenetic approach (an algorithm) elaborated on the basis of Russian experts’ recommendations. Subjects and methods. A total of 262 physicians treating patients with rheumatic diseases participated in the ATUSA (Analgesic Treatment Using a Systemic Algorithm) program. The study enrolled 3,304 patients (54.3% women, 45.7% men; mean age, 48.6±14.3 years) with osteoarthritis, nonspecific back pain (NBP), and rheumatic diseases of periarticular soft tissues, who had experienced MSP. Treatment was performed in accordance with the following algorithm: the first prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (aceclofenac): paracetamol and/or tramadol and a topical NSAID in case of contraindications and muscle relaxants in case of indications. The results of treatment were assessed after 7, 14, and 28 days. The treatment was corrected during each visit; the NSAID was, if necessary, changed; corticosteroids were locally injected; antidepressants or anticonvulsant drugs were used. The investigators assessed dynamic changes in pain using a 0—10 paint intensity numeric rating scale (NRS), the number of patients, in whom MSP was completely relieved, and satisfaction with treatment. Results. The first prescribed medication was oral NSAIDs in 97.5% of the patients and those in combination with a muscle relaxant in 67.6%. By visit 4, MSP decreased from 6.9±1.5 to 2.2±1.3 NRS scores. After 28 days, only 16.2% of patients continued to need analgesics. 88.4% of the patients rated treatment results as good or excellent. NSAID switching was required in 8.1% of cases; local glucocorticosteroid injections were needed in 1.9%; there was a need for the use of an antidepressant or anticonvulsant in 1.5% and for hospitalization in 0.25%. Adverse events were observed in 2.2% of patients. The efficiency of treatment (complete pain relief after 28 days) was influenced by the following factors: NRS diagnosis (OR, 2.24; 95% CI, 1.67 to 3.11), age ≥65 years (OR, 0.72; 95% CI, 0.52 to 0.98), moderate pain (NRS scores of ≤7) at the beginning of the study (OR, 2.63; 95% CI, 1.99 to 3.48), mild/moderate pain (NRS scores of
Equilíbrio corporal, mobilidade e força muscular respiratória de idosas praticantes do método Pilates
Authors: Martinez Jade Almeida Rocha , Da Silva Lívia Regina Gonçalves Carneiro , Ferraz Daniel Dominguez , Neto Mansueto Gomes , Da Silva e Silva Cássio Magalhães , Saquetto Micheli Bernardone
Published: February 2018

INTRODUÇÃO: O Método Pilates é baseado em movimentos do corpo inteiro, respiração, concentração, centralização, precisão e ritmo. Não está claro se a prática desta atividade é superior à manutenção de um estilo de vida ativo. OBJETIVO: Comparar o equilíbrio corporal, a mobilidade e a força muscular respiratória de mulheres idosas praticantes do Método Pilates e idosas ativas. MÉTODOS: Estudo transversal analítico em 22 idosas, sendo 11 praticantes do Método Pilates (PMP) e 11 idosas ativas (IA). As participantes foram classificadas pelo Perfil de Atividade Humana (PAH) e avaliadas por Timed up and Go (TUG), Escala de Equilíbrio de Berg (EEB) e manovacuometria. RESULTADOS: A idade da amostra foi de 69,36 ± 9,49 anos. A média no TUG das PMP foi de 8,06 ± 4,29 segundos, e das IA de 8,28 ± 2,82 (p>0,05). Na EEB, a média do escore pelas PMP foi 54,63 ± 1,91 e pelas IA foi 52,90 ± 4,01 (p>0,05). Quanto à avaliação da força muscular respiratória, também não houve diferença significativa entre os grupos, mas houve diferença nas IA ao comparar os valores reais (PiMáx = 59,00 cmH2O e PeMáx = 54,00 cmH2O), com os preditivos (PiMáx = 77,12 cmH2O e PeMáx = 74,18 cmH2O), com p<0,05. CONCLUSÃO: Manter-se fisicamente ativa ou praticar o Método Pilates parece ter o mesmo efeito sobre o equilíbrio corporal e a mobilidade de mulheres idosas, principalmente entre os 60 e 65 anos. No entanto, idosas que praticam Pilates parecem manter a força muscular respiratória mais adequada à sua idade.
Role of combined exercise on primary dysmenorrhea pain among girls: a quasi-experiment
Authors: Kaur Manpreet , Bains Balwant Singh , Ramachandran Bavaani , Rao Bhamini K.
Published: February 2018

INTRODUCTION: Primary dysmenorrhea is the pain of lower abdominal before and during the menstruation. Primary dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful. OBJECTIVE: The purpose of this study was to investigate effects of selected exercise on primary dysmenorrhea pain among girl. METHODS: Young women aged (21.1±2.0) were included in this study. The intervention with exercises included core strengthening, flexibility, kegel and endurance exercises. The duration of the intervention was eigth weeks, two times per week with duration of 30 minutes per session. Visual Analogue Scale (VAS) was used to measure the intensity of pain. RESULTS: The results show that exercise effects to reduce pain intensity among young women with dysmenorrhea. There was a significant difference in the score for pre-test (M: 6.94, SD: 1.33) and post-test (M: 5.02, SD: 1.15) conditions; t (9.1) = 2.34, p= 0.000. CONCLUSION: This study shows that the mixed exercise of flexibility, core stability and kegle exercise can reduce the primary dysmenorrhea pain among girls.
Avaliação da sinergia abdomino-pélvica durante atividades funcionais em mulheres nulíparas: série de caso
Authors: Pinto Fábia Ribeiro , Saraiva Adriana , Camatti Janine Ribeiro , Luz Cleber Santos
Published: February 2018

INTRODUÇÃO: É relevante compreender que as disfunções do assoalho pélvico (DAP) feminino são condições clínicas que acometem um número crescente de mulheres a cada ano, constituindo um problema de saúde pública. DAP podem ter relação com o desequilíbrio entre a sobrecarga tensional dessa musculatura e a diminuição da capacidade desses músculos em suportar o aumento da pressão nessa região, uma vez que essa musculatura deve se contrair durante qualquer atividade que promova o aumento da pressão intra-abdominal favorecendo a manutenção da continência. OBJETIVO: analisar a presença desta sinergia em três voluntárias descrevendo o comportamento da atividade eletromiográfica de músculos localizados no assoalho pélvico e no abdome durante as atividades funcionais: andar, sentar/levantar, segurar peso, agachar, pular e tossir. MATERIAIS E MÉTODOS: Série de três casos, envolvendo voluntárias jovens universitárias nulíparas, sem queixas miccionais. Foi mensurado o registro da atividade eletromiográfica dos músculos do assoalho pélvico e o grupo muscular formado pelo transverso abdominal e oblíquo interno durante as atividades funcionais, utilizando a eletromiografia de superfície. RESULTADOS: O sinal eletromiográfico aumentou em relação ao repouso durante as atividades funcionais de tossir, pular, agachar, sentar/levantar, segurar peso e andar em ambas as musculaturas analisadas. As maiores atividades eletromiográficas foram observadas durante as atividades de pular e agachar, e as menores ao segurar peso, andar e sentar/levantar. CONCLUSÕES: A partir da coleta eletromiográfica dos músculos transverso abdominal/ oblíquo interno e esfíncter anal externo em três voluntárias nulíparas foi possível observar sinergia destas musculaturas durante as atividades funcionais propostas. Estudos que envolvam grupos maiores de voluntárias, são necessários para podermos afirmar as respostas sobre a sinergia entre esses grupos musculares durante as atividades funcionais.