bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemotherapy-induced acral erythema with involvement of the face and neck
Authors: Ozkol Hatice Uce , Calka Omer , Bulut Gulay
Published: December 2013

Chemotherapy-induced acral erythema (CIAE) is a cutaneous response to diverse chemotherapeutic drug administration. These drugs cause symmetrical and painful erythema of palmoplantar surfaces. Bulla formation, desquamation, and subsequent reepithelialization may occur. Commonly, the lesions slowly resolve over 7–15 days, through desquamation, followed by regeneration of the skin. Here, we described a case of CIAE, with involvement of face and neck in a patient treated for breast cancer using a number of chemotherapeutic agents. Face involvement in CIAE has not been previously reported in the literature.
Changes of c-Myc and DNMT1 mRNA and protein levels in the rat livers induced by dibutyl phthalate treatment
Authors: Urbanek-Olejnik Katarzyna , Liszewska Monika , Winczura Alicja , Kostka Grażyna
Published: December 2013

We investigated the relationship between dibutyl phthalate (DBP)-induced hypomethylation of the c-Myc promoter region (as evident in our early study) and the expression of c-Myc and DNMT1 genes (at messenger RNA (mRNA) and protein level) in the rat liver. Male Wistar rats received DBP in 1, 3, or 14 daily doses of 1800 mg kg−1 body weight. Levels of DNMT1, c-Myc mRNA, and proteins were detected using real-time polymerase chain reaction and Western blot analysis, respectively. Our findings indicate that DBP caused an increase in mRNA levels of c-Myc at all time points. The results showed that protein levels of c-Myc in rat liver also increased significantly by DBP treatment, which were more pronounced at last time point (after 14 doses). Furthermore, overexpression of DNMT1gene have been found after one dose of DBP, which was confirmed at the protein level by Western blot analysis. Reduced levels of DNMT1mRNA and proteins (3 and 14 doses) were coordinated with depletion DNA synthesis (reported previously). Based on our previous results and those presented here, the following conclusion could be drawn: (1) DBP exerted biological activity through epigenetic modulation of c-Myc gene expression; (2) it seems possible that DBP-induced active demethylation of c-Myc gene through mechanism(s) linked to generation of reactive oxygen species by activated c-Myc; and (3) control of DNA replication was not directly dependent on c-Myc transcriptional activity and we attribute this finding to DNMT1gene expression which was tightly coordinated with DNA synthesis.
Predictors of Response to Vagus Nerve Stimulation in Childhood-Onset Medically Refractory Epilepsy
Authors: Arya Ravindra , Greiner Hansel M. , Lewis Amanda , Horn Paul S. , Mangano Francesco T. , Gonsalves Cornelia , Holland Katherine D.
Published: December 2013

This study explored predictors of response to vagus nerve stimulation in childhood-onset epilepsy. This retrospective chart review included all patients with new vagus nerve stimulator insertion between January 1, 2006, and December 31, 2011. Primary outcome was change in seizure frequency classified on the International League Against Epilepsy scale. Overall, 67.4% (95% confidence limits 53.3%-81.6%) of the patients had outcome of class 4 or better, and 4 patients (9.3%, 95% confidence interval 0.5%-18.1%) achieved complete seizure freedom (mean follow-up 3.5 y). Absence of magnetic resonance imaging (MRI) lesion (odds ratio 6.068, 95% confidence interval 1.214-30.329, P = .028) and duration of epilepsy before implantation (odds ratio 1.291, 95% confidence interval 1.015-1.642, P = .038) were found to be statistically significant predictors of good outcome and provided a sufficient fit to the data (area under the receiver operating characteristic curve .80, Hosmer-Lemeshow goodness of fit P = .92). This study provides preliminary evidence that nonlesional patients are significantly more likely to have better outcome with vagus nerve stimulation.
Research on the influence rules of hole type on the quality of sheet embedded cold-pressing joining
Authors: Li Feng , Zhang Xinlong , Yuan Baoguo , Sui Xiaochong
Published: December 2013

The method of embedded cold-pressing joining could achieve the joining of sheets with different thickness and the joining of dissimilar sheets. Besides, it could meet the lightweight request easily. This article expounded the joining mechanism of this method deeply. To expound the joining mechanism of this method, this article has taken aluminum and stainless steel as examples. In addition, numerical stimulation studies of different hole types’ connecting processes had shown that it was easier to reach plastic yield conditions for aluminum and deform it under the same load conditions. The deformation achieved was significantly greater than that for stainless steel. The width increment of the joining parts increased with the increase of the load pressures; however, the thickness changes of the joining parts behaved in an opposite manner. When the pressing volume of the punch reached 2.4 mm, with the width increment of aluminum sheets of the square hole reaching 2.78 mm, which was the maximum width increment, followed by the hexagonal hole, and the round hole being a minimum. Hole type had a small influence on the width of stainless steel sheets. The experimental results of different hole type joining process indicated that compared with round hole and hexagonal hole, the filling of the square hole was relatively difficult. In case of unreasonable process schemes, defects such as “fake joining,” “offset loading” and “hole deformation” would occur. Thus, this article provided a theoretical basis for the scheme establishment and quality control of the embedded cold-pressing joining process.
Switchable dual-port casing treatment scheme for an enhanced turbocharger compressor operating range
Authors: Sun H , Hu L , Zhang J , Hanna D , Krivitzky E , Larosiliere L , Lai M-C , Yang C
Published: December 2013

For both diesel and gasoline internal-combustion engines, stringent emissions regulations and fuel economy requirements have significantly intensified the demand on the turbocharger compressor operating flow range with high efficiency levels. To address these needs, the ongoing research and development effort has been focused on advanced turbocharger technologies for a high efficiency and a wide operating range. In this paper, a research effort is reported to enhance further the classic ported shroud or recirculating casing treatment with the addition of two switchable ports along the impeller shroud, which allows an augmented high-speed choke flow range without sacrificing the surge margin and efficiency. Impeller aerodynamic blade design considerations for exploiting this new dual-port casing treatment concept are discussed. Flow bench test results demonstrate that the underlying concepts of the new dual-port casing treatment implemented with a recently developed advanced centrifugal compressor impeller lead to 12% extra flow capacity at the rated speed over the same compressor with a conventional single-port recirculating casing treatment.
An investigation on the stress–strain relationship of cold-rolled steel sheets used in the automotive industry
Authors: Osma Alev
Published: December 2013

Cold-rolled steels are used in every stage of the automotive industry, from engineering design to manufacturing, and advanced numerical studies of these steels require knowledge of their stress–strain behaviour. Existing stress–strain models for these steels either are only capable of accurate predictions over a limited strain range or are defined by many material parameters and the values of some of these parameters are not available in most of the existing design codes. This study presents an analytical approximation of the stress–strain relationship for cold-rolled steels. For this purpose, tensile tests were conducted with some commercial cold-rolled sheets used in the automotive industry. Data were analysed to construct a robust mathematical model. The residual sum of squares was employed as the common analysing parameter for both linear and non-linear models; residual diagnosis was also applied towards achieving robustness of the model.
Power Anomalies in Testing Mediation
Authors: Kenny David A. , Judd Charles M.
Published: December 2013

Two rather surprising anomalies relating to statistical power occur in testing mediation. First, in a model with no direct effect for which the total effect and indirect effect are identical, the power for the test of the total effect can be dramatically smaller than the power for the test of the indirect effect. Second, when there is a direct effect of a causal variable on the outcome controlling for the mediator, the power of the test of the indirect effect is often considerably greater than the power of the test of the direct effect, even when the two are of the same magnitude. We try to explain the reasons for these anomalies and how they affect practice.
What Does Physical Rotation Reveal About Mental Rotation?
Authors: Gardony Aaron L. , Taylor Holly A. , Brunyé Tad T.
Published: December 2013

In a classic psychological science experiment, Shepard and Metzler (1971) discovered that the time participants took to judge whether two rotated abstract block figures were identical increased monotonically with the figures’ relative angular disparity. They posited that participants rotate mental images to achieve a match and that mental rotation recruits motor processes. This interpretation has become central in the literature, but until now, surprisingly few researchers have compared mental and physical rotation. We had participants rotate virtual Shepard and Metzler figures mentally and physically; response time, accuracy, and real-time rotation data were collected. Results suggest that mental and physical rotation processes overlap and also reveal novel conclusions about physical rotation that have implications for mental rotation. Notably, participants did not rotate figures to achieve a match, but rather until they reached an off-axis canonical difference, and rotational strategies markedly differed for judgments of whether the figures were the same or different.
Point-and-Shoot Memories
Authors: Henkel Linda A.
Published: December 2013

Two studies examined whether photographing objects impacts what is remembered about them. Participants were led on a guided tour of an art museum and were directed to observe some objects and to photograph others. Results showed a photo-taking-impairment effect: If participants took a photo of each object as a whole, they remembered fewer objects and remembered fewer details about the objects and the objects’ locations in the museum than if they instead only observed the objects and did not photograph them. However, when participants zoomed in to photograph a specific part of the object, their subsequent recognition and detail memory was not impaired, and, in fact, memory for features that were not zoomed in on was just as strong as memory for features that were zoomed in on. This finding highlights key differences between people’s memory and the camera’s “memory” and suggests that the additional attentional and cognitive processes engaged by this focused activity can eliminate the photo-taking-impairment effect.
Can ‘the ghetto’ really take over the county? ‘Race’, generation & social change in local football in the UK
Authors: Campbell Paul , Williams John
Published: December 2013

The involvement of people from black and minority ethnic backgrounds in local sports clubs is little used as a route for examining questions of their wider identity politics and exploring the impact of generational change in local sport. This is often because of difficulties involved in conducting qualitative research at the same site over an extended period. In this paper we report on two bouts of intensive ethnographic and interview study spanning a period of almost 20 years at a single African-Caribbean heritage football club in the city of Leicester, in the English east Midlands. Our findings suggest that considerable tensions have emerged over time inside the Meadbrooke Cavaliers club – tensions which threaten the historic cultural meaning of the club as a site for community solidarity, black masculine ‘resistance’ and identity formation. The commodification of local football in England from the early 1990s, signs of black occupational and social mobility and new ‘race’ dynamics for young black men in the city have all combined to reconfigure the role and meaning of the Cavaliers club in the lives of the local black communities which formed and have constituted the club since its founding in 1970.
Help-Seeking Helps
Authors: Wakefield Juliet R. H. , Hopkins Nick , Greenwood Ronni Michelle
Published: December 2013

Seeking help from an outgroup can be difficult, especially when the outgroup is known to stereotype the ingroup negatively and the potential recipient cares strongly about its social image. However, we ask whether even highly identified ingroup members may seek help from a judgmental outgroup if doing so allows them to disconfirm the outgroup’s negative stereotype of the ingroup. We presented participants with one of two negative outgroup stereotypes of their ingroup. One could be disconfirmed through seeking help, the other could not. Study 1 ( n = 43) showed group members were aware of the strategic implications of seeking help for disconfirming these stereotypes. Study 2 ( n = 43) showed high identifiers acted on such strategic knowledge by seeking more help from the outgroup when help-seeking could disconfirm a negative stereotype of their group (than when it could not). Implications for the seeking and acceptance of help are discussed.
Parental Support and Underrepresented Students’ Math/Science Interests
Authors: Garriott Patton O. , Flores Lisa Y. , Prabhakar Brinda , Mazzotta Elizabeth C. , Liskov Alana C. , Shapiro Jaclyn E.
Published: December 2013

Using social cognitive career theory (SCCT), the present study examined the role of parental support and investigative learning experiences (i.e., performance accomplishments, verbal persuasion, vicarious influence, physiological arousal) in the development of math/science interests among high school students of color ( N = 206). Results of structural equation modeling analyses suggested the hypothesized model adequately fit the data. Parental support significantly predicted each learning experience variable, with the exception of physiological arousal. Performance accomplishments were the only learning experience variable that predicted both math/science self-efficacy and math/science outcome expectations. Self-efficacy significantly predicted interests, but did not predict outcome expectations. Furthermore, outcome expectations did not predict interests. Mediation tests indicated that performance accomplishments, vicarious learning, and self-efficacy mediated relationships between contextual and person-cognitive variables. Results are discussed in relation to SCCT and the development of career interests in math/science among underrepresented students.
Prevention of Cataracts by Statins
Authors: Kostis John B. , Dobrzynski Jeanne M.
Published: December 2013

Background:

Current data indicate a persisting concern about possible cataractogenecity of statins.

Objective:

To perform a meta-analysis of studies pertaining to statins and cataract.

Methods:

We identified 363 records by a systematic search of the MedLine, Web of Knowledge, Cochrane database, and ClinicalTrials.gov. After exclusion of duplicates, studies without cataract as an outcome, reviews, and animal or basic science studies, we analyzed 14 studies. Two end points were examined: clinical cataract (requiring extraction or reported by the patient) and lens opacities discovered by slit-lamp examination.

Results:

Using random effects meta-analysis, a statistically significant decrease in cataracts with statins was observed among studies examining clinical cataract (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.71-0.93, P = .0022). Absolute risk reduction was 1.4% ± 0.015%, 95% CI 1.1%-1.7%, P < .0001, corresponding to 71, 95% CI 59-91, number needed to treat. The effect was larger for the harder end point of cataract extraction (OR 0.66, 95% CI 0.61-0.71, P < .0001). Metaregression indicated an increase in benefit with longer duration of statin use with OR varying from 0.54 for a treatment duration of 14 years to 0.95 for a treatment duration of 6 months. Older age was associated with lower benefit (OR 1.03 for persons in their 70s to OR 0.49 for persons in their 40s), and there were no differences by gender. Several sensitivity analyses confirmed the results. Limitations of this analysis include the combination of randomized and observational studies and imprecise ascertainment of exposure and incomplete adjustment for confounders in several observational studies.

Conclusion:

This meta-analysis indicates a clinically relevant protective effect of statins in preventing cataracts. The effect is more pronounced in younger patients and with longer duration of follow-up, while there is no difference by gender.
Marfan Syndrome
Authors: Castellano José M. , Silvay George , Castillo Javier G.
Published: December 2013

Marfan syndrome is a multisystem connective tissue disorder, with primary involvement of the cardiovascular, ocular, and skeletal systems. This autosomal heritable disease is mainly attributable to a defect in the FBN1 gene. Clinical diagnosis of Marfan syndrome has been based on the Ghent criteria since 1996. In 2010, these criteria were updated, and the revised guidelines place more emphasis on aortic root dilation, ectopia lentis, and FBN1 mutation testing in the diagnostic assessment of Marfan syndrome. Among its many different clinical manifestations, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. Recent molecular, surgical, and clinical research has yielded profound new insights into the pathological mechanisms that ultimately lead to tissue degradation and weakening of the aortic wall, which has led to exciting new treatment strategies. Furthermore, with the increasing life expectancy of patients with Marfan syndrome, there has been a subtle shift in the spectrum of medical problems. Consequently, this article focuses on recent advances to highlight their potential impact on future concepts of patient care from a clinical, surgical, and anesthetic perspective.
Smokers run increased risk of developing anti-natalizumab antibodies
Authors: Hedström AK , Alfredsson L , Lundkvist Ryner M , Fogdell-Hahn A , Hillert Jan , Olsson T
Published: December 2013

Background:

Smoking may contribute to the induction of neutralizing antibodies to interferon β-1a.

Objective:

In this study, we aimed to investigate the influence of smoking on the risk of developing antibodies to natalizumab, another biological drug in the treatment of multiple sclerosis.

Methods:

This report is based on 1338 natalizumab-treated multiple sclerosis patients included in either of two Swedish case-control studies in which information on smoking habits was collected. Using logistic regression, patients with different smoking habits were compared regarding risk of developing anti-natalizumab antibodies, by calculating odds ratios with 95% confidence intervals.

Results:

Compared with nonsmokers, the odds ratio of developing anti-natalizumab antibodies was 2.4 (95% CI 1.2–4.4) for patients who smoked at the time of screening, and a significant trend showed higher risk of developing antibodies with higher intensity of smoking. When smoking within two years prior to screening was considered, the odds ratio of developing anti-natalizumab antibodies was 2.7 (1.5–5.1).

Interpretations:

The finding strengthens our hypothesis of the lungs as immune-reactive organs on irritation in relation to autoimmune responses, and may also be of clinical relevance since antibodies against natalizumab abrogate the therapeutic effect of the treatment.
The role of distancing in Werner and Kaplan’s account of symbol formation and beyond
Authors: Müller Ulrich , Yeung Emanuela , Hutchison Sarah Michelle
Published: December 2013

The concept of distancing or polarization plays a central role in Werner and Kaplan’s account of symbol formation. It refers to the process of progressive differentiation and hierarchic integration of the four components constitutive of symbolic activity: addressor, addressee, symbolic vehicle and referent. Specifically, Werner and Kaplan suggest that distancing takes place between person and referent, between person and symbolic vehicle, between symbolic vehicle and referent and between addressor and addressee. We describe the theoretical context and different aspects of the distancing process. Furthermore, we argue that the distancing process identifies central prerequisites of symbolic activity that are largely ignored by contemporary developmental theories. We demonstrate the different aspects of the distancing process in several domains of symbolic development, including words, gestural development and pretend play. Finally, we compare Werner and Kaplan’s concept of distancing to ideas of distancing developed in recent developmental theories.
The spiral: The concept of development after Werner and Kaplan
Authors: Bibace Roger , Kharlamov Nikita A
Published: December 2013

At the core of Heinz Werner’s concept of development is what he called “the genetic principle of spirality:” over the course of ontogenetic development, lower levels, processes, and functions do not disappear, and can even resurface again under specific conditions, normal and pathological. Werner’s work with Bernard Kaplan on symbol formation is a primer on this idea. This paper examines the idea of spirality and develops the notion of dynamic coexistence that can clarify the issue of directionality of development; that is, what is the general trajectory or ground plan that development assumes. Directionality is discussed in terms of the organism-in-environment unfolding over time as the unit of developmental analysis. Thinking on this issue has proceeded from the nature–nurture debates, to recognition of the interaction of external and internal processes, to transactions between the organism and the environment. The idea of dynamic coexistence is developed on this foundation. In the context of Werner and Kaplan’s work, dynamic coexistence represents the syncretic nature of processes and levels of organization: they are neither innately fused nor organized. Instead, the antithesis between fusion and differentiation is resolved only in concrete, context-bound conditions, even as development is generally oriented towards differentiation in maturity. Idiographic science, with its orientation towards generalizing from the unique and its attention to intra-individual variation over time, is discussed as the adequate methodological orientation for Wernerian developmental analysis.
The physiognomic and the geometrical apprehensions of metaphor
Authors: Cornejo Carlos , Olivares Himmbler , Rojas Pablo
Published: December 2013

This article presents the evolution of Heinz Werner’s thought on metaphor from 1919 until Symbol Formation (1963). Early on, he distinguished between the logical and the psychological approach to metaphor, where the former analyzes the conceptual conflation produced by metaphor and the latter centers on the subjective experience of this incongruence. Starting with an inquiry into direct experience, he initially develops the notion of pneuma and later that of physiognomy. In Symbol Formation, Werner and Kaplan (1963) expand this distinction by introducing the concept of physiognomic and geometric properties of language in general. We argue that the holistic-developmental approach is deeply related to the vitalist and romantic traditions of the 19th century. We analyze three theories of metaphor after 1963: conceptual metaphor, semiotic anthropology, and contextual approaches to metaphor. We argue that while the first of these follows the traditional logical–geometrical approach to language, the latter two may better reflect the spirit of Werner and Kaplan.
They married for love but keep it quiet: Same sex partners in Iceland
Authors: Einarsdóttir Anna
Published: December 2013

Iceland is one of a few countries where the recognition of same sex relationships has been practised since the 1990s. This article is based on a mixed method study among civil partners in Iceland and explains why people choose to marry. Whilst the questionnaire data signalled that most people marry for love, love marriages were difficult to explore in the face-to-face interaction, as was the multiple understandings of security. Claiming citizenship rights, in contrast, was generally framed as marrying for the ‘right’ reasons, readily articulated by everyone involved in this study. I argue that this hesitance may partly be explained by the campaign for same sex partnership itself, which promoted security discourses rather than emotional freedom, and consequently hindered the flow of love narratives.
Gender violence revisited: Lessons from violent victimization of transgender identified individuals
Authors: Jauk Daniela
Published: December 2013

Violence against individuals with non-normative gender presentation is an alarming public health problem in the USA. Based on ethnographic research in transgender communities in the American Midwest I demonstrate that the significance of multiple and simultaneous gendered victimization experiences of transgender individuals urges the need to rethink the equation of “gender violence = violence against women.” The findings reveal that: First, violence impedes the quality of transgender lives on a daily basis. Second, violent harassment occurs most if individuals visibly transgress gender norms. Third, the sampled transgender individuals respond to violence in diverse ways: Coping strategies range from resignation, depression, as well as constraints in mobility and gender presentation on one side of the spectrum to active resistance through community building, self-policing, and creative arts on the other.
Interactive patterns of the opening statement in criminal trials: A historical perspective
Authors: Chaemsaithong Krisda
Published: December 2013

This study examines the discursive history and interactive aspects of the opening statement in Anglo-American courts. Informed by the concepts of stance and engagement, the study explicates the process of conceptual interaction which turns the jurors into co-constructors of the discourse, thereby making the opening statement fictively dialogic. Drawing upon 51 opening statements as recorded in Proceedings of the Old Bailey, between 1759 and 1789, the qualitative and quantitative analysis reveals that interactive devices are an integral part of the genre, and that pronouns appear to occur most frequently, followed by the lawyers’ use of attitude markers, questions, and reported discourse, respectively. With these devices, the lawyers are likely to be able to prime the jury into viewing the events and participants in a given direction.
From micro-situational making of agency to multi-level reflection on social relation and structure: The case of Qing Hong Program after ‘5.12’ earthquake of Sichuan, China
Authors: Guo Wei-he , Tsui Ming-sum
Published: December 2013

The tension between social workers’ commitment to values and the effectiveness of their interventions has been often observed and has affected the relationship between research and practice. The evidence-based practice model submits practice to strict positivist scrutiny. It suspends or neglects the value laden in the process of experimental intervention, and argues for seeking justified universal rules or causal-effect relations between variables as the guideline to social work intervention. This invokes strong rebuttals from critical reflective practice. Critical reflective practice within the epistemology of interpretivism highlights multi perspectives from different standpoints and tries to substitute universal rules with contextual consensus as the solution to social problems facing social work. This article borrows practice theory from Giddens and Bourdieu and extended case method from Burawoy to elaborate the debate between evidence-based practice and reflective practice. We reconstruct the reflective practice model, and suggest that social work research and practice should be not only mutually dialogued for the transformation of interaction situations, but also extended to macro structural and institutional factors.
“Aint Justice Wonderful” The Chicago Tribune’s Battle of Midway Story and the Government’s Attempt at an Espionage Act Indictment in 1942
Authors: Sweeney Michael S. , Washburn Patrick S.
Published: December 2013

This monograph examines the government’s only attempt to prosecute a member of the mainstream press, the Chicago Tribune, for an alleged violation of the Espionage Act in World War II stemming from the newspaper’s front-page account of the Battle of Midway. Although other historians have investigated this case, this monograph draws on never-before-seen documents in eleven archives as well as documents released by the Federal Bureau of Investigation (FBI), Justice Department, and Navy in response to Freedom of Information Act requests to provide the fullest account of how the story came to be published and how and why the government decided to seek a grand jury indictment. The prosecution of the Tribune tested the limits of press freedom in wartime, provided an inside look at military censorship and the ethics of war correspondents, and showed the extreme eagerness of President Roosevelt to go after Robert McCormick’s newspaper.
The Crisis of Collage
Authors: Cosenza Julie
Published: December 2013

This performative essay is a collage of personal narratives of family woven together with theories of queer temporalities and crip theory. I juxtapose bits and pieces of performance scripts, papers from graduate seminars, attempts/experiments in performative writing, and other autoethnographic accounts of my families, to explore crises of meanings. My aim is to provide a space for possibilities, for new understandings of time, inheritance, (re)production, family interactions, and privilege. I use chrononormativity, the process of naturalizing dominant notions of time for maximum “productivity,” as a strategic framework to explore intersections of disability and queerness.
Factors affecting surgical results of Wassel type IV thumb duplications
Authors: Patel A. U. C. , Tonkin M. A. , Smith B. J. , Alshehri A. H. , Lawson R. D.
Published: December 2013

The aim of this study is to review the outcomes of Wassel type IV thumb duplications with a minimum of one year follow-up, and to identify any factors that may compromise the quality of results. Forty one patients (42 thumbs) returned for assessment of thumb alignment, metacarpophalangeal joint and interphalangeal joint stability and motion; carpometacarpal joint motion; pinch and grip strengths; and thumb size. The subjective assessment considered thumb shape and contour, scarring, nail deformity and examiner and patient/parent satisfaction. The mean age at surgery was 16 months and the mean follow-up time was 79 months. Metacarpophalangeal joint and interphalangeal joint mal-alignment was present in 56% and 38% of cases, respectively. Interphalangeal ulnar collateral ligament laxity was significant. Metacarpophalangeal joint and interphalangeal joint motion was significantly decreased. Pinch and grip strength measurements were normal. A novel and comprehensive assessment scale is introduced, which revealed results of one (2.5%) excellent, 23 (59%) good, 14 (36%) fair and one (2.5%) poor. We consider that greater attention should be directed to the avoidance of mal-alignment and instability to improve these results.
Nothing Tastes as Good as Thin Feels
Authors: Selby Edward A. , Wonderlich Stephen A. , Crosby Ross D. , Engel Scott G. , Panza Emily , Mitchell James E. , Crow Scott J. , Peterson Carol B. , Le Grange Daniel
Published: December 2013

Positive emotion (PE) has not been well studied in anorexia nervosa. Low positive emotion differentiation (PED), which involves a diminished ability to distinguish between discrete PEs, may contribute to PE dysregulation in anorexia. Specifically, low PED may interact with elevated PE intensity to both motivate and reinforce weight-loss and evaluation behaviors. Using ecological momentary assessment, we examined PE and weight-loss behaviors reported during a 2-week period. As hypothesized, low PED predicted more vomiting, laxative use, exercising, weighing, checking for fat, and restricting. Furthermore, participants with low PED who experienced elevated average PE intensity reported even more frequent behaviors. Within-subjects analyses indicated that for participants with low PED, more weight-loss behaviors at one recording predicted elevated PE at the subsequent recording. Similarly, for participants with low PED, higher momentary PE predicted more subsequent weight-loss behaviors. Thus, low PED in anorexia may reinforce and motivate weight-loss behavior.
Analysis of Low-Field Magnetic Resonance Imaging Scanners for Evaluation of Knee Pathology Based on Arthroscopy
Authors: Lee Christopher S. , Davis Shane M. , McGroder Claire , Stetson William B. , Powell Scott E.
Published: December 2013

Background:

In recent years, few studies have evaluated low-field magnetic resonance imaging (MRI) diagnoses compared with intraoperative findings of the knee.

Purpose:

To determine the accuracy and sensitivity of low-field MRI scanners in diagnosing pathology of the menisci, cruciate ligaments, and osteochondral surfaces.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

MRI examinations without intra-articular contrast were performed on 379 patients for knee pathologies over a 4-year period. The MRI examinations were done using a 0.2-tesla scanner utilizing a dedicated knee coil and read by 1 of 3 board-certified, musculoskeletal fellowship–trained radiologists. Within a mean time of 50 days after MRI, all patients underwent knee arthroscopy performed by 1 of 2 sports fellowship–trained orthopaedic surgeons. Operative notes from the knee arthroscopies were then reviewed by a single independent observer, and the intraoperative findings were compared with the MRI reports.

Results:

For medial meniscus tears, the sensitivity, specificity, positive predictive value, and negative predictive value were 83%, 81%, 89%, and 71%, respectively. For lateral meniscus tears, the values were 51%, 93%, 84%, and 73%, respectively. For anterior cruciate ligament (ACL) tears, the values were 85%, 94%, 69%, and 97%, respectively. For osteochondral lesions, the values were 8%, 99%, 29%, and 94%, respectively. For posterior cruciate ligament (PCL) tears, the specificity and negative predictive value were 99% and 100%, respectively.

Conclusion:

Low-field MRI was an accurate tool for evaluation of medial meniscus and ACL tears. However, within the study population, it is not as effective in diagnosing lateral meniscus tears and showed a poor ability to detect osteochondral lesions. More information is needed to properly assess its ability to diagnose PCL tears.
The hemophilias and their clinical management
Authors: Josephson Neil
Published: December 2013

Outcomes for patients with hemophilia have improved dramatically over the past 50 years. With the increased availability of safe clotting factor concentrates, the primary focus in clinical management is now the prevention of long-term complications, most notably the debilitating hemophilic arthropathy that is associated with severe disease. This article reviews evidence-based approaches for managing both children and adults with hemophilia. Definitive evidence of improved clinical results from primary prophylaxis started in young patients with severe hemophilia A and a minimal bleeding history is presented. Furthermore, recent studies showing benefits for initiating prophylaxis in older adolescents and adults with established joint disease are examined. Inhibitors to factor VIII are the most problematic complication of factor replacement therapy. Patient-specific and treatment-related factors that contribute to the risk of inhibitor formation are discussed and controversies and clinical evidence related to approaches for tolerance induction are reviewed.
Strategies for induction, autologous hematopoietic stem cell transplantation, consolidation, and maintenance for transplantation-eligible multiple myeloma patients
Authors: McCarthy Philip L. , Hahn Theresa
Published: December 2013

There have been major advances in the past decade in the continuum of therapy for transplantation-eligible multiple myeloma patients. For patients requiring therapy, recommended induction treatment consists of triple drug regimens followed by the collection of hematopoietic stem cells. The question of early versus delayed transplantation is under investigation and may identify patients for whom early transplantation is optimal therapy and those for whom it may be delayed. For transplantation-eligible patients, high-dose melphalan remains the standard regimen. After transplantation, consolidation can be considered for patients with less than a complete remission. Maintenance therapy with bortezomib or lenalidomide (or both in very-high-risk patients) is a reasonable option for long-term disease control and improvement in overall survival. Incorporation of new agents into the continuum of multiple myeloma care should result in improved outcomes and long-term disease control.
Key clinical observations after 5-azacytidine and decitabine treatment of myelodysplastic syndromes suggest practical solutions for better outcomes
Authors: Saunthararajah Yogen
Published: December 2013

Clinical experience with 5-azacytidine and decitabine treatment of myelodysplastic syndromes (MDS), complemented by biological and pharmacological studies, has revealed compelling mechanism of action differences compared with traditional myeloid cancer treatment mainstays such as cytarabine. For example, 5-azacytidine and decitabine produce remissions and better overall survival in MDS with high-risk chromosome abnormalities at a surprisingly high rate, consistent with experimental observations that noncytotoxic DNA methyltransferase depletion by 5-azacytidine/decitabine can trigger cell cycle exit independently of p53, thus circumventing a basis for resistance to apoptosis-based DNA-damaging therapy. That responses cut across the chaotic genomic landscape of MDS highlights common threads in disease, such as high expression in myeloblasts of differentiation-driving transcription factors yet paradoxical epigenetic suppression of proliferation-terminating late-differentiation genes. Less toxic regimens (lower dosages but more frequent administration) of 5-azacytidine/decitabine have been more successful, underscoring the importance of preserving functionally normal stem cells, which are rendered more precious by attrition from age, previous cytotoxic treatments, and the disease process and are needed to relieve cytopenias, the cause of morbidity and mortality. Also emphasized is that there can be no therapeutic benefit, regardless of mutation or cytogenetic subtype, if DNA methyltransferase is not depleted by sufficient overlap between intracellular drug half-lives and S-phase entries of malignant cells. Improved understanding of mechanism-of-action differences demands new approaches, from historic (but not scientific) more-is-better and one-size-fits-all empiricism to pharmacodynamic-based designs and combinations directed not solely at suppressing malignant clones, but at improving therapeutic indices.
Focus on the epigenome in the myeloproliferative neoplasms
Authors: Kim Eunhee , Abdel-Wahab Omar
Published: December 2013

The discovery of mutations activating JAK-STAT signaling in the majority of patients with myeloproliferative neoplasms (MPNs) led to identification of tyrosine kinase activation as a predominant mechanism driving MPN pathogenesis. Despite this, the existence of additional genetic events that modify the MPN phenotype, predate JAK2 mutations, and/or contribute to leukemic transformation of MPNs has been suggested. Recently, mutations in several epigenetic modifiers have been described in patients with MPNs, including mutations in ASXL1, DNMT3A, EZH2, IDH1, IDH2, and TET2. Moreover, the mutant JAK2 itself has been shown recently to affect histone posttranslational modifications directly. Here we review the biological and clinical implications of epigenetic alterations in the pathogenesis of MPNs.
Novel clinical trials for pediatric leukemias: lessons learned from genomic analyses
Authors: Biondi Andrea , Cazzaniga Giovanni
Published: December 2013

Acute lymphoblastic leukemia in childhood has shown remarkable improvements in outcome over the past decades. This achievement was the result of better patient risk assessment, intensification of treatment, appropriate use of BM transplantation, and improved supportive therapies. Among risk factors, early response (originally morphologic and today minimal residual disease) has acquired a prominent role. The predictive value of minimal residual disease evaluation as a measurement of in vivo drug resistance opened new perspectives for its use in clinical evaluation to determine a risk-based treatment and as a potential surrogate end point for efficacy. More recently, detailed genomic analyses of childhood acute lymphoblastic leukemia have increased our knowledge in this disease. It is likely that this will lead to further improvement of risk assessment and stratification to targeted therapies. Leukemic subsets defined on the basis of biological mechanisms and driver mutations will be ever smaller. To facilitate continued progress, this new scenario will raise methodological issues in study design and the need for collaboration across large, well-characterized patient populations.
Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective
Authors: Holcomb John B. , Pati Shibani
Published: December 2013

Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the “endotheliopathy of trauma,” or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.
Antiphospholipid syndrome
Authors: Lim Wendy
Published: December 2013

The antiphospholipid syndrome (APS) is defined by venous or arterial thrombosis and/or pregnancy morbidity in patients with persistent presence of antiphospholipid antibodies (aPLs). Catastrophic APS is the most severe form of APS, which is associated with rapid development of microvascular thrombosis resulting in multiorgan failure in patients with aPLs. Patients with APS and catastrophic APS are recognized to have a high risk of recurrent thrombosis that can occur despite anticoagulant therapy. Although antithrombotic therapy remains the mainstay of treatment, bleeding manifestations can complicate management and contribute to increased morbidity. Patients with persistently elevated aPL levels, particularly those who exhibit positive testing for lupus anticoagulant, anticardiolipin antibodies, and anti-β2GPI antibodies (triple positivity), appear to be at increased risk for thrombosis and pregnancy complications, whereas isolated positivity for aPLs appears to be associated with low risk. Recognizing that patients with APS have different thrombotic risk profiles may assist clinicians in assessing the risks and benefits of anticoagulation. The optimal type, intensity, and duration of anticoagulation in the treatment of APS remain controversial, particularly for arterial thrombosis and recurrent thrombosis. Future studies that delineate thrombotic risk in APS and evaluate current and novel anticoagulants as well as nonanticoagulant therapies are required.
The ASH Choosing Wisely® campaign: five hematologic tests and treatments to question
Authors: Hicks Lisa K. , Bering Harriet , Carson Kenneth R. , Kleinerman Judith , Kukreti Vishal , Ma Alice , Mueller Brigitta U. , O'Brien Sarah H. , Pasquini Marcelo , Sarode Ravindra , Solberg Lawrence , Haynes Adam E. , Crowther Mark A.
Published: December 2013

Choosing Wisely® is a medical stewardship and quality improvement initiative led by the American Board of Internal Medicine Foundation in collaboration with leading medical societies in the United States. The ASH is an active participant in the Choosing Wisely® project. Using an iterative process and an evidence-based method, ASH has identified 5 tests and treatments that in some circumstances are not well supported by evidence and which in certain cases involve a risk of adverse events and financial costs with low likelihood of benefit. The ASH Choosing Wisely® recommendations focus on avoiding liberal RBC transfusion, avoiding thrombophilia testing in adults in the setting of transient major thrombosis risk factors, avoiding inferior vena cava filter usage except in specified circumstances, avoiding the use of plasma or prothrombin complex concentrate in the nonemergent reversal of vitamin K antagonists, and limiting routine computed tomography surveillance after curative-intent treatment of non-Hodgkin lymphoma. We recommend that clinicians carefully consider anticipated benefits of the identified tests and treatments before performing them.
Bruton’s tyrosine kinase (BTK) function is important to the development and expansion of chronic lymphocytic leukemia (CLL)
Authors: Woyach Jennifer A. , Bojnik Engin , Ruppert Amy S. , Stefanovski Matthew R. , Goettl Virginia M. , Smucker Kelly A. , Smith Lisa L. , Dubovsky Jason A. , Towns William H. , MacMurray Jessica , Harrington Bonnie K. , Davis Melanie E. , Gobessi Stefania , Laurenti Luca , Chang Betty Y. , Buggy Joseph J. , Efremov Dimitar G. , Byrd John C. , Johnson Amy J.
Published: December 2013

Key Points

Kinase-functional BTK is important in the development and expansion of CLL. Both targeted genetic inactivation of BTK and inhibition of BTK by ibrutinib inhibit the development of CLL in the TCL1 mouse model.