bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies
Authors: Lu Jing , Ting Yuen Ha , Law Kwok Ming , Lau Tze Kin , Leung Tak Yeung
Published: October 2013

Objective: To evaluate the perinatal outcome of monochorionic (MC) multiple pregnancies after selective reduction by radiofrequency ablation (RFA). Methods: A case series of all MC multiple pregnancies with selective reduction by RFA in one single institution was reviewed. Results: Ten consecutive patients with an MC pregnancy (9 pairs of twins and 1 set of triplets) underwent RFA. The median gestational age at the time of the procedure was 15.6 weeks (range, 12.3-19.6). The indications for selective reduction included discordance for fetal anomalies (4 cases), twin reversed arterial perfusion sequence (3 cases), selective intrauterine growth restriction (2 cases) and severe twin-twin transfusion syndrome (1 case). All procedures were technically successful in achieving selective reduction. The overall survival rate of the co-twin was 81.8% (9/11), and the median gestational age at delivery was 35.9 weeks (range, 32.4-38.6). There was one preterm delivery before 34 weeks of gestation (11.1%). Preterm premature rupture of the membranes occurred in 2 patients (20%); however, this was not observed within 4 weeks postoperatively, nor did they deliver before 32 weeks. Conclusions: RFA is a promising technique for selective reduction in complicated MC multiple pregnancies with a high survival rate and low complication rate.
Isoflurane Post-Treatment Ameliorates GMH-Induced Brain Injury in Neonatal Rats
Authors: Leitzke Arthur S. , Rolland William B. , Krafft Paul R. , Lekic Tim , Klebe Damon , Flores Jerry J. , Van Allen Nicole R. , Applegate Richard L. , Zhang John H.
Published: October 2013

Background and Purpose—

This study investigated whether isoflurane ameliorates neurological sequelae after germinal matrix hemorrhage (GMH) through activation of the cytoprotective sphingosine kinase/sphingosine-1-phosphate receptor/Akt pathway.

Methods—

GMH was induced in P7 rat pups by intraparenchymal infusion of bacterial collagenase (0.3 U) into the right hemispheric germinal matrix. GMH animals received 2% isoflurane either once 1 hour after surgery or every 12 hours for 3 days. Isoflurane treatment was then combined with sphingosine-1-phosphate receptor-1/2 antagonist VPC23019 or sphingosine kinase 1/2 antagonist N,N-dimethylsphingosine.

Results—

Brain protein expression of sphingosine kinase-1 and phosphorylated Akt were significantly increased after isoflurane post-treatment, and cleaved caspase-3 was decreased at 24 hours after surgery, which was reversed by the antagonists. Isoflurane significantly reduced posthemorrhagic ventricular dilation and improved motor, but not cognitive, functions in GMH animals 3 weeks after surgery; no improvements were observed after VPC23019 administration.

Conclusions—

Isoflurane post-treatment improved the neurological sequelae after GMH possibly by activation of the sphingosine kinase/Akt pathway.
Male terminalia of Diptera (Insecta): a review of evolutionary trends, homology and phylogenetic implications
Authors: Sinclair Bradley J. , Cumming Jeffrey M. , Brooks Scott E.
Published: October 2013

The male terminalia character system in Diptera is reviewed. The phylogenetic implications of apomorphic changes are traced on published cladograms. New synapomorphies include: anteroventral parameral apodeme for the Tipulomorpha; parameral sheath encompassing desclerotized aedeagus for Neodiptera (exclusive of Axymyiidae); endoaedeagus for Xylophagomorpha + Tabanomorpha. Apystomyiidae are classified as the sister group to the Eremoneura based on four synapomorphies (lateral ejaculatory processes absent, subepandrial sclerite extending from base of hypoproct to phallus, bacilliform sclerites extending to tips of the epandrium and surstyli functionally developed, but not articulated) and lack of eremoneuran synapomorphies (i.e., loss of gonostyli, presence of postgonites and phallic plate). The Diptera sperm pump with a functional ejaculatory apodeme is a possible autapomorphy of Diptera, exclusive of Nymphomyiidae and Deuterophlebiidae. Internal details of the male terminalia ofSylvicolaandMycetobia(Anisopodidae),Hilarimorpha(Hilarimorphidae) andApystomyia(Apystomyiidae) are newly illustrated and homologies of the aedeagus, paramere and sperm pump of the Tipuloidea are clarified.
A new erythroneurine leafhopper genus from China (Hemiptera: Cicadellidae: Typhlocybinae)
Authors: SONG YUE-HUA , LI ZI-ZHONG
Published: October 2013

A new genus of tribe Erythroneurini from China, Laciniata gen. nov. is described and illustrated based on type species L. lijianga sp. nov.
Using Variable-Resolution Meshes to Model Tropical Cyclones in the Community Atmosphere Model
Authors: Zarzycki Colin M. , Jablonowski Christiane , Taylor Mark A.
Published: October 2013

A statically nested, variable-mesh option has recently been introduced into the Community Atmosphere Model’s (CAM's) Spectral Element (SE) dynamical core that has become the default in CAM version 5.3. This paper presents a series of tests of increasing complexity that highlight the use of variable-resolution grids in CAM-SE to improve tropical cyclone representation by dynamically resolving storms without requiring the computational demand of a global high-resolution grid. As a simplified initial test, a dry vortex is advected through grid transition regions in variable-resolution meshes on an irrotational planet with the CAM subgrid parameterization package turned off. Vortex structure and intensity is only affected by grid resolution and no spurious artifacts are observed. CAM-SE model simulations using an idealized tropical cyclone test case on an aquaplanet show no numerical distortion or wave reflection when the cyclone interacts with an abrupt transition region. Using the same test case, the authors demonstrate that a regionally refined mesh with significantly fewer degrees of freedom can produce the same local results as a globally uniform grid. Additionally, the authors discuss a more complex aquaplanet experiment with meridionally varying sea surface temperatures that reproduces a quasi-realistic global climate. Tropical cyclogenesis is facilitated without the need for vortex bogusing in a high-resolution patch embedded within a global grid that is otherwise too coarse to resolve realistic tropical cyclones in CAM.
The Potential for Self-Organizing Maps to Identify Model Error Structures
Authors: Kolczynski Walter C. , Hacker Joshua P.
Published: October 2013

An important aspect of numerical weather model improvement is the identification of deficient areas of the model, particularly deficiencies that are flow dependent or otherwise vary in time or space. Here the authors introduce the use of self-organizing maps (SOMs) and analysis increments from data assimilation to identify model deficiencies. Systematic increments reveal time- and space-dependent systematic errors, while SOMs provide a method for categorizing forecasts or increment patterns. The SOMs can be either used for direct analysis or used to produce composites of other fields. This study uses the forecasts and increments of 2-m temperature and dry column mass perturbation μ over a 4-week period to demonstrate the potential of this technique. Results demonstrate the potential of this technique for identifying spatially varying systematic model errors.
Climate Influences on Meningitis Incidence in Northwest Nigeria
Authors: Abdussalam Auwal F. , Monaghan Andrew J. , Dukić Vanja M. , Hayden Mary H. , Hopson Thomas M. , Leckebusch Gregor C. , Thornes John E.
Published: October 2013

Northwest Nigeria is a region with a high risk of meningitis. In this study, the influence of climate on monthly meningitis incidence was examined. Monthly counts of clinically diagnosed hospital-reported cases of meningitis were collected from three hospitals in northwest Nigeria for the 22-yr period spanning 1990–2011. Generalized additive models and generalized linear models were fitted to aggregated monthly meningitis counts. Explanatory variables included monthly time series of maximum and minimum temperature, humidity, rainfall, wind speed, sunshine, and dustiness from weather stations nearest to the hospitals, and the number of cases in the previous month. The effects of other unobserved seasonally varying climatic and nonclimatic risk factors that may be related to the disease were collectively accounted for as a flexible monthly varying smooth function of time in the generalized additive models, s(t). Results reveal that the most important explanatory climatic variables are the monthly means of daily maximum temperature, relative humidity, and sunshine with no lag; and dustiness with a 1-month lag. Accounting for s(t) in the generalized additive models explains more of the monthly variability of meningitis compared to those generalized linear models that do not account for the unobserved factors that s(t) represents. The skill score statistics of a model version with all explanatory variables lagged by 1 month suggest the potential to predict meningitis cases in northwest Nigeria up to a month in advance to aid decision makers.
Speaking EU defence at home: Contentious discourses and constructive ambiguity
Authors: Rayroux Antoine
Published: October 2013

Using discursive institutionalism as an analytical framework, this article addresses how national actors build, coordinate and communicate discourses on EU defence policy (CSDP) at home. The empirical analysis is based on a comparative study of substantive and interactive discourses in France and Ireland, two contrasted cases. It demonstrates that France and Ireland frame and interpret elements of CSDP that best fit their needs, use them to promote their defence agenda in a legitimate and ‘European’ way and present CSDP as a natural continuation of their preferences. These defence agendas revolve around the preservation of France’s exceptionalism and Ireland’s neutrality. Discursive institutionalism, which methodologically sheds light on agents and institutional contexts, helps to understand the dynamics of constructive ambiguity, a discursive strategy often applied to CSDP and illustrated by these two cases.
A GPU-based discrete event simulation kernel
Authors: Tang Wenjie , Yao Yiping
Published: October 2013

The graphic processing unit (GPU) can perform some large-scale simulations in an economical way. However, harnessing the power of a GPU to discrete event simulation (DES) is difficult because of the mismatch between GPU’s synchronous execution mode and DES’s asynchronous time advance mechanism. In this paper, we present a GPU-based simulation kernel (gDES) to support DES and propose three algorithms to support high efficiency. Since both limited parallelism and redundant synchronization affect the performance of DES based on a GPU, we propose a breadth-expansion conservative time window algorithm to increase the degree of parallelism while retaining the number of synchronizations. By using the expansion method, it can import as many as possible ‘safe’ events. The irregular and dynamic requirement for storing the events leads to uneven and sparse memory usage, thereby causing waste of memory and unnecessary overhead. A memory management algorithm is proposed to store events in a balanced and compact way by using a lightweight stochastic method. When events processed by threads in a warp have different types, the performance of gDES decreases rapidly because of branch divergence. An event redistribution algorithm is proposed by reassigning events of the same type to neighboring threads to reduce the probability of branch divergence. We analyze the superiority of the proposed algorithms and gDES with a series of experiments. Compared to a CPU-based simulator on a multicore platform, the gDES can achieve up to 11×, 5×, and 8× speedup in PHOLD, QUEUING NETWORK, and epidemic simulation, respectively.
Experimental investigation the dynamic pressure attenuation of elastic fabric for compression garment
Authors: Wang Yongrong , Zhang Peihua , Zhang Yiping
Published: October 2013

Compression garments are made of elastic fabric, which is used for operational reasons and clinical applications for treating venous ulceration, deep vein thrombosis or burns. The constant pressure of compression garments exerted on human body is very essential, and the success of the application is extremely dependent on this pressure. However, elastic fabric has a characteristic of hysteresis which contributes to the pressure decay during wearing. In this study, dynamic pressure attenuation is investigated experimentally. Dynamic pressure decreases with the repeated extension and recovery; its pressure attenuation increases as the extension level varied from 10% to 40%. The effects of fabric parameters on dynamic pressure at 1st test cycle and on dynamic pressure attenuation are also analyzed, such as spandex feeding rate and fabric structure. These results provide a better understanding of characteristics of elastic fabric used for making compression garments, and are beneficial for practitioners with scientific developments and for effective applications.
Pulmonary thromboembolism in lung surgery: use of unfractionated heparin
Authors: Yoshida Junichi , Inoue Masaaki , Furugaki Koichi , Oyama Mayumi , Oozono Keigo
Published: October 2013

Background

While thoracic surgeons occasionally encounter pulmonary thromboembolism, the use of unfractionated heparin may cause adverse effects.

Methods

We assessed a series of 323 consecutive pulmonary operations performed during 4 years from 2008 to 2011. All patients were given elastic stockings and intermittent pneumatic compression. During the first 2 years (2008–2009), none of the 169 patients received unfractionated heparin. In the second 2-year period (2010–2011), 135/154 patients received subcutaneous unfractionated heparin, either 5000 units ( n = 37) or 2500 units ( n = 93) twice daily for 3 days, or continuous intravenous unfractionated heparin ( n = 5). The epidural catheters were withdrawn 6 h or more after unfractionated heparin use. Among patients without postoperative unfractionated heparin, 8 (42.1%) had a bleeding risk and 5 (26.3%) had limited operative time.

Results

One (0.6%) patient developed pulmonary thromboembolism during 2008–2009, but none had this complication during 2010–2011. The adverse outcome of intrathoracic bleeding occurred in one (2.7%) of the patients given 5000 units of unfractionated heparin, but no epidural hematomas occurred in these patients.

Conclusion

Patients undergoing thoracic surgery at low risk of bleeding may receive unfractionated heparin to prevent pulmonary thromboembolism while avoiding epidural complications.
Synthesis and characterization of a pH- and enzyme-sensitive poly(ethylene glycol)–hyaluronic acid–melphalan prodrug
Authors: Zhang Xi , Xu Haixing , Newaz Zubad , Zhang Yu , Liu Ming , Huang Zhijun , Liu Hui , Niu Xiaoqian , Wang Jianping , Xu Peihu
Published: October 2013

Prodrug development is an important strategy for improving tumor cell targeting and the selectivity of anticancer drugs. In this study, poly(ethylene glycol) and melphalan, an anticancer drug, were linked to the backbone of hyaluronic acid via amide bonds using carbodiimide chemistry to synthesize a poly(ethylene glycol)–hyaluronic acid–melphalan prodrug. The physicochemical properties of the prodrug were characterized by Fourier transform infrared, proton nuclear magnetic resonance, ultraviolet–visible spectroscopy, and dynamic light scattering and transmission electron microscopy. The in vitro drug release profiles and the corresponding in vitro cell evaluation of the prodrug were investigated. The poly(ethylene glycol)–hyaluronic acid–melphalan prodrug was successfully synthesized and self-assembled into 116.4-nm nanoparticles. The release profiles demonstrated that controlled release of the prodrug could be achieved with a sensitive property involving both pH and enzymatic degradation. The poly(ethylene glycol)–hyaluronic acid–melphalan prodrug was more effectively transferred into the ovarian tumor cell (SKOV3) than into human ovarian fibroblast (HOF) cells. It also had a higher inhibition effect on SKOV3 and a lower inhibition effect on HOF than melphalan. This poly(ethylene glycol)–hyaluronic acid–melphalan prodrug, with its controlled release properties and selectivity, is a promising drug delivery system for cancer therapy.
Preparation and properties of covalently cross-linked sulfonated poly(sulfide sulfone)/polybenzimidazole blend membranes for fuel cell applications
Authors: Yuan Sen , Yan Gengwei , Xia Zijun , Guo Xiaoxia , Fang Jianhua , Yang Xiaohui
Published: October 2013

To improve the radical oxidative stability, a series of covalently cross-linked blend membranes have been prepared from a sulfonated poly(sulfide sulfone) with 80% degree of sulfonation (SPSSF80) and a polybenzimidazole with pendant amino groups (H2N-PBI) using glycidyloxypropyltrimethoxysilane (KH-560) and bisphenol A diglycidyl ether (BADGE) as cross-linkers. The resulting cross-linked membranes show increased tensile strength but slightly decreased elongation at break compared with the plain SPSSF80. The radical oxidative stability of the blend membranes is significantly improved due to the synergic action of the covalent cross-linking and the presence of the PBI component. For example, the cross-linked membrane with the composition of SPSSF80/H2N-PBI/KH-560 = 7/1/3 started to break into pieces after being soaked in Fenton’s reagent for 98 min, which is about 4 times longer than that (20 min) of the plain SPSSF50 (degree of sulfonation = 50%). The covalent cross-linking is also essential to suppress membrane swelling and to enhance membrane water stability. The KH-560-cross-linked blend membranes tend to show higher proton conductivities at low relative humidities than the BADGE-cross-linked one due to the hydrophilic silica network in the former. At fully hydrated state, the cross-linked membranes generally show high proton conductivities comparable with that of Nafion112®.
Instruments Measuring Nursing Staff Competence in Community Health Care
Authors: Bing-Jonsson Pia Cecilie , Bjørk Ida Torunn , Hofoss Dag , Kirkevold Marit , Foss Christina
Published: October 2013

There is currently no review of instruments that measure nursing staff competence in community health care. This study aims to (a) identify competence measurement instruments developed for nursing staff in community health care, and (b) explore conceptual and methodological issues concerning these instruments. A systematic literature search was made for the period 2000-2012. Instruments were evaluated for target group, content, and methodological quality. Of 11 identified instruments, all self-report, only four provided sufficient evidence of instrument validity. Few instruments had conceptualized competence by defining and operationalizing the concept. The evidence of the quality of the instruments varied greatly and was generally not sufficient. This review may help researchers decide which existing competence measurement instrument to use or whether they have to develop a new instrument.
Is OASIS Effective in Predicting Rehospitalization for Home Health Care Elderly Patients?
Authors: Tao Hong , Ellenbecker Carol H.
Published: October 2013

Using the Outcome and Assessment Information Set (OASIS), this study examined the feasibility of using OASIS items to identify direct and indirect factors contributing to rehospitalization among elderly patients receiving home health care. The outcomes revealed that being male, having a median level of cognitive impairment, a lower level of functional ability, and the absence of support, such as environmental support, psychosocial support, or facilitated medical care directly contributed to rehospitalization. While being older, obese, having a poorer clinical status, receiving ADL and/or IADL and less frequent informal care contributed to rehospitalization indirectly through decreased functional ability. Home health care providers may take full advantage of OASIS data, assessing both the direct and indirect factors leading to rehospitalization to identify patients at risk and intervene when needed.
Formative Evaluation
Authors: Henry Gary T. , Smith Adrienne A. , Kershaw David C. , Zulli Rebecca A.
Published: October 2013

Performance-based accountability along with budget tightening has increased pressure on publicly funded organizations to develop and deliver programs that produce meaningful social benefits. As a result, there is increasing need to undertake formative evaluations that estimate preliminary program outcomes and identify promising program components based on their effectiveness during implementation. By combining longitudinal administrative data, multiple comparison group designs, and a progressive series of analyses that test rival explanations, evaluators can strengthen causal arguments and provide actionable program information for key stakeholders to improve program outcomes. In this article, we illustrate the application of rigorous methods to estimate preliminary program effects and rule out alternative explanations for preliminary effects, including site selection bias, individual selection bias, and resentful demoralization through the evaluation of the Collaborative Project, a North Carolina educational improvement project that incorporated multiple components aimed at boosting student achievement.
Characterizing Bicycle Collisions by Neighborhood in a Large Midwestern City
Authors: Chaney Robert A. , Kim Changjoo
Published: October 2013

Introduction. Local environmental factors provide important contributions to bicycle safety. The purpose of this study was to characterize bicycle collisions by neighborhood in Cincinnati, Ohio. Background. The majority of prior bicycle safety research has focused on helmet use, especially among youth. Studies that have considered the neighborhood have centered on the built environment and its facilitation of bicycling (e.g., connectivity of roads and road conditions). Other broad conditions may be associated with injury beyond the use of protective equipment and the physical environment. Method. This study sought to determine spatial clustering, local patterning, temporal differences (time of day and season of year), and significant neighborhood-level predictors of bicycle collisions. Bicycle collision data were obtained from the Cincinnati, Ohio Police Department. Conclusions. This study showed that collisions occur at higher rates in the south-central and southwest neighborhoods of Cincinnati, Ohio. There were seasonal and time-of-day differences with respect to collision rates with summer and afternoon being the most common collision times. Neighborhood ethnicity, population density and presence of public transportation were all significant predictors of bicycle collisions. These findings will be disseminated to local city authorities and bicycle advocacy groups.
Experience Preferred
Authors: Hernandez Kristen E. , Bejarano Sandra , Reyes Francis J. , Chavez Margarita , Mata Holly
Published: October 2013

Universities offering undergraduate degrees in health promotion or health education and/or graduate degrees in public health typically require an internship, practicum, or fieldwork experience. This type of mentored experience is an important aspect of career development for the next generation of public health professionals and benefits not only the students but also the profession and the communities in which they work. This article provides perspectives from four public health professionals who have recently graduated from designated minority-serving institutions and highlights the ways in which internship, practicum, or fieldwork experiences have contributed to their career development. From a career development perspective, internships provide unique opportunities to develop professional networks, practice competencies learned in the classroom, gain experience in different environments, and share lessons learned with others in our field. The diversification of the public health research and practice workforce is increasingly recognized as crucial in building health equity. Internship programs that focus specifically on the academic and professional development of students underrepresented in public health provide experiences that meet or supplement academic requirements, and provide students with real-world experience and an expanded network of mentors and role models.
WikiLeaks
Authors: Sánchez Estop Juan Domingo
Published: October 2013

Wikileaks can safely be considered a revealing experience in testing the limits of power. Julian Assange’s intent is to uncover the roots of power abuse, publicly exposing what is supposed to be the fabric of a hidden authoritarian regime underlying formal democracies. Despite the many—though generally unsurprising—Wikileaks revelations, the whole operation did not have the enormous effects Assange and his supporters anticipated, suggesting that perhaps something was wrong with Assange’s prediction, and the theory underlying it. To be sure, the opposition secrecy vs. transparency was presented in Wikileaks’ founding texts as a contradiction. Wikileaks assumes, first, that one could reach transparency, and second, that transparency, by the mere fact of existing, will be the best guarantee for a democratic power and a free society. This article argues that the main assumption underlying Wikileaks is wrong, since in modern power, transparency and secrecy are much more complementary than contradictory, all the more so when power is conceived of—as Assange himself does—as a reticular structure, a network, or a web. When transparency is not opposed to secrecy anymore, it can become the most refined form of secrecy. In such a regime of truth, whoever tries to get rid of secrecy and promotes transparency, instead of being freed of a “totalitarian regime,” gets entirely entangled in the dialectics of modern power.
Current Concepts of Articular Cartilage Restoration Techniques in the Knee
Authors: Camp Christopher L. , Stuart Michael J. , Krych Aaron J.
Published: October 2013

Context:

Articular cartilage injuries are common in patients presenting to surgeons with primary complaints of knee pain or mechanical symptoms. Treatment options include comprehensive nonoperative management, palliative surgery, joint preservation operations, and arthroplasty.

Evidence Acquisition:

A MEDLINE search on articular cartilage restoration techniques of the knee was conducted to identify outcome studies published from 1993 to 2013. Special emphasis was given to Level 1 and 2 published studies.

Study Design:

Clinical review.

Level of Evidence:

Level 3.

Results:

Current surgical options with documented outcomes in treating chondral injuries in the knee include the following: microfracture, osteochondral autograft transfer, osteochondral allograft transplant, and autologous chondrocyte transplantation. Generally, results are favorable regarding patient satisfaction and return to sport when proper treatment algorithms and surgical techniques are followed, with 52% to 96% of patients demonstrating good to excellent clinical outcomes and 66% to 91% returning to sport at preinjury levels.

Conclusion:

Clinical, functional, and radiographic outcomes may be improved in the majority of patients with articular cartilage restoration surgery; however, some patients may not fully return to their preinjury activity levels postoperatively. In active and athletic patient populations, biological techniques that restore the articular surface may be options that provide symptom relief and return patients to their prior levels of function.
Evaluation and Management of Wolff-Parkinson-White in Athletes
Authors: Rao Ashwin L. , Salerno Jack C. , Asif Irfan M. , Drezner Jonathan A.
Published: October 2013

Context:

Wolff-Parkinson-White (WPW) is a cardiac conduction system disorder characterized by abnormal accessory conduction pathways between the atria and the ventricles. Symptomatic patients classically present with palpitations, presyncope, or syncope that results from supraventricular tachycardia. While rare, sudden cardiac death may be the first manifestation of underlying disease and occurs more frequently in exercising individuals.

Evidence Acquisition:

Medline and PubMed databases were evaluated through 2012, with the following keywords: WPW, Wolff-Parkinson-White, pre-excitation, sudden cardiac death, risk stratification, and athletes. Selected articles identified through the primary search, along with relevant references from those articles, were reviewed for pertinent clinical information regarding the identification, evaluation, risk stratification, and management of WPW as they pertained to the care of athletes.

Study Design:

Systematic review.

Level of Evidence:

Level 1.

Results:

Diagnosis of WPW is confirmed by characteristic electrocardiogram changes, which include a delta wave, short PR interval, and widened QRS complex. Utilization of the electrocardiogram as part of the preparticipation physical evaluation may allow for early identification of asymptomatic individuals with a WPW pattern. Risk stratification techniques identify individuals at risk for malignant arrhythmias who may be candidates for curative therapy through transcatheter ablation.

Conclusion:

WPW accounts for at least 1% of sudden death in athletes and has a prevalence of at least 1 to 4.5 per 1000 children and adults. The risk of lethal arrhythmia appears to be higher in asymptomatic children than in adults, and sudden cardiac death is often the sentinel event. The athlete with WPW should be evaluated for symptoms and the presence of intermittent or persistent pre-excitation, which dictates further consultation, treatment, and monitoring strategies as well as return to play.
DNA prime and peptide boost immunization protocol encoding the Toxoplasma gondii GRA4 induces strong protective immunity in BALB/c mice
Authors: Meng Min , Zhou Aihua , Lu Gang , Wang Lin , Zhao Guanghui , Han Yali , Zhou Huaiyu , Cong Hua , Zhao Qunli , Zhu Xing-Quan , He Shenyi
Published: October 2013

Background

Toxoplasma gondiiis a widespread intracellular parasite, which infects most vertebrate animal hosts and causes zoonotic infection in humans. Vaccine strategy remains a promising method for the prevention and control of toxoplasmosis.T. gondiiGRA4 protein has been identified as a potential candidate for vaccine development. In our study, we evaluated the immune response induced by four different immunization vaccination strategies encoding TgGRA4.

Methods

BALB/c mice were intramuscularly (i.m.) immunized four times according to specific immunization schedules. Generally, mice in experimental groups were immunized with polypeptide, pGRA4, peptide/DNA, or DNA/peptide, and mice in the control groups were injected with PBS or pEGFP. After immunization, the levels of IgG antibodies and cytokine productions were determined by enzyme-linked immunosorbent assays (ELISA). The survival time of mice was also evaluated after challenge infection with the highly virulentT. gondiiRH strain.

Results

The results showed that mice vaccinated with different immunization regimens (polypeptide, pGRA4, peptide/DNA, or DNA/peptide) elicited specific humoral and cellular responses, with high levels of total IgG, IgG2a isotype and gamma interferon (IFN-γ), which suggested a specific Th1 immunity was activated. After lethal challenge, an increased survival time was observed in immunized mice (11.8 ± 4.8 days) compared to the control groups injected with PBS or pEGFP (P < 0.05). Mice injected with PBS or pEGFP died within 8 days, and there was no significant difference in the protection level in two groups (P > 0.05).

Conclusions

These results demonstrated that this DNA prime and peptide boost immunization protocol encoding the TgGRA4 can elicit the highest level of humoral and cellular immune responses compared to other immunized groups, which is a promising approach to increase the efficacy of DNA immunization.
Pulmonary fungus ball caused by Penicillium capsulatum in a patient with type 2 diabetes: a case report
Authors: Chen Min , Houbraken Jos , Pan Weihua , Zhang Chao , Peng Hao , Wu Lihui , Xu Deqiang , Xiao Yiping , Wang Zhilong , Liao Wanqing
Published: October 2013

Background

Following the recent transfer of all accepted species of Penicillium subgenus Biverticillium to Talaromyces (including Talaromyces marneffei, formerly Penicillium marneffei), Penicillium species are becoming increasingly rare causal agents of invasive infections. Herein, we present a report of a type 2 diabetes patient with a fungus ball in the respiratory tract caused by Penicillium capsulatum.

Case presentation

A 56-year-old Chinese female gardener with a 5-year history of type 2 diabetes presented at the Shanghai Changzheng Hospital with fever, a cough producing yellow-white sputum, and fatigue. The therapeutic effect of cefoxitin was poor. An HIV test was negative, but the β-D-glucan test was positive (459.3 pg/ml). Chest radiography revealed a cavitary lesion in the left upper lobe, and a CT scan showed globate cavities with a radiopaque, gravity-dependent ball. The histopathologic features of the tissue after haematoxylin-eosin staining showed septate hyphae. The fungus was isolated from the gravity-dependent ball and identified as Penicillium capsulatum based on the morphological analysis of microscopic and macroscopic features and on ribosomal internal transcribed spacer sequencing. After surgery, the patient was cured with a sequential treatment of fluconazole 400 mg per day for 90 days and caspofungin 70 mg per day for 14 days.

Conclusions

Although the prognosis is often satisfactory, clinicians, mycologists and epidemiologists should be aware of the possibility of infection by this uncommon fungal pathogen in diabetes patients, since it may cause severe invasive infections in immunocompromised hosts such as diabetes and AIDS patients.
Development of a quantitative rapid diagnostic test for multibacillary leprosy using smart phone technology
Authors: Paula Vaz Cardoso Ludimila , Dias Ronaldo Ferreira , Freitas Aline Araújo , Hungria Emerith Mayra , Oliveira Regiane Morillas , Collovati Marco , Reed Steven G , Duthie Malcolm S , Martins Araújo Stefani Mariane
Published: October 2013

Background

Despite efforts to eliminate leprosy as public health problem, delayed diagnosis and disabilities still occur in many countries. Leprosy diagnosis remains based on clinical manifestations and the number of clinicians with expertise in leprosy diagnosis is in decline. We have developed a new immunochromatographic test with the goal of producing a simple and rapid system that can be used, with a minimal amount of training, to provide an objective and consistent diagnosis of multibacillary leprosy.

Methods

The test immobilizes two antigens that have been recognized as excellent candidates for serologic diagnosis (the PGL-I mimetic, ND-O, and LID-1), on a nitrocellulose membrane. This allows the detection of specific IgM and IgG antibodies within 20 minutes of the addition of patient sera. Furthermore, we coupled the NDO-LID® rapid tests with a new cell phone-based test reader platform (Smart Reader®) to provide objective interpretation that was both quantifiable and consistent.

Results

Direct comparison of serologic responses indicated that the rapid test detected a greater proportion of leprosy patients than a lab-based PGL-I ELISA. While positive responses were detected by PGL-I ELISA in 83.3% of multibacillary patients and 15.4% of paucibacillary patients, these numbers were increased to 87% and 21.2%, respectively, when a combination of the NDO-LID® test and Smart Reader® was used. Among multibacillary leprosy the sensitivity of NDO-LID® test assessed by Smart Reader® was 87% (95% CI, 79.2-92.7%) and the specificity was 96.1% (95% CI, 91.7- 98.6%). The positive predictive value and the negative predictive value of NDO-LID® tests were 94% (95% CI, 87.4-97.8%) and 91.4% (95% CI, 85.9-95.2%), respectively.

Conclusion

The widespread provision of rapid diagnostic tests to facilitate the diagnosis or prognosis of multibacillary leprosy could impact on leprosy control programs by aiding early detection, directing appropriate treatment and potentially interrupting Mycobacterium leprae transmission.
The impact on patient health and service outcomes of introducing nurse consultants: a historically matched controlled study
Authors: Lee Diana TF , Choi Kai Chow , Chan Carmen WH , Chair Sek Ying , Chan Dominic , Fung Sylvia YK , Chan Eric LS
Published: October 2013

Background

The position of nurse consultant (NC) was introduced in Hong Kong by the Hospital Authority in January 2009. Seven NCs were appointed in five clinical specialties: diabetes, renal, wound and stoma care, psychiatrics, and continence. This was a pilot to explore the impact of the introduction of NCs on patient health and service outcomes.

Methods

The present paper describes a historically matched controlled study. A total of 280 patients, 140 in each cohort under NC or non-NC care, participated in the study. The patient health and service outcomes of both cohorts were evaluated and compared: accident and emergency visits, hospital admissions, length of hospital stays, number of acute complications, number of times of treatment or regimen altered by nurses according to patient’s condition, glycated haemoglobin A1c (HbA1c) levels, urea and urea-to-creatinine ratios, and number of wound dressings for patients in corresponding specialty units. A patient satisfaction instrument was also used to assess the NC cohort.

Results

The study showed that patients under NC care had favourable patient health and service outcomes compared with those under non-NC care. The NC cohort also reported a high level of patient satisfaction.

Conclusions

The study demonstrates that the introduction of NCs in specialty units may have a positive impact on patients’ health and service outcomes. The high level of patient satisfaction scores indicates that patients appreciate the care they are receiving with the introduction of NCs.
MiR-370 sensitizes chronic myeloid leukemia K562 cells to homoharringtonine by targeting Forkhead box M1
Authors: Zhou MinRan , Zeng JiPing , Wang XiaoMing , Guo Qing , Huang Tao , Shen HaiYu , Fu Yue , Wang LiXiang , Jia JiHui , Chen ChunYan
Published: October 2013

Background

Homoharringtonine (HHT) is a kind of cephalotaxus alkaloid used in traditional Chinese medicine. Although HHT has been successfully used as a therapeutic agent for leukemia, the drug resistance and toxicity are major concerns. MicroRNAs (miRNAs) have been identified to modulate cellular sensitivity to anticancer drugs. We examined the synergistic action between miR-370 and HHT in vitro and in vivo.

Methods

The synergistic action between miR-370 and HHT was examined by flow cytometry. The effect of HHT on miR-370 expression was determined by quantitative RT-PCR (qRT-PCR). The expression of miR-370 and Forkhead box M1 (FoxM1) in 23 patients with newly diagnosed chronic-phase chronic myeloid leukemia (CML-CP) and 10 patients with blast-crisis CML (CML-BP) as well as miR-370–targeted FoxM1 was determined by qRT-PCR and western blot analysis.

Results

Ectopic expression of miR-370 sensitized the CML K562 cell line to HHT by targeting FoxM1, the major regulator in cell proliferation and apoptosis. miR-370 significantly promoted HHT-mediated cell apoptosis and miR-370 and HHT cooperated in affecting FoxM1 expression. As well, miR-370 was moderately upregulated after HHT treatment in K562 cells. In addition, the expression of miR-370 was significantly reduced in CML patients as compared with healthy controls. Furthermore, the expression of miR-370 was lower in CML-BP than CML-CP patients.

Conclusions

MiR-370 sensitized K562 cells to HHT by inducing apoptosis in part by downregulation of FoxM1 expression. These findings may provide further information for CML treatment with HHT.
Improvement of optical transmittance and electrical properties for the Si quantum dot-embedded ZnO thin film
Authors: Kuo Kuang-Yang , Liu Chuan-Cheng , Huang Pin-Ruei , Hsu Shu-Wei , Chuang Wen-Ling , Chen You-Jheng , Lee Po-Tsung
Published: October 2013

A Si quantum dot (QD)-embedded ZnO thin film is successfully fabricated on a p-type Si substrate using a ZnO/Si multilayer structure. Its optical transmittance is largely improved when increasing the annealing temperature, owing to the phase transformation from amorphous to nanocrystalline Si QDs embedded in the ZnO matrix. The sample annealed at 700°C exhibits not only high optical transmittance in the long-wavelength range but also better electrical properties including low resistivity, small turn-on voltage, and high rectification ratio. By using ZnO as the QDs’ matrix, the carrier transport is dominated by the multistep tunneling mechanism, the same as in a n-ZnO/p-Si heterojunction diode, which clearly differs from that using the traditional matrix materials. Hence, the carriers transport mainly in the ZnO matrix, not through the Si QDs. The unusual transport mechanism using ZnO as matrix promises the great potential for optoelectronic devices integrating Si QDs.
Ectopic pancreatic pseudocyst and cyst presenting as a cervical and mediastinal mass - case report and review of the literature
Authors: Rokach Ariel , Izbicki Gabriel , Deeb Maher , Bogot Naama , Arish Nissim , Hadas-Halperen Irith , Azulai Hava , Bohadana Abraham , Golomb Eli
Published: October 2013

Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.

We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.

Virtual slides

The virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671
Adjuvant zoledronic acid therapy for patients with early stage breast cancer: an updated systematic review and meta-analysis
Authors: He Mingfeng , Fan Weidong , Zhang Xianquan
Published: October 2013

Background

Zoledronic acid is a potent inhibitor of osteoclast-mediated bone resorption and has been widely used in bone metastasis malignancies and postmenopausal osteoporosis as a preventive therapy against skeletal-related events. The purpose of this study was to evaluate the clinical outcome of zoledronic acid as an adjuvant therapy for patients with early stage breast cancer.

Patients and methods

Entries in the PubMed and EMBASE databases up to 12 July 2013 were systematically reviewed. Online abstracts from the proceedings of the Annual Meetings of the American Society of Clinical Oncology (ASCO) (1992–2013) and the San Antonio Breast Cancer Symposium (SABCS) (2004–2013) were also reviewed. Primary endpoints included overall survival (OS) and disease-free survival (DFS), while secondary endpoints included bone metastasis-free survival (BMFS), distant metastasis-free survival (DMFS), and fracture-free rate (FFR).

Results

A total of eight studies including 3,866 subjects and 3,864 controls met our search criteria and were evaluated. The use of zoledronic acid was found to improve OS (relative risk (RR), 0.88; 95% confidence interval (CI), 0.77–1.01; p- value = 0.06) and DMFS (RR, 0.77; 95% CI, 0.60–1.00; p- value = 0.05). Furthermore, statistically significant benefits were associated with BMFS (RR, 0.81; 95% CI, 0.66–0.99; p- value = 0.04) and FFRs (RR, 0.75; 95% CI, 0.61–0.92; p- value = 0.007). In contrast, there was no significant difference in DFS with the application of zoledronic acid (RR, 0.88; 95% CI, 0.72–1.09; p- value = 0.24). Sensitivity analysis further identified the improvement of 5-year OS for the adjuvant zoledronic acid therapy in early stage breast cancer patients (RR, 0.86; 95% CI, 0.75–0.99; p- value = 0.03), while a borderline statistically significant benefit was observed for 5-year DFS (RR, 0.90; 95% CI, 0.81–1.00; p- value = 0.06).

Conclusion

Zoledronic acid as an adjuvant therapy appears to improve the 5-year OS rate for early stage breast cancer patients, and was associated with a protective effect for the bone metastases and fractures evaluated in more than 7,000 patients. However, further research is needed to confirm our findings, and sub-group analyses according to menopause status or hormone status may provide further insight.
Information Technology Competencies, Organizational Agility, and Firm Performance: Enabling and Facilitating Roles
Authors: Chakravarty Anindita , Grewal Rajdeep , Sambamurthy V.
Published: October 2013

The hypercompetitive aspects of modern business environments have drawn organizational attention toward agility as a strategic capability. Information technologies are expected to be an important competency in the development of organizational agility. This research proposes two distinct roles to understand how information technology competencies shape organizational agility and firm performance. In their enabling role, IT competencies are expected to directly enhance entrepreneurial and adaptive organizational agility. In their facilitating role, IT competencies should enhance firm performance by helping the implementation of requisite entrepreneurial and adaptive actions. Furthermore, we argue that the effects of the dual roles of IT competencies are moderated by multiple contingencies arising from environmental dynamism and other sources. We test our model and hypotheses through a latent class regression analysis on data from a sample of 109 business-to-business electronic marketplaces. The results provide support for the enabling and facilitating roles of IT competencies. Moreover, we find that these dual effects vary according to environmental dynamism. The results suggest that managers should account for (multiple) contingencies (observed and unobserved) while assessing the effects of IT competencies on organizational agility and firm performance.
Teaching Note—Assigning Regions to Sales Representatives at Pfizer Turkey
Authors: Köksalan Murat , Batun Sakine
Published: October 2013

Case Teaching Note: Interested Instructors please see the Instructor Materials page for access to the restricted materials. To maintain the integrity and usefulness of cases published in ITE, unapproved distribution of the case teaching notes and other restricted materials to any other party is prohibited.