bluuebunny/crossref_metadata_2025 huggingface dataset:
Einschlusskörpermyopathie, Paget-Krankheit und frontotemporale Demenz: eine VCP-bedingte, multisystemische Proteinopathie
Authors: Mengel David , Librizzi Damiano , Schoser Benedikt , Gläser Dieter , Clemen Christoph S. , Dodel Richard , Schröder Rolf
Published: July 2018

Mutationen des humanen VCP-Gens, welches für das Valosin-enthaltende Protein (engl. Valosin Containing Protein; Synonyme: p97, TER ATPase) kodiert, sind mit verschiedenen multisystemischen Proteinaggregationserkrankungen assoziiert. Wir stellen einen Patienten vor, der an einer progressiven Myopathie und beginnenden kognitiven Defiziten leidet. In der diagnostischen Muskelbiospie zeigte sich das Bild einer Einschlusskörpermyopathie mit Proteinaggregaten. Die kraniale MRT- und F18-FDG-PET/CT Bildgebung erbrachte den Nachweis einer deutlichen fronto-temporalen Atrophie sowie einer fronto-temporalen Hypoperfusion. Basierend auf der klinischen Symptomatik des Patienten erfolgte eine molekulargenetische Diagnostik, die eine heterozygote c.277C>T (p.Arg93Cys) Mutation des VCP-Gens detektierte, so dass abschließend die Diagnose einer IBMPFD (engl. Inclusion Body Myopathie with Paget Disease of the Bones and Fronto-temporal Dementia) gestellt werden konnte.
Chronisch immunvermittelte Neuropathien – Diagnostik und Therapie
Authors: Grimm Alexander , Axer Hubertus
Published: July 2018

Die Diagnose einer immunvermittelten Neuropathie ist eine der wichtigsten Differenzialdiagnosen bei Polyneuropathien. Chronisch inflammatorische Neuropathien haben oft eine schwere neurologische Beeinträchtigung zur Folge, weswegen eine frühzeitige Diagnose zur Einleitung einer antientzündlichen Therapie essenziell ist. Therapiekonzepte beinhalten je nach Pathologie Immunglobuline, Kortikosteroide oder Plasmaaustauschverfahren.
Ergebnisse ambulanter orthopädischer Rehabilitation Ergebnismessung mittels Funktionsfragebogen-Hannover-Rücken, DASH- und WOMAC-Score
Authors: Müller Marcus , Gunselmann Isabelle
Published: July 2018

Die vorliegende Studie dient der Evaluation der Behandlungsergebnisse einer ambulanten orthopädischen Rehabilitationseinrichtung im Zeitraum 2013–2016. Die Ergebnisse dokumentieren deutliche Verbesserungen im Rehabilitationsverlauf für die verwendeten Assessments Funktionsfragebogen-Hannover-Rücken (FFbH-R, Rückenpatienten), Disability-of-Arm,-Shoulder,-Hand-Score (DASH, Patienten mit Läsionen der oberen Extremitäten) und Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Patienten mit Läsionen der unteren Extremitäten). Bei insgesamt 3210 Patienten wurden für alle Scores und Diagnosesubgruppen signifikant positive Veränderungen nachgewiesen. Unterschieden wurde nach: • FFbH-R: lumbale Bandscheiben-OP, cervicale Bandscheiben-OP, Spinalkanaldekompression, konservative Rückenschmerzbehandlung, sonstige; • DASH: Rotatorenmanschettenrekonstruktion, Schultergelenk-Endoprothese, Fraktur (konservativ oder osteosynthetisch versorgt), sonstige; • WOMAC: Hüftgelenk-Endprothese, Kniegelenk-Endoprothese, vordere-Kreuzbandplastik, sonstige. Die mittlere Scoredifferenz betrug beim FFbH-R 20,3 Punkte, -24,0 Punkte für den DASH-Score und für den dreigeteilten WOMAC-Score -8,1 (Schmerz), -4,0 (Steifigkeit) sowie -34,0 (Schwierigkeiten). Männer schätzten sich im Vergleich zu Frauen jeweils zu Beginn und Ende der Rehabilitation signifikant günstiger ein. Die Scoredifferenz von Beginn und Ende zeigte jedoch keinen Geschlechtsunterschied. Damit zeigt diese Untersuchung deutlich positive Effekte orthopädischer Rehabilitation im ambulanten Setting.
Spectroscopic diagnostics of laser induced plasma and self-absorption effects in Al lines
Authors: Sabri Nursalwanie Mohd , Haider Zuhaib , Tufail Kashif , Ismail Fairuz Diyana , Ali Jalil
Published: July 2018

Self-absorption (SA) can drastically affect the emission signal which makes quantitative and, in extreme cases, qualitative investigations very challenging in laser induced plasma spectroscopy. In this study, plasma parameters are spectroscopically studied and SA in aluminum emission lines is investigated at various laser energies and gate delays. Q-switched Nd:YAG laser installed on LIBS2500plus system (1064 nm, 6 ns, 10 Hz) was used for ablation. The sample was ablated in air with different laser energies between 5 and 650 mJ, and spectra were recorded at various gate delays between 0 and 23.75 μs. Intensities of spectral lines Al I 308.2 and 309.3 nm were monitored for the range of laser energies and gate delays. The intensity of spectral lines was increased in response to the increasing laser energy. Rapid increase in intensities was observed for the first microsecond after plasma ignition. The maximum intensity of Al is observed at a gate delay of 1.25 μs. Plasma conditions are investigated on the basis of electron density and temperature in response to the change in laser energy and gate-delay. The electron temperature increased from 15 413 K to 20 200 K and the electron density from 5.0 × 1016 cm−3 to 3.5 × 1018 cm−3 with increase in laser energy from 5 to 650 mJ. The electron temperature is exponentially decreased from 26 733 K to 16 649 K and the electron density is reduced from 2.0 × 1017 cm−3 to 1.0 × 1016 cm−3 for increase in the gate delay from 0 to 23.75 μs. The self-absorption effect in resonant spectral lines of Al is estimated on the basis of SA coefficient calculated using FWHM of spectral lines. The highest values of SA coefficient are found for the lowest laser energies and longest gate delays. It states that the SA is significant when the plasma temperature is low and also, when plasma is least dense. It is fairly obvious to conclude that SA effects are least prevalent when the plasma plume is induced by high laser energies and measurements are made at short gate delays.
Supercritical fluid flow dynamics and mixing in gas-centered liquid-swirl coaxial injectors
Authors: Zhang Liwei , Wang Xingjian , Li Yixing , Yeh Shiang-Ting , Yang Vigor
Published: July 2018

Gas-centered, liquid-swirl coaxial injectors similar to those used in the main chambers of oxidizer-rich staged-combustion engines are investigated computationally, in terms of supercritical fluid flow dynamics and mixing. Gaseous oxygen (GOX) is axially directed through a center post at a temperature of 687.7 K. Kerosene is tangentially introduced into the outer coaxial swirler at a temperature of 492.2 K. The mean chamber pressure of 253.0 bars substantially exceeds the thermodynamic critical pressures of oxygen and kerosene. The end of the GOX post is recessed from the entrance of the taper region, which is connected downstream to an open domain. A wide range of recess lengths (and correspondingly, fuel shielding collar lengths) is considered to determine the dependence of flow characteristics on this geometric parameter. Special attention is given to the regions downstream of the GOX post end and in the taper section, where primary mixing occurs. Instantaneous and time-averaged flow properties, as well as mixing effectiveness, are examined. Results indicate that the recess length plays a critical role in determining the flow evolution and mixing behaviors. In a fully recessed injector without fuel shielding, the initial kerosene/GOX interaction resembles a swirling transverse jet into a crossflow, and flow recirculation occurs near the kerosene injection slit and the head end. In other injectors with fuel shielding, the kerosene flow is predominantly axial before it enters the mixing zone; the coflow kerosene and GOX streams expand radially and recirculate in the wake of the GOX post. Flow unsteadiness arising from the fluid injection and mixing and vorticity production in the boundary layer of the GOX stream, along the wall of the fuel passage, and at the kerosene/GOX interface cause the development of salient vortical structures in the downstream flowfield. The geometric changes at the entrance of the taper region and at the injector exit further alter the flow dynamics, inducing multiple toroidal recirculation zones and secondary vortex structures.
Acoustic delay-line filters based on largely distorted topological insulators
Authors: Geng Zhi-Guo , Peng Yu-Gui , Shen Ya-Xi , Zhao De-Gang , Zhu Xue-Feng
Published: July 2018

The topological sound transport, as an interesting phenomenon discovered in sonic crystals, has drawn tremendous interest in recent years. Here, in resonant acoustic systems, we demonstrate the existence of band inversion by slightly changing the lengths of tube resonators, which unveils the acoustic valley Hall phase transition characterized by the inverted valley Chern number. However, when the valley topological insulator is largely distorted, we can obtain flat-band-like edge states in the bandgaps with topological protection still existing. Those edge states can propagate along zigzag delay-lines with the backscatterings suppressed to a large amount. Our work provides a prototype of topological-insulator-based acoustic devices with the frequency-selecting functionality.
Assessment of power industry development in China: Possibilities and challenges
Authors: Ma Bin , Liu Pingkuo , Niu Dongxiao
Published: July 2018

China's power industry is facing the issue of reducing carbon emissions, a particularly important matter to address during the industrial development. Based on the emission reduction status of power industries in China, the possibilities and the challenges of dealing with climate change for Chinese power industries are discussed in this paper by employing PEST (political, economic, social, technological)-strengths, weaknesses, opportunities, and threats analysis. The Tradable Green Certificate (TGC) system and the Carbon Emission Trading scheme for power industry development and environmental protection are analyzed as well. The results show that (1) the possibilities of developing power industries and addressing the climate change issue involve internal advantages (three strengths) and external chances (four opportunities); (2) the challenges for the Chinese power industry involve internal disadvantages (three weaknesses) and external unfavorable factors (four threats); and (3) both the TGC planning and the carbon emission scheme, as an efficient market-oriented strategic change, can jointly adjust the structure of power industries.
The photoinduced isomerization mechanism of the 2-(1-(methylimino)methyl)-6-chlorophenol (SMAC): Nonadiabatic surface hopping dynamics simulations
Authors: Zhao Li , Liu Jianyong , Zhou Panwang
Published: July 2018

The photophysical properties of the Schiff base family are crucial for their applications such as molecular switches and molecular memories. However, it was found that the photophysical behavior is not uniform for all Schiff base molecules, which shows a significant substituent dependent property. In this article, we studied the photoisomerization mechanism of one Schiff base chlorosubstituted derivative 2-(1-(methylimino)methyl)-6-chlorophenol by employing geometrical optimization, energy profiles scanning, and on-the-fly dynamical simulations. Three types of minimum energy conical intersections were located on the S1/S0 crossing seam, with two characterized by twisting motion of the C=N bond and one featured with the excited state intramolecular proton transfer process and then twisting motion around the C=C bond [excited-state intramolecular proton transfer process (ESIPT)-then-twisting]. By a combination of the dynamics simulation results with the energy profiles scanned along with the ESIPT coordinate, it was found that the photophysical property of the targeted molecule is different from that of most Schiff base members, which prefer to decay by a twisting motion around the C=N bridge bond rather than the ESIPT-then-twisting channel. The minor ESIPT channel is probably governed by a tunneling mechanism. The proposed deactivation mechanism can provide a reasonable explanation for the observations in the experiment and would provide fundamental indications for further design of new and efficient photochromic products.
Investigation of argon arc binding to the hafnium cathode
Authors: Sargsyan M. A. , Gadzhiev M. Kh. , Tereshonok D. V. , Tyuftyaev A. S.
Published: July 2018

Spectroscopic and thermometric measurements were performed on the hafnium cathode in argon plasma at atmospheric pressure in a stable burning mode of the arc. The distribution of temperatures on the cathode and distribution of electron temperatures in plasma near the cathode are presented. It was shown that the obtained theoretical range of values for the voltage drop in the volume charge layer is in good agreement with experimental results. Based on the numerical simulations, a range of values were obtained for the current densities of ions and electrons and electric field strength on the cathode tip.
Heat transfer enhancement of turbulent channel flow using tandem self-oscillating inverted flags
Authors: Chen Yujia , Yu Yuelong , Zhou Wenwu , Peng Di , Liu Yingzheng
Published: July 2018

Heat transfer enhancement by tandem self-oscillating inverted flags was investigated for channel flow. An isolated flag was selected as the benchmark. The highly unsteady flapping motion of the inverted flag was captured using a high-speed camera and identified by the structure boundary detection algorithm. The resultant temperature fields were determined by temperature sensitive paint measurement. Three dynamic regimes were observed for the isolated inverted flag: biased, flapping, and deflected modes. The results show that the self-oscillating inverted flag in the flapping mode exhibited the most energetic motion, with a maximum amplitude of 1.75 times of the flag length and a Strouhal number 0.17. This significantly promoted heat removal from the heated wall, with a considerable local Nusselt number ratio exceeding 1.5. Tandem flags flapped synchronously with the same frequency at a low Reynolds number and a close distance G* between two inverted flags, and the phase difference depended linearly on the separation distance. Increases in the separation distance and Reynolds number led to decoupling behavior. Local Nusselt number ratio peak regions were found behind both the front and rear flags, and the heat transfer performance behind the rear flag was superior to that behind the front flag. The global Nusselt number ratio was not sensitive to the separation distance and Reynolds number for tandem flag configurations. Increasing Reynolds number reduced the mechanical loss, so operating the tandem inverted flags’ system at a high Reynolds number moderately improved the heat transfer efficiency.
A systematic investigation of radiative recombination in GaN nanowires: The influence of nanowire geometry and environmental conditions
Authors: Hetzl Martin , Kraut Max , Hoffmann Theresa , Winnerl Julia , Boos Katarina , Zeidler Andreas , Sharp Ian D. , Stutzmann Martin
Published: July 2018

Nanowires intrinsically exhibit a large surface area, which makes them sensitive to physical and chemical interactions with their environment. Here, we investigate the surface recombination at m-plane side walls of selective area-grown GaN nanowires on Si (111) subjected to different environmental conditions. In contrast to the stable photoluminescence observed from c-plane surfaces of films, nanowires exhibit a distinct time-dependent photoluminescence quenching by over 90% within the time scale of seconds in the presence of air or dissociated liquids. This quenching is most pronounced for 50 nm diameter nanowires with interwire spacings larger than 500 nm due to internal electric field and external light field distributions. Ion- and pH-sensitive measurements, in combination with an externally applied voltage, allow the assignment of this effect to anions from the surroundings to accumulate at the nonpolar GaN side walls of the UV-exposed GaN nanowires. The decay times of the luminescence signal follow the dynamics of valence band holes, which deplete GaN surface states and positively charge the nanowire surfaces. This, in turn, induces the buildup of a capacitive anion shell around the nanowires, leading to an enhanced nonradiative surface recombination of photo-generated charge carriers from the GaN nanowire. In the absence of UV light, a recovery of the photoluminescence signal within tens of minutes indicates the dissolution of the anionic shell via charge balancing. The impact of light-induced electronic and ionic charge redistribution on photocarrier recombination represents an important mechanism of function for GaN nanowire-based devices, ranging from sensors to photocatalysts.
Tensegrity cell mechanical metamaterial with metal rubber
Authors: Zhang Qicheng , Zhang Dayi , Dobah Yousef , Scarpa Fabrizio , Fraternali Fernando , Skelton Robert E.
Published: July 2018

We present here a design of the unit cell of a mechanical metamaterial based on the use of a tensegrity structural configuration with a metal rubber. Tensegrity combines the use of compression and tension-only elements, and allows the creation of structures with high rigidity per unit mass. Metal rubber is a multiscale porous metal material with high energy absorption and vibration damping capabilities under compressive load. The combination of the two structural and material concepts gives rise to a mechanical metamaterial with increased energy absorption and tuneable nonlinearity under quasi-static, vibration, and impact loading. We develop prototypes, models, and perform tests under static and dynamic loading conditions to assess the performance of this mechanical metamaterial.
Zn acceptor position in GaN:Zn probed by contactless electroreflectance spectroscopy
Authors: Janicki Łukasz , Mohajerani Matin Sadat , Hartmann Jana , Zdanowicz Ewelina , Wehmann Hergo-Heinrich , Waag Andreas , Kudrawiec Robert
Published: July 2018

The Zn acceptor level position in GaN:Zn was studied on specially designed GaN(undoped)/GaN:Zn([Zn] = 5 × 1016 cm−3) structures by contactless electroreflectance. A well-defined Franz-Keldysh oscillation is present in optical spectra which results from the built-in electric field present in the near-surface layer. The obtained results show that a significant band bending in the GaN:Zn layer occurs lowering the field in the top layer that is in line with predictions for a semiconductor doped with a high ionization energy acceptor. The acceptor level responsible for the Fermi level position in GaN:Zn is found to be at ∼2.3 eV below the conduction band minimum which coincides with levels introduced by Zn atoms substituting nitrogen in the lattice. At the same time, the surface Fermi level of structures is located in the middle of the bandgap, which is in the lower maximum of (0001) GaN surface density of states.
Hot-carrier-mediated impact excitation of Er3+ ions in SiO2 sensitized by Si Nanocrystals
Authors: Lesage A. , Timmerman D. , Lebrun D. M. , Fujiwara Y. , Gregorkiewicz T.
Published: July 2018

Past research has shown that indirect excitation of Er3+ ions in SiO2 solid-state matrix with Si nanocrystals can be achieved by different pathways. Here, we investigate the impact excitation mechanisms in detail by means of time-resolved photoluminescence spectroscopy. We explicitly demonstrate that the free carrier impact excitation mechanism is activated as soon as the carriers obtain sufficient excess energy. The “hot” carriers with the above-threshold energy can be created upon optical pumping in two ways: either upon absorption of (i) a single photon with an energy exceeding a certain threshold hν > Eth or (ii) following absorption of multiple photons of lower energy in a single nanocrystal, hν < Eth, followed by an Auger recombination of the generated multiple e-h pairs. In addition, we show that the impact excitation dynamics by hot carriers are similar, regardless of the mode in which they have been created.
Engineering chimera patterns in networks using heterogeneous delays
Authors: Ghosh Saptarshi , Jalan Sarika
Published: July 2018

Symmetry breaking spatial patterns, referred to as chimera states, have recently been catapulted into the limelight due to their coexisting coherent and incoherent hybrid dynamics. Here, we present a method to engineer a chimera state by using an appropriate distribution of heterogeneous time delays on the edges of a network. The time delays in interactions, intrinsic to natural or artificial complex systems, are known to induce various modifications in spatiotemporal behaviors of the coupled dynamics on networks. Using a coupled chaotic map with the identical coupling environment, we demonstrate that control over the spatial location of the incoherent region of a chimera state in a network can be achieved by appropriately introducing time delays. This method allows for the engineering of tailor-made one cluster or multi-cluster chimera patterns. Furthermore, borrowing a measure of eigenvector localization from the spectral graph theory, we introduce a spatial inverse participation ratio, which provides a robust way for the identification of the chimera state. This report highlights the necessity to consider the heterogeneous time delays to develop applications for the chimera states in particular and understand coupled dynamical systems in general.
Theoretical supercritical fluid dynamics and mixing revealed in study on liquid rocket engines
Authors: DeJarnette Drew
Published: July 2018

Theoretical and numerical results elucidate the flow and mixing behavior of the fuel and oxidizer in gas-centered liquid-swirl coaxial injectors under complex and harsh supercritical conditions.
Cytogenetics: an important inclusion in the conservation genetics toolbox
Authors: Potter Sally , Deakin Janine E.
Published: July 2018

Conservation uses information from genetics to assist in management decisions. However, conservation genetics typically assesses genetic diversity at the DNA level but this alone does not address all the risks associated with managing wild and captive populations. DNA is packaged into chromosomes. Differences in the number and morphology of chromosomes between species or even between populations of the same species can have important implications for management programs for threatened species. Cytogenetics, analysis of the higher molecular chromosome structure, can provide invaluable insight for the management of threatened species, where DNA alone could not address all genetic risks and threats to populations. Here we outline the important and valuable role of cytogenetics in conservation, highlighting two case studies based on threatened Australian marsupials: rock-wallabies and the Tasmanian devil. In conclusion, we summarise how cytogenetics should be better linked to conservation genetics and integrated into our management of threatened species, to ensure they have the best platform from which to persist and adapt into the future.
Vowels and tones in Poula
Authors: Lemaina Veikho Sahiinii , Sarmah Priyankoo
Published: July 2018

This paper presents a sketch of the vowels and tones in the Poula language as spoken in the Naamai (Koide) village of Manipur. Acoustic studies on the vowels and tones are conducted in this work, and it is concluded that Poula has a six vowel inventory like many of the languages in the vicinity; however the distribution of vowels in Poula is quite peculiar, with the absence of high back vowels and presence of two high front vowels. In case of tones, this study reports four tones in Poula, namely, High-falling, Rising-falling, Mid and Low. The paper concludes with a short discussion on tones in Poula underived words.
Complexity and genre distribution of left-dislocated strings after the fixation of SVO syntax
Authors: Tizón-Couto David
Published: July 2018

This paper investigates the diachronic development of strings that include both a left-dislocated constituent and a coreferring resumptive in the subsequent clause, thus resembling the reportedly speech-like and informal contemporary Left Dislocation construction. The data is analyzed according to a range of factors relating to the inner configuration of such strings and examined by means of the pertinent statistical tests. The purpose is to arrive at a clearer and broader picture of (i) the general decline of left-dislocated strings, (ii) the factors determining their structural complexity, and (iii) their role as prospective markers of orality in Modern English speech-related texts.
Sequentiality and the emergence of new constructions
Authors: Shibasaki Reijirou
Published: July 2018

This study aims to investigate a specific construction in spoken discourse, i.e. that’s (not) the bottom line is (that) and its variant forms, in recent American English. The function of the bottom line is (that) is for a speaker to introduce or anticipate upcoming talk, while that’s the bottom line allows a speaker to summarize his/her preceding statement. These constructions give rise to a new construction when repeatedly used in the following sequence: anaphoric that’s (not) the bottom line followed by cataphoric the bottom line is (that). The newly emerging construction, i.e. that’s (not) the bottom line is (that), is an “apo-koinou” construction, which consists of two clauses which have a word or phrase in common. The remainder of the study then discusses how the notions of “constructional change”, “constructionalization”, and “constructional expansion” may be applied to the individual SN-constructions and to the resulting apo-koinou constructions.
United we stand, divided we fall: the early Nietzsche on the struggle for organisation
Authors: Pearson James S.
Published: July 2018

According to Nietzsche, both modern individuals and societies are pathologically fragmented. In this paper, I examine how he proposes we combat this affliction in his Untimely Meditations. I argue that he advocates a dual struggle involving both instrumental domination and eradication. On these grounds, I claim the following: 1. pace a growing number of commentators, we cannot categorise the species of conflict he endorses in the Untimely Meditations as agonistic; and 2. this conflict is better understood as analogous to the species of struggle that Schopenhauer describes in his account of purposive organisation.
Ultrasound effect on structure and properties of Cu–0.5Cr under upsetting
Authors: Donič Tibor , Raab Georgy , Aksenov Denis , Asfandiyarov Rashid , Hadzima Branislav
Published: July 2018

We studied the effect of the regimes of ultrasonic action on the structural transformation during free upsetting with 50% reduction of the copper alloy Cu–0.5Cr. In the process of deformation, the samples were subjected to intermittent and continuous ultrasonic actions. It can be noted that the application of ultrasonic vibrations in the process of deformation leads in both cases to a reduction in yield strength. Under a continuous ultrasonic action with a power of 640 W, the most developed structure is formed, with a fraction of high-angle boundaries equal to 32.4%, with the lowest values of coherent scattering regions, density of dislocations and microdistortions, while the decline in yield strength of the material under deformation is 40 MPa.

This paper is part of a Thematic Issue on Copper and its Alloys.
Ifeoma Okoye: socialist-feminist political horizons in Nigerian literature
Authors: Mayer Adam
Published: July 2018

Nigerian author Ifeoma Okoye’s novel The Fourth World, published in 2013, presents us with a truly 21st century African unified socialist-feminist theory, while it places individual growth firmly in the community of an eponymous shanty in Enugu, Igboland. Through this novel, we observe how dictates of survival are transformed into acts of moral choice through the agency of work by a young girl of extraordinary character, helped by the congeniality of the community and by radical organisers.
Low-Intensity Pulsed Ultrasound Stimulation Induces Coupling Between Ripple Neural Activity and Hemodynamics in the Mouse Visual Cortex
Authors: Yuan Yi , Wang Zhijie , Wang Xingran , Yan Jiaqing , Liu Mengyang , Li Xiaoli
Published: July 2018

Several studies have separately investigated neural activities and hemodynamic responses induced by low-intensity pulsed ultrasound stimulation (LIPUS), less is known about their coupling under LIPUS. This study aims to investigate the neurovascular coupling with LIPUS by measuring neural activity and hemodynamics. We found that the relative power and sample entropy of local field potential at the ripple band have a significant correlation to relative cerebral blood flow over time (correlation coefficients: 0.66 ± 0.13 [P < 0.01] and −0.58 ± 0.11 [P < 0.05]). These results demonstrate that LIPUS can induce neurovascular coupling in the mouse visual cortex.
Analgesic Effects Evoked by Real and Imagined Acupuncture: A Neuroimaging Study
Authors: Cao Jin , Tu Yiheng , Orr Scott P , Lang Courtney , Park Joel , Vangel Mark , Chen Lucy , Gollub Randy , Kong Jian
Published: July 2018

Acupuncture can provide therapeutic analgesic benefits but is limited by its cost and scheduling difficulties. Guided imagery is a commonly used method for treating many disorders, such as chronic pain. The present study examined a novel intervention for pain relief that integrates acupuncture with imagery called video-guided acupuncture imagery treatment (VGAIT). A total of 27 healthy subjects were recruited for a crossover-design study that included 5 sessions administered in a randomized order (i.e., baseline and 4 different interventions). We investigated changes in pain threshold and fMRI signals modulated by: 1) VGAIT, watching a video of acupuncture previously administered on the participant’s own body at baseline while imagining it being concurrently applied; 2) a VGAIT control condition, watching a video of a cotton swab touching the skin; 3) real acupuncture; and 4) sham acupuncture. Results demonstrated that real acupuncture and VGAIT significantly increased pain threshold compared with respective control groups. Imaging showed that real acupuncture produced greater activation of the insula compared with VGAIT. VGAIT produced greater deactivation at the rostral anterior cingulate cortex. Our findings demonstrate that VGAIT holds potential clinical value for pain management.
Interleukin 6 trans-signalling and risk of future cardiovascular events
Authors: Ziegler Louise , Gajulapuri Ashwini , Frumento Paolo , Bonomi Alice , Wallén Håkan , de Faire Ulf , Rose-John Stefan , Gigante Bruna
Published: July 2018

Aims

The pro-inflammatory response to interleukin 6 (IL6) trans-signalling in atherosclerosis is driven by the IL6 and soluble IL6 receptor (sIL6R) binary complex. The binary IL6:sIL6R complex is inactivated by sgp130 through the formation of the ternary IL6:sIL6R:sgp130 complex. The aim of this study was to investigate if IL6 trans-signalling, estimated by a ratio between the binary and ternary complexes, associates with the risk of future cardiovascular events (CVE) in a Swedish cohort of 60-year-old men and women (n = 4232).

Methods and results

Binary and ternary complex levels expressed in nanomol/Litre were derived from serum concentrations of IL6, sIL6R, and sgp130. Cox regression models were used to assess the risk of CVE (myocardial infarction, angina pectoris, and ischaemic stroke, n = 525), expressed as hazard ratio (HR) with 95% confidence interval (CI), associated with increasing circulating levels of the three molecules and with the binary/ternary complex ratio. Estimates were adjusted for the common cardiovascular (CV) risk factors. To assess the level of IL6-trans-signalling, we estimated the binary/ternary complex ratio and then analysed the association with CVE risk. A ratio higher than the median, representing a relative excess of the active binary complex was associated with increased CVE risk (adjusted HR 1.44, 95% CI 1.21–1.72).

Conclusion

The ratio between the functional moieties of IL6 trans-signalling, IL6:sIL6R, and IL6:sIL6R:sgp130, was associated with CVE risk indicating that it could be a promising marker of CV risk and possibly be used in selecting patients for anti-inflammatory therapy.
Probing cosmic velocity–density correlations with galaxy luminosity modulations
Authors: Feix Martin
Published: July 2018

We study the possibility of using correlations between spatial modulations in the observed luminosity distribution of galaxies and the underlying density field as a cosmological probe. Considering redshift ranges, where magnification effects due to gravitational lensing may be neglected, we argue that the dipole part of such luminosity–density correlations traces the corresponding velocity–density signal which may thus be measured from a given galaxy redshift catalogue. Assuming an SDSS-like survey with mean density $\overline{n}=0.01 (h^{-1}$ Mpc)−3 and effective volume Veff = 0.2(h−1 Gpc)3 at a fiducial redshift $z$ = 0.1, we estimate that the velocity–density correlation function can be constrained with high signal-to-noise ratio ≳ 10 on scales 10–100 Mpc. Similar conclusions apply to the monopole which is sensitive to the environmental dependence of galaxy luminosities and relevant to models of galaxy formation.
Effect of Sideritis leptoclada against HT-144 human malignant melanoma
Authors: Aydoğmuş-Öztürk Fatma , Günaydin Keriman , Öztürk Mehmet , Jahan Humera , Duru Mehmet E. , Choudhary Muhammad I.
Published: July 2018

Sideritis leptoclada O. Schwarz et P.H. Davis extracts were evaluated for its singlet oxygen production capacity using spectrophotometric method. The extracts producing singlet oxygen were then evaluated for cytotoxicity against malignant melanoma cancer (HT-144) and fibroblast (3T3) cell lines using the 3-[4,5-dimethylthiazole-2-yl]-2,5-diphenyl-tetrazolium bromide (MTT) assay. The photocytotoxicity against the HT-144 human melanoma cell line in the presence of illumination (∼≥400 nm) was also evaluated. In the standard MTT assay, the ethanol extract of S. leptoclada (100 µg/ml) showed 83.49±3.33% inhibition of HT-144 cancer cells, whereas in the illuminated MTT assay, it showed 77.46±1.97% inhibition of HT-144 cancer cells. The effects of ethanol extract on reactive oxygen species production, apoptosis, and tumor necrosis factor-α secretion were also evaluated on HT-144 cell lines. The extract triggered an increase in intracellular reactive oxygen species production and tumor necrosis factor-α secretion compared with the respective controls. Thus, the ethanol extract may cause apoptosis. The LC-MS/MS analyses of S. leptoclada ethanolic extract showed that it has quinic acid (137213±11.25 µg/g extract), malic acid (1468±0.16 µg/g extract), chlorogenic acid (881.7±0.06 µg/g extract), and apigetrin (223.2±0.13 µg/g extract) as major constituents. The ethanolic extract of S. leptoclada should be further investigated as a potential treatment for malignant melanoma cancer.
A Retrospective Review of Physician Assistant Education Association End of Rotation Examinations
Authors: Rizzolo Denise , Cavanagh Kimberly , Ziegler Olivia , Dallas Andrew D. , Goodman Joshua , Yunker Emily
Published: July 2018

The PAEA End of Rotation™ exams were developed to assess medical knowledge of the 7 core supervised clinical practice experiences, including Emergency Medicine, Family Medicine, Internal Medicine, General Surgery, Pediatrics, Women's Health, and Psychiatry and Behavioral Health. The examinations were created by experienced PA educators and national exam experts with continual review and content updates. This paper summarizes changes since the inception of the exam program, including test construction and development, reliability, validity, and scale scoring. They are built using content blueprints and topic lists that were developed by experienced PA educators and national examination experts. All examination items are peer reviewed by PA educators and statistically validated for accuracy and consistency by psychometricians who specialize in examination development. This article will review the changes since the inception of the exam program including test construction and development, reliability, validity and scale scoring. Also addressed is an update on the PAEA End of Curriculum™ examination.
Antibiotic treatment of hospital-acquired pneumonia: is it different from ventilator-associated pneumonia?
Authors: Niederman Michael S.
Published: July 2018

Purpose of review

Hospital-acquired pneumonia (HAP) is a form of nosocomial pneumonia, distinct from ventilator-associated pneumonia (VAP). This review compares HAP and VAP, highlighting differences in natural history, risk factors, and bacteriology that necessitate a different approach to the therapy of HAP, compared with VAP.

Recent findings

HAP can arise out of the ICU, or in the ICU, and can lead to severe illness, including the need for intubation and mechanical ventilation. New American and European nosocomial pneumonia guidelines make therapy recommendations for HAP. The American guidelines recommend broader spectrum therapy than the European guidelines, but recent studies support the idea that not all HAP patients need antipseudomonal therapy. When the American guideline approach to HAP has been studied, it led to both overtreatment and inappropriate therapy for the identified pathogens. An algorithm, modified from the European guideline, proposes an approach to therapy that necessitates dual antipseudomonal therapy in less than 25% of all HAP patients.

Although more prospective therapy trials of HAP are needed, based on currently available data, it is possible to use an approach that provides appropriate therapy without the overuse of broad-spectrum therapy.
Predictors of Suicidal Ideation Among IBD Outpatients
Authors: Hashash Jana G. , Vachon Ashley , Ramos Rivers Claudia , Regueiro Miguel D. , Binion David G. , Altman Laci , Williams Cheriese , Szigethy Eva
Published: July 2018

Background:

Suicidal ideation (SI) is understudied in inflammatory bowel diseases (IBD). We aim to determine SI rates among IBD outpatients and to evaluate predictors of SI.

Materials and Methods:

This is a prospective observational study of consecutive adult IBD outpatients over 18 months. Patients were screened for depression and SI using patient health questionnaire (PHQ-9). Demographic data were obtained from electronic medical record. Regression modeling was used for predictor analyses.

Results:

In total, 71 of consecutive 1352 IBD outpatients had SI. Significant correlations between SI and depression severity, tricyclic antidepressants (TCA), IBD-related quality of life, and low vitamin D levels were seen. Univariate regression showed that depression severity, TCA use, and quality of life predicted SI. Multivariate regression showed depression severity (β=0.46; P=0.002) and TCA use (β=0.31; P=0.012) made unique contributions.

Conclusions:

SI is associated with depressive severity and less directly with IBD activity. Low-dose TCA, often used for chronic abdominal pain, is also a risk factor. Identifying the subset of IBD patients most vulnerable to SI can facilitate proper referrals to behavioral services and prevent progression to completed suicides.
Probiotics in Pediatric Gastroenterology
Authors: Scarpato Elena , Russo Marina , Staiano Annamaria
Published: July 2018

Etiology of inflammatory bowel disease (IBD) is not yet completely understood, but it is hypothesized that a disruption of the immune tolerance to gut microbiota, due to several potential factors like an abnormal gut microbiota composition and activity, may lead to IBD occurrence. Manipulation of the intestinal microbiota is an attractive target for the management of IBD, and probiotics could be useful to influence the disease’s course. However, the existing literature on the usefulness of probiotics in IBD is relatively limited. At present, there is no evidence of efficacy for any bacterial strain in the induction or maintenance of remission in pediatric Crohn’s disease, while there is limited evidence for the use of VSL#3 and Lactobacillus reuteri ATCC 55730, in addition to standard therapy, for the induction of remission in pediatric ulcerative colitis. Moreover, current data assessing the therapeutic efficacy of probiotics in IBD do not fulfill evidence-based standards, with long-term maintenance studies and larger prospective randomized controlled trials still lacking.
A Quality Improvement Bundle to Improve Informed Choice for Children With Typical, Newly Diagnosed Immune Thrombocytopenia
Authors: Beck Carolyn E. , Carcao Manuel , Cada Michaela , Porter Stephen , Blanchette Victor S. , Parkin Patricia C.
Published: July 2018

IVIG has been the predominant therapy for the initial management of children with newly diagnosed immune thrombocytopenia at our hospital. With current guidelines supporting more conservative management, we undertook a quality improvement initiative to lead practice change. Over a 2-year time period (2013 to 2015), we strove to decrease use of hospital resources (use of IVIG, length of stay) while optimizing family satisfaction. An interdisciplinary working group was struck and a quality improvement bundle was implemented. The bundle comprised a patient information sheet; an evidence-informed, consensus-based protocol; and promotion of shared decision-making via stakeholder engagement and education. Data were collected prospectively; baseline data from a 2007 to 2009 audit were used for comparison. In total, 27 patients were included. Mean initial platelet count was 4×109/L. Bleeding was classified as none or mild in 56% of patients. IVIG use decreased from 88% to 55% of patients, corticosteroid prescription increased from 6% to 15%, and observation increased from 6% to 30% of patients. Hospital length of stay decreased from 47 to 36 hours. Family satisfaction was stable across treatment groups. Through introduction of a quality improvement initiative, we were able to improve family-centered care and decrease use of hospital resources.
Special Therapy and Psychosocial Needs Identified in a Multidisciplinary Cancer Predisposition Syndrome Clinic
Authors: Groves Andrew P. , Gettinger Katie , Druley Todd E. , Kozel Beth A. , Shinawi Marwan , Mohrmann Caroline , Henry Jennifer , Jacobi Celina , Trinkaus Kathryn , Hayashi Robert J.
Published: July 2018

Identification of patients with cancer predisposition syndromes (CPSs) can provide vital information to guide care of an existing cancer, survey for future malignancy, and counsel families. The same underlying mutation responsible for a CPS may also result in other phenotypic abnormalities amenable to therapeutic intervention. The purpose of this study was to examine patients followed in our multidisciplinary CPS clinic to determine the prevalence and scope of medical and psychosocial needs. Data from a baseline evaluation of a single-center patient registry was reviewed. Eligible patients included those with a known or suspected CPS. Over 3 years, 73 patients consented and had successful follow-up. Utilization rate of special therapies, defined as speech therapy, occupational therapy, and/or physical therapy, in the CPS population was 50.7%, significantly higher than a representative sample of children with special needs. Prevalence of 504/IEP (Individualized Education Program) utilization was 20.5%. Patients with CPSs have a high prevalence of medical and psychosocial needs beyond their risk for cancer, for which early screening for necessary interventions should be offered to maximize the patient’s developmental potential. Future research is needed to further define the developmental and cognitive phenotypes of these syndromes, and to evaluate the effectiveness of subsequent interventions.
Brown Recluse Spider Bites in Patients With Neutropenia: A Single-institution Experience
Authors: Hijano Diego R. , Otterson Daniel , Homsi Maysam R. , Su Yin , Tang Li , Kirby Jeannette , Caniza Miguela A.
Published: July 2018

Brown recluse spider bites can cause local and systemic signs, including rash, dermonecrosis, edema, hemolysis, and acute kidney failure. These are mostly attributed to sphingomyelinase D, the main toxin. To evaluate the severity of the disease in pediatric patients with and without neutropenia, we retrospectively reviewed records of patients treated at St. Jude Children’s Research Hospital between 1970 and 2015 and identified 19 patients who met the inclusion criteria. Variables of interest included the type of underlying illness, presence of neutropenia, number of days of hospitalization, disease signs and outcome of the bite, and treatments administered. We used descriptive statistics to summarize the manifestations and severity of spider bites in patients with and without neutropenia. Six patients experienced pain from the bite, 11 had erythema, 7 developed edema, and 5 had fever. The response to spider bites in neutropenic patients was no milder than that in non-neutropenic individuals. Six patients developed systemic complications. Compared with non-neutropenic patients, neutropenic patients had antibiotics prescribed more often and experienced longer hospital stays. Spider bites do not seem to have a different clinical course in neutropenic patients. Therefore, a conservative approach may be best for these patients, with close monitoring and local wound care.
A New Variant of PKLR Gene Associated With Mild Hemolysis may be Responsible for the Misdiagnosis in Pyruvate Kinase Deficiency
Authors: Aydin Köker Sultan , Oymak Yeşim , Bianchi Paola , Gözmen Salih , Karapinar Tuba H. , Fermo Elisa , Vergin Raziye C.
Published: July 2018

Pyruvate kinase deficiency (PKD) is the most common glycolytic defect leading to hemolytic anemia. PKD is caused by the mutations in the PKLR gene; however, the detection of a decreased PK activity should be first measured for rapid diagnosis. We report here the case of a 1-year-old girl with mild hemolysis and PKD. At the time of the study, the patient showed a hemoglobin level of 9.5 g/dL, mean corpuscular volume of 93 fL, reticulocyte of 6.7%, and lactate dehydrogenase of 218 IU/L. Peripheral blood smear showed polychromasia, anisocytosis, tear drop cells, fragmented eyrtrocytes, and target cells. When a biochemical analysis was performed in our patient and her parents who had consanguinity, a decreased PK activity was detected in the patient and her father. After the molecular study of PKLR gene, a new homozygote variant, c.1708G>T (pVal570Leu), was found in our patient and her father. Her father had a misdiagnosis of Gilbert syndrome because he had unconjugated hyperbilirubinemia and not anemia. Her mother was also a carrier of the mutation in heterozygous state. Patients presenting with hemolytic anemia, either severe or mild hemolytic anemia, should be screened for PKD in the first year of life. Patients with mild hemolytic findings can be followed-up with misdiagnoses.