bluuebunny/crossref_metadata_2025 huggingface dataset:
Clusters of Adolescent and Young Adult Thyroid Cancer in Florida Counties
Authors: Amin Raid , Burns James J.
Published: April 2014

Background. Thyroid cancer is a common cancer in adolescents and young adults ranking 4th in frequency. Thyroid cancer has captured the interest of epidemiologists because of its strong association to environmental factors. The goal of this study is to identify thyroid cancer clusters in Florida for the period 2000–2008. This will guide further discovery of potential risk factors within areas of the cluster compared to areas not in cluster.Methods. Thyroid cancer cases for ages 15–39 were obtained from the Florida Cancer Data System. Next, using the purely spatial Poisson analysis function in SaTScan, the geographic distribution of thyroid cancer cases by county was assessed for clusters. The reference population was obtained from the Census Bureau 2010, which enabled controlling for population age, sex, and race.Results. Two statistically significant clusters of thyroid cancer clusters were found in Florida: one in southern Florida (SF) (relative risk of 1.26;Pvalue of <0.001) and the other in northwestern Florida (NWF) (relative risk of 1.71;Pvalue of 0.012). These clusters persisted after controlling for demographics including sex, age, race.Conclusion. In summary, we found evidence of thyroid cancer clustering in South Florida and North West Florida for adolescents and young adult.
Tangent‐Impulse Interception for a Hyperbolic Target
Authors: Wang Dongzhe , Zhang Gang , Cao Xibin
Published: April 2014

The two‐body interception problem with an upper‐bounded tangent impulse for the interceptor on an elliptic parking orbit to collide with a nonmaneuvering target on a hyperbolic orbit is studied. Firstly, four special initial true anomalies whose velocity vectors are parallel to either of the lines of asymptotes for the target hyperbolic orbit are obtained by using Newton‐Raphson method. For different impulse points, the solution‐existence ranges of the target true anomaly for any conic transfer are discussed in detail. Then, the time‐of‐flight equation is solved by the secant method for a single‐variable piecewise function about the target true anomaly. Considering the sphere of influence of the Earth and the upper bound on the fuel, all feasible solutions are obtained for different impulse points. Finally, a numerical example is provided to apply the proposed technique for all feasible solutions and the global minimum‐time solution with initial coasting time.
Adaptability of the Logistics System in National Economic Mobilization Based on Blocking Flow Theory
Authors: Jing Xiangyuan , Tan Qingmei , Wu Liusan , Li Xiaohui
Published: April 2014

In the process of national economic mobilization, the logistics system usually suffers from negative impact and/or threats of such emergency events as wars and accidents, which implies that adaptability of the logistics system directly determines realization of economic mobilization. And where the real‐time rescue operation is concerned, heavy traffic congestion is likely to cause a great loss of or damage to human beings and their properties. To deal with this situation, this article constructs a blocking‐resistance optimum model and an optimum restructuring model based on blocking flow theories, of which both are illustrated by numerical cases and compared in characteristics and application. The design of these two models is expected to eliminate or alleviate the congestion situation occurring in the logistics system, thus effectively enhancing its adaptability in the national economic mobilization process.
On Cluster Points, Continuity, and Boundedness Associated with the Generalized Statistical Convergence in Probabilistic Normed Spaces
Authors: Das Pratulananda , Dutta Kaustubh , Karakaya Vatan
Published: April 2014

We consider the recently introduced notion ofℐ-statistical convergence (Das, Savas and Ghosal, Appl. Math. Lett., 24(9) (2011), 1509–1514, Savas and Das, Appl. Math. Lett. 24(6) (2011), 826–830) in probabilistic normed spaces and in the following (Şençimen and Pehlivan (2008 vol. 26, 2008 vol. 87, 2009)) we introduce the notions like strongℐ-statistical cluster points and extremal limit points, and strongℐ-statistical continuity and strongℐ-statisticalD-boundedness in probabilistic normed spaces and study some of their important properties.
Suppression of Brazier Effect in Multilayered Cylinders
Authors: Shima Hiroyuki , Sato Motohiro , Park Sung-Jin
Published: April 2014

When a straight hollow tube having circular cross-section is bent uniformly into an arc, the cross-section tends to ovalize or flatten due to the in-plane stresses induced by bending; this ovalization phenomenon is called the Brazier effect. The present paper is aimed at theoretical formulation of the Brazier effect observed in multilayered cylinders, in which a set of thin hollow cylinders are stacked concentrically about the common axis. The results indicate that mechanical couplings between stacked cylinders are found to yield pronounced suppression of the cross-sectional ovalization. Numerical computations have been performed to measure the degree of suppression in a quantitative manner and to explore how it is affected by the variations in the bending curvature, the number of stacked cylinders, and the interlayer coupling strength.
Si‐Jun‐Zi Decoction Treatment Promotes the Restoration of Intestinal Function after Obstruction by Regulating Intestinal Homeostasis
Authors: Yu Xiangyang , Cui Zhigang , Zhou Zhenli , Shan Tao , Li Donghua , Cui Naiqiang
Published: April 2014

Intestinal obstruction is a common disease requiring abdominal surgery with significant morbidity and mortality. Currently, an effective medical treatment for obstruction, other than surgical resection or decompression, does not exist. Si‐Jun‐Zi Decoction is a famous Chinese medicine used to replenish qi and invigorate the functions of the spleen. Modern pharmacological studies show that this prescription can improve gastrointestinal function and strengthen immune function. In this study, we investigated the effects of a famous Chinese herbal formula, Si‐Jun‐Zi Decoction, on the restoration of intestinal function after the relief of obstruction in a rabbit model. We found that Si‐Jun‐Zi Decoction could reduce intestinal mucosal injury while promoting the recovery of the small intestine. Further, Si‐Jun‐Zi Decoction could regulate the intestinal immune system. Our results suggest that Si‐Jun‐Zi Decoction promotes the restoration of intestinal function after obstruction by regulating intestinal homeostasis. Our observations indicate that Si‐Jun‐Zi Decoction is potentially a therapeutic drug for intestinal obstruction.
Impulsive Control and Synchronization of Complex Lorenz Systems
Authors: Aly Shaban , Al-Qahtani Ali , Khenous Houari B. , Mahmoud Gamal M.
Published: April 2014

In this paper, we continue our investigations on control and synchronization of the complex Lorenz systems by investigating impulsive control and synchronization. Nonlinear systems involving impulse effects, appear as a natural description of observed evolution phenomena of several real world problems; For example, many biological phenomena involving thresholds, bursting rhythm models in medicine and biology, optimal control models in economics, population dynamics and so forth do exhibit impulsive effects. Some new and more comprehensive criteria for global exponential stability and asymptotical stability of impulsively controlled complex Lorenz systems are established with varying impulsive intervals. The effectiveness of the proposed technique is verified through numerical simulations.
CAF: Cluster Algorithm and A-Star with Fuzzy Approach for Lifetime Enhancement in Wireless Sensor Networks
Authors: Yuan Yali , Li Caihong , Yang Yi , Zhang Xiangliang , Li Lian
Published: April 2014

Energy is a major factor in designing wireless sensor networks (WSNs). In particular, in the real world, battery energy is limited; thus the effective improvement of the energy becomes the key of the routing protocols. Besides, the sensor nodes are always deployed far away from the base station and the transmission energy consumption is index times increasing with the increase of distance as well. This paper proposes a new routing method for WSNs to extend the network lifetime using a combination of a clustering algorithm, a fuzzy approach, and an A-star method. The proposal is divided into two steps. Firstly, WSNs are separated into clusters using the Stable Election Protocol (SEP) method. Secondly, the combined methods of fuzzy inference and A-star algorithm are adopted, taking into account the factors such as the remaining power, the minimum hops, and the traffic numbers of nodes. Simulation results demonstrate that the proposed method has significant effectiveness in terms of balancing energy consumption as well as maximizing the network lifetime by comparing the performance of the A-star and fuzzy (AF) approach, cluster and fuzzy (CF)method, cluster and A-star (CA)method, A-star method, and SEP algorithm under the same routing criteria.
A New Portfolio Rebalancing Model with Transaction Costs
Authors: Wang Meihua , Li Cheng , Xue Honggang , Xu Fengmin
Published: April 2014

A portfolio rebalancing model with self-finance strategy and consideration of V-shaped transaction cost is presented in this paper. Our main contribution is that a new constraint is introduced to confirm that the rebalance necessity of the existing portfolio needs to be adjusted. The constraint is constructed by considering both the transaction amount and transaction cost without any additional supply to the investment amount. The V-shaped transaction cost function is used to calculate the transaction cost of the portfolio, and conditional value at risk (CVaR) is used to measure the risk of the portfolios. Computational tests on practical financial data show that the proposed model is effective and the rebalanced portfolio increases the expected return of the portfolio and reduces the CVaR risk of the portfolio.
Constructing Fair Destination-Oriented Directed Acyclic Graphs for Multipath Routing
Authors: Kalinowska-Górska Katarzyna , Solano Donado Fernando
Published: April 2014

Extensive research in the field of telecommunications has been done on the techniques of multipath routing, as they offer many advantages over conventional single-path routing methods. Some of these techniques make use of the so-called Destination-Oriented Directed Acyclic Graphs (DODAGs) which are constructed on the networks, usually in a distributed way. However, while defining methods of forming DODAGs, the authors of multipath algorithms tend to overlook a possibly significant issue which could, in a way, define the quality of a given DODAG in the context of multipath routing, namely, providing an equitable distribution of the paths between the nodes in the newly created DODAG. In this paper, a few requirements for constructing a “fair” DODAG are identified in the context of multipath routing. An optimization algorithm that tries to find an equitable solution according to these requirements is also presented. Three DODAG-creation algorithms that appear in the literature are simulated and compared against this equitable solution, and none of them is getting close to it in terms of fairness in the distribution of the paths. Moreover, two interesting properties of equitable solutions are revealed in the simulations.
A Refined Teaching‐Learning Based Optimization Algorithm for Dynamic Economic Dispatch of Integrated Multiple Fuel and Wind Power Plants
Authors: Krishnasamy Umamaheswari , Nanjundappan Devarajan
Published: April 2014

Dynamic economic dispatch problem (DEDP) for a multiple fuel power plant is a nonlinear and nonsmooth optimization problem when valve‐point effects, multifuel effects, and ramp‐rate limits are considered. Additionally wind energy is also integrated with the DEDP to supply the load for effective utilization of the renewable energy. Since the wind power may not be predicted, a radial basis function network (RBFN) is presented to forecast a one‐hour‐ahead wind power to plan and ensure a reliable power supply. In this paper, a refined teaching‐learning based optimization (TLBO) is applied to minimize the overall cost of operation of wind‐thermal power system. The TLBO is refined by integrating the sequential quadratic programming (SQP) method to fine‐tune the better solutions whenever discovered by the former method. To demonstrate the effectiveness of the proposed hybrid TLBO‐SQP method, a standard DEDP and one practical DEDP with wind power forecasted are tested based on the practical information of wind speed. Simulation results validate the proposed methodology which is reasonable by ensuring quality solution throughout the scheduling horizon for secure operation of the system.
A New Reconstruction of Variational Iteration Method and Its Application to Nonlinear Volterra Integrodifferential Equations
Authors: Maleknejad K. , Tamamgar M.
Published: April 2014

We reconstruct the variational iteration method that we call, parametric iteration method (PIM). The purposed method was applied for solving nonlinear Volterra integrodifferential equations (NVIDEs). The solution process is illustrated by some examples. Comparisons are made between PIM and Adomian decomposition method (ADM). Also exact solution of the 3rd example is obtained. The results show the simplicity and efficiency of PIM. Also, the convergence of this method is studied in this work.
Substance Use and Associated Factors among University Students in Ethiopia: A Cross-Sectional Study
Authors: Tesfaye Gezahegn , Derese Andualem , Hambisa Mitiku Teshome
Published: April 2014

Studies indicate that substance use among Ethiopian adolescents is considerably rising; in particular college and university students are the most at risk of substance use. The aim of the study was to assess substance use and associated factors among university students. A cross-sectional survey was carried out among 1040 Haramaya University students using self-administered structured questionnaire. Multistage sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done. About two-thirds (62.4%) of the participants used at least one substance. The most commonly used substance was alcohol (50.2%). Being male had strong association with substance use (AOR (95% CI), 3.11 (2.20, 4.40)). The odds of substance use behaviour is higher among third year students (AOR (95% CI), 1.48 (1.01, 2.16)). Being a follower of Muslim (AOR (95% CI), 0.62 (0.44, 0.87)) and Protestant (AOR (95% CI), 0.25 (0.17, 0.36)) religions was shown to be protective of substance use. Married (AOR (95% CI), 1.92 (1.12, 3.30)) and depressed (AOR (95% CI), 3.30 (2.31, 4.72)) students were more likely to use substances than others. The magnitude of substance use was high. This demands special attention, emergency preventive measures, and targeted information, education and communication activity.
Precise Large Deviations of Aggregate Claims with Dominated Variation in Dependent Multi-Risk Models
Authors: Wang Shijie , Wang Xuejun , Wang Wensheng
Published: April 2014

We consider a dependent multirisk model in insurance, where all the claims constitute a linearly extended negatively orthant dependent (LENOD) random array, and then upper and lower bounds for precise large deviations of nonrandom and random sums of random variables with dominated variation are investigated. The obtained results extend some related existing ones.
Probiotics in the Treatment of Chronic Rhinoconjunctivitis and Chronic Rhinosinusitis
Authors: Kramer Matthias F. , Heath Matthew D.
Published: April 2014

Chronic rhinitis and rhinosinusitis (CRS) are relevant health conditions affecting significant percentages of the western population. They are frequently coexisting and aggravating diseases. Both are chronic, noninfectious, and inflammatory conditions sharing to a certain extent important pathophysiologic similarities. Beneficial effects of probiotics are long known to mankind. Research is beginning to unravel the true nature of the human microbiome and its interaction with the immune system. The growing prevalence of atopic diseases in the developed world led to the proposition of the “hygiene hypothesis.” Dysbiosis is linked to atopic diseases; probiotic supplementation is able to alter the microbiome and certain probiotic strains have immunomodulatory effects in favour of a suppression of Th-2 and stimulation of a Th1 profile. This review focuses on randomized, double-blind, placebo-controlled trials investigating clinical parameters in the treatment of chronic rhinitis and CRS. An emerging number of publications demonstrate beneficial effects using probiotics in clinical double-blind placebo-controlled (dbpc) trials in allergic rhinitis (AR). Using probiotics as complementary treatment options in AR seems to be a promising concept although the evidence is of a preliminary nature to date and more convincing trials are needed. There are no current data to support the use of probiotics in non-AR or CRS.
Epstein–Barr Virus Serology as a Potential Screening Marker for Nasopharyngeal Carcinoma among High-Risk Individuals from Multiplex Families in Taiwan
Authors: Coghill Anna E. , Hsu Wan-Lun , Pfeiffer Ruth M. , Juwana Hedy , Yu Kelly J. , Lou Pei-Jen , Wang Cheng-Ping , Chen Jen-Yang , Chen Chien-Jen , Middeldorp Jaap M. , Hildesheim Allan
Published: April 2014

Background: Nasopharyngeal carcinoma (NPC) is an Epstein–Barr virus (EBV)–associated cancer that is highly treatable when diagnosed early, with 5-year disease-free survival of approximately 90%. However, NPC is typically diagnosed at advanced stages, in which disease-free survival is <50%. There is, therefore, a need for clinical tools to assist in early NPC detection, particularly among high-risk individuals.

Methods: We evaluated the ability of anti-EBV IgA antibodies to detect incident NPC among high-risk Taiwanese individuals. NPC cases (N = 21) and age- and sex-matched controls (N = 84) were selected. Serum collected before NPC diagnosis was tested for ELISA-based IgA antibodies against the following EBV peptides: EBNA1, VCAp18, EAp138, Ead_p47, and VCAp18 + EBNA1 peptide mixture. The sensitivity, specificity, and screening program parameters were calculated.

Results: EBNA1 IgA had the best performance characteristics. At an optimized threshold value, EBNA1 IgA measured at baseline identified 80% of the high-risk individuals who developed NPC during follow-up (80% sensitivity). However, approximately 40% of high-risk individuals who did not develop NPC also tested positive (false positives). Application of EBNA1 IgA as a biomarker to detect incident NPC in a previously unscreened, high-risk population revealed that 164 individuals needed to be screened to detect 1 NPC and that 69 individuals tested positive per case detected.

Conclusions: EBNA1 IgA proved to be a sensitive biomarker for identifying incident NPC, but future work is warranted to develop more specific screening tools to decrease the number of false positives.

Impact: Results from this study could inform decisions about screening biomarkers and referral thresholds for future NPC early-detection program evaluations. Cancer Epidemiol Biomarkers Prev; 23(7); 1213–9. ©2014 AACR.
Circulating Estrogen Metabolites and Risk of Breast Cancer in Postmenopausal Women
Authors: Arslan Alan A. , Koenig Karen L. , Lenner Per , Afanasyeva Yelena , Shore Roy E. , Chen Yu , Lundin Eva , Toniolo Paolo , Hallmans Göran , Zeleniuch-Jacquotte Anne
Published: April 2014

Background: It has been hypothesized that predominance of the 2-hydroxylation estrogen metabolism pathway over the 16α-hydroxylation pathway may be inversely associated with breast cancer risk.

Methods: We examined the associations of invasive breast cancer risk with circulating 2-hydroxyestrone (2-OHE1), 16α-hydroxyestrone (16α-OHE1), and the 2-OHE1:16α-OHE1 ratio in a case–control study of postmenopausal women nested within two prospective cohorts: the New York University Women's Health Study (NYUWHS) and the Northern Sweden Mammary Screening Cohort (NSMSC), with adjustment for circulating levels of estrone, and additional analyses by tumor estrogen receptor (ER) status. Levels of 2-OHE1 and 16α-OHE1 were measured using ESTRAMET 2/16 assay in stored serum or plasma samples from 499 incident breast cancer cases and 499 controls, who were matched on cohort, age, and date of blood donation.

Results: Overall, no significant associations were observed between breast cancer risk and circulating levels of 2-OHE1, 16α-OHE1, or their ratio in either cohort and in combined analyses. For 2-OHE1, there was evidence of heterogeneity by ER status in models adjusting for estrone (P ≤ 0.03). We observed a protective association of 2-OHE1 with ER+ breast cancer [multivariate-adjusted OR for a doubling of 2-OHE1, 0.67 (95% confidence interval [CI], 0.48–0.94; P = 0.02)].

Conclusions: In this study, higher levels of 2-OHE1 were associated with reduced risk of ER+ breast cancer in postmenopausal women after adjustment for circulating estrone.

Impact: These results suggest that taking into account the levels of parent estrogens and ER status is important in studies of estrogen metabolites and breast cancer. Cancer Epidemiol Biomarkers Prev; 23(7); 1290–7. ©2014 AACR.
Effects of Systematic Patient Education in Skin Care and Protection in a Hand Eczema Clinic
Authors: Corti Michela A.M. , Stirnimann Regina , Borradori Luca , Simon Dagmar
Published: April 2014

Background: Hand eczema has a high impact on patients' quality of life. The treatment focuses on improving skin barrier function. Objectives: To evaluate the effects and acceptance of a novel educational program for patients with hand eczema. Methods: Retrospectively, the records of 36 patients who attended the prevention program and follow-up visits were analyzed. Physician global assessment (PGA) scores, acceptance and behavioral changes were assessed. Results: In 67% of patients, an improvement of the hand eczema could be attributed to the effects of our educational program. The mean PGA score significantly decreased from 3 before education to 2.2 during follow-up. Behavioral changes in both skin care and protection were reported in 81 and 86%, respectively. Conclusions: Our educational program had a positive effect on clinical outcome as well as adherence to skin care and protection measures. Its integration in a hand eczema clinic was feasible and well accepted by the patients.
Accurate Detection of Parkinson's Disease in Tremor Syndromes Using Olfactory Testing
Authors: Wolz Martin , Hähner Antje , Meixner Linda , Löhle Matthias , Reichmann Heinz , Hummel Thomas , Storch Alexander
Published: April 2014

Background/Aims: The diagnostic value of olfactory testing for the discrimination of tremor-dominant Parkinson's disease (PD) from other tremor disorders remains enigmatic. We evaluated whether olfactory testing can accurately detect PD in tremor patients. Methods: A retrospective analysis of 299 consecutive subjects referred for the differential diagnosis of a tremor disorder was done. Olfactory testing was performed using ‘Sniffin' Sticks', resulting in a composite TDI score of odor threshold (T), discrimination (D), and identification (I). Receiver operating curve (ROC) plots were used to calculate sensitivity/specificity for the detection of PD. Results: Of all subjects, 167 (55.9%) had PD and 85 (28.4%) had essential tremor (ET). The mean TDI score in PD was significantly reduced compared to those in ET and other tremor disorders with no differences between ET and other tremor disorders. ROC analysis revealed strong correlations of TDI scores with PD [area under the curve: 0.85 (95% CI: 0.80-0.89); p < 0.001]. The highest Youden index was observed for a TDI score <25 (Youden index: 0.58). Using this cutoff score and that generated from normative data of healthy controls, the TDI score provided high sensitivity (negative predictive value) and specificity (positive predictive value) of approximately 80% for detecting PD. Conclusion: Olfactory testing is a useful, easily applied and inexpensive diagnostic test which is helpful to detect PD among tremor patients.
Antidepressant and Neuroprotective Effect of the Chinese Herb Kaixinsan against Lentiviral shRNA Knockdown Brain-Derived Neurotrophic Factor-Induced Injury in vitro and in vivo
Authors: Hu Yuan , Zhou Xiao-Jiang , Liu Ping , Dong Xian-Zhe , Mu Li-Hua , Chen Yi-Bang , Liu Ming-Yue , Yu Bing-Ying
Published: April 2014

Depression has been associated with reduced expression of brain-derived neurotrophic factor (BDNF) in the hippocampus. Previous studies have demonstrated that the herbal medicine formula, ‘kaixinsan' (KXS), could ameliorate the severity of depression and increase cAMP response element-binding protein expression. There is direct evidence suggesting that the reduction of the BDNF protein in specific brain sites can provoke depressive-like behaviour or affect neurogenesis in vivo. However, the biological mechanisms between the antidepressant and neuroprotective effect of KXS and the alterations in BDNF levels in in vivo and in vitro models remain unclear. Using BDNF knockdown mediated by lentiviral vectors (LV-shBDNF-3) transfected with primary hippocampal neurons and following injection into the dentate gyrus of the hippocampus, it was demonstrated that a reduction in BDNF expression affects cell viability and animal behaviours associated with depression. During treatment with KXS after the lentiviral shRNA silencing of BDNF in cell and animal, cell viability, body weight, the sucrose preference test (SPT), the open field test (OFT) the Morris Water Maze (MWM) task and BDNF expression were measured. KXS attenuated LV-shBDNF-3-induced cell death in primary hippocampal neurons and also improved the sucrose intake in SPT, ambulatory response in OFT and learning ability in MWM against LV-shBDNF-3-induced depressive-like syndromes. Moreover, immunoblot analysis confirmed that KXS could reverse LV-shBDNF-induced BDNF reduction either in vitro or in vivo. These findings provide substantial evidence for supporting a neurotrophic hypothesis of depression and specify BDNF targets for potential antidepressant interventions. Moreover, the antagonism between LV-shRNA BDNF knockdown and KXS may depend on multiple compounds with synergistic mechanisms that modulate the different signal transduction networks directly or indirectly, increasing BDNF expression and exerting its neuroprotective and antidepressant-like effects.
Detection Rate of Anterior Prostate Cancer in 226 Patients Submitted to Initial and Repeat Transperineal Biopsy
Authors: Pepe Pietro , Dibenedetto Giuseppe , Pennisi Michele , Fraggetta Filippo , Colecchia Maurizio , Aragona Francesco
Published: April 2014

Objective: To evaluate the detection rate of anterior zone (AZ) prostate cancer (PCa) in patients submitted to initial and repeat transperineal prostate biopsy. Methods: From January 2013 to August 2013, 226 patients (median age 64 years) with negative digital rectal examination underwent initial (144 cases) and repeat (82 cases) transperineal prostate biopsy for PSA >10 ng/ml, PSA 4.1-10.0 or 2.6-4.0 ng/ml with free/total PSA ≤25% and ≤20%, respectively. A median of 22 versus 32 cores were performed, including 4 cores of the AZ versus 6 cores (4 anterior plus 2 cores of the transition zone, TZ) at initial versus repeat biopsy, respectively. The detection rate of PCa of the peripheral zone (PZ), AZ and TZ was prospectively evaluated. Results: The median PSA was 7.6 ng/ml; overall, a stage cT1c PCa was found in 104/226 (46%) patients, in 70 (48.6%) and 34 (41.5%) of the men who underwent initial and repeat biopsy, respectively. An AZ PCa was found in 11.5 vs. 8.8% (p = 0.32) of the patients submitted to initial versus repeat biopsy, respectively. AZ cancers demonstrated a number of positive cores (p = 0.03), greatest percentage of cancer (p = 0.001) and total percentage of cancer (p = 0.001) significantly lower in comparison with PZ PCa; moreover, 56.2 vs. 36.5% of AZ versus PZ PCa were characterized by a microfocus of cancer (p = 0.001), respectively. Conclusions: AZ biopsies increase the detection rate of PCa (about 10% of cases) at initial and repeat biopsy, allowing reduction of the biopsy false-negative rate.
Association Study of GABRG2 Polymorphisms with Suicidal Behaviour in Schizophrenia Patients with Alcohol Use Disorder
Authors: Zai Clement C. , Zai Gwyneth C. , Tiwari Arun K. , Manchia Mirko , de Luca Vincenzo , Shaikh Sajid A. , Strauss John , Kennedy James L.
Published: April 2014

Background: Schizophrenia is a severe neuropsychiatric disorder where the role of γ-aminobutyric acid (GABA), an inhibitory neurotransmitter, has been implicated in its aetiopathophysiology. Several genes coding for GABAA subunits, including the GABRG2 gene that encodes the γ2 subunit, are clustered at 5q31-q35, a chromosomal region that is associated with schizophrenia in genome scan studies. We recently reported GABRG2 to be associated with schizophrenia in our case-control and family samples. Methods: We tested eight single-nucleotide polymorphisms spanning the GABRG2 gene for an association with suicidal behaviour in our schizophrenia sample of European ancestry (n = 197), taking into account history of alcohol abuse or dependence. Results: We found the haplotypes of the rs183294 and rs209356 markers to be significantly associated with history of suicide attempt (p < 0.01) as well as suicide specifier scores (p < 0.05). The association appeared to be originating in patients with a history of alcohol dependence or abuse. Conclusions: Taken together, the results of the present study suggest that GABRG2 may be involved in suicidal behaviour in schizophrenia patients with alcohol dependence or abuse, but replications are required. These results may help in the discovery of novel treatments for alcoholism and/or prevention of suicide.
Clinical Outcomes after Arteriovenous Fistula Creation in Chronic Kidney Disease
Authors: Lee Mardiana , Roberts Matthew A. , Smith Maree-Ross , Chuen Jason , Mount Peter F.
Published: April 2014

Background: Optimal timing of arteriovenous fistula (AVF) surgery in chronic kidney disease (CKD) is uncertain. Methods: A single-centre retrospective study of pre-dialysis CKD patients having first AVF surgery. Results: The median estimated glomerular filtration rate (eGFR) at the time of AVF surgery in 100 patients was 15 ml/min/1.73 m2, with patients classified as having an early AVF if eGFR was >15 ml/min/1.73 m2 (n = 46) or a late AVF if eGFR was ≤15 ml/min/1.73 m2 (n = 54). In the eGFR ≤15 group, 81% of patients started haemodialysis (HD), compared with 63% of the eGFR >15 patients (p = 0.04). The median time to starting HD was 30.3 months in the eGFR >15 group compared to 10.7 months for the eGFR ≤15 group (log rank p = 0.018). There were no differences in the requirements for a dialysis catheter (eGFR >15 24% vs. eGFR ≤15 11%, p = 0.20) or additional access procedures between the two groups. Conclusions: AVF surgery with an eGFR >15 ml/min/1.73 m2 was associated with a higher risk of AVF non-use and a more prolonged time to the need for HD.
13C Enrichment of the CO2 in Breast Milk and in the Breath Is Rapidly Modified by Changes in the 13C Content of the Diet
Authors: Villalpando Salvador , Del Prado Martha , Cienfuego Edith , Morales Pedro
Published: April 2014

Background: C4 plants (e.g. corn and sugar cane) have greater 13C enrichment than C3 plants (e.g. wheat and sugar beet). Objective: To assess whether 13C enrichment of CO2 in the breath and breast milk of women on diets based on C3 and C4 foods changes from one diet to the other. Materials and Methods: Six breast-feeding women were studied at 5-6 months postpartum. They ate a controlled C4 diet on days 1 and 2 followed by a C3 diet on days 3 and 4. Diet duplicates, breast milk on days 2 and 4 and hourly breath samples were collected over 4 days. 13C enrichment was measured by isotope-ratio mass spectrometry. Values of δ13C were calculated from the international PDBV standard (δ13CPDBV). Differences between means were compared by paired t test or t test for repeated measurements. Results: δ13CPDBV values were significantly higher in the C4 diet than in the C3 diet composites (p < 0.01). In breath CO2, the δ13CPDBV value was greater on days 1 and 2 (range -15.4 to -13.2, respectively) and declined on days 3 and 4 (range -20.0 to -21.8, respectively, p < 0.01). The lipid and milk serum fractions of breast milk had significantly higher δ13CPDBV on the C3 diet than on the C4 diet (p < 0.01). Conclusions: Subjects eating a C4 diet have a higher δ13CPDBV value in the breath and breast milk fractions, which diminish rapidly on a C3 diet. Further studies focusing on individual nutrients are warranted.
The Safety of Specific Immunotherapy for Patients Allergic to House-Dust Mites and Pollen in Relation to the Development of Neoplasia and Autoimmune Disease: A Long-Term, Observational Case-Control Study
Authors: Bozek Andrzej , Kozłowska Renata , Jarzab Jerzy
Published: April 2014

Background: Specific immunotherapy (SIT) safety has been well documented. However, the prolonged late side effects in patients who terminated SIT several years previously have been reported on in only a limited number of studies. The aim of this study was to perform a 20-year post-SIT observational evaluation for the assessment of any manifestation of serious immunological disease. Materials and Methods: In total, 1,144 patients (521 women and 623 men), with a mean age of 22.8 ± 16.9 years (at the moment of SIT completion) and who had atopic bronchial asthma and/or allergic rhinitis, were observed 20 years after immunotherapy. New neoplastic and autoimmune disease cases were monitored. The SIT group was compared to a control group consisting of 1,154 allergic patients who had never received SIT and had only had symptomatic treatment. Results: There was an inverse association between SIT treatment and the prevalence of new chronic myeloid leukemia and chronic lymphoblastic leukemia cases (OR 0.32, 95% CI 0.18-0.81 and OR 0.58, CI 0.44-0.78, respectively). In other neoplastic diseases, however, prevalences similar to those observed in the control group were confirmed. There were also no significant differences in the autoimmune disease prevalence between the analyzed groups. Conclusion: The results of this long-term observational study indicate a lack of a significant prevalence for new instances of neoplastic and autoimmune diseases, which suggests that SIT in the long term is indeed safe.
Comparative Chromosome Mapping of U2 snRNA and 5S rRNA Genes in Gymnotus Species (Gymnotiformes, Gymnotidae): Evolutionary Dynamics and Sex Chromosome Linkage in G. pantanal
Authors: Utsunomia Ricardo , Scacchetti Priscilla C. , Pansonato-Alves José C. , Oliveira Claudio , Foresti Fausto
Published: April 2014

A comparative mapping of U2 small nuclear RNA (snRNA) and 5S ribosomal RNA (rRNA) genes was performed in 6 Gymnotus species. All species analyzed presented the U2 snDNA organized in conspicuous blocks and not co-located with rRNA genes. In addition, 5 species showed the U2 snDNA located in a single pair of chromosomes, which seems to be a conserved trait in this genus. Conversely, G. pantanal was the only species displaying several terminal signals in different chromosome pairs, including the X1 sex chromosome but not the Y chromosome. This is the first report of U2 snRNA genes in sex chromosomes of fishes. The absence of sites in the Y chromosome of G. pantanal indicates a possible loss of terminal segments of the chromosomes involved in the Y formation.
Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences?
Authors: Kleemann Markus , Benecke Claudia , Helfrich Diana , Bruch Hans-Peter , Keck Tobias , Laubert Tilman
Published: April 2014

Background: Since the beginning of the new millennium gender medicine has become more and more relevant. The goal has been to unveil differences in presentation, treatment response, and prognosis of men and women with regard to various diseases. Methods: This study encompassed 1,061 patients who underwent surgery for rectal cancer at the Department of Surgery, University Medical Center Schleswig-Holstein Campus Lübeck, Germany, between January 1990 and December 2011. Prospectively documented demographic, clinical, pathological, and follow-up data were obtained. Analysis encompassed the comparison of clinical, histopathological, and oncological parameters with regard to the subcohorts of male and female patients. Results: No statistically significant differences could be found for clinical and histopathological parameters, location of tumor, resection with or without anastomosis, palliative or curative treatment, conversion rates, duration of surgery, and long-term survival. For the entire cohort, gender-related statistically significant differences in complications encompassed anastomotic leakage, burst abdomen, pneumonia, and urinary tract complications all of which occurred more often in men. Conclusion: Data obtained in this study suggest that there are no gender-related differences in the oncologic surgical treatment of patients with rectal carcinoma. However, male sex seems to be a risk factor for increased early postoperative morbidity.
Insomnia Subtypes and the Subsequent Risks of Stroke
Authors: Wu Ming-Ping , Lin Huey-Juan , Weng Shih-Feng , Ho Chung-Han , Wang Jhi-Joung , Hsu Ya-Wen
Published: April 2014

Background and Purpose—

The studies assessing the impact of insomnia on stroke are still lacking. We aim to investigate insomnia in relation to subsequent stroke during the 4-year follow-up.

Methods—

Data from the Taiwan National Health Insurance Research Database were used. Enrollees with
International Classification of Diseases, Ninth Revision
,
Clinical Modification
diagnosis code for insomnia were compared with randomly selected, age- and sex-matched noninsomnia enrollees with subsequent hospitalization for stroke during the 4-year follow-up. All enrollees, insomniacs and noninsomniacs, did not have previous diagnosis of stroke, sleep apnea, and insomnia. Individuals with insomnia were further categorized into different subgroups based on their insomnia patterns to explore whether the risk of stroke varies by subtype. The risk of outcomes was assessed with Kaplan–Meier curves and the impact of insomnia was estimated using Poisson regression analysis and Cox proportional hazards models.

Results—

The study included 21 438 (mean age, 52±16 years) insomniacs and 64 314 matched noninsomniacs (mean age, 51±16 years). Compared with noninsomniacs, insomniacs had 54% higher risk of developing stroke (adjusted hazard ratio, 1.54; 95% confidence interval, 1.38–1.72). When breaking down into insomnia subgroups, the persistent insomniacs had a higher 3-year cumulative incidence rate of stroke than those in the remission group (
P
=0.024). The insomniacs-to-noninsomniacs incidence rate ratio for stroke was highest among those aged 18 to 34 years (incidence rate ratio, 8.06).

Conclusions—

Insomnia predisposes individuals to increased risk of stroke and this association is profound among young adults. Our results underscore the clinical importance of identifying and treating insomnia. A novel behavioral intervention targeting insomnia that may prevent stroke should be explored.
Vertebral Artery Hypoplasia
Authors: Thierfelder Kolja M. , Baumann Alena B. , Sommer Wieland H. , Armbruster Marco , Opherk Christian , Janssen Hendrik , Reiser Maximilian F. , Straube Andreas , von Baumgarten Louisa
Published: April 2014

Background and Purpose—

Vertebral artery hypoplasia (VAH) is supposed to be a risk factor for posterior circulation ischemia (PCI), particularly in the territory of the posterior inferior cerebellar artery (PICA). The aim of our study was to determine whether VAH impedes perfusion in the dependent PICA territory even in the absence of manifest PCI.

Methods—

VA diameter was retrospectively measured in 934 consecutive patients who underwent whole-brain multimodal computed tomography because of suspected stroke. VAH was defined by a diameter of ≤2 mm and an asymmetry ratio of ≤1:1.7 of both VAs. We performed blinded computed tomography perfusion reading in patients with VAH without PCI (MRI-confirmed) and in control patients (ratio 1:2) with normal VAs. Four different perfusion maps were evaluated for a relative hypoperfusion in the PICA territory.

Results—

VAH was found in 146 of 934 patients (15.6%). It was more frequent on the right side (66.1%). Of 146 patients, 59 without PCI qualified for computed tomography perfusion analysis. Depending on the perfusion map, ≤42.4% (25/59) of patients with VAH, but only 7.6% (9/118) without VAH, showed an ipsilateral PICA hypoperfusion (
P
<0.001). Sensitivities in patients with VAH were as follows: time to drain 42.4% (25/59)>mean transit time 39.0% (23/59)>cerebral blood flow 25.4% (15/59). Cerebral blood volume was never affected.

Conclusions—

VAH is a frequent vascular variant that can lead to a relative regional hypoperfusion in the PICA territory. Additional research should clarify the pathophysiological role of VAH in PCI.
Clopidogrel Plus Aspirin Versus Warfarin in Patients With Stroke and Aortic Arch Plaques
Authors: Amarenco Pierre , Davis Stephen , Jones Elizabeth F. , Cohen Ariel A. , Heiss Wolf-Dieter , Kaste Markku , Laouénan Cédric , Young Dennis , Macleod Malcolm , Donnan Geoffrey A. , Bladin Christopher F. , Chambers Brian R. , Frayne Judith , Hankey Graeme J. , Levi Christopher R. , Read Stephen J. , Ravaud Philippe , Tatlisumak Turgut , Soinne Lauri , Laine Mika , Syvänne Mikko , Vikatmaa Pirkka , Lepäntalo Mauri , Mentré France , Gosset Simon , Churilov Leonid , De Broucker Thomas , Favrole Pascal , Mawet Jérôme , Mocquard Yves , Obadia Michael , Godefroy Olivier , Hosseini Hassan , Pico Fernando , Garnier Pierre , Malbec Marcel , Pinel Jean-François , Ille Olivier , Vadamme Xavier , Macian-Montoro Francisco , Servan Jérôme , Viallet François , Rosolacci Thierry , Lecoz Patrick , Clavelou Pierre , Detante Olivier , Cho Tae-Hee , Saudeau Denis , Michel Patrik , D’Ombrogio Suzette , Serisier David , Sturm Jonathon , Kimber Thomas , Marcus Romesh , Schwartz Ray , Helme Rob , Blacker David , Wood Jonathan
Published: April 2014

Background and Purpose—

Severe atherosclerosis in the aortic arch is associated with a high risk of recurrent vascular events, but the optimal antithrombotic strategy is unclear.

Methods—

This prospective randomized controlled, open-labeled trial, with blinded end point evaluation (PROBE design) tested superiority of aspirin 75 to 150 mg/d plus clopidogrel 75 mg/d (A+C) over warfarin therapy (international normalized ratio 2–3) in patients with ischemic stroke, transient ischemic attack, or peripheral embolism with plaque in the thoracic aorta >4 mm and no other identified embolic source. The primary end point included cerebral infarction, myocardial infarction, peripheral embolism, vascular death, or intracranial hemorrhage. Follow-up visits occurred at 1 month and then every 4 months post randomization.

Results—

The trial was stopped after 349 patients were randomized during a period of 8 years and 3 months. After a median follow-up of 3.4 years, the primary end point occurred in 7.6% (13/172) and 11.3% (20/177) of patients on A+C and on warfarin, respectively (log-rank,
P
=0.2). The adjusted hazard ratio was 0.76 (95% confidence interval, 0.36–1.61;
P
=0.5). Major hemorrhages including intracranial hemorrhages occurred in 4 and 6 patients in the A+C and warfarin groups, respectively. Vascular deaths occurred in 0 patients in A+C arm compared with 6 (3.4%) patients in the warfarin arm (log-rank,
P
=0.013). Time in therapeutic range (67% of the time for international normalized ratio 2–3) analysis by tertiles showed no significant differences across groups.

Conclusions—

Because of lack of power, this trial was inconclusive and results should be taken as hypothesis generating.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00235248.
Declining Mortality in Cerebral Venous Thrombosis
Authors: Coutinho Jonathan M. , Zuurbier Susanna M. , Stam Jan
Published: April 2014

Background and Purpose—

Cerebral venous thrombosis (CVT) is nowadays considered a disease with a good outcome in most cases, but in the past, these patients were thought to have a grave prognosis. We systematically studied the apparent decline in mortality of patients with CVT over time.

Methods—

A systematic review of the literature (MEDLINE and EMBASE) was performed. Studies with ≥40 patients with CVT that reported mortality at discharge or follow-up were eligible. Duplicate publications based on the same patient cohort were excluded. Studies were ranked according to the year halfway the period of patient inclusion. Two of the authors independently screened all eligible studies.

Results—

We screened 4585 potentially eligible studies, of which 74 fulfilled the selection criteria. The number of patients per study varied from 40 to 706 (median, 76). Data from 8829 patients with CVT, included from 1942 to 2012, were analyzed. The average age was 32.9 years, and 64.7% were women. There was a significant inverse correlation between mortality and year of patient recruitment (Pearson correlation coefficient, −0.72;
P
<0.001). In a sensitivity analysis, the correlation remained significant after exclusion of studies published before 1990, retrospective studies, or single-center studies. Both the frequency of focal neurological deficits and coma also decreased significantly over time (correlation coefficient, −0.50 and −0.52).

Conclusions—

There is a clear trend in declining mortality among patients with CVT over time. Possible explanations are improvements in treatment, a shift in risk factors, and, most importantly, the identification of less severe cases by improved diagnostic methods.
Comparison of Magnetic Resonance Imaging Mismatch Criteria to Select Patients for Endovascular Stroke Therapy
Authors: Mishra Nishant K. , Albers Gregory W. , Christensen Søren , Marks Michael , Hamilton Scott , Straka Matus , Liggins John T.P. , Kemp Stephanie , Mlynash Michael , Bammer Roland , Lansberg Maarten G.
Published: April 2014

Background and Purpose—

The Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution 2 (DEFUSE 2) study has shown that clinical response to endovascular reperfusion differs between patients with and without perfusion–diffusion (perfusion-weighted imaging–diffusion-weighted imaging, PWI–DWI) mismatch: patients with mismatch have a favorable clinical response to reperfusion, whereas patients without mismatch do not. This study examined whether alternative mismatch criteria can also differentiate patients according to their response to reperfusion.

Methods—

Patients from the DEFUSE 2 study were categorized according to vessel occlusion on magnetic resonance angiography (MRA) and DWI lesion volume criteria (MRA–DWI mismatch) and symptom severity and DWI criteria (clinical–DWI mismatch). Favorable clinical response was defined as an improvement of ≥8 points on the National Institutes of Health Stroke Scale (NIHSS) by day 30 or an NIHSS score of ≤1 at day 30. We assessed, for each set of criteria, whether the association between reperfusion and favorable clinical response differed according to mismatch status.

Results—

A differential response to reperfusion was observed between patients with and without MRA–DWI mismatch defined as an internal carotid artery or M1 occlusion and a DWI lesion <50 mL. Reperfusion was associated with good functional outcome in patients who met these MRA–DWI mismatch criteria (odds ratio [OR], 8.5; 95% confidence interval [CI], 2.3–31.3), whereas no association was observed in patients who did not meet these criteria (OR, 0.5; 95% CI, 0.08–3.1;
P
for difference between the odds, 0.01). No differential response to reperfusion was observed with other variations of the MRA–DWI or clinical–DWI mismatch criteria.

Conclusions—

The MRA–DWI mismatch is a promising alternative to DEFUSE 2’s PWI–DWI mismatch for patient selection in endovascular stroke trials.