bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor impairment in very preterm‐born children: links with other developmental deficits at 5 years of age
Authors: Van Hus Janeline W , Potharst Eva S , Jeukens‐Visser Martine , Kok Joke H , Van Wassenaer‐Leemhuis Aleid G
Published: October 2013

Aim

To elucidate the relation between motor impairment and other developmental deficits in very preterm‐born children without disabling cerebral palsy and term‐born comparison children at 5 years of (corrected) age.

Method

In a prospective cohort study, 165 children (81 very preterm‐born and 84 term‐born) were assessed with the Movement Assessment Battery for Children ‐ 2nd edition, Touwen's neurological examination, the Wechsler Preschool and Primary Scale of Intelligence, processing speed and visuomotor coordination tasks of the Amsterdam Neuropsychological Tasks, and the Strengths and Difficulties Questionnaire.

Results

Motor impairment (≤15th centile) occurred in 32% of the very preterm‐born children compared with 11% of their term‐born peers (p=0.001). Of the very preterm‐born children with motor impairment, 58% had complex minor neurological dysfunctions, 54% had low IQ, 69% had slow processing speed, 58% had visuomotor coordination problems, and 27%, 50%, and 46% had conduct, emotional, and hyperactivity problems respectively. Neurological outcome (odds ratio [OR]=41.7, 95% confidence intervals [CI] 7.5–232.5) and Full‐scale IQ (OR=7.3, 95% CI 1.9–27.3) were significantly and independently associated with motor impairment. Processing speed (OR=4.6, 95% CI 1.8–11.6) and attention (OR=3.2, 95% CI 1.3–7.9) were additional variables associated with impaired manual dexterity. These four developmental deficits mediated the relation between preterm birth and motor impairment.

Interpretation

Complex minor neurological dysfunctions, low IQ, slow processing speed, and hyperactivity/inattention should be taken into account when very preterm‐born children are referred for motor impairment.
Determinants of gross motor function of young children with cerebral palsy: a prospective cohort study
Authors: Bartlett Doreen J , Chiarello Lisa A , Mccoy Sarah W , Palisano Robert J , Jeffries Lynn , Fiss Alyssa L , Rosenbaum Peter , Wilk Piotr
Published: October 2013

Aim

The aim of this study was to test a model of determinants of gross motor function of young children with cerebral palsy (CP).

Method

Four hundred and twenty‐nine children with CP (242 males, 187 females; mean age 3y 2mo, SD 11mo) representing all levels of the Gross Motor Function Classification System (GMFCS) participated. Children in levels I to II and III to V were classified as Groups 1 and 2 respectively. Distribution of CP was quadriplegia, 44%; hemiplegia, 24%; diplegia, 23%; triplegia, 6%; and monoplegia, 2% (data not available for 1%). Impairment and motor function data were collected by reliable assessors; parents completed questionnaires on health conditions and adaptive behavior. Seven months later, parents were interviewed about family life and services received. One year after the study onset, motor function was re‐evaluated. Analysis involved structural equation modeling.

Results

The well‐fitting model explained 58% and 75% of the variance in motor function at study completion for Groups 1 and 2 respectively. Primary impairments (spasticity, quality of movement, postural stability, and distribution of involvement; β=0.52–0.68) and secondary impairments (strength, range of motion limitations, and reduced endurance; β=0.25–0.26) explained the most variance. Adaptive behavior was a significant determinant only for Group 2 (β=0.21) and participation in community programs was significant only in Group 1 (β=0.13).

Interpretation

Motor function is supported by optimizing body structures and function for all children and enhancing adaptive behavior for children with greater motor challenges.
Unique Echocardiographic Markers of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) in the Adult
Authors: Ghaderi Fereshteh , Gholoobi Arash , Moeinipour Aliasghar
Published: October 2013

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect in adults. We report a 38‐year‐old male presenting with exertional syncope. He was referred for the evaluation of multiple muscular ventricular septal defects diagnosed on an outpatient echocardiogram. Echocardiography revealed mild left ventricular enlargement, abnormal flow‐pattern in the ventricular septum and dilatation of the right coronary artery. Pulsed‐wave Doppler with sample volume placed in the coronary ostium showed systolic coronary flow predominancy. This unique finding is characteristic for ALCAPA and can differentiate it from other coronary anomalies. Coronary angiography confirmed ALCAPA syndrome. Surgical correction was planned.
Value of Speckle Tracking for the Assessment of Right Ventricular Function in Patients Operated on for Tetralogy of Fallot. Comparison with Magnetic Resonance Imaging
Authors: Bernard Yvette , Morel Mathilde , Descotes‐Genon Vincent , Jehl Jerome , Meneveau Nicolas , Schiele Francois
Published: October 2013

Background

Right ventricular (RV) function is a major prognostic factor in patients (pts) with operated tetralogy of Fallot (TOF). We compared the results of RV speckle tracking (two‐dimensional [2D] strain) with those of magnetic resonance imaging (MRI) in this setting.

Methods

At transthoracic echocardiogram (echo), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), velocity of S‐wave at tricuspid annulus with tissue Doppler, and 2D strain (longitudinal maximal systolic strain) were recorded. Their results were compared to RV indexed end‐diastolic volume (EDV), indexed end‐systolic volume (ESV), and RV ejection fraction (EF) at MRI.

Results

Twenty‐two pts (16 M) aged 11–62 years (mean 23.2 ± 10.8) were included. Parameters of RV systolic function were as follows: RVFAC = 40 ± 10%, TAPSE = 18 ± 4 mm, S‐wave = 10 ± 0.2 cm/sec, and RV EF at MRI = 43 ± 11%. Global RV systolic strain was −15.5 ± 4.2%, free wall strain was −15.1 ± 6.3%, and septal strain was −15.8 ± 3.8% on average for the whole group. Echo indexed RV end‐diastolic area correlated with EDV at MRI (r = 0.73), as well as echo indexed RV end‐systolic area and ESV at MRI (r = 0.71). Global RV 2D strain correlated well with RV EF at MRI: r = 0.68; P < 0.05, and with ESV at MRI: r = 0.63. Feasibility, intra‐ and inter‐observer reproducibility of 2D strain were adequate.

Conclusions

Speckle tracking is a promising method to estimate RV systolic function in pts operated on for TOF.
Aneurysmally Dilated Giant Coronary Sinus Mimicking Accessory Cardiac Chamber
Authors: Vijay Sudarshan Kumar , Tiwari Bhuwan C. , Misra Mukul , Joshi Lalit Mohan , Srivastava Dharmendra Kumar
Published: October 2013

Mini‐Abstract

Coronary sinus dilatation is usually the result of anomalous drainage to the sinus, either from the persistent left superior vena cava, anomalous pulmonary vein drainage or from coronary arterio‐venous fistula. Occasionally, the degree of coronary sinus enlargement is so great that the structure is mistaken for something else, such as accessory cardiac chamber or dilated descending aorta. Herein, we describe a rare case of giant coronary sinus that has an unusual enlargement as cardiac chamber.
Prenatal Diagnosis and Successful Outcome in Neonate of Aorto‐Left Ventricle Tunnel
Authors: Jone Pei‐Ni , Mitchell Max B. , Campbell David N. , da Cruz Eduardo M.
Published: October 2013

Aorto‐left ventricular tunnel (ALVT) is an abnormal congenital communication between the ascending aorta and the left ventricle. Prenatal diagnosis is rare and can be misinterpreted as aortic insufficiency on fetal echocardiogram. We present a case of ALVT diagnosed in a fetus who underwent successful early neonatal surgical repair.
Positive impact of chronic graft‐versus‐host disease on the outcome of patients with de novo myelodysplastic syndrome after allogeneic hematopoietic cell transplantation: a single‐center analysis of 115 patients
Authors: Hiramoto Nobuhiro , Kurosawa Saiko , Tajima Kinuko , Okinaka Keiji , Tada Kohei , Kobayashi Yujin , Shinohara Akihito , Inoue Yoshitaka , Ueda Ryosuke , Tanaka Takashi , Kim Sung‐Won , Yamashita Takuya , Heike Yuji , Fukuda Takahiro
Published: October 2013

To evaluate the impact of graft‐versus‐host disease (GVHD) and prognostic factors for patients with myelodysplastic syndrome (MDS) after allogeneic hematopoietic cell transplantation (allo‐HCT), we retrospectively reviewed 115 patients with MDS or acute myeloid leukemia with multilineage dysplasia (AML‐MLD) after allo‐HCT at our center. Eighty one patients received reduced‐intensity conditioning (RIC) regimens, whereas 34 received myeloablative conditioning regimens. Although the RIC group was significantly older and included more patients with poor cytogenetic risk, no difference in 4‐yr overall survival (OS) was seen between the two groups. In a multivariate analysis, covariates associated with a worse OS were the French‐American‐British stage of refractory anemia excess blasts in transformation/AML‐MLD at peak, poor cytogenetic risk, bone marrow blasts of 20% or higher at HCT and the absence of chronic GVHD (cGVHD). By using semi‐landmark analyses, we found that the presence of cGVHD significantly improved OS in high‐risk patients or the RIC group. However, there was no difference in OS between those with and without cGVHD among low‐risk MDS patients. These findings suggest that the graft‐versus‐leukemia effect may be more beneficial in high‐risk patients who do not receive intensive preparative regimens.
Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult‐to‐treat epilepsy: Evidence of clinical benefit
Authors: Fosi Tangunu , Lax‐Pericall Maria T. , Scott Rod C. , Neville Brian G. , Aylett Sarah E.
Published: October 2013

Purpose

To establish the efficacy and safety of methylphenidate (MPH) treatment for attention deficit hyperactivity disorder (ADHD) in a group of children and young people with learning disability and severe epilepsy.

Methods

This retrospective study systematically reviewed the case notes of all patients treated with methylphenidate (MPH) for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) ADHD at a specialist epilepsy center between 1998 and 2005. Treatment efficacy was ascertained using clinical global impressions (CGI) scores, and safety was indexed by instances of >25% increase in monthly seizure count within 3 months of starting MPH.

Key Findings

Eighteen (18) patients were identified with refractory epilepsies (14 generalized, 4 focal), IQ <70, and ADHD. Male patients predominated (13:5) and ADHD was diagnosed at a median age of 11.5 years (range 6–18 years). With use of a combination of a behavioral management program and MPH 0.3–1 mg/kg/day, ADHD symptoms improved in 61% of patients (11/18; type A intraclass correlation coefficient of CGI 0.85, 95% confidence interval [CI] 0.69–0.94). Daily MPH dose, epilepsy variables, and psychiatric comorbidity did not relate to treatment response across the sample. MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one). There was no statistical evidence for a deterioration of seizure control in this group with the use of MPH.

Significance

Methylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments. Eighteen percent had significant side effects but no attributable increase in seizures. Methylphenidate is useful in this group and is likely to be under employed.
Jakpot! New small molecules in autoimmune and inflammatory diseases
Authors: Ghoreschi Kamran , Gadina Massimo
Published: October 2013

Cytokines are key mediators of the development and homeostasis of haematopoietic cells, critical for host defense, but also for the development of autoimmune and inflammatory diseases such as psoriasis or rheumatoid arthritis (RA). Blocking cytokines activity by interfering with the ligand–receptor association has been successfully employed to treat several immune disorders. A subgroup of cytokines signals through receptors requiring the association with a family of cytoplasmic protein tyrosine kinases known as Janus kinases (Jaks). Jaks have recently gained significant attention as therapeutic targets in inflammation and autoimmunity, and several Jak inhibitory small molecules have been developed. The first two Jak inhibitors, tofacitinib and ruxolitinib, have been approved for the treatment of RA and primary myelofibrosis, respectively. Efficacy and safety data suggest that some of these oral Jak inhibitors as well as their topical formulations may soon enter the daily clinical practice for treating patients with psoriasis, lupus erythematosus or other inflammatory skin diseases. While biologics typically target one single cytokine, these new immunomodulators can inhibit signals from multiple cytokines intra‐cellularly and therefore could be useful when other therapies are ineffective. Thus, Jak inhibitors may replace some traditional immunosuppressive agents and help patients not responding to previous therapies.
Plant responses to elevated temperatures: a field study on phenological sensitivity and fitness responses to simulated climate warming
Authors: Springate David A. , Kover Paula X.
Published: October 2013

Significant changes in plant phenology have been observed in response to increases in mean global temperatures. There are concerns that accelerated phenologies can negatively impact plant populations. However, the fitness consequence of changes in phenology in response to elevated temperature is not well understood, particularly under field conditions. We address this issue by exposing a set of recombinant inbred lines of Arabidopsis thaliana to a simulated global warming treatment in the field. We find that plants exposed to elevated temperatures flower earlier, as predicted by photothermal models. However, contrary to life‐history trade‐off expectations, they also flower at a larger vegetative size, suggesting that warming probably causes acceleration in vegetative development. Although warming increases mean fitness (fruit production) by ca. 25%, there is a significant genotype‐by‐environment interaction. Changes in fitness rank indicate that imminent climate change can cause populations to be maladapted in their new environment, if adaptive evolution is limited. Thus, changes in the genetic composition of populations are likely, depending on the species’ generation time and the speed of temperature change. Interestingly, genotypes that show stronger phenological responses have higher fitness under elevated temperatures, suggesting that phenological sensitivity might be a good indicator of success under elevated temperature at the genotypic level as well as at the species level.
Transient Focal Neurological Episodes, Cerebral Amyloid Angiopathy, and Intracerebral Hemorrhage Risk: Looking beyond TIAs
Authors: Charidimou Andreas , Baron Jean-Claude , Werring David J.
Published: October 2013

When most doctors encounter older patients with transient focal neurological symptoms, they usually suspect a diagnosis of transient ischemic attacks or some of their known mimics (including migraine auras or focal seizures). This article emphasizes new observations on transient focal neurological episodes in the context of cerebral amyloid angiopathy, a common but under-recognized small vessel disease most often encountered as a cause of symptomatic lobar intracerebral hemorrhage. Transient focal neurological episodes in cerebral amyloid angiopathy are of clinical and pathophysiological interest because they can mimic transient ischemic attacks, but are probably more often related to bleeding (especially superficial cortical siderosis or focal convexity sub-arachnoid hemorrhage) rather than ischemia. Importantly, such episodes may also herald a very high future risk of symptomatic intracerebral hemorrhage. The article highlights scenarios encountered in clinical practice and discusses implications for patient care including: (a) the value of blood-sensitive magnetic resonance imaging sequences in investigating transient focal neurological episodes; and (b) treatment implications, as giving antiplatelet or anticoagulant drugs for these episodes could increase the risk of serious intracerebral hemorrhage.
Prevalence of postmicturition urinary incontinence in Japanese men: Comparison with other types of incontinence
Authors: Yoshimura Koji , Nakayama Takeo , Sekine Akihiro , Matsuda Fumihiko , Kosugi Shinji , Sugino Yoshio , Yoshimura Kenichi , Ogawa Osamu ,   Nagahama Cohort Research Group
Published: October 2013

Objective

To investigate the prevalence and correlates of postmicturition urinary incontinence in Japanese men, and to compare with those of other types of urinary incontinence.

Methods

A total of 3224 male participants in a community‐based survey were investigated. Three types of urinary incontinence were assessed; that is, postmicturition urinary incontinence, stress urinary incontinence and urge urinary incontinence. Age, body mass index, alcohol intake, cigarette smoking, and medical history of 18 diseases and conditions were the dependent variables for candidate correlates of the three types of incontinence.

Results

Unlike stress urinary incontinence and urge urinary incontinence, the prevalence of postmicturition urinary incontinence was constant throughout all generations (6.5% for the 30 s, 6.6% for the 40 s, 6.0% for the 50 s, 6.3% for the 60 s and 5.1% for the 70 s). The independent correlates for postmicturition urinary incontinence were asthma (P < 0.001; odds ratio 3.01), prostatic disease (P < 0.001; odds ratio 2.38), rhinosinusitis (P = 0.001; odds ratio 1.92), low back pain (P = 0.003; odds ratio 1.58), sleeplessness (P = 0.013; odds ratio 1.86), depression (P = 0.024; odds ratio 3.41) and body mass index (P = 0.025; odds ratio 0.73).

Conclusions

Postmicturition urinary incontinence has different characteristics from those of stress urinary incontinence and urge urinary incontinence. Unlike stress urinary incontinence and urge urinary incontinence, postmicturition urinary incontinence is not age‐dependent. Several diseases related to an allergic status, such as asthma and rhinosinusitis, are correlates for postmicturition urinary incontinence.
The effect of extension and loading of the carpus on radial rotation
Authors: Bitton Erez , Joseph Rotem , Portman Lena , Segev Gilad , Meiner Yaron , Shipov Anna , Milgram Joshua
Published: October 2013

Objective

To describe the direction and magnitude of the rotation of the radius relative to the ulna during extension of the carpus and to describe the effect of carpal extension on internal and external rotation of the radius relative to the ulna.

Study Design

In vitroexperiment.

Animals

Cadaveric canine thoracic limbs (n = 11).

Methods

Eleven thoracic limbs were collected from 6 healthy mixed breed dogs of medium build. Each specimen was radiographed to ensure that the carpal and elbow joints were free of pathology. The elbow joint was disarticulated and the distal thoracic limb was prepared for biomechanical testing. Each specimen was stripped of soft tissue, leaving the soft tissues around the proximal aspect of the radius and ulna intact. The interosseous ligament, pronator teres muscle, and all the soft tissues distal to the distal metaphysis of the radius were also left intact. In the 1st part of the study, the rotation of the radius relative to the ulna was measured while extending the carpal joint using a system of weights and pulleys attached to the manus. In the 2nd part of the study, the internal and external rotation of the radius relative to the ulna was performed by applying an internal and external rotational load to the radius using a system of weights and pulleys attached to the radius. The internal and external rotation of the radius was measured with the carpus unloaded and with the carpus extended by applying a load of 5 kg to the manus.

Results

Extension of the carpus resulted in internal rotation of the radius relative to the ulna. With the carpus extended under a maximum load of 2 kg, the mean (± SD) internal rotation of the radius was 4.3 ± 2.1° for all specimens. With the carpus unloaded, the mean internal and external rotation of the radius was 11.5 ± 2.9° and 22.5 ± 7.7° for all specimens, respectively. With the carpus loaded (extended under 5 kg load), the mean internal and external rotation of the radius was 3.3 ± 1.2° and 7.3 ± 2.0° for all specimens, respectively. The difference between internal and external rotation with the carpus loaded and unloaded was significant.

Conclusion

Extending the carpus results in internal rotation, and proximal translation of the radius relative to the ulna. Loading the carpus in extension decreases the internal and external rotation of the radius relative to the ulna. A better understanding of the interaction between the carpus and the elbow may improve our understanding of the pathogenesis of elbow dysplasia.
Effects of directional environmental change on extinction dynamics in experimental microbial communities are predicted by a simple model
Authors: Clements Christopher F. , Collen Ben , Blackburn Tim M. , Petchey Owen L.
Published: October 2013

Global temperatures are expected to rise between 1.1 and 6.4°C over the next 100 years, although the exact rate will depend on future greenhouse emissions, and will vary spatially. Temperature can alter an individual's metabolic rate, and consequently birth and death rates. In declining populations, these alterations may manifest as changes in the rate of that population's decline, and subsequently the timing of extinction events. Predicting such events could therefore be of considerable use. We use a small‐scale experimental system to investigate how the rate of temperature change can alter a population's time to extinction, and whether it is possible to predict this event using a simple phenomenological model that incorporates information about population dynamics at a constant temperature, published scaling of metabolic rates, and temperature. In addition, we examine 1) the relative importance of the direct effects of temperature on metabolic rate, and the indirect effects (via temperature driven changes in body size), on predictive accuracy (defined as the proximity of the predicted date of extinction to the mean observed date of extinction), 2) the combinations of model parameters that maximise accuracy of predictions, and 3) whether substituting temperature change through time with mean temperature produces accurate predictions. We find that extinction occurs earlier in environments that warm faster, and this can be accurately predicted (R2> 0.84). Increasing the number of parameters that were temperature‐dependent increased the model's accuracy, as did scaling these temperature‐dependent parameters with either the direct effects of temperature alone, or with the direct and indirect effects. Using mean temperature through time instead of actual temperature produces less accurate predictions of extinction. These results suggest that simple phenomenological models, incorporating metabolic theory, may be useful in understanding how environmental change can alter a population's rate of extinction.

Synthesis

Understanding how populations will respond to future climatic change is a key goal in ecology, however the exact rate of future warming will vary both spatially and temporally. Consequently, mathematical models must be used to understand the potential range of future population dynamics under various warming scenarios. We use a combination of experimentation and modelling to show that the effects of varying rates of environmental change on population dynamics can be predicted by a simple model. However, the accuracy of these predictions depends upon, amongst other things, a detailed knowledge of how temperature will change over time, rather than approximating this change to mean temperature.
Intravenous Alteplase in Ischemic Stroke Patients not Fully Adhering to the Current Drug License in Central and Eastern Europe
Authors: Karlinski Michal , Kobayashi Adam , Mikulik Robert , Sanak Daniel , Wahlgren Nils , Czlonkowska Anna
Published: October 2013

Background

The current European license for alteplase in acute ischemic stroke excludes from treatment large groups of patients. Nevertheless, in everyday practice, many patients receive off-label thrombolysis at the physician's discretion.

Aim

Our aim was to evaluate safety and effectiveness of intravenous alteplase in patients not fully adhering to the drug license compared with those treated strictly according to the license in Central and Eastern Europe.

Methods

We analyzed the data contributed to Safe Implementation of Thrombolysis in Stroke registry from nine countries between February 2003 and February 2010. Statistical analysis included multivariate logistic regression.

Results

Of 5594 consecutive patients, 1919 patients (34·3%) not fully adhered to the license. The most frequent deviations were: time-to-treatment >3 h (13·1%), use of intravenous antihypertensives (8·3%), age >80 years (7·3%), oral anticoagulation (4·2%), a previous stroke with concomitant diabetes (3·9%), and previous stroke <three-months (2·7%). The off-label group showed a significantly higher rate of symptomatic intracranial haemorrhage, which was not confirmed in the multivariate analysis. License nonadherence significantly increased the risk of death or dependency (odds ratio 1·26; 95% confidence interval: 1·08–1·48), with a trend for increased mortality (odds ratio 1·17; 95% confidence interval: 0·97–1·42). Isolated time-to-treatment >3 h was an independent predictor of unfavorable outcome (odds ratio 1·32; 95% confidence interval: 1·01–1·71).

Conclusion

Our findings show that patients not fully adhering to the European license are not at increased risk of symptomatic intracranial haemorrhage but achieve less favorable outcome. Some contraindications appear more redundant than others. However, the final conclusions about safety and effectiveness should be based on the results of ongoing randomized trials.
A Prospective, Randomized, Placebo-Controlled, Double-Blind Trial about Safety and Efficacy of Combined Treatment with Alteplase (rt-PA) and Cerebrolysin in Acute Ischaemic Hemispheric Stroke
Authors: Lang Wilfried , Stadler Christian H. , Poljakovic Zdravka , Fleet David ,   the Lyse Study Group
Published: October 2013

Background

The neurotrophic drug Cerebrolysin accelerated recovery and prevented acute neuronal damage in preclinical models of ischaemia. Previous clinical trials support therapeutic effects in stroke patients. The study investigated whether the combination with alteplase and Cerebrolysin is safe and can further reduce disability after acute ischaemic stroke.

Methods

This placebo-controlled, double-blind trial involved 119 patients with acute ischaemic hemispheric stroke, randomly assigned to a combined treatment with alteplase plus Cerebrolysin or placebo (administered 1 h after thrombolytic treatment) starting within three-hours after onset of symptoms. A daily i.v. infusion of 30 ml Cerebrolysin or placebo was given for 10 consecutive days. Primary outcome was the modified Rankin Scale at day 90. A sequential design with interim analyses was applied.

Results

The third interim analysis did not show a benefit in the modified Rankin Scale for Cerebrolysin on day 90 compared to placebo and the study was stopped. The National Institutes of Health Stroke Scale responder analysis (secondary outcome measure) showed significantly more patients with an improvement of 6 or more points (or a total score of 0 or 1) after two-, five-, 10, and 30 days in the Cerebrolysin group. Similar trends were observed for the modified Rankin Scale responder analysis without achieving statistical significance. There was no difference between treatment groups regarding adverse events.

Conclusions

The combination of Cerebrolysin with recombinant tissue-Plasminogen Activator is safe for treatment of acute ischaemic stroke but did not improve outcome at day 90. During the treatment period with Cerebrolysin (10 days), significantly more patients had a favourable response in neurological outcome measures (National Institutes of Health Stroke Scale) as compared to the placebo group.
A multicenter survey of re‐treatment with pegylated interferon plus ribavirin combination therapy for patients with chronic hepatitis C in Japan
Authors: Oze Tsugiko , Hiramatsu Naoki , Mita Eiji , Akuta Norio , Sakamoto Naoya , Nagano Hiroaki , Itoh Yoshito , Kaneko Shuichi , Izumi Namiki , Nomura Hideyuki , Hayashi Norio , Takehara Tetsuo
Published: October 2013

Aim:  This study aimed to clarify the factors associated the efficacy of re‐treatment with pegylated interferon (PEG IFN) plus ribavirin combination therapy for patients with chronic hepatitis C who had failed to respond to previous treatment.

Methods:  One hundred and forty‐three patients who had previously shown relapse (n = 79), non‐response (n = 34) or intolerance (n = 30) to PEG IFN plus ribavirin were re‐treated with PEG IFN plus ribavirin.

Results:  Twenty‐five patients with intolerance to previous treatment completed re‐treatment and the sustained virological response (SVR) rates were 55% and 80% for hepatitis C virus (HCV) genotype 1 and 2, respectively. On re‐treatment of the 113 patients who completed the previous treatment, the SVR rates were 48% and 63% for genotype 1 and 2, respectively. Relapse after previous treatment and a low baseline HCV RNA level on re‐treatment were associated with SVR in genotype 1 (P < 0.001). Patients with the interleukin‐28B major genotype responded significantly better and earlier to re‐treatment, but the difference in the SVR rate did not reach a significant level between the major and minor genotypes (P = 0.09). Extended treatment of 72 weeks raised the SVR rate among the patients who attained complete early virological response but not rapid virological response with re‐treatment (72 weeks, 73%, 16/22, vs 48 weeks, 38%, 5/13, P < 0.05).

Conclusion:  Relapse after previous treatment and a low baseline HCV RNA level have predictive values for a favorable response of PEG IFN plus ribavirin re‐treatment for HCV genotype 1 patients. Re‐treatment for 72 weeks may lead to clinical improvement for genotype 1 patients with complete early virological response and without rapid virological response on re‐treatment.
A Research Agenda for Global Stakeholder Strategy
Authors: Devinney Timothy M. , Mcgahan Anita M. , Zollo Maurizio
Published: October 2013

This purpose of this article is to provide a framework into which we can integrate global strategy with stakeholder theory. Our aim is to create the basis for a research agenda that deals specifically with issues that are unique to global strategy and to use this perspective to demonstrate the insights that may arise for core stakeholder theory through the pursuit of such an agenda. We argue that a global perspective implies not only the management of stakeholders in various locations across the globe, but also the management of the rising phenomenon of multinationals and other organizations as truly global stakeholders. We argue that global stakeholder management involves a range of issues that are not yet fully considered either in the field of global strategy or the field of stakeholder theory. For example, drawing on recent research that emphasizes stakeholder claims as arising from rules of law, global strategy can involve selectively exposing the corporation across jurisdictions to particular stakeholders. This presents an opportunity for gains from the trade in intellectual ideas, concepts, theories, and empirical findings.
Effects of Anode Microstructure on Mechanical and Electrochemical Properties for Anode‐Supported Microtubular Solid Oxide Fuel Cells
Authors: Sumi Hirofumi , Yamaguchi Toshiaki , Hamamoto Koichi , Suzuki Toshio , Fujishiro Yoshinobu
Published: October 2013

The effects of anode microstructure on mechanical and electrochemical properties were investigated for anode‐supported microtubular solid oxide fuel cells (SOFCs). The anode microstructures can be varied by the change in pore formers. For example, the acrylic resin pore former was burnt more rapidly at lower temperature than the graphite pore former during sintering. The acrylic resin pore former can introduce macropores with a diameter of several micrometers in nickel–yttria‐stabilized zirconia (Ni–YSZ) anode. The walls of the macropores were packed with the nickel and YSZ particles. Although the Ni–YSZ anode microtube using the 10 wt% acrylic resin pore former was compatible with high porosity and mechanical strength, the maximum fuel utilization was limited to 72%. On the other hand, the graphite pore former can produce a relatively uniform distribution of micropores with a diameter of several hundred nanometers. The mechanical strength was reduced with a rise in porosity for the Ni–YSZ microtube using the graphite pore former in comparison with the acrylic resin. However, a high fuel utilization of 93% was realized for the microtubular SOFCs using the 10 wt% graphite pore former in spite of lower porosity than the acrylic resin. The selection of a pore former is important to obtain higher power generation efficiency for anode‐supported microtubular SOFCs.
Consequential Life Cycle Assessment of Policy Vulnerability to Price Effects
Authors: Rajagopal Deepak
Published: October 2013

The application of life cycle assessment (LCA) in a policy context highlights the need for a “consequential” LCA (CLCA), which differs from an “attributional” LCA (ALCA). Although CLCA offers some advantages over ALCA, such as a capacity to account for emissions resulting from both substitution and price effects, it entails additional assumptions and cost and may yield estimates that are more uncertain (e.g., estimates of impact of biofuel policies on greenhouse gas [GHG] emissions). We illustrate how a CLCA that relies on simple partial equilibrium models could provide important insights on the direction and magnitude of price effects while limiting the complexity of CLCA. We describe how such a CLCA, when applied early in the policy life cycle, could help identify policy formulations that reduce the magnitude of adverse price effects relative to the beneficial substitution effect on emissions because—as the experience with biofuel regulations indicates—regulating price effects is costly and controversial. We conclude that the salient contribution of CLCA in the policy process might lie in warning policy makers about the vulnerabilities in a policy with regard to environmental impact and to help modify potentially counterproductive formulations rather than in deriving the precise estimates for uncertain variables, such as the life cycle GHG intensity of product or average indirect emissions.
Turkish nursing students' knowledge of and attitudes towards patients with HIV/AIDS
Authors: Akin Semiha , Mendi Basak , Mendi Onur , Durna Zehra
Published: October 2013

Aims and objectives

To assess nursing students' knowledge of and attitudes towards such patients and to determine the variables associated with students' knowledge and attitudes towards them.

Background

Improving nurses' and nursing students' knowledge and attitudes towards patients with HIV/AIDS is vital for providing quality care for such patients.

Design

This descriptive, cross‐sectional study was conducted at three nursing schools located in two different cities in Turkey. The inclusion criteria for the nursing students were as follows: being at least 18 years old; being a first‐, second‐, third‐ or fourth‐year nursing student; and giving consent to participate in the research.

Methods

The sample comprised 580 nursing students. The study used three data collection tools: (1) the Student Socio‐Demographic Questionnaire, (2) the HIV/AIDS Knowledge Questionnaire and (3) the HIV/AIDS Attitude Questionnaire.

Results

Participants' knowledge was found to be insufficient, particularly with regard to HIV transmission routes. They generally had positive attitudes towards patients with HIV/AIDS. However, they expressed some concerns and were hesitant about working with AIDS and HIV‐positive patients.

Conclusions

The current results reveal that nursing students still have misconceptions and a lack of knowledge of HIV/AIDS and that their attitudes need to be improved.

Relevance to clinical practice

Improving education programmes about HIV/AIDS and using information sources effectively may contribute to better knowledge and more desirable attitudes towards HIV/AIDS.
Lessons from postgenome‐wide association studies: functional analysis of cancer predisposition loci
Authors: Monteiro A. N. A. , Freedman M. L.
Published: October 2013

In the last few years, genome‐wide association studies (GWASs) have identified hundreds of predisposition loci for several types of human cancers. Recent progress has been made in determining the underlying mechanisms through which different single‐nucleotide polymorphisms (SNPs) affect predisposition to cancer. Although there has been much debate about the clinical utility of GWASs, less attention has been paid to how GWASs and post‐GWASs functional analysis have contributed to understanding the aetiology of cancer. Most common variants associated with cancer risk are localized in nonprotein‐coding regions highlighting transcriptional regulation as a common theme in the mechanism of cancer predisposition. Here, we outline strategies to functionally dissect predisposition loci and discuss their limitations as well as challenges for future studies.
Repeatability and reliability of human eye in visual shade selection
Authors: Özat P. B. , Tuncel İ. , Eroğlu E.
Published: October 2013

Deficiencies in the human visual percep‐tion system have challenged the efficiency of the visual shade‐matching protocol. The aim of this study was to evaluate the repeatability and reliability of human eye in visual shade selection. Fifty‐four volunteering dentists were asked to match the shade of an upper right central incisor tooth of a single subject. The Vita 3D‐Master shade guide was used for the protocol. Before each shade‐matching procedure, the definitive codes of the shade tabs were hidden by an opaque strip and the shade tabs were placed into the guide randomly. The procedure was repeated 1 month later to ensure that visual memory did not affect the results. The L*, a* and b* values of the shade tabs were measured with a dental spectrophotometer (Vita Easyshade) to produce quantitative values to evaluate the protocol. The paired samples t‐test and Pearson correlation test were used to compare the 1st and 2nd selections. The Yates‐corrected chi‐square test was use to compare qualitative values. Statistical significance was accepted at P < 0·05. Comparing baseline and 1st month records, statistical significance (P < 0·001) was found among qualitative data regarding repeatability on a yes/no (1/0) basis, revealing a very low percentage of repeatability (11·1%). Comparing baseline and 1st month records, statistical significance was not found (P = 0·000) among the L*, a*, b* and ΔE variables. These results indicate that dentists perform insufficiently regarding repeatability in visual shade matching, but they are able to select clinically acceptable shades.
Evidence‐Based Medicine: The Design and Interpretation of Noninferiority Clinical Trials in Veterinary Medicine
Authors: Freise K.J. , Lin T.‐L. , Fan T.M. , Recta V. , Clark T.P.
Published: October 2013

Noninferiority trials are clinical studies designed to demonstrate that an investigational drug is at least as effective as an established treatment within a predetermined margin. They are conducted, in part, because of ethical concerns of administering a placebo to veterinary patients when an established effective treatment exists. The use of noninferiority trial designs has become more common in veterinary medicine with the increasing number of established veterinary therapeutics and the desire to eliminate potential pain or distress in a placebo‐controlled study. Selecting the appropriate active control and an a priori noninferiority margin between the investigational and active control drug are unique and critical design factors for noninferiority studies. Without reliable historical knowledge of the disease response in the absence of treatment and of the response to the selected active control drug, proper design and interpretation of a noninferiority trial is not possible. Despite the appeal of conducting noninferiority trials to eliminate ethical concerns of placebo‐controlled studies, there are real limitations and possible ethical conundrums associated with noninferiority trials. The consequences of incorrect study conclusions because of poor noninferiority trial design need careful attention. Alternative trial designs to typical noninferiority studies exist, but these too have limitations and must also be carefully considered.
Preliminary Investigation of Cardiac Troponin I Concentration in Cows with Common Production Diseases
Authors: Varga A. , Angelos J.A. , Graham T.W. , Chigerwe M.
Published: October 2013

Background

Increased cTnI concentrations are associated with adverse outcomes in humans and animals. Limited information is available on the prognostic value of cTnI in cows.

Objective

To measure cTnI in cows with noncardiac diseases and evaluate the association of cTnI concentration with adverse outcomes such as death or early removal from the herd.

Animals

Thirty control and 53 diseased cows.

Methods

Serum cTnI concentrations were determined with a point‐of‐care immunoassay. Cows were diagnosed ante‐ or postmortem with metritis (n = 6), mastitis (n = 4), peritonitis (n = 6), LDA (n = 14), LDA and metritis (n = 4), pneumonia (n = 6), dystocia requiring cesarean section (n = 5), and downer cow syndrome (n = 8). Animal survival was determined for up to 2 months after presentation.

Results

The immunoassay showed reliability for the detection of bovine cTnI. Cows with LDA and metritis (P < .05), peritonitis (P < .05), LDA (P < .001), dystocia requiring cesarean section (P < .01), and downer cow syndrome (P < .001) had higher cTnI concentrations than control cows. The odds of a negative outcome (death or culling) for cows with cTnI concentrations of ≥0.05, ≥0.1, ≥0.2, and ≥0.5 ng/mL were 2.4, 2.9, 4.8, and 6.2, respectively.

Conclusion

Cows with noncardiac diseases may have some degree of myocardial injury. The magnitude of cTnI increased may assist clinicians in evaluating the risk of an adverse outcome and help guide decision‐making regarding treatment and prognosis.
Stardust Interstellar Preliminary Examination VIII: Identification of crystalline material in two interstellar candidates
Authors: Gainsforth Zack , Brenker Frank E. , Simionovici Alexandre S. , Schmitz Sylvia , Burghammer Manfred , Butterworth Anna L. , Cloetens Peter , Lemelle Laurence , Tresserras Juan‐Angel Sans , Schoonjans Tom , Silversmit Geert , Solé Vicente A. , Vekemans Bart , Vincze Laszlo , Westphal Andrew J. , Allen Carlton , Anderson David , Ansari Asna , Bajt Saša , Bastien Ron K. , Bassim Nabil , Bechtel Hans A. , Borg Janet , Bridges John , Brownlee Donald E. , Burchell Mark , Changela Hitesh , Davis Andrew M. , Doll Ryan , Floss Christine , Flynn George , Fougeray Patrick , Frank David , Grün Eberhard , Heck Philipp R. , Hillier Jon K. , Hoppe Peter , Hudson Bruce , Huth Joachim , Hvide Brit , Kearsley Anton , King Ashley J. , Lai Barry , Leitner Jan , Leroux Hugues , Leonard Ariel , Lettieri Robert , Marchant William , Nittler Larry R. , Ogliore Ryan , Ong Wei Ja , Postberg Frank , Price Mark C. , Sandford Scott A. , Srama Ralf , Stephan Thomas , Sterken Veerle , Stodolna Julien , Stroud Rhonda M. , Sutton Steven , Trieloff Mario , Tsou Peter , Tsuchiyama Akira , Tyliszczak Tolek , Von Korff Joshua , Zevin Daniel , Zolensky Michael E. ,   >30,000 Stardust@home dusters
Published: October 2013

Using synchrotron‐based X‐ray diffraction measurements, we identified crystalline material in two particles of extraterrestrial origin extracted from the Stardust Interstellar Dust Collector. The first particle, I1047,1,34 (Hylabrook), consisted of a mosaiced olivine grain approximately 1 µm in size with internal strain fields up to 0.3%. The unit cell dimensions were a = 4.85 ± 0.08 Å, b  =  10.34 ± 0.16 Å, c  =  6.08 ± 0.13 Å (2σ). The second particle, I1043,1,30 (Orion), contained an olivine grain ≈ 2 µm in length and >500 nm in width. It was polycrystalline with both mosaiced domains varying over ≈ 20 and additional unoriented domains, and contained internal strain fields < 1%. The unit cell dimensions of the olivine were a = 4.76 ± 0.05 Å, b  =  10.23 ± 0.10 Å, c  =  5.99 ± 0.06 Å (2σ), which limited the olivine to a forsteritic composition (2σ). Orion also contained abundant spinel nanocrystals of unknown composition, but unit cell dimension a  = 8.06 ± 0.08 Å (2σ). Two additional crystalline phases were present and remained unidentified. An amorphous component appeared to be present in both these particles based on STXM and XRF results reported elsewhere.
Evolution of the angrite parent body: Implications of metamorphic coronas in NWA 3164
Authors: Baghdadi Bashar , Godard Gaston , Jambon Albert
Published: October 2013

Northwest Africa 3164 is a coarse‐grained angrite that shows reaction coronas, a unique character among achondrites. Olivine (Fo57; 1.2 wt% CaO), fassaitic clinopyroxene, anorthite, and spinel account for 46–47, 28–29, 8–13, and 4–8 vol%, respectively; kamacite is an accessory phase. The spinel grains in contact with clinopyroxene are bounded by discontinuous 20 μm thick coronas of anorthite and olivine, indicating the reaction Cpx + Spl → Ol + An (R1). In addition, irregular coronas of clinopyroxene and spinel developed around the primary anorthite in contact with primary olivine, during the reaction Ol + An → Cpx + Spl (R2). R2 also generated clinopyroxene and spinel films between the secondary olivine and anorthite coronas produced during R1, implying that R1 preceded R2. Both are metamorphic reactions that developed in the solid state. Finally, the coronas are cross cut by μm‐thick veinlets due to a late shock. A mass‐balance study shows that R2 is almost the reverse of R1. The P–T metamorphic evolution of the rock, modeled by calculating a P–T isochemical diagram, indicates an equilibrium T of 940 ± 120 °C at P < 0.9 GPa for the initial assemblage, followed by an increase of T up to approximately 1000–1200 °C during reaction R1 and a subsequent cooling during R2. Several causes are envisaged to account for this metamorphic evolution. Contact metamorphism due to a hot magmatic intrusion in the angrite parent body is favored, as similar metamorphic coronas are well known in metamorphic terrestrial rocks. In addition to differentiation and magmatism, there is now evidence for metamorphism in the angrite parent body, which would have been a large asteroid or a planetary‐sized body.