bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Smartphone Applications for Cardiopulmonary Resuscitation Training in South Korea
Authors: Ahn Chiwon , Cho Yongtak , Oh Jaehoon , Song Yeongtak , Lim Tae Ho , Kang Hyunggoo , Lee Juncheol
Published: September 2016

Objective. There are many smartphone-based applications (apps) for cardiopulmonary resuscitation (CPR) training. We investigated the conformity and the learnability/usability of these apps for CPR training and real-life supports.Methods. We conducted a mixed-method, sequential explanatory study to assess CPR training apps downloaded on two apps stores in South Korea. Apps were collected with inclusion criteria as follows, Korean-language instruction, training features, and emergency supports for real-life incidents, and analyzed with two tests; 15 medical experts evaluated the apps’ contents according to current Basic Life Support guidelines in conformity test, and 15 nonmedical individuals examined the apps using System Usability Scale (SUS) in the learnability/usability test.Results. Out of 79 selected apps, five apps were included and analyzed. For conformity (ICC, 0.95,p<0.001), means of all apps were greater than 12 of 20 points, indicating that they were well designed according to current guidelines. Three of the five apps yielded acceptable level (greater than 68 of 100 points) for learnability/usability.Conclusion. All the included apps followed current BLS guidelines and a majority offered acceptable learnability/usability for layperson. Current and developmental smartphone-based CPR training apps should include accurate CPR information and be easy to use for laypersons that are potential rescuers in real-life incidents.For Clinical Trials. This is a clinical trial, registered at the Clinical Research Information Service (CRIS, cris.nih.go.kr), numberKCT0001840.
A Ruptured Ectopic Pregnancy Presenting with a Negative Urine Pregnancy Test
Authors: Sheele Johnathan Michael , Bernstein Rachel , Counselman Francis L.
Published: September 2016

A negative urine pregnancy test in the emergency department traditionally excludes the diagnosis of pregnancy. We report a rare case of ruptured ectopic pregnancy in a patient with a negative urine pregnancy test but with a serum beta-human chorionic gonadotropin (β-hCG) of 10 mIU/mL. The patient developed hemoperitoneum and required laparoscopy by Obstetrics and Gynecology (OB/Gyn). This case highlights the fallibility of the urine pregnancy test in diagnosing early pregnancy.
High Quality GaAs Epilayers Grown on Si Substrate Using 100 nm Ge Buffer Layer
Authors: Kuo Wei-Cheng , Hsieh Hung-Chi , Chih-Hung Wu , Wen-Hsiang Huang , Lee Chien-Chieh , Chang Jenq-Yang
Published: September 2016

We present high quality GaAs epilayers that grow on virtual substrate with 100 nm Ge buffer layers. The thin Ge buffer layers were modulated by hydrogen flow rate from 60 to 90 sccm to improve crystal quality by electron cyclotron resonance chemical vapor deposition (ECR-CVD) at low growth temperature (180°C). The GaAs and Ge epilayers quality was verified by X-ray diffraction (XRD) and spectroscopy ellipsometry (SE). The full width at half maximum (FWHM) of the Ge and GaAs epilayers in XRD is 406 arcsec and 220 arcsec, respectively. In addition, the GaAs/Ge/Si interface is observed by transmission electron microscopy (TEM) to demonstrate the epitaxial growth. The defects at GaAs/Ge interface are localized within a few nanometers. It is clearly showed that the dislocation is well suppressed. The quality of the Ge buffer layer is the key of III–V/Si tandem cell. Therefore, the high quality GaAs epilayers that grow on virtual substrate with 100 nm Ge buffer layers is suitable to develop the low cost and high efficiency III–V/Si tandem solar cells.
Complex Approach to Conceptual Design of Machine Mechanically Extracting Oil fromJatropha curcasL. Seeds for Biomass-Based Fuel Production
Authors: Mašín Ivan , Petrů Michal
Published: September 2016

One of important sources of biomass-based fuel isJatropha curcasL. Great attention is paid to the biofuel produced from the oil extracted from theJatropha curcasL. seeds. A mechanised extraction is the most efficient and feasible method for oil extraction for small-scale farmers but there is a need to extract oil in more efficient manner which would increase the labour productivity, decrease production costs, and increase benefits of small-scale farmers. On the other hand innovators should be aware that further machines development is possible only when applying the systematic approach and design methodology in all stages of engineering design. Systematic approach in this case means that designers and development engineers rigorously apply scientific knowledge, integrate different constraints and user priorities, carefully plan product and activities, and systematically solve technical problems. This paper therefore deals with the complex approach to design specification determining that can bring new innovative concepts to design of mechanical machines for oil extraction. The presented case study as the main part of the paper is focused on new concept of screw of machine mechanically extracting oil fromJatropha curcasL. seeds.
Case of Chronic Otitis Media with Intracranial Complication and Contralateral Extracranial Presentation
Authors: Yeoh X. Y. , Lim P. S. , Pua K. C.
Published: September 2016

Intracranial complications of chronic otitis media have been on the decline with advent of antibiotics. Septic thrombosis of the sigmoid sinus is rarer compared to commoner complications such as otogenic brain abscesses and meningitis. This patient presented with recurrent infection after left mastoidectomy secondary to cholesteatoma and a contralateral internal jugular vein thrombosis with parapharyngeal abscess, which was drained. He recovered well postoperatively with antibiotics.
Robot Obstacle Avoidance Learning Based on Mixture Models
Authors: Zhang Huiwen , Han Xiaoning , Fu Mingliang , Zhou Weijia
Published: September 2016

We briefly surveyed the existing obstacle avoidance algorithms; then a new obstacle avoidance learning framework based on learning from demonstration (LfD) is proposed. The main idea is to imitate the obstacle avoidance mechanism of human beings, in which humans learn to make a decision based on the sensor information obtained by interacting with environment. Firstly, we endow robots with obstacle avoidance experience by teaching them to avoid obstacles in different situations. In this process, a lot of data are collected as a training set; then, to encode the training set data, which is equivalent to extracting the constraints of the task, Gaussian mixture model (GMM) is used. Secondly, a smooth obstacle-free path is generated by Gaussian mixture regression (GMR). Thirdly, a metric of imitation performance is constructed to derive a proper control policy. The proposed framework shows excellent generalization performance, which means that the robots can fulfill obstacle avoidance task efficiently in a dynamic environment. More importantly, the framework allows learning a wide variety of skills, such as grasp and manipulation work, which makes it possible to build a robot with versatile functions. Finally, simulation experiments are conducted on a Turtlebot robot to verify the validity of our algorithms.
Two Kinds of Darboux-Bäcklund Transformations for theq-Deformed KdV Hierarchy with Self-Consistent Sources
Authors: Wu Hongxia , Gao Liangjuan , Liu Jingxin , Zeng Yunbo
Published: September 2016

Two kinds of Darboux-Bäcklund transformations (DBTs) are constructed for theq-deformedNth KdV hierarchy with self-consistent sources (q-NKdVHSCS) by using theq-deformed pseudodifferential operators. Note that one of the DBTs provides a nonauto Bäcklund transformation for twoq-deformedNth KdV equations with self-consistent sources (q-NKdVESCS) with different degree. In addition, the soliton solution to the first nontrivial equation ofq-KdVHSCS is also obtained.
Effect of Betula pendula Leaf Extract on α‐Glucosidase and Glutathione Level in Glucose‐Induced Oxidative Stress
Authors: Bljajić Kristina , Šoštarić Nina , Petlevski Roberta , Vujić Lovorka , Brajković Andrea , Fumić Barbara , de Carvalho Isabel Saraiva , Končić Marijana Zovko
Published: September 2016

B. pendula leaf is a common ingredient in traditional herbal combinations for treatment of diabetes in southeastern Europe. Present study investigated B. pendula ethanolic and aqueous extract as inhibitors of carbohydrate hydrolyzing enzymes, as well as their ability to restore glutathione concentration in Hep G2 cells subjected to glucose‐induced oxidative stress. Phytochemical analysis revealed presence of rutin and other quercetin derivatives, as well as chlorogenic acid. In general, ethanolic extract was richer in phenolic substances than the aqueous extract. Furthermore, a comprehensive analysis of antioxidant activity of two extracts (determined by DPPH and ABTS radical scavenging activity, total antioxidant activity, and chelating activity as well as ferric‐reducing antioxidant power) has shown that ethanolic extract was better radical scavenger and metal ion reductant. In addition, ethanolic extract effectively increased cellular glutathione levels caused by hyperglycemia and inhibited α‐glucosidase with the activity comparable to that of acarbose. Therefore, in vitro research using B. pendula plant extracts has confirmed their antidiabetic properties.
Punica granatum L. (Pomegranate) Extract: In Vivo Study of Antimicrobial Activity against Porphyromonas gingivalis in Galleria mellonella Model
Authors: Aparecida Procópio Gomes Livia , Alves Figueiredo Lívia Mara , Luiza do Rosário Palma Ana , Corrêa Geraldo Barbara Maria , Isler Castro Kelly Cristine , Ruano de Oliveira Fugisaki Luciana , Jorge Antônio Olavo Cardoso , de Oliveira Luciane Dias , Junqueira Juliana Campos
Published: September 2016

Due to the increase of bacterial resistance, medicinal alternatives are being explored. Punica granatum L. is an effective herbal extract with broad spectrum of action and bactericidal, antifungal, anthelmintic potential and being able to modulate the immune response. The aim was to evaluate the antimicrobial activity of pomegranate glycolic extract (PGE) against the periodontal pathogen Porphyromonas gingivalis by using Galleria mellonella as in vivo model. Fifteen larvae were used per group. Injection of high concentration (200, 100, and 25 mg/mL) of PGE showed a toxic effect, leading them to death. A suspension of P. gingivalis (106 cells/mL) was inoculated in the left last proleg and PGE (12.5, 6.25, 3.1, and 2.5 mg/mL) were injected into the right proleg. The larvae were then kept at 37°C under the dark. Injection of PGE at any dose statistically improved larvae survival rates. The data were analysed (log-rank test, Mantel-Cox, P<0.05) and showed that all concentrations of PGE (12.5, 6.25, 3.1, and 2.5 mg/mL) presented higher larval survival rates, with significant statistical difference in relation to control group (P. gingivalis). In conclusion, the PGE had antimicrobial action against P. gingivalis in vivo model using G. mellonella.
Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention
Authors: Abdel-karim Abdul-rahman R. , Vo Minh , Main Michael L. , Grantham J. Aaron
Published: September 2016

Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome.
Thermodynamic Stability of Ettringite Formed by Hydration of Ye’elimite Clinker
Authors: Fridrichová Marcela , Dvořák Karel , Gazdič Dominik , Mokrá Jana , Kulísek Karel
Published: September 2016

In order to save limited natural resources by utilising industrial by-products, this paper focuses on an entirely new application of fluidized bed combustion fly ash (FBCFA) into Portland composite cements. It is not currently used because undesirable ettringite, 3CaO·Al2O3·3CaSO4·32H2O, is formed during the hydration of FBCFA. Although the stability of ettringite has been the subject of much research, the solution is not yet fully clear. Ettringite is generally considered to be stable up to a temperature of 110°C; however, some investigators claimed that ettringite may already decompose at even ambient temperatures. To prove these statements, ettringite was prepared by the hydration of ye’elimite, 3CaO·3Al2O3·CaSO4, and the system stored at laboratory temperature in two environments: in laboratory settings and in an environment of saturated water vapour. The mineralogical composition of ettringite was long term (up to 160 days of hydration) and was analysed by X-ray diffraction (XRD) and differential thermal analysis (DTA). The hydration of ye’elimite is a relatively complex process. Only approximately 30% of ettringite was formed under laboratory conditions that appeared to gradually convert into metaettringite. Within an environment of saturated water vapour, we observed the conversion of ettringite into monosulfate. Original ye’elimite was indicated as the dominant phase of both storages.
Systematic Review of Hospital Readmissions in Stroke Patients
Authors: Rao Ahsan , Barrow Emily , Vuik Sabine , Darzi Ara , Aylin Paul
Published: September 2016

Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined.Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science.Results. There were a total of 24 studies (n=2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter.Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users.
Genome-Wide miRNA Analysis Identifies miR-188-3p as a Novel Prognostic Marker and Molecular Factor Involved in Colorectal Carcinogenesis
Authors: Pichler Martin , Stiegelbauer Verena , Vychytilova-Faltejskova Petra , Ivan Cristina , Ling Hui , Winter Elke , Zhang Xinna , Goblirsch Matthew , Wulf-Goldenberg Annika , Ohtsuka Masahisa , Haybaeck Johannes , Svoboda Marek , Okugawa Yoshinaga , Gerger Armin , Hoefler Gerald , Goel Ajay , Slaby Ondrej , Calin George Adrian
Published: September 2016

Purpose: Characterization of colorectal cancer transcriptome by high-throughput techniques has enabled the discovery of several differentially expressed genes involving previously unreported miRNA abnormalities. Here, we followed a systematic approach on a global scale to identify miRNAs as clinical outcome predictors and further validated them in the clinical and experimental setting.

Experimental Design: Genome-wide miRNA sequencing data of 228 colorectal cancer patients from The Cancer Genome Atlas dataset were analyzed as a screening cohort to identify miRNAs significantly associated with survival according to stringent prespecified criteria. A panel of six miRNAs was further validated for their prognostic utility in a large independent validation cohort (n = 332). In situ hybridization and functional experiments in a panel of colorectal cancer cell lines and xenografts further clarified the role of clinical relevant miRNAs.

Results: Six miRNAs (miR-92b-3p, miR-188-3p, miR-221-5p, miR-331-3p, miR-425-3p, and miR-497-5p) were identified as strong predictors of survival in the screening cohort. High miR-188-3p expression proves to be an independent prognostic factor [screening cohort: HR = 4.137; 95% confidence interval (CI), 1.568–10.917; P = 0.004; validation cohort: HR = 1.538; 95% CI, 1.107–2.137; P = 0.010, respectively]. Forced miR-188-3p expression increased migratory behavior of colorectal cancer cells in vitro and metastases formation in vivo (P < 0.05). The promigratory role of miR-188-3p is mediated by direct interaction with MLLT4, a novel identified player involved in colorectal cancer cell migration.

Conclusions: miR-188-3p is a novel independent prognostic factor in colorectal cancer patients, which can be partly explained by its effect on MLLT4 expression and migration of cancer cells. Clin Cancer Res; 23(5); 1323–33. ©2016 AACR.
Intratumor Heterogeneity of Homologous Recombination Deficiency in Primary Breast Cancer
Authors: von Wahlde Marie-Kristin , Timms Kirsten M. , Chagpar Anees , Wali Vikram B. , Jiang Tingting , Bossuyt Veerle , Saglam Ozlen , Reid Julia , Gutin Alexander , Neff Chris , Lanchbury Jerry S. , Hatzis Christos , Hofstatter Erin , Pusztai Lajos
Published: September 2016

Purpose: The 3-biomarker homologous recombination deficiency (HRD) assay measures the number of telomeric allelic imbalances, loss of heterozygosity, and large-scale state transitions in tumor DNA and combines these metrics into a single score that reflects DNA repair deficiency. The goal of this study is to assess the consistency of these HRD measures in different biopsies from distinct areas of the same cancer.

Experimental Design: HRD scores, BRCA mutation status, and BRCA1 promoter methylation were assessed in 99 samples from 33 surgically resected, stage I–III breast cancers; each cancer was biopsied in three distinct areas. Homologous recombination repair (HR) deficiency was defined as either high HRD score (≥42) or tumor BRCA mutation.

Results: Eighty-one biopsies from 32 cancers were analyzed. Tumor BRCA status was available for all samples, HRD scores for 70, and BRCA1 methylation values for 76 samples. The BRCA1/2 mutation and promoter methylation status and HR category showed perfect concordance across all biopsies from the same cancer. All tumors with BRCA1/2 mutations or promoter methylation had high HRD scores, as did 17% (4/24) of the BRCA1/2 wild-type and nonmethylated tumors. The HRD scores were also highly consistent between different biopsies from the same tumor with an intraclass correlation coefficient of 0.977, indicating that only 2.3% of the variance is attributed to within-tumor biopsy-to-biopsy variation.

Conclusions: These results indicate that within-tumor spatial heterogeneity for HRD metrics and the technical noise in the assay are small and do not influence HRD scores and HR status. Clin Cancer Res; 23(5); 1193–9. ©2016 AACR.
Whole Genomic Copy Number Alterations in Circulating Tumor Cells from Men with Abiraterone or Enzalutamide-Resistant Metastatic Castration-Resistant Prostate Cancer
Authors: Gupta Santosh , Li Jing , Kemeny Gabor , Bitting Rhonda L. , Beaver Joshua , Somarelli Jason A. , Ware Kathryn E. , Gregory Simon , Armstrong Andrew J.
Published: September 2016

Purpose: Beyond enumeration, circulating tumor cells (CTCs) can provide genetic information from metastatic cancer that may facilitate a greater understanding of tumor biology and enable a precision medicine approach.

Experimental Design: CTCs and paired leukocytes from men with metastatic castration-resistant prostate cancer (mCRPC) were isolated from blood through red cell lysis, CD45 depletion, and flow sorting based on EpCAM/CD45 expression. We next performed whole genomic copy number analysis of CTCs and matched patient leukocytes (germline) using array-based comparative genomic hybridization (aCGH) from 16 men with mCRPC, including longitudinal and sequential aCGH analyses of CTCs in the context of enzalutamide therapy.

Results: All patients had mCRPC and primary or acquired resistance to abiraterone acetate or enzalutamide. We compiled copy gains and losses, with a particular focus on those genes highly implicated in mCRPC progression and previously validated as being aberrant in metastatic tissue samples and genomic studies of reference mCRPC datasets. Genomic gains in >25% of CTCs were observed in AR, FOXA1, ABL1, MET, ERG, CDK12, BRD4, and ZFHX3, while common genomic losses involved PTEN, ZFHX3, PDE4DIP, RAF1, and GATA2. Analysis of aCGH in a sample with sequential enzalutamide-resistant visceral progression showed acquired loss of AR amplification concurrent with gain of MYCN, consistent with evolution toward a neuroendocrine-like, AR-independent clone.

Conclusions: Genomic analysis of pooled CTCs in men with mCRPC suggests a reproducible, but highly complex molecular profile that includes common aberrations in AR, ERG, c-MET, and PI3K signaling during mCRPC progression, which may be useful for predictive biomarker development. Clin Cancer Res; 23(5); 1346–57. ©2016 AACR.
c-Jun N-Terminal Kinase Inactivation by Mitogen-Activated Protein Kinase Phosphatase 1 Determines Resistance to Taxanes and Anthracyclines in Breast Cancer
Authors: Rincón Raúl , Zazo Sandra , Chamizo Cristina , Manso Rebeca , González-Alonso Paula , Martín-Aparicio Ester , Cristóbal Ion , Cañadas Carmen , Perona Rosario , Lluch Ana , Eroles Pilar , García-Foncillas Jesús , Albanell Joan , Rovira Ana , Madoz-Gúrpide Juan , Rojo Federico
Published: September 2016

MAPK phosphatase-1 (MKP-1) is overexpressed during malignant transformation of the breast in many patients, and it is usually associated with chemoresistance through interference with JNK-driven apoptotic pathways. Although the molecular settings of the mechanism have been documented, details about the contribution of MKP-1 to the failure of chemotherapeutic interventions are unclear. Transient overexpression of MKP-1 and treatment with JNK-modulating agents in breast carcinoma cells confirmed the mediation of MKP-1 in the resistance to taxanes and anthracyclines in breast cancer, through the inactivation of JNK1/2. We next assessed MKP-1 expression and JNK1/2 phosphorylation status in a large cohort of samples from 350 early breast cancer patients treated with adjuvant anthracycline–based chemotherapy. We detected that MKP-1 overexpression is a recurrent event predominantly linked to dephosphorylation of JNK1/2 with an adverse impact on relapse of the tumor and overall and disease-free survival. Moreover, MKP-1 and p-JNK1/2 determinations in 64 locally advanced breast cancer patients treated with neoadjuvant taxane–based chemotherapy showed an inverse correlation between MKP-1 overexpression (together with JNK1/2 inhibition) and the pathologic response of the tumors. Our results emphasize the importance of MKP-1 as a potential predictive biomarker for a subset of breast cancer patients with worse outcome and less susceptibility to treatment. Mol Cancer Ther; 15(11); 2780–90. ©2016 AACR.
Solitary Fibrous Tumor in the Lacrimal Gland Fossa: A Case Report
Authors: Mupas-Uy Jacqueline , Kitaguchi Yoshiyuki , Takahashi Yasuhiro , Takahashi Emiko , Kakizaki Hirohiko
Published: September 2016

Solitary fibrous tumors (SFTs) are benign, spindle-cell tumors of mesenchymal origin that are usually seen in the superior orbital area in adults. We report a rare case of SFT in the lacrimal gland fossa that developed in a young female. A 25-year-old woman had a 6-month history of a progressive painless mass in the left upper eyelid accompanied by proptosis. Computed tomography and magnetic resonance imaging showed an ovoid, demarcated mass with distinct margins in the lacrimal gland region without bone invasion. Excision biopsy with immunohistochemical study, specifically with positive signal transducer and activator of transcription 6, confirmed the diagnosis.
Transthoracic Echocardiography and Chest Computed Tomography Arteriography in Patients with Acute Pulmonary Embolism: A Two-Year Follow-Up Study
Authors: Serra Walter , Crisafulli Ernesto , Sverzellati Nicola , Ugolotti P. Tito , Tzani Panajota , Marangio Emilio , Ardissino Diego , Gherli Tiziano , Chetta Alfredo
Published: September 2016

Background: Pulmonary hypertension (PH) is frequently found at the time of diagnosis of pulmonary embolism (PE). An incomplete resolution of PE can lead to chronic thromboembolic pulmonary hypertension (CTPH). Transthoracic echocardiogram (TTE) is the first step to diagnose an abnormality of the pulmonary vasculature. Based on computed tomography (CT), the Qanadli vascular obstruction index has been extensively used to assess acute PE. Objectives: Our aim was to ascertain whether at the time of diagnosis of an acute PE episode TTE variables and a Qanadli CT index score may be associated with CTPH 2 years later. Method: Patients with PE were prospectively enrolled. TTE was performed and the Qanadli CT obstruction index was calculated on admission to the hospital, while only TTE was repeated at the 2-year follow-up. The NYHA (New York Heart Association) functional classification was evaluated. Correlation analyses were performed. Results: Twenty patients (11 males, median age 69.5 years) were considered for the study. There was no significant correlation between TTE parameters and the Qanadli CT obstruction index. A significant distribution (χ2 = 5.69, p = 0.017) was found in the analysis among patients with CTPH at 24 months and the Qanadli CT index, categorized by a receiver operating characteristic curve cutoff value of 42.5%. Additionally, a significant distribution (χ2 = 4.09, p = 0.043) was found in the analysis among patients with CTPH at 24 months and right ventricular systolic pressure on admission, categorized as PH (>31 mm Hg). Conclusion: Our study demonstrates that in patients with acute PE there is no relationship between the Qanadli CT obstruction index and TTE parameters on admission to the hospital. However, the occurrence of CTPH at the 24-month follow-up is associated with PH and with a high Qanadli CT obstruction index score.
A 6-Month Trial of the Efficacy and Safety of Triptorelin Pamoate (11.25 mg) Every 3 Months in Children with Precocious Puberty: A Retrospective Comparison with Triptorelin Acetate
Authors: Zenaty Delphine , Blumberg Joelle , Liyanage Nilani , Jacqz-Aigrain Evelyne , Lahlou Najiba , Carel Jean-Claude ,   on behalf of co-investigators
Published: September 2016

Background/Aims: To evaluate the efficacy and safety of a triptorelin pamoate (11.25 mg) 3-month formulation in the management of central precocious puberty (CPP) (TP Study) and to retrospectively compare it with a triptorelin acetate (11.25 mg) 3-month formulation (TA Study). Methods: We conducted two phase III, multicentre, single-stage, non-comparative, open-label studies. In the TP Study, patients with CPP received an intramuscular injection of triptorelin pamoate 11.25 mg at baseline and 3 months after baseline. Hormonal changes as well as safety and efficacy endpoints were measured at baseline, 3 months, and 6 months. Results: The baseline characteristics of the 37 patients in the TP Study were similar to those of the TA Study population. A suppressed luteinising hormone (LH) response (LH peak ≤3 IU/l) to the gonadotrophin-releasing hormone test at 3 months (primary endpoint) occurred in 83.8 and 82.8% of the cases in the TP and the TA Study, respectively. At 6 months, a suppressed LH response occurred in 86.5 and 96.8% of the cases in the TP and the TA Study, respectively. Pubertal development was slowed in both studies. Adverse events were mild to moderate and resolved without sequelae in the TP Study. Conclusion: Triptorelin pamoate 11.25 mg administered at 3-month intervals is an effective and well-tolerated treatment in patients with CPP. The efficacy and safety profiles appear similar to those reported in the literature for triptorelin acetate 11.25 mg.
Fetal Serum β2-Microglobulin and Postnatal Renal Function in Lower Urinary Tract Obstruction Treated with Vesicoamniotic Shunt
Authors: Chon Andrew H. , de Oliveira Gustavo H. , Lemley Kevin V. , Korst Lisa M. , Assaf Ryan D. , Chmait Ramen H.
Published: September 2016

Introduction: Although mortality has decreased for fetuses with lower urinary tract obstruction treated with vesicoamniotic shunt (VAS) placement, survivors remain at risk for long-term renal impairment. We tested the association of fetal serum β2-microglobulin (fsβ2M) with postnatal renal function in these patients, hypothesizing that fsβ2M may predict such renal impairment. Materials and Methods: fsβ2M was obtained in patients undergoing VAS placement. The primary outcome was renal function at 3-12 months of life, as assessed by a pediatric nephrologist using medical records. Patients were divided into two groups: (1) ‘stable renal function' - probable stable long-term renal function and reasonable growth - and (2) ‘loss of renal function' - early loss of renal function and failure to thrive. Results: Nineteen patients with preoperative fsβ2M received a VAS. Of the 14 survivors, those with fsβ2M ≤5.6 mg/l tended to have stable renal function compared to those with fsβ2M >5.6 mg/l [5/6 (83.3%) vs. 2/8 (25.0%), OR = 15.00, 95% CI 0.70-709.89; p = 0.1026]. Eight of 9 patients followed for >12 months of age had outcomes consistent with the initial renal assessments. Discussion: Patients with initial fsβ2M >5.6 mg/l and treated with VAS tended to have poor renal outcomes.
Statins in Asthma: A Closer Look into the Pharmacological Mechanism of Action
Authors: Al-Sawalha Nour A. , Knoll Brian J.
Published: September 2016

The effect of stains in asthma is mediated through targeting several signaling molecules that are involved in the development of asthma phenotype. In vitro and in vivo studies revealed that statins reduce airway smooth muscle cells proliferation and inflammatory mediators' release. Statins reduce chemokine release and mucus production from airway epithelial cells besides attenuating subepithelial fibrosis and eosinophils recruitment. In acute and chronic allergen driven animal models of asthma, statins reduce airway hyper-responsiveness, inflammation and remodeling. However, the effectiveness of statins in clinical trials results in contradictory conclusions based on study design and treatment protocol. Therefore, more clinical trials are needed to evaluate their role in asthma patients.
From Small Coronary Artery Aneurysm to Giant Left Ventricle Aneurysm
Authors: Sciacca Sergio , Raffa Giuseppe Maria , Gentile Giovanni , Pilato Michele
Published: September 2016

Objective: To underscore how challenging the treatment of a coronary artery aneurysm (CAA) can be and highlight the need for consensus guidelines based on focused registries. Clinical Presentation and Intervention: A 58-year-old man presented with acute coronary syndrome and underwent elective stent placement on a right CAA. The procedure was complicated by inferior acute myocardial infarction; 8 months later, due to remodeling toward a left ventricular aneurysm of the inferior wall, he experienced several episodes of sustained ventricular tachycardia that required urgent surgical treatment. Conclusion: The best therapeutic option for CAA is still a matter of controversy, and though the percutaneous approach can meet the technical challenges, ‘heart team'-based decision-making is recommended. The case reported here showed that percutaneous treatment of CAA can be a challenging procedure, even in experienced and high-volume centers. In our patient's case, undersizing the covered stent led to further migration and to a complication that was more severe than the original disease.
Alpha-Tocopherol Reduces Brain Edema and Protects Blood-Brain Barrier Integrity following Focal Cerebral Ischemia in Rats
Authors: Haghnejad Azar Adel , Oryan Shahrbanoo , Bohlooli Shahab , Panahpour Hamdollah
Published: September 2016

Objective: This study was conducted to examine the neuroprotective effects of α-tocopherol against edema formation and disruption of the blood-brain barrier (BBB) following transient focal cerebral ischemia in rats. Materials and Methods: Ninety-six male Sprague-Dawley rats were divided into 3 major groups (n = 32 in each), namely the sham, and control and α-tocopherol-treated (30 mg/kg) ischemic groups. Transient focal cerebral ischemia (90 min) was induced by occlusion of the left middle cerebral artery. At the end of the 24-hour reperfusion period, the animals were randomly selected and used for 4 investigations (n = 8) in each of the 3 main groups: (a) assessment of neurological score and measurement of infarct size, (b) detection of brain edema formation by the wet/dry method, (c) evaluation of BBB permeability using the Evans blue (EB) extravasation technique, and (d) assessment of the malondialdehyde (MDA) and reduced glutathione (GSH) concentrations using high-performance liquid chromatography methods. Results: Induction of cerebral ischemia in the control group produced extensive brain edema (brain water content 83.8 ± 0.11%) and EB leakage into brain parenchyma (14.58 ± 1.29 µg/g) in conjunction with reduced GSH and elevated MDA levels (5.86 ± 0.31 mmol/mg and 63.57 ± 5.42 nmol/mg, respectively). Treatment with α-tocopherol significantly lowered brain edema formation and reduced EB leakage compared with the control group (p < 0.001, 80.1 ± 0.32% and 6.66 ± 0.87 µg/g, respectively). Meanwhile, treatment with α-tocopherol retained tissue GSH levels and led to a lower MDA level (p < 0.01, 10.17 ± 0.83 mmol/mg, and p < 0.001, 26.84 ± 4.79 nmol/mg, respectively). Conclusion: Treatment with α-tocopherol reduced ischemic edema formation and produced protective effects on BBB function following ischemic stroke occurrence. This effect could be through increasing antioxidant activity.
Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation
Authors: Shepard Charles W. , Germanakis Ioannis , White Matthew T. , Powell Andrew J. , Co-Vu Jennifer , Geva Tal
Published: September 2016

Background—

Despite its robust diagnostic capabilities in adolescents and adult patients after the arterial switch operation, little information is available on the cardiovascular magnetic resonance findings in this population.

Methods and Results—

The cardiovascular magnetic resonance findings of 220 consecutive patients evaluated in our center were retrospectively reviewed (median age at cardiovascular magnetic resonance, 15.4 years; 66.8% male sex). Compared with published normal values, left and right ventricular end-diastolic volume
z
scores were mildly enlarged (0.48±1.76 and 0.33±1.5;
P
=0.0003 and 0.0038, respectively), with 26% of patients having left ventricular dilatation and 20% having right ventricular dilatation. Left ventricular dysfunction was present in 21.5% of patients (mild in most), and only 5.1% of patients had mild right ventricular dysfunction. Myocardial scar was found in 1.8% of patients. Dilatation of the neoaortic root was common (76%), and root
z
score increased at an average rate of 0.03 points per year. By multivariable analysis, neoaortic root dilatation was associated with worse neoaortic valve regurgitation (OR, 5.29;
P
=0.0016). The diameters of the thoracic aorta distal to the root were near-normal in most patients, whereas the neomain pulmonary artery was typically oval shaped with decreased anteroposterior and normal lateral diameters.

Conclusions—

Although the majority of arterial switch operation patients have normal ventricular size and function and myocardial scar is rare, an important minority exhibits ventricular enlargement or dysfunction. Neoaortic root dilatation, which is present in most patients and progresses over time, is strongly associated with significant neoaortic valve regurgitation. The findings of this study provide reference values against which arterial switch operation patients can be compared with their peers.
Do Acute Myocardial Infarction and Heart Failure Readmissions Flagged as Potentially Preventable by the 3M Potentially Preventable Readmissions Software Have More Process-of-Care Problems?
Authors: Borzecki Ann M. , Chen Qi , Mull Hillary J. , Shwartz Michael , Bhatt Deepak L. , Hanchate Amresh , Rosen Amy K.
Published: September 2016

Background—

The 3M Potentially Preventable Readmissions (3M-PPR) software matches clinically related index admission and readmission diagnoses that may signify in-hospital or postdischarge quality problems. To assess whether the PPR algorithm identifies preventable readmissions, we compared processes of care between PPR software-flagged and nonflagged cases.

Methods and Results—

Using 2006 to 2010 national VA administrative data, we identified acute myocardial infarction and heart failure discharges associated with 30-day all-cause readmissions, then flagged cases (PPR-Yes/PPR-No) using the 3M-PPR software. To assess care quality, we abstracted medical records of 100 readmissions per condition using tools containing explicit processes organized into admission work-up, in-hospital evaluation/treatment, discharge readiness, postdischarge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases on total and section-specific mean scores. For acute myocardial infarction, 77 of 100 cases were flagged as PPR-Yes. Section quality scores were highest for in-hospital evaluation/treatment (20.5±2.8) and lowest for postdischarge care (6.8±9.1). Total and section-related mean scores did not differ by PPR status; respective PPR-Yes versus PPR-No total scores were 61.6±11.1 and 60.4±9.4;
P
=0.98. For heart failure, 86 of 100 cases were flagged as PPR-Yes. Section scores were highest for discharge readiness (18.8±2.4) and lowest for postdischarge care (7.3±8.1). Like acute myocardial infarction, total and section-related mean scores did not differ by PPR status; PPR-Yes versus PPR-No total scores were 61.2±10.8 and 63.4±7.0, respectively;
P
=0.47.

Conclusions—

Among VA acute myocardial infarction and heart failure readmissions, the 3M-PPR software does not distinguish differences in case-level quality of care. Whether 3M-PPR software better identifies preventable readmissions by using other methods to capture poorly documented processes or performing different comparisons requires further study.
Physician–Pharmacist Collaborative Management
Authors: Anderegg Maxwell D. , Gums Tyler H. , Uribe Liz , Coffey Christopher S. , James Paul A. , Carter Barry L.
Published: September 2016

Physician–pharmacist collaboration improves blood pressure, but there is little information on whether this model can reduce the gap in healthcare disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate whether the pharmacist intervention could reduce healthcare disparities by improving blood pressure in high-risk racial and socioeconomic subjects compared with the control group. The analyses in minority subjects were prespecified secondary analyses, but all other comparisons were secondary, post hoc analyses. The 9-month visit was completed by 539 patients: 345 received the intervention, and 194 were in the control group. Following the intervention, mean systolic blood pressure was found to be 7.3 mm Hg (95% confidence interval 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared with the control group (
P
=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% confidence interval 3.2, 13.1) lower than the control group with lower education (
P
=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid, or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. Although disparities in blood pressure were reduced by the intervention, there were still nonsignificant gaps in mean systolic blood pressure when compared with intervention subjects not at risk.

Clinical Trial Registration—

URL:
http://clinicaltrials.gov
. Unique identifier: NCT00935077.
Prediction of Stroke Onset Is Improved by Relative Fluid-Attenuated Inversion Recovery and Perfusion Imaging Compared to the Visual Diffusion-Weighted Imaging/Fluid-Attenuated Inversion Recovery Mismatch
Authors: Wouters Anke , Dupont Patrick , Norrving Bo , Laage Rico , Thomalla Götz , Albers Gregory W. , Thijs Vincent , Lemmens Robin
Published: September 2016

Background and Purpose—

Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4.5 hours could be improved by including various clinical and imaging parameters.

Methods—

In this study, 141 patients in whom magnetic resonance imaging was obtained within 9 hours after symptom onset were included. Relative FLAIR signal intensity was calculated in the region of nonreperfused core. Mean
T
max
was calculated in the total region with
T
max
>6 s. Mean relative FLAIR, mean
T
max
, lesion volume with
T
max
>6 s, age, site of arterial stenosis, core volume, and location of infarct were analyzed by logistic regression to predict stroke onset time before or after 4.5 hours.

Results—

Receiver-operating characteristic curve analysis revealed an area under the curve of 0.68 (95% confidence interval 0.59–0.78) for the visual diffusion-weighted imaging/FLAIR mismatch, thereby correctly classifying 69% of patients with an onset time before or after 4.5 hours. Age, relative FLAIR, and
T
max
increased the accuracy significantly (
P
<0.01) to an area under the curve of 0.82 (95% confidence interval 0.74–0.89). This new predictive model correctly categorized 77% of patients according to stroke onset before versus after 4.5 hours.

Conclusions—

In patients with unknown stroke onset, the accuracy of predicting time from symptom onset within 4.5 hours is improved by obtaining relative FLAIR and perfusion imaging.
Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients
Authors: Boulouis Gregoire , Morotti Andrea , Brouwers H. Bart , Charidimou Andreas , Jessel Michael J. , Auriel Eitan , Pontes-Neto Octavio , Ayres Alison , Vashkevich Anastasia , Schwab Kristin M. , Rosand Jonathan , Viswanathan Anand , Gurol Mahmut E. , Greenberg Steven M. , Goldstein Joshua N.
Published: September 2016

Background and Purpose—

Noncontrast computed tomographic (CT) hypodensities have been shown to be associated with hematoma expansion in intracerebral hemorrhage (ICH), but their impact on functional outcome is yet to be determined. We evaluated whether baseline noncontrast CT hypodensities are associated with poor clinical outcome.

Methods—

We performed a retrospective review of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic medical center between 1994 and 2016. The presence of CT hypodensities was assessed by 2 independent raters on the baseline CT. Unfavorable outcome was defined as a modified Rankin score >3 at 90 days. The associations between CT hypodensities and unfavorable outcome were investigated using uni- and multivariable logistic regression models.

Results—

During the study period, 1342 patients presented with ICH and 800 met restrictive inclusion criteria (baseline CT available for review, and 90-day outcome available). Three hundred and four (38%) patients showed hypodensities on CT, and 520 (65%) patients experienced unfavorable outcome. In univariate analysis, patients with unfavorable outcome were more likely to demonstrate hypodensities (48% versus 20%;
P
<0.0001). After adjustment for age, admission Glasgow coma scale, warfarin use, intraventricular hemorrhage, baseline ICH volume, and location, CT hypodensities were found to be independently associated with an increase in the odds of unfavorable outcome (odds ratio 1.70, 95% confidence interval [1.10–2.65];
P
=0.018).

Conclusions—

The presence of noncontract CT hypodensities at baseline independently predicts poor outcome and comes as a useful and widely available addition to our ability to predict ICH patients’ clinical evolution.
Port State Jurisdiction over Vessel Information: Territoriality, Extra-territoriality and the Future of Shipping Regulation
Authors: Marten Bevan
Published: September 2016

This article discusses the use of port state jurisdiction to impose information requirements on visiting foreign vessels, with reference to the maritime zone-based approach to jurisdiction taken in the United Nations Convention on the Law of the Sea and other maritime Conventions. It argues that port states have extensive options for requesting information from vessels in port, even if that information relates to matters arising beyond the state’s maritime zones (as in the case of the European Union’s 2015 regime for monitoring vessel co2 emissions), without making any excessive claim to extra-territorial jurisdiction. After discussing the manner in which port states may choose to deploy these options in practice, the article addresses some broader trends connected with the increasing automation of shipping and the ever-wider availability of shipping-related information, and the impact these developments may have on international law and shipping regulation in the long term.
Port State Measures—from Residual Port State Jurisdiction to Global Standards
Authors: Swan Judith
Published: September 2016

Residual port State jurisdiction and the development and furtherance of global standards, including the extra-territorial reach, of port State measures to combat illegal, unreported and unregulated fishing are described through a chronological review and assessment of international instruments, measures taken by regional fisheries management organizations and national legislation and procedures. The powerful role of sovereignty, extra-territorial reach and international cooperation, against the backdrop of recently agreed harmonized minimum standards, is exemplified in a case study.
The Proposed losc Implementation Agreement on Areas Beyond National Jurisdiction and Its Impact on International Fisheries Law
Authors: Barnes Richard
Published: September 2016

As the development of an implementation agreement on the conservation and sustainable use of marine biodiversity in areas beyond national jurisdiction gathers pace, it is important to consider how this might impact upon international fisheries law. Although the proposed agreement provides an opportunity to addresses governance gaps both generally and with respect to fisheries, we should not expect too much of it; not least because the inclusion per se of fisheries remains debated by States. Also, positive institutional developments are already occurring beyond this United Nations process. The proposed implementation agreement should not undermine existing laws, but it is unlikely to leave them untouched. The application of integrated governance principles, and the use of area-based management tools and environmental impact assessment will necessarily influence fisheries regulation in abnj. Accordingly, care should be taken to ensure that any innovative governance tools are adapted to existing institutional capacities and circumstances.