bluuebunny/crossref_metadata_2025 huggingface dataset:
External Validation of the Risk Assessment Model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for Medical Patients in a Tertiary Health System
Authors: Rosenberg David , Eichorn Ann , Alarcon Mauricio , McCullagh Lauren , McGinn Thomas , Spyropoulos Alex C.
Published: November 2014

Background

Hospitalized medical patients are at risk for venous thromboembolism (
VTE
). Universal application of pharmacological thromboprophylaxis has the potential to place a large number of patients at increased bleeding risk. In this study, we aimed to externally validate the International Medical Prevention Registry on Venous Thromboembolism (
IMPROVE) VTE
risk assessment model in a hospitalized general medical population.

Methods and Results

We identified medical discharges that met the
IMPROVE
protocol. Cases were defined as hospital‐acquired
VTE
and confirmed by diagnostic study within 90 days of index hospitalization; matched controls were also identified. Risk factors for
VTE were
based on the
IMPROVE risk assessment model
(aged >60 years, prior
VTE
, intensive care unit or coronary care unit stay, lower limb paralysis, immobility, known thrombophilia, and cancer) and were measured and assessed. A total of 19 217 patients met the inclusion criteria. The overall
VTE
event rate was 0.7%. The
IMPROVE risk assessment model
identified 2 groups of the cohort by
VTE
incidence rate: The low‐risk group had a
VTE
event rate of 0.42 (95%
CI
0.31 to 0.53), corresponding to a score of 0 to 2, and the at‐risk group had a
VTE
event rate of 1.29 (95%
CI
1.01 to 1.57), corresponding to a score of ≥3. Low‐risk status for VTE encompassed 68% of the patient cohort. The area under the receiver operating characteristic curve was 0.702, which was in line with the derivation cohort findings.

Conclusions

The
IMPROVE VTE
risk assessment model validation cohort revealed good discrimination and calibration for both the overall
VTE
risk model and the identification of low‐risk and at‐risk medical patient groups, using a risk score of ≥3. More than two thirds of the entire cohort had a score ≤2.
Contracts Contrary to Public Policy under English and Dutch Law
Authors: Mansoor Zeeshan
Published: November 2014

Both English and Dutch law contain general rules that result in the invalidity of contracts which conflict with morality and/or public policy. Working on the premise that each country has its own unique set of factors shaping public interests, this article highlights methodological aspects of identifying the extent to which convergence and divergence exists in the English and Dutch approaches towards the invalidity of contracts on grounds of public policy and good morals. Contracts that tend to commercialise the human body in a manner that raises questions of compatibility with public policy and/or good morals are used as an example in this paper. These contracts are analysed using an ‘interest-based comparative methodology’. Subsequently, the results are comparatively examined. The outcome reveals that while English and Dutch law diverge significantly as far as contracts commercialising the human body are concerned, the underlying interests behind these laws appear to be quite similar.
Identifying a Barotropic Growth Mechanism in East Pacific Tropical Cyclogenesis Using Adjoint-Derived Sensitivity Gradients
Authors: Hoover Brett T.
Published: November 2014

The eastern Pacific tropical cyclone basin is typified by a low-level westerly jet with the main development region residing on its northern, cyclonic-shear side. The persistent meridional shear of the zonal flow associated with the jet allows for the possibility of barotropic conversion of energy from the mean state into the kinetic energy of vortices—possibly contributing to tropical cyclogenesis, but this is difficult to quantify by perturbing the model based on intuition since there is no guarantee that perturbations will favorably interact with the jet to facilitate cyclogenesis.

Here, sensitivity gradients of vortex intensity through cyclogenesis are calculated for a set of cases spanning from 2004 to 2010 and are interpreted dynamically to determine which cases have sensitivities describing structures that can grow barotropically from the low-level jet. The adjoint model is run with adiabatic physics linearized about a basic state that contains moist convection. Optimal perturbations derived from these sensitivities are inserted into the model to observe the impact. Roughly 34% of observed cases exhibited structures in sensitivity to zonal flow that strongly imply barotropic growth, while about 21% exhibited no such structures. The remainder (roughly 45%) exhibit some reliance on barotropic growth. Cases with sensitivities exhibiting strong barotropic growth structures are typified by low-level westerly jets with larger meridional shear. In these cases, optimal perturbations require less initial energy to increase vortex intensity by a specified amount, the energy is more strongly focused at jet level, and the localized energy growth rate of perturbations is most efficient.
Clinical Implication of Highly Sensitive Detection of the BRAFV600E Mutation in Fine-Needle Aspirations According to the Thyroid Bethesda System in Patients With Conventional Papillary Thyroid Carcinoma
Authors: Seo Jae Young , Choi Jong Rak , Moon Hee Jung , Kim Eun-Kyung , Han Kyung Hwa , Kim Hyunki , Kwak Jin Young
Published: November 2014

Background:

We investigated the additional diagnostic yield of the mutation test and evaluated the frequency of the BRAF mutation in conventional PTC (cPTC) according to ultrasound (US) features and the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) based on the BRAFV600E mutation status.

Materials and Methods:

During the study period, 279 patients who underwent FNA with an additional BRAFV600E mutation test were diagnosed as cPTC after surgery. We analyzed the association between the mutation and several clinical factors.

Results:

Of the 279 cPTCs, 250 (89.6%) had the BRAFV600E mutation. The BRAF mutation test was helpful in diagnosing an additional 19% (53/279) of cPTCs. The frequency of the BRAF mutation in cPTCs with suspicious US features was higher than that of cPTCs with negative US features regardless of the BSRTC.

Conclusions:

Suspicious US features may be helpful in deciding whether an additional BRAFV600E mutation test should be done in thyroid nodules with indeterminate cytology.
Severely Obese Preschoolers in a Tertiary Care Obesity Program
Authors: Baughcum Amy E. , Gramling Kerri , Eneli Ihuoma
Published: November 2014

Objectives. To describe the characteristics and management of severely obese 2- to 5-year-olds children referred to a tertiary care multidisciplinary obesity center. Methods. A retrospective chart review was conducted of children 2 to 5 years old evaluated at the center from January 2009 to February 2011. Referral eligibility was a body mass index (BMI) ≥95th percentile. Results. Of the 2- to 5-year-olds seen at the center, 140 (94%) had a BMI >99th percentile. Of these children with severe obesity, 54% were female, 48% were Caucasian, and mean age was 4.60 years (SD = 1.00). Mean BMI and BMI z-score at initial visit was 26.5 kg/m2 (SD = 4.12) and 3.59 (SD = 0.95), respectively. BMI z-scores varied significantly by age—χ2(3, N = 140) = 54.44, P < .001—and gender—χ2(1, N = 140) = −5.31, P < .001—with males and younger children presenting at much higher BMI z-scores. Most of the children had a family history of obesity, (85%), type 2 diabetes (74%), and hypertension (74%). Nearly one third of families reported history of mental health or substance abuse problems. Comorbidities were prevalent, particularly dyslipidemia and problematic eating behaviors. For the 53% of children who returned for at least one follow-up visit, mean BMI z-score decreased significantly by 0.15— t(79) = 5.31, P < .001. Conclusions. Our findings underscore the severity of the condition facing these children and their families. With improved retention, the tertiary care multidisciplinary program may be a viable option for successful intervention for these children.
Effects of Hypoxia on the Immunomodulatory Properties of Human Gingiva–Derived Mesenchymal Stem Cells
Authors: Jiang C.M. , Liu J. , Zhao J.Y. , Xiao L. , An S. , Gou Y.C. , Quan H.X. , Cheng Q. , Zhang Y.L. , He W. , Wang Y.T. , Yu W.J. , Huang Y.F. , Yi Y.T. , Chen Y. , Wang J.
Published: November 2014

The environment of bone marrow mesenchymal stem cells (MSCs) is hypoxic, which plays an important role in maintaining their self-renewal potential and undifferentiated state. MSCs have been proven to possess immunomodulatory properties and have been used clinically to treat autoimmune diseases. Here, we tested the effects of hypoxia on the immunomodulatory properties of MSCs and examined its possible underlying mechanisms. We found that hypoxic stimulation promoted the immunomodulatory properties of human gingiva–derived mesenchymal stem cells (hGMSCs) by enhancing the suppressive effects of hGMSCs on peripheral blood mononuclear cells (PBMCs). The proliferation of PBMCs was significantly inhibited, while the apoptosis of PBMCs was increased, which was associated with the Fas ligand (FasL) expression of hGMSCs. The in vivo study showed that systemically infused hGMSCs could enhance skin wound repair, and 24-h hypoxic stimulation significantly promoted the reparative capacity of hGMSCs. For mechanism, hGMSC treatment inhibited the local inflammation of injured skin by suppressing the inflammatory cells, reducing the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α), and increasing anti-inflammatory cytokine interleukin-10 (IL-10), which was promoted by hypoxia. Hypoxia preconditioning may be a good optimizing method to promote the potential of MSCs for the future cell-based therapy.
Effects of apocynin, an NADPH oxidase inhibitor, on levels of ADMA, MPO, iNOS and TLR4 induced by myocardial ischemia reperfusion
Authors: Uysal A , Sahna E , Ozguler IM , Burma O , Ilhan N
Published: November 2014

Purpose:

In this study, the effects of apocynin, an NADPH oxidase inhibitor, on the levels of inducible nitric oxide synthase (iNOS) and the toll-like receptor 4 (TLR4), which are inflammatory mediators in myocardial ischemia-reperfusion (MIR) injury, and myeloperoxidase (MPO), which is the indicator of neutrophil infiltration and the endogenous nitric oxide synthase inhibitor asymmetric dimethyl arginine (ADMA) increasing with oxidative stress were investigated.

Methods:

MIR injury was accomplished by the application of occlusion for 30 minutes and reperfusion for 120 minutes in the left anterior descending artery (LAD). In the study, 21 Sprague-Dawley male rats were divided into three groups: a sham group (n = 7); a MIR group (n = 7); and a MIR + apocynin treatment group (n = 7, before the procedure, an intraperitoneal administration of 10 mg/kg of apocynin for 15 days). After reperfusion, iNOS, TLR4, MPO and ADMA levels in myocardial tissue were measured by ELISA.

Results:

While myocardial TLR4, MPO and ADMA levels increased in the MIR group, these parameters were found to be decreased significantly in the group treated with apocynin. Although iNOS levels showed an increase in the MIR group compared to the sham group and a reduction in the MIR+apocynin group, there was no statistically significant difference between the groups.

Discussion:

In our study, the effect of the treatment of apocynin in MIR on ADMA, MPO, iNOS and TLR4 levels in myocardial tissue was shown for the first time. It is thought that apocynin treatment may show a protective effect in MIR injury by affecting oxidative stress (ADMA) and inflammatory parameters (iNOS, MPO).
The Effect of Donor Age on Structural and Mechanical Properties of Allograft Tendons
Authors: Swank Katherine R. , Behn Anthony W. , Dragoo Jason L.
Published: November 2014

Background:

Allograft tendons are commonly used in surgical ligament reconstruction. While it is commonly accepted that donor age will affect mechanical properties of graft tissue, the apparent age threshold is unknown.

Hypothesis:

Donor age will significantly influence the structural and mechanical properties of tibialis posterior allograft tendons.

Study Design:

Controlled laboratory study.

Methods:

A total of 550 allograft posterior tibialis tendons were examined. Linear stiffness, ultimate tensile force, ultimate displacement, tensile modulus, ultimate tensile strength, and ultimate tensile strain were calculated for specimens from donors in each of 6 age groups: 15-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years. Both first- and second-order polynomial regressions were performed to determine the correlation between structural and mechanical properties and age. Welch analyses of variance with Games-Howell post hoc tests were performed to facilitate comparisons among age groups.

Results:

All parameters displayed a weak correlation with age, with the highest R2 term being 0.063 for ultimate tensile strength. Linear stiffness, ultimate tensile force, and tensile modulus displayed almost no correlation with age. Ultimate tensile strength increased slightly with age up to 40-49 years and then decreased with further increases in age. Slight decreases in ultimate displacement and ultimate tensile strain were observed with increasing age. Numerous statistically significant differences were observed between age groups for each outcome parameter; however, the magnitudes of the differences between age groups are relatively small (<15%) for all outcome parameters.

Conclusion:

Age explained at most 6% of the variation in structural and mechanical properties of tibialis posterior allograft tendons.

Clinical Relevance:

Posterior tibialis tendons from all age groups displayed structural properties superior to the native anterior cruciate ligament, with higher stiffness and ultimate force, and less displacement to failure. Although statistically significant differences in structural and mechanical properties were observed between age groups, the magnitudes of the differences are small and most likely not clinically relevant. The age of the donor will not likely affect the suitability of a graft for use in surgical reconstruction.
Boundary Tastes at Work
Authors: Willekens Mart , Lievens John
Published: November 2014

In this article, we test three hypotheses about the gendered effect of authority positions in the workplace on tastes in the areas of food and clothing. We use the micro-interactionist model of Randall Collins to formulate new hypotheses on the development of aesthetic and practical taste patterns, as described by Pierre Bourdieu. This leads to the following hypotheses: (1) people in superordinate positions will develop more aesthetic tastes; (2) men in subordinate positions will develop more practical tastes; and (3) women in subordinate positions will develop more aesthetic tastes. Our results show that there is a significant effect of being in a superordinate position on food preferences but not on clothing preferences. Among people in subordinate positions, women score higher than men on a fashion taste in clothing, lower on practical taste in clothing, and lower on a conventional taste in food.
Numerical simulation of prepreg resin impregnation effect in vacuum-assisted resin infusion/prepreg co-curing process
Authors: Ma Xuqiang , Li Yanxia , Gu Yizhuo , Li Min , Zhang Zuoguang
Published: November 2014

A new finite element formulation was developed to simulate the prepreg resin impregnation effect in vacuum-assisted resin infusion/prepreg co-curing process. The numerical model combined the fiber compaction and resin flow model in prepreg part with resin impregnation front tracking model in dry fiber fabric. The influences of processing parameters, including various temperature and time, on the impregnation height in dry fiber fabric and change of fiber volume fraction in prepreg stack were analyzed by numerical model and micrographs in experiment. The accuracy of numerical model was validated by the good agreement between simulation and experimental results. These results are greatly helpful to optimize processing parameters and improve the manufacturing efficiency in co-cured vacuum-assisted resin infusion process.
Three Types of Memory in Emergency Medical Services Communication
Authors: Angeli Elizabeth L.
Published: November 2014

This article examines memory and distributed cognition involved in the writing practices of emergency medical services (EMS) professionals. Results from a 16-month study indicate that EMS professionals rely on distributed cognition and three kinds of memory: individual, collaborative, and professional. Distributed cognition and the three types of memory reduce cognitive workload during a 911 response, and they help evoke information as an EMS professional composes the legally binding patient care report. In addition to presenting results, the article details the author’s interaction with two institutional review boards, which influenced the study’s methods. The article argues that scholars should conduct more research on the collaborative and distributed nature of memory as it relates to workplace writing practices. Furthermore, the article calls for developing writing research methods that involve participant recollection.
Reconstruction of Skull Defects in the Middle Ages and Renaissance
Authors: Missori Paolo , Currà Antonio , Paris Harry S. , Peschillo Simone , Fattapposta Francesco , Paolini Sergio , Domenicucci Maurizio
Published: November 2014

In Egyptian, Greco-Roman, and Arabic medicine, the closure of a skull defect was not provided at the end of a therapeutic trepanation or in cases of bone removal. The literature from the Middle Ages and Renaissance disclosed some striking and forgotten practices. Gilbertus Anglicus (c. 1180 to c. 1250) cites the use of a piece of a cup made from wooden bowl (ciphum or mazer) or a gold sheet to cover the gap and protect the brain in these patients; this citation probably reflected a widely known folk practice. Pietro d’Argellata introduced the use of a fixed piece of dried gourd for brain protection to reconstruct a skull defect. In the late Renaissance, the negative folklore describing this outlandish practice likely led to the use of silver and lead sheets. Nevertheless, for centuries, large numbers of surgeons preferred to leave the dura mater uncovered after bone removal, and failed to apply any brain protection.
Developing Ideal Intermediate Personality Items for the Ideal Point Model
Authors: Cao Mengyang , Drasgow Fritz , Cho Seonghee
Published: November 2014

The importance of intermediate items has been overlooked since the emergence of dominance-based Likert-type scales. The current study aims to advance our understanding of the psychometric properties of intermediate items by showing that they can be successfully calibrated by an ideal point model. A student sample and an MTurk sample were selected to answer personality scales with intermediate items included. Results showed that personality scales with intermediate items demonstrated satisfactory model fits to the ideal point model, but not to the dominance model. When analyzed with the ideal point model, intermediate items provided more information than extreme items for respondents with high latent trait levels. Among four proposed domains of intermediate items (Frequency, Average, Condition, and Transition, “FACT”), the Average domain was consistently found to exhibit the best properties. The proportion of intermediate items in the scale also affected the model fit and the validity of the scale.
Close encounters? Mobile methods, (post)phenomenology and affect
Authors: Spinney Justin
Published: November 2014

There has been a recent upsurge in mobilities research relating to embodied movement, and a corresponding interest in adapting methods to acquire data while on the move. At the same time, many of the questions being asked relate to non-representational aspects of movement, notably the sensory, emotional and affective. While approaches that attempt to enable the researcher to ‘be, see and feel there’ such as mobile video ethnography are becoming more popular, they have not been without their critics. Situated within literature on affect and (post)phenomenology, this article critically examines the go-along to weigh up what we might gain and lose from using such methods. I demonstrate the ways in which such methods have the potential to enhance recollection, empathy and our ability to research ‘quiescence’ through the elicitation of detailed verbal accounts. Acknowledging their shortcomings however, I discuss the potential contribution that bio-sensing technologies may make in conjunction with go-alongs. Ultimately, I argue that despite the value-laden nature of such technologies and the history of anthropometry they are situated within, if used sensitively such tools may be used to promote positive logics of affect and mobility.
Long-term outcomes of surgical treatment in patients with popliteal artery entrapment syndrome
Authors: Yamamoto Satoshi , Hoshina Katsuyuki , Hosaka Akihiro , Shigematsu Kunihiro , Watanabe Toshiaki
Published: November 2014

The object of the study is to determine the long-term outcomes of surgical treatment of patients with popliteal artery entrapment syndrome at a single institute. We retrospectively reviewed 19 limbs of 16 consecutive patients who underwent surgery for popliteal artery entrapment syndrome at our hospital over the past 36 years. The popliteal artery was stenotic in 11 limbs, occlusive in 7 limbs, and compressed and deviated by the medial head of the gastrocnemius muscle but not damaged in 1 limb. Six limbs were treated with autologous saphenous vein bypass, 10 with bypass or venous patch graft concomitant with musculotendinous section, and 3 limbs underwent musculotendinous section alone. The 10-year cumulative patency of the 13 limbs treated with bypass was 100%, although two of them showed occlusion at 23 and 12 years after surgery. One patient who received a venous patch graft showed occlusion 15 years after surgery. Additionally, one asymptomatic patient with an apparently non-damaged popliteal artery who received preventive musculotendinous section alone showed stenosis of the artery 2 years after musculotendinous section. In conclusion, the bypass patency observed in this study was excellent in the long term. Careful examination of popliteal artery anatomy using imaging studies is essential for selecting the appropriate surgical procedure for popliteal artery entrapment syndrome.
Imaging of Physeal Injury
Authors: Jawetz Shari T. , Shah Parina H. , Potter Hollis G.
Published: November 2014

Context:

As the intensity of youth participation in athletic activities continues to rise, the number of overuse injuries has also increased. A subset of overuse injuries involves the physis, which is extremely susceptible to injury. This paper aims to review the utility of the various imaging modalities in the diagnosis and management of physeal injuries in the skeletally immature population.

Evidence Acquisition:

A search for the keywords pediatric, physis, growth plate, x-ray, computed tomography, magnetic resonance imaging, and overuse injury was performed using the PubMed database. No limits were set for the years of publication. Articles were reviewed for relevance with an emphasis on the imaging of growth plate injuries.

Study Design:

Retrospective literature review.

Level of Evidence:

Level 4.

Results:

Three major imaging modalities (radiographs, computed tomography, and magnetic resonance imaging) complement each other in the evaluation of pediatric patients with overuse injuries. However, magnetic resonance imaging is the only modality that offers direct visualization of the physis, and it also offers the best soft tissue contrast for evaluating the other periarticular structures for concomitant injury.

Conclusion:

Imaging has an important role in the diagnosis of physeal injuries, and the information it provides has a tremendous impact on the subsequent management of these patients.
Serum Cartilage Oligomeric Matrix Protein Levels in Collegiate Soccer Athletes over the Duration of an Athletic Season
Authors: Mateer Jessica L. , Hoch Johanna M. , Mattacola Carl G. , Butterfield Timothy A. , Lattermann Christian
Published: November 2014

Objective:

The primary objective of this study was to measure serum cartilage oligomeric matrix protein (sCOMP) levels weekly in a group of collegiate soccer athletes over the duration of a spring soccer season and 2 weeks following the conclusion of the season while documenting minutes of exercise participation as a measure of exercise intensity.

Design:

A repeated-measures study design was employed. A volunteer sample of 6 female soccer athletes participated in this study. Serum samples were collected on 10 separate occasions, 1 week prior to the start of the season (baseline), once a week during the 8-week season (PX1-PX8), and once a week for 2 weeks following the conclusion of the season (postseason; PS1 and PS2). Minutes of participation were documented following all spring soccer activities for each week. Once all samples were collected, sCOMP concentrations were determined using a commercially available enzyme-linked immunosorbent assay.

Results:

The results of Friedman test revealed a significant effect for time ( P = 0.003). Post hoc analysis revealed no significant differences between baseline and practice or postseason levels. A qualitative analysis of the sCOMP levels and minutes indicated higher sCOMP levels occurred when the athletes’ participation in soccer-related activities was higher.

Conclusions:

Qualitatively, our findings suggest that as minutes of participation increased, sCOMP levels increased. However, no statistically significant differences were identified. We speculate these increases were an increase in cartilage turnover and an interesting observation related to increases in physical activity. However, the implications are unclear as there was a return to near baseline levels.
Low Latency Audio Video
Authors: Riley Holly , MacLeod Rebecca B. , Libera Matthew
Published: November 2014

The primary purpose of this study was to examine the potential of LOw LAtency (LOLA), a low latency audio visual technology designed to allow simultaneous music performance, as a distance learning tool for musical styles in which synchronous playing is an integral aspect of the learning process (e.g., jazz, folk styles). The secondary purpose was to describe participant perceptions of the effectiveness of three technologies used to teach music: LOLA, PolyCom, and Skype. To achieve these goals, we isolated a classical masterclass, jazz lesson, and old-time fiddle session and described trends for these lessons across the three technology platforms. Participants rated the overall effectiveness of LOLA ( M = 4.25) higher than PolyCom ( M = 3.06) and Skype ( M = 2.80). Participants shared their perception that LOLA was superior to other technologies for learning and teaching music. Implications for music teaching are discussed.
Transcriptome profiling shows gene regulation patterns in a flavonoid pathway in response to exogenous phenylalanine in Boesenbergia rotunda cell culture
Authors: Md-Mustafa Noor Diyana , Khalid Norzulaani , Gao Huan , Peng Zhiyu , Alimin Mohd Firdaus , Bujang Noraini , Ming Wong Sher , Mohd-Yusuf Yusmin , Harikrishna Jennifer A , Othman Rofina Yasmin
Published: November 2014

Background

Panduratin A extracted from Boesenbergia rotunda is a flavonoid reported to possess a range of medicinal indications which include anti-dengue, anti-HIV, anti-cancer, antioxidant and anti-inflammatory properties. Boesenbergia rotunda is a plant from the Zingiberaceae family commonly used as a food ingredient and traditional medicine in Southeast Asia and China. Reports on the health benefits of secondary metabolites extracted from Boesenbergia rotunda over the last few years has resulted in rising demands for panduratin A. However large scale extraction has been hindered by the naturally low abundance of the compound and limited knowledge of its biosynthetic pathway.

Results

Transcriptome sequencing and digital gene expression (DGE) analysis of native and phenylalanine treated Boesenbergia rotunda cell suspension cultures were carried out to elucidate the key genes differentially expressed in the panduratin A biosynthetic pathway. Based on experiments that show increase in panduratin A production after 14 days post treatment with exogenous phenylalanine, an aromatic amino acid derived from the shikimic acid pathway, total RNA of untreated and 14 days post-phenylalanine treated cell suspension cultures were extracted and sequenced using next generation sequencing technology employing an Illumina-Solexa platform. The transcriptome data generated 101, 043 unigenes with 50, 932 (50.41%) successfully annotated in the public protein databases; including 49.93% (50, 447) in the non-redundant (NR) database, 34.63% (34, 989) in Swiss-Prot, 24,07% (24, 316) in Kyoto Encyclopedia of Genes and Genomes (KEGG) and 16.26% (16, 426) in Clusters of Orthologous Groups (COG). Through DGE analysis, we found that 14, 644 unigenes were up-regulated and 14, 379 unigenes down-regulated in response to exogenous phenylalanine treatment. In the phenylpropanoid pathway leading to the proposed panduratin A production, 2 up-regulated phenylalanine ammonia-lyase (PAL), 3 up-regulated 4-coumaroyl:coenzyme A ligase (4CL) and 1 up-regulated chalcone synthase (CHS) were found.

Conclusions

This is the first report of Boesenbergia rotunda de novo transcriptome data that could serve as a reference for gene or enzyme functional studies in the Zingiberaceae family. Although enzymes that are directly involved in the panduratin A biosynthetic pathway were not completely elucidated, the data provides an overall picture of gene regulation patterns leading to panduratin A production.
Effect of annealing temperature on wettability of TiO2 nanotube array films
Authors: Yang Lei , Zhang Miao , Shi Shiwei , Lv Jianguo , Song Xueping , He Gang , Sun Zhaoqi
Published: November 2014

Highly ordered TiO2 nanotube array (TN) films were prepared by anodization of titanium foil in a mixed electrolyte solution of glycerin and NH4F and then annealed at 200°C, 400°C, 600°C, and 800°C, respectively. The samples were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), water contact angle (WCA), and photoluminescence (PL). It was found that low temperature (below 600°C) has no significant influence on surface morphology, but the diameter of the nanotube increases from 40 to 50 nm with increasing temperature. At 800°C, the nanotube arrays are completely destroyed and only dense rutile film is observed. Samples unannealed and annealed at 200°C are amorphous. At 400°C, anatase phase appears. At 600°C, rutile phase appears. At 800°C, anatase phase changes into rutile phase completely. The wettability of the TN films shows that the WCAs for all samples freshly annealed at different temperatures are about 0°. After the annealed samples have been stored in air for 1 month, the WCAs increase to 130°, 133°, 135°, 141°, and 77°, respectively. Upon ultraviolet (UV) irradiation, they exhibit a significant transition from hydrophobicity to hydrophilicity. Especially, samples unannealed and annealed at 400°C show high photoinduced hydrophilicity.
Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by Mycobacterium tuberculosis - a case report
Authors: Shetty Sachin B , Biswas Jyotirmay , Murali Sowmiya
Published: November 2014

Background

The term multifocal serpiginoid choroiditis (MSC) has been proposed for the infective variant of serpiginous choroiditis (SC) to distinguish it from typical SC believed to be autoimmune related. The role of Mycobacterium tuberculosis (MTb) in MSC has been studied by conventional polymerase chain reaction (PCR). However, the use of real-time PCR (RT-PCR) and nested PCR (N-PCR) in MSC has not been reported. This paper aims to highlight the usefulness of PCR in identifying MTb as a causative agent for MSC leading to its correct treatment with anti-tubercular therapy (ATT).

Findings

A young male with a family history of tuberculosis (TB) presented with a history of diminution of vision (DOV) since 3 months in his right eye (RE). He gave similar history in his left eye (LE) since 3 years. His fundus findings were suggestive of MSC. His high-resolution computed tomography (HRCT) chest and Quanti-FERON TB gold results were positive for MTb. These suggested TB to be the likely cause for MSC. This was confirmed by a positive N-PCR report of his aqueous specimen. Further RT-PCR was done to quantify the bacillary load before starting therapy. He was advised 9 months of ATT with 6 weeks of oral steroids. At last follow-up, the RE showed better healing than the LE with fewer chorioretinal scars and a better visual acuity.

Conclusions

RT and N-PCR for MTb are useful in establishing a tuberculous etiology in MSC. Coupled with a good response to ATT, these tests justify the use of ATT in MSC with a PCR-confirmed MTb report.
Dynamic gene expressions of peripheral blood mononuclear cells in patients with acute exacerbation of chronic obstructive pulmonary disease: a preliminary study
Authors: Wu Xiaodan , Sun Xiaoru , Chen Chengshui , Bai Chunxue , Wang Xiangdong
Published: November 2014

Introduction

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a serious event that is responsible for the progress of the disease, increases in medical costs and high mortality.

Methods

The aim of the present study was to identify AECOPD-specific biomarkers by evaluating the dynamic gene expression profiling of peripheral blood mononuclear cells (PBMCs) from patients with AECOPD on days 1, 3 and 10 after hospital admission and to compare the derived data with data from healthy controls or patients with stable COPD.

Results

We found that 14 genes were co–differentially upregulated and 2 downregulated greater than 10-fold in patients with COPD or AECOPD compared with the healthy individuals. Eight co–differentially upregulated genes and six downregulated genes were identified as a panel of AECOPD-specific genes. Downregulation of TCF7 in PBMCs was found to be associated with the severity of COPD. Dynamic changes of Aminolevulinate-delta-synthase 2 and carbonic anhydrase I had similar patterns of Digital Evaluation Score System scores and may serve as potential genes of interest during the course of AECOPD.

Conclusion

Thus, our findings indicate a panel of altered gene expression patterns in PBMCs that can be used as AECOPD-specific dynamic biomarkers to monitor the course of AECOPD.
Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review
Authors: Visser Mieke , Deliens Luc , Houttekier Dirk
Published: November 2014

Introduction

Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup.

Method

Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians’ knowledge, physicians’ attitudes or physicians’ practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported.

Results

Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians’ attitudes, 24 to physicians’ knowledge and 20 to physicians’ practice. Stronger evidence was found for physicians’ lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient’s true condition.

Conclusions

We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient-, family- and health care system–related barriers need to be examined.
Advancing the science of organ donor management
Authors: Dhanani Sonny , Shemie Sam D
Published: November 2014

There is an increasing burden of responsibility for intensivists to optimize donation potential after the declaration of brain death in patients with catastrophic brain injury. Best practice for donor management, if present, has been formed on low quality and mainly observational studies or consensus. In particular, research into the use of corticosteroids has shown varied benefit. The specific and limited results of the CORTICOME study are less important than the systematic methodology and the development of rigour in the study of deceased organ donation. Donor management would benefit from continued systematic analysis of current literature, understanding of the physiologic basis for therapy, and further prospective controlled trials. Worldwide collaboration partnerships and funding are needed to optimize the management of deceased organ donation.
Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study
Authors: Silversides Jonathan A , Pinto Ruxandra , Kuint Rottem , Wald Ron , Hladunewich Michelle A , Lapinsky Stephen E , Adhikari Neill KJ
Published: November 2014

Introduction

In this cohort study, we explored the relationship between fluid balance, intradialytic hypotension and outcomes in critically ill patients with acute kidney injury (AKI) who received renal replacement therapy (RRT).

Methods

We analysed prospectively collected registry data on patients older than 16 years who received RRT for at least two days in an intensive care unit at two university-affiliated hospitals. We used multivariable logistic regression to determine the relationship between mean daily fluid balance and intradialytic hypotension, both over seven days following RRT initiation, and the outcomes of hospital mortality and RRT dependence in survivors.

Results

In total, 492 patients were included (299 male (60.8%), mean (standard deviation (SD)) age 62.9 (16.3) years); 251 (51.0%) died in hospital. Independent risk factors for mortality were mean daily fluid balance (odds ratio (OR) 1.36 per 1000 mL positive (95% confidence interval (CI) 1.18 to 1.57), intradialytic hypotension (OR 1.14 per 10% increase in days with intradialytic hypotension (95% CI 1.06 to 1.23)), age (OR 1.15 per five-year increase (95% CI 1.07 to 1.25)), maximum sequential organ failure assessment score on days 1 to 7 (OR 1.21 (95% CI 1.13 to 1.29)), and Charlson comorbidity index (OR 1.28 (95% CI 1.14 to 1.44)); higher baseline creatinine (OR 0.98 per 10 μmol/L (95% CI 0.97 to 0.996)) was associated with lower risk of death. Of 241 hospital survivors, 61 (25.3%) were RRT dependent at discharge. The only independent risk factor for RRT dependence was pre-existing heart failure (OR 3.13 (95% CI 1.46 to 6.74)). Neither mean daily fluid balance nor intradialytic hypotension was associated with RRT dependence in survivors. Associations between these exposures and mortality were similar in sensitivity analyses accounting for immortal time bias and dichotomising mean daily fluid balance as positive or negative. In the subgroup of patients with data on pre-RRT fluid balance, fluid overload at RRT initiation did not modify the association of mean daily fluid balance with mortality.

Conclusions

In this cohort of patients with AKI requiring RRT, a more positive mean daily fluid balance and intradialytic hypotension were associated with hospital mortality but not with RRT dependence at hospital discharge in survivors.
Early identification of patients at risk of long-term critical illness-associated physical disability: is it possible?
Authors: Corner Evelyn J , Brett Stephen J
Published: November 2014

ICU-acquired weakness can hinder and determine the course of recovery from critical illness, leading to life-changing disability. Risk factors include multiorgan failure and prolonged bed rest; however, no prognostic model or screening tool for new-onset disability has been established to date. With no way of targeting the at-risk population, it is difficult to demonstrate the benefit of rehabilitation interventions in research and prioritize resources clinically. In a recent issue of Critical Care, Schandl and colleagues aimed to establish a predictive screening tool for new-onset disability using 23 possible predictors. They found that using the following risk factors – low educational level, fractures, reduced core stability and length of ICU stay over 2 days – they were able to develop a risk score predictive of disability at 2 months after hospital discharge. These investigators propose that this will help to identify patients requiring follow-up and may increase the power to detect change in interventional studies. Whilst this is promising work, further validation is essential: firstly, to make it a clinically workable tool in terms of appropriate `cut offs’; secondly, to ensure that it is transferable in different socio-economic environments; and finally, to make sure that those identified as `at risk’ are those that would benefit the most from targeted intervention.
The relationship between bone health and plasma zinc, copper lead and cadmium concentration in osteoporotic women
Authors: Sadeghi Naficeh , Oveisi Mohammad Reza , Jannat Behrooz , Hajimahmoodi Mannan , Behzad Masoomeh , Behfar Abdolazim , Sadeghi Fatemeh , Saadatmand Sahereh
Published: November 2014

Osteoporosis is a multi factorial disease with dimension of genetic and nutritional considerations. The aim of this study was to present data from the association of plasma zinc, copper and toxic elements of lead and cadmium levels with bone mineral density in Iranian women. 135 women gave their information and enrolled. Fasting plasma was used for measurement of trace elements and heavy metals by Differential Pulse Anodic Stripping Voltammetry. Control group (n = 51) were normal in both lumbar spine (L1-L4) and femoral neck density (T-score ≥ -1), but just femoral neck T-score was considered as criterion in selection of patient group (n = 49, Tscore < -1). No differences were found in the nutritional status, number of diseases, drugs and functional activities between these groups. Plasma Zn, Cu, Pb, Cd levels were analyzed by, a method of voltammetry. Mean ± SD levels of copper and zinc was 1.168 ± 0.115, 1.097 ± 0.091 μg/ml in control group, 1.394 ± 0.133, 1.266 ± 0.11 μg/ml in total patient (TP) and 1.237 ± 0.182, 1.127 ± 0.176 μg/ml in Mild patients(-1 > T-score > -1.7), 1.463 ± 0.174, 1.327 ± 0.147 μg/ml in Severe patient group (T-score < -1.7); respectively. Mean ± SD plasma level of lead and cadmium was 168.42 ± 9.61 ng/l, 2.91 ± 0.18 ng/ml in control group, 176.13 ± 8.64 ng/l, 2.97 ± 0.21 ng/ml in TP, 176.43 ± 13.2 ng/l, 2.99 ± 0.1 ng/ml in mild patients, 221.44 ± 20 ng/l and 3.80 ± 0.70 ng/ml in severe patient group, respectively. In this study plasma zinc, copper, lead & cadmium concentrations were higher in the patients than in the control, though differences were not significant. However, differences were higher between the controls and patients with severe disease (T-score < -1.7). In addition adjusted T-score of femur with age and BMI showed negative significant correlation with plasma levels of zinc and lead in total participants (p < 0.05, r = -0.201, p = 0.044, r = -0.201). It seems that more extensive study with larger ample size might supply definite results about this association for copper and cadmium.
Canadian Chronic Kidney Disease Clinics: A National Survey of Structure, Function and Models of Care
Authors: Levin Adeera , Steven Soroka , Selina Allu , Flora Au , Sarah Gil , Braden Manns
Published: November 2014

Background:

The goals of care for patients with chronic kidney disease (CKD) are to delay progression to end stage renal disease, reduce complications, and to ensure timely transition to dialysis or transplantation, while optimizing independence. Recent guidelines recommend that multidisciplinary team based care should be available to patients with CKD. While most provinces fund CKD care, the specific models by which these outcomes are achieved are not known. Funding for clinics is hospital or program based.

Objectives:

To describe the structure and function of clinics in order to understand the current models of care, inform best practice and potentially standardize models of care.

Design:

Prospective cross sectional observational survey study.

Setting, Patients/Participants:

Canadian nephrology programs in all provinces.

Methods and Measurements:

Using an open-ended semi-structured questionnaire, we surveyed 71 of 84 multidisciplinary adult CKD clinics across Canada, by telephone and with written semi-structured questionnaires; (June 2012 to November 2013). Standardized introductory scripts were used, in both English and French.

Results:

CKD clinic structure and models of care vary significantly across Canada. Large variation exists in staffing ratios (Nephrologist, dieticians, pharmacists and nurses to patients), and in referral criteria. Dialysis initiation decisions were usually made by MDs. The majority of clinics (57%) had a consistent model of care (the same Nephrologist and nurse per patient), while others had patients seeing a different nephrologist and nurses at each clinic visit. Targets for various modality choices varied, as did access to those modalities. No patient or provider educational tools describing the optimal time to start dialysis exist in any of the clinics.

Limitations:

The surveys rely on self reporting without validation from independent sources, and there was limited involvement of Quebec clinics. These are relative limitations and do not affect the main results.

Conclusions:

The variability in clinic structure and function offers an opportunity to explore the relationship of these elements to patient outcomes, and to determine optimal models of care. This list of contacts generated through this study, serves as a basis for establishing a CKD clinic network. This network is anticipated to facilitate the conduct of clinical trials to test novel interventions or strategies within the context of well characterized models of care.