bluuebunny/crossref_metadata_2025 huggingface dataset:
Secular trends of pregnancies in women with inflammatory connective tissue disease
Authors: Wallenius Marianne , Salvesen Kjell Å. , Daltveit Anne K. , Skomsvoll Johan F.
Published: August 2015

Introduction

This study examined secular trends in reproductive outcome in women with inflammatory connective tissue disease compared with reference deliveries from the general population.

Material and methods

Historical cohort study based on data registered in the Medical Birth Register of Norway from 1967 to 2009. The study included singleton births in women recorded with connective tissue disease (n = 851) and reference deliveries from the general population (n = 2 437 110). Births were stratified in four periods, 1967–1979, 1980–1989, 1990–1999 and 2000–2009. Associations between connective tissue disease and maternal and perinatal outcomes by decade were assessed in logistic regression analyses and adjusted for maternal age at delivery and parity.

Results

In the 1970s, around 2.7 deliveries/year were registered for women with connective tissue disease (0.004% of all deliveries). This increased to 42 deliveries/year (0.07% of all deliveries) after 2000. Adjusted odds ratios (aOR) for cesarean section were 5.0 (95% CI 2.1–11.9) in the first and 1.8 (95% CI 1.4–2.3) in the last period. For preterm delivery the aOR decreased from 4.9 (95% CI 2.1–11.4) to 3.1 (95% CI 2.3–4.2) and the aOR for birthweight <2500 g changed from 7.3 (95% CI 3.3–16.3) to 4.1 (95% CI 3.0–5.6).

Conclusions

An increasing number of births were observed over time among women with connective tissue disease. Adverse pregnancy outcomes were more common among women with connective tissue disease but risks have decreased over time.
Psychological distress of children with early‐onset type 1 diabetes and their mothers' well‐being
Authors: Hannonen Riitta , Eklund Kenneth , Tolvanen Asko , Komulainen Jorma , Riikonen Raili , Delamater Alan M. , Ahonen Timo
Published: August 2015

Aim

Few studies have focused on the psychological adjustment of pre‐adolescent children with type 1 diabetes. This study examined psychosocial functioning in nine‐ and 10‐year‐old children with early‐onset type 1 diabetes, and their mothers, and associations between psychosocial functioning and diabetes management.

Methods

The mothers of 63 children with early‐onset diabetes and 86 healthy children evaluated their own psychosocial functioning, and their child's, with standardised rating scales. We used general linear models to analyse the children's behaviour problems and the mothers' well‐being. Associations between the children's behaviour problems, diabetes‐related measures and the mothers' well‐being were studied with partial correlations.

Results

Children with diabetes had more internalising problems than the controls (p = 0.001), and these were associated with poor glycaemic control at the early stage of the illness (p = 0.033) and the use of insulin pumps in girls (p = 0.004). Mothers in the diabetes group had more child‐related stress than the controls (p < 0.001), and poorer well‐being was associated with the children's behavioural problems (p < 0.024).

Conclusion

Children with early‐onset diabetes faced an increased risk of internalising problems in middle childhood. The mothers' psychological distress was associated with children's behaviour problems rather than their diabetes.
A comparison of technologically mediated and face‐to‐face help‐seeking sources
Authors: Reeves Philip M. , Sperling Rayne A.
Published: August 2015

Background

Current post‐secondary school students have access to multiple help‐seeking sources. As help‐seeking behaviour relates to academic achievement, the provision of preferred help sources would be beneficial to students, instructors, and course designers.

Aims

This study examines whether students prefer and intend to utilize technologically mediated or face‐to‐face help‐seeking sources.

Sample

Participants (n = 226) were recruited from two sections of an on campus, introductory, educational psychology class.

Methods

An online survey was distributed containing measures of help‐seeking threat, adaptive help‐seeking tendencies, avoidant help‐seeking tendencies, and the intention to seek help from six sources. Correlations and an ANOVA were calculated to determine whether source preferences differed by self‐reported course grade.

Results

Help‐seeking threat was only negatively associated with sources of help that required face‐to‐face interaction. Despite the threat, students intended to use face‐to‐face help‐seeking sources more than technologically mediated sources. Students intended to seek help the most before or after class, via email, or during class. Students intended to seek help the least through the discussion board and during online office hours. Higher performing students preferred face‐to‐face sources, particularly before or after class and during class, more than lower performing students. Lower performing students intended to use mediated sources especially the discussion board and online office hours more than the higher performing students.

Conclusions

The results provide new insights into the help‐seeking process and suggestions for instructors when allocating time and classroom resources. Additionally, the study illustrates the need for continual refinement of a help‐seeking source classification system.
Association between very small tumour size and increased cancer‐specific mortality after radical prostatectomy in lymph node‐positive prostate cancer
Authors: Muralidhar Vinayak , Mahal Brandon A. , Nezolosky Michelle D. , Beard Clair J. , Feng Felix Y. , Martin Neil E. , Efstathiou Jason A. , Choueiri Toni K. , Pomerantz Mark M. , Sweeney Christopher J. , Trinh Quoc‐Dien , Vander Heiden Matthew G. , Nguyen Paul L.
Published: August 2015

Objective

To determine whether very small prostate cancers present in patients who also have lymph node (LN) metastases represent a particularly aggressive disease variant compared with larger LN‐positive tumours.

Patients and Methods

We identified 37 501 patients diagnosed with prostate cancer between 1988 and 2001 treated with radical prostatectomy within the Surveillance, Epidemiology, and End Results database. The primary study variables were tumour size by largest dimension (stratified into: (i) microscopic focus only or 1 mm; (ii) 2–15 mm; (iii) 16–30 mm; (iv) >30 mm), regional LN involvement, and the corresponding interaction term. We evaluated the risk of 10‐year prostate cancer‐specific mortality (PCSM) using the Fine and Gray model for competing risks after controlling for race, tumour grade, T stage, receipt of radiation, number of dissected LNs, number of positive LNs, year of diagnosis, and age at diagnosis.

Results

The median follow‐up was 11.8 years. There was a significant interaction between tumour size and LN involvement (P‐interaction <0.001). In the absence of LN involvement (36 561 patients), the risk of 10‐year PCSM increased monotonically with increasing tumour size. Among patients with LN involvement (940), those with the smallest tumours had increased 10‐year PCSM compared with patients with tumours sized 2–15 mm (24.7% vs 11.8%; adjusted hazard ratio [AHR] 2.84, 95% confidence interval [CI] 1.21–6.71; P = 0.017) or 16–30 mm (24.7% vs 15.5%; AHR 3.12, 95% CI 1.51–6.49; P = 0.002), and similar 10‐year PCSM as those with tumours >30 mm (24.7% vs 24.9%; P = 0.156).

Conclusion

In patients with prostate cancer with LN involvement, very small tumour size may predict for higher PCSM compared with some larger tumours, even after controlling for other prognostic variables. These tumours might be particularly aggressive, beyond what is captured by pathological assessment of tumour grade and stage.
Urinary fistula after robot‐assisted partial nephrectomy: a multicentre analysis of 1 791 patients
Authors: Potretzke Aaron M. , Knight Brent Alexander , Zargar Homayoun , Kaouk Jihad H. , Barod Ravi , Rogers Craig G. , Mass Alon , Stifelman Michael D. , Johnson Michael H. , Allaf Mohamad E. , Sherburne Figenshau Robert , Bhayani Sam B.
Published: August 2015

Objective

To evaluate the incidence of and risk factors for a urine leak in a large multicentre, prospective database of robot‐assisted partial nephrectomy (RPN).

Patients and Methods

A database of 1 791 RPN from five USA centres was reviewed for urine leak as a complication of RPN. Patient and tumour characteristics were compared between patients with and those without postoperative urine leaks. Fisher's exact test was used for qualitative variables and Wilcoxon sum‐rank tests were used for quantitative variables. A review of the literature on PN and urine leak was conducted.

Results

Urine leak was noted in 14/1 791 (0.78%) patients who underwent RPN. The mean (sd) nephrometry score of the entire cohort was 7.2 (1.9), and 8.0 (1.9) in patients who developed urine leak. The median (range) postoperative day of presentation was 13 (3–32) days. Patients with urine leak presented in delayed fashion with fever (two of the 14 patients, 14%), gastrointestinal complaints (four patients, 29%), and pain (five patients, 36%). Eight of the 14 patients (57%) required admission, while eight (57%) and nine (64%) had a drain or stent placed, respectively. Drains and stents were removed after a median (range) of 8 (4–13) days and 21 (8–83) days, respectively. Variables associated with urine leak included tumour size (P = 0.021), hilar location (P = 0.025), operative time (P = 0.006), warm ischaemia time (P = 0.005), and pelvicalyceal repair (P = 0.018). Upon literature review, the historical incidence of urine leak ranged from 1.0% to 17.4% for open PN and 1.6–16.5% for laparoscopic PN.

Conclusion

The incidence of urine leak after RPN is very low and may be predicted by some preoperative factors, affording better patient counselling of risks. The low urinary leak rate may be attributed to the enhanced visualisation and suturing technique that accompanies the robotic approach.
Cinnamaldehyde inhibits inflammation and brain damage in a mouse model of permanent cerebral ischaemia
Authors: Zhao Jingru , Zhang Xiangjian , Dong Lipeng , Wen Ya , Zheng Xiufen , Zhang Cong , Chen Rong , Zhang Ye , Li Yaoru , He Tingting , Zhu Xingyuan , Li Litao
Published: August 2015

Background and Purpose

Recent findings suggest the importance of inflammation in the pathogenesis of cerebral ischaemia and its potential as a therapeutic target. Cinnamaldehyde is a diterpene with a wide range of anti‐inflammatory effects thus may be advantageous in the treatment of cerebral ischaemia. The present study examined the potential therapeutic effects of cinnamaldehyde on cerebral ischaemia using a mouse model with permanent middle cerebral artery occlusion.

Experimental Approach

Male CD‐1 mice, which had the middle cerebral artery occluded, were treated (i.p.) with cinnamaldehyde. Neuroprotection by cinnamaldehyde was analysed by evaluating neurological deficit scores, brain oedema and infarct volume. Expressionsof signal transduction molecules and inflammatory mediators were measured by Western blotting, qRT‐PCR and immunohistochemical staining. Activation of NF‐κB was assessed by Western blotting, immunohistochemistry and immunofluorescence.

Key Results

Cinnamaldehyde reduced the neurological deficit scores, brain oedema and infarct volume. Cinnamaldehyde suppressed the activation of signal transduction molecules including toll‐like receptor 4, tumour necrosis receptor‐associated factor 6 and NF‐κB, attenuated the increased levels of TNF‐α, IL‐1β, CCL2 and endothelial‐leukocyte adhesion molecule‐1 and ultimately reduced leukocyte infiltration into the ischaemic brain areas after cerebral ischaemia.

Conclusions and Implications

Cinnamaldehyde protects against cerebral ischaemia injury by inhibiting inflammation, partly mediated by reducing the expression of toll‐like receptor 4, tumour necrosis receptor‐associated factor 6 and the nuclear translocation of NF‐κB. Our findings suggest that cinnamaldehyde may serve as a new candidate for further development as a treatment for stroke.
Epidemiological data on airborne contact dermatitis – results of the IVDK
Authors: Breuer Kristine , Uter Wolfgang , Geier Johannes
Published: August 2015

Background

Airborne contact dermatitis (AirbCD) is not uncommon, according to a large number of published case reports and review articles. Epidemiological data on AirbCD based on larger clinical samples have not yet been published.

Objectives

To investigate demographic characteristics and patch test reactivity in patients diagnosed with both occupational and non‐occupational AirbCD.

Methods

A retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 1994–2013, including 201 344 consecutively patch tested patients, was performed.

Results

One thousand two hundred and three patients (0.6%) were diagnosed with AirbCD, 421 (35.0%) of these with an occupational background. Occupational dermatitis and face involvement were more prevalent than in patients without AirbCD (n = 200 141). Sensitization to epoxy resin and sensitization to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) were significantly associated with AirbCD, and there was a trend for sensitization to Compositae mix and/or sesquiterpene lactone mix to be associated with AirbCD. Adhesives, plastics, construction materials, paints and varnishes in occupational cases, and plants in non‐occupational cases, were the most commonly documented culprit product categories.

Conclusions

AirbCD is more common in patients with occupational dermatitis than in patients with non‐occupational dermatitis. In our clinical sample, components of epoxy resin systems, MCI/MI and Compositae allergens were the most important contact allergens associated with AirbCD. Patch testing with additional allergens is important.
Reliability of ultrasound texture measures of Biceps Brachialis and Gastrocnemius Lateralis muscles' images
Authors: da Silva Pereira Júnior Newton , da Matta Thiago Torres , Alvarenga André Victor , de Albuquerque Pereira Wagner Coelho , de Oliveira Liliam Fernandes
Published: August 2015

Ultrasound (US) is an important tool for diagnosing of many musculoskeletal tissue conditions. Image texture analysis can be used to characterize this tissue. The complexity curve (CC) is a technique commonly used to characterize the number of grey‐level transitions in an image. Variability and reliability of US texture measures in the muscle tissue are unavailable in the literature. The aim of this study was to determine the variability and reliability of five CC texture parameters from US images of healthy Biceps Brachialis and Gastrocnemius Lateralis (GL) muscles, with longitudinal and transversal orientations of the probe. Eight images per subject were obtained for 30 men in 2 days. Mean, standard deviation, coefficient of variation and intraclass correlation coefficient for the five parameters were calculated for regions of interest. Results showed that the variability was similar for both muscles and most of the parameters showed satisfactory reliability (r > 0·7) for the Biceps Brachialis with the transverse scan and for the GL with the longitudinal scan.
Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer
Authors: Ono Hiroyuki , Yao Kenshi , Fujishiro Mitsuhiro , Oda Ichiro , Nimura Satoshi , Yahagi Naohisa , Iishi Hiroyasu , Oka Masashi , Ajioka Yoichi , Ichinose Masao , Matsui Toshiyuki
Published: August 2015

In response to the rapid and wide acceptance and use of endoscopic treatments for early gastric cancer, the Japan Gastroenterological Endoscopy Society (JGES), in collaboration with the Japanese Gastric Cancer Association (JGCA), has produced ‘Guidelines for ESD and EMR for Early Gastric Cancer’, as a set of basic guidelines in accordance with the principles of evidence‐based medicine. These Guidelines cover the present state of knowledge and are divided into the following seven categories: Indications, Preoperative diagnosis, Techniques, Evaluation of curability, Complications, Long‐term postoperative surveillance, and Histology. Twenty‐three statements were finally accepted as guidelines, and the majority of these were obtained from descriptive studies with lower evidence levels. A number of statements had to be created by consensus (the lowest evidence level), as evidence levels remain low for many specific areas in this field.
Case‐finding for cognitive impairment among people with Type 2 diabetes in primary care using the Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires: the Cog‐ID study
Authors: Koekkoek P. S. , Janssen J. , Kooistra M. , Biesbroek J. M. , Groeneveld O. , van den Berg E. , Kappelle L. J. , Biessels G. J. , Rutten G. E. H. M.
Published: August 2015

Aim

To evaluate two cognitive tests for case‐finding for cognitive impairment in older patients with Type 2 diabetes.

Methods

Of 1243 invited patients with Type 2 diabetes, aged ≥70 years, 228 participated in a prospective cohort study. Exclusion criteria were: diagnosis of dementia; previous investigation at a memory clinic; and inability to write or read. Patients first filled out two self‐administered cognitive tests (Test Your Memory and Self‐Administered Gerocognitive Examination). Secondly, a general practitioner, blinded to Test Your Memory and Self‐Administered Gerocognitive Examination scores, performed a structured evaluation using the Mini‐Mental State Examination. Subsequently, patients suspected of cognitive impairment (on either the cognitive tests or general practitioner evaluation) and a random sample of 30% of patients not suspected of cognitive impairment were evaluated at a memory clinic. Diagnostic accuracy and area under the curve were determined for the Test Your Memory, Self‐Administered Gerocognitive Examination and general practitioner evaluation compared with a memory clinic evaluation to detect cognitive impairment (mild cognitive impairment or dementia).

Results

A total of 44 participants were diagnosed with cognitive impairment. The Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires had negative predictive values of 81 and 85%, respectively. Positive predictive values were 39 and 40%, respectively. The general practitioner evaluation had a negative predictive value of 83% and positive predictive value of 64%. The area under the curve was ~0.70 for all tests.

Conclusions

Both the tests evaluated in the present study can easily be used in case‐finding strategies for cognitive impairment in patients with Type 2 diabetes in primary care. The Self‐Administered Gerocognitive Examination had the best diagnostic accuracy and therefore we would have a slight preference for this test. Applying the Self‐Administered Gerocognitive Examination would considerably reduce the number of patients in whom the general practitioner needs to evaluate cognitive functioning to tailor diabetes treatment.
HypoAware: development and pilot study of a brief and partly web‐based psychoeducational group intervention for adults with Type 1 and insulin‐treated Type 2 diabetes and problematic hypoglycaemia
Authors: Rondags S. M. P. A. , de Wit M. , Snoek F. J.
Published: August 2015

Aim

Our aim was to study the feasibility and acceptability of our partly online psychoeducational group intervention HypoAware targeted at adults with insulin‐treated diabetes and hypoglycaemia problems in an uncontrolled multi‐centre pilot study.

Methods

We developed a 4‐week, party online, group intervention, based on key elements of the evidence‐based Blood Glucose Awareness Training (BGAT) and with input from diabetes healthcare professionals and people with diabetes. We recruited adults with Type 1 and insulin‐treated Type 2 diabetes with impaired hypoglycaemia awareness, frequent hypoglycaemic episodes and/or fear of hypoglycaemia. Feasibility was assessed by means of self‐report questionnaires. Pre–post outcomes included self‐reported frequency of mild hypoglycaemia, fear of hypoglycaemia, confidence in diabetes self‐care, subjective health status, diabetes‐specific and general psychological distress and emotional well‐being.

Results

Organization, recruitment, delivery of HypoAware, retention and compliance yielded no major problems, and both trainers and participants were very satisfied with the programme. The intervention materials required only minor changes. We obtained pre–post intervention measurements in 37 participants from eight hospitals with three drop‐outs. Worries about hypoglycaemia, diabetes distress and confidence in self‐care improved significantly (P < 0.05), although frequency of hypoglycaemia and hypoglycaemia awareness did not.

Conclusions

HypoAware is a new, feasible and acceptable intervention including online modules aimed to help adults with Type 1 and insulin‐treated Type 2 diabetes reduce hypoglycaemia and related problems. A cluster‐randomized controlled trial is planned to test effectiveness, combined with an economic evaluation.
Association between Left Ventricular Postsystolic Shortening and Diastolic Relaxation in Asymptomatic Patients with Systemic Hypertension
Authors: Nogi Shimpei , Ito Takahide , Kizawa Shun , Shimamoto Shinsaku , Sohmiya Koichi , Hoshiga Masaaki , Ishizaka Nobukazu
Published: August 2015

Background

Few data have existed on myocardial postsystolic shortening (PSS) accounting for left ventricular (LV) diastolic dysfunction in systemic hypertension. We examined this relationship, along with clinical and other cardiac parameters, in asymptomatic patients with hypertension.

Methods

We analyzed 104 patients on pharmacological treatment for hypertension who had no signs or symptoms of heart failure for conventional and speckle tracking echocardiography. The sum of the postsystolic index for multiple LV segments (total PSI) and global longitudinal strain (GLS) was computed and used as measures for global PSS and myocardial systolic function, respectively. The tissue Doppler e’ and the speckle tracking–derived global strain rate during early diastole (e'sr) were obtained as indicators of LV relaxation. The circumferential end‐systolic stress was also determined noninvasively and substituted for a measure of myocardial afterload.

Results

Main variables that correlated with the e’ and e'sr were shown to be age, LV mass index, left atrial volume index, GLS, and the total PSI. Multivariate analysis including gender, circumferential end‐systolic stress, and the use of calcium channel blockers as possible covariates revealed that age (β = −0.29, P = 0.002), total PSI (β = −0.26, P = 0.008), and LV mass index (β = −0.25, P = 0.017) were significant independent determinants of e’ and that age (β = −0.34, P < 0.001) and GLS (β = −0.28, P = 0.006) were of e'sr.

Conclusions

Our findings indicate that while depending on the degree of GLS, PSS may affect diastolic relaxation in patients with asymptomatic, but treated, hypertensive patients.
Discordant Electrocardiogram Left Ventricular Wall Thickness and Strain Findings in Influenza Myocarditis
Authors: Hawwa Nael , Popovic Zoran B. , Isma'eel Hussain A.
Published: August 2015

A 42‐year‐old man presented with a viral prodrome and tested positive for influenza A. He rapidly deteriorated developing cardiogenic shock, rhabdomyolysis, and acute kidney injury. Patient improved 1 week later with supportive measures including vasopressors, inotropes, and an intraaortic balloon pump. We report this case as it highlights the discordance between echocardiographic ventricular wall thickening as a result of myocardial edema, and electrocardiographic findings at presentation, with a reversal in findings at time of resolution. Additionally, there was some suggestion of a regional pattern to the reduced longitudinal strain.
Reference Values for Echocardiography in Middle‐Aged Population: The Cardiovascular Risk in Young Finns Study
Authors: Ruohonen Saku , Koskenvuo Juha W. , Wendelin‐Saarenhovi Maria , Savontaus Mikko , Kähönen Mika , Laitinen Tomi , Lehtimäki Terho , Jokinen Eero , Viikari Jorma , Juonala Markus , Taittonen Leena , Tossavainen Päivi , Kallio Merja , Bax Jeroen J. , Raitakari Olli
Published: August 2015

Background

Population and sex‐specific reference limits produced with modern ultrasound equipment are needed for accurate clinical echocardiography diagnostics. We report a comprehensive set of reference limits of cardiac function and dimensions in a group of young and middle‐aged Finnish men and women produced by the recommendations of European Society of Echocardiography and American Society of Cardiology.

Methods and Results

Cardiac structure and function was studied in a standardized comprehensive echocardiographic examination in 1,079 healthy volunteers without cardiovascular diseases or major known risk factors participating in the population‐based Young Finns study (444 men and 635 women, age range 34 and 49 years). We present sex‐specific reference values for echocardiographic parameters reflecting cardiac structure (ventricular and atrial dimensions and volumes, left ventricular wall thickness and mass, aortic root) and function. From the 86 measured parameters, only 7 were not statistically significantly different between sexes.

Conclusion

The Young Finns study provides echocardiographic reference ranges for cardiac structure and function quantification that can be utilized to enhance the accuracy or echocardiography diagnostics. The results emphasize the need for sex‐specific assessment for most echocardiographic parameters.
Radiographic, computed tomographic and surgical anatomy of the equine sphenopalatine sinus in normal and diseased horses
Authors: Tucker R. , Windley Z. E. , Abernethy A. D. , Witte T. H. , Fiske‐Jackson A. R. , Turner S. , Smith L. J. , Perkins J. D.
Published: August 2015

Reasons for performing study

Knowledge of imaging anatomy, surgical anatomy and disorders affecting the sphenopalatine sinus are currently lacking.

Objectives

To describe the computed tomographic (CT) and surgical anatomy of the sphenopalatine sinus and diagnosis, treatment and outcome in clinical cases with sphenopalatine sinus disease.

Study design

Cadaver observational study and retrospective case series.

Methods

The sphenopalatine sinuses of 10 normal cadaver heads were examined with digital radiography,CTand sinoscopic examination prior to anatomical sectioning. Sphenopalatine sinus anatomy was described and compared between cadaver specimens across the imaging modalities. Medical records (January 2004–2014) of cases diagnosed with sphenopalatine sinus disease were reviewed.

Results

The anatomy of the sphenopalatine sinus was variable. The borders of the sphenopalatine sinus were not identifiable on plain radiographs, whereasCTprovided useful anatomical information. The palatine portion of the sphenopalatine sinus was consistently accessible sinoscopically and the sphenoidal portion was accessible in 6/10 cadaver heads. Fourteen cases of sphenopalatine sinus disease were identified, presenting with one or more clinical signs of exophthalmos, blindness, unilateral epistaxis or unilateral nasal discharge. Diagnoses included neoplasia (7), progressive ethmoidal haematoma (4), sinus cyst (2) and empyema (1). Computed tomography provided diagnostic information but could not differentiate the nature of soft tissue masses. Standing sinoscopic access to the palatine portion of the sphenopalatine sinus was possible for evaluation, biopsy and resection of abnormal soft tissues. Surgical access to the sphenoidal portion was limited. Eight horses were alive at 1 year after diagnosis, with a worse outcome associated withCTevidence of bone loss and a diagnosis of neoplasia.

Conclusions

Sphenopalatine sinus disease should be considered a rare cause of the clinical signs described. Knowledge of the anatomical variation of the sphenopalatine sinus is vital for interpretingCTimages. A combination ofCTand sinoscopy provides the most comprehensive approach for diagnosis and treatment of sphenopalatine sinus disease.
Suspected myofibrillar myopathy in Arabian horses with a history of exertional rhabdomyolysis
Authors: Valberg S. J. , McKenzie E. C. , Eyrich L. V. , Shivers J. , Barnes N. E. , Finno C. J.
Published: August 2015

Reasons for performing study

Although exertional rhabdomyolysis (ER) is common in Arabian horses, there are no dedicated studies describing histopathological characteristics of muscle from Arabian horses withER.

Objectives

To prospectively identify distinctive histopathological features of muscle from Arabian endurance horses with a history ofER(pro‐ER) and to retrospectively determine their prevalence in archived samples from Arabian horses with exertional myopathies (retro‐ER).

Study design

Prospective and retrospective histopathological description.

Methods

Middle gluteal muscle biopsies obtained from Arabian controls (n = 14), pro‐ER(n = 13) as well as archived retro‐ER(n = 25) muscle samples previously classified withtype 2polysaccharide storage myopathy (15/25), recurrent exertional rhabdomyolysis (7/25) and no pathology (3/25) were scored for histopathology and immunohistochemical staining of cytoskeletal proteins. Glutaraldehyde‐fixed samples (2 pro‐ER, one control) were processed for electron microscopy. Pro‐ERand retro‐ERgroups were compared with controls using Mann–WhitneyUand Fisher's exact tests.

Results

Centrally located myonuclei in mature myofibres were found in significantly more (P<0.05) pro‐ER(12/13) and retro‐ER(21/25) horses than controls (4/14). Degenerating myofibres were not evident in any biopsies. Retro‐ERhorses had amylase‐resistant polysaccharide (6/25, P<0.05) and higher scores for cytoplasmic glycogen, rimmed vacuoles and rod‐like bodies. A few control horses (3/14) and significantly (P<0.05) more pro‐ER(12/13) and retro‐ER(18/25) horses had disrupted myofibrillar alignment and large desmin and αβ‐crystallin positive cytoplasmic aggregates. Prominent Z‐disc degeneration and focal myofibrillar disruption with regional accumulation of β‐glycogen particles were identified on electron microscopy of the 2 pro‐ERsamples.

Conclusions

In a subset of Arabian horses with intermittent episodes of exertional rhabdomyolysis, ectopic accumulation of cytoskeletal proteins and Z‐disc degeneration bear a strong resemblance to a myofibrillar myopathy. While many of these horses were previously diagnosed withtype 2polysaccharide storage myopathy, pools of glycogen forming within disrupted myofibrils appeared to give the false appearance of a glycogen storage disorder.
Histoplasma capsulatum surmounts obstacles to intracellular pathogenesis
Authors: Garfoot Andrew L. , Rappleye Chad A.
Published: August 2015

The fungal pathogen Histoplasma capsulatum causes respiratory and disseminated disease, even in immunocompetent hosts. In contrast to opportunistic pathogens, which are readily controlled by phagocytic cells, H. capsulatum yeasts are able to infect macrophages, survive antimicrobial defenses, and proliferate as an intracellular pathogen. In this review, we discuss some of the molecular mechanisms that enable H. capsulatum yeasts to overcome obstacles to intracellular pathogenesis. H. capsulatum yeasts gain refuge from extracellular obstacles such as antimicrobial lung surfactant proteins by engaging the β‐integrin family of phagocytic receptors to promote entry into macrophages. In addition, H. capsulatum yeasts conceal immunostimulatory β‐glucans to avoid triggering signaling receptors such as the β‐glucan receptor Dectin‐1. H. capsulatum yeasts counteract phagocyte‐produced reactive oxygen species by expression of oxidative stress defense enzymes including an extracellular superoxide dismutase and an extracellular catalase. Within the phagosome, H. capsulatum yeasts block phagosome acidification, acquire essential metals such as iron and zinc, and utilize de novo biosynthesis pathways to overcome nutritional limitations. These mechanisms explain how H. capsulatum yeasts avoid and negate macrophage defense strategies and establish a hospitable intracellular niche, making H. capsulatum a successful intracellular pathogen of macrophages.
Trophic mismatch and its effects on the growth of young in an Arctic herbivore
Authors: Doiron Madeleine , Gauthier Gilles , Lévesque Esther
Published: August 2015

In highly seasonal environments, timing of breeding of organisms is typically set to coincide with the period of highest resource availability. However, breeding phenology may not change at a rate sufficient to keep up with rapid changes in the environment in the wake of climate change. The lack of synchrony between the phenology of consumers and that of their resources can lead to a phenomenon called trophic mismatch, which may have important consequences on the reproductive success of herbivores. We analyzed long‐term data (1991–2010) on climate, plant phenology and the reproduction of a long‐distance Arctic migrant, the greater snow goose (Chen caerulescens atlantica), in order to examine the effects of mismatched reproduction on the growth of young. We found that geese are only partially able to adjust their breeding phenology to compensate for annual changes in the timing of high‐quality food plants, leading to mismatches of up to 20 days between the two. The peak of nitrogen concentration in plants, an index of their nutritive quality for goslings, occurred earlier in warm springs with an early snow melt. Likewise, mismatch between hatch dates of young and date of peak nitrogen was more important in years with early snow melt. Gosling body mass and structural size at fledging was reduced when trophic mismatch was high, particularly when the difference between date of peak nitrogen concentration and hatching was >9 days. Our results support the hypothesis that trophic mismatch can negatively affect the fitness of Arctic herbivores and that this is likely to be exacerbated by rising global temperatures.
The great 1815 eruption of Tambora and future risks from large‐scale volcanism
Authors: Gertisser R. , Self S.
Published: August 2015

The year 2015 marks the bicentenary of the largest eruption in recent historic times: the 10–11 April 1815 eruption of Mount Tambora, Indonesia. Two hundred years after the eruption, an incomplete or inaccurate record of large eruptions over the past millennia, and uncertainties in determining the true sizes of eruptions, hamper our ability to predict when the next eruption of this scale may occur. Such events would have catastrophic effects locally and, possibly, world‐wide. The problem is compounded by a lack of detailed knowledge of how and over what timescales large magma reservoirs that feed such eruptions grow and assemble, and of the surface manifestations of these processes recorded through geophysical or geochemical monitoring techniques.
Nannofossils: the smoking gun for the Canarian hotspot
Authors: Troll Valentin R. , Deegan Frances M. , Burchardt Steffi , Zaczek Kirsten , Carracedo Juan‐Carlos , Meade Fiona C. , Soler Vicente , Cachao Mario , Ferreira Jorge , Barker Abigail K.
Published: August 2015

The origin of volcanism in the Canary Islands has been a matter of controversy for several decades. Discussions have hinged on whether the Canaries owe their origin to seafloor fractures associated with the Atlas Mountain range or to an underlying plume or hotspot of superheated mantle material. However, the debate has recently come to a conclusion following the discovery of nannofossils preserved in the products of the 2011–2012 submarine eruption at El Hierro, which tell us about the age and growth history of the western‐most island of the archipelago. Light coloured, pumice‐like ‘floating rocks’ were found on the sea surface during the first days of the eruption and have been shown to contain fragments of pre‐island sedimentary strata. These sedimentary rock fragments were picked up by ascending magma and transported to the surface during the eruption, and remarkably retained specimens of pre‐island Upper Cretaceous to Pliocene calcareous nannofossils (e.g. coccolithophores). These marine microorganisms are well known biostratigraphical markers and now provide crucial evidence that the westernmost and youngest island in the Canaries is underlain by the youngest sediment relative to the other islands in the archipelago. This finding supports an age progression for the onset of volcanism at the individual islands of the archipeligo. Importantly, as fracture‐related volcanism is known to produce non‐systematic age‐distributions within volcanic alignments, the now‐confirmed age progression corroberates to the relative motion of the African plate over an underlying mantle plume or hotspot as the cause for the present‐day Canary volcanism.
Physical geology of the Fogo volcano (Cape Verde Islands) and its 2014–2015 eruption
Authors: Worsley Peter
Published: August 2015

The geological development of the Fogo island volcano commenced in the early Quaternary, and much later during the Last Glacial stage this involved a mega‐scale lateral collapse of the former edifice. This later event created a large caldera‐like landform open to the east, the floor of which is known as the Chã, and subsequently within this a strato‐volcanic cone has grown. The last phase of volcanic activity started in late 2014 and persisted for 77 days. It had a devastating impact on the lives of the 1000 plus people who were living within the ‘caldera’, since two large villages and a smaller one were each totally destroyed in a matter of days by the advancing lavas. In addition, large areas of cultivated land, upon which the inhabitants were dependent for their livelihood, were enveloped by lava. The eruption proved to be of a greater magnitude than the immediately preceding one of 1995, when a mass evacuation was necessary but as only a few buildings were affected, resettlement followed. Unfortunately the much greater devastation to the human environment makes it doubtful whether any significant resettlement will be possible after the 2014–2015 event.
Chronic Liver Disease Questionnaire would be a primary screening tool of neuropsychiatric test detecting minimal hepatic encephalopathy of cirrhotic patients
Authors: Hirano Hirotaka , Saito Masaya , Yano Yoshihiko , Momose Kenji , Yoshida Masaru , Tanaka Atsushi , Azuma Takeshi
Published: August 2015

Aim

The neuropsychiatric test (NP test) is a clinically available modality to confirm minimal hepatic encephalopathy (MHE), but it takes at least 30 min for outpatients to complete. An easier primary screening tool of the NP test would be helpful to predict MHE in routine testing on the public.

Methods

We performed a prospective cohort study on 59 cirrhotic outpatients at Kobe University Hospital. Laboratory measurements, the NP test and the Chronic Liver Disease Questionnaire (CLDQ) were performed. As an indicator of MHE, cases with and without two abnormal subsets or more in the NP test were compared, and the independent risk factors were statistically examined. Predictive scoring systems of the risk of MHE were established using multivariate logistic regression.

Results

CLDQ worry (WO) was the best predictive factor of MHE diagnosed by the NP test (P = 0.006). The predictive model using CLDQ WO discriminated well between patients with and without MHE (area under the curve, 0.714; 95% confidence interval, 0.582–0.824). The predictive scores of MHE enable the patient‐specific probability to be easily looked up.

Conclusion

CLDQ WO was shown to be an independent factor associated with the NP test to diagnose MHE in cirrhotic patients. The easy predictive scoring system of the risk of MHE using CLDQ WO could become a primary screening tool before performing the NP test in a social setting.
Predictors of progression into acute‐on‐chronic liver failure from acute deterioration of pre‐existing chronic liver disease
Authors: Zhang Qian , Han Tao , Li Ying , Nie CaiYun , Liu Hua
Published: August 2015

Aim

To compare the prognosis between the patients with progression into acute‐on‐chronic liver failure (ACLF) from acute deterioration of pre‐existing chronic liver disease and patients without this progression, and to determine predictors of this disease progression.

Methods

We retrospectively analyzed clinical data from 285 patients admitted with acute worsening of pre‐existing chronic liver disease within 4 weeks characterized by total bilirubin (TBIL) of 51 μM/L or more and prothrombin activity (PTA) of more than 40% but less than 70%, which did not meet the Asia–Pacific Association for the Study of the Liver criteria for ACLF. Patient survival was estimated by Kaplan–Meier analysis and subsequently compared by log–rank test. Independent predictors of disease progression were determined using univariate analysis and multivariate Cox regression analysis.

Results

The 90‐day survival rates significantly worsened in patients with progression into ACLF compared with those without this progression. Baseline TBIL, baseline Model for End‐Stage Liver Disease (MELD) score, and the maximum changing rates of PTA level and Child–Turcotte–Pugh (CTP) score were independently associated with progression into ACLF in patients with acute deterioration of pre‐existing chronic liver disease.

Conclusion

Patients with acute worsening of pre‐existing chronic liver disease characterized by TBIL of 51 μM/L or more and PTA of more than 40% but less than 70% should receive aggressive prediction and prevention of ACLF development. Baseline TBIL, baseline MELD score, and the maximum changing rates of PTA level and CTP score may early predict the progression into ACLF.
T‐helper 17 cytokines (interleukins 17, 21, 22, and 6, and tumor necrosis factor‐α) in patients with alopecia areata: association with clinical type and severity
Authors: Atwa Mona A. , Youssef Nahed , Bayoumy Nervana M.
Published: August 2015

Background

Alopecia areata (AA) is an organ‐specific autoimmune disease characterized by T‐cell infiltrates and cytokine production. T‐helper 17 (Th17) cells are crucially involved in the pathogenesis of autoimmune diseases.

Objectives

Our aim was to assess the association of Th17 with AA. We examined interleukin (IL)‐17, IL‐21, IL‐22, IL‐6, and tumor necrosis factor‐alpha (TNF‐α) levels in the serum of patients with AA and studied their association with clinical type and severity of AA.

Subjects and methods

The serum concentrations of IL‐17, IL‐21, IL‐22, IL‐6, and TNF‐α were measured in 47 patients with AA and 40 healthy controls. The clinical type of AA was determined, and the severity of hair loss was assessed in accordance with the Alopecia Areata Investigational Assessment Guideline criteria.

Results

The serum concentrations of IL‐17, IL‐21, IL‐22, IL‐6, and TNF‐α were significantly higher in patients with AA as compared with healthy controls (mean: IL‐17 33.23 ± 11.58 vs. 4.62 ± 1.88 pg/ml; P = 0.000, IL‐21 62.10 ± 6.11 vs. 48.38 ± 3.31 pg/ml; P = 0.000, IL‐22 19.27 ± 3.36 vs. 7.09 ± 1.62 pg/ml; P = 0.000, IL‐6 17.18 ± 3.08 vs. 4.59 ± 1.66 pg/ml; P = 0.000, TNF‐α 19.94 ± 3.59 vs. 9.95 ± 2.42 pg/ml; P = 0.000, respectively). There were significant positive correlations between serum IL‐17, TNF‐α, and disease severity. There was also significant positive correlation between serum IL‐22 and duration of AA.

Conclusion

Our results showed high serum levels of Th17 cytokines among patients with AA that may suggest a functional role of these cytokines in the pathogenesis of this important skin disease. It could also provide the rationale for new treatment strategies in AA.
Incidence of Merkel cell carcinoma in Olmsted County, Minnesota: a population‐based study
Authors: Chang Michael B. , Weaver Amy L. , Brewer Jerry D.
Published: August 2015

Background

Merkel cell carcinoma (MCC) is a rare, aggressive, often cutaneous malignancy. The incidence has been estimated from national registries in the USA and elsewhere, and data indicate variations depending on the region studied. The objective of this study was to determine the incidence of MCC in Olmsted County (MN, USA).

Methods

Using the Rochester Epidemiology Project, which contains health records for all the residents of Olmsted County, we retrospectively reviewed the records for all cases of MCC from 1976 to 2011.

Results

The overall annual age‐ and sex‐adjusted incidence of MCC in Olmsted County during 1976–2011 was 0.35 per 100,000 person‐years (95% CI, 0.14–0.57). The incidence tended to be higher among men than women with 0.69 per 100,000 (95% CI, 0.24–1.14) and 0.10 per 100,000 (95% CI, 0–0.24), respectively.

Conclusions

These data are within the range of previous MCC incidence reports, and the incidence of MCC in Olmsted County is consistent with rates reported in the remainder of the USA.
Subacute cutaneous lupus erythematosus starting as linear lupus erythematosus
Authors: Frances Laura , Betlloch Isabel , Leiva‐Salinas Maria , Marin Irene , Pascual Jose Carlos
Published: August 2015

Background

Cutaneous lupus in childhood is usually associated with systemic lupus erythematosus (LE). Linear cutaneous LE (LCLE) is an unusual presentation mostly seen in children and young adults.

Methods

We report a rare case of cutaneous subacute LE with a segmentary pattern following the lines of Blaschko in an 18‐month‐old girl with a 2‐month history of persistent, linear, asymptomatic, erythematous lesions along the right arm. The clinical diagnosis at presentation was lichen striatus.

Results

A biopsy showed an intense, band‐like, inflammatory cell infiltrate with perivascular and periadnexal involvement associated with basal cell liquefactive degeneration. The lesions were treated with topical corticosteroids and healed without scarring. Two months later, new lesions manifested as multiple erythematous, edematous, polycyclic plaques. A new biopsy showed a periadnexal infiltrate, a large amount of mucin, and a thickened basement membrane. Direct immunofluorescence was negative. Our definitive diagnosis was subacute cutaneous LE starting as linear LE. The lesions responded slowly to oral corticosteroids. Six months later, only a mild livedoid skin pattern remained on the patient's legs.

Conclusions

Linear cutaneous LE usually presents with erythematous, atrophic, hyperkeratotic, dyschromic circular lesions arranged in a linear pattern; the main differential diagnosis is lichen striatum. In general, LCLE can be considered as discoid lupus following Blaschko's lines, which correspond to the direction of growth in clones of cutaneous cells that arise during embryogenesis. The present patient represents the first pediatric case of subacute cutaneous LE following Blaschko's lines, with posterior progression to a generalized form of subacute LE.
Role of linoleic acid in arsenical palmar keratosis
Authors: Ahmed Tarafder S. , Misbahuddin Mir
Published: August 2015

Background

Chronic arsenic exposure can lead to palmoplantar keratosis. In the stratum corneum of skin, linoleic acid is of the utmost importance to the inflammation, keratinization, and regeneration processes.

Objectives

The aims of this study were: (i) to present quantitative information on the linoleic acid fraction of intercorneocyte lipids, and (ii) to elucidate the role of linoleic acid in the pathophysiology of arsenical keratosis.

Methods

Lipid extracts were collected from keratotic lesions in seven patients, seven arsenic‐exposed subjects, and seven non‐exposed control subjects. Linoleic acid levels of the specimens were estimated by reverse‐phase high‐performance liquid chromatography (RP‐HPLC).

Results

There was a significant (P < 0.001) increase in mean ± standard error (SE) linoleic acid levels in arsenical keratosis patients (palm: 25.66 ± 4.95 μg/cm2; dorsum: 28.25 ± 6.20 μg/cm2) compared with arsenic‐exposed (palm: 2.75 ± 0.85 μg/cm2; dorsum: 1.96 ± 0.64 μg/cm2) and non‐exposed (palm: 1.52 ± 0.61 μg/cm2; dorsum: 1.28 ± 0.39 μg/cm2) control subjects. There was no significant difference (P = 0.556) in linoleic acid concentration in the non‐affected skin of the dorsum of the hand (28.25 ± 6.20 μg/cm2) compared with that in the palmar sites (25.66 ± 4.95 μg/cm2) in the patient group. The change in linoleic acid levels in the arsenic‐exposed control group did not differ from that in non‐exposed controls (P = 1.000).

Conclusions

Linoleic acid concentration is elevated in arsenical keratosis; this finding warrants further investigation to ascertain whether linoleic acid plays a direct role in the pathophysiology of arsenical keratosis.