bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angiotensin-Converting Enzyme in Smooth Muscle Cells Promotes Atherosclerosis—Brief Report
Authors: Chen Xiaofeng , Howatt Deborah A. , Balakrishnan Anju , Moorleghen Jessica J. , Wu Congqing , Cassis Lisa A. , Daugherty Alan , Lu Hong 
Published: April 2016

Objective—
Angiotensin-converting enzyme (ACE) is present in many cell types of atherosclerotic lesions. This study determined whether ACE activity in endothelial and smooth muscle cells (SMCs), 2 major resident cell types of the aorta, contributes to hypercholesterolemia-induced atherosclerosis.

Approach and Results—

All study mice were in low-density lipoprotein receptor
−/−
background. To determine the contribution of ACE on endothelial cells to atherosclerosis, female ACE floxed mice were bred to male Tie2-Cre transgenic mice. Endothelial cell–specific deletion of ACE significantly decreased serum ACE activity, but had no effect on systolic blood pressure and atherosclerosis. Because ACE protein is present on SMCs, the most abundant cell type of the aorta, we then determined whether ACE on SMCs contributes to atherosclerosis. ACE was depleted from SMCs by breeding female ACE floxed mice with male SM22-Cre transgenic mice. SMC-specific deficiency of ACE did not affect ACE activity in serum, but ablated its presence and activity in the aortic media. Although SMC-specific deficiency of ACE had no effect on systolic blood pressure, it significantly attenuated hypercholesterolemia-induced atherosclerosis in both male and female mice.

Conclusions—
These studies provide direct evidence that ACE derived from endothelial cells does not play a critical role in atherosclerosis. Rather, SMC-derived ACE contributes to atherosclerosis, independent of circulating ACE activity and blood pressure.
Inhibition of the Nuclear Receptor RORγ and Interleukin-17A Suppresses Neovascular Retinopathy
Authors: Talia Dean M. , Deliyanti Devy , Agrotis Alex , Wilkinson-Berka Jennifer L. 
Published: April 2016

Objective—
Although inhibitors of vascular endothelial growth factor (VEGF) provide benefit for the management of neovascular retinopathies, their use is limited to end-stage disease and some eyes are resistant. We hypothesized that retinoic acid–related orphan nuclear receptor γ (RORγ) and its downstream effector, interleukin (IL)-17A, upregulate VEGF and hence are important treatment targets for neovascular retinopathies.

Approach and Results—
Utilizing a model of oxygen-induced retinopathy, confocal microscopy and flow cytometry, we identified that retinal immunocompetent cells, microglia, express IL-17A. This was confirmed in primary cultures of rat retinal microglia, where hypoxia increased IL-17A protein as well as IL-17A, RORγ, and tumor necrosis factor-α mRNA, which were reduced by the RORγ inhibitor, digoxin, and the RORα/RORγ inverse agonist, SR1001. By contrast, retinal macroglial Müller cells and ganglion cells, key sources of VEGF in oxygen-induced retinopathy, did not produce IL-17A when exposed to hypoxia and IL-1β. However, they expressed IL-17 receptors, and in response to IL-17A, secreted VEGF. This suggested that RORγ and IL-17A inhibition might attenuate neovascular retinopathy. Indeed, digoxin and SR1001 reduced retinal vaso-obliteration, neovascularization, and vascular leakage as well as VEGF and VEGF-related placental growth factor. Digoxin and SR1001 reduced microglial-derived IL-17A and Müller cell and ganglion cell damage. The importance of IL-17A in oxygen-induced retinopathy was confirmed by IL-17A neutralization reducing vasculopathy, VEGF, placental growth factor, tumor necrosis factor-α, microglial density and Müller cell, and ganglion cell injury.

Conclusions—
Our findings indicate that an RORγ/IL-17A axis influences VEGF production and neovascular retinopathy by mechanisms involving neuroglia. Inhibition of RORγ and IL-17A may have potential for the improved treatment of neovascular retinopathies.
Relation of Magnesium Intake With Cardiac Function and Heart Failure Hospitalizations in Black Adults
Authors: Taveira Tracey H. , Ouellette Danielle , Gulum Alev , Choudhary Gaurav , Eaton Charles B. , Liu Simin , Wu Wen-Chih 
Published: April 2016

Background—
Little is known about magnesium intake and risk of heart failure (HF) hospitalizations, particularly in blacks. We hypothesize that magnesium intake relates to HF hospitalization in blacks.

Methods and Results—
From the Jackson Heart Study cohort (n=5301), we studied 4916 blacks recruited during 2000 to 2004 in Jackson (Mississippi), who completed an 158-item Food-Frequency Questionnaire that included dietary supplements. Daily magnesium intake derived from the questionnaire was divided by the body weight to account for body storage and stratified by quartiles (0.522–2.308, 2.309–3.147, 3.148–4.226, and ≥4.227 mg magnesium intake/kg). Cox proportional hazards modeling assessed the association between quartiles of magnesium intake/kg and hospitalizations for HF adjusting for HF risk, energy intake, and dietary factors. The cohort had a mean age=55.3 (SD=12.7 years) and composed of 63.4% women, 21.6% diabetes mellitus, 62.7% hypertension, 7.1% coronary disease, and 2.8% with known HF. When compared with participants in the first quartile of magnesium intake/kg, those with higher magnesium intake (>2.308 mg/kg) had decreased risk of HF admission, with adjusted hazard ratios of 0. 66(95% confidence interval, 0.47–0.94) in the second quartile to 0.47 (95% confidence interval, 0.27–0.82) in the highest quartile. Results were similar when individuals with previously diagnosed HF (2.8%) were excluded or when the analysis was repeated using quartiles of magnesium intake without accounting for body weight.

Conclusions—
Magnesium intake <2.3 mg/kg was related to increased risk of subsequent HF hospitalizations. Future studies are needed to test whether serum magnesium levels predict risk of HF.
Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma?
Authors: Tirelli Giancarlo , Piovesana Marco , Gatto Annalisa , Torelli Lucio , Boscolo Nata Francesca 
Published: April 2016

Objectives: Obtaining free resection margins is the main goal of oncological surgeons. Narrow-band imaging (NBI) has been recently used to help define resection margins in transoral laser microsurgery for laryngeal carcinoma. The aim of this study was to evaluate the effect of intraoperative NBI in defining the surgical resection margins of oral and oropharyngeal cancers. Methods: Between January 2014 and March 2015, NBI was used intraoperatively after an initial definition of resection margins with white light in 26 patients (group A). The rate of superficial positive margins at definitive histology was compared with that of a historical cohort of 44 patients (group B) previously managed without the use of intraoperative NBI. Results: A statistically significant reduction in the rate of positive superficial margins was observed at definitive histology in group A ( P = .028). NBI helped to identify the presence of dysplasia and cancer around the visible tumor not otherwise detectable with visual examination alone. Conclusions: NBI could be a useful tool for obtaining free resection margins in oral and oropharyngeal carcinoma.
Next Generation Sequencing and the Microbiome of Chronic Rhinosinusitis
Authors: Jervis Bardy Jake , Psaltis Alkis J. 
Published: April 2016

Objective: Microbiomics in chronic diseases, including chronic rhinosinusitis (CRS), have undergone rapid advances in recent times. The introduction of Next Generation Sequencing (NGS) technology has produced significant clinical insights regarding the bacteriology of these conditions. We review studies that have used 16S rRNA sequencing to specifically investigate the microbiota profiles of patients with CRS in a variety of contexts. Methods: Literature review using the CINAHL, MEDLINE, PUBMED, and the Cochrane databases. Papers utilizing 16S-sequencing technology on CRS specimens published between January 1, 1995, and October 31, 2015, were included. Studies limited to only healthy controls were excluded. Results: Consistent with published studies using non-NGS techniques, the main genera commonly identified from the sinuses of CRS patients included Staphylococcus, Propionibacterium, and Corynebacterium. The microbiome of CRS patients had lower bacterial diversity compared to controls in a number of studies. Also consistent with non-NGS–based studies, Staphylococcus was implicated as an important genus, with highly colonized patients having worse surgical outcomes. Conflicting reports of antibiotic effects on the CRS microbiome were observed. Sampling methods were well investigated, many of the studies reviewed failed to include important methodological detail. Conclusion: While 16S sequencing is a novel microbiological laboratory method, current studies have confirmed our existing understanding of bacteriology of CRS without providing significant additional clinical insight. Complementing 16S studies with more complex NGS methods while developing robust clinical studies aimed at shifting the disrupted CRS microbiome will provide researches with the opportunity to derive further clinical insight and develop new therapeutic targets.
Missed diagnosis: The emerging crisis of borderline personality disorder in older people
Authors: Beatson Josephine , Broadbear Jillian Helen , Sivakumaran Hemalatha , George Kuruvilla , Kotler Eli , Moss Francine , Rao Sathya 
Published: April 2016

Objective: Clinical experience suggests a growing prevalence of borderline personality disorder in aged residential care and psychiatric facilities with attendant difficulties in their management. This paper reviews the literature concerning the prevalence, phenomenology and diagnosis of borderline personality disorder in old age. The aim is to elucidate the phenomenological differences in old age and thus improve identification of the disorder. Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE and PsycINFO databases, employing the search terms including ‘personality disorder’, ‘borderline personality disorder’, ‘aged care’, ‘gerontology’, ‘geriatric psychiatry’ and ‘life span’. The search included articles in English involving participants 65+ years. Long-term prospective studies of borderline personality disorder, long-term follow-up studies and studies involving older adults from 50+ years were also examined. Results: There is a paucity of literature on borderline personality disorder in the elderly. No diagnostic or rating instruments have been developed for borderline personality disorder in the elderly. The phenomenology of borderline personality disorder in the aged population differs in several respects from that seen in younger adults, causing some of the difficulties in reaching a diagnosis. Escalations of symptoms and maladaptive behaviours usually occur when the diagnosis of borderline personality disorder is either not made or delayed. Improved identification of borderline personality disorder in older patients, together with staff education concerning the phenomenology, aetiology and management of these patients, is urgently needed. Conclusion: Diagnostic instruments for borderline personality disorder in the elderly need to be developed. In the interim, suggestions are offered concerning patient symptoms and behaviours that could trigger psychiatric assessment and advice concerning management. A screening tool is proposed to assist in the timely diagnosis of borderline personality disorder in older people. Timely identification of these patients is needed so that they can receive the skilled help, understanding and treatment needed to alleviate suffering in the twilight of their lives.
What happened at the front lines of US welfare reform? Exploring the experiences of front-line implementers
Authors: Chang Hyunjoo 
Published: April 2016

This article aims to explore the story of the front-line implementation of US welfare reform through analyzing the experiences of front-line workers with a grounded theory approach. There were deep concerns about the working poor and unelaborated programs for economic independence, which were attributable to the legislation’s thrust to work-first and a skill mismatch, without taking the quality of jobs into account. Welfare roll reduction resulted in taking a generous approach to welfare clients on the front lines. Although discretion resulted in the operation of more local initiatives on the front lines, it was not a substantial response to the demands of the real lives of clients. This article argues that the quality and sustainability of work is critical, prior to an emphasis on work-first. Front-line implementation must shift to increasing employers’ willingness to create incentives for skill-building and to giving clients some motivation to work. Points for practitioners A gap between policymaking and nonlinear policy implementation on the front lines is inevitable as local demands vary. Particularly, perspectives of front-line implementers are useful in reflecting various local demands and adjusting the different interests of clients in the process of refining welfare reform in lieu of federal policymakers. Although the discretion of front-line implementers is critical, less attention has been paid to how they put welfare reform into practice and what they learned. Qualitative exploration of such issues thus provides field-based evidence to improve its implementation to help the clients, which has rarely been examined in the literature.
The implementation of integrated electronic service delivery in Quebec: the conditions of collaboration and lessons
Authors: Boudreau Christian , Bernier Luc 
Published: April 2016

The article addresses the difficult conditions of interorganisational collaboration for the implementation of integrated electronic service delivery from three theoretical perspectives: institutional, political and managerial. These perspectives are used to conceptually define the main obstacles to interorganisational collaboration and the leverage available to public managers to facilitate the integration of electronic services. Based on a multiple case study in Quebec, the authors examine, more specifically, the institutional, political and managerial conditions that have delayed the integration of electronic services in this Canadian province. They show how the persistency of administrative practices, the desire for autonomy of public organisations and cumbersome governance structures have contributed to the diversification of the supply of online services in Quebec at the expense of an integrated service. Drawing on theoretical considerations and the study results, the authors propose that public managers do not stick only to horizontal governance mechanisms, but also make use of vertical governance mechanisms, to mitigate the effects of certain constraints on interorganisational collaboration and to accelerate the implementation of integrated electronic service delivery. Points for practitioners Several countries have made integrated public service delivery a priority of e-government. To effectively coordinate these projects with their multiple partners, public managers need to apply a hybrid governance to benefit from the stability of the hierarchy and the flexibility of the network. More specifically, the study shows vertical governance to be an effective tool to coordinate the activities of a network of organisations involved in the implementation of integrated service delivery.
Immigrant integration policymaking in Italy: regional policies in a multi-level governance perspective
Authors: Campomori Francesca , Caponio Tiziana 
Published: April 2016

This article contributes to the debate on the ‘local governance turn’ by considering a recent immigration context: the Italian case. We analyse integration policies and governance processes in three regions: Lombardy, Piedmont and Emilia-Romagna. The aim is to shed new light on the multi-level governance relations that shape immigrant integration policies, taking into account the interdependencies of the vertical and horizontal dimensions of multi-level governance. The analysis points out the emergence of different multi-level governance arrangements and highlights the relevance of institutional and organisational factors in accounting for local differentiation. General traditions and established public–non-governmental organisation relations in the social policy field, the internal organisation of the regional administration (specialised staff versus general bureaucratic apparatus), and the role of ideology appear to make a difference. The implications of this analysis for multi-level governance scholarship are discussed, emphasising the need for a middle-range theory approach. Points for practitioners Multi-level governance is considered by policy scholars as a promising approach to make sense of increasingly complex policymaking processes, implying the interaction between different levels of government and between public and non-public actors. By considering the politically sensitive immigrant integration issue, this article attempts to point out how multi-level governance relations concretely take shape at the regional level in Italy, and which factors account for regional differentiation. Our study suggests that contextual and organisational factors are particularly relevant, that is, social policy traditions, the regions’ internal organisation and the individual civil servants’ attitudes. Nevertheless, politics should also be carefully taken into account.
Interventions to improve real-world walking after stroke: a systematic review and meta-analysis
Authors: Stretton Caroline M , Mudge Suzie , Kayes Nicola M , McPherson Kathryn M 
Published: April 2016

Objective: This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained. Data sources: EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies. Review methods: Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data. Results: Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3–6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (–0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were. Conclusions: A small but significant effect was found for current interventions and benefits can be sustained. Interventions that include behaviour change techniques appear more effective at improving real-world walking habits than exercise alone.
Feasibility and efficacy of a robotic device for hand rehabilitation in hemiplegic stroke patients: a randomized pilot controlled study
Authors: Vanoglio Fabio , Bernocchi Palmira , Mulè Chiara , Garofali Francesca , Mora Chiara , Taveggia Giovanni , Scalvini Simonetta , Luisa Alberto 
Published: April 2016

Objective: The purpose of the study was to evaluate the feasibility and efficacy of robot-assisted hand rehabilitation in improving arm function abilities in sub-acute hemiplegic patients. Design: Randomized controlled pilot study. Setting: Inpatient rehabilitation centers. Participants: Thirty hemiplegic stroke patients (Ashworth spasticity index <3) were recruited and randomly divided into a Treatment group (TG) and Control group (CG). Interventions: Patients in the TG received intensive hand training with Gloreha, a hand rehabilitation glove that provides computer-controlled, repetitive, passive mobilization of the fingers, with multisensory feedback. Patients in the CG received the same amount of time in terms of conventional hand rehabilitation. Main outcome measures: Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip and Pinch test) were measured at baseline and after rehabilitation, and the differences, (Δ) mean(standard deviation), compared between groups. Results Twenty-seven patients concluded the program: 14 in the TG and 13 in the CG. None of the patients refused the device and only one adverse event of rheumatoid arthritis reactivation was reported. Baseline data did not differ significantly between the two groups. In TG, ΔMI 23(16.4), ΔNHPT 0.16(0.16), ΔGRIP 0.27(0.23) and ΔPINCH 0.07(0.07) were significantly greater than in CG, ΔMI 5.2(9.2), ΔNHPT 0.02(0.07), ΔGRIP 0.03(0.06) and ΔPINCH 0.02(0.03)] ( p=0.002, p=0.009, p=0.003 and p=0.038, respectively). Conclusions: Gloreha Professional is feasible and effective in recovering fine manual dexterity and strength and reducing arm disability in sub-acute hemiplegic patients.
Non-Gaussian diffusion imaging for malignant and benign pulmonary nodule differentiation: a preliminary study
Authors: Das Sushant Kumar , Yang Dong Jun , Wang Jin Liang , Zhang Chuan , Yang Han Feng 
Published: April 2016

Background Diffusion-weighted imaging (DWI) derived apparent diffusion coefficient (ADC) has demonstrated inconsistent results in pulmonary nodule differentiation. Diffusion kurtosis imaging (DKI), which quantifies non-Gaussian diffusion, is believed to better characterize tissue micro-structure than conventional DWI. Purpose To assess the feasibility of DKI in human lungs and to compare its diagnostic value with standard DWI in differentiating malignancies from benign pulmonary nodules. Material and Methods Thirty-five pulmonary nodules in 32 consecutive patients were evaluated by DKI by using 3b-values of 0, 500, and 1000 s/mm2 and conventional DWI with b values of 0 and 800 s/mm2. Two observers independently evaluated and compared diagnostic accuracy of mean kurtosis (MK) and ADC values in differentiating malignancies from benign pulmonary nodules. The intra- and inter-observer repeatability (intra-class correlation coefficient [ICC]) were also assessed for each derived measures. Results The diagnostic accuracy, and the area under curve (AUC) in differentiating malignancies from benign pulmonary nodule, were not significantly higher for MK (Obs. 1a: 85.70%, 0.87; Obs. 1b: 80.00%, 0.80; and Obs. 2: 82.80%, 0.91) as compared to ADC (Obs. 1a: 77.14%, 0.81; Obs. 1b: 80.00%, 0.85; and Obs. 2: 77.14%, 0.85 respectively). The intra- and inter-observer agreement (ICC) for malignant and benign lesions was substantial for each reading. Conclusion The initial results of this study indicate the feasibility of DKI in human lungs. However, there was no significant benefit of DKI derived MK values over ADC for malignant and benign pulmonary nodule differentiation.