Spatiotemporal Image Correlation and Volumetric Impedance Indices in the Neonatal Brain: Proof of Concept and Preliminary Reproducibility

Objectives—

Changes in tissue perfusion can be critically important in the vulnerable neonate, but they are very difficult to assess at the bedside. Spatiotemporal image correlation (STIC) sonography is an exciting concept that allows assessment of blood flow by rearranging and merging multiple 2-dimensional color images to create serial 3-dimensional images showing regional blood flow throughout the cardiac cycle. Variations in tissue blood flow may reflect tissue impedance and perfusion. The aim of this study was to demonstrate that it is possible to use STIC images to evaluate tissue impedance in the neonatal brain.

Methods—

Spatiotemporal image correlation data sets were acquired by cranial sonography in 19 neonates. Offline data analysis was performed by using virtual organ computer-aided analysis. With the use of STIC images from different phases of the cardiac cycle, impedance indices were calculated, based on maximum (systolic), minimum (diastolic), and mean virtual organ computer-aided analysis values, in the same way that resistive indices are calculated in 2-dimensional sonography.

Results—

Volumetric indices for tissue impedance were obtained for all neonates. Intraclass correlation coefficients (95% confidence intervals) for volumetric impedance indices were as follows: systolic/diastolic ratio, 0.793 (0.615–0.906); pulsatility index, 0.790 (0.609–0.905); and resistive index, 0.783 (0.598–0.901). Interclass correlation coefficients for image processing and analysis were as follows: systolic/diastolic ratio, 0.868 (0.692–0.947); pulsatility index, 0.904 (0.772–0.962); and resistive index, 0.914 (0.794–0.966).

Conclusions—

This study shows that STIC data sets can be used to calculate volumetric impedance indices in the neonatal brain. Preliminary assessment shows that this technique appears reliable and allows evaluation of regional tissue impedance in the neonate.

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Evanescent Hyperechoic Changes After Fine-Needle Aspiration Biopsy of the Thyroid in a Series With a Low Overall Prevalence of Complications

Objectives—

The purpose of this study was to assess the frequency of and risk factors for fine-needle aspiration biopsy (FNAB)-related complications in Japanese patients with thyroid nodules evaluated by standard FNAB techniques.

Methods—

Six hundred fifty-three consecutive Japanese patients with 742 nodules who had undergone FNAB were enrolled. Nodule characteristics were evaluated, and thyroid volumes were measured. Fine-needle aspiration biopsy–related complications were identified on the basis of sonographic findings and patients' conditions after undergoing FNAB. Comparisons of patients' backgrounds and nodule characteristics were made between those with and without complications.

Results—

The prevalence rates for FNAB-related complications, including acute transient thyroid swelling after FNAB and appearance of anechoic lesions, were 0.13% and 0.94%. In this study, we could not identify risk factors for FNAB-related complications. The sudden appearance of bright hyperechoic foci within the thyroid immediately after biopsy was reported as an FNAB-related unfamiliar appearance in 5 cases. Experimental FNA using resected porcine thyroid tissue suggested that the etiology of the hyperechoic appearance may be artificial air bubbles or reversed flow of aspirated fluid.

Conclusions—

Fine-needle aspiration biopsy–related complications are rare if preventive measures are performed and are not specific to Japanese patients with thyroid nodules. The sudden appearance of bright hyperechoic foci may be cause by contamination from air or fluid.

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Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction

Objectives—

Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes.

Methods—

The transverse diameter of the fetal thymus was prospectively measured in 150 healthy and 143 IUGR fetuses between 24 and 40 weeks' gestation. The fetuses with IUGR were further divided according to normal or abnormal Doppler assessment of the umbilical and middle cerebral arteries and ductus venosus. Measurements were compared with reference ranges from controls. To determine which perinatal outcomes were independently associated with a small fetal thymus, a multivariate logistic regression analysis was performed.

Results—

Thymus size was significantly lower in IUGR fetuses compared to controls (P < .05). Among IUGR fetuses, thymus size was significantly smaller in IUGR fetuses with abnormal Doppler flow compared to normal flow (P < .05). A small thymus in IUGR fetuses was independently associated with early delivery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.05–1.49; P= .023), respiratory distress syndrome (OR, 1.36; 95% CI, 1.09–1.78; P= .005), early neonatal sepsis (OR, 1.65; 95% CI, 1.11–2.42; P= .001), and a longer stay in the neonatal intensive care unit (OR, 1.33; 95% CI, 1.08–1.71; P = .017).

Conclusions—

Intrauterine growth restriction is associated with fetal thymic involution, and a small fetal thymus is an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

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Sonography of Abdominal Pain in Children: Appendicitis and Its Common Mimics

Abdominal pain is very common in the pediatric population (<18 years of age). Sonography is a safe modality that can often differentiate the frequently encountered causes of abdominal pain in children. This pictorial essay will discuss the sonographic findings of acute appendicitis, including the imaging appearance of a perforated appendicitis. It will also present the sonographic features of the relatively common mimics of appendicitis, such as mesenteric adenitis/gastroenteritis, intussusception, Meckel diverticulum, and ovarian torsion.

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Evaluation of Underlying Lymphocytic Thyroiditis With Histogram Analysis Using Grayscale Ultrasound Images

Objectives—

The purpose of this study was to evaluate diagnostic performance of histogram analysis using grayscale ultrasound (US) images in the diagnosis of lymphocytic thyroiditis.

Methods—

Three radiologists reviewed a total of 505 US images and classified the images according to the presence/existence of lymphocytic thyroiditis. After 2 months, each reviewer repeated the process with the same 505 images in a randomly mixed order. The intraobserver and interobserver variability was analyzed with a generalized value. Four histogram parameters (mean value, standard deviation, skewness, and kurtosis) were obtained, and an index was calculated from principal component analysis. Diagnostic performances were compared.

Results—

Of 505 patients, 125 (24.8%) had lymphocytic thyroiditis, and 380 (75.2%) had normal thyroid parenchyma on pathologic analysis. The value for intraobserver variance ranged from –0.002 to 0.781, and the overall values for interobserver variance were 0.570 and 0.214 in the first and second tests, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for the 3 reviewers versus the principal component analysis index were 28.0% to 83.2%, 43.7% to 82.6%, 53.5% to 79.0%, 24.6% to 56.2%, and 75.2% to 88.9% versus 58.4%, 72.4%, 68.9%, 41.0%, and 84.1%.

Conclusions—

Histogram analysis of grayscale US images provided confirmable and quantitative information about lymphocytic thyroiditis and was comparable with performers' assessments in diagnostic performance.

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A Novel Method for Sensitive Determination of Subclinical Left-Ventricular Systolic Dysfunction in Subjects With Obstructive Sleep Apnea

BACKGROUND:This study was to evaluate the subclinical left-ventricular (LV) systolic dysfunction with 2-dimensional speckle-tracking echocardiography in subjects with obstructive sleep apnea (OSA) with normal left ventricular ejection fraction and without any confounding disease that can cause myocardial dysfunction.METHODS:Nineteen healthy individuals and 60 subjects with OSA were included in this study. According to the severity of disease, OSA subjects were examined in 3 groups: mild, moderate, and severe OSA. LV apical views (for longitudinal strain) and short-axis views (for circumferential strain) were acquired for evaluation. Three-layer longitudinal strain values and circumferential strain values were determined for each view, and averages of these were used in comparison with other groups.RESULTS:Three-layer longitudinal strain values of the subjects with OSA were lower than those of the healthy individuals, and these values were decreased along with the OSA severity. The difference was significant between severe OSA and all other groups. Three-layer circumferential strain values of the OSA subjects were lower than those of the healthy individuals, and the difference was significant between the control group and all other groups. The apnea hypopnea index was found to be correlated with the 3-layer longitudinal strain (r = −0.74, P < .001; r = −0.72, P < .001; r = −0.69, P = <.001).CONCLUSIONS:Three-layer longitudinal and circumferential LV systolic functions in OSA subjects with normal left ventricular ejection fraction are deteriorated in the subclinical stage. Two-dimensional speckle-tracking echocardiography can be used as an effective method in the determination of subclinical myocardial dysfunction in subjects with OSA.

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Effects of Nebulizer Position, Gas Flow, and CPAP on Aerosol Bronchodilator Delivery: An In Vitro Study

BACKGROUND:The aim of this study was to investigate the effects of different delivery circuit configurations, nebulizer positions, CPAP levels, and gas flow on the amount of aerosol bronchodilator delivered during simulated spontaneous breathing in an in vitro model.METHODS:A pneumatic lung simulator was connected to 5 different circuits for aerosol delivery, 2 delivering CPAP through a high-flow generator tested at 30, 60, and 90 L/min supplementary flow and 5, 10, and 15 cm H2O CPAP and 3 with no CPAP: a T-piece configuration with one extremity closed with a cap, a T-piece configuration without cap and nebulizer positioned proximally, and a T-piece configuration without cap and nebulizer positioned distally. Albuterol was collected with a filter, and the percentage amount delivered was measured by infrared spectrophotometry.RESULTS:Configurations with continuous high-flow CPAP delivered higher percentage amounts of albuterol compared with the configurations without CPAP (9.1 ± 6.0% vs 6.2 ± 2.8%, P = .03). Among configurations without CPAP, the best performance was obtained with a T-piece with one extremity closed with a cap. In CPAP configurations, the highest delivery (13.8 ± 4.4%) was obtained with the nebulizer placed proximal to the lung simulator, independent of flow. CPAP at 15 cm H2O resulted in the highest albuterol delivery (P = .02).CONCLUSIONS:Based on our in vitro study, without CPAP, a T-piece with a cap at one extremity maximizes albuterol delivery. During high-flow CPAP, the nebulizer should always be placed proximal to the patient, after the T-piece, using the highest CPAP clinically indicated.

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Editor's Commentary

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Evaluation of the Infection-Related Ventilator-Associated Events Algorithm for Ventilator-Associated Pneumonia Surveillance in a Trauma Population

BACKGROUND:The Centers for Disease Control and Prevention have recently introduced new ventilator-associated pneumonia (VAP) surveillance on the basis of the infection-related ventilator-associated complication (IVAC) definition. We aim to evaluate the accuracy of this new IVAC algorithm for detecting VAP according to the 2008 Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) definition as the reference diagnosis (VAP-NHSN) in high-risk trauma patients.METHODS:This retrospective single-center study included all trauma subjects who were admitted to the ICU, required mechanical ventilation for >48 h, and received a blood transfusion. The new IVAC surveillance and the criteria for VAP-NHSN diagnosis were applied. The accuracy of the new IVAC surveillance for detecting VAP-NHSN was determined, and the clinical outcomes were compared between groups.RESULTS:The sensitivity, specificity, and positive and negative predictive values of IVAC for VAP-NSHN identification were 28.12%, 91.45, 58.06%, and 75.14%, respectively. Subjects with IVAC, VAP-NHSN, or both had higher morbidity when compared with those without IVAC and VAP-NHSN. Subjects with IVAC only had lower morbidity compared with those with VAP-NHSN only or those with both IVAC and VAP-NHSN. There was no significant difference in clinical outcomes between subjects with VAP-NHSN only and those with both IVAC and VAP-NHSN.CONCLUSIONS:IVAC criteria had a low accuracy for identifying VAP-NHSN in subjects with high-risk trauma.

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Sticking to an Old Definition of Ventilator-Associated Pneumonia Is Not Old-Fashioned

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Noninvasive Ventilation Intolerance: Characteristics, Predictors, and Outcomes

BACKGROUND:Noninvasive ventilation (NIV) intolerance is one reason for NIV failure. However, the characteristics, predictors, and outcomes of NIV intolerance are unclear.METHODS:A prospective observational study was performed in the respiratory intensive care unit of a teaching hospital. Subjects with acute respiratory failure who used NIV were enrolled. Initially, continuous use of NIV was encouraged. However, if the subject could not tolerate NIV, it was used intermittently. NIV intolerance was defined as termination of NIV due to subject refusal to receive it because of discomfort, even after intermittent use was attempted.RESULTS:A total of 961 subjects were enrolled in the study. Of these, 50 subjects (5.2%) experienced NIV intolerance after a median 2.4 h of NIV support. Age (OR = 0.98, 95% CI 0.963–0.996) and heart rate (OR = 1.02, 95% CI 1.006–1.030) measured before NIV were 2 independent risk factors of NIV intolerance. After 1–2 h of NIV, independent risk factors of NIV intolerance were heart rate (OR = 1.03, 95% CI 1.016–1.044) and breathing frequency (OR = 1.06, 95% CI 1.027–1.099). Intolerant subjects had no improvement in mean arterial pressure, heart rate, or breathing frequency after the NIV intervention. Moreover, intolerant subjects had a higher intubation rate (44.0% vs 25.8%, P = .008) and higher mortality (34.0% vs 22.4%, P = .08). The three most common complaints were that NIV worsened subjects' distress (46%), that NIV resulted in dyspnea (26%), and that the flow or pressure of NIV was too strong to bear (16%).CONCLUSIONS:NIV intolerance worsened subjects' outcomes. Younger subjects with a high heart rate and breathing frequency may be more likely to experience NIV intolerance.

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A Comparison of Carbon Dioxide Elimination Measurements Between a Portable Indirect Calorimeter and Volumetric Capnography Monitor: An In Vitro Simulation

BACKGROUND:Gas exchange measurements for carbon dioxide elimination (V̇CO2) and oxygen consumption (V̇O2) have been used to derive resting energy expenditure and guide energy prescription. Volumetric capnography is used in intensive care units and provides V̇CO2 measurements that could be used for titrating respiratory and nutritional support. We have recently suggested that measuring V̇CO2 may be sufficient to obtain a reasonable estimate of energy expenditure. However, data describing the accuracy of gas exchange measurement devices are limited.METHODS:We used an in vitro simulation model to test the accuracy of gas exchange measurements by 2 devices: the CCM Express indirect calorimeter and the NM3, a volumetric capnography monitor. A Huszczuk gas injection system combined with a high-fidelity lung simulator was used to simulate V̇O2 and V̇CO2 values in the pediatric and adult range. Bland-Altman analysis was used to examine the agreement between the measured and simulated values across a range of tidal volumes and gas exchange values. Additionally, agreement between the 2 devices was examined.RESULTS:During the adult simulation with the CCM Express, the mean bias (95% CI) for V̇CO2 values was −12.6% (−16.4 to −8.8%) and −17.5% (−19.9 to −15.1%) for V̇O2 values. For the pediatric simulation with the CCM Express, mean bias for V̇O2 was −14.7% (−16.4 to −13.0%) and V̇CO2 was −10.9% (−13.5 to −8.3%). For the adult and pediatric simulations with the NM3, the bias for V̇CO2 was −8.2% (−15.7 to −0.7%) and −8.3% (−19.4 to −2.8%), respectively. Between the 2 devices, the mean bias was −4.4% (−10.2 to 1.3%) and −2.3% (−11.4 to 6.8%) for the adult and pediatric V̇CO2 simulations, respectively.CONCLUSIONS:Currently available portable gas exchange monitors demonstrated acceptable agreement with reference V̇O2 and V̇CO2 values in an in vitro simulation. The devices demonstrated good agreement with each other.

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Association Between High-Flow Nasal Cannula and End-Expiratory Esophageal Pressures in Premature Infants

BACKGROUND:High-flow nasal cannula (HFNC) is commonly being used to provide noninvasive respiratory support in newborn infants. Continuous distending pressure generated by these devices in preterm infants has not been elucidated. The aim of this work was to determine the association between HFNC flow in L/min and end-expiratory esophageal pressure in cm H2O in premature infants.METHODS:In a prospective observational study, end-expiratory esophageal pressure measurements were conducted in clinically stable premature infants who required HFNC. The end-expiratory esophageal pressure generated by the HFNC was measured by a regular feeding tube overlying the lower esophagus and connected to a pressure transducer. Each infant had different end-expiratory esophageal pressure measurements at different high flows ranging from 2 to 8 L/min.RESULTS:Nineteen premature infants were studied. Their birthweight (mean ± SD) was 904 ± 574 g, and gestational age was 26.6 ± 3.1 weeks. Overall, 93 end-expiratory esophageal pressure measurements were conducted. At the time of the end-expiratory esophageal pressure measurements, infants were 1,458 ± 828 g and 7.2 ± 4.8 weeks old. At HFNC flows ranging from 2 to 8 L/min, the corresponding esophageal pressures ranged from 2 to 15 cm H2O. There was a statistically significant association between esophageal pressures and flows. In a linear regression model with the end-expiratory esophageal pressure as the dependent variable and HFNC flow as the independent variable, there was a significant correlation between the 2 variables: end-expiratory esophageal pressure (cm H2O) = 1.18 × HFNC (L/min) (r2 = 0.95, P < .001).CONCLUSIONS:HFNC-associated end-expiratory esophageal pressure is measurable in premature infants. There is a significant association between flows and generated esophageal pressures. There is also variability in the amount of end-expiratory esophageal pressure generated. These observations should be kept in mind when using high HFNC flows in preterm infants.

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Review of Ultrasound-Guided Radial Artery Catheter Placement

Radial artery catheters are commonly placed for continuous blood pressure monitoring, frequent arterial blood gas analysis, or frequent blood sampling for diagnostic testing. Radial artery cannulation can be challenging and ultrasound guidance has emerged as a valuable adjunct for the placement of radial artery catheters. The advantages of ultrasound guidance include: real-time visualization of landmarks, improved pre-procedure planning, reduction in complications, less time spent at the bedside, and improved first-attempt success rates. Disadvantages of ultrasound guidance include: equipment cost, equipment availability, limited availability of experts to train providers, and the cost of training providers. Ultrasound machines are readily available and widely utilized in many emergency departments, operating rooms, and ICUs. We will summarize the use of ultrasound guidance for the placement of radial artery catheters and describe the techniques used during ultrasound-guided arterial catheter placement. Training on the use of ultrasound should be encouraged for all practitioners who place radial artery catheters.

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Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study

BACKGROUND:Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O2). The aim of this study was to determine whether HFNC compared with standard O2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation.METHODS:This was a pragmatic open randomized controlled trial in adult subjects with hypoxia and tachypnea presenting to a tertiary academic hospital emergency department. The primary outcome was the need for mechanical ventilation in the emergency department.RESULTS:We screened 1,287 patients, 322 met entry criteria and 19 were excluded from analysis. Of these, 165 randomized to HFNC and 138 to standard O2 were analyzed. Baseline characteristics were similar. In the HFNC group, 3.6% (95% CI 1.5–7.9%) versus 7.2% (95% CI 3.8–13%) in the standard O2 group required mechanical ventilation in the emergency department (P = .16), and 5.5% (95% CI 2.8–10.2%) in HFNC versus 11.6% (95% CI 7.2–18.1%) in the standard O2 group required mechanical ventilation within 24 h of admission (P = .053). There was no difference in mortality or stay. Adverse effects were infrequent; however, fewer subjects in the HFNC group had a fall in Glasgow coma score due to CO2 retention, 0% (95% CI 0–3%) versus 2.2% (95% CI 0.4–6%). One in 12 subjects did not tolerate HFNC.CONCLUSIONS:HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O2, although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission.

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Serum Biomarkers of COPD

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Inspiratory Tube Condensation During High-Flow Nasal Cannula Therapy: A Bench Study

BACKGROUND:High-flow nasal cannula (HFNC) therapy provides better humidification than conventional oxygen therapy. To allay loss of vapor as condensation, a servo-controlled heating wire is incorporated in the inspiratory tube, but condensation is not completely avoidable. We investigated factors that might affect condensation: thermal characteristics of the inspiratory tube, HFNC flow, and ambient temperature.METHODS:We evaluated 2 types of HFNC tubes, SLH Flex 22-mm single tube and RT202. Both tubes were connected to a heated humidifier with water reservoir. HFNC flow was set at 20, 40, and 60 L/min, and FIO2 was set at 0.21. Air conditioning was used maintain ambient temperature at close to either 20 or 25°C. We weighed the tubes on a digital scale before (0 h) and at 3, 6, and 24 h after, turning on the heated humidifier, and calculated the amount of condensation by simple subtraction. The amount of distilled water used during 24 h was also recorded.RESULTS:At 25°C, there was little condensation, but at 20°C and HFNC flow of 20, 40, and 60 L/min for 24 h, the amount of condensation with the SLH was 50.2 ± 10.7, 44.3 ± 17.7, and 56.6 ± 13.9 mg, and the amount with the RT202 was 96.0 ± 35.1, 72.8 ± 8.2, and 64.9 ± 0.8 mg. When ambient temperature was set to 20°C, condensation with the RT202 was statistically significantly greater than with the SLH at all flow settings (P < .001).CONCLUSIONS:Ambient temperature statistically significantly influenced the amount of condensation in the tubes.

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FEV1/FEV6 in Primary Care Is a Reliable and Easy Method for the Diagnosis of COPD

BACKGROUND:FEV6 can be used as a convenient alternative to FVC. The aim of this study was to determine an alternative to the fixed cutoff points of FEV1/FVC <0.70 suitable for FEV1/FEV6 in primary care.METHODS:Pulmonary function testing was conducted on volunteers recruited from 4 community centers in Xi'an, China, between July and August 2012. Participants underwent 3 FVC maneuvers. The maneuver with the best FEV1 was retained. FVC, FEV1, and FEV6 were measured by portable spirometer. The receiver operating characteristic curves that corresponded to the optimal combination of sensitivity and specificity for FEV1/FEV6 were determined. A kappa test was used to compare the agreement between FEV1/FVC and FEV1/FEV6. The positive predictive value and negative predictive value were also calculated.RESULTS:A total of 767 volunteers participated in this study, of whom 297 were male and 470 were female. Considering FEV1/FVC <0.70 as the accepted standard for COPD, the area under the curve was 98% (P < .001), and the FEV1/FEV6 cutoff, corresponding to the greatest sum of sensitivity and specificity, was 0.72. For the total population, the FEV1/FEV6 sensitivity, specificity, positive predictive value, and negative predictive value were 96.9, 98.8, 95.8, and 99.2%, respectively. The agreement between the 2 cutoff points was excellent, and the kappa value was 0.954.CONCLUSIONS:FEV1/FEV6 <0.72 can be used in primary care as a valid alternative to FEV1/FVC <0.70 as a fixed cutoff point for the detection of COPD in adults. This study suggests that FEV1/FEV6 is an effective and well validated option that should be used in primary care to detect COPD, which is a rampant problem.

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Prospective Observational Study of Predictors of Re-Intubation Following Extubation in the Surgical ICU

BACKGROUND:Re-intubation is associated with high morbidity and mortality. There is limited information regarding the risk factors that predispose patients admitted to the surgical ICU to re-intubation. We hypothesized that preoperative comorbidities, acquired muscular weakness, and renal dysfunction would be predictors of re-intubation in the surgical ICU population.METHODS:This was a prospective observational study in 2 surgical ICUs of a large tertiary hospital. All patients who were extubated during their surgical ICU stay were included. Demographic and clinical data were collected before and after extubation. The primary outcome was re-intubation within 72 h. Using multivariate logistic regression analysis, independent risk factors of re-intubation were determined, and a prediction score was developed.RESULTS:Between December 1, 2012, and January 31, 2014, we included 764 consecutive subjects. Of these, 65 subjects (8.5%) required re-intubation. Independent risk factors of re-intubation were blood urea nitrogen level of >8.2 mmol/L (odds ratio [OR] 3.66, 95% CI 1.97–6.80), hemoglobin level of <75 g/L (OR 2.10, 95% CI 1.23–3.61), and muscle strength of ≤3 (OR 2.03, 95% CI 1.16–3.55). The presence of all 3 risk factors was associated with an estimated probability for re-intubation of 26.8%.CONCLUSIONS:In noncardiac surgery, surgical ICU subjects, elevated blood urea nitrogen level, low hemoglobin level, and muscle weakness were identified as independent risk factors for re-intubation. The presence of these risk factors can potentially aid clinicians in making informed decisions regarding optimal airway management in patients considered for an extubation attempt. (ClinicalTrials.gov registration NCT01967056.)

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Serum Telomerase Levels and COPD Exacerbations

BACKGROUND:To our knowledge, there is no study on the level of telomerase in subjects with COPD during an exacerbation period. The objective of this work was to compare lipid peroxidation, telomerase, zinc (Zn), copper (Cu), and malondialdehyde levels in asymptomatic smokers and subjects with COPD exacerbation.METHODS:The study included 45 subjects with COPD exacerbation and 42 healthy subjects with tobacco use as a control group. Samples were taken from blood and after the serum levels of telomerase malondialdehyde, Cu, and Zn were measured, the values were compared between the 2 groups. Tests for respiratory function were performed, and sedimentation and C-reactive protein levels were measured.RESULTS:The COPD exacerbation group had a significantly (P < .001) lower Cu/Zn ratio compared with the control group; however, the COPD exacerbation group had significantly (P < .001) higher levels of telomerase malondialdehyde, Cu, and Zn compared with the control group. Malondialdehyde, Cu, Zn, and FEV1 were found negatively correlated in the COPD exacerbation and control groups (P < .001). The COPD exacerbation group had lower FEV1 and FVC compared with the control group. The COPD exacerbation group had significantly (P < .001) higher levels of C-reactive protein and a higher blood cell sedimentation rate compared with the control group.CONCLUSIONS:The reason why the subjects had a reduced Cu/Zn ratio and increased levels of telomerase, Cu, and Zn is likely to be oxidative stress, which can be defined as an increased exposure to oxidants and/or decreased antioxidant capacities It is obvious from this study that lung oxidant-antioxidant balance is abnormal in subjects with COPD exacerbation and also that the increased level of telomerase is associated with this imbalance.

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Value of Computed Tomography of the Chest in Subjects With ARDS: A Retrospective Observational Study

BACKGROUND:The value of computed tomography (CT) of the chest in the management of patients with ARDS is poorly defined. The aim of this study was to assess the clinical utility of thoracic CT scans in subjects with ARDS using the Berlin definition.METHODS:This was a retrospective, observational study in a university hospital ARDS center on all subjects with ARDS in whom a CT scan of the chest was performed immediately before or during an ICU stay between January 1, 2007 and June 30, 2013.RESULTS:During the study period, a total of 1,781 thoracic CT scans were performed, of which 204 cases met inclusion criteria. The most common pathologic findings of the lung parenchyma were consolidations (94.1% of cases) and ground glass opacities (85.3%). Furthermore, CT scans showed pleural effusions (80.4%), mediastinal lymphadenopathy (66.7%), signs of right ventricular strain and pulmonary hypertension (53.9%), pericardial effusion (37.3%), emphysema of the chest wall (12.3%), pneumothorax (11.8%), emphysema of the mediastinum (7.4%), and pulmonary embolism (2.5%). Results of CT scans led to changes in management in 26.5% of cases. Mortality was significantly increased in subjects with involvement of lung parenchyma of >80% (P = .004). Intrahospital transport was associated with critical incidents in 8.3% of cases.CONCLUSIONS:Systematic evaluation of thoracic CT scans yielded information useful for making a diagnosis, predicting prognosis, and recognizing concomitant disorders requiring therapeutic interventions. Results obtained from CT scans led to changes in management in 26.5% of cases.

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Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

BACKGROUND:This study was conducted to measure the serial changes in pulmonary function over 12 months after lobectomy in subjects with lung cancer and to evaluate the actual recovery of pulmonary function in comparison with the predicted postoperative values.METHODS:Subjects who underwent lobectomy for primary lung cancer were included in this study. In the statistical analysis, we included data from 76 subjects (52 men and 24 women; mean age, 63.4 y) who completed perfusion scintigraphy 1 week before surgery and FEV1 and diffusion capacity of the lung for carbon monoxide (DLCO) assessments preoperatively and at 1, 6, and 12 months postoperatively.RESULTS:The actual percent-of-predicted FEV1 1 month postoperatively was 77.9% of the preoperative value, which was almost equal to the predicted postoperative value, and significantly increased to 84.3% by 6 months and 84.2% at 12 months. The actual percent-of-predicted DLCO 1 month postoperatively was 81.8% of the preoperative value, which was similar to the predicted postoperative value, and also significantly increased to 91.3% at 6 months and 96.5% at 12 months. However, the actual pulmonary function test results at 1 y in subjects with COPD or in those who underwent thoracotomy or received adjuvant chemotherapy were not different from the predicted postoperative values.CONCLUSIONS:Actual pulmonary function compared with predicted postoperative values improved over time over 1 y after lobectomy. However, this improvement was not observed in subjects with COPD or in those who underwent thoracotomy or received postoperative adjuvant chemotherapy.

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Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

BACKGROUND:Non-ventilator ICU-acquired pneumonia after cardiothoracic surgery is challenging to diagnose, and little is known about its impact on patient outcomes. Here, our primary objective was to compare the sensitivity and specificity of cultures of 2 types of fiberoptic bronchoscopy (FOB) specimens: endotracheal aspirates (FOB-EA) and bronchoalveolar lavage fluid (FOB-BAL). The secondary objectives were to evaluate the sensitivity and specificity of spontaneous sputum cultures and of the modified Clinical Pulmonary Infection Score (CPIS) and to describe patient outcomes.METHODS:We conducted a prospective observational study of consecutive cardiothoracic surgery subjects with suspected non-ventilator ICU-acquired pneumonia. Using FOB-BAL cultures ≥104 cfu/mL as the reference standard, we evaluated the accuracy of FOB-EA ≥105 cfu/mL and spontaneous sputum ≥107 cfu/mL. On the day of FOB, we determined the modified CPIS. Mortality and antibiotic treatments were recorded.RESULTS:Of 105 subjects, 57 (54.3%) received a diagnosis of non-ventilator ICU-acquired pneumonia. FOB-EA cultures had 82% (95% CI 69–91%) sensitivity and 100% (95% CI 89–100%) specificity and were significantly less sensitive than FOB-BAL cultures (P < .004). Spontaneous sputum was obtained from one-third of subjects. Spontaneous sputum cultures had 82% (95% CI 56–95%) sensitivity and 94% (95% CI 68–100%) specificity and were non-significantly less sensitive than FOB-BAL (P = .061). A modified CPIS >6 had 42% (95% CI 29–56%) sensitivity and 87% (95% CI 74–95%) specificity for non-ventilator ICU-acquired pneumonia. Antibiotic therapy was stopped in all subjects without non-ventilator ICU-acquired pneumonia, after 1.6 ± 1.2 d, without deleterious effects.CONCLUSIONS:The modified CPIS has low diagnostic accuracy for non-ventilator ICU-acquired pneumonia. FOB-EA cultures perform less well than do FOB-BAL cultures for diagnosing non-ventilator ICU-acquired pneumonia. Spontaneous sputum is valuable when FOB cannot be performed but could be obtained in only a minority of subjects. When cultures are negative, antibiotic discontinuation is safe.

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Configuration of Aerosol Delivery Devices and Their Placement: Let's Be Sure We're Paying Attention to the Literature

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Evaluating the Effect of Flow and Interface Type on Pressures Delivered With Bubble CPAP in a Simulated Model

BACKGROUND:Bubble CPAP, used for spontaneously breathing infants to avoid intubation or postextubation support, can be delivered with different interface types. This study compared the effect that interfaces had on CPAP delivery. We hypothesized that there would be no difference between set and measured levels between interface types.METHODS:A validated preterm infant nasal airway model was attached to the ASL 5000 breathing simulator. The simulator was programmed to deliver active breathing of a surfactant-deficient premature infant with breathing frequency at 70 breaths/min inspiratory time of 0.30 s, resistance of 150 cm H2O/L/s, compliance of 0.5 mL/cm H2O, tidal volume of 5 mL, and esophageal pressure of −10 cm H2O. Nasal CPAP prongs, size 4030, newborn and infant RAM cannulas were connected to a nasal airway model and a bubble CPAP system. CPAP levels were set at 4, 5, 6, 7, 8, and 9 cm H2O with flows of 6, 8, and 10 L/min each. Measurements were recorded after 1 min of stabilization. The analysis was performed using SAS 9.4. The Kolmogorov-Smirnov test assessed normality of the data. The Friedman test was used to compare non-normally distributed repeated measures. The Wilcoxon signed-rank test was used to conduct post hoc analysis. All tests were 2-sided, and P values of <.05 were considered as indicating significant differences unless otherwise indicated.RESULTS:At lower set CPAP levels, 4–6 cm H2O, measured CPAP dropped precipitously with the nasal prongs with the highest flow setting. At higher CPAP levels, 7–9 cm H2O measured CPAP concomitantly increased as the flow setting increased. Statistically significant differences in set and measured CPAP occurred for all devices across all CPAP levels, with the measured CPAP less than set for all conditions, P < .001.CONCLUSIONS:Set flow had a profound effect on measured CPAP. The concomitant drop in measured pressure with high and low flows could be attributed to increased resistance to spontaneous breathing or insufficient flow to meet inspiratory demand. Clinicians should be aware of the effect that the interface and flow have on CPAP delivery.

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Histopathology of NET: current concepts and new developments

Publication date: Available online 26 February 2016
Source:Best Practice & Research Clinical Endocrinology & Metabolism
Author(s): Anja M. Schmitt, Annika Blank, Ilaria Marinoni, Paul Komminoth, Aurel Perren
The diagnosis of neuroendocrine tumours is based on their histopathologic appearance and immunohistochemical profile. With the WHO 2010 classification formal staging and grading was introduced for gastro-entero-pancreatic NET, however, the nomenclature for lung neuroendocrine tumors still relies on the carcinoid term.In this review we also focus on the situation of neuroendocrine carcinoma of unknown primary, tissue biomarkers and actual controversies in the histopathology of NEN.



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Editorial Board

Publication date: March 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1859, Issue 3





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Novel functions of PXR in cardiometabolic disease

Publication date: Available online 26 February 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Changcheng Zhou
Cardiometabolic disease emerges as a worldwide epidemic and there is urgent need to understand the molecular mechanisms underlying this chronic disease. The chemical environment to which we are exposed has significantly changed in the past few decades and recent research has implicated its contribution to the development of many chronic human diseases. However, the mechanisms of how exposure to chemicals contribute to the development of cardiometabolic disease are poorly understood. Numerous chemicals have been identified as ligands for the pregnane X receptor (PXR), a nuclear receptor functioning as a xenobiotic sensor to coordinately regulate xenobiotic metabolism via transcriptional regulation of xenobiotic-detoxifying enzymes and transporters. In the past decade, the function of PXR in the regulation of xenobiotic metabolism has been extensively studied by many laboratories and the role of PXR as a xenobiotic sensor has been well-established. The identification of PXR as a xenobiotic sensor has provided an important tool for the study of new mechanisms through which xenobiotic exposure impacts human chronic diseases. Recent studies have revealed novel and unexpected roles of PXR in modulating obesity, insulin sensitivity, lipid homeostasis, atherogenesis, and vascular functions. These studies suggest that PXR signaling may contribute significantly to the pathophysiological effects of many known xenobiotics on cardiometabolic disease in humans. The discovery of novel functions of PXR in cardiometabolic disease not only contributes to our understanding of "gene–environment interactions" in predisposing individuals to chronic diseases but also provides strong evidence to inform future risk assessment for relevant chemicals.



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Prevention and treatment of liver allograft antibody-mediated rejection and the role of the 'two-hit hypothesis'.

Purpose of review: The review outlines the diagnosis, prevention strategies, and possible treatment options for acute and chronic antibody-mediated rejection (AMR). Recent findings: Although rare, severe acute AMR (aAMR) usually occurs in patients with high mean fluorescence index despite serial dilutions or high-titer preformed class I donor-specific alloantibodies (DSA). The diagnosis is suspected when allograft dysfunction occurs with DSA, diffuse C4d staining, and a microvascular injury, and may be aided by the aAMR score. However, the incidence of and treatment approach to combined T-cell-mediated rejection (TCMR) with DSA present and some but not all features of AMR is yet to be determined. Chronic liver allograft AMR is characterized by low-grade chronic inflammation and progressive fibrosis with DSA, the chronic AMR (cAMR) score may facilitate diagnosis. The 'two-hit' hypothesis, whereby a coexistent insult upregulates human leukocyte antigen class II target antigen on the microvascular endothelium, may explain why suboptimal donors with lower sensitization levels might suffer from acute AMR and those with chronic complications (e.g., recurrent original disease) might be more susceptible to chronic AMR. Although treatment algorithms are needed, prevention is preferable and at a minimum includes transfusion minimization, and medication adherence. Summary: Severe acute AMR is rare but diagnosable, and there is need to determine the incidence of and optimal therapy for less severe combined AMR and T cell-mediated rejection. Chronic AMR is likely more common and of significant relevance to long-term allograft survival improvement. The two-hit hypothesis may help to explain the rarity of both findings and shed insight onto future prevention and treatment strategies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Hypothermic machine perfusion in liver transplantation.

Purpose of the review: The purpose of the review is to report recent human application of hypothermic machine liver perfusion, and to discuss potential protective mechanisms. Recent findings: Human application of hypothermic machine liver perfusion is still very limited. Currently, three transplant centers apply this novel treatment in donation after cardiac death (DCD) or donation after brain death (DBD) liver grafts. In all cases, endischemic perfusion was performed after initial cold storage for organ transport. Perfusion conditions differ slightly in terms of oxygenation (pO2 15-60 kPa), perfusion route (dual vs. portal), perfusion time (2-4 h), and perfusate. Summary: The current data support the hypothesis that applying endischemic hypothermic machine liver perfusion protects extended criteria DBD and DCD livers from initial reperfusion injury, with better graft function and less biliary complications. Hypothermic machine perfusion may therefore offer revitalization of liver grafts before implantation by a simple and practical perfusion technique with a high impact on enlarging the donor pool. Multicentric phase III randomized control trials in DBD and DCD liver transplantation have been initiated to further test this strategy, which may establish machine liver perfusion in the clinical setting. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Expansion of the criteria for living donor liver transplantation for hepatocellular carcinoma.

Purpose of review: Several expanded criteria for liver transplantation for hepatocellular carcinoma (HCC) have been suggested out of concern that the Milan criteria may be too strict, and thereby exclude patients who could benefit from this surgical procedure. However, most expanded criteria were designed for deceased donor liver transplantation. Living donor liver transplantation (LDLT) differs from that of deceased donor liver transplantation primarily because LDLT liver grafts are not public resources. Recent findings: In Asian countries, where HCC is endemic, LDLT is the main currently available treatment option for HCC. High-volume LDLT centers throughout Asia have adopted their own expanded selection criteria for LDLT for HCC with acceptable long-term results. Some centers utilize tumor markers as one of the criterion to help select suitable candidates. Indeed, such adjunctive biomarkers may have prognostic relevance for patients with HCC. The use of both biological and histomorphologic parameters may increase the number of transplantable patients. Summary: The overall chance of survival, and recipient/donor preferences as well as the risk of recurrence are considered in the LDLT setting. Therefore, the selection criteria for liver transplantation for HCC could benefit from expansion for LDLT. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Intermediate-term and long-term mortality among acute medical patients hospitalized with community-acquired sepsis: a population-based study.

Objective: Admission with severe sepsis is associated with an increased short-term mortality, but it is unestablished whether sepsis severity has an impact on intermediate-term and long-term mortality following admission to an acute medical admission unit. Patients and methods: This was a population-based study of all adults admitted to an acute medical admission unit, Odense University Hospital, Denmark, from September 2010 to August 2011, identified by symptoms and clinical findings. We categorized the mortality periods into intermediate-term (31-180 days) and long-term (181-365, 366-730, and 731-1096 days). Mortality hazard ratios (HRs), comparing patients admitted with sepsis with those of a well-defined background population, were estimated using multivariable Cox regression. HRs were presented with 95% confidence intervals. Results: In total, 621 (36.3%) presented with sepsis, 1071 (62.5%) presented with severe sepsis, and 21 (1.2%) presented with septic shock. Thirty-day all-cause mortality for patients with sepsis, severe sepsis, and septic shock was 6.1, 18.8, and 38.1%, respectively. The adjusted HR among patients with sepsis of any severity within the time periods 31-180, 181-365, 366-720, and 721-1096 days was 7.1 (6.0-8.5), 2.8 (2.3-3.5), 2.1 (1.8-2.6), and 2.2 (1.7-2.9), respectively. Long-term mortality was unrelated to sepsis severity [721-1096 days: sepsis HR: 2.2 (1.5-3.2), severe sepsis HR: 2.1 (1.5-3.0)]. Conclusion: Patients admitted with community-acquired sepsis showed high intermediate-term mortality, increasing with sepsis severity. Long-term mortality was increased two-fold compared with sepsis-free individuals, but might be explained by unmeasured confounding. Further, long-term mortality was unrelated to sepsis severity. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Lateral epipharyngeal cyst MRI

Cystic lesion in the right pharyngeal recess (fossa of Rosenmüller), behind the paryngeal ostium of the Eustachian tube.

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Replacing Sedentary Time with Physical Activity in Relation to Mortality.

Introduction: Data evaluating mortality benefit from replacing sedentary time with physical activity are sparse. We explored reallocating time spent in sedentary behavior to physical activity of different intensities in relation to mortality risk. Methods: Women and men aged 50-85 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006 cycles with follow-up through December 31, 2011 were included. Sedentary time and physical activity were assessed using an ActiGraph accelerometer. Isotemporal substitution models were used to estimate the effect of replacing one activity behavior with another activity behavior for the same amount of time while holding total accelerometer wear time constant. Results: During a mean follow-up of 6.35 years, 697 deaths from any cause occurred. Replacing 30 minutes of sedentary time with an equal amount of light activity was associated with 14% reduced risk of mortality (multivariable-adjusted hazard ratio (HR)=0.86, 95% confidence interval (CI)=0.83-0.90). Replacement of sedentary time with moderate to vigorous activity was related to 50% mortality risk reduction (HR=0.50, 95% CI=0.31-0.80). We also noted a 42% reduced risk of mortality when light physical activity was replaced by moderate to vigorous activity (HR=0.58, 95% CI=0.36-0.93). Conclusion: Replacing sedentary time with an equal amount of physical activity may protect against preterm mortality. Replacement of light physical activity with moderate to vigorous activity is also associated with protection from premature mortality. (C) 2016 American College of Sports Medicine

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Intensive Exercise Does Not Preferentially Mobilize Skin-Homing T Cells and NK Cells.

Purpose: This study investigated whether natural killer (NK) cells and CD8+ T cells expressing cutaneous lymphocyte antigen (CLA) - a homing molecule for endothelial cell leukocyte adhesion molecule 1 (ELAM-1), which enables transmigration to the skin - are selectively mobilised in response to acute exercise. Methods: Nine healthy males (mean +/- SD age: 22.1 +/- 3.4 years) completed two exercise sessions: high-intensity continuous cycling ('continuous exercise' at 80% V[spacing dot above]O2MAX for 20 min) and low-volume high-intensity interval exercise ('HIIE' at 90% V[spacing dot above]O2MAX 10 x 1 min repetitions with 1 min recovery intervals). Blood was collected before, immediately- and 30 min post-exercise for cryo-preservation of peripheral blood mononuclear cells. CLA+ and CLA- cells were quantified within NK subpopulations (CD56bright 'regulatory' and CD56dim 'cytotoxic' cells) as well as the following CD8+ T cell subpopulations: naive ('NA'; CD45RA+CCR7+), central memory ('CM'; CD45RA-CCR7+), effector-memory ('EM'; CD45RA-CCR7-) and CD45RA-expressing effector-memory cells ('EMRA'; CD45RA+CCR7-). Results: CLA+ NK cells and CD8+ memory T cells increased in response to both exercise bouts, but, overall, their numerical contribution to the exercise lymphocytosis was inferior to CLA- cells, which increased to a much greater extent during exercise. Tellingly, the most exercise-responsive cells - effector memory CD8+ cells and CD56dim cells - were CLA-. Conclusions: A small subset of CLA+ lymphocytes are mobilised into blood during acute intensive exercise, but CLA+ cells are not major contributors to exercise lymphocytosis, thus providing preliminary evidence that the skin is not a major origin, or homing-destination, of exercise-sensitive lymphocytes. (C) 2016 American College of Sports Medicine

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Whole-Body Vibration Intensities in Chronic Stroke: A Randomized Controlled Trial.

Purpose: A single-blinded, randomized controlled study was conducted to investigate the effects of different whole-body vibration (WBV) intensities on body functions/structures, activity, and participation in individuals with stroke. Methods: Eighty-four individuals with chronic stroke (mean age: 61.2 years, SD: 9.2) with mild to moderate motor impairment (Chedoke-McMaster Stroke Assessment lower limb motor score: median = 9 out of 14, interquartile range = 7-11.8) were randomly assigned to a low-intensity WBV, high-intensity WBV, or control group. The former 2 groups performed various leg exercises while receiving low-intensity and high-intensity WBV, respectively. Controls performed the same exercises without WBV. All individuals received 30 training sessions over an average period of 75.5 days (SD = 5.2). Outcome measurements included knee muscle strength (isokinetic dynamometry), knee and ankle joint spasticity (Modified Ashworth Scale), balance (Mini Balance Evaluation Systems Test, Mini-BESTest), mobility (Timed-Up-and-Go test, TUG), walking endurance (6-Minute Walk Test, 6MWT), balance self-efficacy (Activities-specific Balance Confidence scale, ABC), participation in daily activities (Frenchay Activity Index), perceived environmental barriers to societal participation (Craig Hospital Inventory of Environmental Factors), and quality of life (Short-Form 12 Health Survey, SF-12). Assessments were performed at baseline and post-intervention. Results: Intention-to-treat analysis revealed a significant time effect for muscle strength, TUG, distance, and oxygen consumption rate achieved during 6MWT, Mini-BESTest, ABC, and SF-12 physical composite score domain (P 0.05). Conclusion: Addition of the 30-session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone, chronic stroke patients with mild to moderate motor impairments. (C) 2016 American College of Sports Medicine

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The Case of the ‘Curious Document’: Malory, William Matthews, and Eugène Vinaver

Rayner, SJ; (2015) The Case of the 'Curious Document': Malory, William Matthews, and Eugène Vinaver. Journal of the International Arthurian Society , 3 pp. 120-138. 10.1515/jias-2015-0007 .

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C.G. Jung’s Letters to Erich Neumann in the Letters Edition revisited in the Light of the Jung-Neumann Correspondence / Le lettere di C.G. Jung a Erich Neumann nell’edizione rivisitata alla luce della corrispondenza Jung-Neumann

Liebscher, M; (2015) C.G. Jung's Letters to Erich Neumann in the Letters Edition revisited in the Light of the Jung-Neumann Correspondence / Le lettere di C.G. Jung a Erich Neumann nell'edizione rivisitata alla luce della corrispondenza Jung-Neumann. Enkelados , 3 pp. 47-70.

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Many-objective optimization and visual analytics reveal key trade-offs for London's water supply

Matrosov, ES; Huskova, I; Kasprzyk, JR; Harou, JJ; Lambert, C; Reed, PM; (2015) Many-objective optimization and visual analytics reveal key trade-offs for London's water supply. Journal of Hydrology , 531 pp. 1040-1053. 10.1016/j.jhydrol.2015.11.003 . Green open access

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Wealth inequality, family background, and estate taxation

De Nardi, M; Yang, F; (2016) Wealth inequality, family background, and estate taxation. Journal of Monetary Economics , 77 pp. 130-145. 10.1016/j.jmoneco.2015.10.005 . Green open access

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Language lateralization of hearing native signers: A functional transcranial Doppler sonography (fTCD) study of speech and sign production

Gutierrez-Sigut, E; Daws, R; Payne, H; Blott, J; Marshall, C; MacSweeney, M; (2015) Language lateralization of hearing native signers: A functional transcranial Doppler sonography (fTCD) study of speech and sign production. Brain and Language , 151 pp. 23-34. 10.1016/j.bandl.2015.10.006 . Green open access

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Interactions and Pastoralism Along the Southern and Southeastern Frontiers of the Meroitic State, Sudan

Brass, M; (2015) Interactions and Pastoralism Along the Southern and Southeastern Frontiers of the Meroitic State, Sudan. Journal of World Prehistory , 28 (4) pp. 255-288. 10.1007/s10963-015-9089-1 . Green open access

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Genome-wide analysis of genetic correlation in dementia with Lewy bodies, Parkinson's and Alzheimer's diseases

Guerreiro, R; Escott-Price, V; Darwent, L; Parkkinen, L; Ansorge, O; Hernandez, DG; Nalls, MA; Guerreiro, R; Escott-Price, V; Darwent, L; Parkkinen, L; Ansorge, O; Hernandez, DG; Nalls, MA; Clark, L; Honig, L; Marder, K; van der Flier, W; Holstege, H; Louwersheimer, E; Lemstra, A; Scheltens, P; Rogaeva, E; St George-Hyslop, P; Londos, E; Zetterberg, H; Ortega-Cubero, S; Pastor, P; Ferman, TJ; Graff-Radford, NR; Ross, OA; Barber, I; Braae, A; Brown, K; Morgan, K; Maetzler, W; Berg, D; Troakes, C; Al-Sarraj, S; Lashley, T; Compta, Y; Revesz, T; Lees, A; Cairns, NJ; Halliday, GM; Mann, D; Pickering-Brown, S; Powell, J; Lunnon, K; Lupton, MK; International Parkinson's Disease Genomics Consortium (IPDGC), ; Dickson, D; Hardy, J; Singleton, A; Bras, J; - view fewer (2016) Genome-wide analysis of genetic correlation in dementia with Lewy bodies, Parkinson's and Alzheimer's diseases. Neurobiology of Aging , 38 214.e7-214.e10. 10.1016/j.neurobiolaging.2015.10.028 . Green open access

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Plasticity of white matter connectivity in phonetics experts

Vandermosten, M; Price, CJ; Golestani, N; (2015) Plasticity of white matter connectivity in phonetics experts. Brain Structure and Function 10.1007/s00429-015-1114-8 . (In press). Green open access

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Maybe Poor Johnny Really Cannot Encrypt: The Case for a Complexity Theory for Usable Security

Benenson, Z; Lenzini, G; Oliveira, D; Parkin, S; Uebelacker, S; (2015) Maybe Poor Johnny Really Cannot Encrypt: The Case for a Complexity Theory for Usable Security. In: Somayaji, A and Van Oorschot, P and Böhme, R and Mannan, M, (eds.) NSPW '15: Proceedings of the 2015 New Security Paradigms Workshop. (pp. pp. 85-99). Association for Computing Machinery (ACM): New York, NY, USA. Green open access

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The sequence of sequencers: The history of sequencing DNA

Heather, JM; Chain, B; (2016) The sequence of sequencers: The history of sequencing DNA. Genomics , 107 (1) pp. 1-8. 10.1016/j.ygeno.2015.11.003 . Green open access

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Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe

Bobak, M; Malyutina, S; Horvat, P; Pajak, A; Tamosiunas, A; Kubinova, R; Simonova, G; Bobak, M; Malyutina, S; Horvat, P; Pajak, A; Tamosiunas, A; Kubinova, R; Simonova, G; Topor-Madry, R; Peasey, A; Pikhart, H; Marmot, MG; - view fewer (2015) Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe. European Journal of Epidemiology , 31 (1) pp. 21-30. 10.1007/s10654-015-0092-8 . Green open access

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A technique for using employee perception of security to support usability diagnostics

Parkin, S; Epili, S; (2015) A technique for using employee perception of security to support usability diagnostics. In: 2015 Workshop on Socio-Technical Aspects in Security and Trust (STAST). (pp. pp. 1-8). IEEE: Verona, Italy. Green open access

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Exogenous SDF-1α protects human myocardium from hypoxia-reoxygenation injury via CXCR4

Malik, A; Bromage, DI; He, Z; Candilio, L; Hamarneh, A; Taferner, S; Davidson, SM; Malik, A; Bromage, DI; He, Z; Candilio, L; Hamarneh, A; Taferner, S; Davidson, SM; Yellon, DM; - view fewer (2015) Exogenous SDF-1α protects human myocardium from hypoxia-reoxygenation injury via CXCR4. Cardiovascular Drugs and Therapy , 29 (6) pp. 589-592. 10.1007/s10557-015-6622-5 . Green open access

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Validation of clinical acceptability of an atlas-based segmentation algorithm for the delineation of organs at risk in head and neck cancer

Hoang Duc, AK; Eminowicz, G; Mendes, R; Wong, SL; McClelland, J; Modat, M; Cardoso, MJ; Hoang Duc, AK; Eminowicz, G; Mendes, R; Wong, SL; McClelland, J; Modat, M; Cardoso, MJ; Mendelson, AF; Veiga, C; Kadir, T; D'Souza, D; Ourselin, S; - view fewer (2015) Validation of clinical acceptability of an atlas-based segmentation algorithm for the delineation of organs at risk in head and neck cancer. Medical Physics , 42 (9) pp. 5027-5034. 10.1118/1.4927567 . Green open access

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