Isolated ovarian polyarteritis nodosa

Polyarteritis nodosa is a rare disorder and a form of systemic vasculitis. A 48 year-old female was admitted to the hospital because menorrhagia and pelvic pain in February 1993. The patient underwent exploratory laparotomy resulting in a total hysterectomy and bilateral salpingo-oophorectomy for myoma of uterus and a right adnexal cystic mass. Histopathologic examination revealed left ovarian periarteritis nodosa. Further investigation and 9 months follow-up failed to show any systemic involvement. To our knowledge the isolated ovarian polyarteritis nodosa is the first case in the literature.     

Family practice physicians' firearm safety counseling beliefs and behaviors

The purpose of this study was to identify family physicians' firearm safety counseling beliefs and behaviors. A survey was mailed to a random sample of 600 members of the American Academy of Family Physicians. A three wave mailing technique was used to maximize the response rate and yielded 271 usable surveys (55% response rate). Outcome measures included training experience in firearm safety counseling, the prevalence of firearm safety counseling by family physicians, and their perceptions regarding such counseling. The majority (78%) of family physicians lacked formal training on how to counsel patients about firearm safety and 49% believed more time should be spent in residency programs on firearm safety counseling. The majority (84%) of respondents never or rarely counseled patients on firearm safety and 50% believed firearm safety counseling should be a low priority in their delivery of primary care. The majority of respondents did not regularly counsel patients about firearm safety, did not believe firearm safety counseling should be a priority, and did not believe firearm safety counseling would be effective in reducing firearm-related trauma.     

HDL3-mediated cholesterol efflux from cultured enterocytes: The role of apoproteins A-I and A-II

High density lipoproteins (HDL) were recently demonstrated in an enterocyte model (CaCo-2 cells) to mediate reverse cholesterol transport by retroendocytosis. The present study was carried out to define the role of the major HDL apoproteins (apo) A-I and apo A-II in this pathway. HDL₃ was fractionated by heparin affinity chromatography into the two main fractions containing either apo A-I only (fraction A) or both apo A-I and apo A-II (fraction B). In addition, liposomes were reconstituted from purified apo A-I or apo A-II and dimyristoyl phosphatidylcholine. The cell binding properties and cholesterol efflux potential were studied in the lipoprotein fractions and the liposomes. Both fractions exhibited similar maximal binding capacities of 4427 (A) and 5041 (B) ng/mg cell protein, but their dissociation constants differed (40.5 and 167.7 μg/mL, respectively). Fraction A induced cholesterol efflux and stimulated cholesterol synthesis more than did fraction B. Fraction A mobilized both cellular free and esterified cholesterol, whereas fraction B preferentially mobilized cholesteryl esters. Liposomes, containing either apo A-I or apo A-II, showed specific binding, endocytosis and endosomal transport, and were released as intact particles. Apo A-I liposomes also mediated cholesterol efflux. In conclusion, there is evidence that the HDL₃ subfractions A and B, as well as reconstituted liposomes containing either apo A-I or apo A-II, were specifically bound and entered a retroendocytosis pathway which was directly linked to cholesterol efflux. Quantitatively, the apo A-I subfraction appeared to play the dominant role in normal enterocytes. The apo A-II content of fraction B was related to the mobilization of cholesteryl esters.     

Robust Cardiac Function Assessment in 4D PC‐MRI Data of the Aorta and Pulmonary Artery

Four‐dimensional phase‐contrast magnetic resonance imaging (4D PC‐MRI) allows the non‐invasive acquisition of time‐resolved, 3D blood flow information. Stroke volumes (SVs) and regurgitation fractions (RFs) are two of the main measures to assess the cardiac function and severity of valvular pathologies. The flow rates in forward and backward direction through a plane above the aortic or pulmonary valve are required for their quantification. Unfortunately, the calculations are highly sensitive towards the plane's angulation since orthogonally passing flow is considered. This often leads to physiologically implausible results. In this work, a robust quantification method is introduced to overcome this problem. Collaborating radiologists and cardiologists were carefully observed while estimating SVs and RFs in various healthy volunteer and patient 4D PC‐MRI data sets with conventional quantification methods, that is, using a single plane above the valve that is freely movable along the centerline. By default it is aligned perpendicular to the vessel's centerline, but free angulation (rotation) is possible. This facilitated the automation of their approach which, in turn, allows to derive statistical information about the plane angulation sensitivity. Moreover, the experts expect a continuous decrease of the blood flow volume along the vessel course. Conventional methods are often unable to produce this behaviour. Thus, we present a procedure to fit a monotonous function that ensures such physiologically plausible results. In addition, this technique was adapted for the usage in branching vessels such as the pulmonary artery. The performed informal evaluation shows the capability of our method to support diagnosis; a parameter evaluation confirms the robustness. Vortex flow was identified as one of the main causes for quantification uncertainties.     

Distinguishing between green building occupants’ reasoned and unplanned behaviours

Several frameworks incorporate social and psychological elements of environmentally significant behaviour, and most assume cognitive and deliberate decision-making. Household energy consumption behaviours, however, span a spectrum from reasoned and deliberate to unplanned and automatic. The aim of this paper is to advance knowledge of reasoned and unplanned behaviours in the context of pro-environmental action. Using results of a survey administered to occupants of an urban residential green building, this study explores five household consumption behaviours and tests the hypothesis that unplanned behaviours will be poorly predicted by a reasoned, values-based behavioural framework. Using path analyses, variables in a values-based framework are used to predict surveyed behaviours. Findings indicate that behaviours hypothesized to be unplanned were not well predicted by the values-based framework. The framework successfully predicted what was hypothesized to be a fully reasoned behaviour. Three potential reasons are discussed for the lack of prediction of some behaviours. A deeper understanding of how unplanned, automatic or habitual behaviours intervene in conservation intentions can help policy-makers and building designers better respond to influences of occupant behaviour on building performance.     

Porosity measurements in suspension plasma sprayed YSZ coatings using NMR cryoporometry and X-ray microscopy

A large variety of coatings are used to protect structural engineering materials from corrosion, wear, and erosion, and to provide thermal insulation. In this work, yttria-stabilized zirconia coatings produced by suspension plasma spraying were investigated with respect to their microstructure and especially their porosity, as the porosity affects the thermal insulation of the underlying component. To determine porosity, pore size distribution, and pore shape, the coatings were investigated using novel advanced characterization techniques like NMR cryoporometry and X-ray microscopy. In general, the porosity is inhomogeneously distributed and the coatings showed a large variety of pore sizes ranging from a few nanometers to micrometers.     

Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis?

Hyperglycemia is a common condition in critically ill patients admitted to an intensive care unit (ICU). These patients represent an inhomogeneous collective and hyperglycemia might need different evaluation depending on the underlying disorder. To elucidate this, we investigated and compared associations of severe hyperglycemia (>200 mg/dL) and mortality in patients admitted to an ICU for acute myocardial infarction (AMI) or sepsis as the two most frequent admission diagnoses. From 2006 to 2009, 2551 patients 69 (58–77) years; 1544 male; 337 patients suffering from type 2 diabetes (T2DM)) who were admitted because of either AMI or sepsis to an ICU in a tertiary care hospital were investigated retrospectively. Follow-up of patients was performed between May 2013 and November 2013. In a Cox regression analysis, maximum glucose concentration at the day of admission was associated with mortality in the overall cohort (HR = 1.006, 95% CI: 1.004–1.009; p < 0.001) and in patients suffering from myocardial infarction (HR = 1.101, 95% CI: 1.075–1.127; p < 0.001) but only in trend in patients admitted to an ICU for sepsis (HR = 1.030, 95% CI: 0.998–1.062; p = 0.07). Severe hyperglycemia was associated with adverse intra-ICU mortality in the overall cohort (23% vs. 13%; p < 0.001) and patients admitted for AMI (15% vs. 5%; p < 0.001) but not for septic patients (39% vs. 40%; p = 0.48). A medical history of type 2 diabetes (n = 337; 13%) was not associated with increased intra-ICU mortality (15% vs. 15%; p = 0.93) but in patients with severe hyperglycemia and/or a known medical history of type 2 diabetes considered in combination, an increased mortality in AMI patients (intra-ICU 5% vs. 13%; p < 0.001) but not in septic patients (intra-ICU 38% vs. 41%; p = 0.53) could be evidenced. The presence of hyperglycemia in critically ill patients has differential impact within the different etiological groups. Hyperglycemia in AMI patients might identify a sicker patient collective suffering from pre-diabetes or undiagnosed diabetes with its’ known adverse consequences, especially in the long-term. Hyperglycemia in sepsis might be considered as adaptive survival mechanism to hypo-perfusion and consecutive lack of glucose in peripheral cells. AMI patients with hyperglycemic derailment during an ICU-stay should be closely followed-up and extensively screened for diabetes to improve patients’ outcome.     

Stabilizing and destabilizing effects of drug-excipient interactions in spray-dried,freeze-dried,and granulated Sennae fructus extracts

Abstract

The objective of this study was to compare spray-dried and freeze-dried extracts of Sennae fructus regarding the stability of the sennosides. Therefore, the influence of the addition of maltodextrin (MD) not only before the drying processes but also during fluidized bed granulation was investigated. Analysis of the hygroscopicities, the simultaneous TGA-DSC-MS data, and the influence of storage revealed that spray-dried extracts are more stable than freeze-dried extracts. The addition of MD led to an even better stability of the extracts. Lower amounts of MD are sufficient if applied onto the surface of the native extract during fluidized bed granulation.     

Lupine,a source of new as well as hidden food allergens

The present review summarizes current knowledge about lupine allergy, potential sensitization routes, cross‐reactions between lupine and other legumes, and the respective IgE‐binding proteins. Since the 1990s, lupine flour is used as a substitute for or additive to other flours, mostly wheat flour, in several countries of the EU. In 1994, the first case of an immediate‐type allergy after ingestion of lupine flour‐containing pasta was reported. Since then, the number of published incidents following ingestion or inhalation of lupine flour is rising. So far, the Lupinus angustifolius β‐conglutin has been designated as the allergen Lup an 1 by the International Union of Immunological Societies Allergen Nomenclature Subcommittee. Initially, publications focussed on the fact that peanut‐allergic patients were at risk to develop anaphylaxis to lupine due to cross‐reactivity between peanut and lupine. At present, however, the ratio between cases of pre‐existing legume allergy (mostly peanut allergy) to de novo sensitization to lupine seed is nearly 1:1. Although in December 2006, lupine and products thereof were included in the EU foodstuff allergen list according to the Commission Directive 2006/142/EC amending Annex IIIA of Directive 2000/13/EC in order to prevent severe reactions caused by “hidden food allergens”, the majority of patients and medical personnel are still not aware of raw lupine seed as potentially dangerous food allergen.