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Dilated cardiomyopathy (DCM) is typically defined by left ventricular dilation and systolic dysfunction in the absence of a clear precipitant. Idiopathic disease is common; up to 50% of patients with DCM have no cause found despite imaging, genetic and biopsy assessments. Treatment remains focused on managing symptoms, reducing the risk of sudden cardiac death and ameliorating the structural and electrical complications of disease progression. In the absence of aetiology-specific treatments, the condition remains associated with a poor prognosis; mortality is approximately 40% at 10 years. The role of immune-mediated inflammatory injury in the development and progression of DCM was first proposed over 30 years ago. Despite the subsequent failures of three large clinical trials of immunosuppressive treatment (ATTACH, RENEWAL and the Myocarditis Treatment Trial), evidence for an abnormal adaptive immune response in DCM remains significant. In this review, we summarise and discuss available evidence supporting immune dysfunction in DCM, with a specific focus on cellular immunity. We also highlight current clinical and experimental treatments. We propose that the success of future immunosuppressive treatment trials in DCM will be dependent on the deep immunophenotyping of patients, to identify those with active inflammation and/or an abnormal immune response who are most likely to respond to therapy.

Patient satisfaction is an essential indicator for measuring the quality of care. This study assessed patients' satisfaction with primary care services across different public health care system levels.The study was a cross-sectional study conducted across three states in India. We adopted a multi-stage stratified random sampling technique to select the districts(n-13) and facilities (n-55). A total of 4650 patients' exit interviews were conducted. Linear regression and analysis of variance was used to test the association. Analyses was performed using Stata software (version 15.0).Patients visiting the primary facilities were more satisfied within the different domains of quality indicators that is, technical, communication, safety and cleanliness, and cost of services. The highest differences were observed on behaviour of other staff (Reg Coefficient 4.1 ± 0.8) and cleanliness of the ward (Reg Coefficient 4.0 ± 0.9). Significant negative association was observed in patient's satisfaction in the state of Kerala with an increase in age and education level.Our study suggests higher satisfaction at primary care facilities as compared to secondary and tertiary level facilities in the three states. Development of standardized tool and specific research on patient experience and its relation to the quality of care is needed in low- and middle-income countries.

Women's property ownership matters for their well-being and agency, broader economic prosperity, and children's development. However, until recently, a lack of data has constrained further exploration of gender differences in property ownership in the developing world. Using data from 41 developing countries, this paper contributes to the literature by investigating gender gaps in the incidence of property ownership among couples and the factors associated with these gaps, focusing on the role of legal systems. We find that in almost all countries, husbands are more likely to own property than wives. Across countries in our sample, husbands are, on average, 2.7 times more like than wives to own property alone and 1.4 times more likely to own property alone or jointly. Within countries, gender gaps in the incidence of property ownership are most pronounced for disadvantaged groups, that is, the rural population and the poorest quintile. These gender gaps reflect a variety of factors, including discriminatory laws with respect to inheritance, property ownership, marital regimes, and laws that protect from workplace discrimination. Countries with more gender egalitarian legal regimes have higher levels of property ownership by married women, especially housing, suggesting that legal reforms are a potential mechanism to increase women's property ownership.

Monetary poverty measures as well as most existing multidimensional poverty indices (MPI) assume equal distribution within the household and thus are likely to yield a biased assessment of individual poverty, and poverty by age or gender. We show that the direction of the bias of such household‐based assessments in measuring poverty or inequality among individuals depends on how these measures use individual data to determine the poverty status of households. We use data from the 2012 Indian Human Development Survey and compare a standard household‐based MPI to an individual‐level MPI. The poverty rate among women is 14 percent points higher than that of men in our individual MPI measure but almost the same when using the household‐based measure. 22 percent of males and 27 percent of females are misclassified as poor or non‐poor using the household‐based measure. We also show that intra‐household inequality is 30 percent of total inequality.

Objective Diamond Blackfan anemia (DBA) is a rare inherited bone marrow failure syndrome. The mainstays of treatment involve chronic red cell transfusions, long-term glucocorticoid therapy, and stem cell transplantation. Systematic data concerning endocrine function in DBA are limited. We studied patients in the DBA Registry (DBAR) of North America to assess the prevalence of various endocrinopathies.

BACKGROUND Chronic use of tyrosine kinase inhibitors (TKIs) may lead to previously unrecognized adverse events. This study evaluated the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD) in chronic-phase (CP) chronic myeloid leukemia (CML) patients treated with imatinib, dasatinib, and nilotinib. METHODS Four hundred sixty-eight newly diagnosed CP CML patients treated with TKIs were analyzed. The molecular and cytogenetic response data, creatinine, and glomerular filtration rate (GFR) were followed from the start of therapy to the last follow-up (median, 52 months). GFR was estimated with the Modification of Diet in Renal Disease equation. RESULTS Nineteen patients (4%) had TKI-associated AKI. Imatinib was associated with a higher incidence of AKI in comparison with dasatinib and nilotinib (P = .014). Fifty-eight patients (14%) developed CKD while they were receiving a TKI; 49 of these patients (84%) did so while they were being treated with imatinib (P

In the present study, we aim to quantitatively investigate and compare the intellectual landscapes of single-walled carbon nanotubes (SWCNTs) and multi-walled carbon nanotubes (MWCNTs) research between 2000 and 2014. The overall intellectual structure of these fields is illustrated by emerging trends of bursting keywords and thematic concentrations of co-cited references. This study is based on two sets of bibliographic records retrieved from the Web of Science database. The SWCNTs dataset contains 18,700 original research and review articles. The MWCNTs dataset, consisting of 23,584 records, is also collected from the database. We find that both domains have scrutinized chemical concepts which underlie the properties of the materials. Recent thematic trends show that MWCNTs research focuses on the improvement of the material while SWCNTs research lays more emphasis on their applications. In conclusion, it is argued that SWCNTs and MWCNTs have co-evolved. At the same time, both fields are distinctively diverging with their own scientific concerns.

OBJECTIVE Pneumonia is a morbid complication of stroke, but evidence-based strategies for its prevention are lacking. Acid-suppressive medications have been associated with increased risk for nosocomial pneumonia in hospitalized patients. It is unclear whether these results can be extrapolated to stroke patients, where other factors strongly modulate pneumonia risk. We investigated the association between acid-suppressive medication and hospital-acquired pneumonia in patients with acute stroke. METHODS All patients hospitalized with acute ischemic stroke or intracerebral hemorrhage in a large, urban academic medical center in Boston, Massachusetts from June 2000 to June 2010 who were ≥18 years of age and hospitalized for ≥2 days were eligible for inclusion. Acid-suppressive medication use was defined as any pharmacy charge for a proton-pump inhibitor or histamine-2 receptor antagonist. Multivariate logistic regression was used to control for confounders. The main outcome measure was hospital-acquired pneumonia, defined via International Classification of Diseases, Ninth Revision, Clinical Modification codes. RESULTS The cohort comprised 1,676 admissions. Acid-suppressive medication was ordered in 1,340 (80%) and hospital-acquired pneumonia occurred in 289 (17.2%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication compared to those unexposed (20.7% vs 3.6%, odds ratio [OR] = 7.0, 95% confidence interval [CI] = 3.9-12.7). After adjustment, the OR of hospital-acquired pneumonia in the exposed group was 2.3 (95% CI = 1.2-4.6). The association was significant for proton-pump inhibitors (OR = 2.7, 95% CI = 1.4-5.4), but not for histamine-2 receptor antagonists (OR = 1.6, 95% CI = 0.8-3.4). INTERPRETATION In this large hospital-based cohort of patients presenting with acute stroke, acid-suppressive medication use was associated with increased odds of hospital-acquired pneumonia.

BACKGROUND The rate of hyponatremia is higher in hospitalized cancer patients than in hospitalized patients without cancer and is associated with poor clinical outcomes. The availability of V2 receptor antagonists has been a major breakthrough in the management of hyponatremia, but its efficacy and safety in treating hyponatremia in patients with cancer is not known. METHODS Adult patients with cancer who were admitted to The University of Texas MD Anderson Cancer Center with nonhypovolemic hyponatremia (125-130 mmol/L) were randomized to receive either tolvaptan or placebo in a double-blind, placebo-controlled, adaptive, randomized trial. Both groups received the standard of care for hyponatremia, except that patients were allowed to drink to thirst. RESULTS A preplanned Data Safety Monitoring Board analysis of 30 of 48 randomized patients who completed the study revealed that the primary endpoint of hyponatremia correction was met by 16 of 17 patients who received tolvaptan and by 1 of 13 patients who received placebo (94% vs 8%; P 12 mmol/L per day) was noted in the tolvaptan group, and the main adverse events noted were dry mouth, polydipsia, and polyuria, leading to 13% study withdrawal. CONCLUSIONS Although tolvaptan was effective for correcting hyponatremia in patients with cancer, studies with a larger sample size will be required to confirm the current findings, including the outcomes of secondary endpoints. Cancer 2014;120:744–751. © 2013 American Cancer Society.

Background Heart failure (HF) is the leading cause of hospitalizations and readmissions in the United States. Approximately one-third of patients admitted for HF are readmitted within 3 months; however, there are few markers that can identify those at highest risk for readmission. The purpose of this study was to identify clinical and laboratory markers associated with hospital readmission in decompensated HF. Hypothesis Clinical and laboratory markers are associated with readmission rates in decompensated HF. Methods Clinical and laboratory data from 412 patients admitted with HF were analyzed using a multivariable logistic regression analysis to find predictors of HF readmission by 30 days. Results HF readmission rates at 30 days were lowest in those with at least 2 of the following discharge criteria: net fluid reduction >1.3 L (odds ratio [OR]: 0.27, P = 0.019), serum sodium level >135 (OR: 0.46, P = 0.034), and N-terminal brain natriuretic peptide level reduction >23% (OR: 0.11, P = 0.048). In multivariate analysis, those patients meeting ≥2 criteria had a very low risk of 30-day readmission (OR: 0.10, 95% confidence interval: 0.01-0.68, P = 0.019) compared to patients who failed to meet 2 criteria. Conclusions A negative fluid balance, normal serum sodium, and net reduction in N-terminal brain natriuretic peptide level during hospitalization may be important indices to target to help reduce the likelihood of HF readmission within 30 days.

Previous studies in head and neck squamous cell carcinoma (HNSCC) cell lines have revealed that the Ah receptor (AHR) plays a significant role in mediating the "aggressive" phenotype of these cells, which includes enhanced inflammatory signaling (e.g., IL6) and migratory potential. Here we sought to identify putative novel targets of the AHR associated with enhanced tumor invasiveness. Global gene expression analysis identified a number of genes that are repressed upon treatment of OSC-19 or HN30 cells with an AHR antagonist. Three growth factors were targets of AHR activity; amphiregulin (AREG), epiregulin (EREG), and platelet-derived growth factor A (PDGFA) were repressed by an AHR antagonist and further examined. Quantitative PCR analysis, ELISA, and siRNA-mediated knock down of AHR revealed an attenuation of basal and/or induced levels of expression of these growth factors in two HNSCC lines, following AHR antagonism. In silico analysis revealed that these growth factors possess dioxin-like response elements. Two other AHR ligands, 6-formylindolo[3,2-b]carbazole and benzo(a)pyrene (BP) also elicited similar responses. In conclusion, this study identified AREG, EREG, and PDGFA as growth factor targets of AHR activity associated with metastatic phenotype of HNSCC cells, suggesting that attenuation of AHR activity may be a therapeutic strategy.

BACKGROUND: Acute kidney injury (AKIis a common complication in the treatment of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS), but, to the authors' knowledge, its clinical relevance has not been detailed to date. The objective of the current study was to identify the incidence, predictors, and outcome for AKI in patients with AML and HR-MDS. METHODS: Data were analyzed from 537 patients with AML or HR-MDS undergoing induction chemotherapy from 1999 to 2007. Predictors for AKI were identified by logistic regression. Eight-week mortality of patients was estimated by the Kaplan-Meier method stratified by the RIFLE criteria, a novel multilevel classification system for AKI based on the percent rise in serum creatinine from baseline (Risk, >50%; Injury, >100%; and Failure, >200% or requiring dialysis). RESULTS: A total of 187 patients (36%) developed AKI. Significant independent risk factors for AKI included the following: age ≥55 years (odds ratio [OR], 1.8), mechanical ventilation (OR, 16), use of vancomycin (OR, 2.3), diuretics (OR, 3.0), amphotericin B lipid formulation (OR, 2.7), vasopressors (OR, 4.9), leukopenia (OR, 1.9), hypoalbuminemia (OR, 1.4), and use of non-fludarabine–based chemotherapy (OR, 2.7). The 8-week mortality rates were 3.8%, 13.6%, 19.6%, and 61.7% for the non-RIFLE, Risk, Injury, and Failure categories, respectively. Patients requiring dialysis (8%) had a median survival of 33 days. Survival of patients who achieved complete remission was favorable, regardless of degree of AKI. CONCLUSIONS: The RIFLE classification for AKI appears to have prognostic utility in predicting mortality in patients with AML or HR-MDS. Relatively mild elevations in creatinine are associated with higher mortality. Strategies to avoid nephrotoxic drugs or fluid overload may be of benefit. Cancer 2010. © 2010 American Cancer Society.

BACKGROUND Cytologic evaluation of common bile duct brushings has a low sensitivity for diagnosing malignancy because of scant cellularity, poor cellular preservation, or sampling errors occur. The aim of this study was to evaluate whether cytology combined with image analysis improves the diagnostic accuracy of bile duct brushing in comparison with cytology alone. METHODS Forty-nine specimens of bile duct brushings obtained from 45 patients during endoscopic retrograde cholangiopancreatography were evaluated using cytology and image analysis. Specimens were classified as negative, atypical, suspicious, or malignant by using cytologic evaluation. DNA histograms were classified as diploid (D), broad diploid (BD), aneuploid (A), or tetraploid (T). Degree of hyperploidy (DH), representing cells with a DNA content > 5C was evaluated using a cutoff value of ≥ 1%. Final diagnosis of cancer was based on tissue specimens that were obtained by fine-needle aspiration or surgical biopsy and clinical fol- low-up. RESULTS Thirty-four patients ultimately proved to have a malignancy. Cytology revealed 19 negative cases, 15 atypical cases, 9 suspicious cases, and 6 malignant cases. Together, suspicious and malignant cytology cases yielded a sensitivity of 44% and a specificity of 100% for a cytologic diagnosis of cancer. The DNA histogram pattern was D in 24 cases, BD in 9 cases, and A in 16 cases. BD and A patterns were significantly associated with malignancy (P < 0.001). A DH ≥ 1% was noted in 22 cases. DH alone had a sensitivity of 62% and a specificity of 91% and was significantly associated with malignancy (P < 0.004). Atypical cytology alone had a false-negative rate of 29%, but in combination with a DH ≥ 1%, the false-negative rate decreased to 7%. Additionally, when the authors combined atypical, suspicious, and malignant cytology with a DH ≥ 1%, the diagnostic sensitivity increased to 88%, but the specificity decreased to 73%. CONCLUSIONS Combined cytology and image analysis of bile duct brushing increased diagnostic sensitivity compared with cytology alone. The findings suggest that image analysis may help select patients having atypical cytology who should undergo a more rigorous evaluation for malignancy. A larger prospective study of the usefulness of combined cytology and image analysis of bile duct brushing is warranted. Cancer (Cancer Cytopathol) 2001;93:229–235. © 2001 American Cancer Society.

BACKGROUND Patients with locoregional carcinoma of the esophagus or gastroesophageal junction have a poor survival rate after surgery. Preoperative chemotherapy or chemoradiotherapy has not improved the outcome for these patients. Our study was designed to assess the feasibility of preoperative induction combination chemotherapy in addition to chemoradiotherapy to improve the curative resection rate, local control, and survival. PATIENTS AND METHODS Patients having histologic proof of localized carcinoma (either squamous cell carcinoma or adenocarcinoma) of the esophagus or gastroesophageal junction underwent full classification including endoscopic ultrasonography (EUS). Patients first received up to two courses of induction chemotherapy consisting of 5-fluorouracil at 750 mg/m2/day as continuous infusion on Days 1–5, cisplatin at 15 mg/m2/day as an intravenous bolus on Days 1–5, and paclitaxel at 200 mg/m2 as a 24-hour intravenous infusion on Day 1. The second course was repeated on Day 29. This was followed by radiotherapy (45 grays in 25 fractions) and concurrent admission of 5-fluorouracil (300 mg/m2/day as a continuous infusion 5 days/week) and cisplatin (20 mg/m2 on Days 1–5 of radiotherapy). After chemoradiotherapy, patients underwent surgery. The feasibility of this approach, curative resection rates, patient survival, and patterns of failure were assessed. RESULTS Thirty-seven of 38 patients enrolled were evaluable for toxicity and survival. Adenocarcinoma and distal esophageal location of carcinoma were observed frequently. Thirty-five (95%) of the 37 patients underwent surgery, all of whom had an R0 (curative) resection. A pathologic complete response was noted in 11 (30%) of the 37 total patients. In addition, 5 patients (14%) had only microscopic carcinoma. According to EUS classification, 31 (89%) of the 35 patients who underwent surgery had a T3 carcinoma whereas according to pathologic classification only 3 (9%) had a T3 carcinoma (P ≤ 0.01). Similarly, according to EUS classification, 23 patients (66%) had an N1 carcinoma, whereas according to pathologic classification only 7 patients (20%) had an N1 carcinoma (P ≤ 0.01). At a median follow-up of 20 months (minimum follow-up, 13+ months; maximum follow-up, 36+ months), the median survival duration for the 37 patients had not yet been reached. In addition, there were two deaths related to surgery. CONCLUSIONS These data show that the three-step strategy of preoperative paclitaxel-based induction chemotherapy then chemoradiotherapy followed by surgery is feasible and appears quite active in patients having locoregional carcinoma of the esophagus or gastroesophageal junction. Future investigations should focus on substituting cisplatin with less toxic agents and including more systemic therapy with newer classes of agents. Cancer 2001;92:279–86. © 2001 American Cancer Society.

We describe the cytologic features seen in fine-needle aspiration (FNA) specimens from two cases of preoperatively diagnosed lymphoepithelial cyst (LEC) of the pancreas. Pancreatic LEC is a rare, true cyst of uncertain histogenesis that may clinically and radiologically mimic a pseudocyst or cystic neoplasm. Both our patients were middle-aged men who presented with vague abdominal pain. Computed tomography (CT) of the abdomen revealed a mass in or around the pancreas, and CT-guided percutaneous FNA (patient 1) and endoscopic ultrasound-guided FNA (patient 2) yielded paste-like yellow-gray material. Cytologic smears showed numerous anucleated squamous cells in a background of keratinous and amorphous debris. A few benign nucleated squamous cells and plate-like cholesterol crystals were also seen. Unlike LEC of the head and neck region, only rare lymphocytes and histiocytes were present. Pancreatic LEC was diagnosed based on these cytologic findings and was histologically confirmed following cyst enucleation (patient 1) and partial pancreatectomy (patient 2). We conclude that preoperative FNA and recognition of the characteristic cytologic pattern will enable conservative surgical management of pancreatic LEC. Diagn. Cytopathol. 1999;21:346-350.

Exfoliative cytologic studies directed toward atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) have been neglected in the rising postmenopausal population. This retrospective study from 60 cases, initially interpreted as ASCUS or LSIL, concentrates on these lesions and their associated diagnostic pitfalls. Cytologic reevaluation of the 60 patients revealed squamous-cell abnormalities in 45 (18 ASCUS and 27 LSIL) and cervicitis alone in 15 cases. Follow-up studies of the 18 ASCUS cases showed cervicitis in seven, persistent ASCUS in five, CIN I in five, and VAIN I-II in one. Follow-up of the 27 cases categorized as LSIL, showed ASCUS in two, CIN in 20 and VAIN in one, while four had cervicitis alone. Interestingly, two of these 45 patients had only vaginal dysplasia. By application of uniform diagnostic criteria, 15 of the 60 cases were reviewed as benign. Pitfalls included inflammatory and drying alterations, reactive metaplasia, and sampling problems. Thus, squamous-cell abnormalities in postmenopausal women can be significant when artifactual alterations are eliminated.

Aromatic and heteroaromatic compounds were benzoylated efficiently with (trichloromethyl)benzene in 1,2-dichloroethane in the presence of aluminium chloride in good yield

Efficient enantioselective synthesis of (R)- and (S)-enantiomers of 2-(tert-butylamino)-1-(p-methoxyphenyl)-ethanol has been achieved in high enantiomeric excess by using asymmetric sulfoxide as a chiral auxiliary. The present synthetic approach was further extended to the asymmetric synthesis of (R)-salbutamol.

An efficient synthesis leading directly to 1-substituted-1H-1,2,3,4-tetrazoles from easily available amines and sodium azide in stoichiometric proportions using a room-temperature ionic liquid, namely, 1-n-butylimidazolium tetrafluoroborate in excellent yields is described. The inherent Bronsted acidity and high polarity of the IL results in a significant enhancement in the reaction rate.

A highly efficient one-pot methodology has been developed to synthesize a class of substituted l-pyridylimidazo[1,5-a]pyridines, using Bronsted acidic ionic liquid 1-butylimidazolium tetrafluoroborate, [Hbim]BF 4 in excellent isolated yields in the absence of any catalyst. The methodology is characterized by simple work-up procedures along with efficient recovery and recycling of the ionic liquid, which acts as a reaction medium as well as a promoter.

A general and efficient copper-, ligand- and solvent-free synthesis of ynones by coupling of a wide range of acid chlorides with terminal alkynes catalyzed by palladium(II) acetate at room temperature is reported.

Results of the optimized conditions for the one-pot synthesis of 2-substituted indoles via palladium acetate catalyzed tandem Sonogashira coupling 5-endo-dig cyclization at room temperature under ultrasonic irradiation and standard stirred conditions are described. Electron-donating and electron-withdrawing groups present in both coupling partners were well tolerated under these mild conditions. A copper-, ligand- and amine-free condition is an important feature of this protocol. Significant enhancement of reaction rates was observed for the reactions employing ultrasonic irradiation.

The Sonogashira reaction proceeds at ambient temperature (30 degrees C) in acetone or room-temperature ionic liquid, 1,3-di-n-butylimidazolium tetrafluoroborate ([bbim]BF4), as solvent under ultrasound irradiation to give enhanced reaction rates, excellent chemoselectivity, and high yields in the absence of a copper cocatalyst and a phosphine ligand. TEM analysis showed the formation of stable, crystalline, and polydispersed Pd(0) nanoparticles as catalyst for the reaction.

An efficient one‐pot synthesis of 2‐aryl‐4(3H)‐quinazolinones from 2‐amino benzamides and substituted benzoyl chlorides in a room temperature ionic liquid is described. Compared with the classical reaction conditions, this new synthetic method has the advantages of recyclability of ionic liquid, very good to excellent yields (78–92%), the absence of hazardous and expensive catalysts, and easy workup procedures giving rise to a process with minimum waste.

Several room-temperature ionic liquids (ILs) based on 1-butylimidazolium salts with varying anions were synthesized and evaluated for the preparation of biologically active substituted quinolines and fused polycyclic quinolines using the Friedlander heteroannulation reaction. On screening, 1-butylimidazolium tetrafluoroborate [Hbim]BF4 was found to be the best ionic liquid for the heteroannulation reaction, and the reasons to this effect are well explained. The reactions proceed very well under relatively mild conditions without any added catalyst. The IL acts as a promoter for this regiospecific synthesis and can be recycled. By this green approach, various quinolines were prepared in excellent yields and purity and well-characterized.

Aromatic substrates were monobrominated regioselectively with NBS in the ionic liquid 1,3-di-n-butylimidazolium tetrafluoroborate [bbim]BF4 in 5 min at 28°C in excellent isolated yields (80–98%) in the absence of a catalyst.

The behaviour of some enamine-esters, -ketones and -nitriles under electron impact has been investigated by means of low-resolution mass Spectrometry.