Real Entity Research Articles

Antibody-Mediated Rejection in Heart Transplantation: Case Presentation with a Review of Current International Guidelines

Antibody-mediated rejection (AMR) (humoral rejection) of cardiac allografts remains difficult to diagnose and treat. Interest in AMR of cardiac allografts has increased over the last decade as it has become apparent that untreated humoral rejection threatens graft and patient survival. An international and multidisciplinary consensus group has formulated guidelines for the diagnosis and treatment of AMR and established that identification of circulating or donor-specific antibodies is not required and that asymptomatic AMR, that is, biopsy-proven AMR without cardiac dysfunction is a real entity with worsened prognosis. Strict criteria for the diagnosis of cardiac AMR have not been firmly established, although the diagnosis relies heavily on tissue pathological findings. Therapy remains largely empirical. We review an unfortunate experience with one of our patients and summarize recommended criteria for the diagnosis of AMR and potential treatment schemes with a focus on current limitations and the need for future research and innovation.

Dental implant treatment in oral bisphosphonates patients using a drug holiday protocol: a prospective study

Aim Bisphosponates are the most important class of antiresorptive agents commonly used in the management of osteoporosis, Paget’s disease, and tumor-associated osteolysis. Oral bisphosphonateinduced osteonecrosis is a rare but real entity caused by the antiosteoclastic effects of bisphosphonates which inhibit bone turnover. The aim of this work is to determine the extent to which bisphosphonate-associated osteonecrosis occurs after dental implant surgery. We also wanted to determine whether there was any indication that bisphosphonates affected the overall success of the implants. Materials and methods We described 21 patients undergoing dental implants surgery who were taking or had taken oral bisphosphonates. All patients were informed about the risk of osteonecrosis and a written informed consent was obtained from each individual. Results A total of 38 implants were placed in 21 patients who reported having received oral bisphosphonates. None had received intravenous bisphosphonates. There is no evidence of osteonecrosis in any of the patients evaluated. Of the 38 implants, all but 2 fully integrated and met implant success criteria. Conclusion Implant surgery on patients receiving oral bisphosphonates did not result in osteonecrosis. Moreover, oral bisphosphonates did not appear to significantly affect implant success. Nevertheless, sufficient evidence exists to suggest that all patients undergoing implant placement should be questioned about bisphosphonate therapy including the drug taken, the dosage, and length of treatment prior to surgery.

Superior mesenteric artery syndrome: A rare etiology of upper intestinal obstruction in adults

The superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction in adults. Formerly considered controversial, this syndrome has now been recognized as a real clinical entity which results from extrinsic compression of the third portion of the duodenum by reduction of the angle formed between the SMA and the aorta, usually favoured by rapid and dramatic weight loss. We report a case observed in a 25-year-old female. The abdominal scan provided the diagnosis. Laparoscopic duodenojejunostomy provided cure after failure of initial conservative treatment.

Ethical Questions Concerning Sex Reassignment Surgery: Revisions for Version 7 of the World Professional Association for Transgender Health's Standards of Care

ABSTRACT The guiding principle of medical practice, and surgical practice, is “first do no harm,” primum non nocere. But surgical treatment does involve harm in that it damages the tissues with which it is involved. But if surgeons are to conform to the requirement to do no harm, the procedures they perform must, on balance, benefit the patient as a whole. If a surgical intervention produces more harm than good, there is reason to question its validity and effectiveness. Sex reassignment surgery is radical in that genitalia may be removed and replaced with reconstructed genitalia that may not have a completely normal appearance or function. The surgeon operating in this arena must, first of all, believe that the condition of gender identity disorder is a real entity and that genital reconstruction is necessary to provide for the patient's overall health and well-being. This requires the surgeon to have an understanding of what health and well-being are for the patient with gender identity disorder. This article will evaluate the present paragraph in Version 6 of WPATH's Standards of Care (SOC) dealing with this topic and determine what, if any, additions or corrections need to be made in Version 7.

Corporate Social Responsibility in the First Years of Caja de Pensiones para la Vejez y de Ahorros

When Caja de Pensiones para la Vejez y de Ahorros, “la Caixa,” was created in 1905, it was not only the transient response to a serious social, political, and economical problem, but also provided a permanent solution by creating a long-lasting social welfare institution. In addition, its founder understood the responsibility of social welfare institutions not as an isolated responsibility for each institution, but as part of a harmonious whole that is a real moral entity with a socio-economic character, with autonomy and unity of nature, purpose, and form. The purpose of this article is to show how the corporate social responsibility conception of Francesc Moragas, the founder of “la Caixa,” informed the activities of the new institution in a variety of dimensions, including its service to the customers, its economic strengths, the social work, and its participation in the creation of the public system of social security in Spain.

Augmented AVI video file for road surveying

This paper presents a novel video augmentation approach: a video recording of a real entity augmented by structured data. This augmented video is a self-contained entity integrating values of perceptible and non-perceptible attributes of the same real entity. It simplifies data search, storage and management. Streaming, sharing, collaboration and synchronization are also simplified by the fact that the structured data (so-called augmented data) are integrated in the video file and therefore only one file needs to be manipulated. Our approach was applied to address the issues which road engineers experience while using the ROad Measurement and Data Acquisition System (ROMDAS). The ROMDAS system collects and analyses the road-condition state through video recordings and the data corresponding acquired by specific measuring devices. Currently, however, road engineers have to search the videos manually in order to find details of interest provided by the analysis of the data measured due to the separation of the video from the data. The ROMDAS system manages a large collection of road-condition data. It does not offer history management of video recordings of the same road captured at different time. We present this hybrid video augmentation system: the Augmented Video stream Framework (AVF). It allows creation, search, history management and playback of such augmented video files for effective road surveying based on the discrete data recorded in parallel to the video recordings. The AVF provides road engineers with effective and more comfortable perceptible and non-perceptible data search, storage and history management to be used for (collaborative) road inspection and maintenance.

Perceiving one's nation: Entitativity, agency and security in the international arena

The perception of groups as real entities rather than mere aggregates of individuals has important consequences on intergroup relations. Social psychological research, in fact, shows that it affects stereotyping, identification process, and intergroup bias. Previous research has also shown that group entitativity is not a positive or negative group attribute per se; rather, it depends on the context and the relationship between the perceiver and the group. While enhancing entitativity leads to worse expectations about the out-group actions, high entitativity is a valued characteristic when associated with an ally or with the in-group. Indeed, enhancing in-group entitativity leads to stronger in-group identification. The specific reasons for why this is the case, however, remain to be ascertained. What is good about in-group entitativity? In the present contribution we propose that in-group entitativity may lead to perceive the group as a real entity provided with intentions and capacity for planned actions, notably ensuring the safety of its members by protecting them against external threats. We report two correlational studies conducted with American citizens (Study 1) and Italian citizens (Study 2), showing that in-group entitativity is associated with a higher level of identification, attribution of intentionality, and perceived security provided by the in-group. These findings were replicated in a third study-conducted with a role-play method on a fictitious scenario-in which entitativity was manipulated rather than measured. Study 3 also shows that artificially increasing the perception of in-group entitativity enhances perceived safety in an international context and reduces the perception of threat from an out-group. Findings are discussed in terms of possible implications for intergroup and international relations.

Role of echocardiography in toxic heart valvulopathy

The notion that drugs can induce valvular heart disease (VHD) has occurred since the 1960s and has received a lot of attention in recent years. This review focuses on different aspects of this distinct valvulopathy in seven sections: (i) historical background, (ii) drug-induced VHD, is this a real entity?, (iii) its morphological and echocardiographic features, (iv) drugs associated with VHD, (v) the influence of cumulative drug dose and risk factors, (vi) the natural course of toxic valvulopathy, and (vii) practical recommendations when using potential valvulopathic drugs.

From fictions and aggregates to real entities in the theory of the firm

According to the dominant ‘nexus of contracts’ and ‘collection of assets’ views of the firm, the firm is a either a fiction or an aggregate. Although legal personality is important in both accounts, everything is said to be achieved by private contract alone and the law's role in creating legal entity status is dismissed. The paper challenges both these aspects by reconsidering an alternative ‘real entity theory’ that dominated debates at the turn of the twentieth century. This forgotten view holds that the firm is neither a fiction nor an aggregate but a real entity, and underlines the creation of legal entity status as a fundamental role of the law. The paper discusses this view's ontological and legal insights, clarifies the proposition that the firm is a real entity, and proposes it as a starting point for a theory of the firm.

What is a Species? An endless debate

Everybody is familiar with the ubiquitous term ‘species’. But what is a species? Undeniably, this is one of the most complex dilemmas in the history of biology. There is no other concept in biology as elementary yet controversial as the concept of species. In practice, a species is regarded as the fundamental unit of comparison in all biological disciplines like systematics, evolution, ecology, ethology, physiology, and genetics. However, little agreement exists in the scientific community regarding the nature of species, whether it is a real entity or a cultural artifact, its biological significance or how to delineate a species. This article is a review of the seemingly endless debate on the species concept and its implications.

The personality of the corporation and the state (1905)

Although there is now a thriving subdiscipline of economics and law, so far economists working on the theory of the firm have paid relatively little attention to earlier legal doctrines. One neglected juridical school of thought is the ‘real entity’ theory developed by William Jethro Brown (1868–1930) and others. Some writers have recently suggested that this has implications for our understanding of the nature of the firm.

Risk Management - The Forensic Nursing Response ‘Ability’

As risk managers begin to reconsider their nursing roles and responsibilities, the impact of the forensic applications are endless. The forensic element of the role as a health care professional is a very real entity that is often overlooked as the responsibility of someone else. All nurses are responsible for their own documentation, patient care outcomes, knowledge, and education, and must be prepared to speak intelligently to, or defend all, in a court of law. Health care is dynamic and health care facilities should be committed to displaying and ultimately providing an environment of safety and trust to patients. Risk management offers a proactive and preventative approach to meeting these changes effectively. Be prepared--know what the risks are.

Plural Ownership, Funds, and the Aggregation of Wills

This Article suggests that common ownership — better described as "plural ownership" to distinguish the phenomenon from semicommons — may usefully be analyzed from a dual perspective. Plural ownership may simultaneously be seen on the one hand as an aggregation of individualized rights, duties and intentions, and on the other as giving rise to a real entity with a group mind and corporate rights and duties distinct from those of the individual owners. For the purposes of understanding this dualism, the most developed and interesting form of plural ownership is the trust fund with multiple controllers and beneficiaries, an ancient device that now serves as the bedrock of modern capitalism. The fund is here subjected to legal, historical and philosophical scrutiny to uncover how group personality is generated by plural ownership in the absence of formal legal incorporation.

Comparison of clinicoradiologic manifestation of nonspecific interstitial pneumonia and usual interstitial pneumonia/idiopathic pulmonary fibrosis: A report from NRITLD

BACKGROUND:Ever since Katzenstein and Fiorelli introduced the term nonspecific interstitial pneumonia (NSIP) to denote those cases of interstitial pneumonia that cannot be categorized as any of the other types of idiopathic interstitial pneumonias (IIP), there has been continuing debate on whether it is a real clinical entity or not. The American Thoracic Society/European Respiratory Symposium task group tried to identify idiopathic NSIP as a separate disease and exclude it from the category of IIP. However, it appears that the clinical presentation of NSIP and usual interstitial pneumonia (UIP) are the same.OBJECTIVE:To show that the radiologic features of NSIP and UIP should be relied upon, instead of clinical presentation and pathologic findings, to differentiate between the two.MATERIALS AND METHODS:Consecutive patients who had received a diagnosis of either NSIP or UIP on the basis of open lung biopsy between January 2001 and December 2007 were identified for inclusion in this retrospective review. The study included 61 subjects: 32 men and 29 women with a mean age of 59.39 ± 14.5 years. Chest computed tomography images of all the cases were collected for a review. High resolution computed tomography (HRCT) and all pathologic specimens were also evaluated. A weighted kappa coefficient was used to evaluate whether radiology can be used instead of biopsy for the diagnosis of NSIP and UIP. Comparison of the mean ages and the time intervals (i.e., interval between symptom onset and the time of diagnosis) in the UIP and NSIP groups was done using the Mann-Whitney U test. Association between gender and biopsy result was evaluated by the Fisher exact test. Data were evaluated using SPSS, v.13.RESULTS:Sixty-one patients were included in this study, 32 were male and 29 were female. On the basis of biopsy findings, 50 (82%) patients had UIP and 11 (18%) had NSIP. Thirty (60%) of the 50 patients who had UIP were male and 20 (40%) were female; 2 (18.2%) of the 11 patients who suffered from NSIP were male and 9 (81.8%) were female. Based on HRCT findings, 36 (60%) patients were diagnosed to have UIP and 24 (40%) were diagnosed with NSIP. When diagnosis was based on biopsy findings, the time interval in the UIP group was 13.59 ± 8.29 months and in the NSIP group it was 7.90 ± 4.18 months. When diagnosed on the basis of HRCT findings, the time interval in the UIP group was 14.22 ± 8.94 months and in the NSIP group it was 10.54 ± 5.78 months. When diagnosis was on the basis of biopsy, the mean age in the UIP group was 61.30 ± 14.18 years and in the NSIP group it was 50.73 ± 13.14 years.CONCLUSION:HRCT can be used instead of invasive methods like lung biopsy to differentiate between UIP and NSIP.

Debunking evolutionary psychiatry’s schizophrenia paradox

Evolutionary psychiatrists often consider schizophrenia to be an enigma: how come natural selection has not yet eliminated the so-called 'schizophrenia genes' if the disorder is fairly common, heritable and harmful for the reproductive success of its carriers? Usually, the answer is that the schizophrenic genotype is subject to some kind of balancing selection: the benefits it confers would then outbalance the obvious damage it does. However, in this paper I will show that the assumptions underlying such resolution are at least implausible, and sometimes even erroneous. First of all, I will examine some factual assumptions, in particular about schizophrenia's impact on reproductive success, its genetics, its history, and its epidemiology. Secondly, I will take a critical look at a major philosophical assumption in evolutionary psychiatric explanations of schizophrenia. Indeed, evolutionary psychiatrists take it for granted that schizophrenia is a natural kind, i.e. a bounded and objectively real entity with discrete biological causes. My refutation of this natural kind view suggests that schizophrenia is in fact a reified umbrella concept, constructed by psychiatry to cover a heterogeneous group of disorders. Therefore, schizophrenia, as we now know it, simply does not have an evolutionary history.

Wetland characterization using polarimetric RADARSAT-2 capability

The use of single-polarization (HH) RADARSAT-1 synthetic aperture radar (SAR) data has been shown to be important for wetland water extent characterization. However, the limited capability of the RADARSAT-1 single-polarization C-band SAR in vegetation type discrimination makes the use of clear-sky-dependent visible near-infrared (VNIR) satellite data necessary for wetland mapping. In this paper, the potential of polarimetric RADARSAT-2 data for wetland characterization is investigated. The Touzi incoherent decomposition is applied for the roll-invariant decomposition of wetland scattering. In contrast with the Cloude-Pottier decomposition that characterizes target scattering type with a real entity, α, the Touzi decomposition uses a complex entity, the symmetric scattering type, for unambiguous characterization of wetland target scattering. It is shown that, like the Cloude α scattering type, the magnitude αs of the symmetric scattering is not effective for vegetation type discrimination. The phase ϕαs of the symmetric scattering type has to be used for better characterization of wetland vegetation species. The unique information provided by ϕαs for an improved wetland class discrimination is demonstrated using Convair-580 polarimetric C-band SAR data collected over the Mer Bleue wetland in the east of Ottawa, Canada. The use of ϕαs makes possible the discrimination of shrub bog from sedge fen and even permits the discrimination between conifer-dominated treed bog and upland deciduous forest under leafy conditions.

Oral Bisphosphonate-Induced Osteonecrosis: Risk Factors, Prediction of Risk Using Serum CTX Testing, Prevention, and Treatment

To assess the risk and time course of oral bisphosphonate-induced osteonecrosis of the jaws. Detailed data from 30 consecutive cases were compared with 116 cases due to intravenous aminobisphosphonates. Results in part noted a higher incidence related to alendronate (Fosamax; Merck, Whitehouse Station, NJ), a 94.7% predilection for the posterior mandible, and a 50% occurrence spontaneously, with the remaining 50% resulting from an oral surgical procedure, mostly tooth removals. Just over 53% of patients were taking their oral bisphosphonate for osteopenia, 33.3% for documented osteoporosis, and 13.4% for steroid-induced osteoporosis related to 4 or more years of prednisone therapy for an autoimmune condition. There was a direct exponential relationship between the size of the exposed bone and the duration of oral bisphosphonate use. There was also a direct correlation between reports of pain and clinical evidence of infection. The morning fasting serum C-terminal telopeptide (CTX) test results were observed to correlate to the duration of oral bisphosphonate use and could indicate a recovery of bone remodeling with increased values if the oral bisphosphonate was discontinued. A stratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTX values between 100 pg/mL and 150 pg/mL representing moderate risk, and CTX values above 150 pg/mL representing minimal risk. The CTX values were noted to increase between 25.9 pg/mL to 26.4 pg/mL for each month of a drug holiday indicating a recovery of bone remodeling and a guideline as to when oral surgical procedures can be accomplished with the least risk. In addition, drug holidays associated with CTX values rising above the 150 pg/mL threshold were observed to correlate to either spontaneous bone healing or a complete healing response after an office-based debridement procedure. Oral bisphosphonate-induced osteonecrosis is a rare but real entity that is less frequent, less severe, more predictable, and more responsive to treatment than intravenous bisphosphonate-induced osteonecrosis. The morning fasting serum C-terminal telopeptide bone suppression marker is a useful tool for the clinician to assess risks and guide treatment decisions.

A Child with Appendicitis After Appendectomy

Stump appendicitis, although rare, is a real entity that is often not considered during the evaluation of children with right lower quadrant pain and a surgical history of appendectomy. The history of appendectomy in a child may delay the diagnosis and management of this entity by misleading the physician into thinking that this patient could never have appendicitis again. However, the diagnosis of appendicitis should be considered in any patient with right lower quadrant pain, even if there is a history of appendectomy. We report a case of stump appendicitis 2 years after laparoscopic appendectomy. A review of the pertinent literature is included.

Clinical relevance of oxidative stress and sperm chromatin damage in male infertility: an evidence based analysis

Oxidative stress (OS) in the reproductive tract is now a real entity and concern due to the potential harmful effects of high levels of reactive oxygen species (ROS) on sperm number, motility, quality, and function including damage to sperm nuclear DNA. Evaluation of OS related damage to non-functional sperm is highly relevant as intracytoplasmic sperm injection (ICSI) technique, an effective therapy for severe male factor infertility, bypasses the majority of reproductive tract deficiencies. Despite the controversial findings in the existing literature, there is now enough evidence to show that sperm DNA damage is detrimental to reproductive outcomes. In addition, spermatozoa of infertile men are suggested to carry more DNA damage than do the spermatozoa from fertile men. Besides impairment of fertility such damage is likely to increase the transmission of genetic diseases during the assisted reproductive procedures. Standardization of protocols to assess reactive oxygen species and DNA damage is very important in introducing these tests in such clinical practice. Thus evaluation of seminal ROS levels and extent of sperm DNA damage especially in an infertile male may help develop new therapeutic strategies and improve success of assisted reproductive techniques (ART).

Stability problem in Rindler spacetime

The stability problem of the Rindler spacetime is carefully studies by using the scalar wave perturbation. Using two different coordinate systems, the scalar wave equation is investigated. The results are different in the two cases. They are analysed and compared with each other in detail. The following conclusions are obtained: (a) the Rindler spacetime as a whole is not stable; (b) the Rindler spacetime can exist stably only as part of the Minkowski spacetime, and the Minkowski spacetime can be a real entity independently; (c) there are some defects for the scalar wave equation written by the Rindler coordinates, and it is unsuitable for the investigation of the stability properties of the Rindler spacetime. All these results may shed some light on the stability properties of the Schwarzschild black hole. It is natural and reasonable for one to infer that: (a) perhaps the Regge–Wheeler equation is not sufficient to determine the stable properties; (b) the Schwarzschild black hole as a whole might be really unstable; (c) the Kruskal spacetime is stable and can exist as a real physical entity; whereas the Schwarzschild black hole can occur only as part of the Kruskal spacetime.