bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain GABA levels are reduced in alcoholic liver disease: A proton magnetic resonance spectroscopy study
Authors: Morley Kirsten C. , Lagopoulos Jim , Logge Warren , Baillie Andrew , Adams Claire , Haber Paul S.
Published: December 2018

Background and aims

Baclofen, a selective γ‐aminobutyric acid (GABA)B receptor agonist, has emerged as a potential treatment for alcohol use disorder with much unexplained variation in response to treatment efficacy and dose regimen. Several positive studies include patients with alcoholic liver disease (ALD) and/or history of heavy drinking. The aim of this paper was to examine the association of cortical GABA+ concentration with severity of liver disease (including markers of liver injury) and other clinical characteristics in alcohol patients.

Methods

Proton magnetic resonance spectroscopy (1H‐MRS), from the parietal lobe, was analyzed to yield absolute concentration of GABA in 24 alcohol‐dependent individuals. Diagnosis of ALD, markers of liver injury, severity of liver disease (Model for End‐Stage Liver Disease [MELD]), and alcohol history were assessed. Covariates included concurrent medication, age, and recent alcohol consumption.

Results

Multiple linear regression revealed that GABA+ concentration was significantly predicted by MELD scores (F = 5.02, R2 = 0.59, P = 0.01; MELD: B = −0.63, P = 0.02), when controlling for covariates concurrent medication, age, and recent alcohol consumption.

Conclusion

Severity of ALD is associated with lower cortical concentrations of GABA+. These results may explain variations in response to the GABAB agonist, baclofen, in the alcohol‐dependent population.
Impact of a structured lifestyle programme on patients with metabolic syndrome complicated by non‐alcoholic fatty liver disease
Authors: Konerman Monica A. , Walden Patrick , Joseph Megan , Jackson Elizabeth A. , Lok Anna S. , Rubenfire Melvyn
Published: December 2018

Background

Lifestyle interventions are first‐line therapy for non‐alcoholic fatty liver disease (NAFLD).

Aims

To examine the prevalence of NAFLD among participants of the University of Michigan Metabolic Fitness (MetFit) Programme and to assess the impact of this programme on weight, metabolic and liver‐related parameters among patients with and without NAFLD.

Methods

Adults who completed the programme between 2008 and 2016 were included. Clinical and laboratory data were collected at enrolment, and at 12 and 24 weeks. NAFLD was defined based on liver biopsy, imaging or clinical diagnosis.

Results

The cohort (N = 403; 253 12‐week, 150 24‐week) consisted primarily of middle‐aged (median 54 years) white (88%) men (63%) with severe obesity (median BMI 37.4). 47.6% met criteria for NAFLD. At baseline, NAFLD patients were younger (52 vs 55 years), had higher weights and more metabolic derangements (higher fasting insulin and triglyceride, lower high‐density lipoprotein‐cholesterol). At programme completion, 30% achieved weight reduction ≥5%, 62% resolution of hypertriglyceridaemia, 33% resolution of low HDL, 27% resolution of impaired fasting glucose and 43% normalisation of alanine aminotransferase. Endpoints were unaffected by NAFLD. Longer programme duration (OR 6.7, 95% CI 3.6‐12.3) and white race (OR 3.83, 95% CI 1.04‐1.76) were independent predictors of ≥5% weight loss.

Conclusions

Nearly half of the patients referred to a structured lifestyle programme for metabolic syndrome had NAFLD. Although baseline metabolic derangements were more pronounced among NAFLD patients, the programme was equally efficacious in achieving weight loss and resolving metabolic syndrome components. Programme duration was the most important predictor of response.
A Provenance Study of Early Bronze Age Artefacts Found in Asturias (Spain) by Means of Metal Impurities and Lead, Copper and Antimony Isotopic Compositions
Authors: Reguera‐Galan A. , Barreiro‐Grille T. , Moldovan M. , Lobo L. , de Blas Cortina M. Á. , García Alonso J. I.
Published: December 2018

We describe here the first combined isotopic and impurities study on 27 copper artefacts found in the north‐west of Spain. This study follows previous studies on the lead isotopic composition of copper ores in three local mines that were exploited during the Bronze Age. The levels of impurities found were clearly different from ingots and axes, with ingots having much higher levels of impurities. It was not possible to differentiate the origin of the artefacts only by the impurities present. On the other hand, the lead isotopic composition indicated that all artefacts were prepared from local ores, the ‘La Profunda’ mine being the most probable source for most artefacts that carried out a clear radiogenic lead signature. The copper isotopic composition seemed to be able to differentiate artefacts from the ‘El Aramo’ mine from those from the ‘El Milagro’ and ‘La Profunda’ mines. On the other hand, the antimony isotopic signature was not useful for source allocation.
More than the sum of its parts: Cumulative risk effects on school functioning in middle childhood
Authors: Ashworth Emma , Humphrey Neil
Published: December 2018

Background

Risk factors for poor school functioning rarely occur in isolation, but instead are likely to cluster together. As they accumulate, cumulative risk theory (CRT) predicts that the likelihood of negative outcomes increases, often disproportionately.

Aims

We build upon and extend previous research by (i) examining two critical aspects of school functioning (reading attainment and behavioural difficulties); (ii) utilizing a large number of candidate risk factors across multiple ecological domains; (iii) testing the two core assumptions of CRT; and (iv) formally examining the functional form of the risk–outcome relationships.

Sample

Participants were N = 3084 children aged 6–7 attending 77 mainstream primary schools in England.

Methods

Sixteen candidate risk factors (e.g., familial poverty) were modelled using data from the National Pupil Database. Reading attainment and behavioural difficulties data were generated via teachers’ reading assessment scores and the Teacher Observation of Children's Adaptation Checklist (disruptive behaviour subscale), respectively. A cumulative risk score was generated for each pupil. Multilevel modelling was utilized for analysis.

Results

Six risk factors were identified for behaviour and seven for reading attainment. A cumulative risk effect was found for both outcomes, and the two core assumptions of CRT were supported. Quadratic relationships were found for both aspects of school functioning, indicative of a threshold effect.

Conclusions

As the number of risk factors increases, difficulties in school functioning increase disproportionately. Consistent with CRT, our results suggest that the number of risks is more important than their nature. This has implications for future risk research and the implementation of school‐based interventions.
The Challenges Facing Children Reunified With Their Families From an Orphanage in Ghana
Authors: Frimpong‐Manso Kwabena , Bugyei Abraham Gyimah
Published: December 2018

This qualitative case study explores the challenges facing children reunified with their families from an orphanage in Ghana. Eight children, their biological families, and two social workers participated in semi‐structured interviews and shared their experiences and views. The study found that challenges facing the children include educational issues, poor living conditions and social isolation within their communities. The factors causing the challenges included the financial difficulties facing caregivers due to the lack of support, limited preparation for the children and their families for the reunification and the children's limited participation in the decisions concerning such reunification.
Direct and indirect impacts of wildfire on faunal communities of Mediterranean temporary ponds
Authors: Cunillera‐Montcusí David , Gascón Stéphanie , Tornero Irene , Sala Jordi , Àvila Núria , Quintana Xavier D. , Boix Dani
Published: December 2018

The Mediterranean region has historically been affected by wildfires. However, studies addressing wildfire impacts have traditionally focused first on terrestrial systems and second on lotic systems. This bias has left a gap in knowledge related to wildfire effects on some of the emblematic habitats of the Mediterranean region such as temporary ponds.

We hypothesise that temporary ponds will experience indirect consequences of wildfires like those of other aquatic systems (e.g. nutrient increases or trophic alterations). However, the fact that temporary ponds are dry during the summer, when most wildfires occur, could add a new path of disturbance such as an impact on organisms aestivating in the pond sediment due to their direct burning. Based on these hypotheses, the present study analyses wildfire impacts on faunal communities adapted to temporality, focusing on species traits related to expected indirect and direct impacts (i.e. dispersal ability, life history or feeding habits).

We took advantage of a wildfire (summer 2012) that partially affected a Mediterranean temporary pond network, comparing the environmental and the faunal community responses from before and after the wildfire, and between the burned and unburned ponds during the subsequent hydroperiod.

As hypothesised, our results indicated different wildfire effects. First, changes in abundances of some trophic groups from before and after the wildfire but also strong fluctuations at the beginning of the hydroperiod between burned and unburned ponds. Second, a decrease in abundance of organisms that remain in the pond sediment during drought in burned ponds, being probably affected directly by the wildfire.

Only one hydroperiod appears to be sufficient for burned ponds to recover their similarity to unburned ponds, which highlights the high resilience of these communities. Despite their resilience, these communities could become compromised in the future since global change scenarios predict increase wildfire frequency and intensity in the Mediterranean region.
Histochemical changes in early and mature Festulolium and maturation's effects on rumen bacteria activity and in vitro degradation
Authors: González‐Muñoz Sergio S. , Zavaleta‐Mancera Hilda A. , Miranda‐Romero Luis A. , Loera‐Corral Octavio , Pinos‐Rodríguez Juan M. , Campos‐Montiel Rafael G. , Almaraz‐Buendía Isaac
Published: December 2018

The nutritional quality of grasses decreases with maturity due to increases in content of cell wall (CW) and lignified tissue, which affect the degradation and fermentation variables of the grasses. The effect of leaf age and tissue‐microbial attachment during the degradation of Festulolium at 28 and 35 days of regrowth was evaluated in vitro by gas production. Fragments from the middle part of the blade of Festulolium leaves were stained for lignin with phloroglucinol solution, and the lignified area was measured. Subepidermal fibers of the abaxial and adaxial central vein of leaves contributed most to the lignification of Festulolium at 35 days compared with that at 28 days. Variables of gas production and concentrations of volatile fatty acids and ammonia nitrogen were affected by regrowth age. Activity for cellulases (8.19 IU/g dry matter [DM]) was highest between 12 and 16 hr of incubation and for xylanases between 16 and 24 hr (51.09 IU/g DM) without differences between regrowth ages. Scanning electron microscopy showed the following sequence: primary CW degradation started at 12 hr, a large population of microbiota were attached to CWs with extracellular protein complexes at 24 hr, and microbiota were attached to lignified cells at 48 hr. Therefore, during in vitro CW degradation of Festulolium, enzymatic activities increased before microbiota attachment to CWs, which was maintained when xylanase activity declined. Thus, structural analysis conducted using histochemistry and scanning electron microscopy helped to characterize the degradation of plant tissues and the interactions with ruminal microorganisms.
Quartz‐containing glass‐ceramics in the SiO2–Li2O–K2O–MgO–CaO–Al2O3–P2O5 system
Authors: Rampf Markus , Fisch Martin , Helsch Gundula , Deubener Joachim , Ritzberger Christian , Höland Wolfram , Dittmer Marc
Published: December 2018

Volume crystallization of quartz, triggered by adding P2O5, was investigated in the multicomponent SiO2–Li2O–K2O–MgO–CaO–Al2O3–P2O5 glass system. Glass‐ceramics comprising quartz as the main crystal phase besides lithium disilicate (Li2Si2O5) as a minor crystal phase were produced by controlled crystallization from the parent glass. According to quantitative crystal phase analysis by means of Rietveld refinement the mass fraction of the minor Li2Si2O5 phase decreased with increasing P2O5 content, while the fraction of quartz increased. Scanning electron microscopy revealed lath‐like Li2Si2O5 embedded in a matrix of rather globular quartz crystals forming an interlocking microstructure. Well machinable glass‐ceramics with a mean biaxial flexural strength of about 300 MPa and a fracture toughness of about 2.0 MPa × m0.5 could be realized. With mean values ≥13.6 × 10−6 K−1 the glass‐ceramics coefficient of thermal expansion is close to the one reported for low‐quartz crystals. The ease of production based on conventional glass melting and fabrication technology together with the good mechanical, optical, and machining properties enables the application of these materials in prosthodontics.
Pharyngeal observation via transoral endoscopy using a lip cover‐type mouthpiece
Authors: Iwatsubo Taro , Ishihara Ryu , Nakagawa Kentaro , Ohmori Masayasu , Iwagami Hiroyoshi , Matsuno Kenshi , Inoue Shuntaro , Nakahira Hiroko , Matsuura Noriko , Shichijo Satoki , Maekawa Akira , Kanesaka Takashi , Yamamoto Sachiko , Takeuchi Yoji , Higashino Koji , Uedo Noriya , Higuchi Kazuhide
Published: December 2018

Background and Aim

Simultaneous and metachronous head and neck cancers are likely to develop in patients with current or previous esophageal cancer. The Valsalva maneuver facilitates the visualization of the hypopharyngeal area during endoscopic observation, but it requires transnasal endoscopy. We developed a novel Valsalva maneuver using transoral endoscopy with a lip cover‐type mouthpiece.

Methods

Between March 2018 and July 2018, 107 patients with current or previous esophageal cancer who were scheduled to undergo upper gastrointestinal endoscopy were included in our pilot study. We performed the Valsalva maneuver using our newly developed mouthpiece and transoral endoscopy in the patients and evaluated the hypopharyngeal region, including the postcricoid area and the posterior wall of the hypopharynx. The outcome measure was procedural success rate, which was graded as “complete,” “incomplete,” and “none.”

Results

Observation of the hypopharyngeal area was “complete” in 81 patients (76%) using the Valsalva maneuver. However, in 25 patients and in 1 patient, observation was “incomplete” and “none,” respectively. Seven lesions were newly detected in seven patients during the study period.

Conclusions

The Valsalva maneuver using transoral endoscopy with a lip cover‐type mouthpiece is feasible for the visualization of the postcricoid area and the posterior wall of the hypopharynx. Particularly, this technique would contribute to early detection of head and neck cancers.
A Tale of Three Midwives: Inconsistent Policies and the Marginalization of Midwifery in Mexico
Authors: Dixon Lydia Zacher , El Kotni Mounia , Miranda Veronica
Published: December 2018

Este artículo utiliza la investigación etnográfica colectiva para proporcionar una comprensión multifacética y multilocal de cómo los problemas actuales que enfrentan la partería y la salud de las mujeres en México reflejan una relación históricamente tensa entre las poblaciones marginadas y el Estado. Sostenemos que las parteras han sido obstaculizadas en su capacidad de mejorar sistemáticamente la salud materna como resultado de su relación desigual y cambiante con el estado Mexicano. Presentamos estudios de casos de tres parteras Mexicanas con diferentes antecedentes, acceso a capacitación y certificación, y relaciones con los sistemas de salud locales que estructuran cómo interpretan y negocian sus relaciones con las instituciones y políticas estatales. A medida que examinamos estas negociaciones, no perdemos de vista las formas en que las oportunidades, experiencias y desafíos de las parteras se entrelazan con las de las mujeres a las que sirven. Ambos existen en los márgenes del estado Mexicano, un espacio donde chocan sueños de modernidad y legados de desigualdad. [antropología social, género, partería, México, salud]
Myoclonus and hypercalcemia in a dog with poorly differentiated lymphoproliferative neoplasia
Authors: Hare Cassia H. Z. , Archer Joy , Cloup Emilie , Genain Marie‐Aude , Hughes Katherine , McCallum Katie E. , Alves Lisa
Published: December 2018

A 1‐year, 8‐month‐old Rhodesian Ridgeback was presented with obtundation, ambulatory tetraparesis, and myoclonus. Initial clinical findings included ionized hypercalcemia with an apparent marked increase in parathyroid hormone, thrombocytopenia, and nonregenerative anemia. Low numbers of circulating atypical cells were noted on blood film evaluation. Brain magnetic resonance imaging identified an extra‐axial contrast enhancing subtentorial lesion, and cerebrospinal fluid (CSF) analysis documented a marked atypical lymphocytic pleocytosis. Flow cytometry performed on the CSF demonstrated expression of only CD45, CD90, and MHC class II, with Pax5 positivity on subsequent immunohistochemistry. The final diagnosis was of B‐cell lymphoblastic lymphoma or acute leukemia, given the distribution of disease and the presence of significant bone marrow infiltration alongside an aggressive clinical course. The unusual immunophenotype of the neoplastic cells and hypercalcemia presented antemortem diagnostic challenges, highlighting the need for a multidisciplinary approach and caution in the interpretation of clinical abnormalities in cases with multiple comorbidities.
Hepatic copper accumulation in a young cat with familial variations in the ATP7B gene
Authors: Asada Hajime , Kojima Mari , Nagahara Takuro , Goto‐Koshino Yuko , Chambers James K. , Nakagawa Taisuke , Yokoyama Nozomu , Uchida Kazuyuki , Tsujimoto Hajime , Ohno Koichi
Published: December 2018

A 9‐month‐old intact crossbred female cat was presented with jaundice, intermittent anorexia and lethargy, increased hepatic enzyme activities, and hyperammonemia. Abdominal ultrasound and computed tomographic examinations determined that the liver had a rounded and irregular margin, and histopathological examination identified excessive accumulation of copper hepatocytes in the liver. Concentrations of both blood and urine copper were higher than in healthy cats. The patient responded well to treatment with penicillamine. Clinicopathological abnormalities and clinical signs improved within 2 months, and the patient was alive for >9 months after starting treatment. Genetic examination determined that the patient and its littermate had a single‐nucleotide variation (SNV, p. T1297R) that impaired the function of the ATP7B gene product; the gene that is mutated in patients with Wilson's disease (WD). Hepatic copper accumulation was believed to be associated with the SNV of the ATP7B gene, and the patient had a genetic disorder of copper metabolism equivalent to WD in humans.
A Race for the Regs: Unified Government, Statutory Deadlines, and Federal Agency Rulemaking
Authors: MacDonald Jason A. , McGrath Robert J.
Published: December 2018

Theory suggests that Congress should delegate more policymaking authority to the bureaucracy under unified government, where lawmakers are less worried about the president orchestrating “bureaucratic drift.” Yet, all unified governments come to an end, making broad delegations potentially advantageous to future lawmaking coalitions (“coalitional drift”). We seek to assess how lawmakers simultaneously limit the risk of each of these pitfalls of delegation. Our answer is rooted in Congress’s ability to spur agency rulemaking activity under unified government. Specifically, we expect statutes passed under unified government to require agencies to issue regulations quickly and for enacting coalitions to use oversight tools to influence agency policy choices. Such “proximate oversight” allows coalitions to cement policy decisions before a new election changes the configuration of preferences within Congress and the executive branch. We assess our argument using unique data on both congressional rulemaking deadlines (1995–2014) and the speed with which agencies issue regulations (1997–2014).
Use of an occlusive penile clamp during filling cystometry in men with symptoms of stress urinary incontinence
Authors: Sharaf Ala'a , Fader Mandy , Macaulay Margaret , Drake Marcus J.
Published: December 2018

Objective: In severe post‐prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study evaluated cystometry and pressure flow studies (PFS) in men in whom severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Men who had undergone prior radical prostatectomy were identified from a database of patients attending for video urodynamic testing between 2012 and 2017. Symptom scores, bladder diary and free flow rate tests were retrieved. Measurements of the subgroup of men for whom a Thomson‐Walker compression clamp was used to enable full urodynamic evaluation were evaluated. 166 patients were identified. In 30 patients (18%), severe SUI led to incomplete filling cystometry. Following application of the penile compression clamp, further filling was achieved in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs. 46.5 cm H2O; P < 0.001), volume at strong desire to void (132 vs. 242 mL; P = 0.003) and cystometric capacity (226 mL with clamp applied vs. 310 mL; P < 0.001) than the overall post‐prostatectomy incontinence population. Flow rates during PFS were comparable, but detrusor pressure at maximum flow was lower in the clamp group (11 vs. 22 cm H2O; P = 0.009). A penile clamp applied at the time when leakage becomes excessive during filling cystometry avoids premature test termination in men with severe incontinence.
The effect of elective implantation of the ABSORB bioresorbable vascular scaffold on coronary microcirculation: Serial assessment using the index of microcirculatory resistance
Authors: Rampat Rajiv , Williams Timothy , Hildick‐Smith David , Cockburn James
Published: December 2018

Introduction

Stenting with metal stents can affect microcirculatory function. The impact of BVS on the microvascular network has not been studied.

Methods

A total of 30 patients with bifurcation disease of Medina (X,X,0) scheduled for elective PCI with the ABSORB BVS were studied. Pressure wire studies were performed before and after scaffold implantation and at a mean follow‐up of 9 months. At each time point, FFR, IMR, and CFR were calculated using the thermodilution method.

Results

Following scaffold implantation, FFR change from pre‐PCI, post‐PCI and follow‐up was 0.76, 0.92 and 0.91, respectively (P < 0.001 from pre to post‐PCI and P = 0.91 from post‐PCI to follow‐up). There was a statistically significant improvement between pre‐ and post‐procedural IMR (median 27.7 to 17.9, P = 0.02) and CFR (median 2.2 to 2.9, P = 0.02). Median IMR at follow‐up (23.6) remained numerically lower than pre‐procedure but this was not statistically significant (P = 0.05). Similarly, while median CFR at follow‐up remained at post‐procedural level (2.9), this effect did not reach statistical significance (P = 0.06).

Conclusion

There is an immediate reduction in microvascular resistance after elective BVS implantation but this effect is not sustained long term.
Whitened kernel surface: A fast and reliable method for assessing Fusarium severity on cereal grains by digital picture analysis
Authors: Ollier Marine , Talle Vincent , Brisset Anne‐Laure , Le Bihan Zoé , Duerr Simon , Lemmens Marc , Goudemand Ellen , Robert Olivier , Hilbert Jean‐Louis , Buerstmayr Hermann
Published: December 2018

Fusarium head blight (FHB) is a cereal disease of major importance responsible for yield losses and mycotoxin contaminations in grains. Here, we introduce a new measurement approach to quantify FHB severity on grains based on the evaluation of the whitened kernel surface (WKS) using digital image analysis. The applicability of WKS was assessed on two bread wheat and one triticale grain sample sets (265 samples). Pearson correlation coefficients between Fusarium‐damaged kernels (FDK) and WKS range from r = 0.77 to r = 0.81 and from r = 0.61 to r = 0.86 for the correlation between deoxynivalenol (DON) content and WKS. This new scoring method facilitates fast and reliable assessment of the resistance to kernel infection and shows significant correlation with mycotoxin content. WKS can be automated and does not suffer from the “human factor” inherent to visual scorings. As a low‐cost and fast approach, this method appears particularly attractive for breeding and genetic analysis of FHB resistance where typically large numbers of experimental lines need to be evaluated, and for which WKS is suggested as an alternative to visual FDK scorings.
Successful treatment of hemorrhagic bullous Henoch‐Schonlein purpura with intravenous immunoglobulins
Authors: Mauro Angela , Mauro Salvatore , Rega Roberto , Martemucci Luigi , Sottile Rita
Published: December 2018

Henoch‐Schonlein purpura (HSP) is the most common systemic vasculitis in childhood. There is no consensus about the management for isolated cutaneous manifestations in HSP. We describe a case of HSP presenting with severe skin lesions that did not respond to standard therapy with corticosteroids. The 11‐year‐old child was treated with intravenous immunoglobulins, which induced rapid and persistent resolution of symptomatology.
Temporal and spectral profiles of conflict processing among multiple frames of reference
Authors: Nan Weizhi , Wang Chunsheng , Sun Yanlong , Wang Hongbin , Fu Shimin , Li Qi , Liu Xun
Published: December 2018

Individuals rely on various frames of reference (FORs), such as an egocentric FOR (EFOR) and intrinsic FOR (IFOR), to represent spatial information. Previous behavioral studies have shown different IFOR‐IFOR (II) and EFOR‐IFOR (EI) conflict effects and an effect of their interaction. However, the neural mechanism of conflict processing between two FOR‐based conflicts is unclear. In the current ERP study, two FOR‐based conflicts were manipulated using a two‐cannon task to elucidate common and distinct brain mechanisms that underlie FOR‐based conflict processing. The behavioral results showed that both conflicts exhibited longer reaction times and larger error rates in the II (180° cannon angle) and EI (target cannon pointed down) incongruent conditions than in the II (0° cannon angle) and EI (target cannon pointed up) congruent conditions and that an interaction existed between the two conflicts. The ERP results indicated that, for both conflicts, more negative N2 amplitudes and less positive P3 amplitudes occurred in the incongruent conditions than in the congruent conditions, and the interactions between the two conflicts during later P3 amplitudes were significant. Time‐frequency analysis further indicated that, in the early time window, the II conflict and the EI conflict specifically modulated power in the theta bands and beta bands, respectively. In contrast, in the later time window, both conflicts modulated power in the alpha and beta bands. In summary, our findings provide insights into the potential existence of two specific early conflict monitoring systems and a general late executive control system for FOR‐based conflicts.
Neurovascular structures in human vastus lateralis muscle and the ideal biopsy site
Authors: Chen Xin , Abbey Steven , Bharmal Adam , Harris Sophie , Hudson Edward , Krinner Lisa , Langan Emma , Maling Alexandra , Nijran Jagdip , Street Hannah , Wooley Charlotte , Billeter Rudolf
Published: December 2018

A density model of neurovascular structures was generated from 28 human vastus lateralis muscles isolated from embalmed cadavers. The intramuscular portion of arteries, veins, and nerves was dissected, traced on transparencies, and digitized before adjustment to an average muscle shape using Procrustes analysis to generate density distributions for the relative positions of these structures. The course of arteries, veins, and nerves was highly variable between individual muscles. Nevertheless, a zone of lower average neurovascular density was found between the tributaries from the lateral circumflex femoral and the deep femoral arteries. While the area with the lowest density was covered by the iliotibial tract and would therefore not be suitable for biopsies, another low‐density area was located in the distal portion of vastus lateralis. This was just anterior to the iliotibial tract, in a zone that has been described as a good needle biopsy site. The reported complication rates of needle biopsies (0.1%‐4%) are in the range of expectations when simulated based on this model. It is concluded that the optimal human vastus lateralis biopsy site is in the distal portion of the muscle, between ½ and ¾ of the length from the greater trochanter to the lateral epicondyle, just anterior to the iliotibial band.
Plasma asymmetric dimethylarginine concentrations are not related to differences in maximal oxygen uptake in endurance trained and untrained men
Authors: Pawlak‐Chaouch Mehdi , Boissière Julien , Munyaneza Désiré , Tagougui Semah , Gamelin François‐Xavier , Cuvelier Grégory , Heyman Elsa , Goossens Jean‐François , Descat Amandine , Berthoin Serge , Aucouturier Julien
Published: December 2018

New Findings

What is the central question of this study?

Is there an association of plasma concentration of asymmetric dimethylarginine, which is related to exercise capacity in patients with cardiovascular diseases, with oxygen delivery and subsequently exercise capacity in healthy subjects in the absence of the potentially confounding influence of inflammation and oxidative stress?

What is the main finding and its importance?

Plasma asymmetric dimethylarginine concentrations are not related to exercise capacity in healthy subjects, while O2 delivery in the working skeletal muscle during the maximal graded‐exercise test is not associated with any of the l‐arginine analogues. ADMA alone does not play a crucial role in local muscle perfusion and in maintaining exercise capacity.

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) synthesis that could limit oxygen (O2) delivery in the working skeletal muscles by altering endothelium‐dependent vasodilatation. Exercise capacity is associated with plasma ADMA concentrations in patients with cardiovascular diseases, but this issue has still not been investigated in healthy subjects. We aimed to determine whether plasma ADMA concentrations were negatively associated with exercise capacity in young healthy male subjects. Ten men with maximal oxygen uptake () > 65 mL kg−1 min−1 were included in the high exercise capacity group (HI‐FIT), and 10 men with  < 45 mL kg−1 min−1 were included in the low exercise capacity group (LO‐FIT). Plasma ADMA and other l‐arginine analogue concentrations were measured before and after a maximal graded‐exercise test by liquid chromatography–tandem mass spectrometry. Microvascular O2 delivery during exercise was estimated through the pattern from the sigmoid model of muscle deoxygenation in the vastus lateralis measured by near infrared spectroscopy. was 60% higher in the HI‐FIT group (median: 70.2 mL kg−1 min−1; IQR: 68.0–71.9 mL kg−1 min−1) than in the LO‐FIT group (median: 43.8 mL kg−1 min−1; IQR: 34.8–45.3 mL kg−1 min−1). Plasma ADMA concentrations did not differ between the LO‐FIT and HI‐FIT groups before (0.50 ± 0.06 vs. 0.54 ± 0.07 μmol L−1, respectively) and after the maximal incremental exercise test (0.49 ± 0.08 vs. 0.55 ± 0.03 μmol L−1, respectively). There was no significant association of plasma ADMA concentrations with the pattern of local muscle deoxygenation and exercise capacity. Exercise capacity and microvascular O2 delivery are not related to plasma ADMA concentrations in young healthy male subjects. Our findings show that ADMA does not play a crucial role in local muscle perfusion and in maintaining exercise capacity without pathological conditions.
A General Empirical Energy Consumption Model for Computer Numerical Control Milling Machine
Authors: Zeng Yadan , Li Tonghui , Deng Yelin , Yuan Chris
Published: December 2018

Energy consumption of computer numerical control (CNC) machines is significant and various empirical models have been developed to model the specific energy consumption (SEC) of CNC machines. However, most of the models are developed for specific machines and hence have limited applications in manufacturing industry. In this research, a general empirical SEC model for milling machine at certain power level is developed based on actual cutting experimental data. In this model, stand-by power and spindle power are used in the SEC model for the first time. The material removal rate (MRR) is used to represent the cutting parameter. The proposed model is fitted by the regression analysis and validated using experimental data. Results show that the proposed model can be applied on various milling machines with an average absolute residual ratio of 6%. The model is also validated through a series of cutting experiments on a machine center, with an accuracy of 91.5%, for the SEC calculation.
Potassium chloride mixture may maintain hypokalaemia and hypertension
Authors: Mandoe Mette Johannsen , Borg Rikke , Hansen Ditte
Published: December 2018

Hypokalaemia can be treated with potassium chloride mixture. Some mixtures contain liquorice extract (glycyrrhizin) as a supplement to improve taste. Glycyrrhizin can cause pseudohyperaldosteronism and thereby result in hypertension and hypokalaemia. We here present a case where treatment with potassium chloride mixture causes hypertension and hypokalaemia in a 50-year-old woman. After unravelling differential diagnosis, the potassium chloride mixture was stopped. After the discontinuation, the patient’s blood pressure was well managed and the potassium levels normalised.
Subungual and ungual scabies: avoiding severe presentation in high-risk patients
Authors: Last Omer , Reckhow Jensen , Bogen Ben , Rozenblat Mati
Published: December 2018

Scabies is a pruritic disorder caused by Sarcoptes scabiei var. hominis infestation of the skin. Transferred by close body contact, scabies is endemic within nursing homes and among poor and overcrowded populations. Crusted scabies is a severe form of disease, characterised by a large, thick, crusted eruption with significant mite infestation. We report a patient hospitalised with crusted scabies that had massive nail involvement. A 79-year-old female patient with multiple comorbidities and several recent prior scabies diagnoses presented with agitation and dystrophic fingernails; scabies mites were found embedded in and below the nail keratin. Aggressive treatment resulted in complete resolution, with notable improvements in mental status. Crusted scabies with nail involvement is extremely rare and may be more likely to develop from initially subclinical infestation sites. It is important to consider this potential presentation, as standard topical treatments may prove ineffective when there is deep nail involvement.
Toxic anterior segment syndrome following phakic posterior chamber IOL: a rarity
Authors: Singh Archita , Gupta Noopur , Kumar Vinod , Tandon Radhika
Published: December 2018

Implantable collamer lenses (ICL) have gained popularity for correction of myopia where kerato-refractive procedures are not indicated as in cases of high myopic refractive errors. Toxic anterior segment syndrome (TASS) is a very uncommonly reported postoperative complication following ICL implantation. A young patient developed severe corneal oedema and anterior segment inflammation on the first day after ICL implantation. Analysing retrospectively, possible idiosyncratic response to intracameral pilocarpine was considered as a cause for TASS. Prompt and intensive therapy with oral and topical potent steroids was visually rewarding. TASS, though a sterile inflammation can have catastrophic sequelae such as corneal decompensation and secondary glaucoma. Hence, timely identification and management is important.
Buried bumper syndrome presenting with bleeding
Authors: Bamakhrama Khaled , Aldaham Tahani Ahmed , Alassaf Omar
Published: December 2018

Buried bumper syndrome (BBS) is a relatively rare complication of percutaneous endoscopic gastrostomy (PEG) feeding. In this paper, we report the case of a 74-year-old man who attended the emergency department with bleeding from the PEG tube site that was later confirmed by endoscopy to be BBS. The treatment consisted of a PEG tube replacement with a 10-day course of antibiotics. Furthermore, this report discusses possible signs, symptoms and physical examination signs suggesting BBS. It can cause serious complications that might sometimes be fatal. Therefore, the diagnosis needs to be done swiftly and the patient treatment to start without delay. BBS should always top the differentials of physicians once suspected.
Bilateral retinocytoma: multimodal imaging assessment
Authors: Pujari Amar , Azad Shorya Vardhan , Meel Rachna , Lomi Neiwete
Published: December 2018

Clinical evaluation of an early-onset left esotropia in an adolescent revealed a large macular lesion with extensive posterior pole retinochoroidal atrophy from superior arcade to inferior arcade. The lesion also showed pigmentary changes over the base, edges and beyond, along with a popcorn-like calcification just above the inferior arcade. Swept-source optical CT (SS-OCT) confirmed extensive chorioretinal thinning with hyper-reflective foci corresponding to the calcification, and optical CT angiography revealed a disorganised superficial retinal plexus. Likewise, fundus screening of the other eye showed a well-defined fleshy mass lesion along the temporal retina in absence of any calcification. SS-OCT of the left eye lesion showed intraretinal mass with poorly defined retinal layers.
Giant juvenile papillomatosis of the breast in a Nigerian girl
Authors: Olarinoye-Akorede Sefiya Adebanke , Farouk Bilkisu , Liman Almustapha Aliyu , Kajogbola Gbenga Abimbola
Published: December 2018

Juvenile papillomatosis is a benign epithelial proliferative tumour of young women. It was recognised as a distinct clinicopathological entity with defining criteria by Rosenet alsince 1980. However, giant juvenile papillomatosis is rare. We report a case of a 14-year-old girl who presented to our institution’s breast clinic with a huge right breast mass measuring 20 cm × 15 cm. She had no personal history of previous breast disease and there was no family history of breast cancer. Our initial preoperative diagnosis was of a phylloides tumour. The patient had a total excision of her breast mass which revealed florid juvenile papillomatosis at histology. This presentation highlights the clinical presentation and imaging features of juvenile papillomatosis. The classical histopathological characteristics, unusual microscopic findings and management of a huge-sized tumour in an adolescent Nigerian patient are also presented.
Rare case of anterior cervical discectomy and fusion complication in a patient with Zenker’s diverticulum
Authors: Dobran Mauro , Gladi Maurizio , Mancini Fabrizio , Nasi Davide
Published: December 2018

We present a case of Zenker’s diverticulum in a 45-year-old woman, occurred as complication after anterior cervical discectomy and fusion for a cervical spine injury. The oesophageal complication occurred 12 months after vertebral cervical surgery and presenting symptoms were fever, dysphagia and neck pain with evidence of retropharyngeal infection. We performed a posterior cervical stabilisation C3-D1 by screws and rods and a second anterior left cervical approach with anterior plate removing and oesophageal wall break repairing with a sternohyoid muscle patch. Despite pharyngo-oesophageal diverticulum may be a complication of anterior cervical surgery (traction diverticulum), in case of an already present true Zenker’s diverticulum, delayed complication may occur without cervical hardware pull-out.
Haemostatic radiation therapy for a bleeding intraductal papillary neoplasm of the biliary tree
Authors: Sundaravadanan Senthil , Mathew Manu , Ram Thomas Samuel , Joseph Philip
Published: December 2018

Haemostatic radiation was effectively used as a novel rescue therapy in a 60-year-old man who presented with recurrent melaena refractory to all conventional medical and surgical measures. He needed multiple transfusions and was diagnosed to be bleeding from an intraductal papillary biliary neoplasm which was not amenable to surgical resection in view of the background liver disease. He received conventional radiation therapy (RT) of a dose of 3 Gy per fraction for 3 consecutive days after which he stabilised. After cessation of the RT, he did not require transfusion for the next 2 months. His quality of life improved and it gave us time to evaluate for other definitive measures.
Extra-adrenal pheochromocytoma presenting as inverse takotsubo-pattern cardiomyopathy treated with surgical resection
Authors: Tafreshi Shima , Naqvi Syed Yaseen , Thomas Sabu
Published: December 2018

Pheochromocytoma is a rare catecholamine-secreting tumour that is typically located in the adrenal medulla or along the sympathetic ganglia. The typical symptoms are episodic in nature and include tachycardia, sweating and headache. These tumours can present as transient, reversible cardiomyopathy similar to takotsubo cardiomyopathy (TCM). TCM is characterised by transient hypokinesis of the left ventricular apex and is typically induced by emotional stress. We describe the case of a 26-year-old woman with a medical history significant for headaches who presented initially to her family physician with nausea, vomiting, headache and hypertension. She was started on lisinopril 10 mg daily. One week later, she presented to the emergency department with substernal severe chest pressure. Her troponin level was elevated. Coronary angiogram showed normal coronary arteries and left ventriculogram showed inverse TCM pattern. Serum catecholamines were very elevated confirming pheochromocytoma. She was successfully treated with alpha-blockers followed by surgical resection.
Single-incision laparoscopic cholecystectomy using conventional instruments in situs inversus totalis
Authors: Jhobta Rajinder Singh , Gupta Archit , Negi Balwant , Negi Kapil
Published: December 2018

Situs inversus totalis is a rare genetic disorder. Single-incision laparoscopic cholecystectomy (SILC) in situs inversus totalis has been reported rarely. SILC has an advantage of being easier than conventional laparoscopic cholecystectomy in addition to better cosmesis and reduced postoperative pain. We report a case of single-incision laparoscopic cholecystectomy done in a young woman with situs inversus totalis using conventional laparoscopic instruments.
Infection of lung cavitations in a young dog owner with Hodgkin’s lymphoma caused byPasteurella multocida, without a dog bite: confirmed zoonotic transmission by tagmentation microbiome analysis
Authors: van der Reijden Mirek , Riethoff Lesley F V , van der Reijden Wil A , Griffioen-Keijzer Anita
Published: December 2018

Pasteurella multocidais a known pathogen in humans, mostly reported after animal bite incidents. Atraumatic infections have been described, especially in immunocompromised patients. A 20-year-old patient with a history of stage IV Hodgkin’s lymphoma with cavitating pulmonary lesions presented with a bilateral pneumonia. Shortly after finishing antibiotic treatment, she quickly developed the same symptoms of pneumonia. Bronchoscopy showed a large cavity in the right upper lobe andP. multocidawas isolated from all bronchial cultures. The transmission route ofP. multocidavia the patient’s dog was confirmed by sampling the full genome of the dog’s mouth, which matched the uniqueP. multocidasequences found in the patient. This case demonstrates the importance of accurately determining the aetiology of the patient’s symptoms, andPasteurellainfection should be considered in all immunocompromised patients with domestic animal contact, even without a bite incident.
Severe aortic regurgitation masked as sepsis-induced ARDS in a patient withStreptococcus agalactiaeendocarditis
Authors: Lamaa Nader , Bromberg Romina , Foroughi Maryam , Danckers Mauricio
Published: December 2018

Septic shock is the most common type of shock in the intensive care unit with an associated mortality close to 50%. Infective endocarditis (IE) is a rare cause of septic shock but carries significant morbidity and mortality. Group BStreptococcusIE (GBS-IE) is an invasive infection with an incidence of approximately 1.7%. It affects immunocompromised patients such as intravenous drug users, alcoholics, those with HIV and elderly among others. IE with severe acute valvular heart disease challenges physicians when assessing fluid status during the early resuscitation in patients with septic shock. We present a case of GBS-IE complicated by severe acute aortic regurgitation with rapidly progressive acute respiratory failure in the setting of septic shock management.
Imatinib and liver toxicity
Authors: Haq Mohammad Inamul , Nixon Joanna , Stanley Adrian J
Published: December 2018

Imatinib is a specific tyrosine kinase inhibitor which has been approved for the treatment of Philadelphia chromosome-positive chronic myeloid leukaemia and c-KIT (CD117)-positive gastrointestinal stromal tumours. It has been associated with hepatotoxicity ranging from abnormal liver function tests to acute liver failure along with chronic hepatitis B reactivation. We report the case of a patient who was started on adjuvant treatment with imatinib following resection of a primary gastrointestinal stromal cell tumour of jejunum and developed severe hepatotoxicity. There was no history of risk factors for liver disease, and a search for the underlying causes of hepatotoxicity was unremarkable. Imatinib was stopped and she was treated with steroids which resulted in dramatic improvement of liver function tests. Liver biopsy in this case was not performed because liver function tests improved following discontinuation of imatinib and treatment with steroids. Repeat imaging did not reveal any evidence of tumour recurrence.
Newborn with a rare congenital granular cell lesion of the tongue
Authors: Kaminecki Inna , Xu Wenyuan , Abbas Syed Hussain , Kale Meera
Published: December 2018

Congenital granular cell lesion (CGCL) is an uncommon, benign soft tissue lesion that usually arises from the alveolar mucosa of neonates. The present report describes a case of CGCL originating from the tongue of a newborn female infant. The lesion was negative for S-100 differentiating it from congenital granular cell tumour. The lesion was excised under local anaesthesia with no recurrence at 4 months.