bluuebunny/crossref_metadata_2025 huggingface dataset:
Esophageal mucosal innervation in functional heartburn: Closer to healthy asymptomatic subjects than to non‐erosive reflux disease patients
Authors: Nikaki Kornilia , Woodland Philip , Lee Chung , Ghisa Matteo , Marinelli Carla , Savarino Edoardo , Sifrim Daniel
Published: June 2019

Background

Mucosal innervation in non‐erosive reflux disease (NERD; pathological esophageal acid exposure, normal macroscopic mucosa) is clearly distinct from that of healthy volunteers (HV) and from patients with esophagitis or Barrett's esophagus: The nerves in NERD are situated much closer to the luminal surface of the mucosa. Patients with functional heartburn (FH) have a similar symptom profile to patients with NERD and indistinguishable macroscopic appearances. However, they have physiological acid exposure and no reflux‐symptom association. The aim of our study was to delineate the position of esophageal mucosal nerve fibers in patients with FH and compare it with that in NERD and HV.

Methods

Distal esophageal biopsies from patients with FH were immunohistochemically stained for CGRP. CGRP‐positive nerve fibers were identified, and their position relative to the lumen was determined. These results were compared to our previously published cohort of HV and NERD.

Results

Eleven patients were included in the FH group with a mean age of 46 years (range 33‐69); 7F:4M. Nine patients had visible nerve fibers. The location of the afferent nerve fibers in the distal esophageal mucosa (median of 22, range 10.4‐28) was similar to the HV group (median 25.5) and significantly deeper than the superficial nerves seen in NERD (median 9.5).

Conclusions

The mucosal innervation pattern in FH is more alike that of healthy individuals than that of NERD, with afferent nerves lying deep in the mucosa, away from the luminal surface. This supports the theory that heartburn in FH has a distinct nociceptive pathophysiology.
Seed life span and food security
Authors: Colville Louise , Pritchard Hugh W.
Published: June 2019

Much is known about the inter‐specific distribution of life span in a wide diversity of vertebrates and in adult plants, but not for seeds, yet the functional trait seed life span underpins global agriculture, plant species conservation and seed persistence in the soil. We sourced data for five storage conditions (soil seed bank; high temperature – high humidity accelerated ageing; temperate, cooler, open storage; cool, dry, refrigerator; and cold, dry, freezer); and analysed the distribution of orthodox seed life span amongst crop and wild species. In all cases, whether for maximum known in situ life span in the soil seed bank (417 species), or for half‐lives (P50s) ex situ (732 species), the distribution is right‐skewed. The finding that seeds of > 50% of species are likely to have life spans ≤ 20% of the longest recorded under the same conditions has implications for future research on the evolution of seed traits and gene bank collections management.
Interannual variation in season length is linked to strong co‐gradient plasticity of phenology in a montane annual plant
Authors: Ensing David J. , Eckert Christopher G.
Published: June 2019

Species are commonly distributed along latitudinal and elevational gradients of growing season length to which they might respond via phenotypic plasticity and/or adaptive genetic differentiation. However, the relative contribution of these processes and whether plasticity, if it occurs, facilitates expansion along season‐length gradients remain unclear, but are important for predicting species fates during anthropogenic change.

We quantified phenological trait variation in the montane annualRhinanthus minorfor three generations at 12 sites across 900 m of elevation in the Canadian Rocky Mountains and conducted a reciprocal transplant experiment for two generations among nine sites. We compared clines and interannual variation of phenological traits between natural and transplanted individuals.

Season length declined byc. 37% along our elevational gradient and, as expected, plants emerged, reached first flower and made their first seed inc. 41% fewer growing degree days under shorter growing seasons. Although reciprocal transplants revealed modest genetic differentiation across elevation, trait clines primarily were due to striking co‐gradient plasticity that paralleled genetic differentiation.

Co‐gradient plasticity likely evolved in response to considerable interannual variation in season length across our elevational transect, and should prepareR. minorto make adaptive changes to phenology in response to ongoing climate change predicted for montane environments.
Plant responses to fungal volatiles involve global posttranslational thiol redox proteome changes that affect photosynthesis
Authors: Ameztoy Kinia , Baslam Marouane , Sánchez‐López Ángela María , Muñoz Francisco José , Bahaji Abdellatif , Almagro Goizeder , García‐Gómez Pablo , Baroja‐Fernández Edurne , De Diego Nuria , Humplík Jan F. , Ugena Lydia , Spíchal Lukáš , Doležal Karel , Kaneko Kentaro , Mitsui Toshiaki , Cejudo Francisco Javier , Pozueta‐Romero Javier
Published: June 2019

Microorganisms produce volatile compounds (VCs) that promote plant growth and photosynthesis through complex mechanisms involving cytokinin (CK) and abscisic acid (ABA). We hypothesized that plants' responses to microbial VCs involve posttranslational modifications of the thiol redox proteome through action of plastidial NADPH‐dependent thioredoxin reductase C (NTRC), which regulates chloroplast redox status via its functional relationship with 2‐Cys peroxiredoxins. To test this hypothesis, we analysed developmental, metabolic, hormonal, genetic, and redox proteomic responses of wild‐type (WT) plants and a NTRC knockout mutant (ntrc) to VCs emitted by the phytopathogen Alternaria alternata. Fungal VC‐promoted growth, changes in root architecture, shifts in expression of VC‐responsive CK‐ and ABA‐regulated genes, and increases in photosynthetic capacity were substantially weaker in ntrc plants than in WT plants. As in WT plants, fungal VCs strongly promoted growth, chlorophyll accumulation, and photosynthesis in ntrc–Δ2cp plants with reduced 2‐Cys peroxiredoxin expression. OxiTRAQ‐based quantitative and site‐specific redox proteomic analyses revealed that VCs promote global reduction of the thiol redox proteome (especially of photosynthesis‐related proteins) of WT leaves but its oxidation in ntrc leaves. Our findings show that NTRC is an important mediator of plant responses to microbial VCs through mechanisms involving global thiol redox proteome changes that affect photosynthesis.
Natural history of PHACE syndrome: A survey of adults with PHACE
Authors: Stefanko Nicole S. , Cossio Maria‐Laura , Powell Julie , Blei Francine , Davies Olivia M. T. , Frieden Ilona J. , Garzon Maria C. , Lauren Christine T. , Maheshwari Mohit , McCuaig Catherine C. , Metry Denise , Salman Sumaiya , Drolet Beth A. , Siegel Dawn H.
Published: June 2019

Background

Awareness of PHACE syndrome has increased; however, little information exists regarding its natural history, especially in patients over the age of 18. We aim to describe the natural history of PHACE to enhance clinical management and counseling of patients.

Methods

A cohort of patients ≥ 18 years was identified through the PHACE Syndrome Registry and a Vascular Anomalies Clinic Database. A cross‐sectional survey was designed after a review of the literature by PHACE experts (IF, JP, DS). Questions were selected by consensus, and the survey was conducted using the Qualtrics platform and via in‐person interviews. A 75% response rate was found.

Results

Eighteen adults—17 females and one transgender male—completed the survey. Respondents ranged in age from 18 to 59, with 24 being the mean age. Eighty‐nine percent reported experiencing headaches, and 17% reported experiencing acute but transient symptoms mimicking acute ischemic stroke, later diagnosed as atypical migraines. Thirty‐three percent reported hearing loss, and 67% endorsed dental issues. One patient experienced two arterial dissections. Three‐fourths who attempted conception were successful, and none of their children had clinical features of PHACE. Because results were based on a retrospective survey, data captured were prone to recall bias and not objective. Results were limited by a small sample size.

Conclusions

Health care providers should be aware of a possible increased risk of neurovascular complications, including atypical migraines mimicking transient ischemic attacks and arterial dissection, in adults with PHACE. Heritability has not been demonstrated, and future studies are needed to assess the risk of infertility.
The growing role of aquaculture in ecosystem restoration
Authors: Patterson Joshua T.
Published: June 2019

Active restoration in aquatic systems is relatively underdeveloped. Aquaculture, often called gardening or artificial/controlled propagation in this context, is increasingly important in the theory and practice of aquatic restoration. This RE‐New contribution explores current ideas and examples in restoration aquaculture. Challenges exist, and these must be acknowledged and addressed. As impacts to aquatic systems persist, the next 25 years should see a greater role for aquaculture and seeds planted now will be important to future efforts. Eventually, aquaculture may be linked to aquatic systems restoration just as silviculture has been linked to forest restoration.
Paediatric and adult bronchiectasis: Specific management with coexisting asthma, COPD, rheumatological disease and inflammatory bowel disease
Authors: Maglione Marco , Aksamit Timothy , Santamaria Francesca
Published: June 2019

Bronchiectasis, conventionally defined as irreversible dilatation of the bronchial tree, is generally suspected on a clinical basis and confirmed by means of chest high‐resolution computed tomography. Clinical manifestations, including chronic productive cough and endobronchial suppuration with persistent chest infection and inflammation, may deeply affect quality of life, both in children/adolescents and adults. Despite many cases being idiopathic or post‐infectious, a number of specific aetiologies have been traditionally associated with bronchiectasis, such as cystic fibrosis (CF), primary ciliary dyskinesia or immunodeficiencies. Nevertheless, bronchiectasis may also develop in patients with bronchial asthma; chronic obstructive pulmonary disease; and, less commonly, rheumatological disorders and inflammatory bowel diseases. Available literature on the development of bronchiectasis in these conditions and on its management is limited, particularly in children. However, bronchiectasis may complicate the clinical course of the underlying condition at any age, and appropriate management requires an integration of multiple skills in a team of complementary experts to provide the most appropriate care to affected children and adolescents. The present review aims at summarizing the current knowledge and available evidence on the management of bronchiectasis in the other conditions mentioned and focuses on the new therapeutic strategies that are emerging as promising tools for improving patients’ quality of life.
Increased risk of major adverse cardiac events following the onset of acute exacerbations of COPD
Authors: Reilev Mette , Pottegård Anton , Lykkegaard Jesper , Søndergaard Jens , Ingebrigtsen Truls S , Hallas Jesper
Published: June 2019

Background and objective

Acute exacerbations in chronic obstructive pulmonary disease (COPD) may trigger major adverse cardiac events (MACE). We aimed to determine whether the risk of having MACE was transiently increased following the onset of an acute COPD exacerbation.

Methods

We conducted a nationwide, register‐based study from 1997 to 2014 comprising individuals with an acute COPD exacerbation followed by a MACE (acute myocardial infarction (MI), stroke or cardiovascular death). Using the case‐crossover design, we estimated odds ratios (OR) for the association between acute exacerbations of COPD and MACE as well as for single outcomes (acute MI, stroke and cardiovascular death), different levels of severity of exacerbations and within patient subgroups.

Results

We identified 118 807 cases with a MACE preceded by an exacerbation. Overall, the risk of MACE increased almost fourfold following the onset of an acute exacerbation compared to periods without exacerbations in the same individuals (OR: 3.70; 95% CI: 3.60–3.80). The associations were consistent for single outcomes (acute MI, OR: 3.57; cardiovascular death, OR: 4.33; and stroke, OR: 2.78) and particularly strong associations were demonstrated for severe exacerbations (OR: 5.92) and the oldest individuals (OR: 4.18).

Conclusion

The risk of MACE increased substantially following the onset of an acute exacerbation. This highlights that prevention of cardiac events is an important goal in the management of COPD. Attention should be paid to detecting cardiovascular disease following acute COPD exacerbations.
A Tale of Two Markets: Unequal Access to Private Property in a South African City
Authors: Marais Lochner , Awuzie Bankole , Cloete Jan , Napier Mark , Greyling Erica
Published: June 2019

In line with international trends, South Africa’s post‐apartheid government has embarked on a housing policy that emphasises asset building. Homeownership has become a dominant policy for assisting the historically disadvantaged Black population. This paper looks at two property markets in Mangaung, a metropolitan municipality that includes Bloemfontein. We analysed property activity on 2,545 residential stands in former Black and former White areas in Mangaung since 1990. Our findings show two distinct markets. The formal property market in former Black areas shows a low number of transactions, low value and slow turnover. In the former White areas, a housing investment made between 1990 and 2016 would have yielded an annual return of 14 per cent, but in the former Black areas only 7 per cent. This poor return makes it difficult for homeowners in former Black areas to use housing for asset building.
Isolation of canine adipose‐derived mesenchymal stem cells from falciform tissue obtained via laparoscopic morcellation: A pilot study
Authors: DePompeo Christine M. , Giassetti Mariana Ianello , Elnaggar Mahmoud M. , Oatley Jon M. , Davis William C. , Fransson Boel A.
Published: June 2019

Objective

To evaluate the feasibility of stem cell isolation from falciform fat harvested via laparoscopic morcellation.

Study design

Pilot study.

Animals

Eleven client‐owned dogs.

Methods

Falciform was harvested traditionally via laparotomy and laparoscopically via tissue morcellation. Harvested tissue was processed with a commercially available adipose tissue dissociation kit to obtain a stromal vascular fraction (SVF). Cells were subsequently labeled for CD90, CD45, and CD44 cell surface antigens by using magnetic‐activated cell sorting (MACS) and fluorescence‐activated cell sorting flow cytometry. CD90+ cells were quantitated, and their viability was assessed with a hemocytometer and a trypan blue exclusion test of cell viability.

Results

No perioperative complications occurred in dogs undergoing laparoscopic morcellation. Laparoscopically and traditionally harvested samples yielded an average of 0.39 (±0.1) × 106 and 0.33 (±0.1) × 106 CD90+ cells, respectively, per 10 million SVF cells. CD90+ cell viability after MACS was 89% (±11%) for morcellated and 86% (±7%) for traditionally harvested samples. Neither CD90+ cell quantity nor viability was different between samples obtained via traditional laparotomy vs laparoscopic morcellation (P = .38 and P = .63, respectively). Populations of CD90+ cells isolated with each harvest technique had similar CD44 and CD45 expression profiles.

Conclusion

Viable populations of CD90+ cells with similar CD44/CD45 expression profiles were isolated from laparoscopically morcellated and traditionally harvested falciform tissue. No appreciable morbidity was associated with laparoscopic falciform morcellation.

Clinical significance

Laparoscopic morcellation is a safe and effective minimally invasive approach to falciform tissue harvest for adipose‐derived mesenchymal stem cell isolation.
The devil is in the details—Host disease and co‐infections are associated with zoonotic pathogen carriage in Norway rats (Rattus norvegicus)
Authors: Rothenburger Jamie L. , Himsworth Chelsea G. , Nemeth Nicole M. , Pearl David L. , Treuting Piper M. , Jardine Claire M.
Published: June 2019

Traditionally, zoonotic pathogen ecology studies in wildlife have focused on the interplay among hosts, their demographic characteristics and their pathogens. But pathogen ecology is also influenced by factors that traverse the hierarchical scale of biological organization, ranging from within‐host factors at the molecular, cellular and organ levels, all the way to the host population within a larger environment. The influence of host disease and co‐infections on zoonotic pathogen carriage in hosts is important because these factors may be key to a more holistic understanding of pathogen ecology in wildlife hosts, which are a major source of emerging infectious diseases in humans. Using wild Norway rats (Rattus norvegicus) as a model species, the purpose of this study was to investigate how host disease and co‐infections impact the carriage of zoonotic pathogens. Following a systematic trap and removal study, we tested the rats for the presence of two potentially zoonotic bacterial pathogens (Bartonella tribocorum and Leptospira interrogans) and assessed them for host disease not attributable to these bacteria (i.e., nematode parasites, and macroscopic and microscopic lesions). We fitted multilevel multivariable logistic regression models with pathogen status as the outcome, lesions and parasites as predictor variables and city block as a random effect. Rats had significantly increased odds of being infected with B. tribocorum if they had a concurrent nematode infection in one or more organ systems. Rats with bite wounds, any macroscopic lesion, cardiomyopathy or tracheitis had significantly increased odds of being infected with L. interrogans. These results suggest that host disease may have an important role in the ecology and epidemiology of rat‐associated zoonotic pathogens. Our multiscale approach to assessing complex intrahost factors in relation to zoonotic pathogen carriage may be applicable to future studies in rats and other wildlife hosts.
Electrochemical Capacitance Properties of Electrode Based on Polyaniline Coated Graphite Nanoplatelets/Polystyrene Composite Film
Authors: Zia Tanveer ul Haq , Khan Ahmad Nawaz , Ara Behisht , Gul Kashif
Published: June 2019

The electrochemical behavior of the electrode material based on composites of polyaniline (PANI), graphite nanoplatelets (GnP), and polystyrene (PS) matrix was evaluated by applying cyclic voltammetry (CV), galvanostatic charge–discharge (GCD), and electrochemical impedance spectroscopy (EIS), for its application in electrochemical supercapacitor which is an advanced energy storing device. Composites were prepared by coating polyaniline on graphite nanoplatelets (PANI/GnP) via in situ emulsion polymerization, exhibiting specific surface area of 178.75 m2/g as compared with 72.1 m2/g of pristine GnP. The PANI/GnP was then embedded in polystyrene matrix (PANI/GnP/PS), which showed improved electrical conductivity due to an interconnected mesh of PANI/GnP as confirmed by scanning electron microscopy (SEM) morphological analysis. The formation of porous conductive network in PANI/GnP/PS with conductivity value of 8.6 × 10−3 S/cm resulted in high specific capacitance of 411.3 F/g measured at a current density of 0.5 A/g which corresponded to specific energy of 47.94 Wh/kg and specific power of 281.94 W/kg, as well as the decrease in specific capacitance was 32% even after 1600 charge–discharge cycles showing good rate performance which renders it an ideal material for electrodes in supercapacitors.
Simulation of Intermittent Flow Development in a Horizontal Pipe
Authors: Nasrfard Hamed , Rahimzadeh Hassan , Ahmadpour Ali , Amani Ehsan
Published: June 2019

In this study, detailed three-dimensional (3D) numerical simulations of intermittent multiphase flows were carried out to investigate the slug initiation process and various features of intermittent flows inside a horizontal pipe. Air and water are used as working fluids. The domain used for simulations is a 14.4 m long pipe with 54 mm inner diameter. The volume of fluid (VOF) model was used to capture the air/water interface and its temporal evolution. Using the developed computational fluid dynamics (CFD) model, the slug formation and propagation along horizontal circular pipe were successfully predicted and studied comprehensively. Slug length and the frequency of slug formation, as two main features of intermittent flow, were used to validate the model against experimental results and available correlations in the literature. Three-dimensional numerical simulation of intermittent flow proved to be a powerful tool in tackling limitations of experiments and providing detailed data about various features of the intermittent flow. The effect of gas and liquid superficial velocities on the liquid slug and elongated bubble length was explored. Moreover, the study revealed new findings related to the elongated bubble shape and velocity field in the slug unit.
A Computational Fluid Dynamics Methodology for Predicting Aeration in Wet Friction Clutches
Authors: Pardeshi Irsha , Shih Tom I-P.
Published: June 2019

Computational fluid dynamics (CFD) has been unable to reliably predict aeration and drag torque in clutches. In this study, a CFD method was developed to reliably predict the onset of aeration and drag torque as a function of the clutch's rotational speed. This study showed that though the oil and air behave as if they are incompressible at steady-state, the formulation must account for the compressible nature of the gas and the unsteady processes that occur before reaching steady-state. This study also showed that the dynamic nature of the contact angle between the oil and the stationary disk must be accounted for to predict drag torque and aeration as a function of rotational speed, and a model of the dynamic-contact angle was developed.
ISO estimates of noise-induced hearing impairment
Authors: Lempert Barry
Published: June 2019

The revision of International Organization for Standardization (ISO) standard ISO 1999 [(1971). International Organization of Standardization, Geneva, Switzerland)] in 1990 was based on two noise and hearing study databases, one presented by Burns and Robinson [(1970). Hearing and Noise in Industry (Her Majesty's Stationary Office, London)] and the other by Passchier-Vermeer [(1968). Report No. 35 and Supplement to Report No. 35 (Institute for Public Health Engineering, the Netherlands)]. However, the mathematical expression of these data in ISO 1999 neither closely predicts the distribution of hearing threshold levels in these two databases nor those in the National Institute for Occupational Safety and Health database. As a result, lower estimates of the risk of noise-induced hearing impairment are found using ISO 1999. An explanation of the revision is needed to justify these lower risk values.
Comparing Antimicrobial Susceptibilities among
Mycoplasma pneumoniae
Isolates from Pediatric Patients in Japan between Two Recent Epidemic Periods
Authors: Oishi Tomohiro , Takahashi Kento , Wakabayashi Shoko , Nakamura Yoshitaka , Ono Sahoko , Kono Mina , Kato Atsushi , Saito Aki , Kondo Eisuke , Tanaka Yuhei , Teranishi Hideto , Akaike Hiroto , Tanaka Takaaki , Miyata Ippei , Ogita Satoko , Ohno Naoki , Nakano Takashi , Ouchi Kazunobu
Published: June 2019

We compared the antimicrobial susceptibility of
Mycoplasma pneumoniae
isolates from pediatric patients in Japan in 2011–2012 and 2015–2016, when epidemics occurred. The antimicrobial activity of macrolides and tetracyclines against
M. pneumoniae
infection tended to be restored in 2015–2016.
Disrupted CXCR2 Signaling in Oligodendroglia Lineage Cells Enhances Myelin Repair in a Viral Model of Multiple Sclerosis
Authors: Marro Brett S. , Skinner Dominic D. , Cheng Yuting , Grist Jonathan J. , Dickey Laura L. , Eckman Emily , Stone Colleen , Liu Liping , Ransohoff Richard M. , Lane Thomas E.
Published: June 2019

Signaling through the chemokine receptor CXCR2 in oligodendroglia is important for developmental myelination in rodents, while chemical inhibition or nonspecific genetic deletion of CXCR2 appears to augment myelin repair in animal models of the human demyelinating disease multiple sclerosis (MS). To better understand the biology of CXCR2 signaling on oligodendroglia, we generated transgenic mice in whichCxcr2is selectively ablated in oligodendroglia upon treatment with tamoxifen. Using a viral model of neuroinflammation and demyelination, we demonstrate that genetic silencing of CXCR2 on oligodendroglia did not affect clinical disease, neuroinflammation, or demyelination, yet there was increased remyelination. These findings support and extend previous findings suggesting that targeting CXCR2 may offer a therapeutic avenue for enhancing remyelination in patients with demyelinating diseases.
Dynamics of the Humoral Immune Response to a Prime-Boost Ebola Vaccine: Quantification and Sources of Variation
Authors: Pasin Chloé , Balelli Irene , Van Effelterre Thierry , Bockstal Viki , Solforosi Laura , Prague Mélanie , Douoguih Macaya , Thiébaut Rodolphe
Published: June 2019

With no available licensed vaccines or therapies, the West African Ebola virus disease epidemic of 2014 to 2016 caused 11,310 deaths. Following this outbreak, the development of vaccines has been accelerated. Combining different vector-based vaccines as heterologous regimens could induce a durable immune response, assessed through antibody concentrations. Based on data from phase 1 trials in East Africa and Europe, the dynamics of the humoral immune response from 7 days after the boost immunization onwards were modeled to estimate the durability of the response and understand its variability. Antibody production is maintained by a population of long-lived cells. Estimation suggests that half of these cells can persist for at least 5 years in humans. Differences in prime-boost vaccine regimens affect only the short-term immune response. Geographical differences in long-lived cell dynamics were inferred, with higher long-term antibody concentrations induced in European participants.
Two synchronous malignancies: nodular melanoma and renal cell carcinoma in a patient with an underlying germlineBRCA2mutation
Authors: Snow Anson , Ricker Charite , In Gino K
Published: June 2019

Modernised genetic testing among patients with cancer has led to an increasing wealth of knowledge regarding cancer biology and aetiology. Furthermore, some germline mutations have the potential to direct therapeutic approaches as well. WhileBRCA1/2mutations are well-established risk factors for breast and ovarian cancers, their impact on other cancers is less understood. We describe a patient with a germlineBRCA2mutation who developed synchronous melanoma and renal cell carcinoma, but responded well to treatment and is now cancer free.
Optic neuropathy as the first sign of central nervous system relapse in acute myeloid leukaemia: MRI findings and its diagnostic challenge
Authors: Cheung Michelle , Fang Benjamin , Lee Raymand
Published: June 2019

We describe the case of a 22-year-old man who presented with right eye visual impairment and oral mucositis. MRI revealed findings compatible with right optic neuritis. Herpes simplex virus 1 was detected in oral swab. He has a previous history of acute myeloid leukaemia (AML) and was in clinical remission. Initial investigations for possible relapse of AML with central nervous system (CNS) involvement were negative. Treatment for HSV-related optic neuritis was initiated but the patient’s vision deteriorated. Repeat MRI revealed right optic nerve infarct, new left optic nerve abnormality and new leptomeningeal enhancement in the brain. Repeated cerebrospinal fluid analysis confirmed CNS relapse of AML. Despite prompt initiation of pulse steroid and high dose intrathecal cytarabine followed by cranial irradiation, the patient never regained his vision. We present a case of unexpected optic neuropathy as first and sole presentation of CNS relapse of AML.
Bi-level erector spinae plane block for the control of severe back pain related to vertebral metastasis
Authors: Altıparmak Başak , Korkmaz Toker Melike , Uysal Ali İhsan , Gümüş Demirbilek Semra
Published: June 2019

Pain is the most common reason for emergency department visits. Traditionally, pain management has been provided by narcotics, non-steroidal anti-inflammatory drugs and non-narcotics. Erector spinae plane block is a new interfascial plane block that has been successfully used for acute pain control in different surgeries. Two female patients with severe back pain related to breast cancer metastasis applied to emergency department. The pain scores of the patients were between 8 and 10. We performed bilateral erector spinae plane block at the levels of T3 and T6. The pain scores decreased under 2 within 30 min and none of the patients required additional analgesic agent for 24 hours. Previously erector spinae plane block was used for rib and spine fractures in emergency department. Different from previous cases, we performed bi-level blocks to cover a larger area and the block abruptly and effectively reduced pain scores of the patients with breast cancer.
How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial-based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study
Authors: van de Graaf Victor A , van Dongen Johanna M , Willigenburg Nienke W , Noorduyn Julia C A , Butter Ise K , de Gast Arthur , Saris Daniel B F , van Tulder Maurits W , Poolman Rudolf W
Published: June 2019

Objectives

To examine whether physical therapy (PT) is cost-effective compared with arthroscopic partial meniscectomy (APM) in patients with a non-obstructive meniscal tear, we performed a full trial-based economic evaluation from a societal perspective. In a secondary analysis—this paper—we examined whether PT is non-inferior to APM.

Methods

We recruited patients aged 45–70 years with a non-obstructive meniscal tear in nine Dutch hospitals. Resource use was measured using web-based questionnaires. Measures of effectiveness included knee function using the International Knee Documentation Committee (IKDC) and quality-adjusted life-years (QALYs). Follow-up was 24 months. Uncertainty was assessed using bootstrapping techniques. The non-inferiority margins for societal costs, the IKDC and QALYs, were €670, 8 points and 0.057 points, respectively.

Results

We randomly assigned 321 patients to PT (n=162) or APM (n=159). PT was associated with significantly lower costs after 24 months compared with APM (−€1803; 95% CI −€3008 to −€838). The probability of PT being cost-effective compared with APM was 1.00 at a willingness to pay of €0/unit of effect for the IKDC (knee function) and QALYs (quality of life) and decreased with increasing values of willingness to pay. The probability that PT is non-inferior to APM was 0.97 for all non-inferiority margins for the IKDC and 0.89 for QALYs.

Conclusions

The probability of PT being cost-effective compared with APM was relatively high at reasonable values of willingness to pay for the IKDC and QALYs. Also, PT had a relatively high probability of being non-inferior to APM for both outcomes. This warrants further deimplementation of APM in patients with non-obstructive meniscal tears.

Trial registration numbers

NCT01850719and NTR3908.
Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study
Authors: Flannery Caragh , Dahly Darren , Byrne Molly , Khashan Ali , McHugh Sheena , Kenny Louise C , McAuliffe Fionnuala , Kearney Patricia M
Published: June 2019

Objective

The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy.

Design

This is a secondary analysis of data from a prospective cohort study.

Setting

The study was conducted in Cork, Ireland.

Participants

Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks’ gestation.

Primary and secondary outcomes

The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks’ gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models.

Results

From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups:lowPA (n=393),moderatePA (n=960) andhighPA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low).

Conclusion

The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy.

Trial registration number

ACTRN 12607000551493.
Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns
Authors: van Duynhoven Alysha , Lee Anthony , Michel Ross , Snyder Jeremy , Crooks Valorie , Chow-White Peter , Schuurman Nadine
Published: June 2019

Objectives

Medical crowdfunding is a rapidly growing practice where individuals leverage social networks to raise money for health-related needs. This practice has allowed many to access healthcare and avoid medical debt but has also raised a number of ethical concerns. A dominant criticism of this practice is that it is likely to increase inequities in access to healthcare if persons from relatively wealthy backgrounds, media connections, tech-savvy and educational attainments are best positioned to use and succeed with crowdfunding. However, limited data has been published to support this claim. Our objective in this paper is to assess this concern using socioeconomic data and information from crowdfunding campaigns.

Setting

To assess this concern, we present an exploratory spatial analysis of a new dataset of crowdfunding campaigns for cancer-related care by Canadian residents.

Participants

Four datasets were used: (1) a medical crowdfunding dataset that included cancer-related campaigns posted by Canadians, (2) 2016 Census Profile for aggregate dissemination areas, (3) aggregate dissemination area boundaries and (4) forward sortation area boundaries.

Results

Our exploratory spatial analysis demonstrates that use of crowdfunding for cancer-related needs in Canada corresponds with high income, home ownership and high educational attainment. Campaigns were also commonly located near city centres.

Conclusions

These findings support concerns that those in positions of relative socioeconomic privilege disproportionately use crowdfunding to address health-related needs. This study was not able to determine whether other socioeconomic dimensions such as race, gender, ethnicity, nationality and linguistic fluency are also correlated with use of medical crowdfunding. Thus, we call for further research to explore the relationship between socioeconomic variables and medical crowdfunding campaigning to explore these other socioeconomic variables and campaigns for needs unrelated to cancer.
Cohort study on the effects of depression on atherosclerotic cardiovascular disease risk in Korea
Authors: Jee Yon Ho , Chang Hyoungyoon , Jung Keum Ji , Jee Sun Ha
Published: June 2019

Objectives

Depression has been reported to be a risk factor of cardiovascular disease in the western world, but the association has not yet been studied among Asian populations. The aim of this study was to investigate whether depression increases the risk of developing atherosclerotic cardiovascular disease (ASCVD) in a large Korean cohort study.

Design

Population based cohort study.

Setting

Database of National Health Insurance System, Republic of Korea.

Participants

481 355 Koreans (260 695 men and 220 660 women) aged 40–80 years who had a biennial health check-up between 2002 and 2005.

Main outcome measure

The main outcome in this study was the first ASCVD event (hospital admission or death).

Results

Depression increased the risk of developing ASCVD by 41% for men and 48% for women. In men, 3–4 outpatient visits for depression increased the risk of angina pectoris by 2.12 times (95% CI 1.55 to 2.90) and acute myocardial infarction by 2.29 times (95% CI 1.33 to 3.95). Depression was also associated with stroke in men (HR 1.29, 95% CI 1.19 to 1.39) and in women (HR 1.37, 95% CI 1.29 to 1.46). However, no increased risk of ASCVD was found for men who received 10 or more depressive treatments, compared with those without any outpatient visit for depression.

Conclusions

In this cohort, depressed people were at increased risk of ASCVD incidence. Therefore, individuals with depression may need routine monitoring of heart health that may prevent their future CVD risk.
Fatty liver and mortality: a cohort population study in South Italy
Authors: Caruso Maria Gabriella , Veronese Nicola , Notarnicola Maria , Cisternino Anna Maria , Reddavide Rosa , Inguaggiato Rosa , Guerra Vito , Donghia Rossella , Logroscino Antonio , Rotolo Ornella , Chiloiro Marisa , Leandro Gioacchino , De Leonardis Giampiero , Tutino Valeria , Misciagna G , Bonfiglio Caterina , Guerra Rocco , Osella Alberto
Published: June 2019

Objective

Alcoholic fatty liver (AFLD) and non-alcoholic fatty liver (NAFLD) are two common conditions. However, if they can increase the risk of death is poorly explored. We therefore aimed to investigate the potential association between the presence and severity of liver steatosis and mortality in a large sample of older people.

Design

Prospective.

Setting

Community.

Participants

Women and men randomly sampled from the electoral rolls of the population of Castellana Grotte, a town in Southern Italy (Apulia region) between 2005 and 2006. Among 1942 initially contacted, 1708 (=87.9%) participated to the baseline survey (Multicentrica Colelitiasi III (MICOL III)). This specific study included 1445 older participants (mean age=65.2 years, females=44.2%).

Exposure

NAFLD or AFLD.

Primary and secondary outcomes

Mortality (all-cause and specific-cause).

Results

After a median of 12 years, 312 participants (=21.6%) died. After adjusting for nine potential confounders, the presence of steatosis was not associated with any increased risk of death in both NAFLD and AFLD. The severity of liver steatosis was not associated with any increased risk of mortality in NAFLD, while in AFLD, the presence of moderate steatosis significantly increased the risk of overall (HR=2.16; 95% CI 1.19 to 3.91) and cancer-specific (HR=3.54; 95% CI 1.16 to 10.87) death.

Conclusions

Liver steatosis is not associated with any increased risk of death in NAFLD, while moderate steatosis could be a risk factor for mortality (particularly due to cancer) in people affected by AFLD.
Protracted bacterial bronchitis: bronchial aspirate versus bronchoalveolar lavage findings: a single-centre retrospective study
Authors: Verhulst Stijn , Boel Lieve , Van Hoorenbeeck Kim
Published: June 2019

Retrospective chart review of 133 children who underwent bronchoscopy because of possible protracted bacterial bronchitis to compare the results of bronchial aspirates with those of bronchoalveolar lavage (BAL). When comparing BAL and bronchial aspirate in 70 patients where both samples were available, the result was comparable in 46 cases (65%). If only bronchial aspirates would have been available, seven patients (10%) would have been overtreated, four children (6%) undertreated and three (4%) would have received a different treatment. Although, BAL and bronchial aspirate are comparable in the majority of cases, differences exist with an impact on treatment decision, underlying the uncertainties in the pathophysiology of protracted bacterial bronchitis.
What is the evidence that differences in ‘control over destiny’ lead to socioeconomic inequalities in health? A theory-led systematic review of high-quality longitudinal studies on pathways in the living environment
Authors: Orton Lois Catherine , Pennington Andy , Nayak Shilpa , Sowden Amanda , Petticrew Mark , White Martin , Whitehead Margaret
Published: June 2019

Background

Low control and high demand in the places where people work has been shown to partially explain why those in lower socioeconomic positions experience poorer health than their counterparts in higher socioeconomic positions. It would seem likely then that experiences of control in the wider living environment, beyond people’s places of work, might also play a role in shaping these health inequalities. Our recent review of theory revealed potential pathways by which low control in the living environment might explain the social patterning of health via low control beliefs and low actual control.

Methods

Based on the potential pathways identified in our review of theory, we conducted a systematic review of longitudinal studies on the relationship between low control in the living environment and social inequalities in health published by January 2019, in English.

Results

Six studies were included in the review. Taken together, they provide evidence that lower social positions are associated with lower control beliefs and poorer health outcomes, in terms of heart disease, anxiety, depression and self-rated health, and that some of the association between low social position and health outcomes is explained by low control beliefs. No studies investigated the pathway from low actual control to poorer health in more disadvantaged groups.

Conclusion

There is strong evidence from a small number of high-quality longitudinal studies that low perceived control in the living environment may play an important role in the pathways leading from low social position to poorer health and well-being. Further studies are needed to distinguish between the effects of having low control beliefs and having actual low control.
Clinicopathological characteristics of subtypes of chronic inflammatory demyelinating polyradiculoneuropathy
Authors: Ikeda Shohei , Koike Haruki , Nishi Ryoji , Kawagashira Yuichi , Iijima Masahiro , Katsuno Masahisa , Sobue Gen
Published: June 2019

Objective

To evaluate the clinical and pathological correlations characterising each clinical subtype of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).

Methods

We assessed 106 consecutive patients who had CIDP fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society criteria and had been referred for sural nerve biopsy. Patients with anti-neurofascin 155, anti-contactin 1 and anti-LM1 antibodies were excluded.

Results

55 patients were classified as having typical CIDP. Regarding atypical CIDP, the multifocal acquired demyelinating sensory and motor (MADSAM) (n=15), distal acquired demyelinating symmetric (DADS) (n=16) and pure sensory (n=15) forms were major subtypes, while the pure motor (n=4) and focal (n=1) forms were rare. Nerve conduction studies revealed that distal motor latencies and F-wave latencies were markedly prolonged in the typical CIDP group but relatively preserved in the MADSAM group. Motor conduction velocity was conspicuously slowed in the DADS group, and distal motor latencies were markedly prolonged in the pure sensory group. Sural nerve biopsy specimens from patients with MADSAM, DADS and pure sensory type tended to show extreme variation in myelinated fibre density among fascicles due to focal myelinated fibre loss or onion-bulb formation, whereas patients with typical CIDP tended to show mild fascicular variation. Epineurial lymphocytic infiltration was conspicuous in cases with marked fascicular variation in myelinated fibre density.

Conclusions

Preferential involvement of distal and proximal segments and uniform pathological features in typical CIDP indicate a role of humoral factors at sites where the blood–nerve barrier is deficient. By contrast, focal lesions in MADSAM, DADS and pure sensory forms may share neuropathic mechanisms primarily affecting the nerve trunk.
Damage control resuscitation and surgery for indigenous combat casualties: a prospective observational study
Authors: Campbell Kieran , Naumann D N , Remick K , Wright C
Published: June 2019

Introduction

Specialist units that assist indigenous forces (IF) in their strategic aims are supported by medical teams providing point of injury emergency care for casualties, including IF and civilians (Civ). We investigated the activities of a Coalition Forces far-forward medical facility, in order to inform medical providers about the facilities and resources required for medical support to IF and Civ during such operations.

Methods

A prospective observational study (June to August 2017) undertaken at a far-forward Coalition Forces medical support unit (12 rotating personnel) recorded patient details (IF or Civ), mechanism of injury (MOI), number of blood products used, damage control resuscitation (DCR) and damage control surgery (DCS), number of mass casualty (MASCAL) scenarios, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA) and whole blood emergency donor panels (EDP).

Results

680 casualties included 478 IF and 202 Civ (45.5% of the Civ were paediatric). Most common MOIs were blast (n=425; 62.5%) and gunshot wound (n=200; 29.4%). Fifteen (2.2%) casualties died; 627 (92.2%) were transferred to local hospitals. DCR was used for 203 (29.9%), and DCS for 182 (26.8%) casualties. There were 23 MASCAL scenarios, 1220 transfusions and 32 EDPs. REBOA was performed eight times, and thoracotomy was performed 27 times.

Conclusions

A small medical team provided high-tempo emergency resuscitative care for hundreds of IF and Civ casualties within a short space of time using state-of-the-art resuscitative modalities. DCR and DCS were undertaken with a large number of EDPs, and a high survival-to-transfer rate.
No we shouldn’t be afraid of medical AI; it involves risks and opportunities
Authors: McDougall Rosalind J
Published: June 2019

In contrast to Di Nucci’s characterisation, my argument is not a technoapocalyptic one. The view I put forward is that systems like IBM’s Watson for Oncology create both risks and opportunities from the perspective of shared decision-making. In this response, I address the issues that Di Nucci raises and highlight the importance of bioethicists engaging critically with these developing technologies.
Chromatophoroma in a Siamese fighting fish (Betta splendens)
Authors: Ciambrone Chelsea , Chen Laura R , Tokarz Debra A , Lewbart Gregory A
Published: June 2019

An adult male blue Siamese fighting fish (Betta splendens) presented to the North Carolina State University College of Veterinary Medicine with a cranial mass located dorsal to his right eye. A fine‐needle aspiration was performed followed by supportive care. Due to the patient’s small size aggressive treatment was not elected. The mass continued to expand over a course of five months until the patient was found deceased, and a postmortem examination was performed. Histopathology determined the mass to be a chromatophoroma of the iridophoroma or leucophoroma subtypes. This is the first documentation of a chromatophoroma in B splendens.