bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability and Crestal Bone Behavior Following Simultaneous Placement of Multiple Dental Implants (Two or More) with the Bone Splitting Technique: A Clinical and Radiographic Evaluation
Authors: Gehrke Sergio Alexandre , Maté Sánchez de Val José Eduardo , Ramírez Fernández Maria Piedad , Shibli Jamil Awad , Rossetti Paulo Henrique Orlato , Calvo Guirado José Luis
Published: May 2016

Purpose

The present study aimed to measure the implant stability quotient (ISQ) values at three different time points after surgical procedures and crestal bone behavior in multiple implants (two or more) installed simultaneously with the bone splitting technique.

Materials and Methods

For this study, 45 patients with different edentulous areas in the maxilla were selected, and a total of 114 dental implants were installed. Implant stability was measured by resonance frequency analysis immediately following implant placement to assess immediate stability (time 1) and stability at 90 days (time 2), and 150 days (time 3). Crestal bone height was measured in peri‐apical radiographs at 90 and 150 days after implantation in relation to each implant shoulder, given that the implants were installed at the level of the crestal bone.

Results

Six implants were not osseointegrated. Overall, the means and standard deviations of the ISQ values were 60.3 ± 4.94 (95% confidence interval [CI], 44–69) at baseline, 66.6 ± 5.28 (95% CI, 49–75) at 90 days, and 72.1 ± 4.28 (95% CI, 59–79) at 150 days (p < 0.0001). The mean marginal bone loss of the implants was 1.11 ± 0.61 mm on the mesial side and 1.17 ± 0.61 mm on the distal side at time 2, and 1.73 ± 0.68 mm on the mesial side and 1.79 ± 0.70 mm on the distal side at time 3. A strong positive correlation between implant stability and bone loss was detected (p < 0.0001).

Conclusions

Within the limits of this study, the bone splitting technique with simultaneous implant installation exhibited a good success rate with respect to the osseointegration index but requires attention with respect to crestal bone behavior.
Protective behavioural strategies while drinking: do they protect against sexual victimisation and is this protection gendered?
Authors: Daigle Leah E. , Johnson Lee M. , Napper Sarah L. , Azimi Andia M.
Published: May 2016

Introduction and Aims

Although alcohol use has been linked to sexual victimisation among college students , the specific ways in which college students may be able to avoid the negative consequences of excessive drinking as they relate to sexual victimisation have not been fully explored. This study examines whether using protective behavioural strategies attenuates the risk of sexual victimisation for both male and female college students and whether this relationship is moderated by alcohol use.

Design and Method

Data were obtained from the Fall 2012 National College Health Assessment Survey. This survey is conducted on college campuses across the USA and institutions that self‐selected to participate in the survey. The sample used in the study includes 19 881 students (male and female) across 51 schools.

Results

Findings indicate that although women are more likely to use protective behavioural strategies, these strategies work to reduce the likelihood of experiencing sexual victimisation for both sexes among those who are high‐frequency drinkers.

Discussion and Conclusions

This study suggests that the frequency of alcohol use is important when considering the risk of sexual victimisation among college students, and protective behavioural strategies can help reduce this risk among frequent drinkers. [Daigle LE, Johnson LM, Napper SL, Azimi AM. Protective behavioural strategies while drinking: do they protect against sexual victimisation and is this protection gendered?. Drug Alcohol Rev 2016;35:573–579]
Add‐on treatment with intermediate‐acting insulin versus sliding‐scale insulin for patients with type 2 diabetes or insulin resistance during cyclic glucocorticoid‐containing antineoplastic chemotherapy: a randomized crossover study
Authors: Gerards M. C. , de Maar J. S. , Steenbruggen T. G. , Hoekstra J. B. L. , Vriesendorp T. M. , Gerdes V. E. A.
Published: May 2016

The aim of this study was to compare the effectiveness and safety of intermediate‐acting insulin (IMI) titrated on body weight and glucocorticoid dose with that of short‐acting sliding‐scale insulin (SSI) in patients on recurrent high‐dose glucocorticoid‐containing chemotherapy. We enrolled 26 patients with type 2 diabetes mellitus or random blood glucose level >12 mmol/l in a previous cycle of chemotherapy in a randomized crossover study. In two consecutive cycles of glucocorticoid‐containing chemotherapy, participants were treated with either IMI or SSI, as add‐on to routine diabetes medication. We compared time spent in target range (3.9–10 mmol/l), measured by continuous glucose monitoring (CGM), and the occurrence of hypoglycaemia. IMI resulted in a higher proportion of glucose values within target range than SSI (34.4 vs 20.9%; p < 0.001). There were no severe or symptomatic hypoglycaemic events. Two participants in each group had a subclinical hypoglycaemia detected only by CGM. Once‐daily IMI resulted in better glycaemic control than SSI in patients with glucocorticoid‐induced hyperglycaemia during chemotherapy. Safety was not compromised as the incidence of hypoglycaemia was low and not different between both regimens.
In vitro assessment of the tooth staining potential of endodontic materials in a bovine tooth model
Authors: Dettwiler Christian A. , Walter Mirella , Zaugg Lucia K. , Lenherr Patrik , Weiger Roland , Krastl Gabriel
Published: May 2016

Background/Aims

Traumatized teeth requiring endodontic intervention may discolor as a result of the treatment performed. Thus, the aim was to investigate the discoloration potential of different endodontic cements, dressings, and irrigants used in dental traumatology.

Materials and methods

Cylindrical cavities were prepared in 330 bovine enamel–dentine blocks (10 × 10 × 3.5 mm), leaving 2 mm of enamel and dentine on the labial side. The specimens were randomly assigned to 22 groups (n = 15). The cavities were filled with a range of endodontic materials, sealed with composite and stored in physiological saline. The color of the labial enamel surface was measured with a spectrophotometer at 7 time intervals: before (T0) and after the placement of the test material (T1 = baseline), after 1 week (T2), 1 month (T3), 3 months (T4), 6 months (T5), and 12 months (T6). The color difference values (ΔE) were calculated and further analyzed by anova and the Tukey–Kramer post hoc test (α = 0.05).

Results

After 12 months, significant staining was observed among the endodontic cements only in the Portland cement group with additional bismuth oxide (H‐MED PC BiOx; ΔE 22.2). Specimens with other commercially available calcium silicate cements containing bismuth oxide were not significantly discolored. All specimens with endodontic dressings and irrigants were color stable except the tested triple antibiotic paste (M‐TreVitaMix; ΔE 14.9) and the double antibiotic paste (N‐BiMix; ΔE 14.9). Both mixtures did not contain tetracycline derivatives.

Conclusions

The presence of bismuth oxide in calcium silicate cements was not shown to be a reliable predictor for tooth discoloration. Antibiotic pastes without tetracycline derivatives do not guarantee the color stability of teeth.
Reliance of brown trout on terrestrial prey varies with season but not fish density
Authors: Milardi Marco , Thomas Stephen M. , Kahilainen Kimmo K.
Published: May 2016

The importance of terrestrial carbon in aquatic ecosystems is widely recognised, but patterns of terrestrial reliance can be variable. Fish often act as important links between terrestrial and aquatic ecosystems, but little is known about how resource seasonality and fish density influence fish reliance on terrestrial energy in lakes.

We sampled a high‐latitude subarctic lake in Finnish Lapland during the open‐water season over three consecutive years to assess both patterns of terrestrial reliance and trophic niche structure of introduced brown trout (Salmo trutta), the only resident fish species. The small size of the study lake made it possible to sample the whole population by conducting a complete fish removal, allowing for a direct assessment of size structure and changes in brown trout density over time.

We hypothesised that annual and seasonal shifts in the dietary niches of brown trout would directly track the availability of pulsed resources such as aquatic and terrestrial insects as well as rodents. We further expected that dietary niche shifts would be correlated with population density, leading to a smaller trophic niche size at lower densities. We therefore investigated the annual and seasonal patterns of resource use using measures of dietary niche and in particular of terrestrial reliance, derived from stomach content analysis and stable‐isotope analyses (SIA) of liver and muscle, along a temporal gradient of declining fish density.

According to stomach content, terrestrial reliance in brown trout was the highest in each year at mid‐to‐late summer, evidently following the peak abundance of terrestrial invertebrates and rodents. Surprisingly, we could not detect annual or seasonal shifts in terrestrial reliance from estimates provided by isotope ratios in muscle or liver. Furthermore, fish density did not appear to influence either terrestrial reliance or trophic niche size. However, trophic position derived fromSIAof liver tissue decreased with decreasing densities, while fish condition increased.

Large, consistent pulses of terrestrial invertebrates in mid‐summer (or rodents during their peak years) are likely important for brown trout in the long term and could explain the lack of density‐dependent correlation in terrestrial reliance. However, further studies are needed to link the abundance of pulsed resources to resource use by fish across wider gradients of lake size, productivity and fish density.
Comparison of the compact dry TC method with the standard method ISO 21149:2006 for determining aerobic colony counts in cosmetic emulsion
Authors: De Vaugelade S. , Aime M. , Farcette N. , Maurel E. , Lacour T. , Thomas C. , Bouchonnet S. , Pirnay S.
Published: May 2016

Objective

Compact Dry TC, a rapid method kit for determining aerobic colony counts, has been developed by Nissui Pharmaceutical Co. for food application. These plates are pre‐sterilized and contain culture medium, a cold‐soluble gelling agent and a colour redox indicator for rapid enumeration. In this study, the alternative method is compared with the standard method ISO 21149:2006 – Cosmetic – Microbiology – Enumeration and detection of aerobic mesophilic bacteria, for cosmetic emulsions application.

Methods

An oil‐in‐water (o/w) cosmetic emulsion was contaminated with a pool of bacterial strains (Escherichia coli ATCC 8739, Staphylococcus aureus ATCC 6538 and Pseudomonas aeruginosa ATCC 9027). One millilitre of samples was spread on agar as described in ISO 21149. The colonies were enumerated after 3 days of incubation. At the same time, 1.2 mL samples were spread on Compact Dry TC kits. The kit was incubated at 35°C ± 1°C for 48 h, and the colonies were enumerated.

Accuracy determination was carried out using six replicates at four levels of concentrations (10, 50, 100 and 250 CFU mL−1). The repeatability study was carried out using 12 replicates at four levels of concentrations (10, 50, 100 and 250 CFU mL−1). Variations relative to the analyst and to the batch of emulsion have been investigated.

Results

The linear correlation coefficients of Compact Dry TC Kit enumeration with standard method ISO 21149:2006 was 0.9999. In comparison study, no apparent differences were noted between the Compact Dry TC kit and the reference method ISO 21149, for the detection level of aerobic microorganisms. Relative accuracy, repeatability and intermediate precision studies were acceptable.

In the repeatability study, the Shapiro‐Wilk test has confirmed the normally distribution of the twelve assays. No significant variations in Compact Dry TC count results were observed with different analysts and different batches of emulsion.

Conclusion

The results showed that the two compared methods ‘Compact Dry TC’ vs. ‘conventional pour plate’ performed equally well. Demonstration was achieved that the Compact Dry TC method may constitute a useful alternative tool for rapid enumeration of aerobic mesophilic bacteria in cosmetic emulsions.
The patient–physician interaction as a meeting of experts: one solution to the problem of patient non‐adherence
Authors: Yelovich Mary‐Clair
Published: May 2016

Patient non‐adherence is a common and important concern in clinical medicine. Some cases of patient non‐adherence are cases in which the patient disagrees with the physician's recommended treatment based on particular reasons. Drawing upon science and technology studies literature, specifically the discussion by Collins and Evans and Wynne of how best to understand scientific controversies, I relate their ideas to the analogous conflict that may occur within a clinical interaction. I draw upon their recognition of the importance of contributory expertise and interactional expertise in providing legitimate knowledge. I also draw upon Wynne's idea of the ‘negotiation of meanings’ as an important element of the clinical interaction. To resolve potential conflicts between patient and physician before they develop into ‘non‐adherence’, I propose the implementation of a new epistemological framework that recognizes legitimate knowledge offered by the patient as well as the physician. By situating this patient expertise framework within the paradigm of patient‐centred medicine, and by assuming the goal of medical treatment to be treatment of suffering, patient expertise becomes centralized as a means of determining the nature of patient suffering. Two aspects of the patient's tacit knowledge – the body aspect and the meaning aspect – both of which are context‐dependent and directly accessible only to the patient, are thus recognized as knowledge essential to the success of the interaction. The physician's role becomes that of both medical expert and possessor of ‘interactional expertise’, by which the physician recognizes and includes patient expertise in the treatment decision. By recognizing and incorporating the negotiation of meanings into the development of a treatment plan, this epistemological model of patient expertise should prevent cases of non‐adherence based on disagreement.
Dynamic visualisation of storm surge flood routing based on three‐dimensional numerical simulation
Authors: Liu X.J. , Zhong D.H. , Tong D.W. , Zhou Z.Y. , Ao X.F. , Li W.Q.
Published: May 2016

Storm surge flood risk management and mitigation is one of the crucial concerns of the municipalities of coastal areas. The spatial and temporal distribution of hydrological information of floods could be obtained based on computational fluid dynamics simulation. One‐ or two‐dimensional mathematical models, which may fail to simulate the storm surge flood with radically changing characters, are commonly used by investigators. Meanwhile, numerical simulation results may be intricate for people with limited professional knowledge. This study aims at the creation of a three‐dimensional (3D) visualisation of the flood routing process, which can be used to raise awareness of flood risk without waiting for real floods to occur. The numerical simulation is conducted based on the 3D unsteady k–ε mathematical model combined with the volume of fluid established in this work. The dynamic visualisation is realised in a 3D urban scenario utilising the scalar field visualisation techniques, texture mapping technique and smoothed particle hydrodynamics method. The case study demonstrates that 3D visualisation could be an effective tool for presenting the dynamic changes of hydrological information visually and realistically.
Trends in Children's Family Instability, 1995–2010
Authors: Brown Susan L. , Stykes J. Bart , Manning Wendy D.
Published: May 2016

Using data from the 1995 and 2006–2010 National Survey of Family Growth, the authors' study examined children's family instability from birth to age 12, emphasizing variation by racial and ethnic group. Period and cohort estimates revealed little change in children's experiences of family transitions during the past decade. Family instability levels were comparable for White and Hispanic children, and this pattern persisted over time. However, there was an increase in family instability among Black children, reflecting growth in the share of children born to single mothers who eventually formed partnerships. Indeed, children born to single mothers in the more recent cohort experienced more family transitions, on average, than did the earlier cohort, but family instability for children born to cohabiting mothers remained unchanged. This study elucidates the various family life course trajectories children experience, revealing how these patterns differ depending on family context at birth and by racial and ethnic group.
Chronic kidney disease in European patients with obstructive sleep apnea: the ESADA cohort study
Authors: Marrone Oreste , Battaglia Salvatore , Steiropoulos Paschalis , Basoglu Ozen K. , Kvamme John A. , Ryan Silke , Pepin Jean‐Louis , Verbraecken Johan , Grote Ludger , Hedner Jan , Bonsignore Maria R. ,   the ESADA study group
Published: May 2016

The cross‐sectional relationship of obstructive sleep apnea with moderate to severe chronic kidney disease, defined as an estimated glomerular filtration rate <60 mL min−1∙1.73 m−2, was investigated in a large cohort of patients with suspected obstructive sleep apnea studied by nocturnal polysomnography or cardiorespiratory polygraphy. Data were obtained from the European Sleep Apnea Database, where information from unselected adult patients with suspected obstructive sleep apnea afferent to 26 European sleep centres had been prospectively collected. Both the Modification of Diet in Renal Disease and the Chronic Kidney Disease‐Epidemiology Collaboration equations were used for the assessment of estimated glomerular filtration rate. The analysed sample included 7700 subjects, 71% male, aged 51.9 ± 12.5 years. Severe obstructive sleep apnea (apnea–hypopnea index ≥30) was found in 34% of subjects. The lowest nocturnal oxygen saturation was 81 ± 10.2%. Chronic kidney disease prevalence in the whole sample was 8.7% or 6.1%, according to the Modification of Diet in Renal Disease or the Chronic Kidney Disease‐Epidemiology Collaboration equations, respectively. Subjects with lower estimated glomerular filtration rate were older, more obese, more often female, had worse obstructive sleep apnea and more co‐morbidities (P < 0.001, each). With both equations, independent predictors of estimated glomerular filtration rate <60 were: chronic heart failure; female gender; systemic hypertension; older age; higher body mass index; and worse lowest nocturnal oxygen saturation. It was concluded that in obstructive sleep apnea, chronic kidney disease is largely predicted by co‐morbidities and anthropometric characteristics. In addition, severe nocturnal hypoxaemia, even for only a small part of the night, may play an important role as a risk factor for kidney dysfunction.
National survey on concepts for congenital hypothyroidism screening in neonatal intensive care units in Japan
Authors: Uchiyama Atsushi , Sugihara Sigetaka , Kusuda Satoshi
Published: May 2016

Background

Recently, a revised version of the Guidelines for Mass Screening of Congenital Hypothyroidism (CH) was published in Japan, but it is not known whether the guidelines are used routinely in neonatal intensive care units (NICU).

Methods

To clarify the current status and issues of newborn screening (NBS) for CH in Japanese NICU, we sent a questionnaire by mail or email to neonatologists responsible for 100 tertiary NICU in Japan, and analyzed their responses.

Results

The response rate was 92% (92/100). Among respondents, 65% (59/91) performed thyroid function testing separately from NBS for CH. Within this group, 63% (37/59) applied criteria, mostly for very low‐birthweight (VLBW) infants (25/37). Only 29% of respondents (26/90), however, used criteria to select VLBW infants for treatment. Furthermore, criteria differed in each NICU. Fifty‐seven percent of respondents (50/87) reported issues regarding NBS for CH in NICU, which fell into three main areas: establishment of a clear method for the management of VLBW infants; necessity of simultaneous measurement of thyroid‐stimulating hormone and free thyroxine; and overlapping blood collection for NBS and thyroid function tests.

Conclusions

Two‐thirds of tertiary NICU performed thyroid function testing separately from NBS for CH. Approximately 60% of neonatologists responded that current NBS for CH had ongoing issues. Further research is needed to establish the optimal NBS protocol for CH in NICU in Japan.
An Extended Single‐index Model with Missing Response at Random
Authors: Wang Qihua , Zhang Tao , Härdle Wolfgang Karl
Published: May 2016

An extended single‐index model is considered when responses are missing at random. A three‐step estimation procedure is developed to define an estimator for the single‐index parameter vector by a joint estimating equation. The proposed estimator is shown to be asymptotically normal. An algorithm for computing this estimator is proposed. This algorithm only involves one‐dimensional nonparametric smoothers, thereby avoiding the data sparsity problem caused by high model dimensionality. Some simulation studies are conducted to investigate the finite sample performances of the proposed estimators.
Chinese Private Lending Risk and Monetary Policy Operating
Authors: Tian Guangning , Li Kaiyan
Published: May 2016

The private lending risk was more likely expressed as the forms of various funding raising disputes, which originated from the borrowers’ solvency problems. Whether the change of monetary policy had an impact on the civil financial risk and how much of the influence were worth of consideration. Based on the analysis of how monetary policy operated on the private lending risk, we took some key data, such as the amount, the involved number and the interest rates deprived from the private lending disputes cases happened in our country from 2003 to 2014, to construct the model between the index of private lending risk and the monetary policy variables. Also we need to explore the inner relationship between them. The empirical results show that the monetary policy tools do have an impact on the private lending risk to some different degree. More specifically, the implication for the monetary policy operations is that we should not use the deposit reserve policy and the credit policy more frequently, while the rediscount policy and the open market operation have more advantage on the balance of macroeconomic regulation and the private lending risk control.
Quantifying Neuromuscular Fatigue Induced by an Intense Training Session in Rugby Sevens
Authors: Marrier Bruno , Le Meur Yann , Robineau Julien , Lacome Mathieu , Couderc Anthony , Hausswirth Christophe , Piscione Julien , Morin Jean-Benoît
Published: May 2016

Purpose:

To compare the sensitivity of a sprint vs a countermovement-jump (CMJ) test after an intense training session in international rugby sevens players, as well as analyze the effects of fatigue on sprint acceleration.

Methods:

Thirteen international rugby sevens players completed two 30-m sprints and a set of 4 repetitions of CMJ before and after a highly demanding rugby sevens training session.

Results:

Change in CMJ height was unclear (–3.6%; ±90% confidence limits 11.9%. Chances of a true positive/trivial/negative change: 24/10/66%), while a very likely small increase in 30-m sprint time was observed (1.0%; ±0.7%, 96/3/1%). A very likely small decrease in the maximum horizontal theoretical velocity (V0) (–2.4; ±1.8%, 1/4/95%) was observed. A very large correlation (r = –.79 ± .23) between the variations of V0 and 30-m-sprint performance was also observed. Changes in 30-m sprint time were negatively and very largely correlated with the distance covered above the maximal aerobic speed (r = –.71 ± .32).

Conclusions:

The CMJ test appears to be less sensitive than the sprint test, which casts doubts on the usefulness of a vertical-jump test in sports such as rugby that mainly involve horizontal motions. The decline in sprint performance relates more to a decrease in velocity than in force capability and is correlated with the distance covered at high intensity.
A Systematic Review of Submaximal Cycle Tests to Predict, Monitor, and Optimize Cycling Performance
Authors: Capostagno Benoit , Lambert Michael I. , Lamberts Robert P.
Published: May 2016

Finding the optimal balance between high training loads and recovery is a constant challenge for cyclists and their coaches. Monitoring improvements in performance and levels of fatigue is recommended to correctly adjust training to ensure optimal adaptation. However, many performance tests require a maximal or exhaustive effort, which reduces their real-world application. The purpose of this review was to investigate the development and use of submaximal cycling tests that can be used to predict and monitor cycling performance and training status. Twelve studies met the inclusion criteria, and 3 separate submaximal cycling tests were identified from within those 12. Submaximal variables including gross mechanical efficiency, oxygen uptake (VO2), heart rate, lactate, predicted time to exhaustion (pTE), rating of perceived exertion (RPE), power output, and heart-rate recovery (HRR) were the components of the 3 tests. pTE, submaximal power output, RPE, and HRR appear to have the most value for monitoring improvements in performance and indicate a state of fatigue. This literature review shows that several submaximal cycle tests have been developed over the last decade with the aim to predict, monitor, and optimize cycling performance. To be able to conduct a submaximal test on a regular basis, the test needs to be short in duration and as noninvasive as possible. In addition, a test should capture multiple variables and use multivariate analyses to interpret the submaximal outcomes correctly and alter training prescription if needed.
The remnants of coronary heart disease
Authors: Brown J. Mark
Published: May 2016

Rare genetic sequence variants reveal remnant lipoproteins as the next optimal drug target for coronary heart disease.
Nus Factors of
Escherichia coli
Authors: Sen Ranjan , Chalissery Jisha , Qayyum M. Zuhaib , Vishalini V. , Muteeb Ghazala
Published: May 2016

The highly conserved Nus factors of bacteria were discovered as essential host proteins for the growth of temperate phage λ in
Escherichia coli
. Later, their essentiality and functions in transcription, translation, and, more recently, in DNA repair have been elucidated. Close involvement of these factors in various gene networks and circuits is also emerging from recent genomic studies. We have described a detailed overview of their biochemistry, structures, and various cellular functions, as well as their interactions with other macromolecules. Towards the end, we have envisaged different uncharted areas of studies with these factors, including their participation in pathogenicity.
A Herpesviral Lytic Protein Regulates the Structure of Latent Viral Chromatin
Authors: Raja Priya , Lee Jennifer S. , Pan Dongli , Pesola Jean M. , Coen Donald M. , Knipe David M.
Published: May 2016

Latent infections by viruses usually involve minimizing viral protein expression so that the host immune system cannot recognize the infected cell through the viral peptides presented on its cell surface. Herpes simplex virus (HSV), for example, is thought to express noncoding RNAs such as latency-associated transcripts (LATs) and microRNAs (miRNAs) as the only abundant viral gene products during latent infection. Here we describe analysis of HSV-1 mutant viruses, providing strong genetic evidence that HSV-infected cell protein 0 (ICP0) is expressed during establishment and/or maintenance of latent infection in murine sensory neurons
in vivo
. Studies of an
ICP0
nonsense mutant virus showed that ICP0 promotes heterochromatin and latent and lytic transcription, arguing that ICP0 is expressed and functional. We propose that ICP0 promotes transcription of LATs during establishment or maintenance of HSV latent infection, much as it promotes lytic gene transcription. This report introduces the new concept that a lytic viral protein can be expressed during latent infection and can serve dual roles to regulate viral chromatin to optimize latent infection in addition to its role in epigenetic regulation during lytic infection. An additional implication of the results is that ICP0 might serve as a target for an antiviral therapeutic acting on lytic and latent infections.

IMPORTANCE
Latent infection by viruses usually involves minimizing viral protein synthesis so that the host immune system cannot recognize the infected cells and eliminate them. Herpes simplex virus has been thought to express only noncoding RNAs as abundant gene products during latency. In this study, we found genetic evidence that an HSV lytic protein is functional during latent infection, and this protein may provide a new target for antivirals that target both lytic and latent infections.
Fungal Infections Associated with Contaminated Steroid Injections
Authors: Kauffman Carol A. , Malani Anurag N.
Published: May 2016

In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke, spinal or paraspinal infection, or peripheral osteoarticular infection, and 64 (8.5%) died. Most patients had undergone epidural injection, and a few osteoarticular injection, of methylprednisolone acetate that had been manufactured at the New England Compounding Center (NECC). The offending pathogen in most cases was
Exserohilum rostratum
, a brown-black soil organism that previously was a rare cause of human infection. Three lots of methylprednisolone were contaminated with mold at NECC; the mold from unopened bottles of methylprednisolone was identical by whole-genome sequencing to the mold that was isolated from ill patients. Early cases manifested as meningitis, some patients suffered posterior circulation strokes, and later cases were more likely to present with localized infection at the injection site, including epidural abscess or phlegmon, vertebral diskitis or osteomyelitis, and arachnoiditis with intradural involvement of nerve roots. Many patients with spinal or paraspinal infection required surgical intervention. Recommendations for treatment evolved over the first few weeks of the outbreak. Initially, combination therapy with liposomal amphotericin B and voriconazole was recommended for all patients; later, combination therapy was recommended only for those who were most ill, and voriconazole monotherapy was recommended for most patients. Among those patients who continued antifungal therapy for at least 6 months, outcomes for most appeared to be successful, although a few patients remain on therapy.
Environmental Disturbances Decrease the Variability of Microbial Populations within Periphyton
Authors: Herren Cristina M. , Webert Kyle C. , McMahon Katherine D.
Published: May 2016

There are many reasons why microbial community composition is difficult to model. For example, the high diversity and high rate of change of these communities make it challenging to identify causes of community turnover. Furthermore, the processes that shape community composition can be either deterministic, which cause communities to converge upon similar compositions, or stochastic, which increase variability in community composition. However, modeling microbial community composition is possible only if microbes show repeatable responses to extrinsic forcing. In this study, we hypothesized that environmental stress acts as a deterministic force that shapes microbial community composition. Other studies have investigated if disturbances can alter microbial community composition, but relatively few studies ask about the repeatability of the effects of disturbances. Mechanistic models implicitly assume that communities show consistent responses to stressors; here, we define and quantify microbial variability to test this assumption.
Appendicitis during pregnancy in a Greenlandic Inuit woman; antibiotic treatment as a bridge-to-surgery in a remote area
Authors: Dalsgaard Jensen Trine , Penninga Luit
Published: May 2016

Appendicitis during pregnancy causes severe diagnostic problems, and is associated with an increase in perforation rate and morbidity compared to that in the normal population. In addition, it may cause preterm birth and fetal loss. In remote areas, appendicitis during pregnancy, besides presenting diagnostic problems, also creates treatment difficulties. In Northern Greenland, geographical distances are vast, and weather conditions can be extreme. We report a case of a Greenlandic Inuit woman who presented with appendicitis during pregnancy. The nearest hospital with surgical and anaesthetic care was located nearly 1200 km away, and, due to extreme weather conditions, she could not be transferred immediately. She was treated with intravenous antibiotic treatment, and after weather conditions had improved, she was transferred by aeroplane and underwent appendicectomy. She recovered without complications. Our case suggests that appendicitis during pregnancy may be treated with antibiotics in remote areas until surgical treatment is available.
Uncommon cause of acute encephalopathy in liver cirrhosis
Authors: Dieuvil Monique , Malaty John
Published: May 2016

A 49-year-old woman with a medical history of alcoholic cirrhosis status post-transjugular intrahepatic portosystemic shunt (post-TIPS) in 2012, and ongoing alcohol abuse, presented to the hospital, with haematuria. CT intravenous pyelogram (IVP) was normal except for ‘a large intrahepatic cystic mass adjacent to the TIPS, causing intrahepatic biliary duct dilation’. The patient also presented with acute encephalopathy, jaundice, right upper quadrant abdominal pain and hyperbilirubinaemia (total bilirubin of 8.1 mg/dL with direct bilirubin of 3.0 mg/dL). She remained encephalopathic despite adequate treatment for alcohol withdrawal, hepatic encephalopathy and enterococcus urinary tract infection. MRI of the abdomen later confirmed presence of an obstructing biloma. The biloma, drained by CT-guided percutaneous drains, demonstrated an Escherichia coli and ESBL Klebsiella infection. The patient's encephalopathy completely resolved after treatment of the infected biloma. With adequate drainage, her hyperbilirubinaemia resolved to her post-TIPS baseline (total bilirubin of 3.7 mg/dL with direct bilirubin of 3.3 mg/dL).
Benign anlage tumour: a very unusual neck mass
Authors: Parihar Shivani , Gohil Rohit , Oparka Richie , Kennedy Ceilidh
Published: May 2016

A 44-year-old woman presented with a slow-growing asymptomatic neck swelling at the left medial clavicle. Haematological and biochemical work up was normal and an ultrasound confirmed the swelling, but needle aspiration was non-diagnostic. As lymphoma was the main differential diagnosis, the swelling was completely excised. Immunohistochemistry yielded a rare lesion, suspected to represent a myoepithelial/mixed cellularity tumour of soft tissue. The extreme rarity of these tumours required a confirmatory secondary opinion, which ultimately led to it being identified as a benign anlage tumour (previously known as an ectopic hamartomatous thymoma). This case highlights the fact that thorough assessment of patients with neck swellings should be undertaken to rule out sinister causes—keeping in mind more rare differentials—helping to guide final management.
Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period
Authors: Brembilla-Perrot Béatrice , Olivier Arnaud , Sellal Jean-Marc , Manenti Vladimir , Brembilla Alice , Villemin Thibaut , Admant Philippe , Beurrier Daniel , Bozec Erwan , Girerd Nicolas
Published: May 2016

Objectives

There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS.

Setting

Single-centre retrospective study of patient files.

Participants

In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary.

Primary and secondary outcome measures

Occurrence of atrial fibrillation (AF) or procedure-induced adverse event.

Results

Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01).

Conclusions

In this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly patients, the decision for EPS and AP ablation should be discussed in light of their suspected higher risk of events and ablation complications. However, these findings should be further validated in future prospective multicentre studies.
Prevalence and trends of sensitisation to aeroallergens in patients with allergic rhinitis in Guangzhou, China: a 10-year retrospective study
Authors: Wang Weihao , Huang Xuekun , Chen Zhuanggui , Zheng Rui , Chen Yulian , Zhang Gehua , Yang Qintai
Published: May 2016

Objective

To investigate the prevalence and trends of sensitisation to common aeroallergens among outpatients with allergic rhinitis (AR) in Guangzhou, China, over the past decade.

Design

A retrospective study; linear-by-linear association and simple linear regression were used to determine the trends in the prevalence of aeroallergen sensitisation.

Setting

One grade-A hospital in Guangzhou, the largest city in southern China.

Participants

A total of 5486 patients (2297 males and 2489 females) who visited the ear, nose and throat outpatient clinic, from January 2005 to December 2014, were enrolled. All patients who presented with nasal hyper-reactive symptoms and who completed serological allergy testing, measuring specific IgE (sIgE) in the serum, were included. Among them, 4085 participants (2269 males and 1816 females) were diagnosed as being patients with AR.

Outcome measures

Prevalence and trends of sensitisation to various types of aeroallergens were assessed.

Results

The overall prevalence of sIgE-mediated sensitisation to aeroallergens in these patients with AR were as follows: 84.4% for house dust mites (HDMs), 23.4% for pet allergens, 21.1% for cockroaches, 9.1% for mould allergens, 7.7% for tree pollen and 6.0% for weed pollen. When all patients with nasal hyper-reactivity were stratified by decade of age, increasing age was associated with a decrease in sIgE positivity by ∼5.13% (95% CI −7.28% to −2.98%, p<0.01). Within the past decade, the prevalence of sensitisation to pet allergens in patients with AR increased at an annual rate of 1.3% (95% CI 0.85% to 1.67%, p<0.01).

Conclusions

This study demonstrated that HDMs comprised the most common aeroallergen in Guangzhou. The prevalence of sensitisation to aeroallergens decreased with increasing age. During the past decade, the prevalence of sensitisation to pet allergens showed an upward trend, suggesting an urgent need for its prevention and treatment.
Mechanical thrombectomy with the ERIC retrieval device: initial experience
Authors: Raoult Hélène , Redjem Hocine , Bourcier Romain , Gaultier-Lintia Alina , Daumas-Duport Benjamin , Ferré Jean-Christophe , Eugène François , Fahed Robert , Bartolini Bruno , Piotin Michel , Desal Hubert , Gauvrit Jean-Yves , Blanc Raphaël
Published: May 2016

Objective

To report our experience with the Embolus Retriever with Interlinked Cage (ERIC) stentriever for use in mechanical endovascular thrombectomy (MET).

Methods

Thirty-four consecutive patients with acute stroke (21 men and 13 women; median age 66 years) determined appropriate for MET were treated with ERIC and prospectively included over a 6-month period at three different centers. The ERIC device differs from typical stentrievers in that it is designed with a series of interlinked adjustable nitinol cages that allow for fast thrombus capture, integration, and withdrawal. The evaluated endpoints were successful revascularization (Thrombolysis in Cerebral Infarction (TICI) 2b–3) and good clinical outcomes at 3 months (modified Rankin Scale (mRS) 0–2).

Results

Locations of the occlusions included the middle cerebral artery (13 patients), terminal carotid artery (11 patients), basilar artery (1 patient), and tandem occlusions (9 patients). IV thrombolysis was performed in 20/34 (58.8%) patients. Median times from symptom onset to recanalization and from puncture to recanalization were 325.5 min (180–557) and 78.5 min (14–183), respectively. Used as the first-line device, ERIC achieved a successful recanalization in 20/24 (83.3%) patients. Successful recanalization was associated with lower National Institutes of Health Stroke Scale scores at 24 h (8±6.5 vs 21.5±2.1; p=0.008) and lower mRS at 3 months (2.7±2.1 vs 5.3±1.1; p=0.04). Three procedural complications and four asymptomatic hemorrhages were recorded. Good clinical outcomes at 3 months were seen in 15/31 (48.4%) patients.

Conclusions

The ERIC device is an innovative stentriever allowing fast, effective, and safe MET.
Therapeutic implications of autoantibodies in rheumatoid arthritis
Authors: Aletaha Daniel , Blüml Stephan
Published: May 2016

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by the presence of autoantibodies. Their value for diagnostic/prognostic purposes has been well established. In contrast, their role in established disease and their associations with disease activity is less clear. Moreover, as evidence is accumulating that these autoantibodies are causally involved in certain key aspects of the disease, such as the initiation and perpetuation of joint inflammation or join destruction, autoantibodies in RA can no longer be regarded as mere epiphenomena, but are integral elements of the pathophysiology of RA.
Leucocyte subset-specific type 1 interferon signatures in SLE and other immune-mediated diseases
Authors: Flint Shaun M , Jovanovic Vojislav , Teo Boon Wee , Mak Anselm , Thumboo Julian , McKinney Eoin F , Lee James C , MacAry Paul , Kemeny David M , Jayne David RW , Fong Kok Yong , Lyons Paul A , Smith Kenneth GC
Published: May 2016

Objectives

Type 1 interferons (IFN-1) are implicated in the pathogenesis of systemic lupus erythematosus (SLE), but most studies have only reported the effect of IFN-1 on mixed cell populations. We aimed to define modules of IFN-1-associated genes in purified leucocyte populations and use these as a basis for a detailed comparative analysis.

Methods

CD4+ and CD8+ T cells, monocytes and neutrophils were purified from patients with SLE, other immune-mediated diseases and healthy volunteers and gene expression then determined by microarray. Modules of IFN-1-associated genes were defined using weighted gene coexpression network analysis. The composition and expression of these modules was analysed.

Results

1150 of 1288 IFN-1-associated genes were specific to myeloid subsets, compared with 11 genes unique to T cells. IFN-1 genes were more highly expressed in myeloid subsets compared with T cells. A subset of neutrophil samples from healthy volunteers (HV) and conditions not classically associated with IFN-1 signatures displayed increased IFN-1 gene expression, whereas upregulation of IFN-1-associated genes in T cells was restricted to SLE.

Conclusions

Given the broad upregulation of IFN-1 genes in neutrophils including in some HV, investigators reporting IFN-1 signatures on the basis of whole blood samples should be cautious about interpreting this as evidence ofbona fideIFN-1-mediated pathology. Instead, specific upregulation of IFN-1-associated genes in T cells may be a useful biomarker and a further mechanism by which elevated IFN-1 contributes to autoimmunity in SLE.
Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
Authors: Lesuis N , den Broeder A A , Hulscher M E J L , van Vollenhoven R F
Published: May 2016

Objectives

To assess variation in and determinants of rheumatologist guideline adherence in patients with rheumatoid arthritis (RA), in daily practice.

Methods

In this retrospective observational study, guideline adherence in the first year of treatment was assessed for 7 predefined parameters on diagnostics, treatment and follow-up in all adult patients with RA with a first outpatient clinic visit at the study centre, from September 2009 to March 2011. Variation in guideline adherence was assessed on parameter and rheumatologist level. Determinants for guideline adherence were assessed in patients (demographic characteristics, rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide antibody (aCCP) positivity, erythrocyte sedimentation rate, erosive disease, comorbidity and the number of available disease modifying anti-rheumatic drug (DMARD) treatment options) and rheumatologists (demographic and practice characteristics, guideline knowledge and agreement, outcome expectancy, cognitive bias, thinking style, numeracy and personality).

Results

A total of 994 visits in 137 patients with RA were reviewed. Variation in guideline adherence among parameters was present (adherence between 21% and 72%), with referral to the physician assistant as lowest scoring and referral to a specialised nurse as highest scoring parameter. Variation in guideline adherence among rheumatologists was also present (adherence between 22% and 100%). Patient sex, the number of DMARD options, presence of erosions, comorbidity, RF/aCCP positivity, type of patient and the rheumatologists' scientific education status were associated with adherence to 1 or more guideline parameters.

Conclusions

Guideline adherence varied considerably among the guideline parameters and rheumatologists, showing that there is room for improvement. Guideline adherence in our sample was related to several patient and rheumatologist determinants.