bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxoplasma gondii Superinfection and Virulence during Secondary Infection Correlate with the ExactROP5/ROP18Allelic Combination
Authors: Jensen Kirk D. C. , Camejo Ana , Melo Mariane B. , Cordeiro Cynthia , Julien Lindsay , Grotenbreg Gijsbert M. , Frickel Eva-Maria , Ploegh Hidde L. , Young Lucy , Saeij Jeroen P. J.
Published: February 2015

The intracellular parasiteToxoplasma gondiiinfects a wide variety of vertebrate species globally. Infection in most hosts causes a lifelong chronic infection and generates immunological memory responses that protect the host against new infections. In regions where the organism is endemic, multiple exposures toT. gondiilikely occur with great frequency, yet little is known about the interaction between a chronically infected host and the parasite strains from these areas. A widely used model to explore secondary infection entails challenge of chronically infected or vaccinated mice with the highly virulent type I RH strain. Here, we show that although vaccinated or chronically infected C57BL/6 mice are protected against the type I RH strain, they are not protected against challenge with most strains prevalent in South America or another type I strain, GT1. Genetic and genomic analyses implicated the parasite-secreted rhoptry effectors ROP5 and ROP18, which antagonize the host's gamma interferon-induced immunity-regulated GTPases (IRGs), as primary requirements for virulence during secondary infection. ROP5 and ROP18 promoted parasite superinfection in the brains of challenged survivors. We hypothesize that superinfection may be an important mechanism to generateT. gondiistrain diversity, simply because two parasite strains would be present in a single meal consumed by the feline definitive host. Superinfection may drive the genetic diversity of Toxoplasma strains in South America, where most isolates are IRG resistant, compared to North America, where most strains are IRG susceptible and are derived from a few clonal lineages. In summary, ROP5 and ROP18 promote Toxoplasma virulence during reinfection.

IMPORTANCEToxoplasma gondiiis a widespread parasite of warm-blooded animals and currently infects one-third of the human population. A long-standing assumption in the field is that prior exposure to this parasite protects the host from subsequent reexposure, due to the generation of protective immunological memory. However, this assumption is based on clinical data and mouse models that analyze infections with strains common to Europe infections with strains common to Europe and North America. In contrast, we found that the majority of strains sampled from around the world, in particular those from South America, were able to kill or reinfect the brains of hosts previously exposed toT. gondii. TheT. gondiivirulence factors ROP5 and ROP18, which inhibit key host effectors that mediate parasite killing, were required for these phenotypes. We speculate that these results underpin clinical observations that pregnant women previously exposed to Toxoplasma can develop congenital infection upon reexposure to South American strains.
A New Player at the Flagellar Motor: FliL Controls both Motor Output and Bias
Authors: Partridge Jonathan D. , Nieto Vincent , Harshey Rasika M.
Published: February 2015

The bacterial flagellum is driven by a bidirectional rotary motor, which propels bacteria to swim through liquids or swarm over surfaces. While the functions of the major structural and regulatory components of the flagellum are known, the function of the well-conserved FliL protein is not. In Salmonella and Escherichia coli, the absence of FliL leads to a small defect in swimming but complete elimination of swarming. Here, we tracked single motors of these bacteria and found that absence of FliL decreases their speed as well as switching frequency. We demonstrate that FliL interacts strongly with itself, with the MS ring protein FliF, and with the stator proteins MotA and MotB and weakly with the rotor switch protein FliG. These and other experiments show that FliL increases motor output either by recruiting or stabilizing the stators or by increasing their efficiency and contributes additionally to torque generation at higher motor loads. The increased torque enabled by FliL explains why this protein is essential for swarming on an agar surface expected to offer increased resistance to bacterial movement.

IMPORTANCE
FliL is a well-conserved bacterial flagellar protein whose absence leads to a variety of motility defects, ranging from moderate to complete inhibition of swimming in some bacterial species, inhibition of swarming in others, structural defects that break the flagellar rod during swarming in E. coli and Salmonella, and failure to eject the flagellar filament during the developmental transition of a swimmer to a stalk cell in
Caulobacter crescentus
. Despite these many phenotypes, a specific function for FliL has remained elusive. Here, we established a central role for FliL at the Salmonella and E. coli motors, where it interacts with both rotor and stator proteins, increases motor output, and contributes to the normal rotational bias of the motor.
Transmitted/Founder Hepatitis C Viruses Induce Cell-Type- and Genotype-Specific Differences in Innate Signaling within the Liver
Authors: Mitchell Angela M. , Stone Amy E. L. , Cheng Linling , Ballinger Kimberly , Edwards Michael G. , Stoddard Mark , Li Hui , Golden-Mason Lucy , Shaw George M. , Khetani Salman , Rosen Hugo R.
Published: February 2015

Hepatitis C virus (HCV) infection leads to persistence in the majority of cases despite triggering complex innate immune responses within the liver. Although hepatocytes are the preferred site for HCV replication, nonparenchymal cells (NPCs) can also contribute to antiviral immunity. Recent innovations involving single-genome amplification (SGA), direct amplicon sequencing, and phylogenetic inference have identified full-length transmitted/founder (T/F) viruses. Here, we tested the effect of HCV T/F viral RNA (vRNA) on innate immune signaling within hepatocytes and NPCs, including the HepG2 and Huh 7.5.1 cell lines, a human liver endothelial cell line (TMNK-1), a plasmacytoid dendritic cell line (GEN2.2), and a monocytic cell line (THP-1). Transfection with hepatitis C T/F vRNA induced robust transcriptional upregulation of type I and III interferons (IFNs) within HepG2 and TMNK-1 cells. Both the THP-1 and GEN2.2 lines demonstrated higher type I and III IFN transcription with genotype 3a compared to genotype 1a or 1b. Supernatants from HCV T/F vRNA-transfected TMNK-1 cells demonstrated superior viral control. Primary human hepatocytes (PHH) transfected with genotype 3a induced canonical pathways that included chemokine and IFN genes, as well as overrepresentation of RIG-I (DDX58), STAT1, and a Toll-like receptor 3 (TLR3) network. Full-length molecular clones of HCV induce broad IFN responses within hepatocytes and NPCs, highlighting that signals imparted by the various cell types within the liver may lead to divergent outcomes of infection. In particular, the finding that HCV genotypes differentially induce antiviral responses in NPCs and PHH might account for relevant clinical-epidemiological observations (higher clearance but greater necroinflammation in persistence with genotype 3).

IMPORTANCE
Hepatitis C virus (HCV) has become a major worldwide problem, and it is now the most common viral infection for which there is no vaccine. HCV infection often leads to persistence of the virus and is a leading cause of chronic hepatitis, liver cancer, and cirrhosis. There are multiple genotypes of the virus, and patients infected with different viral genotypes respond to traditional therapy differently. However, the immune response to the virus within the liver has not been fully elucidated. Here, we determined the responses to different genotypes of HCV in cell types of the liver. We found that the immune response varied according to both cell type and HCV genotype, leading to a more pronounced induction of inflammatory pathways after exposure to certain genotypes. Therefore, inflammatory pathways that are being robustly activated by certain HCV genotypes could lead to more severe damage to the liver, inducing diverse outcomes and responses to therapy.
Effects of Acupuncture at St36 on Pharmacokinetics of Schisandra lignans in rats
Authors: Ji De , Ning Ziwan , Mao Chunqin , Sun Yong , Liu Jing , Ji Lin , Yang Huan , Huang Zhi-Jun , Lu Tulin
Published: February 2015

Objective

To investigate the influence of acupuncture at ST36 on the pharmacokinetics of Schisandra lignans including schisandrin, deoxyschisandrin and schisandrin B after intragastric administration of Schisandra chinensis (SC) in rats.

Methods

Twelve male Sprague-Dawley rats were randomly divided into two study groups: SC and SC+acupuncture. Rats in both groups received intragastric SC extract at 5.0 g/kg. Rats in the SC+acupuncture group additionally received acupuncture stimulation at ST36 for 30 min after SC administration. Acupuncture needles were rotated bilaterally for 1 min, left in situ for 20 min, then electrically stimulated for 10 min at 50 Hz frequency and 1–3 mA intensity. A sensitive and specific high performance liquid chromatography electrospray tandem mass spectrometry procedure was developed and validated for simultaneous analysis of three bioactive lignans (schisandrin, deoxyschisandrin and schisandrin B) in rat plasma.

Results

There were significant differences (p<0.05) between the two study groups in various pharmacokinetic parameters. Area under the plasma concentration–time curve (AUC0–t), area under the plasma concentration–time curve to time infinity (AUC0–∞) and peak plasma concentration (Cmax) for schisandrin, absorption half-life (T1/2α) and AUC0–t for deoxyschisandrin, and Cmax for schisandrin B were increased in the SC+acupuncture group compared with the SC group. T1/2α for schisandrin B only and time to peak concentration (Tmax) for all three lignans were reduced following acupuncture.

Conclusions

Acupuncture stimulation at ST36 affects the pharmacokinetics of SC in rats. Acupuncture may have a beneficial role in promoting the absorption of lignans from extracts of SC.
Recent advances in paediatric gastroenterology
Authors: Hansen Richard , Russell Richard K , Muhammed Rafeeq
Published: February 2015

Over the last few years, many changes have been introduced in the diagnosis and management of paediatric gastrointestinal problems. This review highlights the recent developments inHelicobacter pyloriinfection, eosinophilic oesophagitis, coeliac disease and inflammatory bowel disease.
Myoepithelial carcinoma of the parotid: a rare tumour that may provide diagnostic difficulty
Authors: Skelton Emily , Jewison Amanda C , Ramesar Keith , Howlett David
Published: February 2015

This report presents the case of a 57-year-old man with a 6-week history of a slowly enlarging lump in the right parotid gland. Initial ultrasound investigation confirmed a 3 cm solid mass located within the superficial lobe of the right parotid gland. Sonographically, the mass demonstrated possible malignant features with internal heterogeneity of architecture and some loss of marginal clarity. Ultrasound-guided core biopsy (USCB) of the mass reported a mixed neoplasm with epithelial and myoepithelial appearances consistent with likely benign adenoma or myoepithelioma. A right superficial parotidectomy was subsequently performed. Histological and immunohistochemical analysis of the excised specimen showed a myoepithelial carcinoma. Postoperative CT and MR staging scans did not show evidence of metastases and no further treatment was given following discussion of the case at the regional speciality multidisciplinary meeting. This case illustrates the clinical and pathological features of this rare salivary gland tumour, but also discusses the diagnostic difficulties that may be encountered preoperatively.
Non-traumatic depressed skull fracture in a neonate or ‘ping pong’ fracture
Authors: Preston David , Jackson Simon , Gandhi Salil
Published: February 2015

This is a case study describing the finding of a depressed skull fracture in a neonate who was delivered without instrumentation and with no history of trauma. Depressed skull fractures are described as being associated with forceps delivery both vaginally and with caesarean section but are much rarer without instrumentation. This obvious abnormality was very concerning for the parents as it was not picked up on antenatal scans and there was no clear cause. There were both cosmetic and neurological concerns and we found no clear consensus on appropriate treatment and prognosis in the literature we had available.
Cardiac arrest following acute puerperal uterine inversion
Authors: Nag Deb Sanjay , Datta Mamta Rath , Samaddar Devi Prasad , Panigrahi Binita
Published: February 2015

Although uterine inversion is a potentially life-threatening complication of childbirth, there are only six case reports of cardiac arrest due to acute inversion to date. We report a successful outcome in a patient with sickle cell disease who had a witnessed cardiac arrest due to acute puerperal uterine inversion. Revival from cardiac arrest and resuscitation was followed by manual repositioning of the uterus. She gradually recovered from the acute kidney injury that developed as sequelae of the cardiac arrest and subsequent circulatory shock. Awareness of this rare complication and timely intervention is the key to a successful outcome in these patients.
Inflammatory bowel disease-like colitis pathology in a patient with common variable immune deficiency
Authors: Comunoglu Nil , Kara Sinem , Kepil Nuray
Published: February 2015

Common variable immunodeficiency (CVID) can show variant histological patterns in the gastrointestinal system. We present a case of an 11-year-old boy who has been followed up with a diagnosis of CVID since he was 6 months old. He presented with abdominal pain and diarrhoea. Colonoscopic biopsy showed crypt destructive colitis, severe decrease and focal absence of plasma cells. Three months later he suffered from abdominal pain, vomiting and bloody diarrhoea. Macroscopic examination of small intestinal resection material revealed multiple perforation areas, ulcers. Histopathology showed mild–moderate active enteritis with aphthous ulcers, purulent peritonitis, decrease in plasma cells and loss of primary follicles in lymph nodes. Histopathological findings were consistent with inflammatory bowel disease (IBD)-like CVID. Although in 6–10% of patients with CVID an IBD-like presentation is observed, this highly aggressive form is rarely seen. We present this case because of its extraordinary presentation displaying perforating active enteropathy.
Giant colonic volvulus due to colonic pseudo-obstruction
Authors: Karaman Kerem , Tanoglu Alpaslan , Beyazit Yavuz , Han Ismet
Published: February 2015

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is a clinical syndrome characterised by gross dilation of the caecum and right hemicolon, which sometimes extends to the sigmoid colon and rectum in the absence of an anatomic lesion in the intestinal lumen. It is characterised by impaired propulsion of contents of the gastrointestinal tract, which results in a clinical picture of intestinal obstruction. A careful examination of the markedly distended colon can exclude several colonic pathologies, including mechanical obstruction and other causes of toxic megacolon. ACPO can sometimes predispose or mimic colonic volvulus, especially in geriatric patients.
The successful use of lipectomy in the management of airway obstruction in a woman with HIV-associated lipodystrophy
Authors: Tsui Edison , Bogdasarian Ronald , Blomain Eric
Published: February 2015

Lipodystrophy is a common complication of highly active antiretroviral therapy and is associated with significant comorbidities. Altered fat distribution, particularly lipohypertrophy of the dorsal cervical fat pad is associated with reduced quality of life as well as medical complications. We report the rare case of a patient with airway obstruction secondary to HIV-associated lipodystrophy. Ultrasound-assisted liposuction was successfully performed to relieve her airway obstruction and to facilitate a tracheostomy. To the best of our knowledge, this is the first documented case of its kind. We also provide a brief review of the literature on the current management options for HIV-associated lipodystrophy.
Transcaval ureter: a rare embryological anomaly causing obstructive uropathy
Authors: Giddy Stephanie , Thangasamy Isaac , Vega Vega Antonio
Published: February 2015

A 21-year-old woman presented with a longstanding history of episodic right flank pain related to fluid consumption and recurrent urinary tract infections. On examination, there was right costovertebral angle tenderness. Renal tract ultrasound demonstrated hydronephrosis and CT urography confirmed transcaval ureter. The patient's clinical presentation was likely due to obstruction associated with the right ureter passing through the opening created by the duplicated segment of the inferior vena cava. While asymptomatic transcaval ureter can be managed conservatively, severe symptoms or complications of ureteric obstruction may require surgical treatment. In this case, treatment comprised a laparoscopic ureteroureterostomy with an end-to-end anastomosis between the proximal and distal sections of the right ureter. The patient's postoperative recovery was uneventful and she reported resolution of the flank pain during the one year of follow-up.
Pathological fractures in a patient with chronic lymphatic leucaemia without disease progression
Authors: Langenberg Jasper C M , Bosman Willem-Maarten , Bremer Jephta van den , Ritchie Ewan D
Published: February 2015

We describe a case of a 59-year-old woman with a medical history of upper leg pain and chronic lymphatic leucaemia (CLL), with known diffuse bone marrow infiltration and without signs of lymphatic or extra-lymphatic disease activity on positron emission tomography CT (PET-CT). She presented with multiple fractures of the pelvis, sacrum and left proximal femur as a result of a low energy fall. During admission, she sustained a non-traumatic fracture of the right proximal femur. Pathological fractures in patients with CLL are usually based on Richter’s transformation or multiple myeloma. However, in the current case, a PET-CT and a bone marrow biopsy showed no signs of this. We did see a normoparathyroid hypercalcaemia in our patient, most likely caused by a CLL-based release of local osteoclast stimulating factors. A combination of fludarabine/cyclofosfamide/rituximab was started as treatment in combination with allopurinol and sodium bicarbonate to prevent further osteolysis.
Coexisting ipsilateral right femoral hernia and incarcerated obturator hernia
Authors: Seppälä Toni T , Tuuliranta Mikko
Published: February 2015

Obturator hernia (OH) is an uncommon cause of bowel obstruction and described in elderly females in the literature. The treatment has traditionally been laparotomy because of an acute nature of the condition. However, because of old age and comorbidities that OH is associated with, general anaesthesia may need to be avoided. In the current case, a transinguinal preperitoneal approach and management are presented after delayed preoperative diagnosis of bowel obstruction caused by a coexisting right incarcerated OH and ipsilateral non-reducible femoral hernia. A 91-year-old woman had a 6-day history of nausea and vomiting. She was referred to surgery because of persisting vomiting, but without any abdominal pain. A CT scan showed a hernia in the right groin area but the diagnosis was delayed. The hernias were repaired using a preperitoneal transinguinal approach. Bowel resection was not needed. The obturator canal and the femoral ring were both covered by a Bard Polysoft patch.
Pneumatosis intestinalis presenting as pneumoperitoneum in a teenage girl with pyloric stenosis
Authors: Wong C W Y , Chung P H Y , Wong K K Y , Tam P K
Published: February 2015

A 16-year-old girl presented with free gas under the diaphragm after endoscopic balloon dilation for pyloric stenosis. There was no perforation site identified on laparotomy. However, there was massive pneumatosis intestinalis involving the entire small bowel.
Iliopsoas tendon rupture: a new differential for atraumatic groin pain post-total hip arthroplasty
Authors: Piggott Robert Pearse , Doody Orla , Quinlan John Francis
Published: February 2015

Groin pain post-total hip arthroplasty (THA) is of concern for the patient and the surgeon, especially when there is no history of any traumatic event. Obvious concern centres on complications from the prosthesis. The use of multiple imaging modalities allow for accurate diagnosis of groin pain. Atraumatic iliopsoas rupture is rare and has only been reported once before in the setting of THA. We present the case of 53-year old female with atraumatic rupture of the iliopsoas tendon that presented with severe groin pain and limited flexion. We discuss the clinical presentation, radiological features and follow-up of the patient. We also discuss the relevant published literature on the topic. This is a rare phenomenon but should be consider in patients with groin pain post-THA, especially after prosthesis complications have been ruled out.
Allergic reaction to polysulphone membrane dialyser masquerading as infection
Authors: Mukaya Japheth E , Jacobson Mitchell S , Esprit Don , Ajayi Tokunbo
Published: February 2015

Hypersensitivity reactions during haemodialysis are well documented in the literature. Most dialysis membrane reactions occur with ethylene oxide or non-biocompatible membranes and less frequently with biocompatible membranes. The symptoms are non-specific except for the temporal relationship typically occurring during the haemodialysis. Patients who present with the non-classic type of reaction pose a diagnostic challenge and clinicians must have a high index of suspicion. We present a non-classic presentation of a hypersensitivity reaction to a polysulfone membrane dialyser with recurrent fevers during and after haemodialysis, initially thought to be due to infection. After a series of negative work ups for infection, dialysis membrane reaction was considered and the patient improved after change of the membrane.
Scimitar syndrome with absent right pulmonary artery and severe pulmonary hypertension treated with coil occlusion of aortopulmonary collaterals in a term neonate
Authors: Parappil Hussain , Masud Faraz , Salama Husam , Rahman Sajjad ur
Published: February 2015

Scimitar syndrome (SS) is a rare congenital malformation with an estimated incidence of approximately 2 in 100 000 births. A wide clinical spectrum is observed in children with this syndrome. The common clinical presentation in infancy is respiratory distress and tachypnoea due to associated pulmonary hypoplasia, pulmonary overcirculation and/or pulmonary hypertension. Babies with SS presenting with cardiac failure are prone to develop exaggerated pulmonary vascular disease. Hence early intervention, using either coil embolisation or surgical intervention, is indicated. We are reporting a case of a term baby boy who presented with respiratory failure during the first 24 h of life. Echocardiogram and CT angiogram revealed SS. The baby needed intubation due to respiratory failure. Aortopulmonary collaterals, identified on aortic angiogram, were successfully occluded with detachable coils.
A case of craniofacial fibrous dysplasia associated with McCune-Albright syndrome lost to follow-up
Authors: Williams Robert Gareth Michael
Published: February 2015

McCune-Albright syndrome is a rare fibro-osseous syndrome characterised by a classic triad of fibrous dysplasia (FD), café-au-lait macules and various underlying endocrinopathies. This case report describes how a patient was rediagnosed by a general dental practitioner following attendance for a routine dental examination. The patient had been previously diagnosed with the condition 28 years earlier but no follow-up or monitoring of her condition had taken place. As a result, she was found to have several undiagnosed and untreated complications of the disease including FD of the mandible, optic neuropathy and potential thyroid involvement.
Extracorporeal laparoscopically assisted resection of a perforated Meckel's diverticulum due to a chicken bone
Authors: Nikolopoulos Ioannis , Ntakomyti Eleni , El-Gaddal Ahmed , Corry Dominic
Published: February 2015

Meckel's diverticulum is the commonest congenital anomaly of the small intestine. It can, however, present acutely relating to a number of complications that may require emergency surgery and possible bowel resection. Perforation is a rare complication and there are only seven cases reported of an inflamed Meckel's diverticulum due to a chicken bone. Laparoscopic repair of Meckel's diverticulum-associated complications has gained popularity over the recent years. We present a case of chicken bone perforation that was treated with laparoscopic-assisted extracorporeal resection of the affected small bowel segment.
Preparticipation injury complaint is a risk factor for injury: a prospective study of the Moscow 2013 IAAF Championships
Authors: Alonso Juan-Manuel , Jacobsson Jenny , Timpka Toomas , Ronsen Ola , Kajenienne Alma , Dahlström Örjan , Spreco Armin , Edouard Pascal
Published: February 2015

Objectives

To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries.

Methods

At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded.

Results

The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001).

Summary and conclusions

About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships.
Comparison of the China growth charts with the WHO growth standards in assessing malnutrition of children
Authors: Yang Zhenyu , Duan Yifan , Ma Guansheng , Yang Xiaoguang , Yin Shian
Published: February 2015

Objectives

To compare the difference between the China growth reference and the WHO growth standards in assessing malnutrition of children under 5 years.

Settings

The households selected from 31 provinces, autonomous regions and municipalities in mainland China (except Taiwan, Hong Kong and Macao).

Participants

Households were selected by using a stratified, multistage probability cluster sampling. Children under 5 years of age in the selected households were recruited (n=15 886).

Primary and secondary outcome measures

Underweight, stunting, wasting, overweight and obesity.

Results

According to the China growth reference, the prevalence of underweight (8.7% vs 4.8%), stunting (17.2% vs 16.1%) and wasting (4.4% vs 3%) was significantly higher than that based on the WHO growth standards, respectively (p<0.001); the prevalence of overweight was lower than that based on the WHO growth standards (9.4% vs 10.2%, p<0.001). In most cases, the prevalence of undernutrition assessed by using the China growth reference was significantly higher. However, the prevalence of overweight was significantly lower by using China charts for boys aged 3–4, 6, 8, 10, 12–18 and 24 months.

Conclusions

The WHO growth standards could be more conservative in undernutrition estimation and more applicable for international comparison for Chinese children. Future researches are warranted for using the WHO growth standards within those countries with local growth charts when there are distinct differences between the two.
Electrophysiological and spinal imaging evidences for sensory dysfunction in amyotrophic lateral sclerosis
Authors: Iglesias Caroline , Sangari Sina , El Mendili Mohamed-Mounir , Benali Habib , Marchand-Pauvert Véronique , Pradat Pierre-François
Published: February 2015

Objectives

The prevalence of sensory impairment at an early stage of amyotrophic lateral sclerosis (ALS) is still debated. The study aim was to investigate the anatomofunctional properties of sensory pathways in patients with ALS, combining spinal diffusion tensor imaging (DTI) and somatosensory evoked potentials (SEPs).

Design

Case–control study.

Settings

ALS referral centre and laboratory of biomedical imaging (Paris, France).

Participants

Well-characterised group of 21 patients with ALS with moderate disability (mean amyotrophic lateral sclerosis Functional Rating Scale (ALSFRS) score 39.3±1.0) and no clinical sensory signs and control group of 21 gender and age-matched healthy subjects.

Outcome measures

Fractional anisotropy and diffusivity of the dorsal columns at C5-T1 levels (DTI metrics) and SEPs after median and ulnar nerve stimulations (latency and amplitude of N9 and N20 components).

Results

Abnormal DTI metrics indicated anatomical damages of ascending sensory fibres in ∼60% of patients (p<0.05). Raw SEPs (μV) were smaller in ∼40% of patients but the difference with healthy subjects was not significant (p>0.16). Their normalisation to prestimulus activity strengthened the difference between groups (p<0.05) and allowed identification of ∼60% of patients with abnormal values. According to N9 latency, the peripheral conduction time was normal in patients (p>0.32) but based on N20 latency, the central conduction time (between spinal cord and parietal cortex) was found to be slower (p<0.05). Significant correlation was found between DTI metrics and N9 amplitude (p<0.05). Altered SEPs were also correlated with the disease duration (p<0.05). Taken together, spinal imaging and electrophysiology helped to identify ∼85% of patients with subclinical sensory defect while separated methods revealed abnormal values in ∼60%.

Conclusions

Sensory impairments have been underestimated at early stages of ALS. These results show for the first time the interest to combine electrophysiology and imaging to assess non-motor system involvement in ALS.

Trial registration number

IDRCB2012-A00016-37.
Perimortem caesarean section
Authors: Parry Richard , Asmussen Tilo , Smith Jason E
Published: February 2015

This review describes a simple approach to perimortem caesarean section (PMCS) that can be used by a doctor in the resuscitation room or prehospital environment when faced with a mother of more than 20 weeks gestation in cardiac arrest. It explores the indications for and contraindications to the procedure, the physiological rationale behind it, equipment needed, technical aspects of the procedure and reviews recent literature on maternal and fetal outcomes. Like other uncommon procedures such as emergency department thoracotomy, rehearsal and preparation for a PMCS is essential to give both mother and baby the best chance of survival.
Burden of irritable bowel syndrome in an increasingly cost-aware National Health Service
Authors: Soubieres Anet , Wilson Patrick , Poullis Andrew , Wilkins Julia , Rance Mark
Published: February 2015

Background

The National Health Service (NHS) is faced with increasing cost pressures that make the efficient use of resources paramount. Irritable bowel syndrome (IBS) places a large burden on the NHS as it has been estimated that at least 12% of the UK population is affected. However, poor clinical coding makes accurate assessment of this burden challenging.

Objective

To calculate primary-care prescribing and both hospital outpatient and admission costs associated with the management of IBS in England.

Design and main outcome measures

Hospital Episode Statistics data for 2012–2013 for all clinical commissioning groups in England were analysed to calculate the tariff cost of IBS. Prescribing analysis and cost tabulation (PACT) data for this period were also analysed.

Results

In 2012–2013, there were 1 219 961 outpatient attendances in gastroenterology and colorectal surgery specialties. Despite this, only 1982 patients were recorded with IBS-specific codes, with a total estimated tariff cost of £812 336. In addition, 28 849 patients were recorded with IBS-related symptom codes at a cost of £11 002 874. In 2011–2012, there were 658 698 diagnostic lower gastrointestinal endoscopies at a tariff cost of £16 967 670 4. Of these, 323 752 (49%) had no further follow-up in secondary care over the subsequent 12 months. PACT data indicated that £44 977 959 and £25 582 752, respectively, were spent on selected laxatives and antispasmodics commonly used to treat IBS in primary care.

Conclusions

Better diagnosing, through improved clinical coding and standardisation of diagnostic criteria, is required to more accurately assess the true burden and allow optimal management of IBS.
LEF1: a highly specific marker for the diagnosis of chronic lymphocytic B cell leukaemia/small lymphocytic B cell lymphoma
Authors: Menter Thomas , Dirnhofer Stephan , Tzankov Alexandar
Published: February 2015

Aims

Chronic lymphocytic B cell leukaemia (CLL)/small lymphocytic B cell lymphoma (SLL) has proven to be not a uniform entity but to consist of various disease subtypes. CLL might also pose diagnostic challenges by demonstrating an uncommon immunohistochemical profile. Recently, the role of lymphocyte enhancer-binding factor 1 (LEF1) in CLL was elucidated being highly expressed and seeming to have a prognostic value. Our aim was to test the applicability of LEF1 as marker for CLL in a diagnostic setting.

Methods

We investigated LEF1 expression in lymphomas by immunohistochemistry on tissue microarrays containing several lymphoma entities (altogether 720 cases, including 61 CLL cases). We also separated CLL cases by zeta-chain-associated protein kinase 70 (ZAP70) and CD38 stainings and fluorescence in situ hybridisation analyses forTP53deletions and trisomy 12 into respective groups and correlated data with LEF1 expression.

Results

The area under the receiver operating characteristic curve for LEF1 as a diagnostic marker for CLL was 0.815 (95% CI 0.742 to 0.888). The relevant diagnostic cut-off value for LEF1 positivity determined by the Youden's index was 10% (specificity 92%, sensitivity 70%). The majority of CLL cases (70%) expressed LEF1. Eighteen per cent of (transformed) diffuse large B cell lymphoma cases also expressed LEF1. In most other lymphoma entities, LEF1 was negative. There was a positive correlation of LEF1 staining with ZAP70 expression (Spearman's rho: 0.438, p<0.001), but not with CD38 expression,TP53deletions or trisomy 12.

Conclusions

LEF1 is a useful marker in the differential diagnosis of CLL in difficult cases. It shows a high specificity (92%) and a reasonable sensitivity (70%) for this entity.
Antiepileptic prophylaxis following severe traumatic brain injury within a military cohort
Authors: Cranley Mark R , Craner M , McGilloway E
Published: February 2015

Introduction

Traumatic brain injury increases the risk of both early and late seizures. Antiepileptic prophylaxis reduces early seizures, but their use beyond 1 week does not prevent the development of post-traumatic epilepsy. Furthermore, prolonged prophylaxis exposes patients to side effects of the drugs and has occupational implications. The American Academy of Neurology recommends that antiepileptic prophylaxis should be started for patients with severe traumatic brain injury and discontinued after 1 week. An audit is presented here that investigates the use of prophylaxis in a cohort of military patients admitted to the UK Defence Medical Rehabilitation Centre (DMRC).

Methods

Data were collected and analysed retrospectively from electronic and paper records between February 2009 and August 2012. The timing and duration of antiepileptic drug use and the incidence of seizures were recorded.

Results

During the study period, 52 patients with severe traumatic brain injury were admitted to the rehabilitation centre: 25 patients (48%) were commenced on prophylaxis during the first week following injury while 27 (52%) did not receive prophylaxis. Only one patient (2%) received prophylaxis for the recommended period of 1 week, 22 patients (42%) received prophylaxis for longer than 1 week with a mean duration of 6.2 months. Two patients (4%) had post-traumatic epilepsy and started on treatment at DMRC.

Conclusions

The use of antiepileptic prophylaxis varies widely and is generally inconsistent with evidence-based guidance. This exposes some patients to a higher risk of early seizures and others to unnecessary use of antiepileptics. Better implementation of prophylaxis is required.
Angiographic suppression of the artery of Adamkiewicz by venous hypertension resolving after embolization in a case of spinal epidural arteriovenous fistula
Authors: Eckart Sorte Danielle , Pardo Carlos A , Gailloud Philippe
Published: February 2015

A case of complete angiographic suppression of the artery of Adamkiewicz and anterior spinal artery in a patient with a spinal epidural arteriovenous fistula (AVF) is reported. Slow flow AVFs typically present with progressive myelopathy secondary to spinal venous hypertension (SVH). The lack of a normal venous phase during angiography and its restoration after treatment is commonly observed with these lesions, yet a similar phenomenon seems exceptional at the arterial level. Right T11 intercostal artery angiograms obtained before and after treatment of a left L4 epidural AVF documented the initial suppression of the artery of Adamkiewicz and anterior spinal artery, and their normal appearance immediately after correction of the SVH by embolization. This report confirms that SVH can angiographically suppress prominent and functionally important spinal arteries, re-emphasizing the potential role played by secondary arterial changes in SVH induced myelopathy. This hemodynamic phenomenon also represents a potential pitfall during diagnostic and therapeutic endovascular procedures.
Depression is a stronger predictor of the risk to consider work disability in early arthritis than disease activity or response to therapy
Authors: Callhoff Johanna , Albrecht Katinka , Schett Georg , Zink Angela , Westhoff Gisela
Published: February 2015

Objectives

To evaluate the factors that influence patients with early inflammatory arthritis to consider a disability pension.

Methods

A total of 528 patients aged 63 or younger from an early arthritis cohort with a mean symptom duration of 3 months at inclusion were asked at 12 and 24 months whether they were considering applying for, had applied for or were receiving a disability pension because of arthritis. Possible predictors were analysed with univariate and multivariate logistic regression.

Results

69 patients (13%) were considering, had applied for or were receiving a disability pension. Univariate predictors were older age, disease activity, several patient-reported outcomes and depression. In a multivariate analysis, age, days on sick leave, impairment of physical function and depression were predictive for considering a disability pension (OR for severe vs no depression: 3.85, 95% CI 1.43 to 10.4).

Conclusions

In patients with early arthritis, depression appears to be a stronger predictor of the risk to consider applying for work disability pension than the features of disease activity. Patients at risk could be identified with one single depression statement. This finding should prompt physicians to react early to signs and symptoms of depression to help patients to maintain their ability to work.
Managing customer service
Authors: Paget Zoe
Published: February 2015

Zoe Paget is the customer services manager at YourVets. Her role includes managing the company's call centre, social media marketing, working with the marketing department to develop customer care initiatives and reporting service levels to the company's directors
Strategic creatine supplementation and resistance training in healthy older adults
Authors: Candow Darren G. , Vogt Emelie , Johannsmeyer Sarah , Forbes Scott C. , Farthing Jonathan P.
Published: February 2015

Creatine supplementation in close proximity to resistance training may be an important strategy for increasing muscle mass and strength; however, it is unknown whether creatine supplementation before or after resistance training is more effective for aging adults. Using a double-blind, repeated measures design, older adults (50–71 years) were randomized to 1 of 3 groups: creatine before (CR-B: n = 15; creatine (0.1 g/kg) immediately before resistance training and placebo (0.1 g/kg cornstarch maltodextrin) immediately after resistance training), creatine after (CR-A: n = 12; placebo immediately before resistance training and creatine immediately after resistance training), or placebo (PLA: n = 12; placebo immediately before and immediately after resistance training) for 32 weeks. Prior to and following the study, body composition (lean tissue, fat mass; dual-energy X-ray absorptiometry) and muscle strength (1-repetition maximum leg press and chest press) were assessed. There was an increase over time for lean tissue mass and muscle strength and a decrease in fat mass (p < 0.05). CR-A resulted in greater improvements in lean tissue mass (Δ 3.0 ± 1.9 kg) compared with PLA (Δ 0.5 ± 2.1 kg; p < 0.025). Creatine supplementation, independent of the timing of ingestion, increased muscle strength more than placebo (leg press: CR-B, Δ 36.6 ± 26.6 kg; CR-A, Δ 40.8 ± 38.4 kg; PLA, Δ 5.6 ± 35.1 kg; chest press: CR-B, Δ 15.2 ± 13.0 kg; CR-A, Δ 15.7 ± 12.5 kg; PLA, Δ 1.9 ± 14.7 kg; p < 0.025). Compared with resistance training alone, creatine supplementation improves muscle strength, with greater gains in lean tissue mass resulting from post-exercise creatine supplementation.
Improved shield tunnel design methodology incorporating design robustness
Authors: Gong Wenping , Huang Hongwei , Juang C. Hsein , Atamturktur Sez , Brownlow Andrew
Published: February 2015

This paper presents an improved design methodology for shield tunnels. Here, a new framework for three-dimensional analysis of shield tunnel “performance” (defined herein as the structural safety and serviceability of each tunnel ring) is developed, which considers the effect of the longitudinal variation of input parameters on the tunnel performance. Within this framework, random fields are used to simulate the longitudinal variation of input parameters, and the three-dimensional problem of shield tunnel performance is solved through a two-stage solution involving a one-dimensional model (for tunnel longitudinal behavior) and a two-dimensional model (for performance of segment rings). Furthermore, the robust design concept is integrated into the design of shield tunnels to guard against the longitudinal variation of tunnel performance caused by the longitudinal variation of input parameters. In the context of robust design, a new measure is developed for determining the robustness of the tunnel performance against the longitudinal variation of noise factors. A multi-objective optimization is then performed to optimize the design with respect to the design robustness and the cost efficiency, while satisfying the safety and serviceability requirements. Through an illustrative example, the effectiveness and significance of the improved shield tunnel design methodology is demonstrated.
Uncorrelated Multiway Discriminant Analysis for Motor Imagery EEG Classification
Authors: Liu Ye , Zhao Qibin , Zhang Liqing
Published: February 2015

Motor imagery-based brain–computer interfaces (BCIs) training has been proved to be an effective communication system between human brain and external devices. A practical problem in BCI-based systems is how to correctly and efficiently identify and extract subject-specific features from the blurred scalp electroencephalography (EEG) and translate those features into device commands in order to control external devices. In real BCI-based applications, we usually define frequency bands and channels configuration that related to brain activities beforehand. However, a steady configuration usually loses effects due to individual variability among different subjects in practical applications. In this study, a robust tensor-based method is proposed for a multiway discriminative subspace extraction from tensor-represented EEG data, which performs well in motor imagery EEG classification without the prior neurophysiologic knowledge like channels configuration and active frequency bands. Motor imagery EEG patterns in spatial-spectral-temporal domain are detected directly from the multidimensional EEG, which may provide insights to the underlying cortical activity patterns. Extensive experiment comparisons have been performed on a benchmark dataset from the famous BCI competition III as well as self-acquired data from healthy subjects and stroke patients. The experimental results demonstrate the superior performance of the proposed method over the contemporary methods.
Measurement of the total cross-section and soft diffraction by the ATLAS and TOTEM experiments at the LHC
Authors: Grafstrom Per
Published: February 2015

This paper reviews measurements of the total proton–proton cross-section at 7 TeV and 8 TeV by the ATLAS and TOTEM collaboration at the LHC. Similarities and differences between the two experiments are discussed. Some results on soft diffraction are also reviewed. The paper ends with a discussion of prospects and future plans of both experiments.
The effect of the angle dependence of d-wave pairing gap on the asymmetric fermion superfluids
Authors: Wang Wei , Shang Xinle
Published: February 2015

A general analysis for the d-wave pairing in two components fermion system. Two physical conditions which can induce mismatched Fermi surfaces are considered: (i) Fixed chemical potential asymmetry δμ and (ii) fixed fermion number asymmetry α. In case (i), the gapless quasiparticle excitation arises both in usual Bardeen–Cooper–Schrieffer (BCS) and Sarma state due to the angle-dependent pairing gap, and they should be distinguished by gap susceptibility κΔ rather than the constraint Δ < δμ. Meanwhile, the d-wave pairing can hold larger chemical potential asymmetry δμ than the s-wave pairing. In case (ii), we find the angle dependence of the d-wave pairing gap can enhance the superfluidity for large asymmetry at low temperature.
Attractivity and Stability Analysis of Uncertain Differential Systems
Authors: Tao Nana , Zhu Yuanguo
Published: February 2015

Uncertain differential system is a type of differential system involving uncertain processes. Stability analysis has been widely studied but no work has been dedicated to attractivity analysis of uncertain differential systems. In this paper, some concepts of attractivity for uncertain differential systems are presented. Then the corresponding sufficient and necessary conditions are given. Furthermore, the stability of the solutions and α-path of uncertain differential systems are studied.