bluuebunny/crossref_metadata_2025 huggingface dataset:
Dehalococcoides mccartyi Strain DCMB5 Respires a Broad Spectrum of Chlorinated Aromatic Compounds
Authors: Pöritz Marlén , Schiffmann Christian L. , Hause Gerd , Heinemann Ulrike , Seifert Jana , Jehmlich Nico , von Bergen Martin , Nijenhuis Ivonne , Lechner Ute
Published: November 2014

Polyhalogenated aromatic compounds are harmful environmental contaminants and tend to persist in anoxic soils and sediments.
Dehalococcoides mccartyi
strain DCMB5, a strain originating from dioxin-polluted river sediment, was examined for its capacity to dehalogenate diverse chloroaromatic compounds. Strain DCMB5 used hexachlorobenzenes, pentachlorobenzenes, all three tetrachlorobenzenes, and 1,2,3-trichlorobenzene as well as 1,2,3,4-tetra- and 1,2,4-trichlorodibenzo-
p
-dioxin as electron acceptors for organohalide respiration. In addition, 1,2,3-trichlorodibenzo-
p
-dioxin and 1,3-, 1,2-, and 1,4-dichlorodibenzo-
p
-dioxin were dechlorinated, the latter to the nonchlorinated congener with a remarkably short lag phase of 1 to 4 days following transfer. Strain DCMB5 also dechlorinated pentachlorophenol and almost all tetra- and trichlorophenols. Tetrachloroethene was dechlorinated to trichloroethene and served as an electron acceptor for growth. To relate selected dechlorination activities to the expression of specific reductive dehalogenase genes, the proteomes of 1,2,3-trichlorobenzene-, pentachlorobenzene-, and tetrachloroethene-dechlorinating cultures were analyzed. Dcmb_86, an ortholog of the chlorobenzene reductive dehalogenase CbrA, was the most abundant reductive dehalogenase during growth with each electron acceptor, suggesting its pivotal role in organohalide respiration of strain DCMB5. Dcmb_1041 was specifically induced, however, by both chlorobenzenes, whereas 3 putative reductive dehalogenases, Dcmb_1434, Dcmb_1339, and Dcmb_1383, were detected only in tetrachloroethene-grown cells. The proteomes also harbored a type IV pilus protein and the components for its assembly, disassembly, and secretion. In addition, transmission electron microscopy of DCMB5 revealed an irregular mode of cell division as well as the presence of pili, indicating that pilus formation is a feature of
D. mccartyi
during organohalide respiration.
Transcriptomics-Aided Dissection of the Intracellular and Extracellular Roles of Microcystin in Microcystis aeruginosa PCC 7806
Authors: Makower A. Katharina , Schuurmans J. Merijn , Groth Detlef , Zilliges Yvonne , Matthijs Hans C. P. , Dittmann Elke
Published: November 2014

Recent studies have provided evidence for both intracellular and extracellular roles of the potent hepatotoxin microcystin (MC) in the bloom-forming cyanobacterium
Microcystis
. Here, we surveyed transcriptomes of the wild-type strain
M. aeruginosa
PCC 7806 and the microcystin-deficient Δ
mcyB
mutant under low light conditions with and without the addition of external MC of the LR variant (MC-LR). Transcriptomic data acquired by microarray and quantitative PCR revealed substantial differences in the relative expression of genes of the central intermediary metabolism, photosynthesis, and energy metabolism. In particular, the data provide evidence for a lower photosystem I (PSI)-to-photosystem II (PSII) ratio and a more pronounced carbon limitation in the microcystin-deficient mutant. Interestingly, only 6% of the transcriptional differences could be complemented by external microcystin-LR addition. This MC signaling effect was seen exclusively for genes of the secondary metabolism category. The orphan polyketide synthase gene cluster IPF38-51 was specifically downregulated in response to external MC-LR under low light. Our data suggest a hierarchical and light-dependent cross talk of secondary metabolites and support both an intracellular and an extracellular role of MC in
Microcystis
.
Genomic Diversity and Virulence Profiles of Historical Escherichia coli O157 Strains Isolated from Clinical and Environmental Sources
Authors: Rump Lydia V. , Gonzalez-Escalona Narjol , Ju Wenting , Wang Fei , Cao Guojie , Meng Sean , Meng Jianghong
Published: November 2014

Escherichia coli
O157:H7 is, to date, the major
E. coli
serotype causing food-borne human disease worldwide. Strains of O157 with other H antigens also have been recovered. We analyzed a collection of historic O157 strains (
n
= 400) isolated in the late 1980s to early 1990s in the United States. Strains were predominantly serotype O157:H7 (55%), and various O157:non-H7 (41%) serotypes were not previously reported regarding their pathogenic potential. Although lacking Shiga toxin (
stx
) and
eae
genes, serotypes O157:H1, O157:H2, O157:H11, O157:H42, and O157:H43 carried several virulence factors (
iha
,
terD
, and
hlyA
) also found in virulent serotype
E. coli
O157:H7. Pulsed-field gel electrophoresis (PFGE) showed the O157 serogroup was diverse, with strains with the same H type clustering together closely. Among non-H7 isolates, serotype O157:H43 was highly prevalent (65%) and carried important enterohemorrhagic
E. coli
(EHEC) virulence markers (
iha
,
terD
,
hlyA
, and
espP
). Isolates from two particular H types, H2 and H11, among the most commonly found non-O157 EHEC serotypes (O26:H11, O111:H11, O103:H2/H11, and O45:H2), unexpectedly clustered more closely with O157:H7 than other H types and carried several virulence genes. This suggests an early divergence of the O157 serogroup to clades with different pathogenic potentials. The appearance of important EHEC virulence markers in closely related H types suggests their virulence potential and suggests further monitoring of those serotypes not implicated in severe illness thus far.
Application of Chitosan Microparticles for Reduction of Vibrio Species in Seawater and Live Oysters (Crassostrea virginica)
Authors: Fang Lei , Wolmarans Bernhard , Kang Minyoung , Jeong Kwang C. , Wright Anita C.
Published: November 2014

Human
Vibrio
infections associated with consumption of raw shellfish greatly impact the seafood industry.
Vibrio cholerae
-related disease is occasionally attributed to seafood, but
V. vulnificus
and
V. parahaemolyticu
s are the primary targets of postharvest processing (PHP) efforts in the United States, as they pose the greatest threat to the industry. Most successful PHP treatments for
Vibrio
reduction also kill the molluscs and are not suitable for the lucrative half-shell market, while nonlethal practices are generally less effective. Therefore, novel intervention strategies for
Vibrio
reduction are needed for live oyster products. Chitosan is a bioactive derivative of chitin that is generally recognized as safe as a food additive by the FDA, and chitosan microparticles (CMs) were investigated in the present study as a potential PHP treatment for live oyster applications. Treatment of broth cultures with 0.5% (wt/vol) CMs resulted in growth cessation of
V. cholerae
,
V. vulnificus
, and
V. parahaemolyticus
, reducing culturable levels to nondetectable amounts after 3 h in three independent experiments. Furthermore, a similar treatment in artificial seawater at 4, 25, and 37°C reduced
V. vulnificus
levels by ca. 7 log CFU/ml after 24 h of exposure, but 48 h of exposure and elevated temperature were required to achieve similar results for
V. parahaemolyticus
and
V. cholerae
. Live oysters that either were artificially inoculated or contained natural populations of
V. vulnificus
and
V. parahaemolyticus
showed significant and consistent reductions following CM treatment (5%) compared to the amounts in the untreated controls. Thus, the results strongly support the promising potential for the application of CMs as a PHP treatment to reduce
Vibrio
spp. in intact live oysters.
Engineering Neurospora crassa for Improved Cellobiose and Cellobionate Production
Authors: Hildebrand Amanda , Szewczyk Edyta , Lin Hui , Kasuga Takao , Fan Zhiliang
Published: November 2014

We report engineering
Neurospora crassa
to improve the yield of cellobiose and cellobionate from cellulose. A previously engineered strain of
N. crassa
(F5) with six of seven β-glucosidase (
bgl
) genes knocked out was shown to produce cellobiose and cellobionate directly from cellulose without the addition of exogenous cellulases. In this study, the F5 strain was further modified to improve the yield of cellobiose and cellobionate from cellulose by increasing cellulase production and decreasing product consumption. The effects of two catabolite repression genes,
cre-1
and
ace-1
, on cellulase production were investigated. The F5 Δ
ace-1
mutant showed no improvement over the wild type. The F5 Δ
cre-1
and F5 Δ
ace-1
Δ
cre-1
strains showed improved cellobiose dehydrogenase and exoglucanase expression. However, this improvement in cellulase expression did not lead to an improvement in cellobiose or cellobionate production. The cellobionate phosphorylase gene (
ndvB
) was deleted from the genome of F5 Δ
ace-1
Δ
cre-1
to prevent the consumption of cellobiose and cellobionate. Despite a slightly reduced hydrolysis rate, the F5 Δ
ace-1
Δ
cre-1
Δ
ndvB
strain converted 75% of the cellulose consumed to the desired products, cellobiose and cellobionate, compared to 18% converted by the strain F5 Δ
ace-1
Δ
cre-1
.
Aerosolization of Respirable Droplets from a Domestic Spa Pool and the Use of MS-2 Coliphage and Pseudomonas aeruginosa as Markers for Legionella pneumophila
Authors: Moore Ginny , Hewitt Matthew , Stevenson David , Walker Jimmy T. , Bennett Allan M.
Published: November 2014

Legionnaires' disease can result when droplets or aerosols containing legionella bacteria are inhaled and deposited in the lungs. A number of outbreaks have been associated with the use of a spa pool where aeration, a high water temperature, and a large and variable organic load make disinfectant levels difficult to maintain. Spa pool ownership is increasing, and the aim of this study, using two surrogate organisms (MS-2 coliphage and
Pseudomonas aeruginosa
[a natural contaminant]), was to assess the potential risk to domestic users when disinfection fails. A representative “entry level” domestic spa pool was installed in an outdoor courtyard. The manufacturer's instructions for spa pool maintenance were not followed. A cyclone sampler was used to sample the aerosols released from the spa pool with and without activation of the air injection system. Samples were taken at increasing heights and distances from the pool. An aerodynamic particle sizer was used to measure the water droplet size distribution at each sample point. When the air injection system was inactivated, neither surrogate organism was recovered from the air. On activation of the air injection system, the mean mass of droplets within the respirable range (10 cm above the water line) was 36.8 μg cm
−3
. This corresponded to a mean air concentration of
P. aeruginosa
of 350 CFU m
−3
. From extrapolation from animal data, the estimated risk of infection from aerosols contaminated with similar concentrations of
Legionella pneumophila
was 0.76 (males) and 0.65 (females). At 1 m above and/or beyond the pool, the mean aerosol mass decreased to 0.04 μg cm
−3
and corresponded to a 100-fold reduction in mean microbial air concentration. The estimated risk of infection at this distance was negligible.
Glutamate Decarboxylase-Dependent Acid Resistance in Brucella spp.: Distribution and Contribution to Fitness under Extremely Acidic Conditions
Authors: Damiano Maria Alessandra , Bastianelli Daniela , Al Dahouk Sascha , Köhler Stephan , Cloeckaert Axel , De Biase Daniela , Occhialini Alessandra
Published: November 2014

Brucella
is an expanding genus of major zoonotic pathogens, including at least 10 genetically very close species occupying a wide range of niches from soil to wildlife, livestock, and humans. Recently, we have shown that in the new species
Brucella microti
, the glutamate decarboxylase (Gad)-dependent system (GAD system) contributes to survival at a pH of 2.5 and also to infection in mice by the oral route. In order to study the functionality of the GAD system in the genus
Brucella
, 47 isolates, representative of all known species and strains of this genus, and 16 strains of the closest neighbor genus,
Ochrobactrum
, were studied using microbiological, biochemical, and genetic approaches. In agreement with the genome sequences, the GAD system of classical species was not functional, unlike that of most strains of
Brucella ceti
,
Brucella pinnipedialis
, and newly described species (
B. microti
,
Brucella inopinata
BO1,
B. inopinata
-like BO2, and
Brucella
sp. isolated from bullfrogs). In the presence of glutamate, these species were more acid resistant
in vitro
than classical terrestrial brucellae. Expression in
trans
of the
gad
locus from representative
Brucella
species in the
Escherichia coli
MG1655 mutant strain lacking the GAD system restored the acid-resistant phenotype. The highly conserved GAD system of the newly described or atypical
Brucella
species may play an important role in their adaptation to acidic external and host environments. Furthermore, the GAD phenotype was shown to be a useful diagnostic tool to distinguish these latter
Brucella
strains from
Ochrobactrum
and from classical terrestrial pathogenic
Brucella
species, which are GAD negative.
Entericidin Is Required for a Probiotic Treatment (Enterobacter sp. Strain C6-6) To Protect Trout from Cold-Water Disease Challenge
Authors: Schubiger Carla B. , Orfe Lisa H. , Sudheesh Ponnerassery S. , Cain Kenneth D. , Shah Devendra H. , Call Douglas R.
Published: November 2014

Flavobacterium psychrophilum
causes bacterial cold-water disease in multiple fish species, including salmonids. An autochthonous
Enterobacter
strain (C6-6) inhibits the
in vitro
growth of
F. psychrophilum
, and when ingested as a putative probiotic, it provides protection against injection challenge with
F. psychrophilum
in rainbow trout. In this study, low-molecular-mass (≤3 kDa) fractions from both
Enterobacter
C6-6 and
Escherichia coli
K-12 culture supernatants inhibited the growth of
F. psychrophilum
. The ≤3-kDa fraction from
Enterobacter
C6-6 was analyzed by SDS-PAGE, and subsequent tandem mass spectroscopy identified EcnB, which is a small membrane lipoprotein that is a putative pore-forming toxin. Agar plate diffusion assays demonstrated that
ecnAB
knockout strains of both
Enterobacter
C6-6 and
E. coli
K-12 no longer inhibited
F. psychrophilum
(
P
< 0.001), while
ecnAB
-complemented knockout strains recovered the inhibitory phenotype (
P
< 0.001). In fish experiments, the engineered strains (C6-6 Δ
ecnAB
and C6-6 Δ
ecnAB
<pET101::
ecnAB
>) and the wild-type strain (C6-6) were added to the fish diet every day for 38 days. On day 11, the fish were challenged by injection with a virulent strain of
F. psychrophilum
(CSF 259-93). Fish that were fed C6-6 had significantly longer survival than fish fed the
ecnAB
knockout strain (
P
< 0.0001), while fish fed the complemented knockout strain recovered the probiotic phenotype (
P
= 0.61). This entericidin is responsible for the probiotic activity of
Enterobacter
C6-6, and it may present new opportunities for therapeutic and prophylactic treatments against similarly susceptible pathogens.
Exposure to Synthetic Gray Water Inhibits Amoeba Encystation and Alters Expression of Legionella pneumophila Virulence Genes
Authors: Buse Helen Y. , Lu Jingrang , Ashbolt Nicholas J.
Published: November 2014

Water conservation efforts have focused on gray water (GW) usage, especially for applications that do not require potable water quality. However, there is a need to better understand environmental pathogens and their free-living amoeba (FLA) hosts within GW, given their growth potential in stored gray water. Using synthetic gray water (sGW) we examined three strains of the water-based pathogen
Legionella pneumophila
and its FLA hosts
Acanthamoeba polyphaga
,
A. castellanii
, and
Vermamoeba vermiformis
. Exposure to sGW for 72 h resulted in significant inhibition (
P
< 0.0001) of amoebal encystation versus control-treated cells, with the following percentages of cysts in sGW versus controls:
A. polyphaga
(0.6 versus 6%),
A. castellanii
(2 versus 62%), and
V. vermiformis
(1 versus 92%), suggesting sGW induced maintenance of the actively feeding trophozoite form. During sGW exposure,
L. pneumophila
culturability decreased as early as 5 h (1.3 to 2.9 log
10
CFU,
P
< 0.001) compared to controls (Δ0 to 0.1 log
10
CFU) with flow cytometric analysis revealing immediate changes in membrane permeability. Furthermore, reverse transcription-quantitative PCR was performed on total RNA isolated from
L. pneumophila
cells at 0 to 48 h after sGW incubation, and genes associated with virulence (
gacA
,
lirR
,
csrA
,
pla
, and
sidF
), the type IV secretion system (
lvrB
and
lvrE
), and metabolism (
ccmF
and
lolA
) were all shown to be differentially expressed. These results suggest that conditions within GW may promote interactions between water-based pathogens and FLA hosts, through amoebal encystment inhibition and alteration of bacterial gene expression, thus warranting further exploration into FLA and
L. pneumophila
behavior in GW systems.
Both the Charged Linker Region and ATPase Domain of Hsp90 Are Essential for Rad51-Dependent DNA Repair
Authors: Suhane Tanvi , Laskar Shyamasree , Advani Siddheshwari , Roy Nabamita , Varunan Shalu , Bhattacharyya Dibyendu , Bhattacharyya Sunanda , Bhattacharyya Mrinal Kanti
Published: November 2014

The inhibition of Hsp90 in cancerous cells has been correlated with the reduction in double-strand break (DSB repair) activity. However, the precise effect of Hsp90 on the DSB repair pathway in normal cells has remained enigmatic. Our results show that the Hsp82 chaperone, the ortholog of mammalian Hsp90, is indispensable for homologous-recombination (HR)-mediated DNA repair in the budding yeast
Saccharomyces cerevisiae
. A considerable reduction in cell viability is observed in an Hsp82-inactivated mutant upon methyl methanesulfonate (MMS) treatment as well as upon UV treatment. The loss of Hsp82 function results in a dramatic decrease in gene-targeting efficiency and a marked decrease in the endogenous levels of the key recombination proteins Rad51 and Rad52 without any notable change in the levels of
RAD51
or
RAD52
transcripts. Our results establish Rad51 as a client of Hsp82, since they interact physically
in vivo
, and also show that when Hsp82 is inhibited by 17-AAG, Rad51 undergoes proteasomal degradation. By analyzing a number of point mutants with mutations in different domains of Hsp82, we observe a strong association between the sensitivity of an ATPase mutant of Hsp82 to DNA damage and the decreases in the amounts of Rad51 and Rad52 proteins. The most significant observations include the dramatic abrogation of HR activity and the marked decrease in Rad51 focus formation in the charged linker deletion mutant of Hsp82 upon MMS treatment. The charged linker region of Hsp82 is evolutionarily conserved in all eukaryotes, but until now, no biological significance has been assigned to it. Our findings elucidate the importance of this region in DNA repair for the first time.
The Hsp90 Cochaperones Cpr6, Cpr7, and Cns1 Interact with the Intact Ribosome
Authors: Tenge Victoria R. , Zuehlke Abbey D. , Shrestha Neelima , Johnson Jill L.
Published: November 2014

The abundant molecular chaperone Hsp90 is essential for the folding and stabilization of hundreds of distinct client proteins. Hsp90 is assisted by multiple cochaperones that modulate Hsp90's ATPase activity and/or promote client interaction, but the
in vivo
functions of many of these cochaperones are largely unknown. We found that Cpr6, Cpr7, and Cns1 interact with the intact ribosome and that
Saccharomyces cerevisiae
lacking
CPR7
or containing mutations in
CNS1
exhibited sensitivity to the translation inhibitor hygromycin. Cpr6 contains a peptidyl-prolyl isomerase (PPIase) domain and a tetratricopeptide repeat (TPR) domain flanked by charged regions. Truncation or alteration of basic residues near the carboxy terminus of Cpr6 disrupted ribosome interaction. Cns1 contains an amino-terminal TPR domain and a poorly characterized carboxy-terminal domain. The isolated carboxy-terminal domain was able to interact with the ribosome. Although loss of
CPR6
does not cause noticeable growth defects, overexpression of
CPR6
results in enhanced growth defects in cells expressing the temperature-sensitive
cns1-G90D
mutation (the G-to-D change at position 90 encoded by
cns1
). Cpr6 mutants that exhibit reduced ribosome interaction failed to cause growth defects, indicating that ribosome interaction is required for
in vivo
functions of Cpr6. Together, these results represent a novel link between the Hsp90 molecular-chaperone machine and protein synthesis.
The Dictyostelium discoideum GPHR Ortholog Is an Endoplasmic Reticulum and Golgi Protein with Roles during Development
Authors: Deckstein Jaqueline , van Appeldorn Jennifer , Tsangarides Marios , Yiannakou Kyriacos , Müller Rolf , Stumpf Maria , Sukumaran Salil K. , Eichinger Ludwig , Noegel Angelika A. , Riyahi Tanja Y.
Published: November 2014

Dictyostelium discoideum
GPHR (
G
olgi
pH
r
egulator)/Gpr89 is a developmentally regulated transmembrane protein present on the endoplasmic reticulum (ER) and the Golgi apparatus. Transcript levels are low during growth and vary during development, reaching high levels during the aggregation and late developmental stages. The
Arabidopsis
ortholog was described as a G protein-coupled receptor (GPCR) for abscisic acid present at the plasma membrane, whereas the mammalian ortholog is a Golgi apparatus-associated anion channel functioning as a Golgi apparatus pH regulator. To probe its role in
D. discoideum
, we generated a strain lacking GPHR. The mutant had different growth characteristics than the AX2 parent strain, exhibited changes during late development, and formed abnormally shaped small slugs and fruiting bodies. An analysis of development-specific markers revealed that their expression was disturbed. The distributions of the endoplasmic reticulum and the Golgi apparatus were unaltered at the immunofluorescence level. Likewise, their functions did not appear to be impaired, since membrane proteins were properly processed and glycosylated. Also, changes in the external pH were sensed by the ER, as indicated by a pH-sensitive ER probe, as in the wild type.
Evidence for a Regulatory Role of Diatom Silicon Transporters in Cellular Silicon Responses
Authors: Shrestha Roshan P. , Hildebrand Mark
Published: November 2014

The utilization of silicon by diatoms has both global and small-scale implications, from oceanic primary productivity to nanotechnological applications of their silica cell walls. The sensing and transport of silicic acid are key aspects of understanding diatom silicon utilization. At low silicic acid concentrations (<30 μM), transport mainly occurs through silicic acid transport proteins (SITs), and at higher concentrations it occurs through diffusion. Previous analyses of the SITs were done either in heterologous systems or without a distinction between individual SITs. In the present study, we examined individual SITs in
Thalassiosira pseudonana
in terms of transcript and protein abundance in response to different silicic acid regimes and examined knockdown lines to evaluate the role of the SITs in transport, silica incorporation, and lipid accumulation resulting from silicon starvation. SIT1 and SIT2 were localized in the plasma membrane, and protein levels were generally inversely correlated with cellular silicon needs, with a distinct response being found when the two SITs were compared. We developed highly effective approaches for RNA interference and antisense knockdowns, the first such approaches developed for a centric diatom. SIT knockdown differentially affected the uptake of silicon and the incorporation of silicic acid and resulted in the induction of lipid accumulation under silicon starvation conditions far earlier than in the wild-type cells, suggesting that the cells were artificially sensing silicon limitation. The data suggest that the transport role of the SITs is relatively minor under conditions with sufficient silicic acid. Their primary role is to sense silicic acid levels to evaluate whether the cell can proceed with its cell wall formation and division processes.
Targeting Toxoplasma Tubules: Tubulin, Microtubules, and Associated Proteins in a Human Pathogen
Authors: Morrissette Naomi
Published: November 2014

Toxoplasma gondii
is an obligate intracellular parasite that causes serious opportunistic infections, birth defects, and blindness in humans. Microtubules are critically important components of diverse structures that are used throughout the
Toxoplasma
life cycle. As in other eukaryotes, spindle microtubules are required for chromosome segregation during replication. Additionally, a set of membrane-associated microtubules is essential for the elongated shape of invasive “zoites,” and motility follows a spiral trajectory that reflects the path of these microtubules.
Toxoplasma
zoites also construct an intricate, tubulin-based apical structure, termed the conoid, which is important for host cell invasion and associates with proteins typically found in the flagellar apparatus. Last, microgametes specifically construct a microtubule-containing flagellar axoneme in order to fertilize macrogametes, permitting genetic recombination. The specialized roles of these microtubule populations are mediated by distinct sets of associated proteins. This review summarizes our current understanding of the role of tubulin, microtubule populations, and associated proteins in
Toxoplasma
; these components are used for both novel and broadly conserved processes that are essential for parasite survival.
Acupuncture Points in the Book of ŞErefeddin SabuncuoğLu, a 15Th Century Turkish Physician
Authors: Acar H Volkan
Published: November 2014

Şerefeddin Sabuncuoğlu (1385–1468?), the author of Cerrahiyetü'l-Haniyye (Imperial Surgery), was a distinguished Ottoman Turkish surgeon. The first illustrated Turkish surgical textbook, Cerrahiyetü'l-Haniyye consisted of three chapters (ie, cauterisation treatments, surgical procedures and fractures and dislocations). Although the main source of the book was Al-Tasrif (Textbook of Surgery) by Albucasis (Abu al-Qasim al-Zahrawi; 936–1013 AD), Sabuncuoğlu added much new information, his clinical experiences and suggestions. The original illustrations and human figures made Cerrahiyetü'l-Haniyye the first illustrated medical textbook in Turkish and Islamic medicine literature. Cerrahiyetü'l-Haniyye was also a valuable source for acupuncturists. Some new sections and additions revealed that Sabuncuoğlu had knowledge of Chinese medicine. In four sections of Cerrahiyetü'l-Haniyye (ie, toothache, haemorrhoids, eczema and dermatophytosis) Sabuncuoğlu described acupuncture techniques and point locations. It is likely that the Chinese medicine content of Cerrahiyetü'l-Haniyye was derived from Central Asian roots of Anatolian Turkish people.
Clinical signs in young patients with stroke related to FAST: results of the sifap1 study
Authors: Kaps Manfred , Grittner Ulrike , Jungehülsing Gerhard , Tatlisumak Turgut , Kessler Christoph , Schmidt Reinhold , Jukka Putaala , Norrving Bo , Rolfs Arndt , Tanislav Christian
Published: November 2014

Objectives

The present study aimed to evaluate the frequency of warning signs in younger patients with stroke with a special regard to the ‘FAST’ scheme, a public stroke recognition instrument (face,arm,speech,timely).

Setting

Primary stroke care in participating centres of a multinational European prospective cross-sectional study (Stroke in Young Fabry Patients; sifap1). Forty-seven centres from 15 European countries participate in sifap1.

Participants

5023 acute patients with stroke (aged 18–55 years) patients (96.5% Caucasians) were enrolled in the study between April 2007 and January 2010.

Primary and secondary outcome measures

sifap1 was originally designed to investigate the relation of juvenile stroke and Fabry disease. A secondary aim of sifap1 was to investigate stroke patterns in this specific group of patients. The present investigation is a secondary analysis addressing stroke presenting symptoms with a special regard to signs included in the FAST scheme.

Results

4535 patients with transient ischaemic attack (TIA; n=1071), ischaemic stroke (n=3396) or other (n=68) were considered in the presented analysis. FAST symptoms could be traced in 76.5% of all cases. 35% of those with at least one FAST symptom had all three symptoms. At least one FAST symptom could be recognised in 69.1% of 18–24 years-old patients, in 74% of those aged 25–34 years, in 75.4% of those aged 35–44 years, and 77.8% in 45–55 years-old patients. With increasing stroke severity signs included in the FAST scheme were more prevalent (National Institute of Health Stroke Scale, NIHSS<5: 69%, NIHSS 6–15: 98.9%, NIHSS>15: 100%). Clustering clinical signs according to FAST lower percentages of strokes in the posterior circulation (65.2%) and in patients with TIA (62.3%) were identified.

Conclusions

FAST may be applied as a useful and rapid tool to identify stroke symptoms in young individuals aged 18–55 years. Especially in patients eligible for thrombolysis FAST might address the majority of individuals.

Study registration

The study was registered in http://www.clinicaltrials.gov (No.NCT00414583).
Introducing the non-invasive prenatal test for trisomy 21 in Belgium: a cost-consequences analysis
Authors: Neyt Mattias , Hulstaert Frank , Gyselaers Wilfried
Published: November 2014

Background

The first- and second-trimester screening for trisomy 21 (T21) are reimbursed for all pregnant women in Belgium. Using a cut-off risk of 1:300 for T21, about 5% of all pregnant women are referred for definitive prenatal diagnosis using an invasive test, at a sensitivity of (only) 72.5%. The sensitivity and specificity of the non-invasive prenatal test (NIPT) are over 99% but come at a cost of €460 (£373) per test. The objective is to estimate the consequences of introducing NIPT for the detection of T21.

Methods

A cost-consequences analysis was performed presenting the impact on benefits, harms and costs. Context-specific real-world information was available to set up a model reflecting the current screening situation in Belgium. This model was used to construct the second and first line NIPT screening scenarios applying information from the literature on NIPT's test accuracy.

Results

Introducing NIPT in the first or second line reduces harm by decreasing the number of procedure-related miscarriages after invasive testing. In contrast with NIPT in the second line, offering NIPT in the first line additionally will miss fewer cases of T21 due to less false-negative test results. The introduction of NIPT in the second line results in cost savings, which is not true for NIPT at the current price in the first line. If NIPT is offered to all pregnant women, the price should be lowered to about €150 to keep the screening cost per T21 diagnosis constant.

Conclusions

In Belgium, the introduction and reimbursement of NIPT as a second line triage test significantly reduces procedure-related miscarriages without increasing the short-term screening costs. Offering and reimbursing NIPT in the first line to all pregnant women is preferred in the long term, as it would, in addition, miss fewer cases of T21. However, taking into account the government's limited resources for universal reimbursement, the price of NIPT should first be lowered substantially before this can be realised.
One lithium level >1.0 mmol/L causes an acute decline in eGFR: findings from a retrospective analysis of a monitoring database
Authors: Kirkham E , Skinner J , Anderson T , Bazire S , Twigg M J , Desborough J A
Published: November 2014

Objectives

Lithium is a mainstay of bipolar disorder treatment, however, there are still differences in opinion on the effects of lithium use on renal function. The aim of this analysis was to determine if there is an association between short-term exposure to various elevated lithium levels and estimated-glomerular filtration rate (eGFR) at ≤3 months, 6 months (±3 months) and 1 year (±3 months) follow-up.

Setting

Norfolk-wide (UK) lithium register and database.

Participants

699 patients from the Norfolk database.

Primary outcome measures

eGFR change from baseline at ≤3 months, 6 months (±3 months) and 1 year (±3 months) after exposure to a lithium level within these ranges: 0.81–1.0 mmol/L (group 2), 1.01–1.2 mmol/L (group 3) and 1.21–2.0 mmol/L (group 4). The reference group was patients whose lithium levels never exceeded 0.8 mmol/L.

Results

Compared to the reference group, groups 3 and 4 showed a significant decrease in eGFR in the first 3 months after exposure (p=0.047 and p=0.040). At 6 months (±3 months) postexposure group 4 still showed a decline in eGFR, however, this result was not significant (p=0.298).

Conclusions

These results show for the first time that a single incident of a lithium level >1.0 mmol/L is associated with a significant decrease in eGFR in the following 3 months when compared to patients whose lithium levels never exceeded 0.8 mmol/L. It is still not known whether the kidneys can recover this lost function and the impact that more than a single exposure to a level within these ranges can have on renal function. These results suggest that lithium level monitoring should be undertaken at least every 3 months, in line with current UK guidelines and not be reduced further until the impact of more than one exposure to these lithium levels has been fully established.
Bee venom acupuncture for rheumatoid arthritis: a systematic review of randomised clinical trials
Authors: Lee Ju Ah , Son Mi Ju , Choi Jiae , Jun Ji Hee , Kim Jong-In , Lee Myeong Soo
Published: November 2014

Objective

To assess the clinical evidence for bee venom acupuncture (BVA) for rheumatoid arthritis (RA).

Design

Systematic review of randomised controlled trials (RCTs).

Setting

We searched 14 databases up to March 2014 without a language restriction.

Participants

Patients with RA.

Intervention

BVA involved injecting purified, diluted BV into acupoints. We included trials on BVA used alone or in combination with a conventional therapy versus the conventional therapy alone.

Primary outcomes

Morning stiffness, pain and joint swelling

Secondary outcomes

Erythrocyte sedimentation rate (ESR), C reactive protein (CRP), rheumatoid factor, the number of joints affected by RA and adverse effects likely related to RA.

Results

A total of 304 potentially relevant studies were identified; only one RCT met our inclusion criteria. Compared with placebo, BVA may more effectively improve joint pain, swollen joint counts, tender joint counts, ESR and CRP but was not shown to improve morning stiffness.

Conclusions

There is low-quality evidence, based on one trial, that BVA can significantly reduce pain, morning stiffness, tender joint counts, swollen joint counts and improve the quality of life of patients with RA compared with placebo (normal saline injection) control. However, the number of trials, their quality and the total sample size were too low to draw firm conclusions.

Trial registration number

PROSPERO 2013: CRD42013005853.
Am I my brother's keeper? A survey of 10 healthcare professions in the Netherlands about experiences with impaired and incompetent colleagues
Authors: Weenink Jan Willem , Westert Gert P , Schoonhoven Lisette , Wollersheim Hub , Kool Rudolf B
Published: November 2014

Background

Dealing with poor individual performance of healthcare professionals is essential in patient safety management. The objective of the current study was to explore potential differences regarding experiences with impaired and incompetent colleagues between a broad range of healthcare professions.

Methods

A survey of 10 legally regulated professions in the Netherlands on knowledge on dealing with impaired/incompetent colleagues, experiences with such colleagues, action taken upon an impaired and incompetent colleague and reasons for not taking action.

Results

We approached 4348 professionals, of whom 1238 responded (28.5%). One-third of the respondents (31.3%) had an experience with an impaired or incompetent colleague in the preceding 12 months, and 84% of these reported cases concerned incompetence. Even under the extreme assumption that all non-respondents had no such experiences, our results indicate that at least 9% of the total sample had dealt with an impaired or incompetent colleague in the previous 12 months. Two-thirds of the professionals (68.6%) who had an experience reported having acted upon it. Respondents significantly less often reported to have acted (49.6% vs 79.1%, p=0.000) when the colleague was working at a different organisation. The primary reason for not taking action was that impairment/incompetence could not be proven.

Conclusions

Even using an extreme correction for our low response rate, at least 9% of healthcare professionals reported dealing with impaired or incompetent colleagues in the past year. Creating and clarifying reporting opportunities when confronted with an incompetent or impaired colleague should be a priority for professional organisations, policymakers and regulatory bodies.
Improving phlebotomy handover to doctors: a quality improvement project
Authors: Shouls Genevieve , Jarrar Zakariya , Wickenden John
Published: November 2014

AIM: To design a hospital-standardised phlebotomy handover method to improve the communication between phlebotomists and doctors. To reduce delays in patient management and discharges which occur due to poor handover.

METHOD: Qualitative data was collected to gauge junior doctors’ experiences of the current handover process. Quantitative data was collected over a two-week period across two medical wards to measure the proportion of requested bloods that could not be taken by phlebotomists that were successfully handed over to doctors. Brainstorming sessions were held with junior doctors, phlebotomists and ward staff in order to design a, cheap, effective, sustainable, hospital-wide method of handover. The chosen intervention was a red ward-based phlebotomy handover folder for phlebotomists to place stickers of unbled patients in. The folder was trialled on two medical wards. Feedback obtained helped improve the intervention before implementing it hospital-wide.

RESULTS: Seventeen of 23 junior doctors (74%) felt that a formalised handover process would be very useful. Baseline measurement over two weeks revealed that 24/129 blood tests ordered for phlebotomists to take were not taken. Only three (13%) of these were handed over to doctors. Post-intervention, 18/106 blood tests requested were not taken. All 18 (100%) were successfully handed over to doctors.

CONCLUSIONS: Implementation of a hospital-standardised phlebotomy handover folder dramatically improved the communication and handover between phlebotomists and doctors allowing for medical teams to take prompt action on unbled patients. This intervention will help improve patient safety, reduce delays in management/discharge and reduce the number of jobs handed over to evening on-call teams.
The impact of nurse-led annual telephone follow-up of patients with inflammatory bowel disease
Authors: Bager Palle
Published: November 2014

Inflammatory bowel diseases (IBD) are characterised by periods of disease activity and period with disease in remission. In Denmark all patients are seen in hospital settings. The aim of this study was to introduce a nurse-led phone service for stable patients replacing annual visits.

The study originated from an outpatient cohort of 1,600 patients with IBD. A research protocol was determined before the intervention was launched, which included surveys among the patients before the intervention, after the intervention, collection of longitudinal data in a three year period, and a clinical audit. Budget impact analysis (BIA) and cost-effectiveness analysis (CEA) were done. Furthermore, the staff evaluated the process.

Almost 30% (n = 474) of the total cohort was enrolled in the service. Eighty-seven per cent of the patients welcomed the phone service beforehand. After implementation, 94% of the patients included were pleased with the service. The programme has shortened the waiting time for most other services, but no improvement in the workload was observed. The BIA showed limited savings. The CEA showed an annual saving of 100€ per patient when using the annual phone service over routine visits.

In conclusion, changing the method of contact from routine annual visits to annual phone calls from a nurse was feasible and well accepted for stable patients with IBD. The benefits of the service were most marked for the patients.
Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: a realist evaluation
Authors: McConnell Tracey , O'Halloran Peter , Donnelly Michael , Porter Sam
Published: November 2014

Objectives

The Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation.

Method

An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semistructured interviews were conducted with two policymakers and 22 participants with experience and/or involvement in management of the LCP during 2011 and 2012.

Results

Key resource inputs included facilitation with a view to maintaining LCP ‘visibility’, reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy, and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care.

Conclusions

There is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.
Salmonellosis due to a monophasic variant of Salmonella Typhimurium in a cow
Authors: Millemann Yves , Granier Sophie A , Boulouis Henri‐Jean , Lailler Renaud , Belbis Guillaume
Published: November 2014

A monophasic Salmonella Typhimurium (mST) variant has emerged in Europe in the last decade. It has mainly been isolated from pigs and humans. However, it seems that it may now also circulate in poultry and cattle. Interestingly, this variant was isolated from healthy subjects regardless of the animal species. Herein, we report the isolation of such a variant from a clinically affected cow that was hospitalised in the Alfort Large Animal Hospital. The 13‐year‐old cow showed the typical clinical signs suggestive of salmonellosis including fever and diarrhoea that contained frank blood and fibrin clots. An mST was isolated from this cow, but it was not recovered from the samples taken from two other cows displaying similar clinical signs or from the other hospitalised animals.
Use of thermography to monitor sole haemorrhages and temperature distribution over the claws of dairy cattle
Authors: Wilhelm K. , Wilhelm J. , Fürll M.
Published: November 2014

Subclinical laminitis, an early pathological event in the development of many claw diseases, is an important factor in the welfare and economics of high‐producing dairy cows. However, the aetiology and pathogenesis of this complex claw disease are not well understood. The present study investigated to what extent thermographic examination of claws is able to give information about corium inflammation, and whether the technique may be used as a diagnostic tool for early detection of subclinical laminitis. Moreover, the temperature distribution over the individual main claws was investigated to obtain further knowledge about pressure distribution on the claws. For this purpose the claws of 123 cows were evaluated in the first week after calving as well as after the second month of lactation for presence of sole haemorrhages (a sign of subclinical laminitis). Furthermore, the ground contact area was analysed by thermography. Sole haemorrhages were significantly increased by the second month of lactation. Thermography showed clear differences between the claws of the front limbs and hindlimbs, as well as between lateral and medial claws. Although the distribution of sole haemorrhages was consistent with the pattern of the temperature distribution over the main claws, no clear correlation was found between the claw temperature after calving and the visible laminitis‐like changes (sole haemorrhages) eight weeks later.
PHOTONIC CRYSTAL SURFACE ENHANCED UPCONVERSION EMISSION OF YF3:Yb3+, Er3+ NANOPARTICLES
Authors: SHAO BO , YANG ZHENGWEN , LI JUN , LIAO JIAYAN , LAI SHENFENG , QIU JIANBEI , SONG ZHIGUO , YANG YONG , ZHOU DACHENG
Published: November 2014

The opal photonic crystals made of polystyrene microspheres with 155, 230, 270 or 410 nm in diameter were used to enhance upconversion (UC) emission of YF 3: Yb 3+, Er 3+ nanoparticles, respectively. The red or green UC emission of YF 3: Yb 3+, Er 3+ nanoparticles can be selectively enhanced when the red or green UC emission wavelength overlapped with the photonic bandgaps of opals, which is attributed to Bragg reflection of photonic bandgap. In addition, when the 980 nm excitation light wavelength was in the region of the photonic bandgap, red and green UC emissions of YF 3: Yb 3+, Er 3+ nanoparticles were enhanced due to the enhancement of excitation field.
Predicting release of total dissolved solids from overburden material using acid-base accounting parameters
Authors: Odenheimer J. , Skousen J. , McDonald L.M. , Vesper D.J. , Mannix M. , Daniels W.L.
Published: November 2014

The Appalachian coal industry has been successful in developing technologies to identify, handle, treat and isolate potentially acid-forming overburden materials at coal mines in the region. Modern coal mining permits have stringent guidelines for reclamation and water discharge limits. Total dissolved solids (TDS) is a new water quality parameter that has been linked to a decrease in survival of aquatic macro-invertebrates in receiving streams. Past techniques to predict acid mine drainage potential to decrease impacts to streams may not accurately predict the release of TDS. The objective of this work was to develop a TDS release index from overburden material that could be used to predict and screen overburden materials that contribute to high TDS concentrations. Forty-one overburden samples containing a range of sandstones and shales were collected from surface mines in West Virginia, Virginia, and Kentucky. Samples were ground to <2 mm particle size and weathered in dilute HNO
3
to determine TDS released. Supernatants were analyzed for pH, electrical conductivity (EC), and other selected ions. Results were compared to Acid-Base Accounting parameters for each sample; i.e. paste pH, maximum potential acidity (MPA), neutralization potential (NP), and net neutralization potential (NNP). Results showed that MPA (sulphur content) had the strongest relationship to TDS release, and low, moderate, and high TDS release indices were developed based on MPA values. Samples with MPA values of 0.0–1.0 g kg
-1
gave <150 mg l
-1
TDS, 1.0–3.0 g kg
-1
gave <300 mg l
-1
, whereas 3.0+ g kg
-1
produced TDS values >500 mg l
-1
. NPP was also a predictor for TDS, with an NPP ≥-2.0 g kg
-1
likely to produce <300 mg l
-1
of TDS and NPP <-2.0 g kg
-1
likely to produce TDS concentrations >300 mg l
-1
.