bluuebunny/crossref_metadata_2025 huggingface dataset:
North‐South foreign direct investment and bilateral investment treaties
Authors: Falvey Rod , Foster‐McGregor Neil
Published: August 2017

Bilateral investment treaties (BITs) have become increasingly popular as a means of encouraging foreign direct investment (FDI) from developed to developing countries. We adopt a difference‐in‐difference analysis to deal with the problem of self‐selection when estimating the effects ofBITs onFDIflows from a sample ofOECDcountries to a broader sample of lesser developed countries. Our results indicate that forming aBITwith a developed country significantly increasesFDIinflows to developing countries. We further find that the development of newFDIflows and the reinvigoration of deterioratingFDIrelationships accounts for the majority of the increase inFDIflows due toBITformation.
INHIBITIVE EFFECT OF COCON NUCIFERA L. (COCONUT PULP) EXTRACT ON MILD STEEL ACID CORROSION
Authors: Sobri S. , Rahim N.
Published: August 2017

In recent years, industrial sectors are concerned with the corrosion of metal and alloys and they also received huge attention from researcher to overcome these problems. To decelerate the rate of corrosion or to stop the corrosion to occur, one of the common methods to deal with this problems is using green inhibitor. The use of local wastes which are organic in nature for the production of green corrosion inhibitor is no doubt the trend of the day. To arrive at an inexpensive non-toxic, eco-friendly inhibitor formulation, the present study on the use of coconut pulp waste extract of Cocon Nucifera L. has been carried out by the weight loss method. The aim of this project is to study the inhibitive effect in terms of time and concentration of the coconut pulp waste extract on the acid corrosion of mild steel in 1.0 M HCL solution. Result showed that the inhibition efficiency was found to increase with increasing inhibitor concentration up to maximum 94.52% for 10 %v/v at 48 hours immersion time. Examination on the extract by Fourier transform infrared spectroscopy (FTIR) confirms that the extract contains functional group of N-H, O-H, C-H, C≡C, C=O, C=C, C-F and C-O that good for corrosion inhibitor while scanning electron microscopy (SEM) studies showed that the deposition of coconut pulp extract on the metal surface. The results of all studies confirmed that the extract of coconut pulp has great potential to prevent the corrosion of mild steel in acidic environment with highest % IE is 94.52 % and the corrosion rate is 3.6919 x10-5.
INVESTIGATING THE ROLE OF MOLECULAR INTERACTIONS IN POLYMORPHISM OF MEFENAMIC ACID IN ETHYL ACETATE SOLUTION
Authors: Abdul Mudalip Siti Kholijah , Abu Bakar Mohd. Rushdi , Adam Fatmawati , Jamal Parveen , Md. Alam Zahangir
Published: August 2017

Mefenamic acid, a widely used nonsteroidal anti-inflammatory and analgesic agent, is one of the active pharmaceutical ingredients that exhibit polymorphisms. This study reports a combined experimental and molecular dynamics simulation study of mefenamic acid crystallization in ethyl acetate. The solid-state characterization of the polymorph produced using Fourier transform infrared spectroscopy (FTIR), X-Ray powder diffractometer (XPRD), and differential scanning calorimetry (DSC) analysis show the characteristic of Form I, which were N-H stretching at 3313cm-1, two endothermic  peaks, and significant XPRD peaks at 6.3°, 13.8°, 15.9°, 21.3°, and 26.3°. The molecular dynamics simulations were performed using COMPASS force field available in the Material Studio 5.5 simulation package. The simulations were run for equilibration with a time step of 1 fs for a period of 250 ps and 2000 ps simulation in NVE (constant number of atoms, volume and energy) and NPT (constant number of atoms, pressure and temperature) thermodynamic ensemble, respectively. The trajectory files from the simulation were analyzed for radial distribution function (RDF) to investigate the intermolecular interactions. The simulation results showed strong solute-solute and solute-solvent interactions, which were O1MA•••H15MA and O1EA•••H15MA. These findings revealed the presence of hydrogen bonds that contributes to the solvation and formation of hydrogen motif in polymorphic Form I of mefenamic acid during crystallization with ethyl acetate as a solvent.
ASSESSING THE FORWARD OSMOSIS PERFORMANCES USING CTA MEMBRANE: EFFECT OF SOLUTION VOLUME RATIO AND TYPE OF DRAW SOLUTE
Authors: Yih Law Jeng , Mohammad Abdul Wahab
Published: August 2017

Osmotically-driven forward osmosis (FO) has gained significant attention in the last decade due to its potential application in various disciplines. Draw solution serves as the driving force in FO process for inducing water transport across the membrane. FO technology can be used to reject or concentrate high valuable products in the chemical and bioprocess industries which often encounter great challenge in terms of dilute product formation. In this study, commercial cellulose triacetate (CTA) flat sheet FO membrane was investigated using several types of inorganic draw solute. Pure water fluxes ranged from 5.20 to 6.30    L.m-2.h-1 were achieved for selected draw solutes. The reverse solute leakage was shown by the increment of conductivity in the feed solution. Among the draw solutes, NaCl demonstrated highest reverse solute leakage (72.45 µS cm-1) attributed to its relatively smaller molecular size. The water fluxes at feed to draw solution volume ratios of 1:2 and 1:3 were found to be slightly lower than that to the volume ratios of 1:0.6 and 1:1. With respect to sodium succinate feed solution, MgCl2 was capable of generating higher osmotic pressure and thus higher water flux was observed compared to NaCl draw solute. Overall, the selected inorganic draw solutes demonstrated encouraging FO performances and could be used for concentrating sodium succinate solution.
THE EFFECTS OF REDUCING POWER FROM METAL CARBONATES ON SUCCINIC ACID PRODUCTION USING ACTINOBACILLUS SUCCINOGENES
Authors: Ping Tan Jian , Md Jahim Jamaliah , Yeong Wu Ta , Harun Shuhaida , Mumtaz Tabassum
Published: August 2017

Bio-succinic acid was first commercialized in 2012 and has a potential to hit $ 15 billion market. Higher conversion or yield in this case, allow bio-succinic acid to be more competitive and could potentially take over the market of other intermediate compound. Redox state of the fermentation medium is reported to have an effect on the metabolic flux and in Actinobacillus succinogenes, one of the best succinic acid producers. It has a direct impact on succinate yield. Therefore, carbonates with different reducing power, CaCO3, NaHCO3, MgCO3, ZnCO3 and (NH4)2CO3 were employed to investigate the effect of their reducing power on succinate yield from glucose. Results showed that a more reducing carbonate, CaCO3 promoted the metabolic flux of A. succinogenes to produce higher reductive metabolite (succinate) to regain its intracellular redox balance. Calcium has a reducing power of 2.87 relative to hydrogen. Ammonium carbonate has an oxidizing power of 0.27, or a negative reducing power relative to hydrogen. Therefore, CaCO3 with a stronger reducing power had a higher succinate yield of 0.68 g/g than (NH4)2CO3 with only 0.14 g/g. On the other hand, MgCO3 had the highest final succinate concentration due to the overall higher sugar consumption by A. succinogenes.
CELLOBIOSE DEHYDROGENASE/ EPOXY- GRAPHITE COMPOSITE WITH ARYL DIAZONIUM REDUCTION FOR LACTOSE DETECTION
Authors: Abu Bakar Mimi Hani , Pasco Neil F , Gooneratne Ravi , Hong Kim Byung
Published: August 2017

Milk is an important ingredient in our day to day diet bacause of the high quality nutrients in it. In the dairy industry including cheese fermentation processes, there is a need to control the release of lactose into wastewater streams. There are methods adopted to recover the lactose and to transform the lactose into energy through renewable energy (RE) pathways. These methods however are expensive and require certain skill to operate them. In this study, in-house electrode, which is simple and can be applied after one day of fabrication were investigated. The method was by using graphite-epoxy composite electrode, surface modified with cellobiose dehydrogenase (CDH) enzyme using aryl diazonium. These designed composite electrodes were tested on its capability as biosensor for sensitivity on detecting the lactose as well as its capability as an anode in enzymatic fuel cell (EFC) on long term electrochemical stability in generating electricity from lactose oxidation. The results showed that the CDH-Aryl diazonium modified on surface of fabricated graphite-epoxy electrodes had Michaelis Menten constant Km for CDH (0.65 – 0.75 mM) comparable to available commercial electrodes reported in the literature (0.7 mM). They are also conductively sensitive with the current intensity 86% more with the above mentioned electrodes when modified with embedded multi-walled carbon nanotube (MWCNT) and gave a high reproducibility signal (63% more than fabricated electrodes without MWCNT). In addition to the above, its performance stability in continuous mode operation for 25 days, recorded almost consistent in current detection (19.2 ± 3.8 µA/ cm2). Hence, these fabricated electrodes give alternative for a sensitive lactose detector which is cheap and simple to fabricate.
The link between exercise and titin passive stiffness
Authors: Lalande Sophie , Mueller Patrick J. , Chung Charles S.
Published: August 2017

New Findings

What is the topic of this review?

This review focuses on how in vivo and molecular measurements of cardiac passive stiffness can predict exercise tolerance and how exercise training can reduce cardiac passive stiffness.

What advances does it highlight?

This review highlights advances in understanding the relationship between molecular (titin‐based) and in vivo (left ventricular) passive stiffness, how passive stiffness modifies exercise tolerance, and how exercise training may be therapeutic for cardiac diseases with increased passive stiffness.

Exercise can help alleviate the negative effects of cardiovascular disease and cardiovascular co‐morbidities associated with sedentary behaviour; this may be especially true in diseases that are associated with increased left ventricular passive stiffness. In this review, we discuss the inverse relationship between exercise tolerance and cardiac passive stiffness. Passive stiffness is the physical property of cardiac muscle to produce a resistive force when stretched, which, in vivo, is measured using the left ventricular end diastolic pressure–volume relationship or is estimated using echocardiography. The giant elastic protein titin is the major contributor to passive stiffness at physiological muscle (sarcomere) lengths. Passive stiffness can be modified by altering titin isoform size or by post‐translational modifications. In both human and animal models, increased left ventricular passive stiffness is associated with reduced exercise tolerance due to impaired diastolic filling, suggesting that increased passive stiffness predicts reduced exercise tolerance. At the same time, exercise training itself may induce both short‐ and long‐term changes in titin‐based passive stiffness, suggesting that exercise may be a treatment for diseases associated with increased passive stiffness. Direct modification of passive stiffness to improve exercise tolerance is a potential therapeutic approach. Titin passive stiffness itself may be a treatment target based on the recent discovery of RNA binding motif 20, which modifies titin isoform size and passive stiffness. Translating these discoveries that link exercise and left ventricular passive stiffness may provide new methods to enhance exercise tolerance and treat patients with cardiovascular disease.
An Efficient First-Principles Saddle Point Searching Method Based on Distributed Kriging Metamodels
Authors: Tran Anh , He Lijuan , Wang Yan
Published: August 2017

Searching for local minima, saddle points, and minimum energy paths (MEPs) on the potential energy surface (PES) is challenging in computational materials science because of the complexity of PES in high-dimensional space and the numerical approximation errors in calculating the potential energy. In this work, a local minimum and saddle point searching method is developed based on kriging metamodels of PES. The searching algorithm is performed on both kriging metamodels as the approximated PES and the calculated one from density functional theory (DFT). As the searching advances, the kriging metamodels are further refined to include new data points. To overcome the dimensionality problem in classical kriging, a distributed kriging approach is proposed, where clusters of data are formed and one metamodel is constructed within each cluster. When the approximated PES is used during the searching, each predicted potential energy value is an aggregation of the ones from those metamodels. The dimension of each metamodel is further reduced based on the observed symmetry in materials systems. The uncertainty associated with the ground-state potential energy is quantified using the statistical mean-squared error in kriging to improve the robustness of the searching method.
Output-Only Damage Identification Using Enhanced Structural Characteristic Deflection Shapes and Adaptive Gapped Smoothing Method
Authors: Cao Shancheng , Ouyang Huajiang
Published: August 2017

Structural characteristic deflection shapes (CDSs) such as mode shapes which contain spatial knowledge of structures are highly sensitive for damage detection and localization. Nevertheless, CDSs are vulnerable to measurement noise, which degrades the accuracy of damage identification. In order to enhance CDS-based damage identification, contributions are made in three aspects. First, a robust CDS estimation approach is proposed based on common principal component analysis, which estimates the CDSs as the common diagonalizer of a set of covariance matrices by joint approximation diagonalization (JAD). Second, an adaptive gapped smoothing method (GSM) is proposed and validated to be more accurate than the traditional GSM. Third, a new damage identification index capable of localizing damage and indicating relative damage severity is defined without requiring information of healthy structures. Finally, numerical and experimental examples of beams and a frame with cracks are studied to demonstrate the advantages of the proposed damage identification method in terms of noise robustness and accuracy.
Application of Inverse Patch Transfer Functions Method With Wideband Holography Algorithm to Sparsely Distributed Sources Identification
Authors: He Yansong , Liu Chong , Xu Zhongming , Zhang Zhifei , Li Shu
Published: August 2017

Inverse patch transfer functions (iPTF) method has been developed to reconstruct the sound field of irregularly shaped sources in a noisy environment. The iPTF method, which uses classic regularization methods to solve the ill-posed problems generally, would incur some sidelobes ghosting in the process of identifying sparse sources. In view of the fact that the algorithm in wideband holography (WBH) can promote sparsity of results, a technique combining iPTF method with WBH algorithm is proposed to identify sparsely distributed sources in the present work. In the proposed technique, double layer pressure measurements are used to replace the measurements of the pressure and normal velocity which uses costly p-u probes. A gradient descent algorithm and a filtering process are applied to solve the minimization problem of identifying the normal velocities of target sources, which can suppress ghosting sources rapidly by an iterative process. In simulations, the field reconstruction results of two antiphase square piston sources show good sparsity and accuracy by employing the technique, nearly without ghosting sources. At different distances and frequencies of the two sources, the technique still performs well. Experimental validations at 200 Hz and 400 Hz are carried out in the end. The results of experiments are also coinciding with those of simulations.
Structural Properties and Simple Compression Behavior of Laboratory-Made Polycrystalline Isotropic Ice at High Temperatures
Authors: Seifaddini M. , Aryanpour G. , Farzaneh M.
Published: August 2017

Polycrystalline isotropic ice was selected as the material of choice for this fundamental study on the mechanical behavior of ice. Two essential properties of the ice structure are the porosity and degree of anisotropy (DA). On the one hand, it is clear that these two factors have a great influence on the mechanical properties of the material. On the other hand, however, they are strongly dependent on the laboratory procedure used to fabricate the ice samples. Thus, in this work, three procedures to produce ice samples are analyzed. For this purpose, the structural and mechanical properties observed in uniaxial compression tests are discussed for each sample fabrication procedure. Then, after the most suitable fabrication procedure has been determined, the viscous behavior of isotropic ice is analyzed and discussed using the results of simple compression test at different temperatures and axial strain rates.
Just noticeable differences for pitch direction, height, and slope for Mandarin and English listeners
Authors: Jongman Allard , Qin Zhen , Zhang Jie , Sereno Joan A.
Published: August 2017

Previous studies on tones suggest that Mandarin listeners are more sensitive to pitch direction and slope while English listeners primarily attend to pitch height. In this study, just noticeable differences were established for pitch discrimination using a three-interval, forced-choice procedure with a two-down, one-up staircase design. A high rising and a high falling Mandarin tone were manipulated in terms of pitch direction, height, and slope. Results indicate that, overall, Mandarin listeners are more sensitive to pitch slope and English listeners to pitch height. However, these effects are modulated by both the direction (falling/rising) and slope of the pitch contours.
Beamforming using subspace estimation from a diagonally averaged sample covariance
Authors: Quijano Jorge E. , Zurk Lisa M.
Published: August 2017

The potential benefit of a large-aperture sonar array for high resolution target localization is often challenged by the lack of sufficient data required for adaptive beamforming. This paper introduces a Toeplitz-constrained estimator of the clairvoyant signal covariance matrix corresponding to multiple far-field targets embedded in background isotropic noise. The estimator is obtained by averaging along subdiagonals of the sample covariance matrix, followed by covariance extrapolation using the method of maximum entropy. The sample covariance is computed from limited data snapshots, a situation commonly encountered with large-aperture arrays in environments characterized by short periods of local stationarity. Eigenvectors computed from the Toeplitz-constrained covariance are used to construct signal-subspace projector matrices, which are shown to reduce background noise and improve detection of closely spaced targets when applied to subspace beamforming. Monte Carlo simulations corresponding to increasing array aperture suggest convergence of the proposed projector to the clairvoyant signal projector, thereby outperforming the classic projector obtained from the sample eigenvectors. Beamforming performance of the proposed method is analyzed using simulated data, as well as experimental data from the Shallow Water Array Performance experiment.
Phonetic enhancement of Mandarin vowels and tones: Infant-directed speech and Lombard speech
Authors: Tang Ping , Xu Rattanasone Nan , Yuen Ivan , Demuth Katherine
Published: August 2017

Speech units are reported to be hyperarticulated in both infant-directed speech (IDS) and Lombard speech. Since these two registers have typically been studied separately, it is unclear if the same speech units are hyperarticulated in the same manner between these registers. The aim of the present study is to compare the effect of register on vowel and tone modification in the tonal language Mandarin Chinese. Vowel and tone productions were produced by 15 Mandarin-speaking mothers during interactions with their 12-month-old infants during a play session (IDS), in conversation with a Mandarin-speaking adult in a 70 dBA eight-talker babble noise environment (Lombard speech), and in a quiet environment (adult-directed speech). Vowel space expansion was observed in IDS and Lombard speech, however, the patterns of vowel-shift were different between the two registers. IDS displayed tone space expansion only in the utterance-final position, whereas there was no tone space expansion in Lombard speech. The overall pitch increased for all tones in both registers. The tone-bearing vowel duration also increased in both registers, but only in utterance-final position. The difference in speech modifications between these two registers is discussed in light of speakers' different communicative needs.
A cluster of immunoresolvents links coagulation to innate host defense in human blood
Authors: Norris Paul C. , Libreros Stephania , Chiang Nan , Serhan Charles N.
Published: August 2017

Factors generated by blood coagulation that elicit immune responses that protect the host are identified.
Tools for the Individualized Therapy of Teicoplanin for Neonates and Children
Authors: Ramos-Martín V. , Neely M. N. , Padmore K. , Peak M. , Beresford M. W. , Turner M. A. , Paulus S. , López-Herce J. , Hope W. W.
Published: August 2017

The aim of this study was to develop a population pharmacokinetic (PK) model for teicoplanin across childhood age ranges to be used as Bayesian prior information in the software constructed for individualized therapy. We developed a nonparametric population model fitted to PK data from neonates, infants, and older children. We then implemented this model in the BestDose multiple-model Bayesian adaptive control algorithm to show its clinical utility. It was used to predict the dosages required to achieve optimal teicoplanin predose targets (15 mg/liter) from day 3 of therapy. We performed individual simulations for an infant and a child from the original population, who provided early first dosing interval concentration-time data. An allometric model that used weight as a measure of size and that also incorporated renal function using the estimated glomerular filtration rate (eGFR), or the ratio of postnatal age (PNA) to serum creatinine concentration (SCr) for infants <3 months old, best described the data. The median population PK parameters were as follows: elimination rate constant (Ke) = 0.03 · (wt/70)
−0.25
· Renal (h
−1
);
V
= 19.5 · (wt/70) (liters); Renal = eGFR
0.07
(ml/min/1.73 m
2
), or Renal = PNA/SCr (μmol/liter). Increased teicoplanin dosages and alternative administration techniques (extended infusions and fractionated multiple dosing) were required in order to achieve the targets safely by day 3 in simulated cases. The software was able to predict individual measured concentrations and the dosages and administration techniques required to achieve the desired target concentrations early in therapy. Prospective evaluation is now needed in order to ensure that this individualized teicoplanin therapy approach is applicable in the clinical setting. (This study has been registered in the European Union Clinical Trials Register under EudraCT no. 2012-005738-12.)
Mycobacterium abscessus
l
,
d
-Transpeptidases Are Susceptible to Inactivation by Carbapenems and Cephalosporins but Not Penicillins
Authors: Kumar Pankaj , Chauhan Varsha , Silva José Rogério A. , Lameira Jerônimo , d'Andrea Felipe B. , Li Shao-Gang , Ginell Stephan L. , Freundlich Joel S. , Alves Cláudio Nahum , Bailey Scott , Cohen Keira A. , Lamichhane Gyanu
Published: August 2017

As a growing number of clinical isolates of
Mycobacterium abscessus
are resistant to most antibiotics, new treatment options that are effective against these drug-resistant strains are desperately needed. The majority of the linkages in the cell wall peptidoglycan of
M. abscessus
are synthesized by nonclassical transpeptidases, namely, the
l
,
d
-transpeptidases. Emerging evidence suggests that these enzymes represent a new molecular vulnerability in this pathogen. Recent studies have demonstrated that inhibition of these enzymes by the carbapenem class of β-lactams determines their activity against
Mycobacterium tuberculosis
. Here, we studied the interactions of β-lactams with two
l
,
d
-transpeptidases in
M. abscessus
, namely, Ldt
Mab1
and Ldt
Mab2
, and found that both the carbapenem and cephalosporin, but not penicillin, subclasses of β-lactams inhibit these enzymes. Contrary to the commonly held belief that combination therapy with β-lactams is redundant, doripenem and cefdinir exhibit synergy against both pansusceptible
M. abscessus
and clinical isolates that are resistant to most antibiotics, which suggests that dual-β-lactam therapy has potential for the treatment of
M. abscessus
. Finally, we solved the first crystal structure of an
M. abscessus
l
,
d
-transpeptidase, Ldt
Mab2
, and using substitutions of critical amino acids in the catalytic site and computational simulations, we describe the key molecular interactions between this enzyme and β-lactams, which provide an insight into the molecular basis for the relative efficacy of different β-lactams against
M. abscessus
.
Influence of β-Lactam Infusion Strategy on Acute Kidney Injury
Authors: Cotner Sarah E. , Rutter W. Cliff , Burgess Donna R. , Wallace Katie L. , Martin Craig A. , Burgess David S.
Published: August 2017

Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE (risk, injury, failure, loss, and end-stage) criteria. Patients in the intermittent group were matched 3:1 to patients in the prolonged-infusion group based on the following: β-lactam agent, age, gender, Charlson comorbidity index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit. A total of 2,390 patients were included in the matched analysis, with 1,700 receiving intermittent infusions and 690 receiving prolonged infusion. The incidence of AKI was similar in the prolonged-infusion group to that in the intermittent-infusion group (21.6% versus 18.6%;
P
= 0.1). After multivariate regression, prolonged infusion was not associated with increased odds of AKI (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 0.83 to 1.39). Independent predictors of AKI included TZP therapy, concomitant nephrotoxins, hypotension, and heart failure. Although AKIs were numerically more common in patients receiving prolonged β-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.
A 2-Hydroxyisoquinoline-1,3-Dione Active-Site RNase H Inhibitor Binds in Multiple Modes to HIV-1 Reverse Transcriptase
Authors: Kirby Karen A. , Myshakina Nataliya A. , Christen Martin T. , Chen Yue-Lei , Schmidt Hilary A. , Huber Andrew D. , Xi Zhaoyong , Kim Seongmi , Rao Rohit K. , Kramer Skyler T. , Yang Qiongying , Singh Kamalendra , Parniak Michael A. , Wang Zhengqiang , Ishima Rieko , Sarafianos Stefan G.
Published: August 2017

The RNase H (RNH) function of HIV-1 reverse transcriptase (RT) plays an essential part in the viral life cycle. We report the characterization of YLC2-155, a 2-hydroxyisoquinoline-1,3-dione (HID)-based active-site RNH inhibitor. YLC2-155 inhibits both polymerase (50% inhibitory concentration [IC
50
] = 2.6 μM) and RNH functions (IC
50
= 0.65 μM) of RT but is more effective against RNH. X-ray crystallography, nuclear magnetic resonance (NMR) analysis, and molecular modeling were used to show that YLC2-155 binds at the RNH-active site in multiple conformations.
Caspase-11 Plays a Protective Role in Pulmonary Acinetobacter baumannii Infection
Authors: Wang Wei , Shao Yue , Li Shengjun , Xin Na , Ma Tingxian , Zhao Chenghai , Song Min
Published: August 2017

Activation of caspase-11 by some Gram-negative bacteria triggers the caspase-1/interleukin 1β (IL-1β) pathway, independent of canonical inflammasomes.
Acinetobacter baumannii
is a Gram-negative, conditionally pathogenic bacterium that can cause severe pulmonary infection in hospitalized patients.
A. baumannii
was revealed to activate canonical and noncanonical inflammasome pathways in bone marrow-derived macrophages (BMDMs). Pulmonary infection of caspase-11
−/−
mice with
A. baumannii
showed that caspase-11 deficiency impaired
A. baumannii
clearance, exacerbated pulmonary pathological changes, and enhanced susceptibility to
A. baumannii
. These data indicate that the caspase-11-mediated innate immune response plays a crucial role in defending against
A. baumannii
.
Stress Reduction, Bacterial Style
Authors: Gottesman Susan
Published: August 2017

Bacteria have robust responses to a variety of stresses. In particular, bacteria like
Escherichia coli
have multiple cell envelope stress responses, and generally we evaluate what these responses are doing by the repair systems they induce. However, probably at least as important in interpreting what is being sensed as stress are the genes that these stress systems downregulate, directly or indirectly. This is discussed here for the Cpx and sigma E systems of
E. coli
.
Massive juvenile nasopharyngeal angiofibroma: ode to the open surgical approach
Authors: Meher Ravi , Arora Nikhil , Bhargava Eishaan Kamta , Juneja Ruchika
Published: August 2017

The management of juvenile nasopharyngeal angiofibroma has undergone a significant evolution, with more surgeons moving towards the minimal invasive endoscopic approaches. Although considered the standard of care by most, an endoscopic approach may not be sufficient for extensive tumours, as exemplified by the current case of a young man presenting with the largest juvenile nasopharyngeal angiofibroma described in English literature until the present that was eventually excised via an anterior external approach.
Huge cardiac myxoma in pregnancy
Authors: Traisrisilp Kuntharee , Kanjanavanit Rungsrit , Taksaudom Noppon , Lorsomradee Suraphong
Published: August 2017

A 28-year-old pregnant woman presented at 28 weeks of gestation. She was diagnosed to have a left atrial myxoma 2 years earlier, but was lost to follow-up. During this pregnancy, the transthoracic echocardiography showed a 9 cm mass in the left atrium obstructing mitral valve inflow, interfering with mitral valve closure, causing severe mitral regurgitation and severe pulmonary hypertension. However, there were no clinical signs of pulmonary and systemic congestion or obstruction. Based on the clinical symptoms of the patient, the echocardiographic findings and the term of her pregnancy, the patient decided to schedule for a vaginal delivery with surgical correction after delivery. She gave birth at 32 weeks of gestation. During labour, pulmonary oedema developed but was detected early and it responded to therapy. Two weeks after delivery, a right anterior thoracotomy was performed to facilitate the removal of the left atrial myxoma and repair of the mitral valve.
Status epilepticus as the initial presentation of antibody-negative Goodpasture's syndrome
Authors: Ting Ingrid PL , Abdul Halim Sanihah , Adnan Azreen , Jaafar Hasnan
Published: August 2017

Goodpasture's syndrome is a rare pulmonary-renal disease. It is characterised by presence of auto-antibodies directed against the glomerular basement membrane (GBM) antigen. These antibodies that bind to the GBM antigens cause rapidly progressive glomerulonephritis. The alveolar basement membrane also contains similar antigen, leading to pulmonary haemorrhage in active disease. We report a case of a young man who initially presented with status epilepticus and later was found to have rapidly progressive glomerulonephritis with pulmonary haemorrhage. Serum anti-GBM antibody was negative but the renal biopsy confirmed the diagnosis by showing typical linear IgG along the GBM on immunofluorescent study. He was treated with plasmapheresis and high-dose steroid in combination with oral cyclophosphamide. His renal function normalised after treatment.
Rare presentation of bilobed posterior tongue in Goldenhar syndrome
Authors: Rajendran Thilaga , Ramalinggam Ganesh , Kamaru Ambu Valuyeetham
Published: August 2017

A bilobed posterior tongue is a rare malformation with few reported cases in the literature. This anomaly has not been demonstrated in patients with Goldenhar syndrome. We report a case of a 5-month-old child with the classic signs of Goldenhar syndrome and laryngomalacia with an incidental finding of a bilobed posterior tongue. Careful assessment and monitoring are crucial, especially in syndromic babies.
A vulnerable plaque identified on CT coronary angiography: when should we act in stable coronary artery disease?
Authors: Blake Sarah R , Heseltine Thomas D , Murray Scott , Ruzsics Balazs
Published: August 2017

CT coronary angiography (CTCA) is increasingly being used to diagnose coronary artery disease (CAD). Recent technological advancements, including dual energy CT and improved gantry times, have led to the ability to image coronary arteries with excellent spatial resolution at low radiation doses. Atheromatous plaques can be identified using CTCA and assessed to establish the risk of acute coronary syndrome from each individual plaque. If CTCA identifies CAD, it should then be used in conjunction with functional testing or invasive angiography with physiological assessment to establish the significance of coronary disease in an individual patient. In this case, the patient was diagnosed with an acute coronary syndrome originating from an atheromatous plaque that had been identified on CTCA 15 months before the acute event. The patient had positive ischaemic testing on myocardial perfusion scan but no symptoms of angina prior to the acute event. This case highlights the increasing difficulties clinicians face when deciding on management for patients with high-risk plaques, as there are little guidelines beyond aggressive secondary prevention.
Pseudo retinitis pigmentosa in a case of missed intraocular foreign body
Authors: Temkar Shreyas , Mukhija Ritika , Venkatesh Pradeep , Chawla Rohan
Published: August 2017

A 35-year-old man presented with history of painless, progressive loss of vision in the left eye for the past 7 years. There was history of trauma to the same eye with an iron object 7 years prior. Fundus examination revealed pigmentary retinopathy (unilateral advanced retinitis pigmentosa (RP)-like picture). X-ray orbits were suspicious of retained intraocular foreign body (IOFB). CT orbits confirmed the presence of IOFB. Electroretinogram revealed depressed responses. Right eye examination was within normal limits. A diagnosis of siderosis bulbi with unilateral pseudo RP-like fundus was made. No surgical intervention was planned for IOFB in view of poor visual prognosis.
Valacyclovir-associated neurotoxicity treated with intensification of peritoneal dialysis
Authors: Prasad Bhanu , McIsaac Mark , Toppings Julie
Published: August 2017

We report a 57-year-old woman with end-stage renal disease (ESRD) on maintenance peritoneal dialysis (PD), who presented to the emergency room (ER) by ambulance with complaints of confusion and altered sensorium for 48 hours. She had been reviewed in a walk-in clinic 72 hours earlier and had been prescribed the standard 1000 mg three times per day of valacyclovir for an acute attack of shingles instead of 500 mg once a day on ESRD. In the ER, she received further 500 mg of intravenous acyclovir as herpes encephalitis was clinically suspected. CT of the brain and lumbar puncture were non-contributory to the diagnosis. Valacyclovir and acyclovir were discontinued when the diagnosis of valacyclovir-associated neurotoxicity became clinically evident. As the patient's Glasgow Coma Scale declined, we intensified her PD regimen from one to six exchanges per day and 24 hours later there was a significant neurological improvement.
Early intracardiac thrombus and pulmonary embolus after trauma
Authors: Desai Neel , Heid Julia , Leitch Andrew
Published: August 2017

Here, we present the case of a patient with the findings of an early intracardiac thrombus and a pulmonary embolus after major trauma. A large clot was identified extending from the inferior vena cava into the right atrium and ventricle in the setting of preserved right ventricular function. Post-traumatic intracardiac thrombus is extremely rare and no comparable cases have previously been described in the absence of a congenital heart defect and obvious myocardial injury. Best practice afterpost-traumatic intracardiac thrombus is not well established but we found that early inferior vena cava filter placement and treatment with therapeutic coagulation resulted in clinical improvement, resolution of the thrombus and no further emboli. The successful use of rivaroxaban, a direct-acting oral anticoagulant, to treat a right heart thrombus has, to our knowledge, not previously been reported. Early acute traumatic coagulopathy has received much attention but the hypercoagulable state that often follows is less well appreciated.
Tuberculosis presenting as broncho-oesophageal fistula in a young healthy man
Authors: Sayeed Ahmed , Alqurashi Eid Humaid , Alzanbagi Adnan B , Ghaleb Nabil Abdulwadod Badr
Published: August 2017

A 21-year-old Saudi man presented with a history of dysphagia and choking. CT scan of the chest showed clear evidence of chronic recurrent aspiration pneumonia in the left lung. It also showed a fistula connecting the left main bronchus to the oesophagus. Endoscopy showed clear opening on the oesophageal side. Bronchoscopy also confirmed the presence of a broncho-oesophageal fistula on the left bronchial side with the presence of secretions on swallowing. Bronchoalveolar lavage (BAL) was done and sent for mycobacterial tuberculosis culture. The fistula was closed with clips under endoscopic guidance, which alleviated his symptoms of dysphagia and choking. The BAL culture grew mycobacterial tubercle bacilli. The patient showed marked improvement after starting antitubercular therapy and was discharged to be followed up in the clinic.
Expanding the differential: toluene-induced toxicity
Authors: Dharmarajan Lavanya , Ammar Hussam
Published: August 2017

A 31-year-old woman presented to the hospital with generalised weakness and lower back and abdominal pain. The only significant finding on physical examination was the weakness of the legs. Laboratory analysis in the emergency department revealed that she was hypokalaemic with metabolic acidosis. She was treated with oral and intravenous potassium, which resolved her weakness. During the search for an explanation for her renal tubular acidosis, she said she was exposed to paint exposure while working on a friend's house. She was discharged on correction of her hypokalaemia, and a subsequent test revealed elevated blood toluene level.
Non-adherence to eye care in people with diabetes
Authors: Murchison Ann P , Hark Lisa , Pizzi Laura T , Dai Yang , Mayro Eileen L , Storey Philip P , Leiby Benjamin E , Haller Julia A
Published: August 2017

Objective

Evaluate individual factors that impact adherence to eye care follow-up in patients with diabetes.

Design and methods

A 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit.

Results

Overall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index.

Conclusions

Patients with moderate to severe DR and/or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence.
Postauthorization safety study of the DPP-4 inhibitor saxagliptin: a large-scale multinational family of cohort studies of five outcomes
Authors: Lo Re Vincent , Carbonari Dena M , Saine M Elle , Newcomb Craig W , Roy Jason A , Liu Qing , Wu Qufei , Cardillo Serena , Haynes Kevin , Kimmel Stephen E , Reese Peter P , Margolis David J , Apter Andrea J , Reddy K Rajender , Hennessy Sean , Bhullar Harshvinder , Gallagher Arlene M , Esposito Daina B , Strom Brian L
Published: August 2017

Objective

To evaluate the risk of serious adverse events among patients with type 2 diabetes mellitus initiating saxagliptin compared with oral antidiabetic drugs (OADs) in classes other than dipeptidyl peptidase-4 (DPP-4) inhibitors.

Research design and methods

Cohort studies using 2009–2014 data from two UK medical record data sources (Clinical Practice Research Datalink, The Health Improvement Network) and two USA claims-based data sources (HealthCore Integrated Research Database, Medicare). All eligible adult patients newly prescribed saxagliptin (n=110 740) and random samples of up to 10 matched initiators of non-DPP-4 inhibitor OADs within each data source were selected (n=913 384). Outcomes were hospitalized major adverse cardiovascular events (MACE), acute kidney injury (AKI), acute liver failure (ALF), infections, and severe hypersensitivity events, evaluated using diagnostic coding algorithms and medical records. Cox regression was used to determine HRs with 95% CIs for each outcome. Meta-analyses across data sources were performed for each outcome as feasible.

Results

There were no increased incidence rates or risk of MACE, AKI, ALF, infection, or severe hypersensitivity reactions among saxagliptin initiators compared with other OAD initiators within any data source. Meta-analyses demonstrated a reduced risk of hospitalization/death from MACE (HR 0.91, 95% CI 0.85 to 0.97) and no increased risk of hospitalization for infection (HR 0.97, 95% CI 0.93 to 1.02) or AKI (HR 0.99, 95% CI 0.88 to 1.11) associated with saxagliptin initiation. ALF and hypersensitivity events were too rare to permit meta-analysis.

Conclusions

Saxagliptin initiation was not associated with increased risk of MACE, infection, AKI, ALF, or severe hypersensitivity reactions in clinical practice settings.

Trial registration number

NCT01086280,NCT01086293,NCT01086319,NCT01086306, andNCT01377935; Results.
Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial
Authors: Collins Karen , Reed Malcolm , Lifford Kate , Burton Maria , Edwards Adrian , Ring Alistair , Brain Katherine , Harder Helena , Robinson Thompson , Cheung Kwok Leung , Morgan Jenna , Audisio Riccardo , Ward Susan , Richards Paul , Martin Charlene , Chater Tim , Pemberton Kirsty , Nettleship Anthony , Murray Christopher , Walters Stephen , Bortolami Oscar , Armitage Fiona , Leonard Robert , Gath Jacqui , Revell Deirdre , Green Tracy , Wyld Lynda
Published: August 2017

Introduction

While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease.

Methods and analysis

This multicentre, parallel group, pragmatic cluster randomised controlled trial (RCT) (2015-18) reported here is nested within a larger ongoing ‘Age Gap Cohort Study’ (2012-18RP-PG-1209-10071), aims to evaluate the effectiveness of a complex intervention of decision support interventions to assist in the treatment decision making for early breast cancer in older women. The interventions include two patient decision aids (primary endocrine therapy vs surgery/antioestrogen therapy and chemotherapy vs no chemotherapy) and a clinical treatment outcomes algorithm for clinicians.

Ethics and dissemination

National and local ethics committee approval was obtained for all UK participating sites. Results from the trial will be submitted for publication in international peer-reviewed scientific journals.

IRAS reference

115550.

Trial registration number

European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2015-004220-61;Pre-results. Sponsor's Protocol Code Number Sheffield Teaching Hospitals STH17086. ISRCTN 32447*.
Guidelines for the symptomatic management of fever in children: systematic review of the literature and quality appraisal with AGREE II
Authors: Chiappini Elena , Bortone Barbara , Galli Luisa , Martino Maurizio de
Published: August 2017

Introduction

Several societies have produced and disseminated clinical practice guidelines (CPGs) for the symptomatic management of fever in children. However, to date, the quality of such guidelines has not been appraised.

Objective

To identify and evaluate guidelines for the symptomatic management of fever in children.

Methods

The research was conducted using PubMed, guideline websites, and Google (January 2010 to July 2016). The quality of the CPGs was independently assessed by two assessors using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument, and specific recommendations in guidelines were summarised and evaluated. Domain scores were considered of sufficient quality when >60% and of good quality when >80%.

Results

Seven guidelines were retrieved. The median score for the scope and purpose domain was 85.3% (range 66.6–100%). The median score for the stakeholder involvement domain was 57.5% (range 33.3–83.3%) and four guidelines scored >60%. The median score for the rigour of development domain was 52.0% (range 14.6–98.9%), and only three guidelines scored >60%. The median score for the clarity of presentation domain was 80.9% (range 50.0–94.4%). The median score for the applicability domain was 39.3% (8.3–100%). Only one guideline scored >60%. The median score for the editorial independence domain was 48.84% (0–91.6%); only three guidelines scored >60%.

Conclusion

Most guidelines were recommended for use even if with modification, especially in the methodology, the applicability and the editorial independence domains. Our results could help improve reporting of future guidelines, and affect the selection and use of guidelines in clinical practice.