bluuebunny/crossref_metadata_2025 huggingface dataset:
Choreography of the Mycobacterium Replication Machinery during the Cell Cycle
Authors: Trojanowski Damian , Ginda Katarzyna , Pióro Monika , Hołówka Joanna , Skut Partycja , Jakimowicz Dagmara , Zakrzewska-Czerwińska Jolanta
Published: February 2015

It has recently been demonstrated that bacterial chromosomes are highly organized, with specific positioning of the replication initiation region. Moreover, the positioning of the replication machinery (replisome) has been shown to be variable and dependent on species-specific cell cycle features. Here, we analyzed replisome positions in
Mycobacterium smegmatis
, a slow-growing bacterium that exhibits characteristic asymmetric polar cell extension. Time-lapse fluorescence microscopy analyses revealed that the replisome is slightly off-center in mycobacterial cells, a feature that is likely correlated with the asymmetric growth of Mycobacterium cell poles. Estimates of the timing of chromosome replication in relation to the cell cycle, as well as cell division and chromosome segregation events, revealed that chromosomal origin-of-replication (
oriC
) regions segregate soon after the start of replication. Moreover, our data demonstrate that organization of the chromosome by ParB determines the replisome choreography.

IMPORTANCE
Despite significant progress in elucidating the basic processes of bacterial chromosome replication and segregation, understanding of chromosome dynamics during the mycobacterial cell cycle remains incomplete. Here, we provide
in vivo
experimental evidence that replisomes in
Mycobacterium smegmatis
are highly dynamic, frequently splitting into two distinct replication forks. However, unlike in
Escherichia coli
, the forks do not segregate toward opposite cell poles but remain in relatively close proximity. In addition, we show that replication cycles do not overlap. Finally, our data suggest that ParB participates in the positioning of newly born replisomes in M. smegmatis cells. The present results broaden our understanding of chromosome segregation in slow-growing bacteria. In view of the complexity of the mycobacterial cell cycle, especially for pathogenic representatives of the genus, understanding the mechanisms and factors that affect chromosome dynamics will facilitate the identification of novel antimicrobial factors.
Characterization of Host and Microbial Determinants in Individuals with Latent Tuberculosis Infection Using a Human Granuloma Model
Authors: Guirado Evelyn , Mbawuike Uchenna , Keiser Tracy L. , Arcos Jesus , Azad Abul K. , Wang Shu-Hua , Schlesinger Larry S.
Published: February 2015

Granulomas sit at the center of tuberculosis (TB) immunopathogenesis. Progress in biomarkers and treatment specific to the human granuloma environment is hindered by the lack of a relevant and tractable infection model that better accounts for the complexity of the host immune response as well as pathogen counterresponses that subvert host immunity in granulomas. Here we developed and characterized anin vitrogranuloma model derived from human peripheral blood mononuclear cells (PBMCs) and autologous serum. Importantly, we interrogated this model for its ability to discriminate between host and bacterial determinants in individuals with and without latent TB infection (LTBI). By the use of this model, we provide the first evidence that granuloma formation, bacterial survival, lymphocyte proliferation, pro- and anti-inflammatory cytokines, and lipid body accumulation are significantly altered in LTBI individuals. Moreover, we show a specific transcriptional signature ofMycobacterium tuberculosisassociated with survival within human granuloma structures depending on the host immune status. Our report provides fundamentally new information on how the human host immune status and bacterial transcriptional signature may dictate early granuloma formation and outcome and provides evidence for the validity of the granuloma model and its potential applications.

IMPORTANCEIn 2012, approximately 1.3 million people died from tuberculosis (TB), the highest rate for any single bacterial pathogen. The long-term control of TB requires a better understanding ofMycobacterium tuberculosispathogenesis in appropriate research models. Granulomas represent the characteristic host tissue response to TB, controlling the bacilli while concentrating the immune response to a limited area. However, complete eradication of bacteria does not occur, sinceM. tuberculosishas its own strategies to adapt and persist. Thus, theM. tuberculosis-containing granuloma represents a unique environment for dictating both the host immune response and the bacterial response. Here we developed and characterized anin vitrogranuloma model derived from blood cells of individuals with latent TB infection that more accurately defines the human immune response and metabolic profiles ofM. tuberculosiswithin this uniquely regulated immune environment. This model may also prove beneficial for understanding other granulomatous diseases.
The association of environmental heat stress with performance: analysis of the 2014 FIFA World Cup Brazil
Authors: Nassis George P , Brito Joao , Dvorak Jiri , Chalabi Hakim , Racinais Sebastien
Published: February 2015

Objective

The 2014 FIFA World Cup Brazil included 64 matches in temperate to tropical environmental conditions. We analysed performance data in relation to the environmental conditions to identify potential association.

Methods

Wet-bulb globe temperature (WBGT) parameters were obtained at the centre of the field 1 h before the start of play. Environmental stress was estimated (low, moderate and high) for each match using WBGT and relative humidity. Various physical and technical performance indices were recorded during each match (average of both teams).

Results

Over the 64 matches, 28 were played under low, 20 under moderate and 16 under high environmental stress. There was no difference in actual playing time (p=0.517), total distance covered (p=0.491), number of goals scored (p=0.485) and number of cards (p=0.618) between the matches played under different environmental stress categories. The number of sprints was lower in high than in moderate or low environmental stress (−10%, p<0.05) but peak speed was unaffected. The distance covered at high intensity was also lower under high (24.8±2.8 m/min/player) than low environmental stress (26.9±2.3 m/min/player, p=0.02). Number of passes was not different but the rate of successful passes was higher under high (76.8±4.4%) than low (73.6±10.8%) environmental stress (p=0.031).

Conclusions

Top-level players seem to modulate their activity pattern during matches in a hot and humid environment (ie, less high-intensity but more low-intensity running and successful passes) to preserve the global match characteristics (ie, similar actual playing time, total distance covered, peak running speed and goals scored).
Republished: Endovascular treatment of jugular bulb diverticula causing debilitating pulsatile tinnitus
Authors: Mortimer Alex M , Harrington Tim , Steinfort Brendan , Faulder Ken
Published: February 2015

We describe the case of a patient who presented with debilitating pulsatile tinnitus in association with two jugular bulb diverticula. The diverticula were treated with stenting of the jugular bulb and coil embolization of the diverticula over two procedures. This resulted in successful resolution of symptoms and at 10 months follow-up the patient is asymptomatic. The technique is discussed with regard to similar published cases and surrogate measures of safety taken from the literature pertaining to idiopathic intracranial hypertension.
Alterations in enzymatic antioxidant defence in diabetes mellitus − a rational approach
Authors: Szaleczky Erika , Prechl József , Fehér János , Somogyi Anikó
Published: February 2015

Defence against the reactive oxidants produced during aerobic metabolism is a complex process and is provided by a system of enzymes and antioxidant compounds capable of preventing excess radical production, neutralising free radicals and repairing the damage caused by them. Regulation of the antioxidant system must provide sufficient, properly located, antioxidant compounds and enzymes. Damage to this system has been proved to play a role in various disorders. Long-term complications of diabetes mellitus are supposed to be partially mediated by oxidative stress. The authors summarise experimental and clinical investigations in this field and analyse the possible importance of the changes in the antioxidant system in the development of diabetic vascular complications.
Management of non-Hodgkin's lymphomas
Authors: Mounter P J , Lennard A L
Published: February 2015

The non-Hodgkin's lymphomas (NHL) are a heterogenous group of disorders characterised by malignant proliferation of lymphoid cells. The cellular origin is relatively well established with subtypes corresponding to the various stages of lymphocyte differentiation. The term encompasses a hotchpotch of conditions with very different morphological appearance, behaviour and clinical outcome. NHL comprise 2.4% of all cancers, with incidence increasing with age. The commonest presentation is with progressive lymphadenopathy, though extranodal manifestations are present in a significant proportion. The clinical behaviour ranges from a benign, indolent course to rapidly progressive disease; prognosis varies from weeks to many years. Treatment is correspondingly diverse, from ‘watchful waiting’ to high-dose chemotherapy with bone marrow stem cell transplantation. Cure is possible in an increasing number of patients and much interest currently lies in identifying patients with high-risk disease necessitating the use of intensive treatment regimens.
Intra-operative localisation of skull base tumours. A case report using the ISG viewing wand in the management of trigeminal neuroma
Authors: McEvoy A W , Porter D G , Bradford R , Wright A
Published: February 2015

Deep-seated skull base tumours provide as much a challenge to the surgeons' skills of localisation as to his technical abilities during the resection. These lesions are frequently inaccessible and lie adjacent to vital structures requiring extensive cerebral retraction for adequate exposure and direct visualisation. The ISG viewing wand is a newly developed image guidance system to aid direction of the operative approach and localisation of intracerebral pathology. We discuss its use in the management of a trigeminal neuroma.
Tuberculosis of the central nervous system
Authors: Garg Ravindra Kumar
Published: February 2015

Tuberculous involvement of the brain and spinal cord are common neurological disorders in developing countries and have recently shown a resurgence in developed ones. Tuberculous meningitis is an important manifestation and is associated with high morbidity and mortality. Diagnosis is based on clinical features, cerebrospinal fluid changes, and imaging characteristics. Bacteriological confirmation is not possible in all cases as serological tests do not have sufficient sensitivity and specificity. The polymerase chain reaction shows promise for the future. Appropriate chemotherapeutic agents should be administered as early as possible, although there is no unanimity concerning chemotherapeutic regimens or optimal duration of treatment. The patient's clinical stage at presentation is the most important prognostic factor. The role of corticosteroids is controversial but they should be administered to all patients presenting in stage III. Surgical procedures are directed at management of the hydrocephalus. Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord. They do not usually require surgical intervention and respond well to antituberculous treatment, along with corticosteroids.
Production and evaluation of guidelines for the management of inflammatory bowel disease: the Leicester experience
Authors: Read A M , Stone M A , Rathbone B J , de Caestecker J , Wicks A C B , Longworth S , O'Shea C R , Baker R , Spence D , Hall A W , Kelly M J , Cannon J , Robinson R J , Hart A R , Miles P , Mayberry J F
Published: February 2015

Consensus guidelines for the management of patients with inflammatory bowel disease were produced by gastroenterologists, gastrointestinal surgeons and a cross-section of general practitioners (GPs) from Leicestershire in order to develop a seamless pattern of care with a common approach to diagnosis and treatment. It was hoped that the guidelines would encourage a movement towards care in the community for many patients with stable disease and so speed up new consultation rates. The study then assessed the impact of these guidelines on the referral letters of GPs to hospital consultants, the prediction of disease and adherence to them on re-referring patients after discharge. The guidelines were distributed to all 487 GPs in the Leicester Health Authority area and the gastroenterology teams within the hospitals. The value of the guidelines was assessed by an audit of referral letters, the length of time from referral letter to out-patient appointment, both before and after the launch of the guidelines, adherence to the guidelines on re-referral, and monitoring the outcome of the discharged patients. Whilst the guidelines may have helped GPs to manage stable patients in the community, the content of referral letters and the diagnostic abilities of GPs were not seen to improve since the launch of the guidelines. However, only 5% of stable patients who were discharged from one clinic were re-referred for inflammatory bowel disease.
Brain parenchymal, subarachnoid racemose, and intraventricular cysticercosis in an Indian man
Authors: Ghosh D , Dubey T N , Prabhakar S
Published: February 2015

The coexistence of brain parenchymal cysts at various stages of evolution, both intraventricular and subarachnoid racemose, is reported in a patient with neurocysticercosis. The condition has a variety of presentations, depending on the location of the cyst. This case is of particular interest because of the rarity of this condition in India.
Transmission of Helicobacter pylori
Authors: Stone Margaret A
Published: February 2015

Helicobacter pylori is found predominantly in human gastric mucosa. Transfer of the bacterium remains an open topic, but it is likely that infection is usually acquired at a young age, particularly where lower socio-economic conditions prevail. Transmission via an external source such as water supply is a possibility but, in general, infection is probably passed from person to person. Arguments for and against faecal–oral, oral–oral and gastric–oral transmission have been presented, but the dominance of one of these routes is still to be determined.
Targeting pneumococcal vaccination to high-risk groups: a feasibility study in one general practice
Authors: Siriwardena A N
Published: February 2015

The Department of Health recommends pneumococcal vaccination opportunistically or when immunising against influenza. This was a study in one general practice to assess the feasibility of targeting patients for pneumococcal vaccination in primary care. We also examined the rate of uptake of pneumococcal vaccine in identified risk groups after one year of a pneumococcal vaccination programme. A self-administered questionnaire was given to patients attending for influenza vaccine between September and December 1996. A total of 551/747 (73.8%) patients returned completed questionnaires. Few patients receiving influenza vaccination (133/509, 26%) were aware of pneumococcal vaccine. Only 55/108 (51%) of those given influenza vaccination were in a clinical risk group for pneumococcal vaccine. Attitudes towards vaccination were more positive and intention to take up pneumococcal vaccination significantly greater in high-risk patients compared to those who were not in a risk group. A targeted vaccination campaign directed at high-risk patients, both opportunistically and those attending for influenza vaccination over one year, resulted in the following proportions of patients in at-risk groups being vaccinated: coronary disease 144/312 (46%), diabetes 79/132 (60%), splenectomy 2/2 (100%), chronic obstructive airways disease and asthma 135/700 (19%), and chronic renal failure 5/9 (56%). Most doses of pneumococcal vaccine (336/463; 73%) were delivered to patients in high-risk groups. We conclude that a well-organised pneumococcal vaccination campaign can improve coverage of at-risk patients in general practice. Programmes to increase patient awareness of the vaccine, improved availability of vaccine, and practice guidelines, would help to target the vaccine to at-risk patients. Patients with chronic lung disease and asthma were particularly difficult to define and target in this study. A review of the UK guidelines, aligning those for pneumococcal and influenza vaccination and including patients over 65 years, would improve the logistics of vaccine delivery.
The use of hypnosis in gastroscopy: a comparison with intravenous sedation
Authors: Conlong Philip , Rees Wynne
Published: February 2015

A total of 124 subjects who were undergoing routine endoscopy were randomly assigned to one of three groups. All three groups received lignocaine throat spray. The first group additionally received midazolam, the second received hypnosis, whilst the third only received lignocaine throat spray. Although hypnotised patients were deemed by an independent observer to be less agitated than the other two groups (p<0.03), they reported the gastroscopy to be significantly more uncomfortable (p<0.042) and scored higher in their memory for the procedure (p<0.001). They also took slightly longer to induce than the midazolam group. The midazolam group on the other hand rated the procedure as significantly more comfortable although paradoxically were seen by an independent observer as being more agitated. They were also significantly more amnesic. The endoscopist encountered more procedural difficulties with this group but this did not reach levels of significance. Hypnosis was not shown to be an effective alternative to intravenous sedation in gastroscopy.
High-altitude illness induced by tooth root infection
Authors: Finsterer J
Published: February 2015

High-altitude illness may occur after recent pulmonary infection, but high-altitude illness after root canal therapy has not been described previously. A 44-year-old man is presented who skied to a 3333 m high peak in the Eastern Alps one day after he had undergone root canal therapy because of a tooth root infection. After 4 hours above 3000 m severe symptoms of high-altitude illness, including pulmonary oedema, developed. His condition improved after immediate descent. The next day he presented with local and general signs of infection which were successfully treated with gingival incisions and antibiotics. In conclusion, acute tooth root infection and root canal therapy may induce high-altitude illness at an altitude just above 3000 m.
Lumbar hernia: a rare cause of large bowel obstruction
Authors: Hide I G , Pike E E , Uberoi R
Published: February 2015

We describe a 70-year-old woman presenting with large bowel obstruction secondary to incarceration of the mid descending colon within a lumbar hernia. This was diagnosed on barium enema and successfully treated surgically.
Early use of ‘open-air’ treatment for ‘pulmonary phthisis’ at the Dreadnought Hospital, Greenwich, 1900–1905
Authors: Cook G C
Published: February 2015

The use of open-air treatment for tuberculosis (‘pulmonary phthisis’) at the Dreadnought Hospital, Greenwich from 1900 to 1905 is reviewed. A marked reduction in mean mortality rate compared to ‘orthodox’ management was observed.
Gynaecological cancer
Authors: Kitchener H C
Published: February 2015

Gynaecological cancer encompasses a number of tumours with different epidemiology, pathology and treatment strategies. This article reviews the principal clinical advances and areas of development in cancer of the ovary, cervix, endometrium and vulva.
Risk factors for acquisition of gentamicin-resistant enterococcal infection: a case-controlled study
Authors: Viagappan M , Holliman R E
Published: February 2015

High-level gentamicin-resistant enterococci present problems in the treatment of infected patients, especially as synergy between penicillin and gentamicin is lost. Previous studies have suggested various risk factors for the acquisition of these enterococci. A case-controlled study was performed on 17 patients infected with resistant enterococci and 26 infected with sensitive strains who attended a London hospital. The key risk factors for acquisition of infection with high-level gentamicin-resistant enterococci were found to be prior prolonged antibiotic treatment, use of five or more antibiotics, and the presence of a urinary catheter. It is proposed that infection control measures should be targeted at patients at higher risk. In addition, control of antibiotic usage in a hospital may help to prevent acquisition and spread of these organisms.
Efficacy of statin therapy: possible effect of phenytoin
Authors: Murphy M J , Dominiczak M H
Published: February 2015

Statins are currently the most widely prescribed lipid-lowering drugs. Individual statins are known to be metabolised by the CYP3A4 isoform of the cytochrome P450 system. The effect of CYP3A4 inducers such as phenytoin on the metabolism and efficacy of these agents is unknown. We report a patient with familial hypercholesterolaemia and epilepsy in whom the introduction and subsequent discontinuation of phenytoin were associated with marked changes in the lipid response to treatment with simvastatin and atorvastatin. The serum activity of γ-glutamyl transpeptidase may have acted as a marker of microsomal induction by phenytoin, since it rose markedly when phenytoin was introduced and returned to normal after it was discontinued.
Medication-induced oesophageal injury leading to broncho-oesophageal fistula
Authors: McAndrew N A , Greenway M W
Published: February 2015

Medication-induced oesophageal injury is one of the least recognised side-effects of oral medication and, in contrast to other oesophageal pathologies, is rarely considered in the differential diagnosis of chest pain. We describe a case of medication-induced oesophageal injury with a rare complication in which the diagnosis was not considered until the characteristic features were demonstrated at endoscopy.
The role of exercise testing in the evaluation and management of heart failure
Authors: Wright D J , Tan L B
Published: February 2015

The clinical syndrome of heart failure has been investigated so extensively that it may now almost be regarded as a metabolic disorder. Although an initial insult reduces cardiac pump efficacy, the resultant physiological response culminates in complex neurohormonal dysfunction. This has created confusion and prevented the acceptance of a universal definition of cardiac failure. With much current research concentrating on the pharmacological modification of neuro-endocrine imbalance, it is easy to lose sight of the fundamental principles behind heart failure management, namely, to improve cardiac function. In attempting to achieve this, the issues of morbidity and mortality must be addressed jointly; they are not mutually exclusive entities. Discrepant results between mortality studies and changes in exercise capacity have undermined the value of exercise testing. Because a treatment enhances longevity we should not ignore its effect on symptomatic status, and likewise we should not discard a therapy, which improves function because adverse events result in occasional premature deaths. Informed patient choice must exist.

Historically, exercise testing has been quintessential in our understanding and evaluation of heart failure. Peak oxygen consumption remains the best overall indicator of symptomatic status, exercise capacity, prognosis and hospitalisation. Unfortunately, muddling of surrogate and true end-points has confused many of these issues. Improved comprehension may be gained by applying the concept of cardiac reserve which has been described in a variety of heart conditions and used in cardiac failure patients to provide an indication of prognosis and functional capacity.
A patient with fever and an abdominal aortic aneurysm
Authors: Barlow Gavin D , Green Stephen T
Published: February 2015

A 55-year-old man with an abdominal aortic aneurysm presented with fever and abdominal pain 3 weeks after an episode of Salmonella gastroenteritis. His symptoms persisted despite antimicrobial therapy. Two abdominal computed tomography (CT) scans showed no evidence of aortitis. His abdominal pain worsened and further investigation including a third CT scan demonstrated a leaking aortic aneurysm. The wall of the aorta was shown to contain Gram-negative bacilli. This case illustrates the difficulty in diagnosing bacterial aortitis.
A lesson in the management of testicular cancer in a patient with a solitary testis
Authors: Sawyer E J , Oliver R T D , Tobias J S , Badenoch D F
Published: February 2015

Five per cent of patients with germ cell tumours of the testis will develop a further tumour in the contralateral testis. Standard treatment in such cases is a second orchidectomy, resulting in infertility, hormone replacement, and psychological morbidity. In this case report we explore the role of testis conservation in these patients and also show that there is a risk of removing a potentially normal testis if a histological diagnosis is not sought prior to orchidectomy.
Pancreatic cancer: any prospects for prevention?
Authors: Hart Andrew R
Published: February 2015

Primary prevention of pancreatic cancer and public health measures to reduce its incidence are dependent on data from epidemiological studies. Currently, the only definite risk factor is smoking, although a diet rich in fruit and vegetables may be protective. The K-ras mutation may have a role in diagnosis and screening.
Aetiology and outcome in 53 cases of native valve staphylococcal endocarditis
Authors: Hricak V , Kovacik J , Marks P , West D , Kromery V
Published: February 2015

Within the last 30 years the profile of infective endocarditis has altered considerably with regard to microbiological causation, clinical features, and natural history. A contributory factor has undoubtedly been the development of potent antibiotics and their sometimes indiscriminate use. The increase in intravenous drug abuse in urban centres, the use of immunosuppressive agents, and the use of prosthetic heart valves have also all contributed. Although cardiac surgery in the uninfected heart provides a perfect environment for infective endocarditis, the improved design of prosthetic valves and the enhanced long-term survival and decreased immediate operative risk, means that surgery is viewed as the best option in many cases. In a series of 53 cases of staphylococcal endocarditis from a national endocarditis survey, those risk factors which influenced outcome were analysed. Thirty out of 53 patients had predisposing heart disease. Mortality was 39.6%. Statistical analysis revealed that attributable mortality was significantly associated with skin infection, systemic embolisation, and inappropriate therapy. Interestingly, surgical treatment was associated with better outcome.
Cytomegalovirus retinitis in patients with acquired immune deficiency syndrome
Authors: Eong K G Au , Beatty S , Charles S J
Published: February 2015

Cytomegalovirus (CMV) retinitis is the most common intra-ocular infection in patients with acquired immune deficiency syndrome (AIDS), and a leading cause of AIDS-related morbidity. Untreated CMV retinitis in AIDS patients is a progressive and potentially blinding disorder. The diagnosis of CMV retinitis is a clinical one and it is important for physicians to be familiar with the clinical features of the disease. Ophthalmic screening of AIDS sufferers should be undertaken at regular intervals, and this is dictated, in part, by the patient's CD4+ T-lymphocyte (CD4) counts. CMV retinitis may be treated with systemic ganciclovir, foscarnet or cidofovir, or with local (intravitreal) therapy. CMV-related retinal detachment is treated surgically. In some patients with quiescent CMV retinitis receiving highly active anti-retroviral therapy, anti-CMV maintenance therapy may be discontinued in favour of close ophthalmologic observation and CD4 count monitoring.
Primary lymphoma of the bladder treated successfully with mitozantrone gel
Authors: Porter P , Cornaby A J , Al-Hilali M , Chakrabarti A M
Published: February 2015

We describe a young man who presented with a short history of painless haematuria. Subsequent investigations and biopsy of lesions found in his bladder at cystoscopy confirmed the diagnosis of primary lymphoma of the bladder. Computed tomography studies confirmed the disease was localised to his bladder. Unfortunately, the tumour was not eradicated by radiotherapy. However, it was successfully treated with intravesical mitozantrone given in a novel gel formation. Three years after diagnosis the patient remains well with no evidence of recurrence.
A variant of pyothorax-associated lymphoma
Authors: Cheung C , Schonell M , Manoharan A
Published: February 2015

A case of pleural lymphoma that developed after an episode of empyema is described. This may be a variant presentation of the rare yet distinct condition termed pyothorax-associated lymphoma. This condition was first recognised in Japan; there have been only a few reports in Western countries to date. A feature of this case is the relatively short interval between diagnosis of empyema and subsequent development of lymphoma.
Co-prescription of H2 receptor blockers and proton pump inhibitors with warfarin in general practice
Authors: Hungin A Pali S , Rubin Greg P , O'Flanagan Hilda
Published: February 2015

Acid-suppressing drugs and anticoagulants are used increasingly in general practice. Warfarin is potentiated by some acid-suppressing drugs, notably cimetidine and omeprazole, through interference of the cytochrome P450 system. This study aimed to ascertain the extent of co-prescribing of warfarin and acid-suppressing drugs in general practice. We conducted a retrospective survey of the records of all patients prescribed acid-suppressing drugs over a 2-year period to ascertain those who had also taken warfarin; we also made a cross-sectional survey of all patients on warfarin to ascertain those who had taken acid-suppressing drugs. From a general practice population of 45 574 patients in northern England, 3423 (7.5%) had been prescribed acid-suppressing drugs during the previous 24 months. Of 274 patients who had been on warfarin, 44 (16.1%) had also taken acid-suppressing drugs (26 H2 receptor blockers and 18 proton-pump inhibitors). The commonest reasons for anticoagulation were thrombo-embolic disease (40.9%), atrial fibrillation (36.4%), valvular heart disease (18.2%), and surgical prophylaxis (4.5%). The indications for concurrent acid-suppressing drugs were: ‘dyspepsia’ 38.6%, reflux 22.7%, oesophagitis 13.6%, duodenal ulcer 13.6%, gastric ulcer 4.5%, unknown 6.8%. There have been no studies from primary care to evaluate the possible clinical effects of the concomitant use of acid-suppressing drugs and warfarin; some fluctuations in coagulation control, particularly in patients taking the combinations intermittently, may be due to this.
Diagnostic work-up in peripheral neuropathy: an analysis of 171 cases
Authors: Lubec Doris , Müllbacher Wolf , Finsterer Josef , Mamoli Bruno
Published: February 2015

This study was set up to evaluate retrospectively the efficacy of a standard diagnostic procedure, including non-invasive and invasive (spinal tap, nerve/muscle biopsy) investigations, in the diagnosis of peripheral neuropathy. The medical records of 171 in-patients with the final diagnosis of peripheral neuropathy of determined or undetermined cause were reviewed and each individual diagnostic work-up was analysed. Basic investigations included the patient's history, a clinical examination and basic laboratory tests. Depending on the individual presentation, course, and severity, further non-invasive and invasive examinations were added according to the department's standard diagnostic procedure. The aetiology could be clarified in 124 patients (73%) and remained unclear in 47 cases. Excluding cases with acute and chronic inflammatory polyneuropathy (n=14), the number of idiopathic peripheral neuropathies dropped to 33. Non-invasive investigations were sufficient to reveal the underlying aetiology in 114 cases (83 %). It is concluded that, with the application of a standard procedure for the diagnosis of peripheral neuropathy, the aetiology can be clarified in 81% of patients. In the other 19% of patients the aetiology remains idiopathic. In the majority of cases, non-invasive investigations were sufficient for diagnosis.
Visceral leishmaniasis masquerading as tuberculosis in a patient with AIDS
Authors: Yaduvanshi Amitabh , Jain Meenakshi , Jain S K , Jain Shyama , Arora Suneet
Published: February 2015

We report a case of visceral leishmaniasis presenting as significant lymphadenopathy in a patient with acquired immune deficiency syndrome. The lymphadenopathy was initially suspected to be tubercular in nature on pathological examination. This report highlights the increasing incidence of acquired immune deficiency syndrome and Leishmania co-infection in India, and the importance of demonstrating tubercle bacilli on culture before suggesting a diagnosis of tuberculosis.
Fatal phenytoin hypersensitivity syndrome
Authors: Mahadeva U , Al-Mrayat M , Steer K , Leen E
Published: February 2015

The phenytoin (hydantoin) hypersensitivity syndrome is rare but potentially fatal. Often, as in this case, it presents with non-specific symptoms and signs, requiring a high degree of clinical suspicion for diagnosis.
Management of pulmonary thrombo-embolism using catheter manipulation: a report of four cases and review of the literature
Authors: Wong Peter S C , Singh Shyam P , Watson Robert D S , Lip Gregory Y H
Published: February 2015

To date the management of pulmonary thrombo-embolism is still largely limited to anticoagulation. Heparin and oral anticoagulation have been shown to be effective in reducing recurrence and death in venous thrombo-embolism. During the acute stage, systemic thrombolytic therapy has also been advocated for the rapid dissolution of the thrombus in patients with haemodynamic instability. We describe four patients with acute pulmonary thrombo-embolism who were managed with catheter-based thrombus manipulation with intrapulmonary thrombolysis. This management strategy should be considered in patients with pulmonary thrombo-embolism who continue to deteriorate despite conventional management with anticoagulation or systemic thrombolysis.
CT dimensions, volumes and densities of normal canine eyes
Authors: Salgüero R. , Johnson V. , Williams D. , Hartley C. , Holmes M. , Dennis R. , Herrtage M.
Published: February 2015

Although ultrasound and MRI are the imaging modalities of choice for the investigation of ocular diseases, the eyes are included in routine CT examinations of the head and should be examined as part of the complete evaluation. This report describes the dimensions, volumes and densities of the normal canine globe in CT. Forty‐four eyes were studied. The mean axial length of the globe was 2.09 cm and its mean volume was 4.65 cm3. The mean anteroposterior distance of the anterior chamber was 0.4 cm and of the vitreous chamber was 0.96 cm. There was a statistically significant difference between the mean aqueous humour density, 14.76 Hounsfield units (HU), and the mean vitreous humour density, 11.20 HU (P=0.0009). Statistically significant differences were also seen in both humours in precontrast and postcontrast studies. The mean anteroposterior dimension of the lens was 0.74 cm; its mean equatorial distance was 1.15 cm. The mean volume was 0.43 cm3and its mean density was 131.9 HU. There was contrast enhancement of the ciliary body, iris and retina/sclera/choroid complex. This study provides reference values to help in the interpretation of ocular structures on CT scans of the head, where incidental findings can change the medical management of specific cases.
Exercise training modifies gut microbiota in normal and diabetic mice
Authors: Lambert Jennifer E. , Myslicki Jason P. , Bomhof Marc R. , Belke Darrell D. , Shearer Jane , Reimer Raylene A.
Published: February 2015

Cecal microbiota from type 2 diabetic (db/db) and control (db/+) mice was obtained following 6 weeks of sedentary or exercise activity. qPCR analysis revealed a main effect of exercise, with greater abundance of select Firmicutes species and lower Bacteroides/Prevotella spp. in both normal and diabetic exercised mice compared with sedentary counterparts. Conversely, Bifidobacterium spp. was greater in exercised normal but not diabetic mice (exercise × diabetes interaction). How exercise influences gut microbiota requires further investigation.
Two new methods for computing vibrational energy levels
Authors: Carrington Tucker
Published: February 2015

I review two new ideas for coping with the size of large product basis sets and large product grids when one computes vibrational energy levels. The first is based on a tensor reduction scheme. It exploits advantages of a sum-of-products potential. The key idea is to use a basis each of whose function is a sum of optimized products and to compress the number of terms in each basis function. When the potential does not have the sum-of-products form, it is usually necessary to use quadrature. The second idea uses a nondirect product grid that has structure and is therefore compatible with efficient matrix–vector products.
Effect of shear stud clusters in composite girder bridge design
Authors: Huh Ben , Lam Clifford , Tharmabala Bala
Published: February 2015

As part of ongoing efforts to accelerate bridge construction in Ontario, the Ministry of Transportation of Ontario (MTO) has turned increasingly to prefabricated bridge technology as a bridge construction method when conditions allow. One of the prefabricated deck systems commonly used by MTO involves installing precast full-depth deck panels with pre-formed shear pockets on top of the naked steel girders, which are then made composite with the girders through shear studs installed inside the shear pockets. Construction of the deck slab is completed by filling the shear pockets with in situ concrete. Recent prefabricated bridge projects have shown an increasing tendency to concentrate the shear studs into clusters of closely-spaced studs in shear pockets that are spaced at relatively large distances apart. Concerns have been raised about the effectiveness of the resulting composite action between the precast panels and the supporting girders. As a result, MTO’s Bridge Office recently carried out a comprehensive experimental research study to investigate the issue by using reduced scale models of single composite beam systems as well as shear push-out specimens. This paper describes the laboratory research project and the tests that were carried out and discusses the results obtained. Comparisons with theoretical results are made to assess the composite action that is developed. Experimental test results indicate that closely-spaced studs in the shear pockets in the precast deck panels provide adequate composite action in composite bridge girder design.
Classes of states of discrete systems
Authors: Krawczyk Malgorzata J.
Published: February 2015

We present a method which allows for a reduction of a size of a simulated system. The method can be applied to any system where one can define a finite set of possible states of the system and an elementary process which transforms one state of the system to another. The method is based on the system symmetry; we get classes of states, which can be used instead of states. A detailed procedure is presented for undirected/directed and/or unweighted/weighted graphs. Several applications of the method are shown for different types of systems. In particular, new results are presented for the random Boolean networks.
Variable exponents and grand Lebesgue spaces: Some optimal results
Authors: Fiorenza Alberto , Rakotoson Jean Michel , Sbordone Carlo
Published: February 2015

Consider p : Ω → [1, +∞[, a measurable bounded function on a bounded set Ø with decreasing rearrangement p* : [0, |Ω|] → [1, +∞[. We construct a rearrangement invariant space with variable exponent p* denoted by [Formula: see text]. According to the growth of p*, we compare this space to the Lebesgue spaces or grand Lebesgue spaces. In particular, if p*(⋅) satisfies the log-Hölder continuity at zero, then it is contained in the grand Lebesgue space Lp*(0))(Ω). This inclusion fails to be true if we impose a slower growth as [Formula: see text] at zero. Some other results are discussed.
ADVANCES REGARDING POWERED PROSTHESIS FOR TRANSTIBIAL AMPUTATION
Authors: LEMOYNE ROBERT
Published: February 2015

The necessity for developing advanced prostheses are apparent in light of projections that the forecast for the number of people enduring amputation will double by the year 2050. The transtibial powered prosthesis that enables positive mechanical work about the ankle during the powered plantar flexion aspect of stance phase constitutes a paradigm shift in available transtibial prostheses. The objective of the review is to advocate the state of the art regarding the transtibial powered prosthesis. The historic origins of the prosthesis and motivations for amputation are clarified. The phases of gait and the compensatory mechanisms and asymmetries inherent with passive transtibial prostheses are described. The three general classes of transtibial prosthesis (passive, energy storage and return and powered prostheses) are defined. Subsystems that are integral to the powered prosthesis are explained, such as the series elastic actuator and control architecture. Gait analysis systems and their role for the test and evaluation of energy storage and return and powered prostheses are demonstrated. Future advanced concepts; such as the integration of titin into novel muscle models that account for force enhancement and force depression including their implications for cutting edge bio-inspired actuators are elucidated. The review accounts for the evolution of the prosthetic device with regards to the scope of transtibial amputation and assesses the current state-of-the-art.
A Survival Analysis of Business Insolvency in ICT and Automobile Industries
Authors: Yang Chang-Gyu , Trimi Silvana , Lee Sang-Gun , Yang Joon-Sun
Published: February 2015

This study examines the differences in business insolvency between the information and communication technology (ICT) industry and the automobile industry, as well as their sub-categories of manufacturers and service providers, based on survival analysis. The results indicate that, unlike the technology diffusion model, the survival analysis provided clearer explanations on the differences in business solvency among ICT, automobile, manufacturing, and service firms. We found that insolvency of ICT firms is influenced by the short life cycle of the products/services that these firms provide to their customers, as compared to a much longer life cycle of the products of manufacturers. We also identified that ICT service providers’ business depends heavily on ICT manufacturers, but to strengthen their survival ability they must continuously introduce technological innovations. In addition, the study examined the causes of business insolvency of ICT firms based on the characteristics of the ICT industry, including the swing effect, the bandwagon effect, and winner-take-all outcomes. The study results provide valuable insights in developing survival strategies for ICT and automobile firms. The study also makes contributions to the literature in that the business insolvency phenomenon can be better explained through statistical significance analysis.
Libra
Authors: Jimenez Xavier , Novo David , Ienne Paolo
Published: February 2015

Hybrid flash storages combine a small
Single-Level Cell
(SLC) partition with a large
Multilevel Cell
(MLC) partition. Compared to MLC-only solutions, the SLC partition exploits fast and short local write updates, while the MLC part brings large capacity. On the whole, hybrid storage achieves a tangible performance improvement for a moderate extra cost. Yet, device lifetime is an important aspect often overlooked: in a hybrid system, a large ratio of writes may be directed to the small SLC partition, thus generating a local stress that could exhaust the SLC lifetime significantly sooner than the MLC partition's. To address this issue, we propose
Libra
, which builds on flash storage made solely of MLC flash and uses the memory devices in SLC mode when appropriate; that is, we exploit the fact that writing a single bit per cell in an MLC provides characteristics close to those of an ordinary SLC. In our scheme, the cell bit-density of a block can be decided dynamically by the flash controller, and the physical location of the SLC partition can now be moved around the whole device, balancing wear across it. This article provides a thorough analysis and characterization of the SLC mode for MLCs and gives evidence that the inherent flexibility provided by
Libra
simplifies considerably the stress balance on the device. Overall, our technique improves lifetime by up to one order of magnitude at no cost when compared to any hybrid storage that relies on a static SLC-MLC partitioning.
Two-Stage Document Length Normalization for Information Retrieval
Authors: Na Seung-Hoon
Published: February 2015

The standard approach for term frequency normalization is based only on the document length. However, it does not distinguish the verbosity from the scope, these being the two main factors determining the document length. Because the verbosity and scope have largely different effects on the increase in term frequency, the standard approach can easily suffer from insufficient or excessive penalization depending on the specific type of long document. To overcome these problems, this article proposes two-stage normalization by performing verbosity and scope normalization separately, and by employing different penalization functions. In verbosity normalization, each document is prenormalized by dividing the term frequency by the verbosity of the document. In scope normalization, an existing retrieval model is applied in a straightforward manner to the prenormalized document, finally leading us to formulate our proposed verbosity normalized (VN) retrieval model. Experimental results carried out on standard TREC collections demonstrate that the VN model leads to marginal but statistically significant improvements over standard retrieval models.
Toward Optimal Monitoring of Flow-Based Systems Using Mobile Wireless Sensor Networks
Authors: Suresh Mahima Agumbe , Zhang Wei , Gong Weijiao , Stoleru Radu , Rasekh Amin , Banks M. Katherine
Published: February 2015

Monitoring flow-based systems (FBS) (e.g., water distribution systems, oil and gas pipelines, the human cardiovascular system) is of paramount importance considering their economic and health impacts. FBS monitoring typically has been achieved by costly, complex, static sensors that are strategically placed. To reduce the cost of monitoring, we propose a mobile wireless sensor network (WSN) system comprised of mobile sensors (their movement aided by the inherent flow in the FBS) and static beacons that aid in locating sensors. This article presents the first complete architectural design, algorithms, and protocols for optimal monitoring of FBS. Our proposed solution includes sensing and communication models, MAC and group management protocols for sensor and beacon communication, and algorithms for sensor and beacon placement. We compare our proposed solution with the state of the art through extensive simulations and a proof-of-concept system implementation. We demonstrate performance improvements, such as a dramatic reduction (a factor of 91) in the number of sensors when the sensing range is marginally (2.5 times) increased.