bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver transplantation during infancy: No increased rate of neurological complications
Authors: Ameres Markus , Melter Michael , Zant Robert , Schilling Stefan , Geis Tobias
Published: October 2018

pLT is a highly standardized therapy for children with end‐stage liver disease and liver‐based metabolic diseases. However, NCs after transplantation occur and especially younger children are considered as more vulnerable and susceptible to NCs. Up to now, detailed data particularly for the very young age group do not exist. We therefore retrospectively studied NCs in children after pLT under age of 24 months. Forty children aged between 19 days and 22 months were evaluated according to type of NC and potential risk factors. NCs occurred in 8/40 patients (20%). All experienced new‐onset seizures and in 1/6 surviving patients, seizures evolved into epilepsy. Other NCs were intracerebral abscess (1/8 patients) and subdural hemorrhage (1/8 patients). The overall 3‐year mortality rate was 10% (4/40 patients). Significant risk factors for NCs and therefore seizures were HAT (P = 0.020), total surgery time (P = 0.009), retransplantation (P < 0.001), period of catecholamine therapy (P = 0.024), period of mechanical ventilation (P = 0.014), and period of sedation (P = 0.010). Our study is the first to provide detailed information on NCs after pLT in children under 24 months of age. The incidence of NCs in this particular group of very young patients was not increased compared to previously published data of children of all ages. Main NC was new‐onset seizure. In the surviving infants, prognosis of seizure was excellent and the risk of developing epilepsy was low. Even more, the occurrence of NCs did not significantly affect mortality or survival in this particular age group.
Expression analysis of cellulose synthases that comprise the Type II complex in hybrid aspen
Authors: Osako Y. , Takata N. , Nuoendagula  , Ishikawa S. , Umezawa T. , Taniguchi T. , Kajita S.
Published: October 2018

Gene duplication in plants occurs via several different mechanisms, including whole genome duplication, and the copied genes acquire various forms and types. The cellulose synthase (CesA) family functions in cellulose synthesis complex (CSC) formation, which is involved in the synthesis of primary and secondary cell walls in plants. In the genome of Populus, 17 CesA have been annotated, and some of them appeared through whole genome duplication. The nucleotide sequence of the duplicated genes changed during subsequent evolution, and functional differentiation of genes might have occurred.

To gain insight into the evolutionary fate of the duplicated CesA, expression analysis with quantitative reverse transcription polymerase chain reactions and promoter–reporter assays was performed on three duplicated gene pairs whose products have been reported to form a single CSC.

Changes in expression of each gene at different developmental stages were detected and divergent expression patterns in different organs and tissues observed between the gene pairs. Among the tested genes, expression of PttCesA3‐C was apparently lower than that of its counterpart, PttCesA3‐D.

The results suggest that the six CesA are approaching sub‐functionalisation or non‐functionalisation. Furthermore, the level of functionalisation may vary among the three pairs of genes, and functional specialisation of each CesA should have been achieved, at least partially, through differences in expression of genes.
Sperm quality during extra‐gonadal sperm reserve depletion in stallions
Authors: Len Jose A. , Beehan David , Eilts Bruce , Lyle Sara K.
Published: October 2018

Contents

To estimate when, during stallions’ extra‐gonadal reserves (EGR) depletion period, sperm quality would reach its highest quality, six light breed sexually rested stallions were collected daily for 7 days to deplete EGR. On collection days 1, 3, 5, and 7, sperm output, total (TM) and progressive (PM) motility, morphology, and plasma membrane (PLM) integrity were evaluated. Sperm output decreased as EGR depletion advanced, stabilizing on days 5–7. Sperm motility (TM and PM) and morphology were not different during EGR depletion. Plasma membrane integrity improved from day 1 to 3; however, no further improvement observed on days 5 and 7. Sperm of sexually rested stallions reach the highest quality on day 3 of the EGR depletion period.
Downstepped High Tone in Persian Spontaneous Speech Intonation
Authors: Sadat‐Tehrani Nima
Published: October 2018

This corpus‐based research examines a downstepped boundary tone in Persian spontaneous declaratives and yes/no questions (YNQs), by looking at 318 minutes of spontaneous phone conversations of 21 female and 21 male speakers in three age groups, 20s, 30s, and 40s. The downsteppedYNQs lack the final rise typically found in read utterances, which is associated with the non‐genuineness of the interrogative and a lowered degree of the hearer's commitment to provide a reply. The downstep in declaratives, accompanied by a following pause, creates functions such as topicalization and facilitates the cognitive pre‐planning of speech. There is no effect of sex and age on the production of this tone. The specific functions of this tone and its independence of adjacent tones argue for its inclusion in the grammar of Persian intonation. Additionally, this research is in itself a first‐time investigation of the intonation of Persian spontaneousYNQs and shows that the majority of them share the same intonation pattern with lab producedYNQs.
Emergency response of four transfusion centers during the last Chikungunya outbreak in Italy
Authors: Pierelli Luca , Vacca Michele , Zini Gina , Maresca Maddalena , Menichella Giacomo , Santinelli Susanna , Stigliano Maria Alba , Mandarello Gabriele , Gasbarri Roberto , Vaglio Stefania
Published: October 2018

Between September 15 and November 11, 2017, the area of Rome was subjected to cessation of donation in an area of approximately 1,300,000 inhabitants and with a 5‐day quarantine for the rest of metropolitan areas due to Chikungunya virus (CHIKV) outbreak. Quarantine was applied to red blood cell (RBC) and plasma units while platelet concentrates (PCs) were subjected to pathogen inactivation methods (PIMs). Quarantine was based on an active recall of all donors and, in case of declared absence of any symptom or illness, on release of RBC and plasma units after 5 days. Four regional centers in which PIMs were already performed were charged for PIMs for the rest of Rome's area. These centers increased by 236% their previous PIM procedures, producing additional 1425 pathogen‐reduced (PR) PCs in 57 days, beside their production (996 PR PCs) for local needs. The emergency support was close to the maximal production capacity of the four centers and was successful only thanks to the limited length of emergency. No adverse events were reported by all centers through a passive hemovigilance approach and by a follow‐up of approximately 4 months. None of the donors referred symptoms or illness at recall and none of the blood products were discarded after quarantine. To date, no cases of CHIKV‐transmitted infection were reported in transfused patients. This experience has taught some relevant strategic and organizing aspects that should be taken into account when an infectious outbreak must be faced in a large metropolitan area.
The altered mechanical phenotype of fetal fibroblasts hinders myofibroblast differentiation
Authors: Jerrell Rachel J. , Leih Mitchell J. , Parekh Aron
Published: October 2018

During the dermal wound healing process, the mechanical rigidity of the newly deposited extracellular matrix and transforming growth factor‐β1 promote the transition of fibroblasts into myofibroblasts. Myofibroblasts generate large cellular forces that contract and remodel the extracellular matrix leading to scar formation. In contrast, myofibroblasts are not detected in fetal dermal wounds which are more compliant and contain less transforming growth factor‐β1 than adult wounds. Instead, fetal fibroblasts orchestrate scarless healing of dermal wounds resulting in healed tissues that resemble uninjured dermis. While these biomechanical differences suggest that the fetal wound environment promotes smaller cellular forces which enable regeneration, previous studies indicate that fetal fibroblasts have unique contractile properties that may facilitate scarless dermal repair. Therefore, we tested whether physiologic wound rigidities and transforming growth factor‐β1 induce contractile forces and myofibroblast differentiation of fetal dermal fibroblasts. In comparison to their adult dermal counterparts, we found that fetal fibroblasts exhibit a deficient contractile response to rigid extracellular matrix and transforming growth factor‐β1. Our data suggest that the contractile phenotype of fetal dermal fibroblasts limits their cellular force production and prevents their ability to differentiate into myofibroblasts.
Diverse relaxation rates exist among rat cardiomyocytes isolated from a single myocardial region
Authors: Clark J. Alexander , Campbell Stuart G.
Published: October 2018

Key points

Prior studies have shown variation in the functional properties of cardiomyocytes isolated from different regions of the left ventricular myocardium.

We found that these region‐dependent variations vanish below a tissue volume of ∼7 mm3 in the adult rat myocardium, revealing a fixed level of intrinsic relaxation rate heterogeneity that is independent of tissue volume.

Within these microscopically varying cell populations, fast‐relaxing cells were shown to have elevated phosphorylated troponin I compared to slow‐relaxing cells.

Relaxation rate was also correlated with cardiomyocyte length, in that slow‐relaxing cells were longer than fast‐relaxing cells.

These results show a new relationship between cardiomyocyte morphology and myofilament relaxation, and suggest that functional diversity among individual myocytes at the microscale may contribute to bulk relaxation of the myocardium.

The mean contractility and calcium handling properties of cardiomyocytes isolated from different regions of the ventricular myocardium are known to vary significantly. We designed experiments to quantify the variance in contractile properties among cells within the same myocardial region. Longitudinal strips of myocardial tissue were excised from the epicardial left ventricular free walls of adult Sprague–Dawley rats and then treated with collagenase to isolate individual myocytes. Cardiomyocytes were characterized by measuring sarcomere length changes and calcium transients during electrical pacing. Variance of the time from peak sarcomere shortening to 50% re‐lengthening (RT50) was assessed in each cell population. Isolating cells from progressively shorter strips allowed an estimate of the myocardial volume below which regional variation vanished and only microscale heterogeneity remained (∼7 mm3). The SD of RT50 within this myocardial volume was 28% of the mean. In a series of follow‐up experiments, RT50 was shown to correlate significantly with resting myocyte length, suggesting a connection between cell morphology and intrinsic relaxation behaviour. To explore the mechanistic basis of varying RT50, a novel single‐cell aspirator was employed to collect small batches of cardiomyocytes grouped according to their relaxation rates (fast or slow). Western blot analysis of the two groups revealed significantly elevated troponin I phosphorylation in fast‐relaxing cells. Our observations suggest that cell‐to‐cell heterogeneity of active contractile properties is substantial, with implications for how we understand myocardial relaxation and design drug therapies intended to alter relaxation rate.
Oxygen, evolution and redox signalling in the human brain; quantum in the quotidian
Authors: Bailey Damian Miles
Published: October 2018

Rising atmospheric oxygen (O2) levels provided a selective pressure for the evolution of O2‐dependent micro‐organisms that began with the autotrophic eukaryotes. Since these primordial times, the respiring mammalian cell has become entirely dependent on the constancy of electron flow, with molecular O2 serving as the terminal electron acceptor in mitochondrial oxidative phosphorylation. Indeed, the ability to ‘sense’ O2 and maintain homeostasis is considered one of the most important roles of the central nervous system (CNS) and probably represented a major driving force in the evolution of the human brain. Today, modern humans have evolved with an oversized brain committed to a continually active state and, as a consequence, paradoxically vulnerable to failure if the O2 supply is interrupted. However, our pre‐occupation with O2, the elixir of life, obscures the fact that it is a gas with a Janus face, capable of sustaining life in physiologically controlled amounts yet paradoxically deadly to the CNS when in excess. A closer look at its quantum structure reveals precisely why; the triplet ground state diatomic O2 molecule is paramagnetic and exists in air as a free radical, constrained from reacting aggressively with the brain's organic molecules due to its ‘spin restriction’, a thermodynamic quirk of evolutionary fate. By further exploring O2’s free radical ‘quantum quirkiness’, including emergent (quantum) physiological phenomena, our understanding of precisely how the human brain senses O2 deprivation (hypoxia) and the elaborate redox‐signalling defence mechanisms that defend O2 homeostasis has the potential to offer unique insights into the pathophysiology and treatment of human brain disease.
The Impacts of Residential Segregation on Obesity
Authors: Yu Chia-Yuan , Woo Ayoung , Hawkins Christopher , Iman Sara
Published: October 2018

Background: This study examined the association between residential segregation and obesity for Whites, African Americans, Hispanics, and Asians. This study considered 3 dimensions of residential segregation, isolation, dissimilarity, and concentration. Methods: By combining individual-level data from the Behavioral Risk Factor Surveillance System and county-level data from the County Health Rankings and Roadmaps, the total sample size was 204,610 respondents (160,213 Whites, 21,865 African Americans, 18,027 Hispanics, and 4505 Asians) from 205 counties in the United States. Two-level logistic regression models were performed. Results: African Americans and Hispanics in counties with high levels of isolation, dissimilarity, and concentration were more likely to be obese; these relationships did not hold true for Whites and Asians. Counties with a higher percentage of populations with the income below the poverty line and a higher percentage of fast food restaurants in the county were associated with a higher likelihood of obesity for all racial/ethnic groups. African Americans and Hispanics with low levels of education and income were more likely to be obese. Conclusions: Residential segregation had a contextual influence on weight status, and the context of counties influenced racial/ethnic groups differently. Obesity reduction programs should consider the contextual influence on minority populations and target subgroups living in highly segregated areas.
Goals Matter: Exercising for Well-Being But Not Health or Appearance Predicts Future Exercise Among Parents
Authors: Mailey Emily L. , Dlugonski Deirdre , Hsu Wei-Wen , Segar Michelle
Published: October 2018

Background: Many parents are insufficiently active. Further research is needed to understand the goals that drive sustained exercise participation among parents. The purpose of this study was to use self-determination theory derived constructs to examine the relationship between parents’ exercise goals and their autonomous motivation, controlled motivation, and exercise behavior across 1 year.Methods: Mothers (n = 226) and fathers (n = 70) of children less than 16 years completed the Exercise Motivations Inventory-2 and, 1 year later, the Behavioral Regulation in Exercise Questionnaire-2 and Godin Leisure-Time Exercise Questionnaire. Linear mixed effects models were used to examine the longitudinal relationships between exercise goals and autonomous motivation, controlled motivation, and leisure-time exercise.Results: All goals except weight management were significantly associated with autonomous motivation, whereas only weight and appearance goals predicted controlled motivation. Exercising for stress management and revitalization, but not health- or appearance-related goals, was significantly related to exercise behavior over 1 year.Conclusions: Only goals related to immediate affective outcomes were associated with both autonomous motivation and exercise behavior over time. These findings support recent calls to “rebrand exercise” as a means to improve daily well-being. Such goals may drive parents to prioritize exercise because they value the immediate benefits it provides.
Group-Based Trajectory Analysis of Physical Activity Change in a US Weight Loss Intervention
Authors: Imes Christopher C. , Zheng Yaguang , Mendez Dara D. , Rockette-Wagner Bonny J. , Mattos Meghan K. , Goode Rachel W. , Sereika Susan M. , Burke Lora E.
Published: October 2018

Background: The obesity epidemic is a global concern. Standard behavioral treatment including increased physical activity, reduced energy intake, and behavioral change counseling is an effective lifestyle intervention for weight loss. Purpose: To identify distinct step count patterns among weight loss intervention participants, examine weight loss differences by trajectory group, and examine baseline factors associated with trajectory group membership. Methods: Both groups received group-based standard behavioral treatment while the experimental group received up to 30 additional, one-on-one self-efficacy enhancement sessions. Data were analyzed using group-based trajectory modeling, analysis of variance, chi-square tests, and multinomial logistic regression. Results: Participants (N = 120) were mostly female (81.8%) and white (73.6%) with a mean (SD) body mass index of 33.2 (3.8) kg/m2. Four step count trajectory groups were identified: active (>10,000 steps/day; 11.7%), somewhat active (7500–10,000 steps/day; 28.3%), low active (5000–7500 steps/day; 27.5%), and sedentary (<5000 steps/day; 32.5%). Percent weight loss at 12 months increased incrementally by trajectory group (5.1% [5.7%], 7.8% [6.9%], 8.0% [7.4%], and 13.63% [7.0%], respectively; P = .001). At baseline, lower body mass index and higher perceived health predicted membership in the better performing trajectory groups. Conclusions: Within a larger group of adults in a weight loss intervention, 4 distinct trajectory groups were identified and group membership was associated with differential weight loss.
Rates of Obesity and Obesogenic Behaviors of Rural Appalachian Adolescents: How Do They Compare to Other Adolescents or Recommendations?
Authors: Smith Laureen H. , Laurent Devin , Baumker Erica , Petosa Rick L.
Published: October 2018

Background: To better understand the unique challenges of Appalachians, community-based studies are needed to establish benchmark rates. This study compares obesity rates and obesogenic behaviors among Appalachian adolescents to other adolescent populations or clinical recommendations. Methods: This study was conducted in 11 Appalachian schools. Body mass index, body mass index percentile, and body fat percentage were measured using a Tanita DC-430U analyzer. Physical activity was measured using Actigraph wGT3X-BT accelerometers. Sugar-sweetened beverage consumption was self-reported. Pearson’s correlations, independent t tests, and multivariate analyses with tests of between-subject effects were conducted. Results: Mean (n = 345) age was 15.23 (SD = 1.02) years. Appalachian adolescents were extremely obese (13.1%) by more than double that of national adolescent rates. Nearly 29% of males and over 55% of females were at increased cardiovascular risk. Only 15% were moderately active for at least 60 minutes a day, but only for 1 day per week. Mean afterschool sedentary time was 4.75 hours. Only 2.1% recorded vigorous activity for a minimum of 10 minutes at 1 day per week. Nearly all regularly consumed sugar-sweetened beverages. Conclusion: Obesogenic health disparities were evident in Appalachia. Rates of obesogenic factors among Appalachian adolescents exceed national rates. Appalachian adolescents were far less active, and extreme obesity is a major health concern.
Are We Overestimating Physical Activity Prevalence in Children?
Authors: Price Lisa , Wyatt Katrina , Lloyd Jenny , Abraham Charles , Creanor Siobhan , Dean Sarah , Hillsdon Melvyn
Published: October 2018

Background: Physical activity guidelines state that children should achieve at least 60 minutes of moderate to vigorous physical activity (MVPA) on each day of the week. Accurate assessment of adherence to these guidelines should, ideally, include measurement over 7 days. When less than 7 days of data are available, researchers often report the average minutes of MVPA per day as a proxy for 7-day measurement. The aim of this study was to compare prevalence estimates generated by average MVPA per day versus MVPA assessed over 7 days. Methods: Data were collected as part of the Healthy Lifestyles Programme. One class from each school was randomized to wear a GENEActiv accelerometer for 8 days. The percentages of children achieving an average of ≥60 minutes of MVPA per day and those achieving ≥60 minutes of MVPA on each of 7 days were calculated. Results: A total of 807 children provided 7 days of data. When the average MVPA per day was calculated, 30.6% (n = 247) of children accumulated ≥60 minutes of MVPA per day. Only 3.2% (n = 26) accumulated ≥60 minutes of MVPA on every day of the week. Conclusion: Previous studies utilizing average MVPA per day are likely to have overestimated the percentage of children meeting recommendations.
Living donor renal transplant in a patient with end-stage renal disease due to Hermansky-Pudlak syndrome
Authors: Abdullah Nassreen , Davis Niall F , Quinn John , Mohan Ponnusamy
Published: October 2018

Hermansky-Pudlak syndrome (HPS) is a rare genetic disorder characterised by oculocutaneous albinism, bleeding diathesis and end-stage renal disease (ESRD), due to interstitial deposition of ceroid lipofuscin. Renal transplantation is potentially a definitive treatment option for patients with ESRD due to HPS. Herein, we describe the case of a 55-year-old male patient with HPS that successfully underwent a living donor kidney transplant. We also emphasise the importance of multidisciplinary input during the preoperative, perioperative and postoperative phases in this high-risk clinical scenario.
Unusual case of unilateral conductive hearing loss: chronic lymphocytic leukaemia
Authors: Davis Amelia Leigh , Gangatharan Shane , Kuthubutheen Jafri
Published: October 2018

This presentation reports a novel case of chronic lymphocytic leukaemia (CLL), presenting with an early cutaneous lesion within the external auditory canal, in a patient being assessed for conductive hearing loss. It has previously been reported that infiltrative CLL can involve the head and neck; however, isolated external ear canal involvement is rare. Given that the incidence of CLL in Australia is rising, this case highlights the importance of considering CLL as a differential diagnosis for presentations of unilateral conductive hearing loss.
Cerebrospinal fluid hydrocele caused by scrotal migration of a ventriculoperitoneal shunt
Authors: Nawaz Atif , Chaudhry Mustafa Belal Hafeez , Mirza Waseem Akhtar
Published: October 2018

A 6-month-old boy presented with painless right hemiscrotal swelling. The scrotal ultrasound revealed a cerebrospinal fluid hydrocele caused by the migration of a ventriculoperitoneal shunt (VPS) catheter tip into the right hemiscrotum and associated undescended left testis. Earlier, he underwent a VPS placement for hydrocephalus secondary to neonatal bacterial meningitis and ventriculitis. The patient was treated with bilateral herniotomy, left-sided orchidopexy and repositioning of VPS into the peritoneal cavity.
Disseminated nocardiosis with infective endocarditis of a transplanted heart
Authors: Hazim Antonious Ziad , Mansoor André Martin
Published: October 2018

Nocardiosis is caused by various species of Nocardia and typically occurs as an opportunistic infection. It frequently disseminates, most often involving the lungs, subcutaneous tissues and central nervous system. It has rarely been reported to affect native heart valves. We report the case of a 64-year-old man with disseminated nocardiosis involving the brain, lungs, muscle and tricuspid valve of a transplanted heart. Following antimicrobial therapy, the patient improved clinically and there was no evidence of residual infection on follow-up imaging. This case highlights the presentation of nocardiosis, current therapeutic guidelines and the question of prophylaxis against Nocardia in immunocompromised patients.
Unusual cause of fever, vision loss and super refractory status epilepticus in association with simian virus 40 (SV40)
Authors: Agarwal Ayush , Vibha Deepti , Chawla Rohan , Sharma Mehar Chand
Published: October 2018

We present a case of a 23-year-old man with history of fever followed by painless complete vision loss, with subsequent new-onset refractory status epilepticus (NORSE). He initially developed bilateral retinitis. A few days later, he started having focal seizures, and subsequently developed super-refractory status epilepticus, requiring anaesthetic agents. MRI brain revealed multifocal cortical and subcortical hyperintensities in occipital and temporoparietal regions without contrast enhancement. MRI repeated a month later showed new lesions with non-visualisation of some previous lesions. Finally, a brain biopsy was done which revealed presence of lymphocytic infiltrate with SV40 inclusions in oligodendrocyte. We propose the affliction of an atypical virus affecting the retina and brain grey and white matter, presenting with NORSE in our patient. Future similar cases and isolation of the virus may help in establishing the conclusive diagnosis.
Corneal ulcer as the presenting feature of type 2 diabetes mellitus
Authors: Kutubi Muhammad , Smith Alaric
Published: October 2018

A 60-year-old woman, with no significant medical or ophthalmic history, presented with a unilateral large corneal ulcer and hypopyon. Despite a severely injected conjunctiva and large corneal epithelial defect, the patient denied any discomfort in the eye. The ulcer was extremely slow to heal requiring prolonged treatment with topical and systemic broad-spectrum antibiotics. Due to the corneal opacification, fundal examination was not possible. Subsequent examination of the fellow eye revealed an appearance consistent with proliferative diabetic retinopathy. She was given treatment with panretinal laser photocoagulation. There was no history of diabetes and the patient denied experiencing any of the classical symptoms of hyperglycaemia. With blood tests revealing a raised plasma glucose and Haemoglobin A1c (HbA1c), a new diagnosis of diabetes mellitus was made. With the commencement of treatment for diabetes, there were signs of improvement in the corneal appearance.
Toxic epidermal necrolysis: the red eye and red herrings in casualty
Authors: Barry Robert J , Zanetto Ulises , Kolli Sai , Morjaria Rupal
Published: October 2018

A 38-year-old woman presented to casualty with bilateral red eyes associated with a recent upper respiratory tract infection. This was initially diagnosed as conjunctivitis, however systemic review revealed an erythematous facial and skin rash, mildly swollen lips and mild swallowing difficulties. The patient was referred for an urgent medical assessment, by which time she was found to have erythema affecting 54% of her body surface area and diagnosed with suspected toxic epidermal necrolysis (TEN). She rapidly deteriorated over 24 hours with a spreading blistering skin rash and airway compromise requiring urgent intubation and admission to the intensive treatment unit (ITU). Subsequent skin biopsies confirmed the diagnosis of TEN, attributed to recent use of ibuprofen. Treatment included broad-spectrum antibiotics and high-dose corticosteroids. The patient had a prolonged hospital stay and developed severe scarring of the ocular surface. She was discharged home and remains under continuing outpatient follow-up with ophthalmology and dermatology teams.
Sleeping beauty syndrome presenting with insomnia
Authors: Hussain Sara , Al Jarman Khulood , Hussain Sahar
Published: October 2018

A young man previously diagnosed with Kleine-Levin syndrome (KLS) presented with abnormal behaviour over the last 8 days. This included decreased sleeping hours and appetite, hypersexuality, aggressiveness and visual hallucinations. All blood tests and investigations in the emergency department yielded normal results. A preliminary diagnosis of a KLS episode with psychosis was made and the patient was started on a regimen of aripiprazole 10 mg once daily along with lorazepam 2 mg intravenously in two divided doses in the event of agitation or insomnia. On discharge 5 days later, the patient had returned to his premorbid level of functioning and was willing to follow up in the neurology clinic. He was discharged on aripiprazole 10 mg once daily and lorazepam 2 mg two times daily as needed for 2 weeks to help with his agitation and insomnia, as well as lithium carbonate 400 mg at night.
Acute pancreatitis-induced takotsubo cardiomyopathy and cardiogenic shock treated with a percutaneous left ventricular assist device
Authors: Koop Andree H , Bailey Ryan E , Lowman Philip E
Published: October 2018

A 63-year-old man was admitted for severe acute pancreatitis. On day 3 of hospitalisation, he developed shortness of breath and acute pulmonary oedema. Echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%, and he was diagnosed with takotsubo cardiomyopathy. He developed cardiogenic shock which was treated successfully with a percutaneous left ventricular assist device. His left ventricular ejection fraction improved by hospital follow-up 3 weeks later.
Stage III Kienböck’s disease treated with hyperbaric oxygen: the role of an unusual approach to a rare condition
Authors: Figueira Paulo Jorge , Alpuim Costa Diogo , Barbagallo Nunzio , Guerreiro Francisco Gamito
Published: October 2018

Kienböck’s disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck’s disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2.5 atm, for 70 min periods, once daily, five times per week). In April 2018, a favourable clinical and radiological evolution was observed, with an improvement in the patterns of pain, motion and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of Kienböck’s disease treated with hyperbaric oxygen.
Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome
Authors: Raiker Nisha Krishnakant , Cajigas Hector
Published: October 2018

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.
Large endotracheal tumour presenting as severe COPD: flow–volume loop analysis, not always a straightforward diagnostic test
Authors: Amaza Iliya P , Lee Swan , Sanchez Rolando
Published: October 2018

The flow–volume loop (FVL) analysis is typically helpful in establishing the diagnosis of airway obstruction caused by endobronchial lesions. In this report, we describe a patient with emphysema and tobacco abuse who presented with chronic dry cough and severe chronic obstructive pulmonary disease (COPD) refractory to standard therapy. The initial FVL showed a relatively normal forced expiratory peak flow shape followed by a smooth flattening of the expiratory curve on spirometry, a pattern consistent with distal airway obstruction as seen in severe asthma or COPD. The patient was later found to have a large endotracheal mass. This atypical presentation, along with the unusual FVL, led to a significant delay in the diagnosis of the tracheal mass. A high level of suspicion is needed to diagnose variable intrathoracic airway obstruction in patients presenting with severe asthma or COPD who fail to improve with standard therapy.
Trends in social determinants of child health and perinatal outcomes in European countries 2005–2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data
Authors: Rajmil Luis , Taylor-Robinson David , Gunnlaugsson Geir , Hjern Anders , Spencer Nick
Published: October 2018

Objective

To assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children’s health (SDCH) in rich countries

Design

Longitudinal ecological study of country-level time trends in perinatal outcomes and SDCH and from 2005 to 2015.

Setting and participants

16 European countries using available data from the International Monetary Fund, the Organisation for Economic Co-operation and Development and Eurostat.

Main outcome measures

Trends in perinatal outcomes (low birth weight (LBW); infant mortality) and the SDCH: child poverty rates; severe material deprivation in families with primary education; preschool investment in three time periods: 2005–2007, 2008–2010 and 2012–2015. Outcomes were compared according to the cyclically adjusted primary balance (CAPB, differences between 2013 and 2009) as a measure of austerity, stratified in tertiles. Generalised estimating equation models of repeated measures were used to assess time trend differences in three periods.

Results

Countries with higher levels of austerity had worse outcomes, mainly at the last study period. Material deprivation increased during the period 2012–2015 in those countries with higher CAPB (interaction CAPB-period 2012–2015, B: 5.62: p<0.001), as did LBW (interaction CAPB-period 2012–2015, B: 0.25; p=0.004).

Conclusions

Countries that implemented more severe austerity measures have experienced increasing LBW, and for families with primary education also increasing material deprivation, worsening the negative impact of economic crisis. Reversing austerity policies that impact children is likely to improve child health outcomes.
New anthropometric classification scheme of preoperative nutritional status in children: a retrospective observational cohort study
Authors: Stey Anne , Ricks-Oddie Joni , Innis Sheila , Rangel Shawn J , Moss R Lawrence , Hall Bruce L , Dibbins Albert , Skarsgard Erik D
Published: October 2018

Objective

WHO uses anthropometric classification scheme of childhood acute and chronic malnutrition based on low body mass index (BMI) (‘wasting’) and height for age (‘stunting’), respectively. The goal of this study was to describe a novel two-axis nutritional classification scheme to (1) characterise nutritional profiles in children undergoing abdominal surgery and (2) characterise relationships between preoperative nutritional status and postoperative morbidity.

Design

This was a retrospective observational cohort study.

Setting

The setting was 50 hospitals caring for children in North America that participated in the American College of Surgeons National Surgical Quality Improvement Program Paediatric from 2011 to 2013.

Participants

Children >28 days who underwent major abdominal operations were identified.

Interventions/main predictor

The cohort of children was divided into five nutritional profile groups based on both BMI and height for age Z-scores: (1) underweight/short, (2) underweight/tall, (3) overweight/short, (4) overweight/tall and (5) non-outliers (controls).

Main outcome measures

Multiple variable logistic regressions were used to quantify the association between 30-day morbidity and nutritional profile groups while adjusting for procedure case mix, age and American Society of Anaesthesiologists class.

Results

A total of 39 520 cases distributed as follows: underweight/short (656, 2.2%); underweight/tall (252, 0.8%); overweight/short (733, 2.4%) and overweight/tall (1534, 5.1%). Regression analyses revealed increased adjusted odds of composite morbidity (35%) and reintervention events (75%) in the underweight/short group, while overweight/short patients had increased adjusted odds of composite morbidity and healthcare-associated infections (43%), and reintervention events (79%) compared with controls.

Conclusion

Stratification of preoperative nutritional status using a scheme incorporating both BMI and height for age is feasible. Further research is needed to validate this nutritional risk classification scheme for other surgical procedures in children.
Associations between adverse childhood experiences and acquired brain injury, including traumatic brain injuries, among adults: 2014 BRFSS North Carolina
Authors: Guinn Angie S , Ports Katie A , Ford Derek C , Breiding Matt , Merrick Melissa T
Published: October 2018

Adverse childhood experiences (ACEs) can negatively affect lifelong health and opportunity. Acquired brain injury (ABI), which includes traumatic brain injury (TBI) as well as other causes of brain injury, is a health condition that affects millions annually. The present study uses data from the 2014 North Carolina Behavioral Risk Factor Surveillance System to examine the relationship between ACEs and ABI. The study sample included 3454 participants who completed questions on both ABI and ACEs. Multivariable logistic regression models were used to determine the relationship between ACEs and ABI as well as ACEs and TBI. Sexual abuse, emotional abuse, physical abuse, household mental illness and household substance abuse were significantly associated with ABI after adjusting for age, race/ethnicity, gender and employment. Compared with those reporting no ACEs, individuals reporting three ACEs had 2.55 times the odds of having experienced an ABI; individuals reporting four or more ACEs had 3.51 times the odds of having experienced an ABI. Examining TBI separately, those who experienced sexual abuse, physical abuse, household mental illness and had incarcerated household members in childhood had greater odds of reported TBI, after adjusting for age, race/ethnicity, gender and income. Respondents reporting three ACEs (AOR=4.16, 95% CI (1.47 to 11.76)) and four or more ACEs (AOR=3.39, 95% CI (1.45 to 7.90)) had significantly greater odds of reporting TBI than respondents with zero ACEs. Prevention of early adversity may reduce the incidence of ABI; however, additional research is required to elucidate the potential pathways from ACEs to ABI, and vice versa.
Apical hypertrophic cardiomyopathy: what are the risks in our diverse military population?
Authors: Eveson Leanne Jane , Williams A
Published: October 2018

We present the case of a 50-year-old, fit, asymptomatic gurkha officer. At a routine medical, an ECG showed T-wave inversion in the chest leads V3–6. Transthoracic echo showed left ventricular apical hypertrophy and cavity obliteration consistent with apical hypertrophic cardiomyopathy (ApHCM). Cardiac magnetic resonance imaging showed apical and inferior wall hypertrophy in the left ventricle with no aneurysm or scarring. A 24-hour monitor showed normal sinus rhythm with no evidence of non-sustained ventricular tachycardia. Eighteen-panel genetic testing revealed no specific mutations. Cardiopulmonary exercise testing demonstrated a V̇O2 max, anaerobic threshold and peak V̇O2 consistent with above average cardiopulmonary capacity. There was no family history of either ApHCM or sudden cardiac death (SCD). Risk of SCD by the European Society of Cardiology’s HCM calculator was low. This case generates discussion on the prognosis of ApHCM, factors that worsen prognosis, occupational limitation considerations and appropriate monitoring in this patient group.
Pathophysiology of primary blast injury
Authors: Smith Jason E , Garner J
Published: October 2018

The majority of patients injured in the recent conflicts in Iraq and Afghanistan were as a result of explosion, and terrorist incidents have brought blast injuries to the front door of many civilian hospitals that had not previously encountered such devastation. This article reviews the physics and pathophysiology of blast injury with particular relevance to the presentation and management of primary blast injury, which is the mechanism least familiar to most clinicians and which may cause devastating injury without externals signs.
Renal Denervation Reduced Ventricular Arrhythmia After Myocardial Infarction by Inhibiting Sympathetic Activity and Remodeling
Authors: Zhang Wen‐hui , Zhou Qi‐na , Lu Yan‐mei , Li Yao‐dong , Zhang Ling , Zhang Jiang‐hua , Xing Qiang , Lv Wen‐kui , Cheng Xin‐chun , Zhang Ge‐ge , Wang Xue‐sheng , Gu Qi , Lou Xue , Guli Buajier , Tang Bao‐peng , Zhou Xian‐hui
Published: October 2018

Background

Ventricular arrhythmia after myocardial infarction is the most important risk factor for sudden cardiac death, which poses a serious threat to human health. As the correlation between autonomic nervous systemic dysfunction and heart rhythm abnormality has been gradually revealed, remedies targeting autonomic nervous system dysfunction, especially the sympathetic nerve, have emerged. Among them, renal denervation is noted for its powerful effect on the inhibition of sympathetic nerve activity. We aim to investigate whether renal denervation can reduce ventricular arrhythmia after myocardial infarction and thus decrease the risk of sudden cardiac death. In addition, we explore the potential mechanism with respect to nerve activity and remodeling.

Methods and Results

Twenty‐four beagles were randomized into the control (n=4), renal denervation (n=10), and sham (n=10) groups. Permanent left anterior descending artery ligation was performed to establish myocardial infarction in the latter 2 groups. Animals in the renal denervation group underwent both surgical and chemical renal denervation. Compared with dogs in the sham group, dogs in the renal denervation group demonstrated attenuated effective refractory period shortening and inhomogeneity, flattened restitution curve, increased ventricular threshold, and decreased ventricular arrhythmia. Heart rate variability assessment, catecholamine measurement, and nerve discharge recordings all indicated that renal denervation could reduce whole‐body and local tissue sympathetic tone. Tissue analysis revealed a significant decrease in neural remodeling in both the heart and stellate ganglion.

Conclusions

Surgical and chemical renal denervation decreased whole‐body and local tissue sympathetic activity and reversed neural remodeling in the heart and stellate ganglion. Consequently, renal denervation led to beneficial remodeling of the electrophysiological characteristics in the infarction border zone, translating to a decrease in ventricular arrhythmia after myocardial infarction.
Incidence of Cancer Treatment–Induced Arrhythmia Associated With Novel Targeted Chemotherapeutic Agents
Authors: Nickel Andrew C. , Patel Akshar , Saba Nabil F. , Leon Angel R. , El‐Chami Mikhael F. , Merchant Faisal M.
Published: October 2018

Background

The incidence of cancer treatment–induced arrhythmia (
CTIA
) associated with novel, targeted chemotherapeutic agents (
TCA
s) has not been well described.

Methods and Results

We identified all patients treated at our institution from January 2010 to December 2015 with selected
TCA
s. We defined
CTIA
as any new arrhythmia diagnosis code within 6 months after treatment initiation. As a comparison, we also identified patients treated with anthracycline chemotherapy during the same period. We identified 5026 patients, of whom 2951 (58.7%) received
TCA
s and 2075 (41.3%) received anthracycline chemotherapy. In the overall cohort, 601 patients (12.0%) developed
CTIA
. Patients with
CTIA
were significantly older and more likely to have hypertension, diabetes mellitus, congestive heart failure, coronary disease, and sleep apnea. The incidence of
CTIA
at 6 months was significantly lower in the
TCA
group (9.3% versus 15.8%;
P
<0.001). In multivariate analysis, a history of hypertension (hazard ratio, 1.63; 95% confidence interval, 1.34–1.98), congestive heart failure (hazard ratio, 2.12; 95% confidence interval, 1.78–2.68), and male sex (hazard ratio, 1.25; 95% confidence interval, 1.06–1.47) were associated with a significantly increased risk of
CTIA
, whereas treatment with
TCA
s, compared with anthracycline chemotherapy, was associated with a significantly lower risk (hazard ratio, 0.60; 95% confidence interval, 0.51–0.71).

Conclusions

Compared with anthracyclines, treatment with TCAs was associated with an ≈40% reduced risk of new‐onset arrhythmia diagnoses during the first 6 months of treatment.