bluuebunny/crossref_metadata_2025 huggingface dataset:
Resolution of Acute Priapism in Two Children With Sickle Cell Disease Who Received Nitrous Oxide
Authors: Greenwald Michael H. , Gutman Colleen K. , Morris Claudia R.
Published: June 2019

Background

Nitrous oxide (N O) is an inhalational medication that has anxiolytic, amnestic, potent venodilatory and mild‐to‐moderate analgesic properties commonly used in the emergency department (ED) setting. N2O has a rapid onset of action (<5 minutes) and recovery (<5 minutes) and can be quickly titrated to effect without the need for IV access. It has few side effects, does not require renal or hepatic metabolism for excretion and has no reports of allergic reaction. Priapism is a serious complication of sickle cell disease (SCD) affecting approximately 35% of males, with an adverse impact on quality of life. Treatment options are limited and not evidence based, including hydration, alkalization, analgesia, oxygenation to prevent further sickling, and exchange transfusion. Patients who do not respond within 4 hours often require a painful invasive procedure that includes aspiration of blood from the corpus cavernosum and phenylephrine injections. Case reports have described a therapeutic benefit from oral pseudoephedrine, sildenafil, and intravenous (IV) arginine, however controlled clinical trials are lacking. Although a 50:50 nitrous oxide/oxygen mix is commonly used in France to enhance analgesia in patients with SCD and vasoocclusive pain events (VOE) not sufficiently responding to IV morphine, there are no reports of its use to treat priapism. We describe the effects of N2O for the treatment of acute priapism associated with SCD in a pediatric ED.

Methods

This is a case series of two adolescent boys with Hb‐SS who on 3 separate occasions presented to the ED with acute priapism that failed oral therapy (pseudoephedrine and opioids). N2O gas was utilized to help facilitate IV catheter placement.

Results

In each presentation (at ages 8 and 10 years for patient 1; age 15 years for patient 2), the patient experienced complete resolution of the priapism within 4‐15 min of receiving N2O (max 60%). The patients were discharged from the ED following each presentation and had no recurrence during the subsequent week.

Conclusions

Priapism is a challenging complication of SCD associated with long‐term morbidity and a paucity of treatment options. Opioids are commonly used. Given the risks and inconsistent results of current recommended therapy, N2O may represent a potential opioid‐sparing treatment option for priapism presenting to the ED that warrants further investigation. Although anecdotal, N2O inhalation is an intervention to consider during a time when a treating ED physician may have few alternatives.
Research‐implementation gap limits the actionability of human‐carnivore conflict studies in East Africa
Authors: Gray S. M. , Booher C. R. , Elliott K. C. , Kramer D. B. , Waller J. C. , Millspaugh J. J. , Kissui B. M. , Montgomery R. A.
Published: June 2019

Conflict with humans is one of the primary reasons why large carnivore populations are declining worldwide. Rates of human‐carnivore conflict (HCC) are particularly high in East Africa, where human settlements tend to surround protected areas, maximizing potential for human‐carnivore interactions. Despite extensive HCC research in this region, HCC persists and carnivore populations continue to decline. Evident disconnects between HCC research and conservation action, management practices and policy formation have been cited as mechanisms associated with these trends. We conducted a literature review to determine the extent to which HCC research in East Africa is actionable within the context of management and policy formation. We evaluated 36 papers for co‐production, interdisciplinary collaboration, applied or theoretical publication and stakeholder engagement. Many were published by co‐authors in academia (63.8%) and collaborative efforts between academics and non‐governmental organizations (25.0%), with limited representation outside these sectors. Collaboration with disciplines outside the natural sciences, specifically the social and political sciences (both 2.8%), was also uncommon although humans were the primary topic of study in 28% of papers. Moreover, while many papers were published in applied journals (86%), few explicitly stated policy and management objectives. Stakeholder engagement was mostly in the form of surveys and questionnaires rather than direct involvement in the research process. Our review indicates that HCC research currently lacks strong evidence of actionability and we provide recommendations for improving the practical salience of conservation research.
A hypoallergenic peptide mix containing T cell epitopes of the clinically relevant house dust mite allergens
Authors: Huang Huey‐Jy , Curin Mirela , Banerjee Srinita , Chen Kuan‐Wei , Garmatiuk Tetiana , Resch‐Marat Yvonne , Carvalho‐Queiroz Claudia , Blatt Katharina , Gafvelin Guro , Grönlund Hans , Valent Peter , Campana Raffaela , Focke‐Tejkl Margarete , Valenta Rudolf , Vrtala Susanne
Published: June 2019

Background

In the house dust mite (HDM) Dermatophagoides pteronyssinus, Der p 1, 2, 5, 7, 21, and 23 have been identified as the most important allergens. The aim of this study was to define hypoallergenic peptides derived from the sequences of the six allergens and to use the peptides and the complete allergens to study antibody, T cell, and cytokine responses in sensitized and nonsensitized subjects.

Methods

IgE reactivity of HDM‐allergic and non‐HDM‐sensitized individuals to 15 HDM allergens was established using ImmunoCAP ISAC technology. Thirty‐three peptides covering the sequences of the six HDM allergens were synthesized. Allergens and peptides were tested for IgE and IgG reactivity by ELISA and ImmunoCAP, respectively. Allergenic activity was determined by basophil activation. CD4+ T cell and cytokine responses were determined in PBMC cultures by CFSE dilution and Luminex technology, respectively.

Results

House dust mite allergics showed IgE reactivity only to complete allergens, whereas 31 of the 33 peptides lacked relevant IgE reactivity and allergenic activity. IgG antibodies of HDM‐allergic and nonsensitized subjects were directed against peptide epitopes and higher allergen‐specific IgG levels were found in HDM allergics. PBMC from HDM‐allergics produced higher levels of IL‐5 whereas non‐HDM‐sensitized individuals mounted higher levels of IFN‐gamma, IL‐17, pro‐inflammatory cytokines, and IL‐10.

Conclusion

IgG antibodies in HDM‐allergic patients recognize peptide epitopes which are different from the epitopes recognized by IgE. This may explain why naturally occurring allergen‐specific IgG antibodies do not protect against IgE‐mediated allergic inflammation. A mix of hypoallergenic peptides containing T cell epitopes of the most important HDM allergens was identified.
Visual information processing skills are associated with academic performance in Grade 2 school children
Authors: Hopkins Shelley , Black Alex A. , White Sonia L. J. , Wood Joanne M.
Published: June 2019

Purpose

This study evaluated the association between performance on visual information processing tests and academic performance in school children.

Methods

Visual‐motor integration (VMI), the Developmental Eye Movement (DEM) test, visual acuity and stereoacuity were assessed in 222 Grade 2 children (mean age: 7.90 ± 0.33 years). Academic performance was assessed using standardized tests of reading and mathematics (PAT‐R and PAT‐M). Linear regression analyses examined associations between visual information processing (VMI and DEM) and academic measures, adjusting for school socio‐economic background and age. Receiver operating characteristic (ROC) analysis was used to assess the ability of the tests to identify children with below average academic performance.

Results

Visual‐motor integration (VMI) and DEM (horizontal time) were most strongly associated with PAT‐R and PAT‐M. Linear regression models explained 28.6% of variance in PAT‐R (VMI: standardized regression coefficient = 0.31, p < 0.01; DEM horizontal time: −0.28, p < 0.01) and 24.1% of variance in PAT‐M (VMI: standardized regression coefficient = 0.29, p < 0.01; DEM horizontal time: −0.16, p = 0.02). Receiver operating characteristic (ROC) curve analysis indicated that VMI was most strongly associated with below average PAT‐R (area under curve [AUC] of 0.74 [95% CI: 0.67–0.81]) and PAT‐M (AUC of 0.73 [95% CI: 0.66–0.81]).

Conclusion

Visual‐motor integration (VMI) was most strongly associated with reading and mathematics scores in school children. A child's academic performance can be an important factor in their optometric management. The ability of clinical tests to identify children at risk of underachieving academically provides additional support to clinicians in managing their patients.
Global gene expression reveals an increase of HMGB1 and APEX1 proteins and their involvement in oxidative stress, apoptosis and inflammation pathways among beta‐thalassaemia intermedia and major phenotypes
Authors: Maia de Oliveira da Silva João Pedro , Brugnerotto Ana Flávia , S. Romanello Karen , K. L. Teixeira Karina , Lanaro Carolina , S. Duarte Adriana , G. L. Costa Gustavo , da Silva Araújo Aderson , C. Bezerra Marcos André , de Farias Domingos Igor , Pereira Martins Diego A. , Malavazi Iran , F. Costa Fernando , da Cunha Anderson F.
Published: June 2019

Beta‐thalassaemia (BT) is classified according to blood transfusion requirement as minor (BTMi), intermedia (BTI) and major (BTM). BTM is the most severe form, requiring regular transfusions while transfusion need is only occasional in BTI. Differential gene expression between patients has not been assessed so far. Here, we evaluated the global gene expression profiles during differentiation of human erythroid cells of two patients carrying the same mutation [CD39, (C → T)], though displaying different phenotypes (BTI and BTM). Considering the role of reactive oxygen species (ROS) in the pathophysiology of thalassaemia, we focused on differentially expressed genes involved in metabolic pathways triggered by ROS, such as inflammation and apoptosis, and, from these, we selected the Apurinic/Apyrimidinic Endodeoxyribonuclease 1 (APEX1) and High Mobility Group Box1 (HMGB1) genes, whose role in BT is not well established. An in‐depth expression analysis of transcriptional and protein levels in patients carrying a range of mutations associated with BT phenotypes indicated that APEX1 was increased in both BTI and BTM. Furthermore, higher amounts of HMGB1 was found in the plasma of BTI patients. Our findings suggest that these proteins have important roles in BT and could represent new targets for further studies aiming to improve the management of the disease.
Proximity proteomics identifies cancer cell membrane cis‐molecular complex as a potential cancer target
Authors: Kotani Norihiro , Yamaguchi Arisa , Ohnishi Tomoko , Kuwahara Ryusuke , Nakano Takanari , Nakano Yuka , Ida Yui , Murakoshi Takayuki , Honke Koichi
Published: June 2019

Cancer‐specific antigens expressed in the cell membrane have been used as targets for several molecular targeted strategies in the last 20 years with remarkable success. To develop more effective cancer treatments, novel targets and strategies for targeted therapies are needed. Here, we examined the cancer cell membrane‐resident “cis‐bimolecular complex” as a possible cancer target (cis‐bimolecular cancer target: BiCAT) using proximity proteomics, a technique that has attracted attention in the last 10 years. BiCAT were detected using a previously developed method termed the enzyme‐mediated activation of radical source (EMARS), to label the components proximal to a given cell membrane molecule. EMARS analysis identified some BiCAT, such as close homolog of L1 (CHL1), fibroblast growth factor 3 (FGFR3) and α2 integrin, which are commonly expressed in mouse primary lung cancer cells and human lung squamous cell carcinoma cells. Analysis of cancer specimens from 55 lung cancer patients revealed that CHL1 and α2 integrin were highly co–expressed in almost all cancer tissues compared with normal lung tissues. As an example of BiCAT application, in vitro simulation of effective drug combinations used for multiple drug treatment strategies was performed using reagents targeted to BiCAT molecules. The combination treatment based on BiCAT information moderately suppressed cancer cell proliferation compared with single administration, suggesting that the information about BiCAT in cancer cells is useful for the appropriate selection of the combination among molecular targeted reagents. Thus, BiCAT has the potential to contribute to several molecular targeted strategies in future.
Variability of photosensitive period and voltinism among populations of a butterfly, Ypthima multistriata, inhabiting similar latitudes and altitudes
Authors: Hasegawa Yuto , Takeuchi Tsuyoshi , Hirai Norio
Published: June 2019

In Ypthima multistriata Butler (Lepidoptera: Nymphalidae), there are univoltine and bivoltine populations in adjacent areas with similar climatic conditions. A previous study revealed that larvae of both univoltine and bivoltine populations diapause under a constant short day (i.e., a constant short light period; L13:D11), but not under a constant long‐day condition (L16:D8). However, in both types of populations, adults of an overwintering generation appear and oviposit in June and soon thereafter larvae hatch. Therefore, the younger larvae (at least the first instars) of both types of populations experience a long day; nevertheless, the larvae of univoltine populations diapause in nature. To resolve this inconsistency, we set up two hypotheses: (1) the photosensitive stage of larvae is the second instar or later, and (2) the photosensitive stage of univoltine populations is later than that of bivoltine populations. To test these hypotheses, we performed rearing experiments with two univoltine populations and two bivoltine ones. The results indicated that the photosensitive stage was the second or third instar and that the photosensitive stage was later in one univoltine population than in the two bivoltine populations. Larvae of the other univoltine population diapaused under all conditions. The former result supports our hypothesis, and the latter result indicates that the response to photoperiod is different among univoltine populations. In addition, larval development was slower in one univoltine population than in the bivoltine populations, which also delays the timing of the diapause decision in this univoltine population. Larvae that experienced a long day during the first and middle instars but experienced a short day at the end of their larval stage developed faster than larvae that experienced a constant long day. This may be an adaptation to enable emergence before the start of a cold season that is unsuitable for reproduction.
Traumatic dental injuries and experiences along the life course – a study among 16‐yr‐old pupils in western Norway
Authors: Bratteberg Magnus , Thelen Dorina S. , Klock Kristin S. , Bårdsen Asgeir
Published: June 2019

The study assessed risk factors for traumatic dental injuries (TDI) using experiences along the life course. A retrospective longitudinal study, including historical clinical data, was conducted on 16‐yr‐old pupils in western Norway. All first‐grade pupils born in 1997 and attending public high schools were invited to participate (n = 5,184). Participants responded to an electronically administered closed‐ended questionnaire (39.6%,n = 2,055). Information on the occurrence ofTDIand events during the life course (categorized as socio‐economic, biological, psychosocial, and behavioural indicators) was collected. Variables with a significant bivariate association with three different dependent variables (TDI, severity ofTDI, and multiple episodes ofTDI) were tested in a hierarchical logistic regression analysis. Traumatic dental injuries were more frequent among boys, adolescents of higher socio‐economic status, and adolescents with adverse psychosocial and behavioural scores. Moderate and severeTDIs were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in the sport of wrestling. Multiple episodes ofTDIwere more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in sports activities. Incorporation of different life‐course indicators is important in evaluatingTDIseverity and repeated incidents.
Importance of infection of haemosporidia blood parasites during different life history stages for long‐term reproductive fitness of collared flycatchers
Authors: Fletcher Kevin , Träff Johan , Gustafsson Lars
Published: June 2019

The interaction between birds and haemosporidia blood parasites is a well‐used system in the study of parasite biology. However, where, when and how parasites are transmitted is often unclear and defining parasite transmission dynamics is essential because of how they influence parasite‐mediated costs to the host. In this study, we used cross‐sectional and longitudinal data taken from a collared flycatcherFicedula albicollispopulation to investigate the temporal dynamics of haemosporidia parasite infection and parasite‐mediated costs to host fitness. We investigated host–parasite interactions starting at the nestling stage of the bird's life‐cycle and then followed their progress over three breeding attempts to quantify their fitness – measured as the number of offspring they produced that recruited back into the breeding population. We found that the majority of haemosporidia blood parasite infections occurred within the first year of life and that the most common parasite lineages that infected the breeding population also infected juvenile birds in the natal environment. Moreover, our findings suggest that collared flycatcher nestlings in poorer condition could be at a higher risk of haemosporidia blood parasite infection. In this study, only female and not male bird fitness was adversely affected by parasite infection and the cost of infection on female fitness depended on the timing of transmission. In conclusion, our study indicates that in collared flycatchers, early‐life is potentially important for many of the interactions with haemosporidia parasite lineages, and evidence of parasite‐mediated costs to fitness suggest that these parasites may have influenced the host population dynamics.
Dietitians’ perspectives of the barriers and enablers to delivering patient‐centred care
Authors: Levey R. , Ball L. , Chaboyer W. , Sladdin I.
Published: June 2019

Background

Patient‐centred care (PCC) is widely recognised as being important with respect to the delivery of quality health care. However, limited research has exploredPCCin the dietetic context. In particular, dietitians’ views of the barriers and enablers to delivering a patient‐centred approach have not been investigated. Therefore, the present study aimed to explore primary care dietitians’ perspectives of the barriers and enablers to deliveringPCC.

Methods

The present study was situated in a constructivist–interpretivist paradigm and used qualitative methods. Both convenience and snowball sampling were used to recruit Australian Accredited Practising Dietitians (APD) who were working in primary care. Individual semi‐structured interviews explored dietitians’ perspectives of the barriers and enablers to deliveringPCC. Data were analysed thematically.

Results

TwelveAPDs were interviewed between March and April 2018. Seven themes were discovered: (i) challenges in definingPCC; (ii) valuingPCC; (iii) enactingPCC; (iv) requiring additional education inPCC; (v) evaluating one's own practice; (vi) workplace pressures and constraints; and (vii) keeping up with expectations.

Conclusions

These findings suggest that: (i) the meaning ofPCCin dietetics should be clarified to ensure it is being practiced consistently; (ii) undergraduate curricula require a greater emphasis onPCCso that dietitians graduate with the necessary knowledge and skills; (iii) there is a need for more professional development training to facilitate uptake ofPCCin practice; and (iv) quantitative measurement ofPCCusing validated instruments is needed to evaluatePCCin the dietetic setting. Addressing some of these factors may assist dietitians to adopt these practices.
Gonadal hormones differentially regulate sex‐specific stress effects on glia in the medial prefrontal cortex
Authors: Bollinger Justin L. , Salinas Isabella , Fender Emily , Sengelaub Dale R. , Wellman Cara L.
Published: June 2019

Women are more susceptible to various stress‐linked psychopathologies, including depression. Dysfunction of the medial prefrontal cortex (mPFC) has been implicated in depression, and studies indicate sex differences in stress effects on mPFC structure and function. For example, chronic stress induces dendritic atrophy in the mPFC in male rats, yet dendritic growth in females. Recent findings suggest glial pathways toward depression. Glia are highly responsive to neuronal activity and function as critical regulators of synaptic plasticity. Preclinical models demonstrate stress‐induced microglial activation in mPFC in males, yet deactivation in females. By contrast, stress reduces astrocyte complexity in mPFC in male rats, whereas the effects in females are unknown. Glia possess receptors for most gonadal hormones and gonadal hormones are known to modulate neuronal activity. Thus, gonadal hormones represent a potential mechanism underlying sex differences in glia, as well as divergent stress effects. Therefore, we examined the role of gonadal hormones in sex‐specific stress effects on neuronal activity (ie FosB/ ΔFosB induction) and glia in the mPFC. The findings obtained indicate greater microglial activation in mPFC in females and a greater astrocyte area in males. Basal astrocyte morphology is modulated by androgens, whereas androgens or oestrogens dampen the microglial state in males. Astrocyte morphology is associated with neuronal activity in both sexes, regardless of hormonal condition. Chronic stress induced astrocytic atrophy in males, yet hypertrophy in females, with gonadal hormones partly regulating this difference. Stress effects on microglia are oestradiol‐dependent in females. Taken together, these data suggest sex‐specific, gonadal hormone‐dependent stress effects on astrocytes and microglia in the mPFC.
Alterations in the expression of EMT‐related proteins claudin‐1, claudin‐4 and claudin‐7, E‐cadherin, TWIST1 and ZEB1 in oral lichen planus
Authors: Hämäläinen Lasse , Soini Ylermi , Pasonen‐Seppänen Sanna , Siponen Maria
Published: June 2019

Background

Oral lichen planus (OLP) is a chronic T‐cell‐mediated inflammatory disease, which is associated with increased risk of developing oral squamous cell carcinoma. Epithelial‐to‐mesenchymal transition is a physiological phenomenon occurring during growth and organogenesis, but it has also an important role in tumorigenesis. In the present work, we studied the expression of known epithelial‐to‐mesenchymal transition markers in oral lichen planus.

Methods

In total, 54 oral lichen planus and 22 control samples were analyzed for epithelial‐to‐mesenchymal transition markers. Samples were immunohistochemically stained for claudin‐1, claudin‐4 and claudin‐7, cadherin‐1 (E‐cadherin), Twist‐related protein 1 (TWIST1) and zinc finger E‐box‐binding homeobox 1 (ZEB1).

Results

The expression of claudin‐1, claudin‐4 and E‐cadherin was significantly weaker in oral lichen planus epithelium compared to controls (P < 0.001). The quantity of claudin‐7‐expressing cells (P < 0.001) and claudin‐7 staining intensity (P < 0.05) in the stroma was greater in lichen planus than in control samples. TWIST1 and ZEB1 stainings were negative in the epithelium in both lichen planus and controls. The number of TWIST1‐expressing cells in the stroma was higher in lichen planus than in controls (P < 0.001). There was a statistically significant difference in ZEB1 staining intensity in the stroma between lichen planus and control samples (P < 0.05).

Conclusions

The data indicate that the expression of claudin‐1, claudin‐4 and E‐cadherin is decreased in oral lichen planus. This may lead to disturbance in epithelial tight junctions, cell‐cell connections and epithelial permeability, contributing to oral lichen planus pathogenesis. Based on the present study, the role of TWIST1 and ZEB1 in oral lichen planus remains unclear.
New combinations in Sarocalamus for Chinese bamboos (Poaceae: Bambusoideae)
Authors: Stapleton Chris M. A.
Published: June 2019

Sarocalamus was described for three high altitude bamboos from the Himalayas and SW China. They have strong morphological affinity to Arundinaria, which is now widely considered to be restricted to North America. Since the description of the genus additional potential members have come to light, and in molecular analyses they have been resolved in a clade with species already included in the genus. Sarocalamus has a Himalayan type but all other putative members of the genus are geographically disjunct from the Himalayan species. In Chinese literatur they have been placed in Arundinaria, Sinarundinaria, Bashania and Gelidocalamus. Here, branching characters in a range of temperate bamboo genera were investigated, and strong similarities between the Himalayan type species and a species from N Yunnan were evident. Species from the Himalayas and China appear congeneric on morphological and phylogenetic grounds, and three further species are transferred into Sarocalamus.
Identification of a novel HLA‐B*15 allele, HLA‐B*15:504, in a Chinese individual
Authors: Wang Linlin , Zhou Yunli
Published: June 2019

The new allele HLA‐B*15:504 showed one nucleotide difference compared to B*15:18:01 at position 142 (T > G).
A novel HLA‐B allele, HLA‐B*44:03:01:19, identified by next‐generation sequencing in a Saudi individual
Authors: Alqasem Afnan , Alanazi Hanan , Aloufi Faisal , Alanazi Aisha , Hajeer Ali H.
Published: June 2019

HLA‐B*44:03:01:19 differs from HLA‐B*44:03:01:01 by a single nucleotide substitution (T➔C) at position 3856.
No increased risk of transfusion‐transmissible infections after tattooing, body piercing, or acupuncture among blood donors in the Netherlands
Authors: Prinsze Femmeke J. , van de Laar Thijs , Slot Ed , de Jong Maarten , Bokhorst Arlinke , de Kort Wim , Zaaijer Hans , van den Hurk Katja
Published: June 2019

BACKGROUND

In the Netherlands, needle‐related events (NREs) including tattoos, piercings, and acupuncture are a reason for temporary blood donor deferral. This study aims to evaluate whether donors with recent NREs had a higher risk of transfusion‐transmissible infections (TTIs) compared to donors without recent NREs.

STUDY DESIGN AND METHODS

Data from 2006 through 2015 on all blood donation attempts in the Netherlands were collected. Multivariate regression models (for repeated measurements) were used to assess the associations between recent NREs and the acquisition of TTIs. Posttest counseling data were used to determine the most likely risk factor in TTI‐positive new and repeat donors.

RESULTS

Recent NREs were documented in 97,518 out of 9,266,036 (1.1%) donation attempts; 14,097 (14.5%) NREs resulted in NRE‐based donor deferral. Recent NREs reported pre‐donation were not associated with an increased risk for TTIs. A total of 29 out of 287 TTI‐positive donors (11 repeat donors, 18 new donors) reported a recent NRE pre‐ and/or post‐donation. Recent NREs, all needle‐stick injuries, were the likely route of transmission in 12 out of 287 (4.2%) of TTI‐positive donors. The donor health questionnaire (DHQ) identified only 1 out of 12 TTI‐linked NREs. Non‐return after NRE deferral, any deferral, or no deferral was 24, 15, and 5%, respectively.

DISCUSSION

Recent tattoos, body piercings, or acupuncture were not associated with an increased risk for TTIs in Dutch donors. Given the lower return rates of donors following a temporary NRE‐based deferral, we advocate ending blood donor deferral policies for acupuncture, tattooing, and body piercings, but not needle‐stick injuries, in countries where these practices can be considered safe.
Retrospective evaluation of pericardial catheter placement in the management of pericardial effusion in dogs (2007–2015):18 cases
Authors: Cook Simon , Cortellini Stefano , Humm Karen
Published: June 2019

Objective

To describe the use of pericardial catheters in dogs with pericardial effusion (PE), and detail any associated adverse events.

Design

Retrospective study.

Setting

University teaching hospital.

Animals

Eighteen client‐owned dogs that had pericardial catheters placed for pericardial fluid drainage between May 2007 and January 2015.

Interventions

None.

Measurements and main results

All pericardial catheters were placed within 5 hours of presentation, usually within 1 hour (median 72.5 min, range 45–300 min). Ten of 18 cases were sedated with butorphanol, and 4 with additional midazolam. Four had pericardial catheters positioned for single drainage only and were immediately removed. The other 14 pericardial catheters remained in situ for a median of 18 hours (range 2–88 h). Ten of the remaining 14 cases were redrained after pericardial catheter placement. The main adverse events reported were new arrhythmias in 6/18 cases, with 4 of these 6 patients being administered anti‐arrhythmic therapy. No infectious or functional complications were reported. Ten patients were discharged, 1 died and 7 were euthanized.

Conclusions

Thoracic drainage catheters inserted into the pericardial space via a modified‐Seldinger technique can be positioned in dogs to aid management of PEs. The main associated adverse event is arrhythmia. Minimal sedation is required for placement, and dogs tend not to require postprocedural analgesia. Catheters can remain in situ for repeated drainage, potentially decreasing staffing time requirement and repeat sedation. Their use is associated with a rate of arrhythmia requiring treatment of 22%, compared to that of needle pericardiocentesis alone at 13%. They are easy to position using equipment available in many facilities.
Primary care models for community-dwelling adults with long-term conditions: a scoping review protocol
Authors: Whiting Samantha , Robertson David , Bannigan Katrina
Published: June 2019

Objective:

This scoping review aims to map primary care models designed to support adults with long-term conditions. The review will analyze the following in relation to the models identified: characteristics, impact reported, implications for practice and outcome measures.

Introduction:

Robust solutions to support individuals with long-term conditions need to be established in order to increase health service capacity and provide cost-effective solutions while, most importantly, ensuring they receive the best services to live meaningful and productive lives.

Inclusion criteria:

The concept to be mapped is primary care models used to support adults living with long-term conditions. This may also encompass services not solely designed for people with long-term conditions; however, they will be services that may be the first port of call for this group. Operational a priori criteria have been designed to assist with distinguishing appropriate literature.

Methods:

Due to the nature of the scoping review, literature from a range of published and unpublished sources will be utilized from 1995 to 2019. Databases to be searched will include: MEDLINE, Embase, PsycINFO, HMIC, CINAHL, Cochrane Database of Systematic Reviews and Web of Science. Appropriate gray literature will be searched, alongside hand searching selected primary care journals, conference abstracts and professional and government bodies. Articles will be restricted to English. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Charting of the data will include details about the population, concept, context, study methods and key findings relevant to the review objective.
STIM calcium sensing and conformational change
Authors: Gudlur Aparna , Zeraik Ana Eliza , Hirve Nupura , Hogan Patrick G.
Published: June 2019

The control of calcium influx at the plasma membrane by endoplasmic reticulum (ER) calcium stores, a process common to invertebrates and vertebrates, is central to physiological calcium signalling and cellular calcium balance. Stromal interaction molecule 1 (STIM1) is a calcium sensor and regulatory protein localized to the ER. ORAI1 is a calcium channel in the plasma membrane (PM). In outline, STIM1 senses an ER‐luminal calcium decrease, relocalizes to ER–PM junctions, and recruits and gates ORAI1 channels. Recent work, reviewed here, has offered detailed insight into the process of sensing and communicating ER calcium‐store depletion, and particularly into the STIM1 conformational change that is the basis for communication between the ER and the PM.

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Evaluating intermuscular Golgi tendon organ feedback with twitch contractions
Authors: Lyle Mark A. , Nichols T. Richard
Published: June 2019

Key points

Golgi tendon organ feedback has been evaluated most frequently using electrical stimulation of peripheral nerves, which is not a physiological or selective stimulus for Golgi tendon organs.

Golgi tendon organs are most responsive to active muscle contractions.

This study provides evidence that muscle stimulation evoked twitches – a physiological stimulus for Golgi tendon organs – induces intermuscular effects most likely due to mechanical activation of Golgi tendon organ feedback and not direct activation of sensory axons.

The results demonstrate that twitch contractions are a feasible non‐invasive approach that can be used to advance understanding of the functional role of Golgi tendon organ feedback.

Force feedback from Golgi tendon organs (GTOs) has widespread intermuscular projections mediated by interneurons that share inputs from muscle spindles, among others. Because current methods to study GTO circuitry (nerve stimulation or muscle stretch) also activate muscle spindle afferents, the selective role of GTOs remains uncertain. Here, we tested the hypothesis that intramuscular stimulation evoked twitch contractions could be used to naturally bias activation of GTOs and thus evaluate their intermuscular effects in decerebrate cats. This was achieved by comparing the effects of twitch contractions and stretches as donor inputs onto the motor output of recipient muscles. Donor–recipient pairs evaluated included those already known in the cat to receive donor excitatory muscle spindle feedback only, inhibitory GTO feedback only, and both excitatory spindle and inhibitory GTO effects. Muscle stretch, but not twitch contractions, evoked excitation onto recipient muscles with muscle spindle afferent inputs only. Both donor muscle stretch and twitch contractions inhibited a recipient muscle with GTO projections only. In a recipient muscle that receives both muscle spindle and GTO projections, donor muscle stretch evoked both excitatory and inhibitory effects, whereas twitch contractions evoked inhibitory effects only. These data support the hypothesis that muscle stimulation evoked contractions can induce intermuscular effects most consistent with mechanical GTO receptor activation and not direct activation of sensory axons. We propose this approach can be used to evaluate GTO circuitry more selectively than muscle stretch or nerve stimulation and can be adapted to study GTO feedback non‐invasively in freely moving cats and humans.
Genetic basis of ruminant headgear and rapid antler regeneration
Authors: Wang Yu , Zhang Chenzhou , Wang Nini , Li Zhipeng , Heller Rasmus , Liu Rong , Zhao Yue , Han Jiangang , Pan Xiangyu , Zheng Zhuqing , Dai Xueqin , Chen Ceshi , Dou Mingle , Peng Shujun , Chen Xianqing , Liu Jing , Li Ming , Wang Kun , Liu Chang , Lin Zeshan , Chen Lei , Hao Fei , Zhu Wenbo , Song Chengchuang , Zhao Chen , Zheng Chengli , Wang Jianming , Hu Shengwei , Li Cunyuan , Yang Hui , Jiang Lin , Li Guangyu , Liu Mingjun , Sonstegard Tad S. , Zhang Guojie , Jiang Yu , Wang Wen , Qiu Qiang
Published: June 2019

Phylogeny and characteristics of ruminants

Ruminants are a diverse group of mammals that includes families containing well-known taxa such as deer, cows, and goats. However, their evolutionary relationships have been contentious, as have the origins of their distinctive digestive systems and headgear, including antlers and horns (see the Perspective by Ker and Yang). To understand the relationships among ruminants, L. Chen
et al.
sequenced 44 species representing 6 families and performed a phylogenetic analysis. From this analysis, they were able to resolve the phylogeny of many genera and document incomplete lineage sorting among major clades. Interestingly, they found evidence for large population reductions among many taxa starting at approximately 100,000 years ago, coinciding with the migration of humans out of Africa. Examining the bony appendages on the head—the so-called headgear—Wang
et al.
describe specific evolutionary changes in the ruminants and identify selection on cancer-related genes that may function in antler development in deer. Finally, Lin
et al.
take a close look at the reindeer genome and identify the genetic basis of adaptations that allow reindeer to survive in the harsh conditions of the Arctic.

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RareKodamaea ohmerikeratitis following a trivial vegetative trauma
Authors: Saud Al-Abbas Ali Hadi , Ling Jiunn Loong , Muhammed Julieana , Hussein Adil
Published: June 2019

Kodamaea ohmerikeratitis is an opportunistic pathogen seen in patients who have undergone invasive procedures and immunocompromised state. It has been identified in septicemia patients, resulting in mortality. To the best of our knowledge, we identified the first case ofK. ohmerikeratitis following an injury with vegetative material. A 57-year-old woman with underlying, poorly controlled diabetes mellitus was gardening when a tree leaf accidentally poked her in the eye. Two weeks later, the patient presented with right eye pain, redness and progressive blurring of vision due to a traumatised right cornea. Slit-lamp examination showed a small inferior paracentral corneal stromal infiltrate with overlying epithelial defect. A corneal scraping sample yieldedK. ohmerifrom Analytical Profile Index (API) 20C yeast identification system. She was treated with intensive topical amphotericin B and fluconazole. After 6 weeks of treatment, the keratitis resolved with faint scar tissue, and her visual acuity improved.
Severe recurrent gastrointestinal bleeding following percutaneous endoscopic gastrostomy tube placement: a rare complication
Authors: Enofe Ikponmwosa , Rai Manoj P , Yam Julie L
Published: June 2019

Severe bleeding requiring blood transfusions following endoscopic, percutaneous gastrostomy tube placement is a rare complication. We describe a case of severe recurrent haemorrhage with bright red blood from rectum from endoscopic, percutaneous gastrostomy tube placement, which ultimately required removal of the percutaneous endoscopic gastrostomy tube.
Corneal melt secondary to eosinophilic granulomatosis with polyangiitis
Authors: Fennelly Evelyn , Greenan Emily , Murphy Conor C
Published: June 2019

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody-associated vasculitis that can affect any organ system. It is most often characterised by chronic airway inflammation along with prominent peripheral blood eosinophilia, although the disease can affect the cardiovascular, gastrointestinal, renal or central nervous systems. Ocular manifestations are uncommon and when they do occur, are varied in their clinical presentations. To the best of our knowledge, this is the first case of corneal melt secondary to EGPA to have been reported.
Acquired amegakaryocytic thrombocytopenia as a rare cause of thrombocytopenia during pregnancy
Authors: Zimmerman Brittney S , Marcellino Bridget , El Jamal Siraj M , Renteria Anne S
Published: June 2019

A rare case of acquired amegakaryocytic thrombocytopenia (AATP) in a 35-year-old woman who presented with anaemia and thrombocytopenia at 22 weeks gestation. The first diagnostic impression was of an evolving aplastic anaemia; however, the patient was simultaneously diagnosed with severe vitamin B12deficiency in the setting of vegetarianism. Once the cyanocobalamin deficiency was corrected, a repeat bone marrow biopsy revealed an isolated depletion of megakaryocytes, which suggested the diagnosis of AATP. Supportive care was provided for her anaemia and thrombocytopenia and she delivered a healthy baby girl with a normal platelet count. The patient was subsequently started on romiplostim with steady improvement in her platelet counts. This rare AATP case presentation highlights the importance of a well-structured diagnostic approach to thrombocytopenia during pregnancy and supports the successful use of thrombopoietin agonists for the management of AATP.
Recurrent epistaxis secondary to nasal haemangioma with a misleading CT angiogram
Authors: Wright Oliver , Bowles Philippe , Pelser Andrew
Published: June 2019

The majority of epistaxes are anterior in nature, resolve with simple first aid measures and require no further follow-up. However, some cases pose more of a diagnostic challenge and prove resistant to standard investigation and treatment. We present a case of recurrent epistaxis, refractory to multiple treatment modalities and with CT imaging suggestive of a vascular aetiology which was ultimately disproved. The case highlights the shortcomings of CT imaging and importance of thorough examination technique. Nasal haemangiomas are a rare but recognised cause of epistaxis and should be considered in refractory cases.
Thyroid dysfunction and electrocardiographic changes in subjects without arrhythmias: a cross-sectional study of primary healthcare subjects from Copenhagen
Authors: Tayal Bhupendar , Graff Claus , Selmer Christian , Kragholm Kristian Hay , Kihlstrom Magnus , Nielsen Jonas Bille , Olsen Anne-Marie Schjerning , Pietersen Adrian Holger , Holst Anders G , Søgaard Peter , Christiansen Christine Benn , Faber Jens , Gislason Gunnar Hilmar , Torp-Pedersen Christian , Hansen Steen M
Published: June 2019

Objective

The objective of the present study was to investigate associations of both overt and subclinical thyroid dysfunction with common ECG parameters in a large primary healthcare population.

Design

Cross-sectional study.

Setting and participants

The study population comprised of primary healthcare patients in Copenhagen, Denmark, who had a thyroid function test and an ECG recorded within 7 days of each other between 2001 and 2011.

Data sources

The Danish National Patient Registry was used to collect information regarding baseline characteristics and important comorbidities.

Outcome measure and study groups

Common ECG parameters were determined using Marquette 12SL software and were compared between the study groups. The study population was divided into five groups based on their thyroid status. Euthyroid subjects served as the reference group in all analyses.

Results

A total of 132 707 patients (age 52±17 years; 50% female) were included. Hyperthyroidism was significantly associated with higher heart rate and prolonged QTc interval with significant interaction with age (p<0.009) and sex (p<0.001). These associations were less pronounced for patients with higher age. Subclinical hyperthyroidism was associated with higher heart rate among females, and a similar trend was observed among males. Hypothyroidism was associated with slower heart rate and shorter QTc but only in women. Moreover, longer P-wave duration, longer PR interval and low voltage were observed in patients with both subclinical and overt hypothyroidism. However, the presence of low voltage was less pronounced with higher age (p=0.001).

Conclusion

Both overt and subclinical thyroid disorders were associated with significant changes in important ECG parameters. Age and gender have significant impact on the association of thyroid dysfunction particularly on heart rate and QTc interval.
Observational study to determine the utility of hospital administrative data to support case finding of English patients at higher risk of severe healthcare-related harm
Authors: Hogan Helen , Cooke-O’Dowd Nora , Chattopadhyay Kaushik , van der Meulen Jan , Sherlaw-Johnson Christopher , Black Nick
Published: June 2019

Objectives

To identify ways of using routine hospital data to improve the efficiency of retrospective reviews of case records for identifying avoidable severe harm

Design

Development and testing of thresholds and criteria for two indirect indicators of healthcare-related harm (long length of stay (LOS) and emergency readmission) to determine the yield of specified harms coded in Hospital Episode Statistics (HES).

Setting

Acute National Health Service hospitals in England.

Participants

HES for acute myocardial infarction (AMI), bowel cancer surgery and hip replacement admissions from 2014 to 2015.

Interventions

Case-mix-adjusted linear regression models were used to determine expected LOS. Different thresholds were examined to determine the association with harm. Screening criteria for readmission included time to readmission, length of readmission and diagnoses in initial admission and readmission. The association with harm was examined for each criterion.

Results

The proportions of AMI cases with a harm code increased from 14% among all cases to 47% if a threshold of three times the expected LOS was used. For hip replacement the respective increase was from 10% to 51%. However as the number of patients at these higher thresholds was small, the overall proportion of harm identified is relatively small (15%, 19%, 9% and 8% among AMI, urgent bowel surgery, elective bowel surgery and hip replacement cohorts, respectively). Selection of the time to readmission had an effect on the yield of harms but this varied with condition. At least 50% of surgical patients had a harm code if readmitted within 7 days compared with 21% of patients with AMI.

Conclusions

Our approach would select a substantial number of patients for case record review. Many of these cases would contain no evidence of healthcare-related harm. In practice, Trusts may choose how many reviews it is feasible to do in advance and then select random samples of cases that satisfy the screening criteria.