bluuebunny/crossref_metadata_2025 huggingface dataset:
The Decreasing Prevalence of Severe Villous Atrophy in Dermatitis Herpetiformis
Authors: Mansikka Eriika , Hervonen Kaisa , Salmi Teea T. , Kautiainen Hannu , Kaukinen Katri , Collin Pekka , Reunala Timo
Published: April 2016

Goals:

We analyzed from our prospectively collected series of patients with dermatitis herpetiformis (DH) whether small-bowel histologic findings are changing and how serum tissue transglutaminase (TG2) IgA antibodies correlate to mucosal damage.

Background:

DH is an extraintestinal manifestation of celiac disease presenting with itchy blistering rash and pathognomonic IgA deposits in the skin. Prominent gastrointestinal symptoms are rare, and small-bowel findings range from severe villous atrophy (SVA) and partial villous atrophy (PVA) to normal mucosa with inflammatory changes.

Methods:

The cohort included 393 patients (214 male and 179 female) with DH having small-bowel biopsies performed at Tampere University Hospital since 1970. The small-bowel findings were calculated in the three 15-year periods, and in the last period they were correlated with serum IgA class TG2 antibody levels measured by enzyme-linked immunosorbent assay.

Results:

The prevalence of SVA decreased significantly (P=0.032), from 42% in the first study period to 29% in the last study period. A concomitant increase was seen in PVA, from 33% to 41%, and normal villous architecture, from 25% to 30%. The patients with SVA (P<0.001) and PVA (P=0.046) had significantly higher TG2 antibody levels than those with normal villous architecture.

Conclusions:

This long-term study in patients with DH disclosed a significant decrease in the occurrence of SVA. Serum IgA TG2 antibody levels correlated to damage in the small bowel. The trend toward milder small-bowel histology in DH suggests that a similar pattern could occur in the pool of undiagnosed celiac disease from which DH develops.
Device-assisted Enteroscopy for Obscure Gastrointestinal Bleeding in the Setting of Thienopyridine Antiplatelet Therapy
Authors: Bollinger Elizabeth E. , Spera Melissa A. , Raines Daniel L.
Published: April 2016

Background:

Current guidelines recommend suspending thienopyridine therapy 5 to 7 days before therapeutic endoscopy to reduce the risk of bleeding-related complication. However, interruption of antiplatelet therapy may increase the risk of a cardiovascular event. The aim of this study was to evaluate the safety and diagnostic yield of device-assisted enteroscopy (DAE) with endoscopic therapy in patients receiving thienopyridine antiplatelet therapy.

Materials and Methods:

A retrospective chart review was performed for patients treated in the LSU Health Sciences Gastroenterology Clinics between the dates of October 4, 2007 and February 15, 2015. A total of 774 enteroscopy procedures were reviewed to identify patients on active thienopyridine therapy at the time of DAE.

Results:

During the study period, a total of 68 patients underwent DAE while on thienopyridine therapy. Confirmed or suspected small bowel bleeding was the most common procedural indication. A total of 143 endoscopic interventions were performed, primarily argon plasma coagulation for ablation of intestinal angioectasias. There were no significant bleeding-related complications associated with these procedures. In addition, the diagnostic yield for these procedures was high (77%) with a significant percentage of patients in the thienopyridine group found to have an active bleeding source at the time of DAE.

Conclusions:

The performance of DAE procedures with endoscopic intervention such as argon plasma coagulation may be safe in patients on thienopyridine therapy. Continuing thienopyridines may also increase the diagnostic yield of these procedures by promoting active bleeding from the culprit source.
Population-representative Incidence of Acute-On-Chronic Liver Failure
Authors: Qin Gang , Shao Jian-Guo , Zhu Yong-Chang , Xu Ai-Dong , Yao Jian-Hua , Wang Xu-Lin , Qian Yin-Kun , Wang Hua-Yu , Shen Yi , Lu Peng , Wang Lu-Jun
Published: April 2016

Background:

Acute-on-chronic liver failure (ACLF) is a major cause of hepatic death in the world, but no population-based studies have evaluated the incidence of ACLF. This study was conducted to determine the incidence and short-term outcomes of ACLF in a region of Eastern China.

Methods:

In this prospective cross-sectional study, we collected data from public hospitals in Nantong city between January 1, 2005, and December 31, 2014. All hospitals with admission potential for ACLF patients were included. The primary outcome was ACLF defined as severe jaundice and coagulopathy with underlying chronic liver disease, according to diagnostic and laboratory criteria suggested by Chinese Society for Hepatology (CSH).

Results:

During the 10-year period, a consecutive sample of 1934 ACLF patients was included in this study. The overall ACLF incidence rate over the 10-year period was 2.53 (95% confidence interval, 2.16-2.91) per 100,000 population per year, decreasing from 3.35 in 2005 to 2.06 in 2014. Chronic hepatitis B virus (HBV) infection was the leading cause of chronic liver disease and HBV reactivation was the most common cause of acute hepatic event. The 28-day mortality for the ACLF patients had a clear decline during the study period, form 50.39% in 2005 to 35.44% in 2014.

Conclusions:

In the Eastern China population, the incidence of ACLF is decreasing and the prognosis improving. Short-term mortality was associated with the presence of cirrhosis and growing age. While ACLF remains a life-threatening disorder, our findings suggest that nationwide and long-term cohorts should be conducted for the natural history of ACLF.
Short article: Faldaprevir, deleobuvir and ribavirin in IL28B non-CC patients with HCV genotype-1a infection included in the SOUND-C3 phase 2b study
Authors: Zeuzem Stefan , Mantry Parvez , Soriano Vicente , Buynak Robert J. , Dufour Jean-François , Pockros Paul J. , Wright David , Angus Peter , Buti Maria , Stern Jerry O. , Kadus Werner , Vinisko Richard , Böcher Wulf , Mensa Federico J.
Published: April 2016

Background

SOUND-C3 was a multicentre, open-label, phase 2b study exploring the safety and efficacy of the interferon-free combination of faldaprevir (an NS3/A4 protease inhibitor), deleobuvir (BI 207127, a non-nucleoside polymerase inhibitor) and ribavirin in treatment-naive patients with chronic hepatitis C virus (HCV) genotype-1 infection. Results in patients with HCV genotype-1b and in IL28B CC genotype patients with HCV genotype-1a have been described previously. This report describes the results in IL28B non-CC genotype patients with HCV genotype-1a.

Methods

Patients were randomized to receive faldaprevir 120 mg once daily with deleobuvir at either 800 mg twice daily (b.i.d.; N=26) or 600 mg three times daily (t.i.d.; N=25), and weight-based ribavirin for 24 weeks. The primary endpoint was sustained virological response 12 weeks after treatment (SVR12).

Results

In each group, five patients completed 24 weeks of treatment. SVR12 rates were 19% (5/26) and 8% (2/25) in the b.i.d. and t.i.d. groups, respectively. On-treatment breakthrough [50% (13/26) and 68% (17/25) in the b.i.d. and t.i.d. groups, respectively] was the most frequent reason for not achieving SVR12. Adverse events led to premature treatment discontinuation in six (23%) patients in the b.i.d. group and in two patients (8%) in the t.i.d. group. The majority of adverse events were mild or moderate; the most frequently reported were nausea (67%), fatigue (35%) and diarrhoea (35%).

Conclusion

In this small study, the interferon-free regimen of faldaprevir, deleobuvir and ribavirin resulted in high rates of virological breakthrough and low rates of SVR12 in IL28B non-CC genotype patients infected with genotype-1a HCV (
http://www.clinicaltrials.gov
NCT01132313).
Efficacy of Cognitive Behavioral Therapy for Insomnia in Older Adults With Occult Sleep-Disordered Breathing
Authors: Fung Constance H. , Martin Jennifer L. , Josephson Karen , Fiorentino Lavinia , Dzierzewski Joseph M. , Jouldjian Stella , Tapia Juan Carlos Rodriguez , Mitchell Michael N. , Alessi Cathy
Published: April 2016

Objectives

The aims of the study were to determine whether mild, occult sleep-disordered breathing (SDB) moderates the efficacy of cognitive behavioral therapy for insomnia (CBTI) in older adults and to explore whether CBTI reduces the number of patients eligible for positive airway pressure (PAP) therapy.

Methods

Data were analyzed for 134 adults 60 years or older with insomnia and apnea-hypopnea index (AHI) of less than 15 who were randomized to a larger study of CBTI versus a sleep education control. Sleep outcomes (sleep onset latency, total wake time, wake after sleep onset, sleep efficiency, Pittsburgh Sleep Quality Index) were compared between CBTI and control at 6 months using repeated-measures analysis of variance adjusted for baseline values. AHI of 5 or greater versus less than 5 was included as an interaction term to evaluate changes in sleep outcomes. The number of participants at baseline and 6 months with mild SDB for whom insomnia was their only other indication for PAP was also compared between CBTI and control.

Results

AHI status (AHI ≥ 5 [75.5% of participants] versus AHI < 5) did not moderate improvements in sleep associated with CBTI (all p values ≥ .12). Nine (45.0%) of 20 participants with mild SDB for whom insomnia was their only other indication for PAP therapy at baseline no longer had another indication for PAP at 6 months, with no significant difference between CBTI and control.

Conclusions

CBTI improves sleep in older veterans with insomnia and untreated mild SDB. Larger trials are needed to assess whether CBTI reduces the number of patients with mild SDB eligible for PAP.
Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients
Authors: Stewart Jesse C. , Hawkins Misty A.W. , Khambaty Tasneem , Perkins Anthony J. , Callahan Christopher M.
Published: April 2016

Objective

Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD).

Methods

We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke for 8 years in a diverse sample of 2041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files.

Results

During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models—adjusted for demographic and CVD risk factors—revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0–3: anxiety hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.21−1.96, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.81−1.21), p = .93; depression HR = 1.10, CI = 0.88−1.36, p = .41), as well as when entered into the same model (Years 0–3: anxiety HR = 1.53, CI = 1.20−1.95, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.80−1.21, p = .99; depression HR = 1.03, CI = 0.82−1.29, p = .82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome.

Conclusions

Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts.
Associations Between Depression and Obesity in Parents and Their Late-Adolescent Offspring: A Community-Based Study
Authors: Marmorstein Naomi R. , Iacono William G.
Published: April 2016

Objective

Major depressive disorder (MDD) and obesity are associated within individuals, but little is known about the association between MDD and obesity within families. We hypothesized that parental MDD would predict increased risk for adolescent obesity and that parental obesity would predict increased risk for adolescent MDD.

Methods

Participants were drawn from the community-based Minnesota Twin Family Study (N = 7307; 17 years old: n = 3774). Parents and their 17-year-old offspring were assessed for MDD using a structured diagnostic interview, and direct assessments of height and weight were conducted (and diagnoses of obesity were derived from these measurements).

Results

Parental MDD was associated with offspring obesity (odds ratio [OR] = 1.74, 95% confidence interval [CI] = 1.24–2.46). ORs representing the risk associated with maternal and paternal MDD were similar (OR = 1.42, 95% CI = 1.02–1.92; OR = 1.40, 95% CI = 0.88–2.20, respectively). This parental effect remained significant when adjusting for parental obesity and offspring MDD (OR = 1.67, 95% CI = 1.18–2.37). Maternal obesity was associated with increased risk for MDD in offspring (OR = 1.32, 95% CI = 1.06–1.64), but paternal obesity was associated with decreased risk for MDD among offspring (OR = 0.70, 95% CI = 0.54–0.91). These effects remained significant when adjusting for parental MDD and offspring obesity (OR = 1.36, 95% CI = 1.07–1.73; OR = 0.65, CI = 0.49–0.87, respectively). There were no differences in these findings by offspring sex (p values for all tests of a sex interaction term > .374).

Conclusions

We found general support for hypothesized cross-disorder associations between MDD and obesity in parents and offspring, suggesting that a shared etiology may underlie these associations. Contrary to prediction, paternal obesity was associated with decreased risk for offspring MDD, a finding that requires further investigation.
Mortality in Women With Anorexia Nervosa: The Role of Comorbid Psychiatric Disorders
Authors: Kask Jan , Ekselius Lisa , Brandt Lena , Kollia Natasa , Ekbom Anders , Papadopoulos Fotios C.
Published: April 2016

Objective

To investigate mortality in anorexia nervosa (AN) with a psychiatric comorbidity.

Methods

Using Swedish registers, data for 8069 female inpatients with AN were retrospectively collected for 1973–2010. Mortality patterns were assessed using standardized mortality ratios (SMRs), Cox regression-derived hazard ratios, and incidence rate ratios. A control cohort of 76,995 women was used.

Results

Patients with AN and a psychiatric comorbidity had higher mortality rates did than those without a comorbidity. The SMRs for patients with AN and a psychiatric comorbidity were 5.4 (95% confidence interval [CI] = 4.6–6.4) and 18.1 (95% CI = 15.2–21.3) for natural and unnatural causes of death, respectively. The SMRs for patients with AN without a comorbidity were 2.8 (95% CI = 2.3–3.5) and 3.1 (95% CI = 2.2–4.1) for natural and unnatural causes of death, respectively. The adjusted hazard ratios for mortality from natural or unnatural causes were 2.0 (95% CI = 1.5–2.7) and 5.7 (95% CI = 3.9–8.2), respectively. Incidence rate ratios comparing patients with AN and controls, both with psychiatric comorbidities, suggest a negative synergistic effect of comorbid AN and psychiatric disorder on mortality, which was greater for unnatural causes of death.

Conclusions

Mortality in patients with AN was greater in the presence of a psychiatric comorbidity, and even more pronounced for unnatural causes of death and suicides. Substance abuse, especially alcohol use disorder, increased mortality from natural causes of death. These findings highlight the need for early detection and treatment of psychiatric comorbidity in AN, to potentially improve long-term outcomes.
Graph analysis of structural brain networks in Alzheimer’s disease
Authors: John Majnu , Ikuta Toshikazu , Ferbinteanu Janina
Published: April 2016

Background

Changes in brain connectivity in patients with early Alzheimer’s disease (AD) have been investigated using graph analysis. However, these studies were based on small data sets, explored a limited range of network parameters, and did not focus on more restricted sub-networks, where neurodegenerative processes may introduce more prominent alterations.

Methods

In this study, we constructed structural brain networks out of 87 regions by using data from 135 healthy elders and 100 early AD patients selected from the Open Access Series of Imaging Studies (OASIS) database. We evaluated the graph properties of these networks by investigating metrics of network efficiency, small world properties, segregation, product measures of complexity, and entropy. Because degenerative processes take place at different rates in different brain areas, analysis restricted to sub-networks may reveal changes otherwise undetected. Therefore, we first analyzed the graph properties of a network encompassing all brain areas considered together, and then repeated the analysis after dividing the brain areas into two sub-networks constructed by applying a clustering algorithm.

Results

At the level of large scale network, the analysis did not reveal differences between AD patients and controls. In contrast, the same analysis performed on the two sub-networks revealed modifications accompanying AD. Changes in small world properties suggested that the ability to engage concomitantly in integration and segregation of information diminished with AD in the sub-network containing the areas of medial temporal lobe known to be heaviest and earliest affected. In contrast, we found that the second network showed an increase in small world propensity, a novel metric that unbiasedly quantifies small world structure. Complexity and entropy measures indicated that the intricacy of connection patterns and structural diversity decreased in both sub-networks.

Conclusions

These results show that neurodegenerative processes impact volumetric networks in a non-global fashion. Our findings provide new quantitative insights into topological principles of structural brain networks and their modifications during early stages of Alzheimer’s disease.
Evolutionary mysteries in meiosis
Authors: Lenormand Thomas , Engelstadter Jan , Johnston Susan E. , Wijnker Erik , Haag Christoph R.
Published: April 2016

Meiosis is a key event of sexual life cycles in eukaryotes. Its mechanistic details have been uncovered in several model organisms, and most of its essential features have received various and often contradictory evolutionary interpretations. In this perspective, we present an overview of these often “weird” features. We discuss the origin of meiosis (origin of ploidy reduction and recombination, two-step meiosis), its secondary modifications (in polyploids or asexuals, inverted meiosis), its importance in punctuating life cycles (meiotic arrests, epigenetic resetting, meiotic asymmetry, meiotic fairness) and features associated with recombination (disjunction constraints, heterochiasmy, crossover interference and hotspots). We present the various evolutionary scenarios and selective pressures that have been proposed to account for these features, and we highlight that their evolutionary significance often remains largely mysterious. Resolving these mysteries will likely provide decisive steps towards understanding why sex and recombination are found in the majority of eukaryotes.
Neighborhood regulation by lncRNA promoters, transcription, and splicing
Authors: Engreitz Jesse M. , Haines Jenna E. , Munson Glen , Chen Jenny , Perez Elizabeth M. , Kane Michael , McDonel Patrick E. , Guttman Mitchell , Lander Eric S.
Published: April 2016

Mammalian genomes are pervasively transcribed to produce thousands of spliced long noncoding RNAs (lncRNAs), whose functions remain poorly understood. Because recent evidence has implicated several specific lncRNA loci in the local regulation of gene expression, we sought to determine whether such local regulation is a property of many lncRNA loci. We used genetic manipulations to dissect 12 genomic loci that produce lncRNAs and found that 5 of these loci influence the expression of a neighboring gene incis. Surprisingly, however, none of these effects required the specific lncRNA transcripts themselves and instead involved general processes associated with their production, including enhancer-like activity of gene promoters, the process of transcription, and the splicing of the transcript. Interestingly, such effects are not limited to lncRNA loci: we found similar effects on local gene expression at 4 of 6 protein-coding loci. These results demonstrate that ‘crosstalk’ among neighboring genes is a prevalent phenomenon that can involve multiple mechanisms andcisregulatory signals, including a novel role for RNA splicing. These mechanisms may explain the function and evolution of some genomic loci that produce lncRNAs.
Efficiency of genome-wide association study in open-pollinated populations
Authors: Viana José Marcelo Soriano , Mundim Gabriel Borges , Silva Fabyano Fonseca e , Garcia Antonio Augusto Franco
Published: April 2016

Genome-wide association studies (GWAS) with plant species have employed inbred lines panels. Thus, to our knowledge, no information is available on theory and efficiency of GWAS in open-pollinated populations. Our objectives are to present quantitative genetics theory for GWAS, evaluate the relative efficiency of GWAS in non-inbred and inbred populations and in an inbred lines panel, and assess factors affecting GWAS, such as linkage disequilibrium (LD), sample size, and quantitative trait locus (QTL) heritability. Fifty samples of 400 individuals from populations with LD were simulated. Individuals were genotyped for 10,000 single nucleotide polymorphisms (SNPs) and phenotyped for traits with different degrees of dominance controlled by 10 QTLs and 90 minor genes. The average SNP density was 0.1 centiMorgan and the trait heritabilities were 0.4 and 0.8. We assessed GWAS efficiency based on the power of QTL detection, number of false-positive associations, bias in the estimated QTL position, and range of the significant SNPs for the same QTL. When the LD between a QTL and one or more SNPs is restricted to markers very close to or within the QTL, GWAS in open-pollinated populations can be highly efficient, depending mainly on QTL heritability and sample size. GWAS achieved the highest power of QTL detection, the smallest number of false-positive associations, and the lowest bias in the estimated QTL position for the inbred lines panel correcting for population structure. Under low QTL heritability and reduced sample size, GWAS is ineffective for non-inbred and inbred populations and for inbred lines panel.
Characterization of a putative NsrR homologue inStreptomyces venezuelaereveals a new member of the Rrf2 superfamily
Authors: Munnoch John T. , Martinez Ma Teresa Pellicer , Svistunenko Dimitri A. , Crack Jason C. , Le Brun Nick E. , Hutchings Matthew I.
Published: April 2016

Members of the Rrf2 superfamily of transcription factors are widespread in bacteria but their functions are largely unexplored. The few that have been characterized in detail sense nitric oxide (NsrR), iron limitation (RirA), cysteine availability (CymR) and the iron sulfur (Fe-S) cluster status of the cell (IscR). In this study we combined ChIP- and dRNA-seq within vitrobiochemistry to characterize a putative NsrR homologue inStreptomyces venezuelae.ChIP-seq analysis revealed that rather than regulating the nitrosative stress response likeStreptomyces coelicolorNsrR, Sven6563 binds to a conserved motif at a different, much larger set of genes with a diverse range of functions, including a number of regulators, genes required for glutamine synthesis, NADH/NAD(P)H metabolism, as well as general DNA/RNA and amino acid/protein turn over. Our biochemical experiments further show that Sven6563 has a [2Fe-2S] cluster and that the switch between oxidized and reduced cluster controls its DNA binding activityin vitro.To our knowledge, both the sensing domain and the putative target genes are novel for an Rrf2 protein, suggesting Sven6563 represents a new member of the Rrf2 superfamily. Given the redox sensitivity of its Fe-S cluster we have tentatively named the protein RsrR forRedox sensitive responseRegulator.
Artefactual origin of biphasic cortical spike-LFP correlation
Authors: Okun Michael
Published: April 2016

Electrophysiological data acquisition systems introduce various distortions into the signals they record. While such distortions were discussed previously, their effects are often not appreciated. Here I show that the biphasic shape of cortical spike-triggered LFP average (stLFP), reported in multiple studies, is likely an artefact introduced by high-pass filter of the neural data acquisition system when the actual stLFP has a single trough around the zero lag.
Origin of modern syphilis and emergence of a contemporary pandemic cluster
Authors: Arora Natasha , Schuenemann Verena J. , Jäger Günter , Peltzer Alexander , Seitz Alexander , Herbig Alexander , Strouhal Michal , Grillová Linda , Sánchez-Busó Leonor , Kühnert Denise , Bos Kirsten I. , Rivero Davis Leyla , Mikalová Lenka , Bruisten Sylvia , Komericki Peter , French Patrick , Grant Paul R. , Pando María A. , Gallo Vaulet Lucía , Rodríguez Fermepin Marcelo , Martinez Antonio , Centurion Lara Arturo , Giacani Lorenzo , Norris Steven J. , Šmajs David , Bosshard Philipp P. , González-Candelas Fernando , Nieselt Kay , Krause Johannes , Bagheri Homayoun C.
Published: April 2016

Syphilis swept across the world in the 16th century as one of most prominent documented pandemics and is re-emerging worldwide despite the availability of effective antibiotics. Little is known about the genetic patterns in current infections or the evolutionary origins of the disease due to the non-cultivable and clonal nature of the causative bacteriumTreponema pallidumsubsp.pallidum. In this study, we used DNA capture and next generation sequencing to obtain whole genome data from syphilis patient specimens and from treponemes propagated in laboratory settings. Phylogenetic analyses indicate that the syphilis strains examined here share a common ancestor after the 15th century. Moreover, most contemporary strains are azithromycin resistant and members of a globally dominant cluster named here as SS14-Ω. This cluster diversified from a common ancestor in the mid-20thcentury and has the population genetic and epidemiological features indicative of the emergence of a pandemic strain cluster.
Holocene variability of an Amazonian hyperdominant
Authors: Bush Mark B. , McMichael Crystal N. H.
Published: April 2016

Little is known regarding the long‐term stability or instability of Amazonian plant communities.

We assessed whether the most abundant species, hyperdominants, may have risen to prominence at the Pleistocene–Holocene transition, following subsequent changes in moisture regimes, or as a result of human activity later in the Holocene.

The fossil pollen history of the commonest western Amazonian tree, Iriartea deltoidea (hereafter Iriartea), is investigated using fossil pollen data from 13 lakes. Iriartea is a monospecific genus with diagnostic pollen. It is also considered a ‘useful’ plant, and its abundance could have been enriched by human action.

Iriartea pollen was found to have increased in abundance in the last 3000 years, but did not show a consistent relationship with human activity.

The suggestion that the hyperdominants in modern Amazonian forests are a legacy of pre‐Columbian people is unsupported.

The abundance of Iriartea pollen is related to increasing precipitation, not human activity over the last 3000 years. This member of the hyperdominant category of Amazonian trees has only recently acquired this status.

Synthesis. Our findings are consistent with the observation that communities in complex systems are ephemeral. The populations of even the most abundant species can change over a few tens of generations. The relative abundance of tree species, even in relatively stable systems such as those of Amazonian floodplains, changes on ecological not evolutionary timescales.
Symphysiotomy for obstructed labour: a systematic review and meta‐analysis
Authors: Wilson A , Truchanowicz EG , Elmoghazy D , MacArthur C , Coomarasamy A
Published: April 2016

Background

Obstructed labour is a major cause of maternal mortality. Caesarean section can be associated with risks, particularly in low‐ and middle‐income countries, where it is not always readily available. Symphysiotomy can be an alternative treatment for obstructed labour and requires fewer resources. However, there is uncertainty about the safety and effectiveness of this procedure.

Objectives

To compare symphysiotomy and caesarean section for obstructed labour.

Search strategy

MEDLINE, EMBASE, Cochrane library, CINAHL, African Index Medicus, Reproductive Health Library and Science Citation Index (from inception to November 2015) without language restriction.

Selection criteria

Studies comparing symphysiotomy and caesarean section in all settings, with maternal and perinatal mortality as key outcomes.

Data collection and analysis

Quality of the included studies was assessed using the STROBE checklist and the Newcastle Ottawa scale. Relative risks (RR) were pooled using the random effects model. Heterogeneity was assessed using I2 tests.

Main results

Seven studies (n = 1266 women), all of which were set in low‐ and middle‐income countries (as per the World Bank definition) and compared symphysiotomy and caesarean section were identified. Meta‐analyses showed no significant difference in maternal (RR 0.48, 95% CI 0.13–1.76; P = 0.27) or perinatal (RR 1.12, 95% CI 0.64–1.96; P = 0.69) mortality with symphysiotomy when compared with caesarean section. There was a reduction in infection (RR 0.30, 95% CI 0.14–0.62) but an increase in fistulae (RR 4.19, 95% CI 1.07–16.39) and stress incontinence with symphysiotomy (RR 10.04, 95% CI 3.23–31.21).

Conclusion

There was no difference in key outcomes of maternal and perinatal mortality with symphysiotomy when compared with caesarean section.

Tweetable abstract

Symphysiotomy could be an alternative to caesarean section when resources are limited.
Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives
Authors: Grob Rachel , Schlesinger Mark , Parker Andrew M. , Shaller Dale , Barre Lacey Rose , Martino Steven C. , Finucane Melissa L. , Rybowski Lise , Cerully Jennifer L.
Published: April 2016

Objective

To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement.

Data Sources/Study Setting

Two rounds of experimental data (N = 48 each) collected in 2013–2014, using a nationally representative Internet panel.

Study Design

Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a “gold standard” for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.

Data Collection/Extraction Methods

We randomized participants between telephone and web‐based modalities and between protocols placed before and after a closed‐ended survey.

Principal Findings

Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five‐question protocol that has been tested and refined yields three‐ to sixfold increases in completeness and four‐ to tenfold increases in meaningfulness, compared to a single open‐ended question. It performs equally well for healthy and sick patients.

Conclusions

Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.
Does Bt maize expressing Cry1Ac protein have adverse effects on the parasitoid Macrocentrus cingulum (Hymenoptera: Braconidae)?
Authors: Wang Zeng‐Xia , Li Yun‐He , He Kang‐Lai , Bai Shu‐Xiong , Zhang Tian‐Tao , Cai Wan‐Zhi , Wang Zhen‐Ying
Published: April 2016

The potential effects of insect‐resistant, genetically engineered (GE) crops on non‐target organisms, especially on predators and parasitoids, must be evaluated before their commercial cultivation. The effects of GE maize that produces Cry1Ac toxin on the parasitoid Macrocentrus cingulum were assessed by direct bioassay and indirect bioassay. In the indirect bioassay, parasitism rate, cocoon weight and the number of M. cingulum progeny produced per host were significantly reduced when M. cingulum‐parasitized Cry1Ac‐susceptible Ostrinia furnacalis were fed a diet containing purified Cry1Ac; however, life‐table parameters of M. cingulum were not adversely affected when the same assay was performed with Cry1Ac‐resistant O. furnacalis. These results indicated that the detrimental effects detected with a Cry1Ac‐susceptible host were mediated by poor host quality. In a direct bioassay, no difference in life‐table parameters were detected when M. cingulum adults were directly fed a 20% honey solution with or without Cry1Ac; however, survival and longevity were significantly reduced when M. cingulum adults were fed a honey solution containing potassium arsenate, which was used as a positive control. The stability and bioactivity of Cry1Ac toxin in the food sources and Cry1Ac toxin uptake by the host insect and parasitoid were confirmed by enzyme‐linked immunosorbent assay and sensitive‐insect bioassays. Our results demonstrate that M. cingulum is not sensitive to Cry1Ac toxin at concentrations exceeding those encountered in Bacillus thuringiensis maize fields. This study also demonstrates the power of using resistant hosts when assessing the risk of genetically modified plants on non‐target organisms and will be useful for assessing other non‐target impacts.
Meta‐analysis of confocal laser endomicroscopy for the diagnosis of gastric neoplasia and adenocarcinoma
Authors: Qian Wei , Bai Tao , Wang Huan , Zhang Lei , Song Jun , Hou Xiao Hua
Published: April 2016

Objective

Confocal laser endomicroscopy (CLE) is a recently developed technique used to diagnose gastrointestinal diseases. The current meta‐analysis aimed to systematically assess the ability of CLE to diagnose neoplasia and gastric adenocarcinoma.

Methods

A comprehensive literature search was performed using PubMed, Embase and the Cochrane Library for endomicroscopy, gastric neoplasia and gastric adenocarcinoma. Sensitivity and specificity data on the diagnosis of neoplasia and gastric adenocarcinoma were pooled. A summary receiver operating characteristic (sROC) curve was performed and the area under the curve was calculated.

Results

In all, 13 studies were included in the current study. The pooled sensitivity and specificity assessing CLE as a method to diagnose gastric neoplasia were 0.81 and 0.98, respectively. For the diagnosis of gastric adenocarcinoma, the pooled sensitivity and specificity were 0.89 and 0.99, respectively. The pooled sensitivity and specificity were 0.82 and 0.95 when differentiating high‐grade intraepithelial neoplasia from low‐grade intraepithelial neoplasia. Additionally, the pooled sensitivity and specificity were 0.87 and 0.96, respectively, when distinguishing undifferentiated gastric adenocarcinoma from differentiated gastric adenocarcinoma.

Conclusion

CLE has a high sensitivity and specificity for diagnosing gastric intraepithelial neoplasia and gastric adenocarcinoma; therefore, it could be considered an alternative to the endoscopic method used to diagnose gastric intraepithelial neoplasia and gastric adenocarcinoma.
The IRIS (Insulin Resistance Intervention after Stroke) trial: A new perspective on pioglitazone
Authors: Inzucchi Silvio E. , Furie Karen L.
Published: April 2016

Highlights

The TZD, pioglitazone, reduced stroke and MI by 24% in 3876 insulin resistant patients with a history of recent stroke or TIA.

The progression to diabetes was also reduced by 52% in this group of patients ‐ many of whom had pre‐diabetes.

Pioglitazone is the sole glucose-lowering drug demonstrated to reduce atherosclerotic events.

亮点

TZD,在3876名最近有中风或者TIA病史的胰岛素抵抗患者中,吡咯列酮可使中风或者MI减少24%。

在这组患者中进展为糖尿病的风险也减少了52%——他们中的许多人先前都处于糖尿病前期。

吡咯列酮是唯一得到证实可以减少动脉粥样硬化事件的降糖药物。
Comparison of heart rate variability and classic autonomic testing for detection of cardiac autonomic dysfunction in patients with fibromyalgia
Authors: Lee Kyung‐Eun , Choi Sung‐Eun , Kang Ji‐Hyoun , Yim Yi‐Rang , Kim Ji‐Eun , Lee Jeong‐Won , Wen Lihui , Park Dong‐Jin , Kim Tae‐Jong , Park Yong‐Wook , Lee Shin‐Seok
Published: April 2016

Aim

Cardiac autonomic dysfunction (CAD) is frequently found in patients with fibromyalgia (FM). Thus, we evaluated whether heart rate variability (HRV) is superior to the Ewing tests in detecting CAD in FM patients.

Methods

We studied 35 females with FM and 25 age‐matched healthy females. In Ewing tests, results were added to yield an overall score. An abnormal result on deep breathing, the Valsalva maneuver, or orthostatic standing was counted as 1 point. A change in systolic blood pressure (SBP) of > 10 mmHg while standing counted as 1 point, and a change of > 20 mmHg as 2 points. A score of 0 was regarded as no CAD, a score of ≥ 2 as severe CAD and a score of 1 as mild CAD. HRV was measured in two ways: by R‐R intervals (time‐domain analysis) and by spectral analysis of a series of successive R‐R intervals (frequency‐domain analysis).

Results

FM patients had significantly lower expiratory/inspiratory (E/I) ratios, lower Valsalva ratios and higher SBP values than healthy controls (P < 0.05, P < 0.05, P < 0.01, respectively). In the frequency domain, very low‐frequency and low‐frequency bands were also lower in FM patients than controls (both P < 0.05). Based on the discriminant analysis of the Ewing tests, 54.4% of cases were correctly classified. The addition of HRV parameters did not improve the reclassification.

Conclusion

HRV does not improve detection of CAD in FM patients over classic autonomic testing.
Safety of anti‐rheumatic drugs for rheumatoid arthritis in pregnancy and lactation
Authors: Ngian Gene‐Siew , Briggs Andrew M. , Ackerman Ilana N. , Van Doornum Sharon
Published: April 2016

Women with rheumatoid arthritis (RA) are often of childbearing age and therefore questions regarding reproductive health and the use of medications, including disease‐modifying anti‐rheumatic drugs (DMARDs) may arise during the clinical consultation. Each patient requires individual assessment in order to effectively manage the disease while minimizing any treatment‐associated risks to the fetus. Although good‐quality controlled trials are lacking, there is an increasing volume of evidence surrounding the use of immunosuppressive therapies in pregnancy and lactation. This review summarizes the currently available information which can be of benefit to clinicians guiding patients and their families through the risks and benefits of continuing RA therapy during pregnancy and lactation. Further studies and ongoing surveillance of drug safety in pregnancy are required to resolve the uncertainties that remain regarding synthetic and biologic DMARDs.
IgG4‐related retroperitoneal fibrosis: a newly characterized disease
Authors: Lian Linjuan , Wang Cong , Tian Jian‐li
Published: April 2016

Retroperitoneal fibrosis (RPF) is a rare disease characterized by chronic, nonspecific inflammatory and sclerotic or fibrotic tissue in the periaortic or periiliac retroperitoneum that encases adjacent structures. There will be a series of clinical manifestations once the proliferated fibrous tissues encase the abdominal aorta, iliac arteries and urinary duct. RPF is generally divided into two types: idiopathic retroperitoneal fibrosis (IRPF) without identified pathogenesis, making up about two‐thirds of cases, and secondary retroperitoneal fibrosis. Recent studies on Immunoglobulin G4‐related disease (IgG4‐RD) reveal that abundant infiltration of IgG4 positive plasma cells is found in biopsies on the mass of RPF of some IRPF patients, which is identified as one spectrum of IgG4‐RD and is named IgG4‐related RPF. IgG4‐related RPF is often misdiagnosed as retroperitoneal visceral malignancy and is treated with surgery. In addition, because of its good response to glucocorticoid, early detection and treatment is important. We review the definition, epidemiology, clinical features, diagnostic criteria, treatment and prognosis of IgG4‐related RPF in this article to raise awareness of this newly characterized disease.
The experience of patients admitted to hospital with acute low back pain: a qualitative study
Authors: El‐Haddad Carlos , Damodaran Arvin , Patrick McNeil H. , Hu Wendy
Published: April 2016

Aim

To understand the patient experience of being admitted to hospital with acute low back pain (LBP), with a view to developing suggestions for care and LBP management guidelines.

Method

Interpretive phenomenological analysis (IPA) was adopted to examine semi‐structured interviews from patients admitted to hospital with acute LBP. Sampling continued until thematic saturation was reached (n = 14). Data were analyzed using the Framework Method, so that data from multiple participants could be systematically summarized, compared, and analyzed.

Results

Four themes were identified: pain and helplessness, desire for validation, interactions with healthcare teams, and a return to pre‐morbid identity and roles. Patients' initial presentation to hospital was characterized by severe pain, disability and difficulty in communicating their illness experience. Patients expected doctors to investigate for an underlying cause of the back pain. To recover, they were required to navigate a system they did not understand, interacting with healthcare workers who seemed to operate independently rather than as a team. Patients viewed medical treatment as a means of returning to pre‐morbid activities of daily living, roles and relationships. Using these themes, a model of the inpatient journey was developed.

Conclusion

We have described new patient insights which highlight how the hospital environment adds unique challenges to managing acute LBP. Several suggestions for acute LBP management guidelines are made: developing lay summaries for patients, including methods for communicating the team structure and roles to patients, and ensuring all members of treating teams are educated to ensure guidelines are consistently implemented.
Dual energy computed tomography: a novel technique for diagnosis of gout
Authors: Ahmad Zohra , Gupta Arun Kumar , Sharma Raju , Bhalla Ashu Seith , Kumar Uma , Sreenivas V.
Published: April 2016

Aim

To evaluate the sensitivity and specificity of dual energy computed tomography (DECT) for diagnosing gout compared with a composite gold standard (CGS) comprising joint aspiration and/or American College of Rheumatology clinico‐radiographic criteria.

Methods

Ninety patients of suspected gout underwent radiography and DECT of bilateral feet and knees. Radiographs and non‐contrast CT (NCCT) were assessed for morphological characteristics, following which DECT was used to identify urate deposits.

Results

With CGS as a reference (n = 90), sensitivity of radiographs was 15% (95% confidence interval [CI]: 6–27%) while specificity was 100% (95% CI: 90–100%). Sensitivity of NCCT was 26% (95% CI: 15–40%) while specificity was 97% (95% CI: 85–99%). Sensitivity of DECT was 82% (95% CI: 68–90%) while specificity was 89% (95% CI: 73–96%). Fifty‐five patients underwent joint aspiration. Sensitivity and specificity of radiographs and NCCT with aspiration as a reference (n = 55) were not much different from that of CGS. However, DECT showed a higher sensitivity of 100% (95% CI: 86–100%) and a lower specificity of 48% (95%CI: 28–68%) with aspiration alone.

Conclusions

Dual energy computed tomography had higher sensitivity compared to conventional imaging with CGS as a reference; however, its specificity dropped with aspiration as a reference. It may be a useful adjunct for the diagnosis of gout, especially in the acute and inter‐critical stage.
Effect of early treatment on physical function in daily management of rheumatoid arthritis: a 5‐year longitudinal study of rheumatoid arthritis patients in the National Database of Rheumatic Diseases in Japan
Authors: Hirata Akie , Suenaga Yasuo , Miyamura Tomoya , Matsui Toshihiro , Tohma Shigeto , Suematsu Eiichi , Ohnaka Keizo , Takayanagi Ryoichi
Published: April 2016

Aim

The purpose of this study was to assess 5‐year changes in physical function and factors associated with improvement among patients with rheumatoid arthritis (RA) in daily clinical practice, focusing on the effect of treatments, including biologic agents, in the early stage of disease course.

Methods

The National Database of Rheumatic Diseases by iR‐net in Japan (NinJa) was searched for patients with disease duration ≤ 2 years and modified health assessment questionnaire (mHAQ) > 0 between 2004 and 2007, so that 510 patients were included in the final analysis. Multivariate‐logistic regression analyses were used to identify predictors of 5‐year mHAQ disability score improvement.

Results

Median mHAQ score was 0.40 at baseline and decreased to a median 0.17 after 5 years. Seventy‐four percent of the patients were treated with methotrexate (MTX) and 25% with biologic agents, with early use of biologic agents (within 2 years of RA onset) increasing over time. Multivariate analyses identified higher baseline Disease Activity Score of 28 joints – C‐reactive protein and early use of MTX (within 1 year of RA onset) and of biologic agents (within 2 years) as significantly associated with improved mHAQ; odds ratios of the early treatment were 1.83 (P = 0.01) for MTX and 2.23 (P = 0.04) for biologic agents, respectively.

Conclusion

Five‐year mHAQ improved in early RA patients in the NinJa database. In daily clinical management of RA, likewise in clinical trials, early administration of MTX or biologic agents is able to improve physical function outcome.
Anti‐Sm is associated with the early poor outcome of lupus nephritis
Authors: Ahn Sung Soo , Yoo Byung‐Woo , Song Jason Jungsik , Park Yong‐Beom , Lee Soo‐Kon , Lee Sang‐Won
Published: April 2016

Aim

We investigated whether anti‐Smith (Sm) is associated with the outcome of kidney biopsy‐proven lupus nephritis.

Methods

We retrospectively analyzed clinical, laboratory and histological results in 90 patients with kidney biopsy‐proven lupus nephritis. We defined persistent administration of immunosuppressants for more than 3 months after the kidney biopsy as early poor outcome of lupus nephritis. We compared baseline variables and delta values of lupus nephritis‐related variables between patients with and without anti‐Sm. The independent predictive values for early poor outcome were analyzed using logistic regression analysis.

Results

The median age was 32.0 years old, and 77 patients (85.5%) were women. Anti‐Sm was found in 44 of 90 patients (48.8%). When we analyzed the differences in delta values of variables reflecting the kidney function or the early poor outcome between patients with and without anti‐Sm, we found significant difference in the early poor outcome between the two groups (80.0% of patients having anti‐Sm vs. 56.5% of those not having anti‐Sm, P = 0.022). In multivariate logistic regression analysis, along with age and Systemic Lupus Erythematosus Disease Activity Index, the presence of anti‐Sm increased the potential of the early poor outcome of lupus nephritis (odds ratio 2.870, 95% confidence interval, 1.033, 7.976, P = 0.043).

Conclusion

Our data suggest that anti‐Sm identified at kidney biopsy might have a predictive value for the early poor outcome of biopsy‐proven lupus nephritis during the follow‐up period.