bluuebunny/crossref_metadata_2025 huggingface dataset:
Putative Antiparasite Defensive System Involving Ribosomal and Nonribosomal Oligopeptides in Cyanobacteria of the Genus Planktothrix
Authors: Rohrlack Thomas , Christiansen Guntram , Kurmayer Rainer
Published: February 2013

Parasitic chytrid fungi can inflict significant mortality on cyanobacteria but frequently fail to keep cyanobacterial dominance and bloom formation in check. Our study tested whether oligopeptide production, a common feature in many cyanobacteria, can be a defensive mechanism against chytrid parasitism. The study employed the cyanobacterial strain
Planktothrix
NIVA-CYA126/8 and its mutants with knockout mutations for microcystins, anabaenopeptins, and microviridins, major oligopeptide classes to be found in NIVA-CYA126/8. Four chytrid strains were used as parasite models. They are obligate parasites of
Planktothrix
and are unable to exploit alternative food sources. All chytrid strains were less virulent to the NIVA-CYA126/8 wild type than to at least one of its oligopeptide knockout mutants. One chytrid strain even failed to infect the wild type, while exhibiting considerable virulence to all mutants. It is therefore evident that producing microcystins, microviridins, and/or anabaenopeptins can reduce the virulence of chytrids to
Planktothrix
, thereby increasing the host's chance of survival. Microcystins and anabaenopeptins are nonribosomal oligopeptides, while microviridins are produced ribosomally, suggesting that
Planktothrix
resists chytrids by relying on metabolites that are produced via distinct biosynthetic pathways. Chytrids, on the other hand, can adapt to the oligopeptides produced by
Planktothrix
in different ways. This setting most likely results in an evolutionary arms race, which would probably lead to
Planktothrix
and chytrid population structures that closely resemble those actually found in nature. In summary, the findings of the present study suggest oligopeptide production in
Planktothrix
to be part of a defensive mechanism against chytrid parasitism.
Norovirus Genotypes Present in Oysters and in Effluent from a Wastewater Treatment Plant during the Seasonal Peak of Infections in Ireland in 2010
Authors: Rajko-Nenow Paulina , Waters Allison , Keaveney Sinéad , Flannery John , Tuite Gráinne , Coughlan Suzie , O'Flaherty Vincent , Doré William
Published: February 2013

We determined norovirus (NoV) concentrations in effluent from a wastewater treatment plant and in oysters during the peak period of laboratory-confirmed cases of NoV infection in Ireland in 2010 (January to March). Weekly samples of influent, secondary treated effluent, and oysters were analyzed using real-time quantitative reverse transcription-PCR for NoV genogroup I (GI) and genogroup II (GII). The mean concentration of NoV GII (5.87 × 10
4
genome copies 100 ml
−1
) in influent wastewater was significantly higher than the mean concentration of NoV GI (1.40 × 10
4
genome copies 100 ml
−1
). The highest concentration of NoV GII (2.20 × 10
5
genome copies 100 ml
−1
) was detected in influent wastewater during week 6. Over the study period, a total of 931 laboratory-confirmed cases of NoV GII infection were recorded, with the peak (
n
= 171) occurring in week 7. In comparison, 16 cases of NoV GI-associated illness were reported during the study period. In addition, the NoV capsid N/S domain was molecularly characterized for selected samples. Multiple genotypes of NoV GI (GI.1, GI.4, GI.5, GI.6, and GI.7) and GII (GII.3, GII.4, GII.6, GII.7, GII.12, GII.13, and GII.17), as well as 4 putative recombinant strains, were detected in the environmental samples. The NoV GII.4 variant 2010 was detected in wastewater and oyster samples and was the dominant strain detected in NoV outbreaks at that time. This study demonstrates the diversity of NoV genotypes present in wastewater during a period of high rates of NoV infection in the community and highlights the potential for the environmental spread of multiple NoV genotypes.
Contact Killing of Bacteria on Copper Is Suppressed if Bacterial-Metal Contact Is Prevented and Is Induced on Iron by Copper Ions
Authors: Mathews Salima , Hans Michael , Mücklich Frank , Solioz Marc
Published: February 2013

Bacteria are rapidly killed on copper surfaces, and copper ions released from the surface have been proposed to play a major role in the killing process. However, it has remained unclear whether contact of the bacteria with the copper surface is also an important factor. Using laser interference lithography, we engineered copper surfaces which were covered with a grid of an inert polymer which prevented contact of the bacteria with the surface. Using
Enterococcus hirae
as a model organism, we showed that the release of ionic copper from these modified surfaces was not significantly reduced. In contrast, killing of bacteria was strongly attenuated. When
E. hirae
cells were exposed to a solid iron surface, the loss of cell viability was the same as on glass. However, exposing cells to iron in the presence of 4 mM CuSO
4
led to complete killing in 100 min. These experiments suggest that contact killing proceeds by a mechanism whereby the metal-bacterial contact damages the cell envelope, which, in turn, makes the cells susceptible to further damage by copper ions.
Use of Loop-Mediated Isothermal Amplification for Detection of Ophiostoma clavatum, the Primary Blue Stain Fungus Associated with Ips acuminatus
Authors: Villari Caterina , Tomlinson Jennifer A. , Battisti Andrea , Boonham Neil , Capretti Paolo , Faccoli Massimo
Published: February 2013

Loop-mediated isothermal amplification (LAMP) is an alternative amplification technology which is highly sensitive and less time-consuming than conventional PCR-based methods. Three LAMP assays were developed, two for detection of species of symbiotic blue stain fungi associated withIps acuminatus, a bark beetle infesting Scots pine (Pinus sylvestris), and an additional assay specific toI. acuminatusitself for use as a control. In common with most bark beetles,I. acuminatusis associated with phytopathogenic blue stain fungi involved in the process of exhausting tree defenses, which is a necessary step for the colonization of the plant by the insect. However, the identity of the main blue stain fungus vectored byI. acuminatuswas still uncertain, as well as its frequency of association withI. acuminatusunder outbreak and non-outbreak conditions. In this study, we employed LAMP technology to survey six populations ofI. acuminatussampled from the Southern Alps.Ophiostoma clavatumwas detected at all sampling sites, whileOphiostoma brunneo-ciliatum, reported in part of the literature as the main blue stain fungus associated withI. acuminatus, was not detected on any of the samples. These results are consistent with the hypothesis thatO. clavatumis the main blue stain fungus associated withI. acuminatusin the Southern Alps. The method developed in the course of this work provides a molecular tool by which it will be easy to screen populations and derive important data regarding the ecology of the species involved.
Panmictic Structure of the Cryptosporidium parvum Population in Irish Calves: Influence of Prevalence and Host Movement
Authors: De Waele Valérie , Van den Broeck Frederik , Huyse Tine , McGrath Guy , Higgins Isabella , Speybroeck Niko , Berzano Marco , Raleigh Pat , Mulcahy Grace M. , Murphy Thomas M.
Published: February 2013

In total, 245
Cryptosporidium parvum
specimens obtained from calves in 205 Irish herds between 2003 and 2005 were subtyped by sequencing the glycoprotein gene
gp60
and performing multilocus analysis of seven markers. The transmission dynamics of
C. parvum
and the influence of temporal, spatial, parasitic, and host-related factors on the parasite (sub)populations were studied. The relationship of those factors to the risk of cryptosporidiosis was also investigated using results from 1,368 fecal specimens submitted to the veterinary laboratories for routine diagnosis during 2005. The prevalence was greatest in the northwest and midwest of the country and on farms that bought in calves. The panmixia (random mating) detected in the
C. parvum
population may relate to its high prevalence, the cattle density, and the frequent movement of cattle. However, local variations in these factors were reflected in the
C. parvum
subpopulations. This study demonstrated the importance of biosecurity in the control of bovine cryptosporidiosis (e.g., isolation and testing of calves before introduction into a herd). Furthermore, the zoonotic risk of
C. parvum
was confirmed, as most specimens possessed GP60 and MS1 subtypes previously described in humans.
Degradation of Sulfadiazine by Microbacterium lacus Strain SDZm4, Isolated from Lysimeters Previously Manured with Slurry from Sulfadiazine-Medicated Pigs
Authors: Tappe Wolfgang , Herbst Michael , Hofmann Diana , Koeppchen Stephan , Kummer Sirgit , Thiele Björn , Groeneweg Joost
Published: February 2013

Sulfadiazine (SDZ)-degrading bacterial cultures were enriched from the topsoil layer of lysimeters that were formerly treated with manure from pigs medicated with
14
C-labeled SDZ. The loss of about 35% of the applied radioactivity after an incubation period of 3 years was attributed to CO
2
release due to mineralization processes in the lysimeters. Microcosm experiments with moist soil and soil slurries originating from these lysimeters confirmed the presumed mineralization potential, and an SDZ-degrading bacterium was isolated. It was identified as
Microbacterium lacus
, denoted strain SDZm4. During degradation studies with
M. lacus
strain SDZm4 using pyrimidine-ring labeled SDZ, SDZ disappeared completely but no
14
CO
2
was released during 10 days of incubation. The entire applied radioactivity (AR) remained in solution and could be assigned to 2-aminopyrimidine. In contrast, for parallel incubations but with phenyl ring-labeled SDZ, 56% of the AR was released as
14
CO
2
, 16% was linked to biomass, and 21% remained as dissolved, not yet identified
14
C. Thus, it was shown that
M. lacus
extensively mineralized and partly assimilated the phenyl moiety of the SDZ molecule while forming equimolar amounts of 2-aminopyrimidine. This partial degradation might be an important step in the complete mineralization of SDZ by soil microorganisms.
Denitrifying Alphaproteobacteria from the Arabian Sea That Express
nosZ
, the Gene Encoding Nitrous Oxide Reductase, in Oxic and Suboxic Waters
Authors: Wyman Michael , Hodgson Sylvia , Bird Clare
Published: February 2013

Marine ecosystems are significant sources of the powerful greenhouse gas nitrous oxide (N
2
O). A by-product of nitrification and an intermediate in the denitrification pathway, N
2
O is formed primarily in oxygen-deficient waters and sediments. We describe the isolation of a group of alphaproteobacteria from the suboxic waters of the Arabian Sea that are phylogenetically affiliated with
Labrenzia
spp. and other denitrifiers. Quantitative PCR assays revealed that these organisms were very broadly distributed in this semienclosed ocean basin. Their biogeographical range extended from the productive, upwelling region off the Omani shelf to the clear, oligotrophic waters that are found much further south and also included the mesotrophic waters overlying the oxygen minimum zone (OMZ) in the northeastern sector of the Arabian Sea. These organisms actively expressed NosZ (N
2
O reductase, the terminal step in the denitrification pathway) within the OMZ, an established region of pelagic denitrification. They were found in greatest numbers outside the OMZ, however, and
nosZ
mRNAs were also readily detected near the base of the upper mixed layer in nutrient-poor, oxic regions. Our findings provide firm molecular evidence of a potential sink for N
2
O within well-ventilated, oceanic surface waters in this biogeochemically important region. We show that the
Labrenzia
-like denitrifiers and their close relatives are habitual colonizers of the pseudobenthic environment provided by
Trichodesmium
spp. We develop the conjecture that the O
2
-depleted microzones that occur within the colonies of these filamentous, diazotrophic cyanobacteria might provide unexpected niches for the reduction of nitrogen oxides in tropical and subtropical surface waters.
Use of Degradation Tags To Control Protein Levels in the Cyanobacterium Synechocystis sp. Strain PCC 6803
Authors: Landry Brian P. , Stöckel Jana , Pakrasi Himadri B.
Published: February 2013

We generated a collection of
ssrA
-based C-terminal protein degradation tags with different degradation strengths. The steady-state fluorescence levels of different enhanced yellow fluorescent protein (eYFP) tag variants in a
Synechocystis
sp. indicated a tunable range from 1% to 50% of untagged eYFP.
Defining the RNA-Protein Interactions in the Trypanosome Preribosomal Complex
Authors: Wang Lei , Ciganda Martin , Williams Noreen
Published: February 2013

In eukaryotes, 5S rRNA is transcribed in the nucleoplasm and requires the ribosomal protein L5 to deliver it to the nucleolus for ribosomal assembly. The trypanosome-specific proteins P34 and P37 form a novel preribosomal complex with the eukaryotic conserved L5-5S rRNA complex in the nucleoplasm. Previous results suggested that P34 acts together with L5 to bridge the interaction with 5S rRNA and thus to stabilize 5S rRNA, an important role in the early steps of ribosomal biogenesis. Here, we have delineated the domains of the two protein components, L5 and P34, and regions of the RNA partner, 5S rRNA, that are critical for protein-RNA interactions within the complex. We found that the L18 domain of L5 and the N terminus and RNA recognition motif of P34 bind 5S rRNA. We showed that
Trypanosoma brucei
L5 binds the β arm of 5S rRNA, while P34 binds loop A/stem V of 5S rRNA. We demonstrated that 5S rRNA is able to enhance the association between the protein components of the complex, L5 and P34. Both loop A/stem V and the β arm of 5S rRNA can separately enhance the protein-protein association, but their effects are neither additive nor synergistic. Domains in the two proteins for protein-protein and protein-RNA interactions overlap or are close to each other. This suggests that 5S rRNA binding might cause conformational changes in L5 and P34 and might also bridge the interactions, thus enhancing binding between the protein partners of this novel complex.
The [URE3] Prion in Candida
Authors: Edskes Herman K. , Wickner Reed B.
Published: February 2013

Ure2p, normally a regulator of nitrogen catabolism in
Saccharomyces cerevisiae
, can be a prion (infectious protein) by forming a folded in-register parallel amyloid called [URE3]. Using
S. cerevisiae
as a test bed, we previously showed that Ure2p of
Candida albicans
(CaUre2p) can also form a prion, but that Ure2p of
C. glabrata
(CgUre2p) cannot. Here, we constructed
C. glabrata
strains to test whether CgUre2p can form a prion in its native environment. We find that while CaUre2p can form a [URE3] in
C. glabrata
, CgUre2p cannot, although the latter has a prion domain sequence more similar to that of ScUre2p than that of CaUre2p. This supports the notion that prion formation is not a conserved property of Ure2p but is a pathology arising sporadically. We find that some [URE3
albicans
] variants are restricted in their transmissibility to certain recipient strains. In addition, we show that the
C. glabrata
HO can induce switching of the
C. glabrata
mating type locus.
Involvement of Regulatory Interactions among Global Regulators GlxR, SugR, and RamA in Expression of
ramA
in Corynebacterium glutamicum
Authors: Toyoda Koichi , Teramoto Haruhiko , Gunji Wataru , Inui Masayuki , Yukawa Hideaki
Published: February 2013

The central carbon metabolism genes in
Corynebacterium glutamicum
are under the control of a transcriptional regulatory network composed of several global regulators. It is known that the promoter region of
ramA
, encoding one of these regulators, interacts with its gene product, RamA, as well as with the two other regulators, GlxR and SugR,
in vitro
and/or
in vivo
. Although RamA has been confirmed to repress its own expression, the roles of GlxR and SugR in
ramA
expression have remained unclear. In this study, we examined the effects of GlxR binding site inactivation on expression of the
ramA
promoter-
lacZ
fusion in the genetic background of single and double deletion mutants of
sugR
and
ramA
. In the wild-type background, the
ramA
promoter activity was reduced to undetectable levels by the introduction of mutations into the GlxR binding site but increased by
sugR
deletion, indicating that GlxR and SugR function as the transcriptional activator and repressor, respectively. The marked repression of
ramA
promoter activity by the GlxR binding site mutations was largely compensated for by deletions of
sugR
and/or
ramA
. Furthermore,
ramA
promoter activity in the
ramA
-
sugR
double mutant was comparable to that in the
ramA
mutant but was significantly higher than that in the
sugR
mutant. Taken together, it is likely that the level of
ramA
expression is dynamically balanced by GlxR-dependent activation and repression by RamA along with SugR in response to perturbation of extracellular and/or intracellular conditions. These findings add multiple regulatory loops to the transcriptional regulatory network model in
C. glutamicum
.
RNA Type III Secretion Signals That Require Hfq
Authors: Niemann George S. , Brown Roslyn N. , Mushamiri Ivy T. , Nguyen Nhu T. , Taiwo Rukayat , Stufkens Afke , Smith Richard D. , Adkins Joshua N. , McDermott Jason E. , Heffron Fred
Published: February 2013

Salmonella
virulence is largely mediated by two type III secretion systems (T3SS) that deliver effector proteins from the bacterium to a host cell; however, the secretion signal is poorly defined. Effector N termini are thought to contain the signal, but they lack homology, possess no identifiable motif, and adopt intrinsically disordered structures. Alternative studies suggest that RNA-encoded signals may also be recognized and that they can be located in the 5′ untranslated leader sequence. We began our study by establishing the minimum sequence required for reporter translocation. Untranslated leader sequences predicted from 42 different
Salmonella
effector proteins were fused to the adenylate cyclase reporter (CyaA′), and each of them was tested for protein injection into J774 macrophages. RNA sequences derived from five effectors,
gtgA
,
cigR
,
gogB
,
sseL
, and
steD
, were sufficient for CyaA′ translocation into host cells. To determine the mechanism of signal recognition, we identified proteins that bound specifically to the
gtgA
RNA. One of the unique proteins identified was Hfq. Hfq had no effect upon the translocation of full-length CigR and SteD, but injection of intact GtgA, GogB, and SseL was abolished in an
hfq
mutant, confirming the importance of Hfq. Our results demonstrated that the
Salmonella
pathogenicity island 2 (SPI-2) T3SS assembled into a functional apparatus independently of Hfq. Since particular effectors required Hfq for translocation, Hfq-RNA complexes may participate in signal recognition.
A Genomic Signature and the Identification of New Sporulation Genes
Authors: Abecasis Ana B. , Serrano Mónica , Alves Renato , Quintais Leonor , Pereira-Leal José B. , Henriques Adriano O.
Published: February 2013

Bacterial endospores are the most resistant cell type known to humans, as they are able to withstand extremes of temperature, pressure, chemical injury, and time. They are also of interest because the endospore is the infective particle in a variety of human and livestock diseases. Endosporulation is characterized by the morphogenesis of an endospore within a mother cell. Based on the genes known to be involved in endosporulation in the model organismBacillus subtilis, a conserved core of about 100 genes was derived, representing the minimal machinery for endosporulation. The core was used to define a genomic signature of about 50 genes that are able to distinguish endospore-forming organisms, based on complete genome sequences, and we show this 50-gene signature is robust against phylogenetic proximity and other artifacts. This signature includes previously uncharacterized genes that we can now show are important for sporulation inB. subtilisand/or are under developmental control, thus further validating this genomic signature. We also predict that a series of polyextremophylic organisms, as well as several gut bacteria, are able to form endospores, and we identified 3 new loci essential for sporulation inB. subtilis:ytaF,ylmC, andylzA. In all, the results support the view that endosporulation likely evolved once, at the base of theFirmicutesphylum, and is unrelated to other bacterial cell differentiation programs and that this involved the evolution of new genes and functions, as well as the cooption of ancestral, housekeeping functions.
Sialic Acid Catabolism in Staphylococcus aureus
Authors: Olson Michael E. , King Jessica M. , Yahr Timothy L. , Horswill Alexander R.
Published: February 2013

Staphylococcus aureus
is a ubiquitous bacterial pathogen that is the causative agent of numerous acute and chronic infections.
S. aureus
colonizes the anterior nares of a significant portion of the healthy adult population, but the mechanisms of colonization remain incompletely defined. Sialic acid (
N
-acetylneuraminic acid [Neu5Ac]) is a bioavailable carbon and nitrogen source that is abundant on mucosal surfaces and in secretions in the commensal environment. Our findings demonstrate that Neu5Ac can serve as an
S. aureus
carbon source, and we have identified a previously uncharacterized chromosomal locus (
nan
) that is required for Neu5Ac utilization. Molecular characterization of the
nan
locus indicates that it contains five genes, organized into four transcripts, and the genes were renamed
nanE
,
nanR
,
nanK
,
nanA
, and
nanT
. Initial studies with gene deletions indicate that
nanT
, predicted to encode the Neu5Ac transporter, and
nanA
and
nanE
, predicted to encode catabolic enzymes, are essential for growth on Neu5Ac. Furthermore, a
nanE
deletion mutant exhibits a growth inhibition phenotype in the presence of Neu5Ac. Transcriptional fusions and Northern blot analyses indicate that NanR represses the expression of both the
nanAT
and
nanE
transcripts, which can be relieved with Neu5Ac. Electrophoretic mobility studies demonstrate that NanR binds to the
nanAT
and
nanE
promoter regions, and the Neu5Ac catabolic intermediate
N
-acetylmannosamine-6-phosphate (ManNAc-6P) relieves NanR promoter binding. Taken together, these data indicate that the
nan
gene cluster is essential for Neu5Ac utilization and may perform an important function for
S. aureus
survival in the host.
Spontaneous discharge of ‘spilled gallstone’ with complete resolution of retroperitoneal abscess in a patient treated for putative tuberculosis
Authors: Bastianpillai Christopher , Neal Christopher P , Patel Meera , Garcea Giuseppe
Published: February 2013

A 76-year-old man presented 5 months following an open cholecystectomy with a complicated retroperitoneal abscess secondary to a retained gallstone, which was misdiagnosed as a tuberculous abscess. Subsequently, the stone was eventually spontaneously discharged with complete resolution of the associated collection.
Transient improvement of poststroke apathy with zolpidem: a single-case, placebo-controlled double-blind study
Authors: Autret Katell , Arnould Annabelle , Mathieu Sarah , Azouvi Philippe
Published: February 2013

We report the case of a 44-year-old patient with severe and disabling apathy nearly 2 years after a right hemisphere haemorrhagic stroke. The effect of a single dose of zolpidem was tested over a 2-week period, in alternation with either no treatment or a placebo in a double-blind randomised trial. Zolpidem was associated with a dramatic improvement in apathy, as assessed with the Apathy Inventory and the Behavioral Dysexecutive Syndrome Inventory. No adverse effect occurred during the trial.
Unusual fundus examination findings in tuberculous meningitis
Authors: Verma Rajesh , Chaudhari Tejendra S
Published: February 2013

Vision impairment is one of the devastating complications of central nervous system tuberculosis (CNS TB). Optic atrophy is a sequelae of various forms of CNS TB which, ultimately, is responsible for vision impairment. It is usually the secondary optic atrophy which occurs in CNS TB. In this case report, we present two cases of CNS tuberculosis developing primary optic atrophy, which is infrequently reported. The relevant pathophysiology and causes of vision impairment in CNS TB are also discussed.
Syphilis: a reversible cause of nephrotic syndrome
Authors: Handoko M Louis , Duijvestein Marjolijn , Scheepstra Cornelis G , de Fijter Carola W H
Published: February 2013

A patient in his late 30s presented with symptoms consistent with a nephrotic syndrome. Renal biopsy revealed membranous nephropathy. He also mentioned a spontaneous resolving ‘rash’ at his glans penis after unprotected intercourse. Therefore, he was tested for sexually transmitted diseases as a possible underlying cause of his nephrotic syndrome. Serology for syphilis was positive with high titres. After a single penicillin injection, there was fast and complete clinical recovery.
Autoimmune hepatitis in a teenage boy: ‘overlap’ or ‘outlier’ syndrome—dilemma for internists
Authors: Talukdar Arunansu , Khanra Dibbendhu , Mukherjee Kabita , Saha Manjari
Published: February 2013

An 18-year-old boy presented with upper gastrointestinal bleeding and jaundice. Investigations revealed coarse hepatomegaly, splenomegaly and advanced oesophageal varices. Blood reports showed marked rise of alkaline phosphatase and more than twofold rise of transaminases and IgG. Liver histology was suggestive of piecemeal necrosis, interphase hepatitis and bile duct proliferation. Antinuclear antibody was positive in high titre along with positive antismooth muscle antibody and antimitochondrial antibody. The patient was positive for human leukocyte antigen DR3 type. Although an ‘overlap’ syndrome exists between autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC), a cholestatic variant of AIH, a rare ‘outlier’ syndrome could not be excluded in our case. Moreover, ‘the chicken or the egg’, AIH or PBC, the dilemma for the internists continued. The patient was put on steroid and ursodeoxycholic acid with unsatisfactory response. The existing international criteria for diagnosis of AIH are not generous enough to accommodate its variant forms.
Omental flap for treatment of long standing lymphoedema of the lower limb: can it end the suffering? Report of four cases with review of literatures
Authors: Attash Saad Muwafaq , Al-Sheikh Mohammad Yaseen
Published: February 2013

We report our experience of four cases of long-standing unilateral, secondary lymphoedema of the lower limb, for which conservative treatment has failed, that were treated in our centre using pedicled omental flap. The four patients were followed for a period of 1 year after the procedures and frequent measurements of the circumference of the affected limb revealed a reduction in the circumference ranging between 50% in the first patient to 75% in the fourth patient together with an excellent functional improvement in terms of resuming walking, daily activities, sports and work. We think that pedicled omental flap is an important, relatively easy and safe option that deserves consideration in refractory cases of lymphoedema of the lower limb.
Angina bullosa haemorrhagica
Authors: Singh Dipti , Misra Neeta , Agrawal Sudhanshu , Misra Pradyumna
Published: February 2013

Angina bullosa haemorrhagica is the term used to describe benign subepithelial oral mucosal blisters filled with blood that are not attributable to a systemic disorder or haemostatic defect. It is a very rare condition. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long-term use of steroid inhalers has also been implicated in the disease. We present a 50-year-old patient with angina bullosa haemorrhagica. Trauma by sharp cusp of adjacent tooth and metal crown were identified as aetiological factors in this case. Lesions healed after removal of the metal crown and rounding of the cusp. Therefore, recognition of the lesion is of great importance to dentists, to avoid misdiagnosis.
The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study
Authors: Verrelst Ruth , Willems Tine Marieke , Clercq Dirk De , Roosen Philip , Goossens Lennert , Witvrouw Erik
Published: February 2013

Objective

To prospectively identify proximal risk factors contributing to the development of exertional medial tibial pain (EMTP).

Methods

Data were prospectively collected on healthy female students in physical education, who were freshmen in 2010–2011 and 2011–2012. 95 female students, aged 18.15±0.84, were tested at the beginning of their first academic year. Testing included isokinetic hip strength measurements of the abductors, adductors, internal rotators and external rotators. The follow-up of the individulas was assessed using a weekly online questionnaire and a 3-monthly retrospective control questionnaire. EMTP was diagnosed by an experienced MD (Doctor of Medicine). Cox regression analysis was used to identify the potential risk factors for the development of EMTP.

Results

21 individuals were diagnosed with EMTP during follow-up. The results of this study identified that decreased hip abductor concentric strength is a predictive parameter for the development of EMTP in females. More specifically, total work (p=0.010) and average power (p=0.045) for concentric abduction strength were found to be significant predictors for this lower leg overuse injury.

Conclusions

Hip abductor weakness is a significant predictor for EMTP in women. Preventive screening methods for EMTP should therefore include this proximal contributing factor.
Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique
Authors: Parkkali Saara , Abacassamo Fatima , Nwaru Bright Ibeabughichi , Salomé Graca , Augusto Orvalho , Regushevskaya Elena , Dgedge Martinho , Sousa Cesar , Cliff Julie , Chilundo Baltazar , Hemminki Elina
Published: February 2013

Objective

To present the pregnancy results and interim birth results of a pragmatic randomised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV.

Design

A pragmatic randomised controlled trial.

Setting

Two health centres (1° de Maio and Machava) in Maputo, Mozambique, a setting of endemic malaria and high prevalence of HIV.

Participants

Pregnant women (≥18-year-olds; non-high-risk pregnancy, n=4326) attending prenatal care consultation at the two health centres were recruited to the trial.

Interventions

The women were randomly allocated to either Routine iron (n=2184; 60 mg ferrous sulfate plus 400 μg of folic acid daily throughout pregnancy) or Selective iron (n=2142; screening and treatment for anaemia and daily intake of 1 mg of folic acid).

Outcome measures

The primary outcomes were preterm delivery (delivery <37 weeks of gestation) and low birth weight (<2500 g). The secondary outcomes were symptoms suggestive of malaria and self-reported malaria during pregnancy; birth length; caesarean section; maternal and child health status after delivery.

Results

The number of follow-up visits was similar in the two groups. Between the first and fifth visits, the two groups were similar regarding the occurrence of fever, headache, cold/chills, nausea/vomiting and body aches. There was a suggestion of increased incidence of self-reported malaria during pregnancy (OR 1.37, 95% CI 0.98 to1.92) in the Routine iron group. Birth data were available for 1109 (51%) in the Routine iron group and for 1149 (54%) in the Selective iron group. The birth outcomes were relatively similar in the two groups. However, there was a suggestion (statistically non-significant) of poorer outcomes in the Routine iron group with regard to long hospital stay after birth (relative risk (RR) 1.43, 95% CI 0.97 to 1.26; risk difference (RD) 0.02, 95% CI −0.00 to 0.03) and unavailability of delivery data (RR 1.06, 95% CI 1.00 to 1.13; RD 0.03, 95% CI −0.01 to 0.07).

Conclusions

These interim results suggest that routine iron prophylaxis during pregnancy did not confer advantage over screening and treatment for anaemia regarding maternal and child health. Complete data on birth outcomes are being collected for firmer conclusions.

Trial registration

The trial is registered at ClinicalTrials.gov, numberNCT00488579(June 2007). The first women were randomised to the trial proper April 2007–March 2008. The pilot was November 2006–March 2008. The 3-month lag was due to technical difficulties in completing trial registration.
Dietary patterns and colorectal cancer recurrence and survival: a cohort study
Authors: Zhu Yun , Wu Hao , Wang Peizhong Peter , Savas Sevtap , Woodrow Jennifer , Wish Tyler , Jin Rong , Green Roger , Woods Michael , Roebothan Barbara , Buehler Sharon , Dicks Elizabeth , Mclaughlin John R , Campbell Peter T , Parfrey Patrick S
Published: February 2013

Objective

To examine the association between dietary patterns and colorectal cancer (CRC) survival.

Design

Cohort study.

Setting

A familial CRC registry in Newfoundland.

Participants

529 newly diagnosed CRC patients from Newfoundland. They were recruited from 1999 to 2003 and followed up until April 2010.

Outcome measure

Participants reported their dietary intake using a food frequency questionnaire. Dietary patterns were identified with factor analysis. Multivariable Cox proportional hazards models were employed to estimate HR and 95% CI for association of dietary patterns with CRC recurrence and death from all causes, after controlling for covariates.

Results

Disease-free survival (DFS) among CRC patients was significantly worsened among patients with a high processed meat dietary pattern (the highest vs the lowest quartile HR 1.82, 95% CI 1.07 to 3.09). No associations were observed with the prudent vegetable or the high-sugar patterns and DFS. The association between the processed meat pattern and DFS was restricted to patients diagnosed with colon cancer (the highest vs the lowest quartile: HR 2.29, 95% CI 1.19 to 4.40) whereas the relationship between overall survival (OS) and this pattern was observed among patients with colon cancer only (the highest vs the lowest quartile: HR 2.13, 95% CI 1.03 to 4.43). Potential effect modification was noted for sex (p value for interaction 0.04, HR 3.85 for women and 1.22 for men).

Conclusions

The processed meat dietary pattern prior to diagnosis is associated with higher risk of tumour recurrence, metastasis and death among patients with CRC.
The relative incidence of fracture non-union in the Scottish population (5.17 million): a 5-year epidemiological study
Authors: Mills Leanora Anne , Simpson A Hamish R W
Published: February 2013

Objectives

In the UK there are approximately 850 000 new fractures seen each year. Rates of non-union of 5–10% of fractures have been suggested, the cost to the National Health Service of treating non-union has been reported to range between £7000 and £79 000 per person yet there are little actual data available. The objective of this epidemiological study therefore is for the first time to report the rates of fracture non-union.

Design

A cross-sectional epidemiological study.

Setting

The population of Scotland.

Participants

All patient admissions to hospital in Scotland are coded according to diagnosis. These data are collected by (and were obtained from) Information Services Department Scotland. Those who have been coded for a bone non-union between 2005 and 2010 were included in the study. No patients were excluded. Population data were obtained from the Registrar General for Scotland.

Outcome measure

The number of fracture non-unions per 100 000 population of Scotland according to age, sex and anatomical distribution of non-union.

Results

4895 non-unions were treated as inpatients in Scotland between 2005 and 2010, averaging 979 per year, with an overall incidence of 18.94 per 100 000 population per annum. The distribution according to gender was 57% male and 43% female. The overall peak incidence according to age was between 30 and 40 years. The mean population of Scotland between 2005 and 2010 was 5 169 140 people.

Conclusion

Fracture non-union in the population as a whole remains low at less than 20 per 100 000 population and peaks in the fourth decade of life. Further research is required to determine the risk of non-union per fracture according to age/sex/anatomical distribution.

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Methods to improve recruitment to randomised controlled trials: Cochrane systematic review and meta-analysis
Authors: Treweek Shaun , Lockhart Pauline , Pitkethly Marie , Cook Jonathan A , Kjeldstrøm Monica , Johansen Marit , Taskila Taina K , Sullivan Frank M , Wilson Sue , Jackson Catherine , Jones Ritu , Mitchell Elizabeth D
Published: February 2013

This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 4, Art. No.: MR000013 DOI: 10.1002/14651858.MR000013.pub5 (seewww.thecochranelibrary.comfor information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

Objective

To identify interventions designed to improve recruitment to randomised controlled trials, and to quantify their effect on trial participation.

Design

Systematic review.

Data sources

The Cochrane Methodology Review Group Specialised Register in the Cochrane Library, MEDLINE, EMBASE, ERIC, Science Citation Index, Social Sciences Citation Index, C2-SPECTR, the National Research Register and PubMed. Most searches were undertaken up to 2010; no language restrictions were applied.

Study selection

Randomised and quasi-randomised controlled trials, including those recruiting to hypothetical studies. Studies on retention strategies, examining ways to increase questionnaire response or evaluating the use of incentives for clinicians were excluded. The study population included any potential trial participant (eg, patient, clinician and member of the public), or individual or group of individuals responsible for trial recruitment (eg, clinicians, researchers and recruitment sites). Two authors independently screened identified studies for eligibility.

Results

45 trials with over 43 000 participants were included. Some interventions were effective in increasing recruitment: telephone reminders to non-respondents (risk ratio (RR) 1.66, 95% CI 1.03 to 2.46; two studies, 1058 participants), use of opt-out rather than opt-in procedures for contacting potential participants (RR 1.39, 95% CI 1.06 to 1.84; one study, 152 participants) and open designs where participants know which treatment they are receiving in the trial (RR 1.22, 95% CI 1.09 to 1.36; two studies, 4833 participants). However, the effect of many other strategies is less clear, including the use of video to provide trial information and interventions aimed at recruiters.

Conclusions

There are promising strategies for increasing recruitment to trials, but some methods, such as open-trial designs and opt-out strategies, must be considered carefully as their use may also present methodological or ethical challenges. Questions remain as to the applicability of results originating from hypothetical trials, including those relating to the use of monetary incentives, and there is a clear knowledge gap with regard to effective strategies aimed at recruiters.
Economic evaluation of Australian acute care accreditation (ACCREDIT-CBA (Acute)): study protocol for a mixed-method research project
Authors: Mumford Virginia , Greenfield David , Hinchcliff Reece , Moldovan Max , Forde Kevin , Westbrook Johanna I , Braithwaite Jeffrey
Published: February 2013

Introduction

The Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork—Cost–Benefit Analysis (ACCREDIT-CBA (Acute)) study is designed to determine and make explicit the costs and benefits of Australian acute care accreditation and to determine the effectiveness of acute care accreditation in improving patient safety and quality of care. The cost–benefit analysis framework will be provided in the form of an interactive model for industry partners, health regulators and policy makers, accreditation agencies and acute care service providers.

Methods and design

The study will use a mixed-method approach to identify, quantify and monetise the costs and benefits of accreditation. Surveys, expert panels, focus groups, interviews and primary and secondary data analysis will be used in cross-sectional and case study designs.

Ethics and dissemination

The University of New South Wales Human Research Ethics Committee has approved this project (approval number HREC 10274). The results of the study will be reported via peer-reviewed publications, conferences and seminar resentations and will form part of a doctoral thesis.
Deriving the East Riding Elbow Rule (ER2): a maximally sensitive decision tool for elbow injury
Authors: Arundel David , Williams Paul , Townend Will
Published: February 2013

Objective

To derive a maximally sensitive decision rule for clinical practice to rule out the need for x-ray examination after elbow injury in adults and children.

Methods

Emergency department patients with acute elbow injury were recruited. Practitioners used their usual judgement to assess whether x-ray examination was required. Radiographs were reported on by radiologists blind to clinical assessment. Patients not x-rayed were followed-up at 7 days by telephone interview, and those with ongoing pain were recalled for assessment. Recursive partitioning was used to derive a maximally sensitive decision tool. Inter-rater variability for significant discriminators was subsequently evaluated by a cohort of 20 emergency department clinicians.

Results

492 patients were recruited (May 2006–November 2008): 50.4% were male; 26.8% were children; 444 (90.2%) had an x-ray; 167 (37.6%) showed abnormality. A follow-up telephone interview was conducted with 28; none were recalled. Thirteen could not be contacted, none of whom returned within 3 months. Sixteen patients with fractures were able to fully extend their elbow. The sensitivity of elbow extension alone was 84% (95% CI 77% to 88%), with specificity of 54% (95% CI 53% to 58%). A 100% sensitive (95% CI 97% to 100%) decision rule for adults (n=348) was derived based on (1) inability to fully extend the elbow, (2) tenderness over radial head, olecranon or medial epicondyle, and (3) presence of bruising (specificity 24% (95% CI 19% to 30%)). A similar rule for children could not be derived.

Conclusions

A simple and highly sensitive clinical decision rule for adult elbow fracture was derived in our cohort. A validation study in a second population is now required. At present, we are unable to recommend a rule-out strategy for elbow injuries in children.
Presence of Clostridium botulinum and botulinum toxin in milk and udder tissue of dairy cows with suspected botulism
Authors: Böhnel H. , Gessler F.
Published: February 2013

Clostridium botulinum is an anaerobic spore‐forming bacterium prevalent in the environment, and causes botulism in man and animals via toxins. Dairy cattle may be contaminated or infected by feed, water or other environmental factors. Milk may also carry the pathogen. Hence, milk and udder samples need to be tested. The number of clinical cases of bovine botulism in Germany has been increasing since the mid‐1990s. Besides routine samples, additional 99 milk samples from 37 farms, and 51 udder samples from 51 farms from sick animals presumably affected by botulism were tested microbiologically by the mouse bioassay. Milk from three farms (8.1 per cent) contained botulinum toxin, and from two (5.4 per cent) bacterial states of C botulinum. Ten udder samples (19.6 per cent) contained toxin, and 7 (13.7 per cent) bacterial forms, including one case where both toxin and bacteria were found. The findings are discussed. Positive milk samples containing botulinum toxin or bacteria raise concern of food safety for the human consumer. Pathological udder samples may show either infection prior to, or contamination after death.
Recent shifts in the global proportions of canine uroliths
Authors: Lulich J. P. , Osborne C. A. , Albasan H. , Koehler L. A. , Ulrich L. M. , Lekcharoensuk C.
Published: February 2013

Epidemiological surveys are important tools to identify emerging trends in disease. The Minnesota Urolith Centre has been tracking the occurrence of uroliths for over 30 years. To evaluate global changes in the frequencies of canine uroliths, submissions to the Minnesota Urolith Centre in 1999 and 2000 (n = 39,965) were compared with submissions in 2009 and 2010 (n = 99,598). The proportion of calcium oxalate uroliths rose on every continent except in Europe. Seventy‐five per cent of dogs with calcium oxalate uroliths were between 5 and 11 years old. The proportion of struvite uroliths decreased on every continent except in Australia‐Oceania. Seventy‐seven per cent of all struvite formers were between two and eight years old. The proportion of purine uroliths has declined slightly. Worldwide, uroliths composed of cystine, calcium phosphate, calcium phosphate carbonate and silica remain uncommon. Epidemiological studies of urolithiasis are essential for constructing effective experimental designs and selecting appropriate cases and controls to conduct clinical trials with meaningful results.
Application of a single vascularised skin flap in eastern imperial eagle with skin defects
Authors: Kožár M. , Molnár L. , Trbolová A. , Kožárová I.
Published: February 2013

Skin defects are a frequent problem in avian clinical practice. They require rapid and effective therapy due to the absence of available skin around the skin defects and desiccation of the surrounding tissue. Within the period of one year, between March 2010 and April 2011, several specimens of eastern imperial eagle (Aquila heliaca) were treated at the Clinic of Exotic and Free‐Living Animals of the University of Veterinary Medicine and Pharmacy in Košice. Three of them (cases 1, 2 and 3) had damaged skin on their limbs. The skin defects presented in these patients required surgical treatment by a vascularised skin flap. Acceptance of the skin flap on the entire recipient site was seen in all three patients. Complete healing, as well as functioning of the damaged sites were observed within two months from the surgery. Using surgical treatment in case of extensive skin damages, as well as skin damages in hardly accessible locations, helps to prevent a number of complications associated with the management of the treatment of open wounds. The given method appears suitable also due to a better cosmetic effect and lower degree of stress to the patients.