bluuebunny/crossref_metadata_2025 huggingface dataset:
Strain, temperature, and electric-field effects on the phase transition and piezoelectric responses of K0.5Na0.5NbO3 thin films
Authors: Zhou Meng-Jun , Wang Jian-Jun , Chen Long-Qing , Nan Ce-Wen
Published: April 2018

A KNbO3-based solid solution system is environmentally friendly with good electromechanical performance. This work established the misfit strain–strain and temperature–strain phase diagrams for K0.5Na0.5NbO3 thin films and calculated the polarization switching, phase transition, and piezoelectric responses of K0.5Na0.5NbO3 thin films under various strains, temperatures, and electric fields. The results show that the piezoelectric coefficient d33 can be enhanced near the phase boundaries. For the ferroelectric phase with a nonzero out-of-plane polarization component, an optimal electric field is identified for maximizing d33, which is desired in applications such as thin-film piezoelectric micro-electromechanical systems, transducers for ultrasound medical imaging, and energy harvesting. The present results are expected to provide guidance for the future experimental study of KxNa1−xNbO3 thin films and the optimization of ferroelectric thin film-based devices.
Evaluation of phosphate-uptake mechanisms by Fe(III) (oxyhydr)oxides in Early Proterozoic oceanic conditions
Authors: Hemmingsson Christoffer , Pitcairn Iain K. , Chi Fru Ernest
Published: April 2018

Environmental contextReconstructing the Precambrian oceanic P cycle, in conjunction with the As cycle, is critical for understanding the rise of atmospheric O2 in Earth’s history. Bioavailable phosphorus (P) has been found to regulate photosynthetic activity, whereas dissolved arsenic (As) maxima correlate with photosynthetic minima. New data on empirical adsorption and coprecipitation models with Fe(III) (oxyhydr)oxides suggest coprecipitation is a more efficient method of P sorption than is adsorption in Precambrian surface ocean conditions.
AbstractBanded iron formations (BIF) are proxies of global dissolved inorganic phosphate (DIP) content in Precambrian marine waters. Estimates of Precambrian DIP rely on constraining the mechanisms by which Fe(III) (oxyhydr)oxides scavenge DIP in NaCl solutions mimicking elevated Precambrian marine Si and Fe(II) concentrations. The two DIP binding modes suggested for Early Proterozoic marine waters are (1) surface attachment on pre-formed Fe(III) (oxyhydr)oxides (adsorption), and (2) incorporation of P into actively growing Fe(III) (oxyhydr)oxides (coprecipitation) during the oxidation of Fe(II) to Fe(III) (oxyhydr)oxides in the presence of DIP. It has been suggested that elevated Si concentrations, such as those suggested for Precambrian seawater, strongly inhibit adsorption of DIP in Fe(III) (oxyhydr)oxides; however, recent coprecipitation experiments show that DIP is scavenged by Fe(III) (oxyhydr)oxides in the presence of Si, seawater cations and hydrothermal As. In the present study, we show that the DIP uptake onto Fe(III) (oxyhydr)oxides by adsorption is less than 5 % of DIP uptake by coprecipitation. Differences in surface attachment and the possibility of structural capture within the Fe(III) (oxyhydr)oxides are inferred from the robust influence Si has on DIP binding during adsorption, meanwhile the influence of Si on DIP binding is inhibited during coprecipitation when As(III) and As(V) are present. In the Early Proterozoic open oceans, Fe(III) (oxyhydr)oxides precipitated when deep anoxic Fe(II)-rich waters rose and mixed with the first permanently oxygenated ocean surface waters. Our data imply that, DIP was removed from surface waters through coprecipitation with those Fe(III) (oxyhydr)oxides, rather than adsorption. Local variations in DIP and perhaps even stratification of DIP in the oceans were likely created from the continuous removal of DIP from surface waters by Fe(III) (oxyhydr)oxides, and by the partial release of DIP into the anoxic bottom waters and buried sediments. In addition to a DIP famine, the selectivity for DIP over As(V) may have led to As enrichment in surface waters, both of which would have most likely decreased the productivity of cyanobacteria and O2 production.
Draft genome sequence of
Camellia sinensis
var.
sinensis
provides insights into the evolution of the tea genome and tea quality
Authors: Wei Chaoling , Yang Hua , Wang Songbo , Zhao Jian , Liu Chun , Gao Liping , Xia Enhua , Lu Ying , Tai Yuling , She Guangbiao , Sun Jun , Cao Haisheng , Tong Wei , Gao Qiang , Li Yeyun , Deng Weiwei , Jiang Xiaolan , Wang Wenzhao , Chen Qi , Zhang Shihua , Li Haijing , Wu Junlan , Wang Ping , Li Penghui , Shi Chengying , Zheng Fengya , Jian Jianbo , Huang Bei , Shan Dai , Shi Mingming , Fang Congbing , Yue Yi , Li Fangdong , Li Daxiang , Wei Shu , Han Bin , Jiang Changjun , Yin Ye , Xia Tao , Zhang Zhengzhu , Bennetzen Jeffrey L. , Zhao Shancen , Wan Xiaochun
Published: April 2018

Significance

A high-quality genome assembly of
Camellia sinensis
var.
sinensis
facilitates genomic, transcriptomic, and metabolomic analyses of the quality traits that make tea one of the world’s most-consumed beverages. The specific gene family members critical for biosynthesis of key tea metabolites, monomeric galloylated catechins and theanine, are indicated and found to have evolved specifically for these functions in the tea plant lineage. Two whole-genome duplications, critical to gene family evolution for these two metabolites, are identified and dated, but are shown to account for less amplification than subsequent paralogous duplications. These studies lay the foundation for future research to understand and utilize the genes that determine tea quality and its diversity within tea germplasm.
Characterization of CoPK02, a Ca2+/calmodulin-dependent protein kinase in mushroomCoprinopsis cinerea
Authors: Yamashita Masashi , Sueyoshi Noriyuki , Yamada Hiroki , Katayama Syouichi , Senga Yukako , Takenaka Yasuhiro , Ishida Atsuhiko , Kameshita Isamu , Shigeri Yasushi
Published: April 2018

We surveyed genome sequences from the basidiomycetous mushroom Coprinopsis cinerea and isolated a cDNA homologous to CMKA, a calmodulin-dependent protein kinase (CaMK) in Aspergillus nidulans. We designated this sequence, encoding 580 amino acids with a molecular weight of 63,987, as CoPK02. CoPK02 possessed twelve subdomains specific to protein kinases and exhibited 43, 35, 40% identity with rat CaMKI, CaMKII, CaMKIV, respectively, and 40% identity with CoPK12, one of the CaMK orthologs in C. cinerea. CoPK02 showed significant autophosphorylation activity and phosphorylated exogenous proteins in the presence of Ca2+/CaM. By the CaM-overlay assay we confirmed that the C-terminal sequence (Trp346-Arg358) was the calmodulin-binding site, and that the binding of Ca2+/CaM to CoPK02 was reduced by the autophosphorylation of CoPK02. Since CoPK02 evolved in a different clade from CoPK12, and showed different gene expression compared to that of CoPK32, which is homologous to mitogen-activated protein kinase-activated protein kinase, CoPK02 and CoPK12 might cooperatively regulate Ca2+-signaling in C. cinerea.
The Utilization of VCO (Virgin Coconut Oil) in Manufacturing of Solid Soap with Red Betel Leaf Extract Addition (Paper Crotum Ruiz &Pav)
Authors: Sari M
Published: April 2018

Soap is a compound of sodium or potassium with fatty acids from vegetable oils or solid animal fats, soft or liquid, and foamy. Considering the potential of VCO as the raw material for making soap and supported by the benefits of red betel leaves, then this research is done by making solid bath soap from VCO which is supplemented with Red betel leaf extract. The purpose of this research is to make solid soap from VCO with an extract of red betel leaf based on SNINo.06-3532199. Analyzing VCO oil, which is used for the manufacture of soap, consists of analysis of saponification figures, Iodine number and peroxide number. Has made solid soap from VCO oil with Red betel leaf extract. From the five quality standards established under SNI 06-3532-1994 only two quality standards that can be done that is water quality and the amount of acidity. The percent of water quality obtained is 10% meanwhile the amount of acidity obtained is 9,32%. According to the data, it can be concluded that the solid soap made was not fulfill SNI 06-3532-1994.
Commentary on “Arithmetic on curves” by Barry Mazur
Authors: Totaro Burt
Published: April 2018

Immediately following the commentary below, this previously published article is reprinted in its entirety: B. Mazur, Arithmetic on curves, Bull. Amer. Math. Soc. (N.S.) 14 (1986), no. 2, 207–259.
NeuroMorphoVis: a collaborative framework for analysis and visualization of neuronal morphology skeletons reconstructed from microscopy stacks
Authors: Abdellah Marwan , Hernando Juan , Eilemann Stefan , Lapere Samuel , Antille Nicolas , Markram Henry , Schürmann Felix
Published: April 2018

Motivation

From image stacks to computational models, processing digital representations of neuronal morphologies is essential to neuroscientific research. Workflows involve various techniques and tools, leading in certain cases to convoluted and fragmented pipelines. The existence of an integrated, extensible and free framework for processing, analysis and visualization of those morphologies is a challenge that is still largely unfulfilled.

Results

We present NeuroMorphoVis, an interactive, extensible and cross-platform framework for building, visualizing and analyzing digital reconstructions of neuronal morphology skeletons extracted from microscopy stacks. Our framework is capable of detecting and repairing tracing artifacts, allowing the generation of high fidelity surface meshes and high resolution volumetric models for simulation and in silico imaging studies. The applicability of NeuroMorphoVis is demonstrated with two case studies. The first simulates the construction of three-dimensional profiles of neuronal somata and the other highlights how the framework is leveraged to create volumetric models of neuronal circuits for simulating different types of in vitro imaging experiments.

Availability and implementation

The source code and documentation are freely available on https://github.com/BlueBrain/NeuroMorphoVis under the GNU public license. The morphological analysis, visualization and surface meshing are implemented as an extensible Python API (Application Programming Interface) based on Blender, and the volume reconstruction and analysis code is written in C++ and parallelized using OpenMP. The framework features are accessible from a user-friendly GUI (Graphical User Interface) and a rich CLI (Command Line Interface).

Supplementary information

Supplementary data are available at Bioinformatics online.
Automatic selection of verification tools for efficient analysis of biochemical models
Authors: Bakir Mehmet Emin , Konur Savas , Gheorghe Marian , Krasnogor Natalio , Stannett Mike
Published: April 2018

Motivation

Formal verification is a computational approach that checks system correctness (in relation to a desired functionality). It has been widely used in engineering applications to verify that systems work correctly. Model checking, an algorithmic approach to verification, looks at whether a system model satisfies its requirements specification. This approach has been applied to a large number of models in systems and synthetic biology as well as in systems medicine. Model checking is, however, computationally very expensive, and is not scalable to large models and systems. Consequently, statistical model checking (SMC), which relaxes some of the constraints of model checking, has been introduced to address this drawback. Several SMC tools have been developed; however, the performance of each tool significantly varies according to the system model in question and the type of requirements being verified. This makes it hard to know, a priori, which one to use for a given model and requirement, as choosing the most efficient tool for any biological application requires a significant degree of computational expertise, not usually available in biology labs. The objective of this article is to introduce a method and provide a tool leading to the automatic selection of the most appropriate model checker for the system of interest.

Results

We provide a system that can automatically predict the fastest model checking tool for a given biological model. Our results show that one can make predictions of high confidence, with over 90% accuracy. This implies significant performance gain in verification time and substantially reduces the ‘usability barrier’ enabling biologists to have access to this powerful computational technology.

Availability and implementation

SMC Predictor tool is available at http://www.smcpredictor.com.

Supplementary information

Supplementary data are available at Bioinformatics online.
Bayesian negative binomial regression for differential expression with confounding factors
Authors: Dadaneh Siamak Zamani , Zhou Mingyuan , Qian Xiaoning
Published: April 2018

Motivation

Rapid adoption of high-throughput sequencing technologies has enabled better understanding of genome-wide molecular profile changes associated with phenotypic differences in biomedical studies. Often, these changes are due to multiple interacting factors. Existing methods are mostly considering differential expression across two conditions studying one main factor without considering other confounding factors. In addition, they are often coupled with essential sophisticated ad-hoc pre-processing steps such as normalization, restricting their adaptability to general experimental setups. Complex multi-factor experimental design to accurately decipher genotype-phenotype relationships signifies the need for developing effective statistical tools for genome-scale sequencing data profiled under multi-factor conditions.

Results

We have developed a novel Bayesian negative binomial regression (BNB-R) method for the analysis of RNA sequencing (RNA-seq) count data. In particular, the natural model parameterization removes the needs for the normalization step, while the method is capable of tackling complex experimental design involving multi-variate dependence structures. Efficient Bayesian inference of model parameters is obtained by exploiting conditional conjugacy via novel data augmentation techniques. Comprehensive studies on both synthetic and real-world RNA-seq data demonstrate the superior performance of BNB-R in terms of the areas under both the receiver operating characteristic and precision-recall curves.

Availability and implementation

BNB-R is implemented in R language and is available at https://github.com/siamakz/BNBR.

Supplementary information

Supplementary data are available at Bioinformatics online.
Identification of Novel Neisseria gonorrhoeae Lineages Harboring Resistance Plasmids in Coastal Kenya
Authors: Cehovin Ana , Harrison Odile B , Lewis Steven B , Ward Philip N , Ngetsa Caroline , Graham Susan M , Sanders Eduard J , Maiden Martin C J , Tang Christoph M
Published: April 2018

Background

Africa has the highest incidence of gonorrhea in the world. However, little is known about gonococcal populations in this continent or mechanisms of antimicrobial resistance (AMR).

Methods

Whole-genome sequence data were analyzed from 103 Neisseria gonorrhoeae isolates from 73 patients, mainly men who have sex with men, from coastal Kenya. We annotated loci, defined the core genome, defined mechanisms of AMR, and performed phylogenetic analysis. For patients with multiple episodes of gonorrhea, we determined whether infections occurred with related strains.

Results

We identified 3 clusters of isolates that are phylogenetically distinct from isolates found elsewhere. Plasmids were virtually ubiquitous: pTetM and pblaTEM were found in 97%, and 55% of isolates, respectively. This was associated with high doxycycline use for undiagnosed sexually transmitted infections. Twenty-three percent of multiple episodes of gonorrhea in the same individual were caused by a related strain, suggesting inadequate treatment or reinfection.

Conclusions

The prevalence of plasmid-mediated AMR in Kenyan gonococci contrasts with that in wealthy countries, where AMR is largely chromosomally mediated. Antimicrobials have a profound effect on the maintenance of lineages harboring plasmids. Doxycycline can select for tetracycline and penicillin resistance, through plasmid cooperation. Understanding the mechanisms of AMR in high-risk groups is required to inform treatment strategies.
Immune gene expression in kidney biopsies of lupus nephritis patients at diagnosis and at renal flare
Authors: Mejia-Vilet Juan M , Parikh Samir V , Song Huijuan , Fadda Paolo , Shapiro John P , Ayoub Isabelle , Yu Lianbo , Zhang Jianying , Uribe-Uribe Norma , Rovin Brad H
Published: April 2018

Background

Up to 50% of lupus nephritis (LN) patients experience renal flares after their initial episode of LN. These flares contribute to poor renal outcomes. We postulated that intrarenal immune gene expression is different in flares compared with de novo LN, and conducted these studies to test this hypothesis.

Methods

Glomerular and tubulointerstitial immune gene expression was evaluated in 14 patients who had a kidney biopsy to diagnose LN and another biopsy at their first LN flare. Ten healthy living kidney donors were included as controls. RNA was extracted from laser microdissected formalin-fixed paraffin-embedded kidney biopsies. Gene expression was analyzed using the Nanostring nCounter® platform and validated by quantitative real-time polymerase chain reaction. Differentially expressed genes were analyzed by the Ingenuity Pathway Analysis and Panther Gene Ontology tools.

Results

Over 110 genes were differentially expressed between LN and healthy control kidney biopsies. Although there was considerable molecular heterogeneity between LN biopsies at diagnosis and flare, for about half the LN patients gene expression from the first LN biopsy clustered with the repeated LN biopsy. However, in all patients, a set of eight interferon alpha-controlled genes had a significantly higher expression in the diagnostic biopsy compared with the flare biopsy. In contrast, nine tumor necrosis factor alpha-controlled genes had higher expression in flare biopsies.

Conclusions

There is significant heterogeneity in immune-gene expression of kidney tissue from LN patients. There are limited but important differences in gene expression between LN flares, which may influence treatment decisions.
Abacavir Use and Risk for Myocardial Infarction and Cardiovascular Events: Pooled Analysis of Data From Clinical Trials
Authors: Nan Cassandra , Shaefer Mark , Urbaityte Rimgaile , Oyee James , Hopking Judy , Ragone Leigh , Perger Teodora , Win Beta , Vangerow Harald , McCoig Cynthia , Vannappagari Vani
Published: April 2018

Background

Some observational studies and randomized controlled trials (RCTs) have suggested an association between abacavir (ABC) use and myocardial infarction (MI), whereas others have not.

Methods

This pooled analysis of 66 phase II–IV RCTs estimates exposure-adjusted incidence rates (IRs) and relative rates (RRs) of MI and cardiovascular events (CVEs) in participants receiving ABC- and non-ABC-containing combination antiretroviral therapy (cART). The primary analysis of MI included ABC-randomized trials with ≥48-week follow-up. Sensitivity analyses of MI and CVEs included non-ABC-randomized and <48-week follow-up trials.

Results

In 66 clinical trials, 13 119 adults (75% male, aged 18–85 years) were on ABC-containing cART and 7350 were not. Exposure-adjusted IR for MI was 1.5 per 1000 person-years (PY; 95% confidence interval [CI], 0.67–3.34) in the ABC-exposed group and 2.18 per 1000 PY (95% CI, 1.09–4.40) in the unexposed group. The IR for CVEs was 2.9 per 1000 PY (95% CI, 2.09–4.02) in the exposed group and 4.69 per 1000 PY (95% CI, 3.40–6.47) in the unexposed group with studies of ≥48 weeks of follow-up, with an RR of 0.62 (95% CI, 0.39–0.98). The inclusion of nonrandomized and shorter-duration trials did not significantly change the RR for MI or coronary artery disease.

Conclusions

This pooled analysis found comparable IRs for MI and CVEs among ABC-exposed and -unexposed participants, suggesting no increased risk for MI or CVEs following ABC exposure in a clinical trial population. Modifiable risk factors for MI and CVEs should be addressed when prescribing ART.
Ethics of Radiological Protection—recent developments
Authors: Zölzer F
Published: April 2018

The International Commission on Radiological Protection (ICRP) has recently reviewed the ethical foundations of its recommendations. The approach taken in its report is similar to principlism, i.e. the system of Beauchamp and Childress proposed in their ‘Principles of Biomedical Ethics.’ The commission identifies a number of ‘core values’ which have helped shape the evolution of the ICRP system of radiological protection, namely ‘Beneficence and non-maleficence’, ‘Prudence’, ‘Justice’ and ‘Dignity’. In addition, ‘procedural values’ are cited that are important for the system’s applications in practice, ‘Accountability’, ‘Transparency’ and ‘Inclusiveness (Stakeholder Participation)’. It is emphasized that these values are common to or at least acceptable for people from different cultural backgrounds, which for an endeavour as global in nature as radiological protection seems to be quite important and appropriate. Thus, the ICRP document on ‘Ethics of radiological protection’ could set a standard for other areas.
Practice Makes Perfect: Integrating Technology to Teach Language Barrier Solutions
Authors: Pavill Brenda
Published: April 2018

This article highlights how academia and industry leaders in health care communication can partner to provide students practice caring for individuals who are limited English proficient and how such practice opportunities can be integrated into academic programs. Highlighted are key elements to consider when partnering with industry leaders to develop a program for students. A course exemplar provides a comprehensive description of a practice exercise integrated in a nursing physical assessment course. Students obtain hands-on experiences caring for limited English proficient standardized patients using state-of-the-art digital video interpreting technology.
Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients*
Authors: Preiser Jean-Charles , Lheureux Olivier , Thooft Aurelie , Brimioulle Serge , Goldstein Jacques , Vincent Jean-Louis
Published: April 2018

Objectives:

Tight glycemic control using intermittent blood glucose measurements is associated with a risk of hypoglycemia. Glucose concentrations can now be measured near continuously (every 5–15 min). We assessed the quality and safety of glycemic control guided by a near-continuous glucose monitoring system in ICU patients.

Design:

Prospective, cluster-randomized, crossover study.

Setting:

Thirty-five–bed medico-surgical department of intensive care with four separate ICUs.

Patients:

Adult patients admitted to the department and expected to stay for at least 3 days were considered for inclusion if they had persistent hyperglycemia (blood glucose > 150 mg/dL) up to 6 hours after admission and/or were receiving insulin therapy.

Interventions:

A peripheral venous catheter was inserted in all patients and connected to a continuous glucose monitoring sensor (GlucoClear; Edwards Lifesciences, Irvine, CA). The four ICUs were randomized in pairs in a crossover design to glycemic control using unblinded or blinded continuous glucose monitoring monitors. The insulin infusion rate was adjusted to keep blood glucose between 90 and 150 mg/dL using the blood glucose values displayed on the continuous glucose monitor (continuous glucose monitoring group—unblinded units) or according to intermittent blood glucose readings (intermittent glucose monitoring group—blinded units).

Measurements and Main Results:

The quality and safety of glycemic control were assessed using the proportion of time in range, the frequency of blood glucose less than 70 mg/dL, and the time spent with blood glucose less than 70 mg/dL (TB70), using blood glucose values measured by the continuous glucose monitoring device. Seventy-seven patients were enrolled: 39 in the continuous glucose monitoring group and 38 in the intermittent glucose monitoring group. A total of 43,107 blood glucose values were recorded. The time in range was similar in the two groups. The incidence of hypoglycemia (8/39 [20.5%] vs 15/38 [39.5%]) and the TB70 (0.4% ± 0.9% vs 1.6% ± 3.4%; p < 0.05) was lower in the continuous glucose monitoring than in the intermittent glucose monitoring group.

Conclusions:

Use of a continuous glucose monitoring–based strategy decreased the incidence and severity of hypoglycemia, thus improving the safety of glycemic control.
Prepectoral Versus Subpectoral Tissue Expander Placement: A Clinical and Quality of Life Outcomes Study
Authors: Walia Gurjot S. , Aston Jeffrey , Bello Ricardo , Mackert Gina A. , Pedreira Rachel A. , Cho Brian H. , Carl Hannah M. , Rada Erin M. , Rosson Gedge D. , Sacks Justin M.
Published: April 2018

Background:

Traditionally, tissue expanders (TEs) for breast reconstruction have been placed beneath the pectoralis major muscle with or without acellular dermal matrix. More recently, full acellular dermal matrix coverage has been described for prepectoral TE placement. Our study aims to explore differences in clinical and quality-of-life (QOL) outcomes for prepectoral versus subpectoral TE breast reconstruction.

Methods:

We identified patients who underwent postmastectomy breast reconstruction with prepectoral or subpectoral TE placement between 2011 and 2015 and completed QOL surveys. Primary outcomes were postoperative pain and QOL scores. Secondary outcomes were clinical outcomes. We used Wilcoxon rank-sum test, chi-square test, and linear regression to compare outcomes. Postoperative follow-up for each patient was at least 60 days, except that of pain scores, which were at least 30 days. Mean age was 49 ± 10 years.

Results:

Twenty-six prepectoral TE patients and 109 subpectoral TE patients met inclusion criteria. Pain scores were significantly lower at 12 hours, 1 day, 7 days, and 30 days postoperatively for the prepectoral group, compared with the subpectoral group, even after adjusting for confounding variables [PO12H: Sub-Pectoral (SP) median (interquartile range), 7 (5–8), Pre-Pectoral (PP), 5 (2.5–7.5), P value = 0.004; PO1D: SP, 5 (4–6), PP 3 (2–4), P value = < 0.001; PO7D: SP, 2 (0–4), PP, 0 (0–2), P value = 0.004; PO30D: SP, 0 (0–2), PP, 0 (0–0), P value = 0.039)]. Breast-Q scores were not significantly different between study groups. RAND-36 Physical Health scores were lower among prepectoral TE patients.

Conclusions:

Prepectoral TE breast reconstruction presents an opportunity to improve upon current reconstructive methods and does result in significantly lower pain scores. The associated risks have yet to be fully described and are important considerations, as these prepectoral patients had lower physical health outcome scores.
Identification of a Novel TCF4 Isoform in the Human Corneal Endothelium
Authors: Eghrari Allen O. , Vasanth Shivakumar , Gapsis Briana C. , Bison Henry , Jurkunas Ula , Riazuddin S. Amer , Gottsch John D.
Published: April 2018

Purpose:

Alternative splice isoforms of TCF4, a gene implicated in Fuchs corneal dystrophy, have been identified in multiple human tissues outside of the eye. The aim of this study was to identify the transcriptional profile of TCF4 in the corneal endothelium.

Methods:

We extracted RNA from the donor corneal endothelium and performed rapid amplification of cDNA ends. We tested the expression pattern of 1 newly identified isoform (7b) in a panel of cDNA derived from multiple human tissues and included cDNA from corneal endothelial (CE) and retinal pigment epithelial cell lines. To further delineate differential expression of TCF4 splice variants that span CTG18.1, we analyzed expression of 6 alternative splice isoforms that are transcribed from either exon 2 or 3 in RNA extracted from the corneal endothelium of 3 normal donors and a CE cell line.

Results:

We identified 11 different isoforms in control CE tissue, including 1 isoform (7b) not reported previously. This isoform is enriched specifically in the corneal endothelium and placenta compared with other tissues in a panel of human cDNA.

Conclusions:

We demonstrate the complex expression profile of TCF4 in the human corneal endothelium and reveal expression of alternative splice variants of TCF4.
Thymectomy for Nonthymomatous Myasthenia Gravis
Authors: Bagheri Reza , Boonstani Reza , Sadrizadeh Ali , Salehi Maryam , Afghani Reza , Rahnama Ali , Azmounfar Vahab , Hakimian Saeed , Firoozabadi Mohammad Baradaran
Published: April 2018

Objective

Thymectomy considered as a standard procedure in treatment of all the steps of myasthenia gravis. Video-assisted thoracoscopic surgery (VATS) thymectomy is one of the minimally invasive procedures that because of the short duration of hospitalization, less postoperative pain, and scar after surgery, nowadays it is replaced the traditional methods of surgery for patients with myasthenia gravis, but there are still differences and concerns. The aim of this study was to compare outcomes of two different techniques of surgery, VATS versus transsternal (TS) in the treatment of myasthenia gravis.

Methods

In this pilot study, 42 patients with myasthenia gravis and without a thymus tumor were evaluated based on Myasthenia Gravis Foundation of America classification and drug consumption. Then, they randomly underwent two different techniques of surgery: VATS versus TS. Patients were evaluated based on preoperative and postoperative variables.

Results

Duration of intensive care unit stay and hospitalization has been reduced in patients who underwent VATS thymectomy operation technique. In addition, duration of surgical procedure has been reduced significantly in these patients. These patients have less blood loss during surgery compared with TS group. The Myasthenia Gravis Foundation of America postoperative status in VATS thymectomy revealed that the number of patients with complete stable remission was higher and number of persons remained unchanged was lower in this group.

Conclusions

VATS thymectomy is a safe and appropriate approach comparing with traditional methods such as TS thymectomy for patients with myasthenia gravis. This method has better results after surgery and can be used as a minimally invasive alternative method instead of TS thymectomy.
Surgical Antimicrobial Prophylaxis Among Pediatric Patients in South Africa Comparing Two Healthcare Settings
Authors: van der Sandt Nicolene , Schellack Natalie , Mabope Lindi A. , Mawela Mothahadini P.B. , Kruger Danie , Godman Brian
Published: April 2018

Background:

Appropriate use of surgical antimicrobial prophylaxis (SAP) is a concern in view of its impact on morbidity, mortality and costs. Little is currently known about SAP in South Africa.

Objective:

To assess compliance to SAP guidelines for pediatric patients undergoing surgery in 1 of 4 surgical subspecialties among hospitals in South Africa.

Methods:

An eight-month retrospective chart review in both a teaching hospital and a private hospital between February and August 2015. Prescriptions of antimicrobials as SAP were compared with current SAP Guidelines, consolidated from a literature review, regarding 5 criteria—appropriate antimicrobial selection, dosing, timing of administration, redosing and duration of treatment.

Results:

We reviewed 224 charts, 112 from each hospital type. The majority (P = 1.000) of patients received SAP when indicated (77.3% and 100.0%, respectively, from the teaching and private hospitals). A noteworthy 21.1% and 45.9% of patients received antimicrobials without an indication, respectively, from teaching and private hospitals. Compliance to all 5 of the criteria was not met by either hospital type. Overall, the teaching hospital met the most criteria (3 out of 5) in 58.8% of situations.

Conclusions:

Current SAP practices in South Africa’s teaching and private hospitals diverge from current SAP Guidelines. Inappropriate overuse of SAP occurs in both hospital sectors, while underuse was found in the teaching hospital. Full compliance to the 5 criteria was not met by either hospital. Noncompliance was largely attributed to inappropriate selection and dosing. Quality improvement interventions, continued surveillance and local standardized evidence-based SAP Guidelines are needed to improve care. This is already happening.
Second-trimester Ultrasound and Neuropathologic Findings in Congenital Zika Virus Infection
Authors: Ho Cheng-Ying , Castillo Nicolas , Encinales Liliana , Porras Alexandra , Mendoza Alejandro Rico , Lynch Rebecca , Nemirovsky Amy , Mantus Grace , DeBiasi Roberta L. , Bethony Jeffrey M. , Simon Gary L. , Chang Aileen Y.
Published: April 2018

Zika virus is a mosquito-borne virus that causes congenital Zika syndrome, characterized by microcephaly and other fetal brain anomalies. This case report presents a case of Zika virus–related fetal brain anomalies including pathologic evidence of cerebral neuronal apoptosis and macrophage infiltrates and intracerebral calcification, ventriculomegaly and corpus callosum dysgenesis detected by ultrasound at 18 weeks of pregnancy.
Mu-opioid receptors in nociceptive afferents produce a sustained suppression of hyperalgesia in chronic pain
Authors: Severino Amie , Chen Wenling , Hakimian Joshua K. , Kieffer Brigitte L. , Gaveriaux-Ruff Claire , Walwyn Wendy , Marvizón Juan Carlos G.
Published: April 2018

The latent sensitization model of chronic pain reveals that recovery from some types of long-term hyperalgesia is an altered state in which nociceptive sensitization persists but is suppressed by the ongoing activity of analgesic receptors such as μ-opioid receptors (MORs). To determine whether these MORs are the ones present in nociceptive afferents, we bred mice expressing Cre-recombinase under the Nav1.8 channel promoter (Nav1.8cre) with MOR-floxed mice (flMOR). These Nav1.8cre/flMOR mice had reduced MOR expression in primary afferents, as revealed by quantitative PCR, in situ hybridization, and immunofluorescence colocalization with the neuropeptide calcitonin gene-related peptide. We then studied the recovery from chronic pain of these mice and their flMOR littermates. When Nav1.8cre/flMOR mice were injected in the paw with complete Freund adjuvant they developed mechanical hyperalgesia that persisted for more than 2 months, whereas the responses of flMOR mice returned to baseline after 3 weeks. We then used the inverse agonist naltrexone to assess ongoing MOR activity. Naltrexone produced a robust reinstatement of hyperalgesia in control flMOR mice, but produced no effect in the Nav1.8/flMOR males and a weak reinstatement of hyperalgesia in Nav1.8/flMOR females. Naltrexone also reinstated swelling of the hind paw in flMOR mice and female Nav1.8cre/flMOR mice, but not male Nav1.8cre/flMOR mice. The MOR agonist DAMGO inhibited substance P release in flMOR mice but not Nav1.8cre/flMOR mice, demonstrating a loss of MOR function at the central terminals of primary afferents. We conclude that MORs in nociceptive afferents mediate an ongoing suppression of hyperalgesia to produce remission from chronic pain.
Time to Reconsider the Role of Relative Blood Volume Monitoring for Fluid Management in Hemodialysis
Authors: Keane David F. , Baxter Paul , Lindley Elizabeth , Rhodes Laura , Pavitt Sue
Published: April 2018

Relative blood volume (RBV) monitoring during hemodialysis has been used to help guide fluid management for decades, although with little supporting evidence. The technique relies on the assumption that variation in RBV during fluid removal reflects the capacity for vascular refilling and that efficient refilling is related to fluid overload. This study investigated the relationship between RBV variation and bioimpedance-based fluid overload in 47 patients on stable hemodialysis. Mean treatment ultrafiltration volume (UFV) was 1.7 L and RBV reduction was 3.2%/hour. Relative blood volume slopes were grouped based on trajectory: flatline (no decrease), linear decrease, or linear decrease followed by flatline. Fluid overload was similar (p > 0.05) across groups pre-dialysis (1.0, 2.2, and 1.6 L, respectively) and post-dialysis (−0.8, −0.1, and −0.1 L), whereas UFV was higher in patients with a linear decrease (1.8, 2.5, and 1.6 L; p = 0.02). Specific ultrafiltration rate, but not fluid overload, was associated with RBV change over dialysis. At least half the patients in each group finished dialysis fluid depleted based on bioimpedance, suggesting that the link between refilling and fluid overload is not as straightforward as previously assumed. These results question the assumptions that the absence of an appreciable decrease in RBV indicates fluid overload, and a rapid fall suggests fluid depletion.
Enhancing HIV Pre-exposure Prophylaxis Practices via an Educational Intervention
Authors: Newman Rebecca , Katchi Tasleem , Karass Michael , Gennarelli Melissa , Goutis Jason , Kifayat Alina , Solanki Shantanu , Yandrapalli Srikanth , Forman Leanne , Nabors Christopher
Published: April 2018

Background:

Pre-exposure prophylaxis (PrEP) for HIV involves using antiretroviral drugs to prevent individuals at high risk from acquiring HIV infection. Most practicing primary care providers believe PrEP to be safe and effective, but less than half have prescribed or referred for PrEP. Attitudes and prescribing patterns among house officers have not been well described previously.

Study Question:

Can an educational intervention enhance HIV PrEP practices among internal medicine house officers?

Study Design:

This study relied on a pretest/posttest design. All categorical trainees at a medium-sized internal medicine program were offered a baseline survey to assess their knowledge on PrEP. This was followed by a PrEP-focused educational intervention and a postintervention survey.

Measures and Outcomes:

Likert scales captured perceptions regarding safety, effectiveness, barriers, factors that would promote PrEP use, potential side effects, impact on risk-taking behavior, and provider comfort level in assessing behavioral risks and in PrEP prescribing. Data were analyzed using descriptive statistics, Wilcoxon signed rank test, and the Kruskal–Wallis test. Significance was accepted for P < 0.05.

Results:

Forty-eight (100%) trainees participated in the educational session, 45 (94%) in a preintervention survey, and 36 (75%) in a postintervention survey. Before PrEP training, 22% of respondents were unaware of PrEP, 78% believed PrEP was effective, 66% believed PrEP was safe, 62% had fair or poor awareness of side effects; 18% of residents had referred for or prescribed PrEP, and 31% believed they were likely to prescribe PrEP in the next 6 months. After the intervention, 94% of trainees believed PrEP was effective (P < 0.001), 92% believed PrEP was safe (P < 0.001), and two-thirds believed they were likely to prescribe PrEP in the next 6 months.

Conclusions:

Brief, focused training on HIV prevention promotes awareness, acceptance, and likelihood of prescribing PrEP by internal medicine trainees.
Functional Correlation Between the Pancreas and the Small Intestine in Humans
Authors: Hayashi Daijuro , Hirooka Yoshiki , Kawashima Hiroki , Ohno Eizaburo , Ishikawa Takuya , Kuwahara Takamichi , Kawai Manabu , Yamamura Takeshi , Furukawa Kazuhiro , Funasaka Kohei , Nakamura Masanao , Miyahara Ryoji , Watanabe Osamu , Ishigami Masatoshi , Hashimoto Senju , Goto Hidemi
Published: April 2018

Objectives

The aim of this study is to evaluate a functional correlation between the pancreas and the small intestine and the association of this relationship with nutritional status, using magnifying enteroscopy.

Methods

The subjects were adults aged 20 years or older who underwent upper gastrointestinal endoscopy. An endoscope was inserted into the jejunum, and 10% glucose was sprayed under magnifying observation to evaluate changes in blood flow in the villous capillary network. Mucosal biopsy was performed before and after spraying to evaluate the incretin response in the jejunal mucosa.

Results

A total of 124 patients participated in the study. There was a positive correlation between villous blood flow change and exocrine pancreas function (R = 0.4337, P < 0.0001). Changes of gastric inhibitory polypeptide and glucagon-like peptide messenger RNAs in biopsy samples were positively correlated with endocrine pancreas function in 88 patients without treatment for diabetes (R = 0.4314, P = 0.0012; R = 0.4112, P = 0.0081). In patients with lower villous blood flow change and decreased pancreatic exocrine function, the prognostic nutritional index were significantly lower (P = 0.0098), compared with other patients.

Conclusions

This study provides the first evidence of a close functional correlation between the pancreas and the small intestine.
Acquired Versus Congenital Neonatal Purpura Fulminans: A Case Report and Literature Review
Authors: Findley Tina , Patel Minal , Chapman John , Brown Deborah , Duncan Andrea F.
Published: April 2018

Neonatal purpura fulminans (PF) is a life-threatening disorder caused by congenital or acquired deficiencies of protein C (PC) or S. PF presents as a cutaneous manifestation of disseminated intravascular coagulation. We describe a case of PF in a newborn with left leg ischemia and undetectable PC levels soon after birth. Despite anticoagulation therapy and PC concentrate, left foot amputation was required. Genetic testing of PROC for congenital PC deficiency was normal. This case highlights the course of PF due to acquired PC deficiency in a newborn treated with PC concentrate which is rarely described in the literature.
Kidney-protective Effect of Magnesium Supplementation in Cisplatin-containing Chemotherapy for Pediatric Cancer: A Retrospective Study
Authors: Matsui Motohiro , Saito Yuya , Yamaoka Shoko , Yokokawa Yuichi , Morikawa Yoshihiko , Makimoto Atsushi , Yuza Yuki
Published: April 2018

In total, 158 chemotherapy courses containing cisplatin for 37 pediatric cases of newly diagnosed cancer were divided into 2 groups depending on whether magnesium (Mg) supplementation was administered (Mg+: 92 courses) or not (Mg−: 66 courses). Renal impairment was defined as grade 2 or higher creatinine elevation (CE) after each chemotherapy course. The incidence of CE in the Mg+ was significantly lower than in the Mg− (9.8% vs. 22.7%; P=0.025). Multivariate analysis revealed that Mg supplementation significantly reduced the incidence of CE (odds ratio, 0.36; confidence interval, 0.13-0.99). In pediatric patients, Mg supplementation during cisplatin-containing chemotherapy was associated with less cisplatin-induced nephrotoxicity to prevent cisplatin-induced nephrotoxicity.
A Rare Case of Hemophagocytic Lymphohistiocytosis Associated With Myelodysplastic Syndrome and Trisomy 8 in a Pediatric Patient
Authors: Kim Seh Hyun , Yi Dae Yong , Lee Na Mi , Yun Sin Weon , Chae Soo Ahn , Lim In Seok
Published: April 2018

Hemophagocytic lymphohistiocytosis (HLH) is a rare disease resulting in clinical and biochemical manifestations of extreme inflammation. Myelodysplastic syndrome (MDS) represents a heterogenous group of clonal hematopoietic disorders. The development of MDS is common in children with trisomy of chromosome 8. Here, we report a fatal case of 8-year-old girl who was admitted to the emergency department with status epilepticus, and later diagnosed with HLH associated with MDS and trisomy of chromosome 8. We believe this is the first reported case of HLH associated with MDS and trisomy 8 in a pediatric patient.
A Retrospective Analysis of Sociodemographic and Hematologic Characteristics Associated With Achieving Optimal Hydroxyurea Therapy in Children With Sickle Cell Disease
Authors: George Paul E. , Bazo-Alvarez Juan C. , Sheehan Vivien A.
Published: April 2018

Hydroxyurea (HU) has proven hematologic and clinical benefits, especially when escalated to the maximum tolerated dose (MTD). We reviewed clinical data from patients with sickle cell disease (January 2011 to 2016) to determine baseline sociodemographic and laboratory parameters associated with reaching HU MTD without significant delays. In total, 210 patients (mean HU start age, 6.6 y) were included. Initial Kaplan-Meier event analysis showed 1 year to be an inflection point for reaching MTD. In total, 116 patients (55%) reached MTD in <1 year, with 56 (27%) taking >1 year to reach MTD and 38 (18%) patients not successfully reaching MTD during follow-up. In both crude and adjusted analyses, age at HU start was found to be significantly and inversely associated with reaching MTD within 1 year. The data presented, specifically the inflection point of reaching MTD at 1 year and the association of young HU start age with reaching MTD within a year, suggest that successful achievement of MTD may be facilitated by starting patients on HU at a young age and that older patients should receive additional intervention to attain MTD within 1 year. Patients who do not achieve MTD within a year may need the most extensive intervention.
Magnet® or Pathway® Recognition
Authors: Graystone Rebecca , Pabico Christine
Published: April 2018

The Directors of the Magnet Recognition Program® and Pathway to Excellence® use this column to compare and contrast the 2 programs. Both programs profile nursing excellence.
A Retrospective Study of Non–Ventilator-Associated Hospital Acquired Pneumonia Incidence and Missed Opportunities for Nursing Care
Authors: Tesoro Mary , Peyser Diane J. , Villarente Farley
Published: April 2018

OBJECTIVE

To determine non–ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities.

BACKGROUND

NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention.

METHODS

This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data.

RESULTS

Two hundred five NV-HAP cases occurred in 1 year at Montefiore Medical Center, equating to an incidence of 0.47 per 1000 patient-days and an estimated excess cost of $8.2 million. ICU transfer following pneumonia occurred in 15.6% of cases. Care requirements from specialist nursing facilities increased at discharge (26.8%), as compared with care requirements on admission (17.6%). Complete nursing care documentation was missing for most patients, with oral care undocumented 60.5% of the time.

CONCLUSIONS

Preventable NV-HAP cases and their negative impact on cost and patient outcomes may decrease through improved basic nursing care.