bluuebunny/crossref_metadata_2025 huggingface dataset:
Physiological and comparative genomic analysis of new isolated yeasts Spathaspora sp. JA1 and Meyerozyma caribbica JA9 reveal insights into xylitol production
Authors: Trichez Débora , Steindorff Andrei S , Soares Carlos E V F , Formighieri Eduardo F , Almeida João R M
Published: April 2019

Xylitol is a five-carbon polyol of economic interest that can be produced by microbial xylose reduction from renewable resources. The current study sought to investigate the potential of two yeast strains, isolated from Brazilian Cerrado biome, in the production of xylitol as well as the genomic characteristics that may impact this process. Xylose conversion capacity by the new isolates Spathaspora sp. JA1 and Meyerozyma caribbica JA9 was evaluated and compared with control strains on xylose and sugarcane biomass hydrolysate. Among the evaluated strains, Spathaspora sp. JA1 was the strongest xylitol producer, reaching product yield and productivity as high as 0.74 g/g and 0.20 g/(L.h) on xylose, and 0.58 g/g and 0.44 g/(L.h) on non-detoxified hydrolysate. Genome sequences of Spathaspora sp. JA1 and M. caribbica JA9 were obtained and annotated. Comparative genomic analysis revealed that the predicted xylose metabolic pathway is conserved among the xylitol-producing yeasts Spathaspora sp. JA1, M. caribbica JA9 and Meyerozyma guilliermondii, but not in Spathaspora passalidarum, an efficient ethanol-producing yeast. Xylitol-producing yeasts showed strictly NADPH-dependent xylose reductase and NAD+-dependent xylitol-dehydrogenase activities. This imbalance of cofactors favors the high xylitol yield shown by Spathaspora sp. JA1, which is similar to the most efficient xylitol producers described so far.
Overexpression of endogenous stress-tolerance related genes in Saccharomyces cerevisiae improved strain robustness and production of heterologous cellobiohydrolase
Authors: Lamour Jarryd , Wan Chun , Zhang Mingming , Zhao Xinqing , Den Haan Riaan
Published: April 2019

To enable Saccharomyces cerevisiae to produce renewable fuels from lignocellulose in a consolidated bioprocess, a heterologous cellulase system must be engineered into this yeast. In addition, inherently low secretion titers and sensitivity to adverse environmental conditions must be overcome. Here, two native S. cerevisiae genes related to yeast stress tolerance, YHB1 and SET5, were overexpressed under transcriptional control of the constitutive PGK1 promoter and their effects on heterologous secretion of Talaromyces emersonii cel7A cellobiohydrolase was investigated. Transformants showed increased secreted enzyme activity that ranged from 22% to 55% higher compared to the parental strains and this did not lead to deleterious growth effects. The recombinant strains overexpressing either YHB1 or SET5 also demonstrated multi-tolerant characteristics desirable in bioethanol production, i.e. improved tolerance to osmotic and heat stress. Quantitative reverse transcriptase PCR analysis in these strains showed decreased transcription of secretion pathway genes. However, decreased unfolded protein response was also observed, suggesting novel mechanisms for enhancing enzyme production through stress modulation. Overexpression of YHB1 in an unrelated diploid strain also enhanced stress tolerance and improved ethanol productivity in medium containing acetic acid. To our knowledge, this is the first demonstration that improved heterologous secretion and environmental stress tolerance could be engineered into yeast simultaneously.
A Criterion for Splitting of a Projective Module in Terms of Its Generic Sections
Authors: Kanti Das Mrinal
Published: April 2019

Let $R$ be a smooth affine domain of dimension $d\geq 3$ over $\overline{{\mathbb{F}}}_p$ with $p\neq 2$. Let $P$ be a projective $R$-module of rank $d-1$ with trivial determinant. We prove that $P$ splits off a free summand of rank 1 if and only if $P$ surjects onto a complete intersection ideal of height $d-1$.
Effects of 3-nitrooxypropanol on enteric methane production, rumen fermentation, and feeding behavior in beef cattle fed a high-forage or high-grain diet1
Authors: Kim Seon-Ho , Lee Chanhee , Pechtl Heather A , Hettick Jade M , Campler Magnus R , Pairis-Garcia Monique D , Beauchemin Karen A , Celi Pietro , Duval Stephane M
Published: April 2019

The objective of the study was to determine whether feeding a diet supplemented with 3-nitrooxypropanol (3-NOP) affects feeding behavior altering intake and rumen fermentation. Two experiments were conducted with 9 rumen-cannulated beef steers in a replicated 3 × 3 Latin square design where animals received a high-forage or high-grain diet. Treatments were 1) a basal diet (CON), the CON diet supplemented with 3-NOP (dNOP; 100 mg/kg in dietary DM or 1 g/d), or the CON diet with 3-NOP (1 g/d) infused into the rumen (infNOP). Each experimental period consisted of 14-d diet adaptation and 7-d sample collection. A 7-d washout period was provided between experiment periods. All data were analyzed as a Latin square design using Mixed Procedure of SAS. In Exp. 1 (high-forage diet), methane yield (measured by the Greenfeed system) was lowered by 18% (18.6 vs. 22.7 g/kg DMI; P < 0.01) by dNOP compared with CON. Rumen fermentation was altered similarly by both NOP treatments compared with CON where dNOP and infNOP increased (P < 0.01) rumen pH at 3 h and decreased (P < 0.01) proportion of acetate in total VFA. However, DMI, feed consumption rate (0 to 3, 3 to 6, 6 to 12, and 12 to 24 h after feeding), particle size distribution of orts, and feeding behavior (videotaped for individual animals over 48 h) were not affected by dNOP and infNOP compared with CON. In Exp. 2 (high-grain diet), methane production was not affected by dNOP or infNOP compared with CON. Dry matter intake, feed consumption rate, particle size distribution of orts, and feeding behavior were not altered by dNOP and infNOP compared with CON. However, both dNOP and infNOP affected rumen fermentation where total VFA decreased (P = 0.04) and acetate proportion in total VFA tended to decrease (P = 0.07) compared with CON. In conclusion, dietary supplementation of 3-NOP did not affect feeding behavior of beef steers fed a high-forage or high-grain diet. However, rumen fermentation was similarly changed when 3-NOP was provided in the diet or directly infused in the rumen. Thus, observed changes in rumen fermentation with 3-NOP were not due to changes in feeding behavior indicating no effects on the organoleptic property of the diets. In addition, according to small or no changes in DMI in both experiments and relatively small changes in rumen fermentation in Exp. 2, a greater dosage level of 3-NOP than 100 mg/kg (dietary DM) may need further examination of its effects on feeding behavior of beef cattle.
Supplementation with eicosapentaenoic and docosahexaenoic acids in late gestation in ewes changes adipose tissue gene expression in the ewe and growth and plasma concentration of ghrelin in the offspring1
Authors: Nickles Kirsten R , Hamer Lauren , Coleman Danielle N , Relling Alejandro E
Published: April 2019

Omega-3 long chain fatty acids have a positive impact on production. When consumed during late gestation, it might have fetal programming effects on the fetus, which will have lifelong impacts on development and production. The objectives of the present study were to evaluate the effect of increasing doses of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the diet of ewes in the last third of gestation on their body weight (BW), subcutaneous adipose tissue relative mRNA abundance of genes associated with adipose tissue metabolism, and growth performance and plasma metabolites and hormones of their offspring during the finishing phase. Ewes (n = 72) were blocked by BW and allotted to pens (8 per treatment) with 3 ewes per pen. Ewes were supplemented with an EPA and DHA source (Strata G113) at concentrations of 0, 1, or 2% of dry matter intake during the last 50 d of gestation. At lambing, all ewes were penned together and offered the same diet. After weaning at 60 d of age, lambs were blocked by BW and sex and fed for 56 d. All lambs were fed the same pellet diet (61.09% ground corn, 24.08% soy hulls, 11.09% soybean meal, 1.48% Ca salt of palm oil, and 2.26% mixed mineral vitamin), and were weighed every 14 d until the end of the trial. Blood samples were collected on the weight sampling days. Dry matter intake and refusals were weighed daily. Data were analyzed as a randomized complete block design with repeated measurements (SAS 9.4). Polynomial contrast (linear-L and quadratic-Q) was used for mean separation. There were no differences in ewe body condition score, milk production, milk fat, or milk protein, but there was a trend for increased (L, P = 0.06) lactose concentration, and also differences in DGAT1 (L, P = 0.04), Δ5-desaturase (Q, P = 0.06) and Δ6-desaturase (Q, P = 0.07), PPARα (Q, P = 0.03), ELOVL2 and 5 (Q, P < 0.07), FABP4 (Q, P = 0.04), FATP1 (Q, P = 0.06), leptin (Q, P = 0.02), and resistin (L, P = 0.05). Feeding pregnant ewes an increased amount of EPA and DHA in late gestation increased final BW (L, P = 0.01), ADG (L, P = 0.04; Q, P = 0.01), DMI (Q, P ≤ 0.01), plasma glucose concentration (L, P = 0.04), and trended to decrease ghrelin concentrations (L, P = 0.07) in offspring during the finishing period. Dam supplementation did not affect G:F, nor plasma NEFA concentration (P ≥ 0.53) of lambs. Therefore, increasing supplementation of EPA and DHA in pregnant ewes has an impact on offspring performance, increasing DMI, ADG, and BW.
Contact Chemosensory Genes Identified in Leg Transcriptome of Apis cerana cerana (Hymenoptera: Apidae)
Authors: Du Yali , Xu Kai , Ma Weihua , Su Wenting , Tai Miaomiao , Zhao Huiting , Jiang Yusuo , Li Xianchun
Published: April 2019

Correct gustatory recognition and selection of foods both within and outside the hive by honey bee workers are fundamental to the maintenance of colonies. The tarsal chemosensilla located on the legs of workers are sensitive to nonvolatile compounds and proposed to be involved in gustatory detection. However, little is known about the molecular mechanisms underlying the gustatory recognition of foods in honey bees. In the present study, RNA-seq was performed with RNA samples extracted from the legs of 1-, 10-, and 20-d-old workers of Apis cerana cerana Fabricius, a dominant indigenous crop pollinator with a keen perception ability for phytochemicals. A total of 124 candidate chemosensory proteins (CSPs), including 15 odorant-binding proteins (OBPs), 5 CSPs, 7 gustatory receptors (GRs), 2 sensory neuron membrane proteins (SNMPs), and 95 odorant receptors (ORs), were identified from the assembled leg transcriptome. In silico analysis of expression showed that 36 of them were differentially expressed among the three different ages of A. c. cerana workers. Overall, the genes encoding OBPs and CSPs had great but extremely variable FPKM values and thus were highly expressed in the legs of workers, whereas the genes encoding ORs, GRs, and SNMPs (except SNMP2) were expressed at low levels. Tissue-specific expression patterns indicated that two upregulated genes, AcerOBP15 and AcerCSP3, were predominately expressed in the legs of 20-d-old foragers, suggesting they may play an essential role in gustatory recognition and selection of plant nectars and pollens. This study lays a foundation for further research on the feeding preferences of honey bees.
Integration of Common Factors and Specific Ingredients
Authors: Wampold Bruce E. , Ulvenes Pål G.
Published: April 2019

This chapter presents the theoretical framework and research evidence of the contextual model, which integrates common factors and specific ingredients in psychotherapy. In working with clients, the specific ingredients and common factors of various therapy approaches are not mutually exclusive but work together to make psychotherapy effective. The benefits of psychotherapy accrue through three pathways: the real relationship, expectations created through explanation for distress and a cogent treatment plan, and the specific actions enacted in treatment. It is suggested that the outcome of psychotherapy can be improved by the deliberate practice of particular skills that characterize effective therapists. The chapter concludes with case examples, diversity considerations, and future directions.
The Transtheoretical Approach
Authors: Prochaska James O. , DiClemente Carlo C.
Published: April 2019

The transtheoretical model outlines important dimensions of intentional behavior change from an integrative perspective. Stages describe the motivational and temporal dimension and the critical multidimensional tasks involved in creating sustained change. Processes are an eclectic set of cognitive/experiential and behavioral coping activities that act as mechanisms or engines of change that drive completion of stage tasks. The chapter summarizes the origins of the approach, its applicability and structure, therapeutic relationship, and diversity considerations. A case example illustrates its assessment and treatment foundations. The transtheoretical approach has demonstrated utility in tailoring treatment and predicting outcomes across a variety of health, mental health, and addictive behaviors.
Cyclical Psychodynamics and Integrative Relational Psychotherapy
Authors: Wachtel Paul L. , Gagnon Gregory J.
Published: April 2019

This chapter covers an integrative psychotherapy known as cyclical psychodynamics and features its origins, applicability, assessment, treatment, therapy relationship, case example, outcome research, and future directions. Cyclical psychodynamics is an approach to theory and therapy that centers on the repetitive interaction cycles that maintain adaptive and maladaptive patterns of living. Employing concepts and methods from psychodynamic, behavioral, cognitive-behavioral, systemic, and humanistic-experiential perspectives, the aim is to interrupt these cycles to enable the person not only to be relieved of distressing symptoms but to live more fully and richly. A key focus is on how the person unwittingly recruits “accomplices” in the maintenance of the pattern through the behaviors his actions evoke in others. Also central is attention to the ways that early attachment experiences lead some of our thoughts, wishes, and feelings to be cast into the background, rendered difficult to access consciously or to draw upon adaptively in one’s life. The therapy proceeds integratively, attending both to the expansion of subjective experience and to more adaptive daily behavior, as well as to how each promotes the other.
A New Hoccleve Literary Manuscript: The Trilingual Miscellany in London, British Library, MS Harley 219
Authors: Schieberle Misty
Published: April 2019

This essay identifies a hand which copies and corrects much of the literary manuscript, London, British Library, MS Harley 219, as that of Thomas Hoccleve. Texts in Hoccleve’s handwriting include selections from Odo of Cheriton’s Fables and the Gesta Romanorum (a source for the Series), all of a unique copy of Christine de Pizan’s Epistre Othea, and a glossary of French terms translated into Latin and English. Additionally, Hoccleve’s handwriting can be found in corrections to a French Secretum Secretorum (a source for The Regiment of Princes) that is otherwise copied in another hand. This essay offers preliminary observations on the literary implications of these identifications and attempts to situate these texts within Hoccleve’s career as a clerk and poet.
Effects of Vasopressors on Cerebral Circulation and Oxygenation: A Narrative Review of Pharmacodynamics in Health and Traumatic Brain Injury
Authors: Thorup Line , Koch Klaus U. , Upton Richard N. , Østergaard Leif , Rasmussen Mads
Published: April 2019

The clinical use of vasoactive drugs aims to improve hemodynamic variables and thereby maintain or restore adequate perfusion and oxygenation in accordance with metabolic demands. A main focus in the management of patients with brain pathology during surgery and neurointensive care is restoring and/or maintaining adequate cerebral perfusion pressure in order to ensure cerebral blood flow in accordance with metabolic demands. One commonly used clinical strategy is the administration of vasoactive drugs aiming to increase mean arterial blood pressure and thereby cerebral perfusion pressure. Here, we first describe the anatomic and physiological basis for the cerebrovascular effects of vasopressor agents. Next, we review the pharmacodynamics of commonly used vasopressors under normal circumstances and in the presence of head injury. We further discuss the role of blood-brain barrier disruption and microvascular dysfunction with regard to the effects of the reviewed vasopressor agents.
Hypotension and Hypocapnia During General Anesthesia in Piglets: Study of S100b as an Acute Biomarker for Cerebral Tissue Injury
Authors: Clausen Nicola G. , Antonsen Steen , Spielmann Nelly , Hansen Tom G. , Weiss Markus , Ringer Simone K.
Published: April 2019

Background:

Hypotension and/or hypocapnia might increase general anesthesia (GA)-related neuromorbidity in infants, but safe levels of perioperative blood pressure are poorly defined. Serum protein S100b has been used as screening, monitoring, and prediction tool in the management of patients with traumatic brain injury. Using an animal model, we investigated serum S100b as an acute biomarker of cerebral hypoperfusion and cerebral cell dysfunction during hypotension, hypocapnia, or combined hypotension/hypocapnia during GA.

Methods:

Fifty-seven sevoflurane-midazolam anesthetized piglets aged 4 to 6 weeks were randomly allocated to control (n=9), hypotension (n=18), hypocapnia (n=20), or combined hypotension and hypocapnia (n=10). Hypotension (target mean arterial blood pressure: 35 to 38 or 27 to 30 mm Hg) was induced by blood withdrawal and nitroprusside infusion, and hypocapnia by hyperventilation (target PaCO2: 28 to 30 and 23 to 25 mm Hg). Serum S100b and albumin were measured at baseline, before and 60 minutes after the interventions, and following 60-minute recovery.

Results:

Serum S100b concentrations decreased over time (P=0.001), but there was no difference in S100b between control piglets and those exposed to hypotension, hypocapnea, or a combination of the both (P=0.105). Albumin decreased in all 4 groups (P=0.001).

Conclusion:

S100b did not increase following 60 minutes of systemic hypotension and/or hypocapnia during GA in piglets. In this setting, the use of S100b as a biomarker of cerebral cell tissue dysfunction cannot be supported.
Effects of an Implementation Intervention to Promote Use of Patient-Reported Outcome Measures on Clinicians' Perceptions of Evidence-Based Practice, Implementation Leadership, and Team Functioning
Authors: Heinemann Allen W. , Nitsch Kristian P. , Ehrlich-Jones Linda , Malamut Leah , Semik Patrick , Srdanovic Nina , Kocherginsky Masha , Hobbs Sara
Published: April 2019

Introduction:

Patient-reported outcome measures (PROMs) are administered rarely during rehabilitation hospitalizations because clinicians are unfamiliar with their use and the technology to integrate PROMs into electronic medical records is nascent. This study evaluated an implementation intervention that targeted teams' perceptions of evidence-based practice (EBP), implementation leadership, and team functioning that might facilitate PROM use.

Methods:

We compared clinicians' perceptions on three inpatient rehabilitation units, with sequential implementation across units. Clinicians completed the EBP Attitudes Scale, Implementation Leadership Scale, and the Team Functioning Survey before, shortly after, and 1 month after training.

Results:

Forty-seven clinicians participated, including nurses (27.7%), occupational (21.3%) and physical therapists (21.3%), and two physicians. They worked on spinal cord injury (46.8%), neurologic (40.4%), or pediatric (12.8%) units. EBP Attitude Scale scores improved from preintervention to postintervention and remained above baseline levels at follow-up. The interaction between time and unit was statistically significant for the Divergence subscale such that Pediatric Unit scores increased from preintervention to postintervention and follow-up, while on the spinal cord injury, unit scores increased from preintervention to postintervention, and on the Neurologic Unit scores declined from preintervention to postintervention and follow-up. The EBP Attitudes Requirements score increased at postintervention and follow-up. The Implementation Leadership Scale Proactive score and team functioning survey scores decreased slightly.

Discussion:

Implementing PROMs had varied effects on EBP attitudes and perceptions of leadership and team functioning. Perceptions across units were distinctive on the Evidence-Based Practice Attitudes Scale Divergence subscale. Introduction of PROMs should consider clinician attitudes regarding EBP as well as implementation leadership and team functioning.
Histopathological and Immunohistochemical Characteristics of Measles Exanthema: A Study of a Series of 13 Adult Cases and Review of the Literature
Authors: Liersch Julia , Omaj Rizan , Schaller Jörg
Published: April 2019

Despite available vaccination, measles is one of the leading causes of death among young children in developing countries. In clinical practice, the spectrum of differential diagnoses of morbilliform exanthemas associated with fever is wide, and it can be hard to differentiate from other infectious eruptions, especially in adults or in atypical courses in immunocompromised patients. The goal of our study was to identify characteristic histomorphological and immunohistochemical patterns of measles exanthema through the study of 13 skin biopsy specimens obtained from 13 patients with this disease and a review of cases in the literature. Histopathological features of measles exanthema are quite distinctive and characterized by a combination of multinucleated keratinocytes, and individual and clustered necrotic keratinocytes in the epidermis with pronounced folliculosebaceous as well as acrosyringeal involvement. Immunohistochemical staining of skin biopsies with anti-measles virus (MeV) nucleoprotein and anti-MeV phosphoprotein can be of great value in confirming the diagnosis of measles. Both methods can serve as quick additional diagnostic tools for prompt implementation of quarantine measures and for providing medical assistance, even in patients in whom the clinician did not consider measles as a differential diagnosis of the rash due to the rarity of the disease in a putatively vaccinated community.
On the Assessment of Human Exposure to Electromagnetic Fields Transmitted by 5G NR Base Stations
Authors: Keller Helmut
Published: April 2019

The fifth-generation new radio cellular network will be rolled out within the next few years. Several assessment methods of human exposure to electromagnetic fields transmitted by fifth-generation new radio base stations are discussed. Currently no method exists that allows extrapolation to the maximum theoretical exposure. Thus two new extrapolation methods are proposed. A 95th percentile exposure can be derived from the maximum theoretical exposure by an agreed-upon reduction factor if a more realistic exposure assessment is required.
Assessment of neurocognitive function after cardiac arrest
Authors: Blennow Nordström Erik , Lilja Gisela
Published: April 2019

Purpose of review

Impaired neurocognitive function is common in cardiac arrest survivors and the use of specific neurocognitive assessments are recommended in both clinical trials and daily practice. This review examines the most recent evidence to guide in the selection of neurocognitive outcome assessment tools after cardiac arrest.

Recent findings

Neurocognitive impairment after cardiac arrest was recently reported as one of the major predictors for societal participation, highlighting the need for neurocognitive assessments. A subjective report is a simple method to screen for cognitive problems, but divergent findings were reported when comparing with objective measures. A standardized observer report may be useful for cognitive screening postcardiac arrest. The Montreal Cognitive Assessment (MoCA) was recommended for cognitive screening after cardiac arrest. Detailed neurocognitive assessments were reported as valuable for in-depth evaluation of patients in interventional studies. The best time-point for neurocognitive assessments remains unknown. Recent findings report that most neurocognitive recovery is seen within the first months after cardiac arrest, with some improvement also noted between 3 and 12 months postcardiac arrest.

Neurocognitive assessments after cardiac arrest are important and the approach should differ depending on the clinical situation. Large, prospective, well designed studies, to guide the selection of neurocognitive assessments after cardiac arrest, are urgently needed.
Out-of-hospital cardiac arrest survivors need both cardiological and neurological rehabilitation!
Authors: Boyce Liesbeth W. , Goossens Paulien H. , Moulaert Véronique R. , Pound Gemma , van Heugten Caroline M.
Published: April 2019

Purpose of review

Most survivors of out-of-hospital cardiac arrest (OHCA) suffer from cardiologic symptoms and approximately half of them experience cognitive problems because of hypoxic brain damage. Symptoms of anxiety and depression are also common. This review aims to give an overview of recent literature on rehabilitation treatment aiming at improvement of quality of life after OHCA.

Recent findings

Existing cognitive screening tools are now validated for OHCA survivors. OHCA patients with cognitive deficits may have lower exercise capacity. Cardiac rehabilitation seems to be well tolerated for OHCA survivors, with outcomes comparable to myocardial infarction patients. Many caregivers suffer from posttraumatic stress disorder and emotional stress. Interventions for them are available. Implementation of integrated programs covering both cognitive and cardiac rehabilitation is hampered by lack of knowledge and organizational barriers.

OHCA survivors should be routinely screened for cognitive and emotional problems. When patients with mild cognitive deficits participate in cardiac rehabilitation, their program should be adjusted to their cognitive abilities. For patients with severe cognitive or emotional problems, individualized rehabilitation seems favorable. Integrated rehabilitation treatment between cardiac and cognitive rehabilitation departments is recommended. Attention should be paid to the burden of caregivers.
Functional connectivity in multiple sclerosis after robotic rehabilitative treatment
Authors: Bonanno Lilla , Russo Margherita , Bramanti Alessia , Calabrò Rocco Salvatore , Marino Silvia
Published: April 2019

Rationale:

Multiple sclerosis (MS) is an inflammatory demyelinating disease of central nervous system and it is associated with an impaired motor function status. The efficacy of rehabilitation in promoting functional recovery and increasing quality of life in MS patients has been demonstrated.

Patient concerns:

A 47-year-old woman was diagnosed with relapsing-remitting multiple sclerosis (RRMS) in November 2014 because of left upper limb hypoesthesia and weakness with difficulty in hand manipulation skills (there was a 1-point Expanded Disability Status Scale (EDSS) progression, i.e., 2.5 vs 1.5). Magnetic resonance image (MRI) showed a new frontal right cortical high-signal-intensity lesion.

Diagnosis:

Neurological and MRI examination were suggestive of MS diagnosis.

Interventions:

Patient was treated with robotic rehabilitation and evaluated by a Glove Analyzer for fMRI system (GAF). Functional MRI (fMRI) was acquired before and at the end of rehabilitative treatment performed with robotic device (Armeo-power).

Outcomes:

At the end of the rehabilitation program, most of the behavioral parameters, GAF and fMRI evaluation, showed a significative improvement. Moreover, fMRI showed a significantly increased functional activation within the sensory-motor network in the active, motor task.

Lessons:

Our findings suggest a possible restorative effect of robotics on brain networks. Moreover, we may argue that GAF may be a valuable tool in assessing functional recovery after upper limb rehabilitation, especially of associated to fMRI examination.
Statins improve the long-term prognosis in patients who have survived sepsis
Authors: Hu Sung-Yuan , Hsieh Ming-Shun , Lin Tzu-Chieh , Liao Shu-Hui , Hsieh Vivian Chia-Rong , Chiang Jen-Huai , Chang Yan-Zin
Published: April 2019

Most patients diagnosed with sepsis died during their first episode, with the long-term survival rate upon post-sepsis discharge being low. Major adverse cardiovascular events and recurrent infections were regarded as the major causes of death. No definite medications had proven to be effective in improving the long-term prognosis. We aimed to examine the benefits of statins on the long-term prognosis of patients who had survived sepsis.

Between 1999 and 2013, a total of 220,082 patients who had been hospitalized due to the first episode of sepsis were included, with 134,448 (61.09%) of them surviving to discharge. The surviving patients who were subsequently prescribed statins at a concentration of more than 30 cumulative Defined Daily Doses (cDDDs) during post-sepsis discharge were defined as the users of statin.

After a propensity score matching ratio of 1:5, a total of 7356 and 36,780 surviving patients were retrieved for the study (statin users) and comparison cohort (nonstatin users), respectively. The main outcome was to determine the long-term survival rate during post-sepsis discharge.

HR with 95% CI was calculated using the Cox regression model to evaluate the effectiveness of statins, with further stratification analyses according to cDDDs.

The users of statins had an adjusted HR of 0.29 (95% CI, 0.27–0.31) in their long-term mortality rate when compared with the comparison cohort. For the users of statins with cDDDs of 30–180, 180–365, and >365, the adjusted HRs were 0.32, 0.22, and 0.16, respectively, (95% CI, 0.30–0.34, 0.19–0.26, and 0.12–0.23, respectively), as compared with the nonstatins users (defined as the use of statins <30 cDDDs during post-sepsis discharge), with the P for trend <.0001. In the sensitivity analysis, after excluding the surviving patients who had died between 3 and 6 months after post-sepsis discharge, the adjusted HR for the users of statins remained significant (0.35, 95% CI 0.32–0.37 and 0.42, 95% CI 0.39–0.45, respectively).

Statins may have the potential to decrease the long-term mortality of patients who have survived sepsis. However, more evidence, including clinical and laboratory data, is necessary in order to confirm the results of this observational cohort study.

Trial registration: CMUH104-REC2-115.
Risk factors for graft failure after penetrating keratoplasty
Authors: Barraquer Rafael Ignacio , Pareja-Aricò Luis , Gómez-Benlloch Alba , Michael Ralph
Published: April 2019

The objective of our study was to define principal risk factors for graft failure in patients who underwent penetrating keratoplasty (PK).

Retrospective data obtained from a cohort of 895 penetrating keratoplasties performed between 2001 and 2006 were analysed. Recipient related factors, graft characteristics, and surgical technique were assessed in a univariate analysis and with a multivariate proportional hazard model to detect principal risk factors for definitive graft failure.

Multivariate analysis showed clear significance for diagnosis and number of previous grafts and border line significance for the oldest donor age group. Patients with keratoconus had the best 10-year survival estimate (95%), followed by endothelial and stromal dystrophies (both 55%), infectious leukomas (49%), trauma (33%) and chemical burns (14%). Primary PK grafts had a survival rate of 81%, second grafts of 33% and third or more grafts of 16%. Overall 10-year survival estimate based on univariate analysis was found to be 65%.

In conclusion, we found that primary diagnosis and previous graft failures in the recipient are the most important risk factors of graft failure after a PK.
Meta-analysis of macrolide maintenance therapy for prevention of disease exacerbations in patients with noncystic fibrosis bronchiectasis
Authors: Wang Donghai , Fu Wenlong , Dai Jihong
Published: April 2019

Background:

Macrolide maintenance treatment remains controversial for patients with noncystic fibrosis (non-CF) bronchiectasis, we performed a meta-analysis to estimate the benefits and safety of macrolides therapy in adults and children with non-CF bronchiectasis.

Methods:

PubMed, Embase, the Cochrane Library, and Web of Science databases were searched for all the randomized controlled trials of macrolides for treating non-CF bronchiectasis. The primary outcome was improvement of bronchiectasis exacerbations. Secondary outcomes included adverse events and macrolide resistance.

Results:

A total of 10 studies involving 602 patients were included in the analysis. Pooled results showed that macrolide therapy significantly reduced the number of patients who suffered from exacerbations (RR = 1.56, 95% CI = 1.14–2.14,P = .006,I2 = 72%), number of patients who experienced at least 3 exacerbations (RR = 0.55, 95% CI = 0.39–0.77,P = .0005,I2 = 40%), average exacerbations per patient during the observation time (SMD = −0.69, 95% CI = −1.06 to −0.32,P = .0002,I2 = 60%), and bronchiectasis exacerbation-related admissions (RR = 0.46, 95% CI = 0.23–0.96,P = .04,I2 = 0%). Specified subgroup analyses of the number of patients free from exacerbations were further performed; macrolide therapy showed a significant benefit in both children (RR 5.03, 95% CI 2.02–12.50,P = .0005,I2 = 45%) and adults (RR = 1.66, 95% CI = 1.37–2.02,P < .00001,I2 = 79%); azithromycin showed a significant reduction on the number of patients who suffered from exacerbations (RR = 2.25, 95% CI = 1.67–3.02,P < .00001,I2 = 0%), was different from erythromycin (RR = 1.33, 95% CI = 0.92–1.94,P = .13,I2 = 0%) and roxithromycin (RR = 1.14, 95% CI = 0.97–1.35,P = .11,I2 = 0%). The pooled results also showed no higher risk of adverse events (RR = 0.98, 95% CI = 0.85–1.13,P = .80,I2 = 8%), even a lower risk of severe adverse events (RR = 0.53, 95% CI = 0.33–0.85,P = .009,I2 = 0%). However, a higher risk of macrolide resistance (RR = 3.59, 95% CI 2.6–4.96,P < .00001,I2 = 0%) was observed.

Conclusion:

For both children and adults with non-CF bronchiectasis, macrolide maintenance therapy can effectively reduce bronchiectasis exacerbations, especially for patients with more frequent exacerbations and needing hospital treatment. Azithromycin was more effective than other macrolides. Macrolide maintenance therapy did not increase the risk of adverse events, but may increase the risk of macrolide resistance.
Glycogenic hepatopathy as an unusual etiology of deranged liver function in a patient with type 1 diabetes
Authors: Lui David TW , Woo Yu-Cho , Chow Wing-Sun , Lee Chi-Ho , Lee Alan CH , Leung Eunice KH , Tan Kathryn CB , Lam Karen SL , Lam Joanne KY
Published: April 2019

Rationale:

Deranged liver function is a common finding among patients with diabetes mellitus. We report a case of liver biopsy-proven glycogenic hepatopathy (GH) in a patient with long-standing poorly controlled type 1 diabetes (DM1), presented with recurrent transaminitis.

Patient concerns:

A 28-year-old Chinese woman was noted to have deranged liver function with transaminases elevated to more than 15 times the upper limit of normal.

Diagnosis:

She had underlying long-standing poorly controlled DM1. Blood tests including hepatitis serology and autoimmune panel were negative. Liver biopsy confirmed the diagnosis of GH, showing an increase in glycogen deposition with intact liver parenchymal architecture, and no inflammation or significant fibrosis.

Interventions:

Her glycemic control was optimized.

Outcomes:

Her transaminase levels normalized upon subsequent follow-up with improved glycemic control.

Lessons:

GH is suspected when transaminase flare occurs in patients with poorly controlled DM1, usually with exaggerated hemoglobin A1c levels, especially after drug-induced, viral, autoimmune and metabolic liver diseases are excluded. The gold standard of diagnosis is liver biopsy. When diagnosis of GH is ascertained, the mainstay of treatment is to optimize glycemic control. Typically, the transaminases may become normal within days to months after improvement of glycemic control. Compared to non-alcoholic fatty liver disease, GH is associated with favorable prognosis and runs a benign course, making this differentiation clinically important.
Evaluation of photodynamic therapy in pericoronitis
Authors: Schalch Tânia Oppido , Palmieri Michelle , Longo Priscila Larcher , Braz-Silva Paulo Henrique , Tortamano Isabel Peixoto , Michel-Crosato Edgard , Mayer Marcia Pinto Alves , Jorge Waldyr Antonio , Bussadori Sandra Kalil , Pavani Christiane , Negreiros Renata Matalon , Horliana Anna Carolina Ratto Tempestini
Published: April 2019

Introduction:

Pericoronitis is a common disease in the eruption phase of third molars, sometimes debilitating, with an impact on the quality of life. The most indicated treatment in the initial phase is the irrigation for cleanliness of the region. In order to reduce the chances of systemic dissemination of the infection and antibiotics use, it is mandatory to test effective treatments in the initial phase of pericoronitis avoiding the evolution of the infectious disease. Photodynamic therapy (PDT) is an interesting alternative because it is an effective antimicrobial treatment that is easy to perform and does not select bacterial resistance. The methylene blue (MB) used in PDT has been studied in an oral formulation, which optimizes the formation of monomers increasing its antimicrobial action.

Objective:

The aim of this study is to evaluate the effectiveness of PDT with MB in an astringent vehicle in pericoronitis on the initial phase in healthy patients through microbiological, clinical, and immune response. The impact of pericoronitis on oral health-related quality of life (OHRQoL) of these patients will also be evaluated.

Method:

In this randomized, controlled, double-blind clinical bioequivalence protocol, 64 healthy patients with pericoronitis will be evaluated. Patients will be randomized into the positive control group (G1) (n = 32): irrigation with sterile saline and PDT (conventional MB at 0.005% concentration and irradiation with low intensity laser λ = 660 nm, 9J per point and radiant exposure of 318 J/cm2), and the experimental group (G2) (n = 32): treatment identical to G1, however, MB will be delivered in a new formulation for oral use. Microbiological analysis will be performed by RT-PCR for the bacterium Tannerella forsythia. Gingival crevicular fluid and saliva will be collected to evaluate cytokines by Luminex assay (Luminex Corporation, Austin, TX). The pain (visual analogue scale), swelling and buccal opening (digital caliper), and OHRQoL will also be evaluated through the OHIP-14 questionnaire. The variables will be evaluated in T1 (baseline), T2 (immediately after PDT), and T3 (4th day after PDT). Registration: clinicaltrials.gov NCT 03576105. Registered in July 2018.
A meta-analysis of laparoscopic surgery versus conventional open surgery in the treatment of colorectal cancer
Authors: Song Xiao-Jun , Liu Zhi-Li , Zeng Rong , Ye Wei , Liu Chang-Wei
Published: April 2019

Background:

This meta-analysis aimed to explore the overall effect and safety of anterior laparoscopic surgery versus conventional open surgery for patients with colorectal cancer based on eligible randomized controlled trials (RCTs), especially the difference in the postoperative incidence of deep venous thrombosis (DVT).

Methods:

PubMed, Cochrane, and Embase were searched based on keywords to identify eligible studies before February 2018. Only RCTs were eligible. We analyzed the main outcomes using the relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI).

Results:

In this meta-analysis, we analyzed a total of 24 studies with 4592 patients in the laparoscopic surgery group and 3865 patients in the open surgery group. The results indicated that compared with the open surgery, laparoscopic surgery significantly decreased estimated blood loss (SMD: −1.14, 95%CI: −1.70 to −0.57), hospital stay (SMD: −1.12, 95%CI: −1.76 to −0.47), postoperative mortality (RR: 0.60, 95%CI: 0.41–0.86) and postoperative complication (RR: 0.83, 95%CI: 0.72–0.95). However, the operative time (WMD: 40.46, 95%CI: 35.94–44.9) was statistically higher in the laparoscopic surgery group than the open surgery group, and there was no significant difference in the incidence of DVT between the 2 groups (RR: 0.96, 95%CI: 0.46–2.02).

Conclusion:

Laparoscopic surgery is superior to open surgery for patients with colorectal cancer. But the 2 surgeries showed no significant difference in the incidence of DVT.
Effects of on-pump versus off-pump coronary artery bypass grafting on myocardial metabolism
Authors: Xie Hong-tao , Kang Xiao-qin , Zhang Shun , Tian Yong-cang , Liu De-jun , Bai Ben-jian
Published: April 2019

Background:

On-pump coronary artery bypass grafting (ON-PCABG) and off-pump coronary artery bypass grafting (OF-PCABG) greatly affect myocardial metabolism (MCMB). However, no study has systematically explored and compared the impacts of ON-PCABG and OF-PCABG on MCMB. This study will aim to explore and to compare the effects of ON-PCABG and OF-PCABG on MCMB systematically.

Methods:

We will conduct the comprehensive literature search from the following electronic databases from inception to the present: Cochrane Library, EMBASE, MEDILINE, CINAHL, AMED and 4 Chinese databases without language restrictions. This systematic review will only concern randomized controlled trials (RCTs) and case-control studies of ON-PCABG and OF-PCABG on MCMB. The methodological quality of each entered study will be assessed by using Cochrane risk of bias tool.

Results:

Primary outcomes include myocardial cellular markers, myocardial lactate, oxygen utilization, pyruvate, and intramyocardial concentrations of glucose, urea and lactate. Secondary outcome comprises of glutathione, superoxide dismutase, myeloperoxidase, and oxidative stress and any other complications post surgery.

Conclusion:

This study will provide a high-quality synthesis and will assess and compare the effects of ON-PCABG and OF-PCABG on MCMB based on the current relevant literature evidence.

Dissemination and ethics:

The results will be submitted to peer-reviewed journals for publication. This study does not require ethic approval, because it only analyzes the data from published literature.

Systematic review registration:

PROSPERO CRD42019125381.
Nationwide epidemiologic study for pediatric osteomyelitis and septic arthritis in South Korea
Authors: Kim Jihye , Lee Min Uk , Kim Tae-Hwan
Published: April 2019

Epidemiologic studies of pediatric bone and joint infection have been done mostly by developed Western countries, and such results could be expected to be biased. Therefore, an epidemiologic study to identify the distinct features of an Eastern country would be beneficial to improve their health outcomes and to reduce health care cost. A study was planned to investigate the epidemiology of pediatric osteomyelitis and septic arthritis in South Korea and to find out epidemiologic factors related with the occurrence of surgery.

We conducted a cross-sectional study among hospitalized pediatric patients (<18 years old) with osteomyelitis and septic arthritis using nationwide cohort based on the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2016. Percentage of hospitalization was additionally calculated according to several epidemiologic factors including age, month, site of infection, and region of residence. Logistic regression analysis was performed to find out the association between epidemiologic factors and occurrence of surgery

Annual hospitalization rates (per 100,000) in our country were 7.8 to 9.1 for osteomyelitis, and 11.9 to 20.8 for septic arthritis. Frequent sites of osteomyelitis and septic arthritis were pelvis and lower extremity. The hospitalization rates of osteomyelitis and septic arthritis showed increasing trend with age. After multivariate logistic regression analysis, female gender, children, and adolescents rather than infants, rural area rather than urban area were associated with significantly increased odd ratios for surgery.

The hospitalization rate of septic arthritis (11.9 to 20.8 per 100,000) in South Korea was higher than the Western countries (1.1 to 11 per 100,000), and the hospitalization rate of osteomyelitis (peak at 12 years) and septic arthritis (peak at 17 years) showed increasing trend with age, which was different from those of the developed Western countries showing higher incidence in children aged under 5 years. After multivariate logistic regression analysis, our study identified female gender, higher age group including children, and adolescents, and rural residence as epidemiologic risk factors associated with surgery.
Cumulative sum analysis of learning curve for video-assisted mini-laparotomy partial nephrectomy in renal cell carcinoma
Authors: Park Jee Soo , Ahn Hyun Kyu , Na Joonchae , Lee Hyung Ho , Yoon Young Eun , Yoon Min Gee , Han Woong Kyu
Published: April 2019

Video-assisted mini-laparotomy surgery (VAMS), a hybrid of open and laparoscopic surgical techniques, is an important surgical approach in the field of partial nephrectomy. The learning curve for VAMS partial nephrectomy has not been studied to date; we therefore, evaluated this learning curve.

We prospectively evaluated 20 consecutive patients who underwent VAMS partial nephrectomy performed by a single surgeon (YEY) between March 2015 and December 2016. The learning curve was evaluated using the cumulative sum method. The measure of surgical performance was composed of 3 parameters (total operation time [Op time], warm ischemic time [WIT], and estimated blood loss [EBL]).

Among the 20 patients who underwent VAMS partial nephrectomy, the mean age was 54.6 years. The mean Op time and WIT were 172.5 and 28.8 minutes, respectively. The learning curve for the Op time, WIT, and EBL consisted of 3 unique phases: phase 1 (the first 7 cases), phase 2 (the next 5 to 7 cases), and phase 3 (all subsequent cases). Phase 1 represents the initial learning curve, and the phase 2 plateau represents the period of expert competency. Phase 3 represents when one is competent in VAMS partial nephrectomy.

The learning curve for VAMS partial nephrectomy is relatively short and after a learning curve of approximately 7 cases, the surgeon became familiar with VAMS partial nephrectomy; after 12 to 14 cases, the surgeon became competent in this procedure.