bluuebunny/crossref_metadata_2025 huggingface dataset:
Reynolds Intellectual Screening Instrument 1st versus 2nd Edition in a Memory Disorder Sample
Authors: Ruchinskas Robert , Goette William
Published: August 2020

Objective

The Reynolds Intellectual Screening Instrument (RIST) and its second edition (RIST-2) are brief intelligence screening instruments that potentially have value in older populations as their norms extend over age 90. This study examined performance on these two instruments in a sample of individuals presenting for evaluation in a memory disorder clinic.

Method

A sample of 1,145 subjects over the age of 50 was chosen from 1,761 consecutive referrals. Individuals who obtained a consensus diagnosis of Mild Cognitive Impairment (MCI; n = 536), possible dementia of the Alzheimer Type (DAT; n = 400), or those with subjective cognitive complaints (SCC; n = 209) and who completed a neuropsychological battery that included either the RIST (n = 747) or the RIST-2 (n = 398) were included in the sample. No clinically significant demographic or neuropsychological performance differences were found for those taking either version of the RIST.

Results

Unlike the original version, RIST-2 Total and subtest scores were well below the mean for the DAT group and over 1 SD mean difference was seen for the DAT group when comparing the RIST and RIST-2 Totals. Diagnostic accuracy calculations suggested that the RIST-2 showed greater discrimination between the three groups although both versions achieved greater sensitivity than specificity.

Conclusions

Performance differences were evident when comparing the RIST and RIST-2, particularly for the DAT group. Although the RIST-2 evidenced greater diagnostic accuracy than its predecessor it should not be utilized in isolation for the clinical determination of DAT or MCI.
FastBMD: an online tool for rapid benchmark dose–response analysis of transcriptomics data
Authors: Ewald Jessica , Soufan Othman , Xia Jianguo , Basu Niladri
Published: August 2020

Motivation

Transcriptomics dose–response analysis is a promising new approach method for toxicity testing. While international regulatory agencies have spent substantial effort establishing a standardized statistical approach, existing software that follows this approach is computationally inefficient and must be locally installed.

Results

FastBMD is a web-based tool that implements standardized methods for transcriptomics benchmark dose–response analysis in R. It is >60 times faster than the current leading software, supports transcriptomics data from 13 species, and offers a comprehensive analytical pipeline that goes from processing and normalization of raw gene expression values to interactive exploration of pathway-level benchmark dose results.

Availability and implementation

FastBMD is freely available at www.fastbmd.ca.

Supplementary information

Supplementary data are available at Bioinformatics online.
A Quest for Indigenising Social Work Services for Disadvantaged Children in Vietnam
Authors: Thai Lan Nguyen Thi
Published: August 2020

This article presents a qualitative study about ways in which social work services for disadvantaged children can be indigenised in a Southeast Asian country. The research employed a multiple case study approach with five selected international organisations. Thirty-nine in-depth interviews, three group discussions combined with document analysis and participant observations being conducted. The findings have showcased Vietnamese social work professionalisation in the process of internationalisation through foreign influences. The study pictures the involvement of international organisations and its relation with local partners in the development of social work services in the local context. Importantly, the findings advocate for the complex process of indigenisation through the application of cultural relevance, contextual appropriateness and localisation of services for local disadvantaged children.
Ultrahigh-resolution MRI Reveals Extensive Cortical Demyelination in a Nonhuman Primate Model of Multiple Sclerosis
Authors: Donadieu Maxime , Kelly Hannah , Szczupak Diego , Lin Jing-Ping , Song Yeajin , Yen Cecil C C , Ye Frank Q , Kolb Hadar , Guy Joseph R , Beck Erin S , Jacobson Steven , Silva Afonso C , Sati Pascal , Reich Daniel S
Published: August 2020

Cortical lesions are a primary driver of disability in multiple sclerosis (MS). However, noninvasive detection of cortical lesions with in vivo magnetic resonance imaging (MRI) remains challenging. Experimental autoimmune encephalomyelitis (EAE) in the common marmoset is a relevant animal model of MS for investigating the pathophysiological mechanisms leading to brain damage. This study aimed to characterize cortical lesions in marmosets with EAE using ultrahigh-field (7 T) MRI and histological analysis. Tissue preparation was optimized to enable the acquisition of high-spatial resolution (50-μm isotropic) T2*-weighted images. A total of 14 animals were scanned in this study, and 70% of the diseased animals presented at least one cortical lesion on postmortem imaging. Cortical lesions identified on MRI were verified with myelin proteolipid protein immunostaining. An optimized T2*-weighted sequence was developed for in vivo imaging and shown to capture 65% of cortical lesions detected postmortem. Immunostaining confirmed extensive demyelination with preserved neuronal somata in several cortical areas of EAE animals. Overall, this study demonstrates the relevance and feasibility of the marmoset EAE model to study cortical lesions, among the most important yet least understood features of MS.
Qualitative and Quantitative Analysis of the New Sulfone Bactericide 2-(4-Fluorophenyl)-5-(Methylsulfonyl)-1,3,4-Oxadiazole and Identification of Its Degradation Pathways in Paddy Water
Authors: Meng Xingang , Wang Niao , Long Xiaofang , Chen Lingzhu , Hu Deyu
Published: August 2020

Rapid and simple methods for the determination of Jiahuangxianjunzuo (JHXJZ) in paddy water, brown rice, soil and rice straw was developed and validated. This method involved the use of ultrahigh-performance liquid chromatography equipped with photodiode array detector. The most important factor was chromatographic conditions, as identified through an orthogonal experimental design. This method showed good recoveries and precisions, thereby indicating its suitability for monitoring of JHXJZ residues in paddy water, brown rice, soil and rice straw. Furthermore, hydrolysis experiment was conducted in the laboratory under pH = 7 buffer solutions, and its degradation product was identified as 2-(4-fluorophenyl)-5-methoxy-1,3,4-oxadiazole by high-resolution mass spectrometry. JHXJZ has a major degradation pathway in the water which the OH− nucleophilic attack the C5 of 1,3,4-oxadiazole ring. Then it leaves mesyl to form intermediate 5-(4-fluorophenyl)-1,3,4-oxadiazol-2-ol and the intermediate combined with methanol formed the degradation product 2-(4-fluorophenyl)-5-methoxy-1,3,4-oxadiazole by the loss of one H2O.The degradation pathways of JHXJZ under the present indoor simulation conditions were proposed.
Human Immunodeficiency Virus (HIV) Infection Is Associated With Lower Risk of Hepatocellular Carcinoma After Sustained Virological Response to Direct-acting Antivirals in Hepatitis C Infected Patients With Advanced Fibrosis
Authors: Corma-Gómez Anaïs , Macías Juan , Lacalle-Remigio Juan Ramón , Téllez Francisco , Morano Luis , Rivero Antonio , Serrano Miriam , Ríos María José , Vera-Méndez Francisco Jesús , Alados Juan Carlos , Real Luis Miguel , Palacios Rosario , Santos Ignacio De Los , Imatz Arkaitz , Pineda Juan Antonio ,   RIS-HEP13 and GEHEP 011 study groups, Merino Dolores , Jose Galindo Maria , Galera Carlos , Ángel López-Ruz Miguel , Geijo Paloma , Javier Reus Bañuls Sergio , Pérez Camacho Inés
Published: August 2020

Background

The aim of this study was to assess the impact of human immunodeficiency virus (HIV) infection on the risk of developing hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV) who achieve sustained virological response (SVR) with direct-acting antiviral (DAA).

Methods

Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: (1) SVR with DAA-based combination; (2) liver stiffness (LS) ≥9.5 kPa previous to treatment; (3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients.

Results

In total, 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1–Q3) follow-up time of 43 (31–49) months, 19 (1.8%) patients developed HCC (11 [3.0%]; HCV-monoinfected, 8[1.2%]; HIV/HCV-coinfected individuals; P = .013). In the multivariable analysis, HIV coinfection was associated with a lower adjusted risk of developing HCC (subhazard ratio [sHR] = 0.27, 95% confidence interval [CI]: .08–.90; P = .034). Predictors of HCC emergence were: HCV genotype 3 (sHR = 7.9, 95% CI: 2.5–24.9; P < .001), MELD score at SVR >10 (sHR = 1.37, 95% CI: 1.01–1.86; P = .043) and LS value at SVR (sHR = 1.03, 95% CI: 1.01–1.06, for 1 kPa increase; P = .011). Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC (powered HR = 0.33, 95% CI: .11–.85).

Conclusions

Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.
Unique Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 Causing a Large Coronavirus Disease 2019 Outbreak in Hong Kong
Authors: To Kelvin Kai-Wang , Chan Wan-Mui , Ip Jonathan Daniel , Chu Allen Wing-Ho , Tam Anthony Raymond , Liu Raymond , Wu Alan Ka-Lun , Lung Kwok-Cheung , Tsang Owen Tak-Yin , Lau Daphne Pui-Ling , To Wing-Kin , Kwan Mike Yat-Wah , Yau Yat-Sun , Ng Anthony Chin-Ki , Yip Cyril Chik-Yan , Chan Kwok-Hung , Tse Herman , Hung Ivan Fan-Ngai , Yuen Kwok-Yung
Published: August 2020

After 2 months of relative quiescence, a large coronavirus disease 2019 outbreak occurred in Hong Kong in July 2020 after gradual relaxation of social distancing policy. Unique severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) phylogenetic clusters have been identified among locally acquired cases, with most genomes belonging to cluster HK1, which is phylogenetically related to SARS-CoV-2 reported overseas.
Fatal Respiratory Diphtheria Caused by ß-Lactam–Resistant Corynebacterium diphtheriae
Authors: Forde Brian M , Henderson Andrew , Playford Elliott G , Looke David , Henderson Belinda C , Watson Catherine , Steen Jason A , Sidjabat Hanna E , Laurie Gordon , Muttaiyah Sharmini , Nimmo Graeme R , Lampe Guy , Smith Helen , Jennison Amy V , McCall Brad , Carroll Heidi , Cooper Matthew A , Paterson David L , Beatson Scott A
Published: August 2020

Background

Diphtheria is a potentially fatal respiratory disease caused by toxigenic Corynebacterium diphtheriae. Although resistance to erythromycin has been recognized, β-lactam resistance in toxigenic diphtheria has not been described. Here, we report a case of fatal respiratory diphtheria caused by toxigenic C. diphtheriae resistant to penicillin and all other β-lactam antibiotics, and describe a novel mechanism of inducible carbapenem resistance associated with the acquisition of a mobile resistance element.

Methods

Long-read whole-genome sequencing was performed using Pacific Biosciences Single Molecule Real-Time sequencing to determine the genome sequence of C. diphtheriae BQ11 and the mechanism of β-lactam resistance. To investigate the phenotypic inducibility of meropenem resistance, short-read sequencing was performed using an Illumina NextSeq500 sequencer on the strain both with and without exposure to meropenem.

Results

BQ11 demonstrated high-level resistance to penicillin (benzylpenicillin minimum inhibitory concentration [MIC] ≥ 256 μg/ml), β-lactam/β-lactamase inhibitors and cephalosporins (amoxicillin/clavulanic acid MIC ≥ 256 μg/mL; ceftriaxone MIC ≥ 8 μg/L). Genomic analysis of BQ11 identified acquisition of a novel transposon carrying the penicillin-binding protein (PBP) Pbp2c, responsible for resistance to penicillin and cephalosporins. When strain BQ11 was exposed to meropenem, selective pressure drove amplification of the transposon in a tandem array and led to a corresponding change from a low-level to a high-level meropenem-resistant phenotype.

Conclusions

We have identified a novel mechanism of inducible antibiotic resistance whereby isolates that appear to be carbapenem susceptible on initial testing can develop in vivo resistance to carbapenems with repeated exposure. This phenomenon could have significant implications for the treatment of C. diphtheriae infection, and may lead to clinical failure.
Differential diagnosis of perinatal Bartter, Bartter and Gitelman syndromes
Authors: Bamgbola Oluwatoyin Fatai , Ahmed Youssef
Published: August 2020

The common finding of hypokalemic alkalosis in several unrelated disorders may confound the early diagnosis of salt-losing tubulopathy (SLT). Antenatal Bartter syndrome (BS) must be considered in idiopathic early-onset polyhydramnios. Fetal megabladder in BS may allow its distinction from third-trimester polyhydramnios that occurs in congenital chloride diarrhea (CCD). Fetal megacolon occurs in CCD while fecal chloride >90 mEq/L in infants is diagnostic. Failure-to-thrive, polydipsia and polyuria in early childhood are the hallmarks of classic BS. Unlike BS, there is low urinary chloride in hypokalemic alkalosis of intractable emesis and cystic fibrosis. Rarely, renal salt wasting may result from cystinosis, Dent disease, disorders of paracellular claudin-10b and Kir4.1 potassium-channel deficiency. Acquired BS may result from calcimimetic up-regulation of a calcium-sensing receptor or autoantibody inactivation of sodium chloride co-transporters in Sjögren syndrome. A relatively common event of heterozygous gene mutations for Gitelman syndrome increases the likelihood of its random occurrence in certain diseases of adult onset. Finally, diuretic abuse is the most common differential diagnosis of SLT. Unlike the persistent elevation in BS, urinary chloride concentration losses waxes and wanes on day-to-day assessment in patients with diuretic misuse.
Related Blogs’ Summarization With Natural Language Processing
Authors: Baliyan Niyati , Sharma Aarti
Published: August 2020

There is plethora of information present on the web, on a given topic, in different forms i.e. blogs, articles, websites, etc. However, not all of the information is useful. Perusing and going through all of the information to get the understanding of the topic is a very tiresome and time-consuming task. Most of the time we end up investing in reading content that we later understand was not of importance to us. Due to the lack of capacity of the human to grasp vast quantities of information, relevant and crisp summaries are always desirable. Therefore, in this paper, we focus on generating a new blog entry containing the summary of multiple blogs on the same topic. Different approaches of clustering, modelling, content generation and summarization are applied to reach the intended goal. This system also eliminates the repetitive content giving savings on time and quantity, thereby making learning more comfortable and effective. Overall, a significant reduction in the number of words in the new blog generated by the system is observed by using the proposed novel methodology.
OCCAM: prediction of small ORFs in bacterial genomes by means of a target-decoy database approach and machine learning techniques
Authors: R. Cerqueira Fabio , Vasconcelos Ana Tereza Ribeiro
Published: August 2020

Small open reading frames (ORFs) have been systematically disregarded by automatic genome annotation. The difficulty in finding patterns in tiny sequences is the main reason that makes small ORFs to be overlooked by computational procedures. However, advances in experimental methods show that small proteins can play vital roles in cellular activities. Hence, it is urgent to make progress in the development of computational approaches to speed up the identification of potential small ORFs. In this work, our focus is on bacterial genomes. We improve a previous approach to identify small ORFs in bacteria. Our method uses machine learning techniques and decoy subject sequences to filter out spurious ORF alignments. We show that an advanced multivariate analysis can be more effective in terms of sensitivity than applying the simplistic and widely used e-value cutoff. This is particularly important in the case of small ORFs for which alignments present higher e-values than usual. Experiments with control datasets show that the machine learning algorithms used in our method to curate significant alignments can achieve average sensitivity and specificity of 97.06% and 99.61%, respectively. Therefore, an important step is provided here toward the construction of more accurate computational tools for the identification of small ORFs in bacteria.
Mucosal Inflammatory and Wound Healing Gene Programmes Reveal Targets for Stricturing Behaviour in Paediatric Crohn’s Disease
Authors: Haberman Yael , Minar Phillip , Karns Rebekah , Dexheimer Phillip J , Ghandikota Sudhir , Tegge Samuel , Shapiro Daniel , Shuler Brianne , Venkateswaran Suresh , Braun Tzipi , Ta Allison , Walters Thomas D , Baldassano Robert N , Noe Joshua D , Rosh Joel , Markowitz James , Dotson Jennifer L , Mack David R , Kellermayer Richard , Griffiths Anne M , Heyman Melvin B , Baker Susan S , Moulton Dedrick , Patel Ashish S , Gulati Ajay S , Steiner Steven J , LeLeiko Neal , Otley Anthony , Oliva-Hemker Maria , Ziring David , Gokhale Ranjana , Kim Sandra , Guthery Stephen L , Cohen Stanley A , Snapper Scott , Aronow Bruce J , Stephens Michael , Gibson Greg , Dillman Jonathan R , Dubinsky Marla , Hyams Jeffrey S , Kugathasan Subra , Jegga Anil G , Denson Lee A
Published: August 2020

Background and Aims

Ileal strictures are the major indication for resective surgery in Crohn’s disease [CD]. We aimed to define ileal gene programmes present at diagnosis and linked with future stricturing behaviour during 5-year follow-up, and to identify potential small molecules to reverse these gene signatures.

Methods

Antimicrobial serologies and pre-treatment ileal gene expression were assessed in a representative subset of 249 CD patients within the RISK multicentre paediatric CD inception cohort study, including 113 that are unique to this report. These data were used to define genes associated with stricturing behaviour and for model testing to predict stricturing behaviour. A bioinformatics approach to define small molecules which may reverse the stricturing gene signature was applied.

Results

A total of 19 of the 249 patients developed isolated B2 stricturing behaviour during follow-up, while 218 remained B1 inflammatory. Using deeper RNA sequencing than in our previous report, we have now defined an inflammatory gene signature including an oncostatin M co-expression signature, tightly associated with extra-cellular matrix [ECM] gene expression, in those who developed stricturing complications. We further computationally prioritise small molecules targeting macrophage and fibroblast activation and angiogenesis which may reverse the stricturing gene signature. A model containing ASCA and CBir1 serologies and a refined eight ECM gene set was significantly associated with stricturing development by Year 5 after diagnosis {AUC (area under the curve) (95th CI [confidence interval]) = 0.82 [0.7–0.94)}.

Conclusions

An ileal gene programme for macrophage and fibroblast activation is linked to stricturing complications in treatment of naïve pediatric CD, and may inform novel small molecule therapeutic approaches.
Native and Edible Ornamental Plant Congeners Enhance Ecosystem Services Through Key Pest Avoidance and Multifunctionality in Residential Landscapes
Authors: Borden Matthew A , Dale Adam G
Published: August 2020

Tea scale, Fiorinia theae Green (Hemiptera: Diaspididae), has long been one of the most important pests of Ilex and Camellia plants, particularly in the southeastern United States. This exotic armored scale insect reduces host plant health and function, and often requires insecticide use, which poses risks to nontarget organisms. While the use of Ilex (Aquifoliales: Aquifoliaceae) and Camellia (Ericales: Theaceae) spp. as landscape ornamentals for aesthetic function is firmly established, we have a poor understanding of species-level susceptibility to F. theae. Additionally, two species, Ilex vomitoria Ait. and Camellia sinensis (L.) O. Kuntze are emerging tisane- and tea-producing commodities in the region, respectively. We propose that these consumable plants may be well-suited alternatives to their traditionally used ornamental congeners in residential landscapes where they may provide enhanced ecosystem services. However, the potential impact of key pests, like F. theae, on these species should be evaluated to anticipate pest pressure that may undermine or offset benefits. In this study, we examine six species within the known host range of tea scale, comparing nonnative I. cornuta Lindl. ‘Dwarf Burford,’ C. japonica L., C. sasanqua Thunb., and C. sinensis, along with native I. opaca Ait. and I. vomitoria. We found that plant species show a wide range of susceptibility to F. theae and associated damage, with the two native Ilex species and tea-producing C. sinensis displaying the least susceptibility. By reducing the impact of a key pest and considering other ecosystem service traits, these results may help guide more sustainable plant selection decisions where the goal is to integrate native and edible plants into residential landscapes.
Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study
Authors: Lin Andrew , Nerlekar Nitesh , Yuvaraj Jeremy , Fernandes Katrina , Jiang Cathy , Nicholls Stephen J , Dey Damini , Wong Dennis T L
Published: August 2020

Aims 

Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD).

Methods and results

Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (−82.3 ± 5.5 HU) compared with patients with stable CAD (−90.6 ± 5.7 HU, P < 0.001) and controls (−95.8 ± 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation.

Conclusion

PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.
Impact of three-dimensional global longitudinal strain for patients with acute myocardial infarction
Authors: Iwahashi Noriaki , Kirigaya Jin , Abe Takeru , Horii Mutsuo , Toya Noriko , Hanajima Yohei , Takahashi Hironori , Akiyama Eiichi , Okada Kozo , Matsuzawa Yasushi , Maejima Nobuhiko , Hibi Kiyoshi , Kosuge Masami , Ebina Toshiaki , Tamura Kouichi , Kimura Kazuo
Published: August 2020

Aims

In patients with ST-segment elevation myocardial infarction (STEMI), predicting left ventricular (LV) remodelling (LVR) and prognosis is important. We explored the clinical usefulness of three-dimensional (3D) speckle-tracking echocardiography to predict LVR and prognosis in STEMI.

Methods and results

The study group comprised 255 first STEMI patients (65 years; 210 men) treated with primary percutaneous coronary intervention between April 2008 and May 2012 at Yokohama City University Medical Center. Baseline global longitudinal strain (GLS) was measured with two-dimensional (2D) and 3D speckle-tracking echocardiography. Within 48 of admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-GLS and 3D-GLS were calculated. Infarct size was estimated by 99mTc-sestamibi single-photon emission computed tomography. Echocardiography was performed at 1 year repeatedly in 239 patients. The primary endpoint was LVR, defined as an increase of 20% of LV end-diastolic volume index and major adverse cardiac and cerebrovascular events (MACE: cardiac death, non-fatal MI, heart failure, and ischaemic stroke) at 1 year, and the secondary endpoint was cardiac death and heart failure. Patients were followed for 1 year; 64, 25, and 16 patients experienced LVR, MACE, and the secondary endpoint, respectively. Multivariate analysis revealed that 3D-GLS was the strongest predictor of LVR (odds ratio = 1.437, 95% CI: 1.047–2.257, P = 0.02), MACE (odds ratio = 1.443, 95% CI: 1.240–1.743, P = 0.0002), and the secondary end point (odds ratio = 1.596, 95% CI: 1.17–1.56, P < 0.0001). Receiver-operating characteristic curve analysis showed that 3D-GLS was superior to 2D-GLS in predicting LVR and 1-year prognosis.

Conclusion

3D-GLS obtained immediately after STEMI is independently associated with LVR and 1-year prognosis.
Midterm complications of ROX arteriovenous coupler device, managed by targeted endovascular repair: a case report
Authors: Sultan Sherif , Mustafa Mohamed K E , Barrett Nora , Hynes Niamh
Published: August 2020

Background 

Resistant and uncontrolled hypertension prominently amplifies the risk of end-stage renal disease and fatal cardiovascular events. Therapeutic inertia, despite maximum tolerated anti-hypertensive medications, puts patients at high risk, thus non-pharmacologic therapies have been proposed. The ROX arteriovenous coupler (ROX, Medical Inc., San Clemente, CA, USA), initially developed for treatment of chronic obstructive pulmonary disease, exploits the biomechanical effects of diverting arterial blood into a low-resistance, high-compliance venous segment, thereby decreasing arterial vascular resistance and blood pressure (BP).

Case summary 

A 76-year-old male, non-smoker and non-diabetic with resistant primary hypertension presented to our institution with disabling claudication, lower limb swelling and right hip pain. He had concomitant saccular abdominal aortic and right iliac aneurysms. He had previously undergone renal denervation on two separate occasions yet continued to require increasing anti-hypertensive medications. He subsequently had an insertion of an ROX coupler device between his right external iliac artery and vein after failure of insertion into his left iliac system. He developed right hip and buttock pain and consequently underwent a total hip replacement and subsequent revision, which did not alleviate his symptoms. Ankle-brachial indices were reduced to 0.70 on the right limb and normal on the left. Insertion of the ROX coupler device was reversed with concomitant endovascular aortic repair.

Discussion 

There is no clear consensus on reversal of the ROX coupler device. Endovascular aortic repair reversal of the ROX coupler device in this case was safe, effective, and improved symptoms including patient’s BP control and limb symptoms
Clinical features and outcomes of thoracic surgery patients during the COVID-19 pandemic
Authors: Salmerón Jiménez María , Hermoso Alarza Fátima , Martínez Serna Ivan , Marrón Fernández Carmen , Meneses Pardo José Carlos , García Salcedo José Alberto , Torres Serna Alejandro , Manama Gama Mario Gustavo , Colmenares Mendoza Oscar Enrique , Diaz-Hellín Gude Vicente , Gamez García Antonio Pablo
Published: August 2020

OBJECTIVES

The goal of this study was to describe the clinical features and outcomes of thoracic surgery patients during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Thirty-five patients were treated at the 12 de Octubre University Hospital in Madrid between 1 March 2020 and 24 April 2020 during the COVID-19 pandemic. Patient demographics, surgical procedures, complications, COVID-19 symptoms and outcomes were recorded. A protocol was introduced to reduce the risk of operating on patients with COVID-19, including symptom screening, a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and computed tomography scans of the chest. Surgical activity changed significantly during this time, from an initial period of near-normal activity, through an emergency-only period and finally a recovery period when some oncological surgical cases were restarted. Selection criteria for surgical patients are also described.

RESULTS

A total of 34 patients underwent surgery during the pandemic period. We performed 22 lung resections (11 lobectomies and 11 sublobar resections). No hospital deaths were recorded. An elective surgery patient and an emergency surgery patient were diagnosed with COVID-19 (5.88%). The former died within 30 days after surgery.

CONCLUSIONS

Severe acute respiratory syndrome coronavirus 2 represents a tremendous limitation for thoracic surgical practice. Preoperative practices to exclude asymptomatic cases infected with the virus allowed us to perform thoracic surgical procedures.
Perspectives in surgical and anaesthetic management of lung cancer in the era of coronavirus disease 2019 (COVID-19)
Authors: Fiorelli Silvia , Massullo Domenico , Ibrahim Mohsen , Piccioni Federico , Andreetti Claudio , Vanni Camilla , Rocco Monica , Rendina Erino Angelo , Menna Cecilia
Published: August 2020

Early in 2020, coronavirus disease 2019 (COVID-19) quickly spread globally, giving rise to a pandemic. In this critical scenario, patients with lung cancer need to continue to receive optimal care and at the same be shielded from infection with the potentially severe acute respiratory syndrome coronavirus 2. Upgrades to the prevention and control of infection have become paramount in order to lower the risk of hospital contagion. Aerosol-generating procedures such as endotracheal intubation or endoscopic procedures may expose health care workers to a high risk of infection. Moreover, thoracic anaesthesia usually requires highly complex airway management procedures because of the need for one-lung isolation and one-lung ventilation. Therefore, in the current pandemic, providing a fast-track algorithm for scientifically standardized diagnostic criteria and treatment recommendations for patients with lung cancer is urgent. Suggestions for improving existing contagion control guidelines are needed, even in the case of non-symptomatic patients who possibly are responsible for virus spread. A COVID-19-specific intraoperative management strategy designed to reduce risk of infection in both health care workers and patients is also required.
Safety and efficacy of tracheotomy for critically ill patients with coronavirus disease 2019 (COVID-19) in Wuhan: a case series of 14 patients
Authors: Aodeng Surita , Wang Weiqing , Chen Yu , Feng Guodong , Wang Jian , Lv Wei , Yang Hua , Ding Xin , Song Kaicheng , Zhao Sirui , Liu Jiazhen , Zhang Shuyang , Gao Zhiqiang
Published: August 2020

OBJECTIVES

Coronavirus disease 2019 (COVID-19) is a global pandemic. Critically ill patients often require prolonged intubation for mechanical ventilation to support breathing; thus, the artificial airway must be managed by tracheotomy. Therefore, studies exploring appropriate and safe methods for tracheotomy that minimize the risks of nosocomial transmission are important.

METHODS

A retrospective analysis of the clinical characteristics of 14 critically ill patients with COVID-19, who underwent bedside tracheotomy from March to April 2020 was conducted to summarize the indications for tracheotomy and key points related to personal protective equipment and surgical procedures.

RESULTS

All 14 patients were diagnosed with COVID-19 and were critically ill. All tracheotomies were performed in the late phase of the infection course. The interval between the infection and tracheotomy was 33 days, and the median interval between intubation and tracheotomy was 25.5 days. The reverse transcription-polymerase chain reaction results of secretions from the operative incision and inside the tracheotomy tube were negative. Twelve patients improved after tracheotomy, with SpO2 levels maintained above 96%. One patient died of progressive respiratory failure; another patient died of uncontrolled septic shock. No medical staff who participated in the tracheotomy was infected.

CONCLUSIONS

Tracheotomy in critically ill patients with COVID-19 who meet the indications for tracheotomy potentially represents a safer approach to manage the airway and help improve the treatment outcomes. A tracheotomy performed in the late phase of the disease has a relatively low risk of infection. Adherence to key steps in the tracheotomy procedure and donning adequate personal protection will help medical staff avoid infection.
Extra-thoracic rupture of giant subclavian artery aneurysm
Authors: Savlania Ajay , Jain Prashant , Thakur Uttam Kumar , Singh Charan
Published: August 2020

Subclavian artery aneurysms are rare, but they are frequently responsible for limb or life-threatening complications. The clinical presentation, as supraclavicular mass to rupture, has been reported in literature, with management strategies being endovascular intervention to open conventional surgery. We report a case of giant subclavian artery aneurysm measuring 10 cm × 12 cm, which presented with a large anterior chest wall lump and massive bleed to our emergency department. We successfully treated this patient by ligating the aneurysm and evacuating the chest wall haematoma.
Negotiating the Illegal: On the United Nations and the Illegal Occupation of Palestine, 1967–2020
Authors: Imseis Ardi
Published: August 2020

This article takes a critical look at the United Nations’ commitment to the international rule of law through an examination of its position on occupied Palestine post 1967. Occupation of enemy territory is meant to be temporary, and the occupying power may not rightfully claim sovereignty over such territory. Since 1967, Israel has systematically and forcibly altered the status of occupied Palestine, with the aim of annexing, de jure or de facto, most or all of it. While the UN has focused on the legality of Israel’s discrete violations of humanitarian and human rights law, it has paid scant attention to the legality of Israel’s occupation regime as a whole. By what rationale can it be said that Israel’s prolonged occupation of Palestine remains legal? This article argues that the occupation has become illegal for its systematic violation of at least three jus cogens norms. Although an increasing number of commentators have subscribed to this view, little attention has been paid to its relevant international legal consequences which dictate a paradigm shift away from negotiations as the condition precedent for ending the occupation, as unanimously affirmed by the international community through the UN.
Cyber Attribution: Technical and Legal Approaches and Challenges
Authors: Tsagourias Nicholas , Farrell Michael
Published: August 2020

Considering the role of attribution in the law of state responsibility, this article examines the technical and international law methodologies and determinants used when attributing malicious cyber activities falling below the use-of-force threshold to a state, and identifies the challenges that arise which lead to responsibility gaps. The article goes on to discuss a number of proposals that aim to improve the effectiveness of the attribution process and also close some of the existing responsibility gaps. They include institutional proposals envisaging the creation of an international attribution agency; normative proposals advocating the revision of the legal determinants of attribution; and proposals concerning the standard of proof. The aim of the article is to reconstruct the theory and practice of cyber attribution in order to enhance the regulatory potential of international law in this area.
The Sheldon Friel Memorial Lecture 2020 It’s not just about the teeth: Patient-centred Orthodontics*
Authors: Cunningham Susan J
Published: August 2020

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients’ views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients’ views regarding how services may be enhanced in the future.

This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.
Life-course risk factors are associated with activity of daily living disability in older adults
Authors: Macinko James , Vaz de Melo Mambrini Juliana , Bof de Andrade Fabíola , Drumond Andrade Flavia Cristina , Lazalde Gabriela E , Lima-Costa Maria Fernanda
Published: August 2020

Background

Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

Methods

Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

Results

In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country’s HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

Conclusions

Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.
Isolation and plasmid characterisation of Salmonella enterica serovar Albany harbouring mcr-5 from retail chicken meat in Japan
Authors: Wakabayashi Yuki , Sekizuka Tsuyoshi , Yamaguchi Takahiro , Fukuda Akira , Suzuki Masato , Kawahara Ryuji , Taguchi Masumi , Kuroda Makoto , Semba Keiko , Shinomiya Hiroto , Kawatsu Kentaro
Published: August 2020

The emergence of plasmid-mediated colistin resistance genes (mcr), which is occurring in numerous countries, is a worldwide concern, primarily because colistin is a last-resort antibiotic. Compared to E. coli, prevalence of mcr genes in Salmonella is unclear in Japan. Here we screened for mcr-1–5 genes in our collection of Salmonella strains isolated from retail meat products collected in Japan from 2012 through 2016. We found that Salmonella Albany strain 27A-368 encodes mcr-5 and that mcr genes were undetectable among the remaining 202 isolates. The resistance plasmid p27A-368 was transferred by conjugation to S. Infantis and was stably retained as a transconjugant. Whole-genome sequencing revealed that mcr-5 resided on a 115 kb plasmid (p27A-368). The plasmid backbone of p27A-368 is more similar to that of pCOV27, an ESBL-encoding plasmid recovered from avian pathogenic E. coli, rather than pSE13-SA01718 of S. Paratyphi B that encodes mcr-5. Further, mcr-5 is located on a transposon, and its sequence is similar to that of pSE13-SA01718. A phylogenetic tree based on single nucleotide variants implies a relationship between 27A-368 and S. Albany isolated in Southeast Asian countries.
Kinetic and substrate complex characterization of RamA, a corrinoid protein reductive activase from Methanosarcina barkeri
Authors: Huening Katherine A , Jiang Ruisheng , Krzycki Joseph A
Published: August 2020

In microbial corrinoid-dependent methyltransferase systems, adventitious Co(I)-corrinoid oxidation halts catalysis and necessitates repair by ATP-dependent reductive activases. RamA, an activase with a C-terminal ferredoxin domain with two [4Fe-4S] clusters from methanogenic archaea, has been far less studied than the bacterial activases bearing an N-terminal ferredoxin domain with one [2Fe-2S] cluster. These differences suggest RamA might prove to have other distinctive characteristics. Here, we examine RamA kinetics and the stoichiometry of the corrinoid protein:RamA complex. Like bacterial activases, K+ stimulates RamA. Potassium stimulation had been questioned due to differences in the primary structure of bacterial and methanogen activases. Unlike one bacterial activase, ATP is not inhibitory allowing the first determination of apparent kinetic parameters for any corrinoid activase. Unlike bacterial activases, a single RamA monomer complexes a single corrinoid protein monomer. Alanine replacement of a RamA serine residue corresponding to the serine of one bacterial activase which ligates the corrinoid cobalt during complex formation led to only moderate changes in the kinetics of RamA. These results reveal new differences in the two types of corrinoid activases, and provide direct evidence for the proposal that corrinoid activases act as catalytic monomers, unlike other enzymes that couple ATP hydrolysis to difficult reductions.
Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis
Authors: Zhang Qiang , Cai Jian-Qun , Wang Zhen
Published: August 2020

Background

Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method.

Methods

This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs.

Results

A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027).

Conclusions

ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.
Evolutionary Remodeling of the Cell Envelope in Bacteria of the Planctomycetes Phylum
Authors: Mahajan Mayank , Seeger Christian , Yee Benjamin , Andersson Siv G E
Published: August 2020

Bacteria of the Planctomycetes phylum have many unique cellular features, such as extensive membrane invaginations and the ability to import macromolecules. These features raise intriguing questions about the composition of their cell envelopes. In this study, we have used microscopy, phylogenomics, and proteomics to examine the composition and evolution of cell envelope proteins in Tuwongella immobilis and other members of the Planctomycetes. Cryo-electron tomography data indicated a distance of 45 nm between the inner and outer membranes in T. immobilis. Consistent with the wide periplasmic space, our bioinformatics studies showed that the periplasmic segments of outer-membrane proteins in type II secretion systems are extended in bacteria of the order Planctomycetales. Homologs of two highly abundant cysteine-rich cell wall proteins in T. immobilis were identified in all members of the Planctomycetales, whereas genes for peptidoglycan biosynthesis and cell elongation have been lost in many members of this bacterial group. The cell wall proteins contain multiple copies of the YTV motif, which is the only domain that is conserved and unique to the Planctomycetales. Earlier diverging taxa in the Planctomycetes phylum contain genes for peptidoglycan biosynthesis but no homologs to the YTV cell wall proteins. The major remodeling of the cell envelope in the ancestor of the Planctomycetales coincided with the emergence of budding and other unique cellular phenotypes. The results have implications for hypotheses about the process whereby complex cellular features evolve in bacteria.