bluuebunny/crossref_metadata_2025 huggingface dataset:
Most Colletotrichum species associated with tree tomato (Solanum betaceum) and mango (Mangifera indica) crops are not host‐specific
Authors: Cabrera L. , Rojas P. , Rojas S. , Pardo‐De la Hoz C. J. , Mideros M. F. , Danies G. , Lopez‐Kleine L. , Jiménez P. , Restrepo S.
Published: January 2018

An important constraint for crop production in Colombia is the high incidence of anthracnose caused by Colletotrichum species. Although several studies have focused on these fungi, the relationship between the different fungal species within the genus and their hosts and whether they display any host preference or host specificity has yet to be examined. In Colombia, diseases caused by Colletotrichum species are particularly severe in mango (Mangifera indica) and tree tomato (Solanum betaceum) crops. In a previous investigation, the Colletotrichum phylogenetic species attacking these crops were identified. The present study aimed to determine whether isolates collected from tree tomato and mango showed host preference or host specificity by assessing aggressiveness, spore density, latent period, and fitness of each strain on the two hosts. In the departments of Cundinamarca and Tolima, Colombia, isolates were collected from plants that presented typical anthracnose symptoms and were identified as C. acutatum, C. asianum, C. boninense, C. gloeosporioides, C. tamarilloi and C. theobromicola. Inoculation of conidia of each isolate onto both hosts showed isolates had no host preference and only the C. gloeosporioides isolate showed host specificity. However, in general, isolates produced a higher spore density when inoculated on the alternate host, which may indicate a difference in the degree of adaptation to each host. Statistical analyses of the assessed parameter values revealed that isolates use different infection strategies when infecting each host. In light of these results, the implications of using quantitative estimations of fitness when studying fungal pathogens are discussed.
Non-Parametric Bayesian Multivariate Metaregression: An Application in Environmental Epidemiology
Authors: Sim Gyuseok , Kim Ho , Zanobetti Antonella , Schwartz Joel , Chung Yeonseung
Published: January 2018

In biomedical research, meta-analysis is a popular tool to combine evidence from multiple studies to investigate an exposure–response association. A two-stage analytical approach is used in meta-analysis for its computational convenience and flexibility. The first stage estimates the association for each study whereas the second stage combines the study-specific estimates correcting for the study-specific error. The second stage often incorporates study-specific covariates (metapredictors) and is called metaregression. One application where the two-stage meta-analysis is useful is an epidemiological study for the health effects of environmental exposure, which often analyses time series data of exposure and health outcome collected from multiple locations. The first stage models location-specific association, which is often represented by multiple parameters as the association is non-linear or delayed, and the second stage conducts a multivariate metaregression with location-specific characteristics as metapredictors. The currently used multivariate metaregression is a form of normal linear regression, which may be limited as it assumes linearity in metapredictors, residual normality and homoscedasticity. In the paper, we propose a flexible multivariate metaregression in a non-parametric Bayesian modelling framework incorporating a residual spatial dependence. The proposed metaregression was evaluated through a simulation study and applied to investigate a temperature–mortality association in the 135 US cities.
Nematode eggs observed in cytology of cerebrospinal fluid diagnostic for intramedullary Spirocerca lupi spinal cord migration
Authors: Klainbart Sigal , Chai Orit , Vaturi Rafael , Rapoport Kira , Aroch Itamar , Shamir Merav Hagar
Published: January 2018

Spinal spirocercosis due to aberrant Spirocerca lupi nematode migration is an emerging etiology for acute myelitis in dogs in Israel, causing severe, mostly nonsymmetrical hind limb paresis or paralysis, and sometimes tetraparesis or tetraparalysis. So far, incidental identification of parasites during spinal surgery or at necropsy provides the only definite diagnosis, while antemortem diagnosis of this condition has been uncertain. Specifically, antemortem diagnosis is based on the typical clinical presentation of acute, progressive, asymmetrical hind limb paresis or paralysis, with moderate to severe eosinophilic to mixed cerebrospinal fluid (CSF) pleocytosis and increased CSF protein concentration. Exclusion of other differential diagnoses also requires using spinal cord imaging. In this novel report, we document a case of an intradural spinal spirocercosis in a dog, diagnosed antemortem, by detecting S lupi eggs in the CSF, and subsequent treatment, resulting in the resolution of the clinical signs.
Evaluation of a point‐of‐care blood glucose monitor in healthy goats
Authors: Quandt Jane E. , Barletta Michele , Cornell Karen K. , Giguère Steeve , Hofmeister Erik H.
Published: January 2018

Objective

To assess agreement between a point‐of‐care glucometer (POCG) and a laboratory chemistry analyzer for blood glucose measurements in goats.

Design

Prospective study.

Setting

University teaching hospital.

Animals

Eighteen healthy adult goats.

Investigations

Whole blood samples were obtained via jugular venipuncture prior to premedication with xylazine and butorphanol (T0), following premedication (T20), and after 1 hour of inhalant anesthesia (T60). Each sample was tested with a POCG and a laboratory analyzer (HITA). Agreement was assessed using concordance correlation coefficients and calculation of bias and 95% limits of agreement.

Measurements and Main Results

Mean blood glucose concentration at T0 was 3.9 ± 0.6 mmol/L (70 ± 10 mg/dL; POCG) and 2.9 ± 0.4 mmol/dL (53 ± 8 mg/dL; HITA). Glucose concentrations at T20 were 6.7 ± 2.4 mmol/L (121 ± 43 mg/dL) and 5.4 ± 2.1 mmol/L (97 ± 37 mg/dL) and at T60 were 5.7 ± 1.7 mmol/L (102 ± 31 mg/dL) and 4.7 ± 1.3 mmol/L (85 ± 24 mg/dL) when measured with the POCG and HITA, respectively. The POCG overestimated blood glucose compared to the HITA. The bias ± SD was 1.08 ± 0.53 mmol/L (19.4 ± 9.5 mg/dL) (95% LOA 0.04 to 2.11 mmol/L [0.7 to 38.0 mg/dL]) and the concordance correlation coefficient was 0.82. After correcting the results of the POCG using a mixed‐effects linear model, the bias was 0.0 ± 0.38 mmol/L (0.0 ± 6.8 mg/dL) (95% LOA ± 0.74 mmol/L [± 13.4 mg/dL]) and the concordance correlation coefficient was 0.98.

Conclusions

The POCG overestimated blood glucose concentrations in goats, compared to the HITA, but when the POCG concentrations were corrected, the agreement was excellent.
Extracorporeal shockwave therapy for treatment of keloid scars
Authors: Wang Ching‐Jen , Ko Jih‐Yang , Chou Wen‐Yi , Cheng Jai‐Hong , Kuo Yur‐Ren
Published: January 2018

The purpose of this investigation was to study the effectiveness of extracorporeal shockwave therapy (ESWT) for the treatment of keloid scars, and compared the results with intralesional steroid injection. Thirty‐nine patients were randomly divided into 22 in ESWT group and 17 in steroid group. The ESWT group received 3 ESWT treatments in 6 weeks. The steroid group received three intra‐lesional triamcinolone injections in 6 weeks. The evaluations included gross morphology, functional outcome, local blood flow perfusion, biopsy for histopathological examination, and immunohistochemical analysis. Both groups showed significant improvements in appearance with less discoloration, flattening and softer consistency, and more elasticity of the lesions. There is a significant reduction in keloid height after treatment in both groups, and significant differences are noticed between two groups after treatment. The volume of keloid was decreased after treatment but there is no statistically significant difference between two groups. Both groups showed comparable functional scores, POSAS patient, and observer scales. The blood flow perfusion rates were statistically not significant between two groups before and after treatments. Histopathological findings revealed no significant difference in cell count, cell activity, and cell concentration between two groups. After ESWT, the significant decreases in collagen type I, type III, and Masson Trichrome stain were observed as compared with steroid group. However, very little changes were noticed in angiogenesis, inflammatory cytokines, proliferating and regeneration, and apoptosis, with no statistical significance noticed between two groups before and after treatment. This study revealed that ESWT showed comparable functional outcome and POSAS patient and observer scales as compared with steroid injection for keloid scars. Treatment of keloid scars with ESWT resulted in significant decreases in collagen fibers and increases in MMP‐13 enzyme.
Human phenotypes caused by PIEZO1 mutations; one gene, two overlapping phenotypes?
Authors: Martin‐Almedina Silvia , Mansour Sahar , Ostergaard Pia
Published: January 2018

PIEZO1 is a large mechanosensitive ion channel protein. Diseases associated with PIEZO1 include autosomal recessive generalised lymphatic dysplasia of Fotiou (GLDF) and autosomal dominant dehydrated hereditary stomatocytosis with or without pseudohyperkalemia and/or perinatal oedema (DHS). The two disorders show overlapping features, fetal hydrops/perinatal oedema have been reported in both. Electrophysiological studies suggest opposite mechanisms of action: the mutations identified in GLDF patients cause a loss‐of‐function mechanism of disease and mutations in DHS patients cause gain of function. This raises the question: Is the pathogenic disease mechanism behind the fetal oedema the same in the two phenotypes? In this Symposium Review, we will discuss the two conditions and highlight key questions that remain to be answered. For instance, the perinatal oedema often resolves soon after birth and we are still at a loss to understand why. Are there any mechanisms which could compensate for the faulty PIEZO1 in these patients? Are there physiological changes at birth that are less reliant on the function of PIEZO1? Thus, there is a clear need for further studies into the two disorders, in order to fully understand the role of PIEZO1 in health and disease.

image
Workspace of Multifingered Hands Using Monte Carlo Method
Authors: Chaudhury Arkadeep Narayan , Ghosal Ashitava
Published: January 2018

Multifingered hands have the capability of dexterous manipulation of grasped objects and thus significantly increase the capabilities of a robot equipped with multifingered hands. Inspired by a multijointed human finger and the hand, we propose a six degree-of-freedom (DOF) model of a three-fingered robotic hand as a parallel manipulator. Two kinds of contact, namely point contact with friction and rolling without slipping between the fingertips and the grasped object, are considered. The point contact with friction is modeled as a three DOF spherical joint, and for rolling without slipping, we use the resultant nonholonomic constraints between the grasped object and the fingers. With realistic limits on the joints in the fingers and dimensions of finger segments, we obtain the well-conditioned manipulation workspace of the parallel manipulator using a Monte Carlo-based method. Additionally, we present two new general results—it is shown that maximum position and orientation workspace is obtained when the cross-sectional area of the grasped object is approximately equal to the area of the palm of the hand and when rolling without slipping is ensured the size of the well-conditioned workspace is significantly larger (∼1.2–1.5 times). We also present representative experiments of manipulation by a human hand and show that the experimental results are in reasonable agreement with those obtained from simulations.
Effectiveness of an Immersive Virtual Environment for Collaboration With Gesture Support Using Low-Cost Hardware
Authors: Coburn Joshua Q. , Salmon John L. , Freeman Ian
Published: January 2018

Since the advent of modern computer-aided design software, engineers have been divorced from the highly collaborative environment previously enjoyed. Today's highly complex designs require modern software tools and the realities of a global economy often constrain engineers to remote collaboration. These conditions make it highly impractical to collaborate locally around physical models. Various approaches to creating new collaboration tools and software, which alleviate these issues, have been tried previously. However, past solutions either used expensive hardware, which is not widely available, or used standard two-dimensional (2D) monitors to share three-dimensional (3D) information. Recently, new low-cost virtual reality (VR) hardware has been introduced, which creates a highly immersive 3D experience at a tiny fraction of the cost of previous hardware. This work demonstrates an immersive collaborative environment built using a network of this hardware, which allows users to interact with gestures virtually and conducts a study to show its advantages over traditional video conferencing software.
A Study on the Design and Performance of Epicycloid Bevels of Pure-Rolling Contact
Authors: Tan Rulong , Chen Bingkui , Xiang Dongyun , Liang Dong
Published: January 2018

To avoid the negative influence of sliding contact, this paper tries to investigate the spiral bevels of pure-rolling contact that can be manufactured by existing manufacture technology. In this process, spatial conjugate curve meshing theory and conjugate surface theory are both introduced to investigate the geometric principles and face hobbing process of the pure-rolling contact epicycloid bevel (PCEB for short in this paper). The tooth surface models of PCEBs by face hobbing process are obtained. Next, a sample is represented to show an application of this model. Then, finite element analysis (FEA) is applied to investigate the contact mechanics characteristics of these gears. Finally, the performance experiment of a prototype is completed to evaluate the deviations between theoretical expectations and practical results. From the FEA and experimental results, it is concluded that the PCEBs can mesh correctly and achieve a higher transmission efficiency.
A Novel Modular Tonometry-Based Device to Measure Pulse Pressure Waveforms in Radial Artery
Authors: Choudhury Mohammad Ikbal , Singh Pranjal , Juneja Rajneesh , Tuli Suneet , Deepak K. K. , Prasad Anamika , Roy Sitikantha
Published: January 2018

The paper presents the development of a new device for measuring continuous pulse pressure waveforms (PPW) from the radial artery via applanation tonometry. The development focuses on improved accuracy, open and affordable design using off-the-shelf components, and greater user control in setting operational and calibration parameters to address user variability. The device design parameters are optimized through a tissue device interaction study based on a computational model. The design incorporates modular components and includes a sensor module for arterial flattening and pressure pick-up, a differential screw mechanism and a related algorithm for controlled stepwise motion and data collection during flattening, and a brace for wrist-flexion adjustment. Maximum pulse amplitude (PA) was used as an indicator of the optimum level of arterial flattening for recording the PPW. The PPW was observed to distort due to changes in parameters like gel-head placement, hold-down pressure (HDP), and wrist extension. The pressure waveforms collected using the device were validated using limited data against established products and showed good correlation within ±1.96 standard deviation of the mean difference in a Bland–Altman plot. This paper thus details the development of a simple and validated mechanical design to measure PPW using arterial tonometry.
Droplet Heat Transfer on Micropost Arrays With Hydrophobic and Hydrophilic Characteristics
Authors: Al-Sharafi Abdullah , Yilbas Bekir S. , Ali Haider
Published: January 2018

Heat transfer analysis for a water droplet on micropost arrays is carried out while mimicking the environmental conditions. Since the micropost arrays spacing size alters the state of the hydrophilicity of the surface, the size of the micropost arrays spacing is varied and the resulting heat transfer characteristics are analyzed. Spreading rate of water droplet on the micropost arrays is considered and the adhesion force for the pinning of the water droplet on the micropost arrays is presented. Temperature and flow fields are predicted and the predictions of flow velocity inside the water droplet are validated through the particle image velocimetry (PIV). The Nusselt number variation for various sizes of the micropost arrays is obtained for two droplet volumes. It is found that reducing the solid fraction of micropost array beyond ϕs = 0.25, the Cassie and Baxter state of the surface changes to the Wenzel state; in which case, hydrophobic characteristics changes to hydrophilic characteristics for the water droplet. Heat transfer from the droplet bottom gives rise to development of the buoyancy and the Marangoni currents, which in turn generate two counter rotating circulation cells. The center of circulation cells moves further in the droplet upper part for the hydrophobic droplet case. The Nusselt number attains high values for the hydrophobic droplet at micropost array spacing size b = 10 μm and hydrophobic droplet at spacing size b = 50 μm due to fin effects of the micropost arrays.
Mathematical Model for Dropwise Condensation on a Surface With Wettability Gradient
Authors: Singh Manjinder , Kondaraju Sasidhar , Bahga Supreet Singh
Published: January 2018

We present a mathematical model for dropwise condensation (DWC) heat transfer on a surface with wettability gradient. We adapt well-established population balance model for DWC on inclined surfaces to model DWC on a surface with wettability gradient. In particular, our model takes into account the effect of wettability gradient and energy released during drop coalescence to determine the drop departure size. We validate our model with published experimental data of DWC heat flux and drop size distribution. Based on various experimental studies on drop motion, we also propose a mechanism that explains how the energy released during drop coalescence on a surface with wettability gradient and in a condensation environment aids drop motion. The mechanism correctly explains the shift of center of mass of two coalescing drops on a surface with wettability gradient toward the drop on high wetting region. Using the model, we analyze the effect of wettability gradient on the DWC heat flux. Our model predictions show that the optimal choice of wettability gradient is governed by differential variations in population density and heat transfer through a drop with change in wettability of the surface. We also demonstrate that contact angle at which there is maximum heat transfer through a drop varies with thickness of coating layer leading to change in optimal wettability gradient.
A Numerical and Experimental Study of Kick Dynamics at Downhole
Authors: Islam Rakibul , Khan Faisal , Venkatesan Ramchandran
Published: January 2018

The early detection of a kick and mitigation with appropriate well control actions can minimize the risk of a blowout. This paper proposes a downhole monitoring system, and presents a dynamic numerical simulation of a compressible two-phase flow to study the kick dynamics at downhole during drilling operation. This approach enables early kick detection and could lead to the development of potential blowout prevention strategies. A pressure cell that mimics a scaled-down version of a downhole is used to study the dynamics of a compressible two-phase flow. The setup is simulated under boundary conditions that resemble realistic scenarios; special attention is given to the transient period after injecting the influx. The main parameters studied include pressure gradient, raising speed of a gas kick, and volumetric behavior of the gas kick with respect to time. Simulation results exhibit a sudden increase of pressure while the kick enters and volumetric expansion of gas as it flows upward. This improved understanding helps to develop effective well control and blowout prevention strategies. This study confirms the feasibility and usability of an intelligent drill pipe as a tool to monitor well conditions and develop blowout risk management strategies.
Experimental Study of the Pore Structure Characterization in Shale With Different Particle Size
Authors: Zhang Shuwen , Xian Xuefu , Zhou Junping , Liu Guojun , Guo Yaowen , Zhao Yuan , Lu Zhaohui
Published: January 2018

In order to study the effects of particle size on the determination of pore structure in shale, the outcrop of Ordovician Wufeng (WF) and Silurian Longmaxi shale (LMX) samples from Sichuan basin were chosen and crushed into various particle sizes. Then, pore structure was analyzed by using low-pressure gas adsorption (LPGA) tests. The results show that the pore of shales is mainly composed of slit-type pores and open pores. The specific surface areas of shale are mainly contributed by micropores, while the largest proportion of the total pore volume in shale is contributed by mesopores. With the decreasing of particle size, the specific surface area of both samples is decreased, while average pore diameter and the total pore volume are increased gradually. The influences of particle size on the pore structure parameters are more significant for micropore and macropore, as the particle sizes decrease from 2.36 mm to 0.075 mm, the volume of micropores in Longmaxi shale increases from 0.283 cm3/100 g to 0.501 cm3/100 g with an increment almost 40%, while the volume of macropores decreases from 0.732 cm3/100 g to 0.260 cm3/100 g with a decrement about 50%. This study identified the fractal dimensions at relative pressures of 0–0.50 and 0.50–0.995 as D1 and D2, respectively. D1 increases with the decrease of particle size of shale, while D2 shows an opposite tendency in both shale samples.
Analysis and Efficiency Assessment of Direct Conversion of Wind Energy Into Heat Using Electromagnetic Induction and Thermal Energy Storage
Authors: Karasu Huseyin , Dincer Ibrahim
Published: January 2018

This study deals with thermodynamic analyses of an integrated wind thermal energy storage (WTES) system. The thermodynamic analyses of the proposed system are performed through energy and exergy approaches, and the energy and exergy efficiencies of the components in the system and overall system are determined and assessed. The magnitudes of irreversibilities are determined, and the impacts of different parameters on the performance of the system are identified. The overall energy and exergy efficiencies of the proposed system and its subsystems are computed as well. The energy and exergy efficiencies of the overall system are defined and obtained as 7.0% and 8.6%, respectively. WTES plants with combined molten salt energy storage application can run continuously, and can provide electrical power for both on-grid and off-grid systems. By converting the wind power into a permanent energy source, the WTES offers a practical solution that can meet the electrical demand of the regions where the climate conditions are feasible for consistent, environmentally benign and cost-effective electric power, and it can be considered as a potential energy solution.
Design and Development of a Fiber-Optic Hybrid Day-Lighting System
Authors: Lawless Sean , Gorthala Ravi
Published: January 2018

The primary objective of this study was to develop a fiber-optic hybrid day-lighting system for mobile application such as military shelters in order to cut energy use and the use of fossil fuels. The scope included the design, development, and testing of a hybrid lighting system that is capable of producing about 16,000 lm output with design challenges including light-weight, compactness, and optics that can tolerate a high tracking misalignment. The designed system is comprised of two subsystems: the solar collector and the solar hybrid lighting fixture (SHLF). The solar collector, consists of a housing, a structural stand (tripod), a dual axis tracking system, Fresnel lenses, secondary optics, and fiber-optic cables. The collector is a telescoping aluminum box that holds eight 10-in diameter Fresnel lenses, which focus sunlight onto eight secondary optics and deliver uniform light to the fiber-optic cables. The secondary optics have filters to block UV/IR. The optics has been designed to have a high half-acceptance angle of 1.75 deg and can accommodate a tracking accuracy of 1.50 deg or better. This novel SHLF consists of two components: a solar fiber-optic system and a light emitting diode (LED) system. The fiber-optic cable is coupled to an acrylic light diffusing rod that delivers the sunlight into the room. During sunny periods, the solar fiber-optic lighting could provide full illumination level. In order to keep the same level of lighting during cloudy periods, the LED portion of the light fixture can supplement the output of the SHLF. A compact, light-weight prototype system was built and tested. The results showed that the system's output per lens for the 20 ft cable was about 1750±50 lm at a global solar illuminance of 115,000 lx. The total system was capable of delivering 14,000 lm of sunlight.
Lead-Free Alternatives for Interconnects in High-Temperature Electronics
Authors: Mallampati Sandeep , Yin Liang , Shaddock David , Schoeller Harry , Cho Junghyun
Published: January 2018

Predominant high melting point solders for high-temperature and harsh environment electronics (operating temperatures from 200 to 250 °C) are Pb-based systems, which are being subjected to RoHS regulations because of their toxic nature. In this study, high bismuth (Bi) alloy compositions with Bi-XSb-10Cu (X from 10 wt % to 20 wt %) were designed and developed to evaluate their potential as high-temperature, Pb-free replacements. Reflow processes were developed to make die-attach samples made from the cast Bi alloys. Die-attach joints made from Bi-15Sb-10Cu alloy exhibited an average shear strength of 24 MPa, which is comparable to that of commercially available high Pb solders. These alloy compositions also retained original shear strength even after thermal shock (TS) between −55 °C and +200 °C and high-temperature storage (HTS) at 200 °C. Brittle interfacial fracture sometimes occurred along the interfacial NiSb layer formed between Bi(Sb) matrix and Ni metallized surface. In addition, heat dissipation capabilities, using flash diffusivity, were measured on the die-attach assembly and were compared to the corresponding bulk alloys. The thermal conductivity of all the Bi–Sb alloys was higher than that of pure Bi. By creating high volume fraction of precipitates in a die-attach joint microstructure, it was feasible to further increase thermal conductivity of this joint to 24 W/m·K, which is three times higher than that of pure Bi (8 W/m·K). Bi–15Sb–10Cu alloy has so far shown the most promising performance as a die-attach material for high-temperature applications (operated over 200 °C). Hence, this alloy was further studied to evaluate its potential for plastic deformation. Bi–15Sb–10Cu alloy has shown limited plastic deformation in room temperature tensile testing in which premature fracture occurred via the cracks propagated on the (111) cleavage planes of rhombohedral crystal structure of the Bi(Sb) matrix. The same alloy has, however, shown up to 7% plastic strain under tension when tested at 175 °C. The cleavage planes, which became oriented at smaller angles to the tensile stress, contributed to improved plasticity in the high-temperature test.
Direct measurements of DOCO isomers in the kinetics of OD + CO
Authors: Bui Thinh Q. , Bjork Bryce J. , Changala P. Bryan , Nguyen Thanh L. , Stanton John F. , Okumura Mitchio , Ye Jun
Published: January 2018

Frequency comb spectroscopy captures real-time dynamics of
cis
- and
trans
-DOCO isomers produced from the OD + CO reaction.
Case of acute severe postpartum urinary incontinence: an extravesical subsphincteric prolapsed ureterocoele
Authors: Seth Jai H , Walker Roger
Published: January 2018

A 32-year-old woman presents to outpatients 10 days postpartum, with symptoms of an intermittent vaginal lump and urinary incontinence. Vaginal examination revealed no demonstrable prolapse or stress incontinence. A swelling in the bladder was noted during an antenatal scan suggesting a ureterocoele. She was referred for pelvic floor physiotherapy in the first instance. Forty-eight hours later, she represented to casualty with discomforting vaginal lump symptoms and continuous urinary incontinence. At this stage on vaginal inspection, there was an evident dusky lump emerging from the urethra with continuous incontinence. An extravesical subsphincteric prolapsed ureterocoele was evident, 5 cm beyond the external urethral meatus. The diagnosis was confirmed with an MRI scan which demonstrated the prolapsed obstructing ureterocoele causing significant left-sided hydroureteronephrosis. The ureterocoele was managed with a cystoscopy and transurethral incision of the ureterocoele under anaesthesia, which facilitated drainage and resolution. At 3-month postoperatively, the patient remains continent and satisfied.
Pelvic and buttock hypoplasia reconstructed with anatomical breast implants
Authors: Page Felicity , Harb Ayad , Titley Garth
Published: January 2018

Radiation therapy is used in the management of a number of childhood cancers and can have significant effects on skeletal growth. We present the case of a 35-year-old woman who developed a hypoplastic pelvis and buttocks following radiotherapy for rhabdomyosarcoma of the vagina at the age of 2. At the age of 25, the patient underwent bilateral buttock augmentation with a two-stage reconstruction using tissue expansion followed by definitive augmentation with anatomical breast implant insertion. The patient continues to have a satisfactory outcome 10 years following reconstruction, having undergone a single uplift procedure and exchange of implants through the original incision 9 years postoperatively. This case represents a unique reconstructive challenge to plastic surgeons and was successfully managed with a novel approach.
Rheumatoid disease: an unusual cause of relapsing meningoencephalitis
Authors: Alexander Sian K , Di Cicco Maria , Pohl Ute , Cifelli Alberto
Published: January 2018

A 73-year-old man presented with three episodes of dysphasia and disinhibited behaviour, a single seizure and transient ischaemic attack-like events characterised by right arm and/or leg weakness. These episodes were separated by month-long asymptomatic intervals. Medical history included rheumatoid arthritis, which was clinically quiescent on leflunomide.

Repeated cerebrospinal fluid examination showed a persistent lymphocytosis with mildly reduced glucose and elevated protein; oligoclonal bands and viral PCR were negative. MRI of the brain was initially normal, but 7 months after initial presentation revealed meningeal enhancement with bifrontal cortical hyperintensities on T2/fluid-attenuated inversion recovery. Brain biopsy demonstrated necrotising granulomatous meningitis with mixed T cell and B cell infiltrates and without evidence of vasculitis or infection. Serum anticyclic citrullinated peptide antibodies were strongly positive.

The diagnosis of rheumatoid meningoencephalitis was made on the basis of brain biopsy findings and serological evidence of active rheumatoid disease. Steroids and rituximab therapy were started leading to clinical stabilisation.
Inter-relationship between ocular perfusion pressure, blood pressure, intraocular pressure profiles and primary open-angle glaucoma: the Singapore Epidemiology of Eye Diseases study
Authors: Tham Yih-Chung , Lim Sing-Hui , Gupta Preeti , Aung Tin , Wong Tien Y , Cheng Ching-Yu
Published: January 2018

Objective

To elucidate the inter-relationship between ocular perfusion pressure (OPP), blood pressure (BP), intraocular pressure (IOP) profiles and primary open-angle glaucoma (POAG) in a multiethnic Asian population.

Methods

Participants were recruited from the Singapore Epidemiology of Eye Diseases Study and underwent standardised ocular and systemic examinations. POAG was defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses with generalised estimating equation models were performed and used to account for correlation between eyes.

Results

A total of 9877 participants (19 587 eyes), including 213 POAG cases (293 eyes) were included. Eyes with lowest quartile levels of systolic OPP (SOPP <110 mm Hg) were 1.85 times (95% CI 1.16 to 2.95) likely to have POAG, compared with eyes with mid-range SOPP levels (123–137 mm Hg; third quartile), after adjusting for relevant covariates and IOP. Consistently, we found that lowest quartile of systolic BP (SBP <124 mm Hg) was 1.69 times (95% CI 1.08 to 2.66) likely to have POAG, compared with mid-range SBP levels (138–153 mm Hg; third quartile). Furthermore, the effect of lower SBP on POAG was more pronounced in eyes with IOP ≥21 mm Hg (OR 3.90; 95% CI 1.24 to 12.30). Both the mean and diastolic profiles of OPP and BP were not significantly associated with POAG, after adjusting for relevant covariates and IOP.

Conclusions

In this population-based sample of nearly 10 000 Asian individuals, we showed that low SOPP was associated with POAG. This association was potentially in part secondary to low SBP and high IOP. Our findings provide further clarity on the roles of OPP surrogates and BP profiles in POAG.
Economic burden of neonatal sepsis in sub-Saharan Africa
Authors: Ranjeva Sylvia L , Warf Benjamin C , Schiff Steven J
Published: January 2018

Background and significance

The third Sustainable Development Goal for child health, which aims to end preventable deaths of newborns and children less than 5 years of age by 2030, cannot be met without substantial reduction of infection-specific neonatal mortality in the developing world. Neonatal infections are estimated to account for 26% of annual neonatal deaths, with mortality rates highest in sub-Saharan Africa (SSA). Reliable and comprehensive estimates of the incidence and aetiology surrounding neonatal sepsis in SSA remain incompletely available. We estimate the economic burden of neonatal sepsis in SSA.

Methods

Data available through global health agencies and in the medical literature were used to determine population demographics in SSA, as well as to determine the incidence, disease burden, mortality and resulting disabilities associated with neonatal sepsis. The disability-adjusted life years (DALY) associated with successful treatment or prevention of neonatal sepsis in SSA for 1 year were calculated. The value of a statistical life (VSL) methodology was estimated to evaluate the economic burden of untreated neonatal sepsis in SSA.

Results

We conservatively estimate that 5.29–8.73 million DALYs are lost annually in SSA due to neonatal sepsis. Corresponding VSL estimates predict an annual economic burden ranging from $10 billion to $469 billion.

Conclusions

Our results highlight and quantify the scope of the public health and economic burden posed by neonatal sepsis in SSA. We quantify the substantial potential impact of more successful treatment and prevention strategies, and we highlight the need for greater investment in strategies to characterise, diagnose, prevent and manage neonatal sepsis and its long-term sequelae in SSA.
Effectiveness and safety of oral sedation in adult patients undergoing dental procedures: protocol for a systematic review
Authors: Araújo Jimmy de Oliveira , Motta Rogério Heládio Lopes , Bergamaschi Cristiane de Cássia , Guimarães Caio Chaves , Ramacciato Juliana Cama , de Andrade Natalia Karol , Fiqueiró Mabel Fernandes , Lopes Luciane Cruz
Published: January 2018

Introduction

The management of anxious patients undergoing dental procedures is still a challenge in clinical practice. Despite a wide variety of drugs for oral sedation in adult patients, there are relatively few systematic reviews that compare the effectiveness and safety of different drugs administered via this route. Thus, this study will evaluate the effectiveness and safety of oral sedation with benzodiazepines and other agents to patients undergoing dental surgical procedures.

Method/design

We will conduct a systematic review and, if appropriate, a meta-analysis of randomised controlled clinical trials that will evaluate the use of conscious sedation administered orally to adult patients undergoing oral surgery. The search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), CINAHL (via Ovid), Lilacs (SciELO) and Capes database, without restriction of languages or date of publication. Primary outcomes include anxiety, sedation, treatment satisfaction, pain and adverse effects. Secondary outcomes include vital parameters (heart rate, respiratory rate and blood pressure) and patient cooperation during intervention. A team of reviewers will independently assess each citation for eligibility and in duplicates. For eligible studies, the same reviewers will perform data extraction, risk of bias assessment and determination of the overall quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation classification system.

Ethics and dissemination

The evidence gathered from this study should provide dental surgeons with knowledge on the effectiveness and safety of oral sedation in adults requiring dental surgical procedures. This in turn should contribute towards the decision-making process in dental practice, minimising the risks of anxiety and ineffective pain control in clinical procedures, as well as possible side effects. Ethics approval is not required in protocols for systematic reviews. The systematic review will be published in a peer-reviewed journal and presented at conferences.

PROSPERO registration number

CRD42017057142.
Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry
Authors: Apenteng Patricia N , Gao Haiyan , Hobbs FD Richard , Fitzmaurice David A
Published: January 2018

Objective

To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF).

Design

Prospective, multicentre, international registry.

Setting

186 primary care practices in the UK.

Participants

3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent.

Main outcome measures

Antithrombotic treatment initiated at diagnosis, overall and according to stroke and bleeding risks. Stroke risk was retrospectively calculated using CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)–vascular disease, age 65–74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)).

Results

42.7% were women and the mean age was 74.5 years. The median CHA2DS2-VASc score was 3 in all cohorts and the median HAS-BLED score was 2 in all cohorts. There was a statistically significant increase in the use of anticoagulant therapy from C2 to C5 (C2 54.7%, C3 60.3%, C4 73.1%, C5 73.9%; P value for trend <0.0001). The increase in the use of anticoagulant was mainly in patients with CHA2DS2-VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%).

Conclusion

There has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs.

Trial registration number

NCT01090362; Pre-results.
Cohort profile: the Comparative Outcomes And Service Utilization Trends (COAST) Study among people living with and without HIV in British Columbia, Canada
Authors: Eyawo Oghenowede , Hull Mark W , Salters Kate , Samji Hasina , Cescon Angela , Sereda Paul , Lima Viviane D , Nosyk Bohdan , Whitehurst David G T , Lear Scott A , Montaner Julio S G , Hogg Robert S
Published: January 2018

Purpose

The Comparative Outcomes And Service Utilization Trends (COAST) Study in British Columbia (BC), Canada, was designed to evaluate the determinants of health outcomes and health care services use among people living with HIV (PLHIV) as they age in the period following the introduction of combination antiretroviral therapy (cART). The study also assesses how age-associated comorbidities and health care use among PLHIV may differ from those observed in the general population.

Participants

COAST was established through a data linkage between two provincial data sources: The BC Centre for Excellence in HIV/AIDS Drug Treatment Program, which centrally manages cART dispensation across BC and contains prospectively collected data on demographic, immunological, virological, cART use and other clinical information for all known PLHIV in BC; and Population Data BC, a provincial data repository that holds individual event-level, longitudinal data for all 4.6 million BC residents. COAST participants include 13 907 HIV-positive adults (≥19 years of age) and a 10% random sample inclusive of 516 340 adults from the general population followed from 1996 to 2013.

Findings to date

For all participants, linked individual-level data include information on demographics, health service use (eg, inpatient care, outpatient care and prescription medication dispensations), mortality, and HIV diagnostic and clinical data. Publications from COAST have demonstrated the significant mortality reductions and dramatic changes in the causes of death among PLHIV from 1996 to 2012, differences in the amount of time spent in a healthy state by HIV status, and high levels of injury and mood disorder diagnosis among PLHIV compared with the general population.

Future plans

To capture the dynamic nature of population health parameters, regular data updates and a refresh of the data linkage are planned to occur every 2 years, providing the basis for planned analysis to examine age-associated comorbidities and patterns of health service use over time.
Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis
Authors: Sana Adama , Somda Serge M A , Meda Nicolas , Bouland Catherine
Published: January 2018

Introduction

Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities.

Methods

We conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: “wood”, “charcoal”, “biomass”, “solid fuels”, “organic fuel”, “biofuel”, “female”, “women”, “COPD”, “chronic bronchitis”, “emphysema”, “chronic obstructive pulmonary disease”. Studies were eligible if they were case–control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR.

Results

24 studies were included: 5 case–control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57).

Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case–control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas.

Conclusions

This study showed that biomass smoke exposure is associated with COPD in rural and urban women.

In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.
Screening and functional exploration of prothrombin Arg596 related mutations in Chinese venous thromboembolism patients
Authors: Wu Xi , Li Lei , Ding Qiulan , Wang Xuefeng , Wu Fang , Wu Wenman
Published: January 2018

Aims

Dysfunctional prothrombin residue Arg596 associated mutation has been found to precipitate venous thromboembolism (VTE). In the current study we investigated the prevalence of Arg596 associated mutations in Chinese patients with VTE and explored the functional impact of Arg596Gln mutation on coagulation function in affected patients.

Methods

Prothrombin clotting activity was measured in 267 unrelated patients with unprovoked VTE. Patients with moderately decreased activities underwent further analysis of theF2gene. Prothrombin amidolytic activity and antigen levels were detected in mutation carriers. Specific family members were investigated about their VTE histories and clinical phenotypes. The thrombin generation test (TGT) was used to evaluate thrombin function and antithrombin resistance assay was applied to assess the extent of impaired antithrombin inhibition of mutation carriers.

Results

Two heterozygous mutation carriers of prothrombin Arg596Gln were identified, both of whom had moderately decreased clotting activities but normal amidolytic activities and antigen levels. Among the families of the two probands, nine out of 13 mutation carriers experienced episodes of VTE. TGTs showed that patients had elevated endogenous thrombin potential and prolonged start tail time. Thrombin generation could be inhibited in the presence of thrombomodulin. The thrombin Arg596Gln variant in patients’ plasma presented strong resistance to antithrombin inhibition.

Conclusion

Prothrombin Arg596Gln mutation is a risk factor for Chinese patients with VTE due to its moderately decreased clotting activity but strong resistance to antithrombin inhibition. Prothrombin clotting activity screening and its encoding gene sequencing should be considered in patients with VTE when other established risk factors are absent.