bluuebunny/crossref_metadata_2025 huggingface dataset:
Incomplete scleral penetration of dexamethasone (Ozurdex) intravitreal implant
Authors: Sherman Thomas , Raman Vasant
Published: December 2018

Ozurdex (Allergan, Irvine, California, USA) is a biodegradable sustained release intravitreal implant containing 0.7 mg dexamethasone in a solid polymer drug delivery system. In the UK, it is approved for use in patients with macular oedema secondary to retinal vein occlusion, diabetic maculopathy and non-infectious uveitis. Although the implant is meant to be injected into the vitreous cavity, it can be inadvertently injected into the crystalline lens. This can also migrate into the anterior chamber, under altered anatomical conditions of the anterior segment. We report a case of incompletely penetrated dexamethasone implant, in a patient undergoing treatment for macular oedema secondary to retinal vein occlusion. The partially penetrated implant was managed conservatively with a good outcome.
Citrobacter freundiisepsis in an immunosuppressed patient with pemphigus vulgaris
Authors: Ferranti Martina , Tadiotto Cicogna Giulia , Sattin Andrea , Alaibac Mauro
Published: December 2018

Pemphigus vulgaris is an autoimmune bullous disease that involves the skin and mucous membranes. Current therapies aim to decrease antibody production by means of the use of systemic corticosteroids, immunosuppressive agents and, recently, rituximab, an anti-CD20 monoclonal antibody. However, the chronic immune suppression could entail complications, like infections and secondary malignancies. We describe a case of a patient with pemphigus who developed a sepsis due toCitrobacter freundiiinfection.
Catatonia due to alprazolam withdrawal
Authors: Iyengar Siddharth , Bornmann Charles , Abdelmalak Farid , LaRocca Tulisa
Published: December 2018

A 50-year-old man with multiple psychiatric comorbidities including major depressive disorder and general anxiety disorder presented to the emergency room (ER) with altered mental status, immobility and mutism. The patient was unresponsive to commands and unable to provide any history. In the ER he was given a provisional diagnosis of cerebrovascular accident (CVA). Vital signs on admission were stable. On physical examination, he exhibited grimacing, muscle rigidity and areflexia. Workup for CVA and infectious aetiology was unremarkable and the patient’s urine toxicology screen was negative. History from the patient’s family revealed that 4 days prior to presentation, the patient had discontinued his prescribed dose of alprazolam 1 mg four times per day. The patient was diagnosed with catatonia due to benzodiazepine withdrawal and had gradual return to baseline with administration of lorazepam 1 mg intravenous three times per day.
Acute eosinophilic appendicitis simulating uncomplicated appendicitis
Authors: Takabatake Kazuya , Imanishi Tsutomu , Yoshikawa Tetsuji
Published: December 2018

Acute appendicitis is one of the most common abdominal emergencies worldwide. Uncomplicated appendicitis (UA), which does not involve perforation or peritonitis, has recently been treated with antibiotic therapy. Here, we report a case of acute eosinophilic appendicitis (AEA) that simulated UA and did not respond to antibiotic therapy. A 20-year-old Japanese woman emergently presented with the chief complaint of pain at the right iliac fossa. CT showed only swelling of the appendix. She was diagnosed with UA, and she received antibiotic therapy initially. However, the treatment was not effective and appendectomy was performed. The final histopathological diagnosis was AEA. The findings of this case suggest that AEA is likely to be diagnosed as UA. As AEA can simulate UA, the possibility of AEA should be considered when antibiotic therapy is not effective.
Rare presentation of cutaneous cryptococcosis in advanced HIV
Authors: Sivaraj Venkateshwaran , Kulasegaram Ranjababu , Rickaby William , Dwyer Ellen
Published: December 2018

Cryptococcus neoformansis an encapsulated yeast which causes opportunistic infection in the context of immunosuppression, including advanced HIV infection. Cryptococcal infection is systemic and can result in a fatal meningoencephalitis. Cutaneous lesions occur in 15% of those with systemic cryptococcosis and may be the first indicator of infection. Identification of these lesions may therefore expedite diagnosis and access to treatment. Cutaneous lesions typically present as papulonodular molluscum-like lesions; however, may vary significantly in appearance. We describe a rare case of extraneuronal cryptococcal infection manifesting as large subcutaneous tumours in a patient with advanced HIV-related immune deficiency.
Acute subretinal abscess inStaphylococcus aureussepticaemia with endophthalmitis showcased by multimodal retinal imaging and with 2-year follow-up
Authors: Prajapati Rita , Newton Pippa , Ahmad Sameena , Kelly Simon
Published: December 2018

A middle-aged man presented to emergency services with central vision loss in the setting of flu-like illness with fever. A striking subfoveal abscess was observed in the right fundus. Focal acute chorioretinal inflammation was noted in the asymptomatic fellow eye.Staphylococcus aureussepticaemia was subsequently diagnosed. He presented with undiagnosed HIV infection and latent syphilis. Serial high-definition multimodal retinal imaging showcased resolution of the dome-shaped subretinal abscess following treatment with intravenous flucloxacillin. A chorioretinal scar swiftly replaced the subfoveal abscess. Peripheral right vision and full left vision was retained. Vision loss due to endogenous endophthalmitis in systemic sepsis is an emergency requiring prompt multidisciplinary care. Sight and life are at risk—thus this is not a diagnosis to miss! Early recognition is paramount to health and in retaining vision. We briefly review relevant literature and portray how multimodal imaging guided response to treatment of acute subretinal abscess.
Agenesis of the corpus callosum with interhemispheric cyst: clinical implications and outcome
Authors: Revanna Krishna Gopagondanahalli , Rajadurai Victor Samuel , Chandran Suresh
Published: December 2018

We describe two cases of agenesis of the corpus callosum (ACC) with interhemispheric cyst (IHC). Case 1: a male infant was born at 36 weeks gestation with a history of second trimester fetal ultrasound (US) scan and MRI showing ACC with IHC. His head circumference at birth and 5 months was at 90th centile. He developed infantile spasm and electroencephalogram showed hypsarrhythmia at 5 months of age. Seizures were controlled. He is under evaluation for surgical treatment. Case 2: ACC with a midline cyst was reported in the midtrimester US scan of a male infant. Subsequent fetal scans showed increasing size of the cyst. At birth, he had macrocephaly with a head circumference above 97th centile. MRI of the brain confirmed ACC with IHC. The parents refused a cystoperitoneal shunt offered. The child displayed gross neurodevelopmental delay with progressive hydrocephalus on follow-up and succumbed to aspiration pneumonia at 22 months of age.
Dermatomyositis as a paraneoplastic phenomenon in oesophageal cancer
Authors: Laidler Nicholas Kevin
Published: December 2018

Dermatomyositis is a multisystem disease manifesting as an idiopathic inflammatory myopathy, characterised predominantly by cutaneous and muscular abnormalities. Patients with dermatomyositis display characteristic skin changes in addition to muscle weakness. Many consider dermatomyositis a paraneoplastic syndrome, as up to 32% of patients with dermatomyositis will develop cancer. Discussed here is the case of a 69-year-old man with a new diagnosis of dermatomyositis who was referred to a tertiary institution with an 8-month history of rash, proximal muscle weakness, fatigue and weight loss. In the absence of clinical symptoms, negative cancer markers and a negative CT chest, abdomen and pelvis, positron emission tomography–CT prompted a gastroscopy, which led to the discovery of a stage T1b oesophageal adenocarcinoma. The oesophageal adenocarcinoma was treated with a gastrointestinal endoscopic mucosal resection and subsequent oesophajectomy. The patient’s dermatomyositis was treated successfully with oral prednisolone and methotrexate.
Glycosylated haemoglobin: a false sense of security
Authors: Finan Emily , Joseph Joe
Published: December 2018

We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.
Autoimmune pancreatitis with associated ulcerative colitis in a teenager
Authors: Gouveia Carolina Isabel , Oliveira Laura , Campos António P , Cabral José
Published: December 2018

Autoimmune pancreatitis (AIP) is a rare entity that is extremely uncommon in children. Its diagnosis is also a clinical challenge. This form of chronic pancreatitis often presents itself with obstructive jaundice and/or a pancreatic mass and it is sometimes misdiagnosed as pancreatic cancer. We describe the case of a 13-year-old boy with obstructive jaundice and a 4 cm mass in the head of the pancreas that was diagnosed as AIP with associated ulcerative colitis.
Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline
Authors: Prasad Kameshwar , Siemieniuk Reed , Hao Qiukui , Guyatt Gordon , O’Donnell Martin , Lytvyn Lyubov , Heen Anja Fog , Agoritsas Thomas , Vandvik Per Olav , Gorthi Sankar Prasad , Fisch Loraine , Jusufovic Mirza , Muller Jennifer , Booth Brenda , Horton Eleanor , Fraiz Auxiliadora , Siemieniuk Jillian , Fobuzi Awah Cletus , Katragunta Neelima , Rochwerg Bram
Published: December 2018

What is the role of dual antiplatelet therapy after high risk transient ischaemic attack or minor stroke? Specifically, does dual antiplatelet therapy with a combination of aspirin and clopidogrel lead to a greater reduction in recurrent stroke and death over the use of aspirin alone when given in the first 24 hours after a high risk transient ischaemic attack or minor ischaemic stroke? An expert panel produced a strong recommendation for initiating dual antiplatelet therapy within 24 hours of the onset of symptoms, and for continuing it for 10-21 days. Current practice is typically to use a single drug
Accumulated or continuous exercise for glycaemic regulation and control: a systematic review with meta-analysis
Authors: Shambrook Philip , Kingsley Michael , Taylor Nicholas , Gordon Brett
Published: December 2018

Objective

To compare the effectiveness of accumulating exercise in multiple bouts of at least 10 min throughout a day with exercise completed in a single bout (continuous or interval), or no exercise, on glycaemic control and regulation in inactive people without diagnosed glycaemic dysfunction.

Design

Systematic review and meta-analysis.

Data sources

Seven electronic databases were searched: CINAHL (EBSCO), Cochrane Library, EMBASE (Ovid), MEDLINE 1948-(Ovid), SCOPUS (Elsevier), SPORTDiscus (EBSCO) and Web of Science (ISI) with no restrictions on date and included all titles indexed up to February 2018.

Eligibility criteria for selecting studies

Articles reporting insufficiently active adults (19 to 64 years) without metabolic dysfunction, measuring glycaemic control or regulation following at least 6 weeks of aerobic exercise.

Results

Only one study compared accumulated exercise to single-bout exercise with no significant effect on fasting glucose (95% CI: −0.04 to 0.24 mmol·L-1) or fasting insulin (95% CI: −1.79 to 9.85 pmol·L-1) reported 48 hours after the final bout. No studies compared accumulated exercise with no-exercise. Compared with no-exercise, single-bout exercise reduces insulin resistance (mean difference (MD): −0.53 pmol·L-1; 95% CI: −0.93 to −0.13). Insulin resistance was clearly reduced with moderate-intensity (−0.68 (−1.28 to −0.09)) but not with high-intensity (−0.38 (−1.20 to 0.44)) exercise. Single-bout exercise was not statistically more beneficial than no-exercise for glycated haemoglobin (HbA1c) (MD: −0.11 %; 95% CI: −0.24 to 0.02) in metabolically healthy individuals.

Summary/conclusion

The glycaemic response to accumulated exercise or single-bout exercise might not be different, however exercise intensity might influence the mechanisms generating the response.

PROSPERO registration number

CRD42015025042.
Tandem cervical carotid stenting for stenosis with flow diversion embolisation for the treatment of intracranial aneurysms
Authors: Campos Jessica K , Lin Li-Mei , Beaty Narlin B , Bender Matthew T , Jiang Bowen , Zarrin David A , Coon Alexander L
Published: December 2018

Background

An estimated 2%–3% of the population harbour an intracranial aneurysm. Concomitant atherosclerotic cervical carotid disease is not uncommon. The management of these two entities remains a challenge within the field.

Case presentation

We report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.

Discussion

No consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis. Here, we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment. The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.
Development and simulation of magnetorheological damper for segment erector vibration control
Authors: Yang Bo , Zhang Ao , Bai Yan , Zhang Kuo , Li He
Published: December 2018

In this paper, magnetorheological dampers are applied to a segment erector to replace passive vibration dampers. Because magnetorheological damper dynamics are highly nonlinear, design of a direct control system is impossible. To apply linear control theory directly to design the magnetorheological damper controller, the Takagi–Sugeno fuzzy model analytically represents the segment erector model. In addition, a disturbance observer based on a Takagi–Sugeno fuzzy controller is proposed for this system. Both simulations and experiments validate the performance enhancement and stability of the controller. The results show that the acceleration of the segment erector was reduced by 59.6% and 32.1% in oblique wave excitation and random excitation, respectively, compared to a conventional passive damper. The proposed fuzzy controller and magnetorheological dampers have great potential in practical applications because they can significantly improve the performance of a segment erector.
A Generalized Evaluation Framework for Multimedia Recommender Systems
Authors: Ge Mouzhi , Persia Fabio
Published: December 2018

With the widespread availability of media technologies, such as real-time streaming, new Internet-of-Thing devices and smart phones, multimedia data are extensively increased and the big multimedia data rapidly spread over various social networks. This has created complexity and information overload for users to choose the suitable multimedia objects. Thus, different multimedia recommender systems have been emerging to help users find the useful multimedia objects that are possibly preferred by the user. However, the evaluation of these multimedia recommender systems is still in an ad-hoc stage. Given the distinct features of multimedia objects, the evaluation criteria adopted from the general recommender systems might not be effectively used to evaluate multimedia recommendations. In this paper, we therefore review and analyze the evaluation criteria that have been used in the previous multimedia recommender system papers. Based on the review, we propose a generalized evaluation framework to guide the researchers and practitioners to perform evaluations, especially user-centric evaluations, for multimedia recommender systems.
A hybrid Markov chain-tree valuation framework for stochastic volatility jump diffusion models
Authors: Nguyen Duy
Published: December 2018

We develop a unified hybrid valuation framework for computing option values under stochastic volatility (SV) models with a jump component. The proposed method originates from the tree method and regime switching approximation. Conditions on the choices of key parameters for the tree design are provided to guarantee the positivity of branch probabilities. We also prove the weak convergence of the proposed method to the true stochastic models. Numerical results are provided to illustrate the effectiveness of the proposed method.
A Taxonomy and Future Directions for Sustainable Cloud Computing
Authors: Gill Sukhpal Singh , Buyya Rajkumar
Published: December 2018

The cloud-computing paradigm offers on-demand services over the Internet and supports a wide variety of applications. With the recent growth of Internet of Things (IoT)--based applications, the use of cloud services is increasing exponentially. The next generation of cloud computing must be energy efficient and sustainable to fulfill end-user requirements, which are changing dynamically. Presently, cloud providers are facing challenges to ensure the energy efficiency and sustainability of their services. The use of a large number of cloud datacenters increases cost as well as carbon footprints, which further affects the sustainability of cloud services. In this article, we propose a comprehensive taxonomy of sustainable cloud computing. The taxonomy is used to investigate the existing techniques for sustainability that need careful attention and investigation as proposed by several academic and industry groups. The current research on sustainable cloud computing is organized into several categories: application design, sustainability metrics, capacity planning, energy management, virtualization, thermal-aware scheduling, cooling management, renewable energy, and waste heat utilization. The existing techniques have been compared and categorized based on common characteristics and properties. A conceptual model for sustainable cloud computing has been presented along with a discussion on future research directions.
Thermodynamics of Charged AdS Black Holes in Rainbow Gravity
Authors: Li Ping , He Miao , Ding Jia-Cheng , Hu Xian-Ru , Deng Jian-Bo
Published: December 2018

In this paper, the thermodynamic property of charged AdS black holes is studied in rainbow gravity. By the Heisenberg Uncertainty Principle and the modified dispersion relation, we obtain deformed temperature. Moreover, in rainbow gravity we calculate the heat capacity in a fixed charge and discuss the thermal stability. We also obtain a similar behaviour with the liquid-gas system in extending phase space (including P and r) and study its critical behavior with the pressure given by the cosmological constant and with a fixed black hole charge Q. Furthermore, we study the Gibbs function and find its characteristic swallow tail behavior, which indicates the phase transition. We also find that there is a special value about the mass of test particle which would lead the black hole to zero temperature and a diverging heat capacity with a fixed charge.
Comparisons of Jaw Line and Face Line after Mandibular Setback: Intraoral Vertical Ramus versus Sagittal Split Ramus Osteotomies
Authors: Chen Chun-Ming , Tseng Yu-Chuan , Ko Edward Chengchuan , Chen Michael Yuan-Chien , Chen Kwei-Jing , Cheng Jung-Hsuan
Published: December 2018

Background. This study investigates the differences in the lateral profile and frontal appearance after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) procedures for the correction of mandibular prognathism. Methods. Sixty patients (30 SSRO and 30 IVRO) underwent mandibular setback surgery. Serial cephalograms were obtained: (1) T1: approximately 1 month before surgery; (2) T2: at least 6 months after surgery for SSRO and at least 1 year after surgery for IVRO. The landmarks, linear distances, and related angles were measured. The t-test was applied to the intragroup and intergroup comparisons. The null hypothesis was that SSRO and IVRO made no difference in the facial appearance. Results. In the IVRO group, the ramus and gonial widths significantly decreased by 3.9 mm and 5.8 mm, respectively. SSRO significantly reduced the gonial angle by 2.6°, and IVRO increased it significantly by 5.3°. The postoperative increases at frontal bone levels 0 and 1 after IVRO were significantly larger than those after SSRO, but, at level 3, the increases after SSRO were larger than those after IVRO. In the frontal muscular and facial planes, SSRO and IVRO presented no difference. The frontal jaw angle and face angle were significantly larger with IVRO than with SSRO. Therefore, the null hypothesis was rejected. Conclusions. The ramus width and gonial width were significantly decreased in IVRO compared to SSRO. IVRO increased angles in the lateral profile (gonial angle and mandibular plane angle) and frontal appearance (jaw angle and face angle) more than SSRO did.
A Low-Cost Named Entity Recognition Research Based on Active Learning
Authors: Huang Han , Wang Hongyu , Jin Dawei
Published: December 2018

Named entity recognition (NER) is an indispensable and very important part of many natural language processing technologies, such as information extraction, information retrieval, and intelligent Q & A. This paper describes the development of the AL-CRF model, which is a NER approach based on active learning (AL). The algorithmic sequence of the processes performed by the AL-CRF model is the following: first, the samples are clustered using the k-means approach. Then, stratified sampling is performed on the produced clusters in order to obtain initial samples, which are used to train the basic conditional random field (CRF) classifier. The next step includes the initiation of the selection process which uses the criterion of entropy. More specifically, samples having the highest entropy values are added to the training set. Afterwards, the learning process is repeated, and the CRF classifier is retrained based on the obtained training set. The learning and the selection process of the AL is running iteratively until the harmonic mean F stabilizes and the final NER model is obtained. Several NER experiments are performed on legislative and medical cases in order to validate the AL-CRF performance. The testing data include Chinese judicial documents and Chinese electronic medical records (EMRs). Testing indicates that our proposed algorithm has better recognition accuracy and recall rate compared to the conventional CRF model. Moreover, the main advantage of our approach is that it requires fewer manually labelled training samples, and at the same time, it is more effective. This can result in a more cost effective and more reliable process.
Nasal Discharge Eosinophils in Childhood Asthma Patients as a Predictive Factor for Persistent Asthma
Authors: Murayama Norihide , Murayama Kikuno
Published: December 2018

Objective. Eosinophilic inflammation is thought to play a role in childhood asthma. Thus, examination of nasal eosinophils, instead of sputum, may be useful for the diagnosis of not only eosinophil-positive rhinitis but also persistent asthma. Nasal eosinophil examination is a routine for the diagnosis of nasal eosinophil-positive rhinitis in patients with rhinorrhea symptoms. This retrospective study investigated whether testing for nasal discharge eosinophils is useful for diagnosing childhood allergic asthma and whether nasal discharge eosinophils are predictive of persistent asthma. Methods. Infants and young children (n=180) with at least 3 recurrent episodes of respiratory symptoms and bronchodilator inhalation improvements at intervals of ≥1 week were divided into the asthma group and the nonasthma group, and the presence or absence of nasal discharge eosinophils was examined by age. Correlations between nasal discharge eosinophils and other predictive factors for persistent asthma were also examined. Results. The evaluation of nasal discharge eosinophils in the asthma group showed a significantly higher positive rate in older age groups than in the 0–1-year-old age group (p<0.05–0.001). However, none of the asthma patient groups had any significant changes between the 0–1-year-old and older groups. This pattern was similar for other risk factors, showing correlations between nasal discharge eosinophils and other predictive factors. Conclusions. Testing for nasal discharge eosinophils with asthma symptoms increases with age. Nasal discharge eosinophils with asthma symptoms may be a predictive factor for persistent asthma. This trial is registered with UMIN Clinical Trials (registration number UMIN000030776).
Factors Contributing to Low Adherence to Community-Based Health Insurance in Rural Nyanza District, Southern Rwanda
Authors: Mukangendo Mecthilde , Nzayirambaho Manasse , Hitimana Regis , Yamuragiye Assumpta
Published: December 2018

Background. Community-based health insurance (CBHI) schemes are an emerging mechanism for providing financial protection against health-related poverty. In Rwanda, CBHI is being implemented across the country, and it is based on four socioeconomic categories of the “Ubudehe system”: the premiums of the first category are fully subsidized by government, the second and third category members pay 3000 frw, and the fourth category members pay 7000 frw as premium. However, low adherence of community to the scheme since 2011 has not been sufficiently studied. Objective. This study aimed at determining the factors contributing to low adherence to the CBHI in rural Nyanza district, southern Rwanda. Methodology. A cross-sectional study was conducted in nine health centers in rural Nyanza district from May 2017 to June 2017. A sample size of 495 outpatients enrolled in CBHI or not enrolled in the CBHI scheme was calculated based on 5% margin of error and a 95% confidence interval. Logistic regression was used to identify the determinants of low adherence to CBHI. Results. The study revealed that there was a significant association between long waiting time to be seen by a medical care provider and between health care service provision and low adherence to the CBHI scheme (P value < 0.019) (CI: 0.09107 to 0.80323). The estimates showed that premium not affordable (P value < 0.050) (CI: 0.94119 to 9.8788) and inconvenient model of premium payment (P value < 0.001) (CI: 0.16814 to 0.59828) are significantly associated with low adherence to the CBHI scheme. There was evidence that the socioeconomic status as measured by the category of Ubudehe (P value < 0.005) (CI: 1.4685 to 8.93406) increases low adherence to the CBHI scheme. Conclusion. This study concludes that belonging to the second category of the Ubudehe system, long waiting time to be seen by a medical care provider and between services, premium not affordable, and inconvenient model of premium payment were significant predictors of low adherence to CBHI scheme.
Identification of In Vivo Metabolites of Dictamnine in Mice Using HPLC-LTQ-Orbitrap Mass Spectrometry
Authors: Fu Yudong , Deng Yujie , Yu Qing , Meng Xuxia , Wang Dabo , Wang Pei , Wang Ping
Published: December 2018

Dictamnine (4-methoxyfuro[2,3-b]quinolone, DIC), a common furoquinoline alkaloid in the family of Rutaceae, showed diverse biological activities. To investigate the in vivo metabolic pathways of DIC, metabolism of DIC in mice was studied using a high-performance liquid chromatography coupled to electrospray ionization of hybrid linear trap quadrupole orbitrap (HPLC-LTQ-Orbitrap) mass spectrometer. Nine metabolites were identified in the DIC-treated mouse urine, plasma, and fecal samples, of which two were identified as new metabolites. The major metabolic pathways of DIC in animal and human liver microsomes were confirmed in the present study, including o-demethylation, monohydroxylation, N-oxidation, and 2,3-olefinic epoxidation pathways. For the first time, a mono-acetylcysteine conjugate of DIC (M9) was detected from DIC-treated mouse urine and plasma samples, and 4-methoxy-2-oxo-1,2-dihydroquinoline-3-carboxylic acid (M10) and 2-(2,8-dihydroxy-4-methoxyquinolin-3-yl)acetaldehyde (M11) were identified as new metabolites of DIC; furthermore, using an in vitro human fecal incubation model, furo[2,3-b]quinolin-4-ol (M1) was verified to be a microbial demethylated metabolite of DIC. Collectively, the present study provided new information on the in vivo metabolic fate of DIC.
Inflammatory Profiles in Depressed Adolescents Treated with Fluoxetine: An 8-Week Follow-up Open Study
Authors: Pérez-Sánchez Gilberto , Becerril-Villanueva Enrique , Arreola Rodrigo , Martínez-Levy Gabriela , Hernández-Gutiérrez María Eugenia , Velasco-Velásquez Marco A. , Alvarez-Herrera Samantha , Cruz-Fuentes Carlos , Palacios Lino , de la Peña Francisco , Pavón Lenin
Published: December 2018

Changes in cytokine levels in major depression and during treatment have been reported in adults. However, few studies have examined cytokine levels in an adolescent sample despite this being a common age of onset.Methods. We measured proinflammatory (IL-2, IFN-γ, IL-1β, TNF-α, IL-6, IL-12, and IL-15) and anti-inflammatory (IL-4, IL-5, IL-13, IL-1Ra, and IL-10) cytokine serum levels in 22 adolescents with major depression and 18 healthy volunteers. Cytokines were measured by multiplex bead-based immunoassays at baseline, and 4 and 8 weeks after commencement of fluoxetine administration in the clinical group.Results. Compared to healthy volunteers, adolescents with major depression at baseline showed significant increases in all pro- and anti-inflammatory cytokines, except IL-1Ra and IL-10. Significant changes were observed in fluoxetine treatment compared to baseline: proinflammatory cytokines IFN-γ, IL-1β, TNF-α, IL-6, IL-12, and IL-15 were decreased only at week 4 whereas IL-2 was increased only at week 8; anti-inflammatory cytokines IL-4 and IL-5 were increased at week 8 while IL-1Ra was reduced only at week 4. There were no significant correlations between cytokine levels and symptomatic improvement in HDRS.Discussion. The results suggest a significant interplay between cytokine levels, the depressive state, and the stage of treatment with an SSRI. To the best of our knowledge, this is the first report in depressed adolescents with elevated IL-12, IL-13, and IL-15 levels. Further studies are necessary to clarify the role and mechanisms of altered cytokine levels in the pathogenesis and physiopathology of major depressive disorder.
Complex Clonal Diversity ofStaphylococcus aureusNasal Colonization among Community Personnel, Healthcare Workers, and Clinical Students in the Eastern Province, Saudi Arabia
Authors: El-Mahdy Taghrid S. , Al-Agamy Mohamed H. , Emara Mohamed , Barakat Assem , Goering Richard V.
Published: December 2018

Here, 210 healthy participants including community personnel (70), clinical students (68), and healthcare workers (HCWs) (72) from the eastern region of Saudi Arabia were studied. Sixty-threeStaphylococcus aureusisolates were obtained from the nares of 37% of the community personnel and 26% of the clinical students and HCWs. Methicillin-resistantS. aureus(MRSA) was found in 16% (10 isolates) of the 63 isolates; six were from HCWs. Molecular characterization revealed high clonal diversity among the isolates, with 19 differentspatypes, 12 clonal complexes (CCs), and seven sequence types (STs) detected. The most common strain type was USA900, CC15, and t084, seen in 11 methicillin-susceptibleS. aureus(MSSA) isolates. Moreover, three novelspatypes in six isolates and one novel ST in two isolates were identified, most from HCWs. Interestingly, 29 isolates weremecA positive by PCR, whereas only 10 isolates were MRSA by disk diffusion (cefoxitin resistant). Of the 19 MSSAmecA-positive isolates, 16 were PBP2a negative, leaving three unique isolates from HCWs that weremecA and PBP2a positive yet cefoxitin susceptible. Our findings highlight the importance of phenotypically and genotypically characterizingS. aureusstrains isolated from healthy communities to monitor the risk of possible cross-transmission to hospitalized patients. The identified strains showed a clonal lineage relationship with previously reportedS. aureusand MRSA strains acquired from hospital settings.
The Prophylactic and Therapeutic Effects of Fermented Cordyceps sinensis Powder, Cs‐C‐Q80, on Subcortical Ischemic Vascular Dementia in Mice
Authors: Chen Ying , Fu Lifeng , Han Min , Jin Meiying , Wu Jiaying , Tan Li , Chen Zhong , Zhang Xiangnan
Published: December 2018

Corbrin Capsule, a preparation of Cordyceps sinensis analogue, is a pleiotropic traditional Chinese patent medicine with the main component of fermentative cordyceps fungus powder (Cs‐C‐Q80). The neuroprotective effects of Cs‐C‐Q80, as a substitution of Cordyceps sinensis, have not been fully identified. The objectives of this study were to explore the prophylactic and therapeutic effects of Cs‐C‐Q80 in vascular dementia mice model. The efficacy of Cs‐C‐Q80 was investigated in a molecular level as well. The subcortical ischemic vascular dementia was modelled by permanent right unilateral common carotid arteries occlusion (rUCCAO) in adult male mice. The animals were randomly divided and treated by gavage with vehicle (1% CMC‐Na solution) (rUCCAO model) or Cs‐C‐Q80 powder at 0.2 g/kg or 1.0 g/kg, respectively. Preventive treatment was administrated by gavage daily for 7 days before rUCCAO, while therapeutic treatment was administrated continuously from 28 days after rUCCAO. Object recognition test and Morris water maze test were performed to evaluate the learning and working memory. The luxol fast blue stain (Kluver‐Barrera method) and immunohistochemistry for myelin basic protein (MBP) were employed to determine the severity of white matter damage. Both preventive and therapeutic treatment with Cs‐C‐Q80 protected against the rUCCAO‐induced memory impair in mice as determined by object recognition and Morris water maze tests. The histopathological analyses revealed significant white matter rarefaction and reduction of MBP expression in corpus callosum after rUCCAO, which could be counteracted by either preventive or therapeutic treatment with Cs‐C‐Q80. Moreover, the Cs‐C‐Q80 treatments inhibited rUCCAO‐induced astrocytes activation and the tumor necrosis factor α (TNF‐α) and interleukin‐1β expression, indicating the anti‐inflammatory roles of Cs‐C‐Q80 against subcortical ischemia. Cs‐C‐Q80 is a potential preparation for the prophylaxis and treatment of subcortical ischemic vascular dementia. The underlying pharmacological efficacy might be associated with suppression of myelin degeneration, glia activation, and inflammatory cytokines release.
Toxoplasma gondii Infection in Diabetes Mellitus Patients in China: Seroprevalence, Risk Factors, and Case-Control Studies
Authors: Li Yong-Xin , Xin Hai , Zhang Xiang-Yan , Wei Cui-Ying , Duan Yu-He , Wang Hao-Fu , Niu Hai-Tao
Published: December 2018

The association between Toxoplasma gondii (T. gondii) infection and diabetes mellitus remains controversial. With the improvement of living standards, the prevalence rate of diabetes is steadily increasing in China. Thus, it is necessary to explore the possible association between toxoplasmosis and diabetes mellitus in China. Hence, case-control studies were conducted to explore the T. gondii seroprevalence and identify the risk factors and possible transmission routes of T. gondii infection in different types of diabetes, including type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) patients in China. Four hundred serum samples for each type of diabetes mellitus, matched with 400 control subjects for each group, were collected and examined for anti-T. gondii IgG and IgM antibodies using commercially available enzyme immunoassay kits. The total T. gondii seroprevalence in T1DM, T2DM, and GDM patients was 16.50%, 23.50%, and 21.25%, respectively. Each type of diabetes mellitus patients had a significantly higher T. gondii seroprevalence than the control subjects. Multivariate regression identified three variables as risk factors for T. gondii infection in diabetes patients, including keeping cats at home and consumption of raw oysters for T1DM patients and consumption of raw/undercooked meat and raw oysters for T2DM patients, which may help to guide future research and control policies in diabetes mellitus patients.
A Simple Alternating Direction Method for the Conic Trust Region Subproblem
Authors: Zhu Honglan , Ni Qin
Published: December 2018

A simple alternating direction method is used to solve the conic trust region subproblem of unconstrained optimization. By use of the new method, the subproblem is solved by two steps in a descent direction and its orthogonal direction, the original conic trust domain subproblem into a one-dimensional subproblem and a low-dimensional quadratic model subproblem, both of which are very easy to solve. Then the global convergence of the method under some reasonable conditions is established. Numerical experiment shows that the new method seems simple and effective.
Unexpected Stabilization ofα-Ni(OH)2Nanoparticles in GO Nanocomposites
Authors: Gonçalves Josué M. , Alves Kamilla M. , Gonzalez-Huila Manuel F. , Duarte Alfredo , Martins Paulo R. , Araki Koiti
Published: December 2018

Large specific charge capacity Ni(OH)2@GO nanocomposites, able to withstand high current densities and more than 500 redox cycles without significant loss of charge storage capacity, were realized thanks to unexpected stabilization of electrochemically activeα-Ni(OH)2nanoparticles by GO and were characterized by TEM, XRD, FTIR, TXRF, and confocal Raman microscopy. Stable and adherent films with low electric resistance, able to withstand current densities as high as 100 A·g−1, were generated, as demonstrated by CV, EIS, and galvanostatic charge-discharge measurements, showing good perspectives as electrode material for hybrid energy storage devices.
Impact of Early versus Late Initiation of Renal Replacement Therapy in Patients with Cardiac Surgery-Associated Acute Kidney Injury: Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials
Authors: Cui Jie , Tang Da , Chen Zhen , Liu Genglong
Published: December 2018

Background. Previous studies have examined the effect of the initiation time of renal replacement therapy (RRT) in patients with cardiac surgery-associated acute kidney injury (CSA-AKI), but the findings remain controversial. The aim of this meta-analysis was to systematically and quantitatively compare the impact of early versus late initiation of RRT on the outcome of patients with CSA-AKI.Methods. Four databases (PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase) were systematically searched from inception to June 2018 for randomized clinical trials (RCTs). Two investigators independently performed the literature search, study selection, data extraction, and quality evaluation. Meta-analysis and trial sequential analysis (TSA) were used to examine the impact of RRT initiation time on all-cause mortality (primary outcome). The Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the level of evidence.Results. We identified 4 RCTs with 355 patients that were eligible for inclusion. Pooled analyses indicated no difference in mortality for patients receiving early and late initiation of RRT (relative risk [RR] = 0.61, 95% confidence interval [CI] = 0.33 to 1.12). However, the results were not confirmed by TSA. Similarly, early RRT did not reduce the length of stay (LOS) in the intensive care unit (ICU) (mean difference [MD] = -1.04; 95% CI = -3.34 to 1.27) or the LOS in the hospital (MD = -1.57; 95% CI = -4.62 to 1.48). Analysis using GRADE indicated the certainty of the body of evidence was very low for a benefit from early initiation of RRT.Conclusion. Early initiation of RRT had no beneficial impacts on outcomes in patients with CSA-AKI. Future larger and more adequately powered prospective RCTs are needed to verify the benefit of reduced mortality associated with early initiation of RRT.Trial Registration. This trial is registered with PROSPERO registration number CRD42018084465, registered on 11 February 2018.
Anogenital Ulcers: An Unusual Manifestation of Invasive Aspergillosis
Authors: Vargas Pablo , Valenzuela Fernando , Kaplan Viera , Yumha Jacob , Arceu Montserrat , Morales Claudia
Published: December 2018

Aspergillus spp. is one of the most ubiquitous fungi but generally does not cause disease in immunocompetent patients. It is the second most frequent agent of opportunistic fungal infections, after Candida albicans, with a rise in its incidence on recent years. Invasive fungal diseases represent an important cause of morbidity and mortality. Its origin can be primary, in relation to a cutaneous injury, or secondary, by extension from contiguous tissues, or by hematogenous spread, usually in the context of pulmonary aspergillosis. In this report, we describe the case of an elderly woman with invasive aspergillosis that manifested with anogenital and skin ulcers, with unfavorable outcome, despite intensive therapy and intravenous antifungals.
Microfluidic Preparation of Liposomes Using Ethyl Acetate/n-Hexane Solvents as an Alternative to Chloroform
Authors: Yang Eunhye , Yu Hyunjong , Park Jun-Young , Park Kyung-Min , Chang Pahn-Shick
Published: December 2018

Although liposomes have been used as a nutrient delivery carrier in the pharmaceutical, cosmetic, and food industries, they still suffer from the critical issue caused by the use of halogenated solvents (e.g., chloroform), which may be harmful to humans. Nonhalogenated solvents have been screened as candidate substitutes for chloroform based on their physicochemical properties. However, none of the candidates examined to date could form stable inverted micelles when used alone. Here, to obtain physicochemical properties similar to chloroform, combined mixtures were prepared using various ratios of each candidate. Based on the results of random combination trials with numerous candidates, ethyl acetate: n-hexane = 4 : 1(v/v) was selected as the optimum ratio because it could form stable inverted micelles and a transparent liposome solution without phase separation. The ethyl acetate and n-hexane mixture are a potential substitute for chloroform, which may resolve concerns regarding the toxicity of residual halogenated solvents in lipid nanovesicles.
Errors in Aerosol Inhaler Use and Their Effects on Maternal and Fetal Outcomes among Pregnant Asthmatic Women (Subanalysis from QAKCOP Study)
Authors: Ibrahim Wanis H. , Rasul Fatima , Ahmad Mushtaq , Bajwa Abeer S. , Alamlih Laith I. , El Arabi Anam M. , Al-Mohannadi Dhabia , Siddiqui Mohammed Y. , Al-Sheikh Israa S. , Ibrahim Azdin A.
Published: December 2018

Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient’s understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient’s cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient’s education is imperative.
Carotid Artery Endarterectomy Effect on Choroidal Thickness: One-Year Follow-Up
Authors: Rabina Gilad , Barequet Dana , Mimouni Michael , Rabinovitch Yefim , Wolf Yehuda , Barak Adiel , Loewenstein Anat , Schwartz Shulamit
Published: December 2018

Purpose. To evaluate the change in choroidal thickness after carotid artery endarterectomy (CEA) in patients without retinal pathology. Methods. A prospective series of patients who underwent CEA at the Tel Aviv Medical Center. Spectral domain optical coherence tomography (SD-OCT) was performed one day before the CEA and at least 6 months after. Data included medical history, smoking history, percentage of carotid stenosis before and after CEA, best-corrected visual acuity (BCVA), central macular thickness (CMT), and choroidal thickness (subfoveal, 500 µm, 1000 µm, and 1500 µm nasal and temporal). Results. Eight patients (seven male and one female) with a mean age of 70.5 ± 6.1 years were included in the study. The mean internal carotid artery (ICA) stenosis was 89.8% ± 5.1 in the operated side, 33.7% ± 10.9 in the nonoperated side (p<0.0001), and 0% after CEA (p<0.0001). Operated side BCVA was 0.35 ± 0.66 compared to 0.61 ± 0.83 in the nonoperated side (p=0.51). The mean subfoveal choroidal thickness (SFChT) of the operated side was 277 ± 67 µm compared to 268 ± 71 µm in the nonoperated side (p=0.81). SFChT and CMT after CEA were 275 ± 64 µm (p=0.96) and 268 ± 29 µm (p=0.98), respectively. Conclusions. SFChT and CMT in patients without retinal or choroidal pathology and significant ICA stenosis can be normal and may not change after successful ipsilateral CEA.