bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetics and Yields of Pesticide Biodegradation at Low Substrate Concentrations and under Conditions Restricting Assimilable Organic Carbon
Authors: Helbling Damian E. , Hammes Frederik , Egli Thomas , Kohler Hans-Peter E.
Published: December 2013

The fundamentals of growth-linked biodegradation occurring at low substrate concentrations are poorly understood. Substrate utilization kinetics and microbial growth yields are two critically important process parameters that can be influenced by low substrate concentrations. Standard biodegradation tests aimed at measuring these parameters generally ignore the ubiquitous occurrence of assimilable organic carbon (AOC) in experimental systems which can be present at concentrations exceeding the concentration of the target substrate. The occurrence of AOC effectively makes biodegradation assays conducted at low substrate concentrations mixed-substrate assays, which can have profound effects on observed substrate utilization kinetics and microbial growth yields. In this work, we introduce a novel methodology for investigating biodegradation at low concentrations by restricting AOC in our experiments. We modified an existing method designed to measure trace concentrations of AOC in water samples and applied it to systems in which pure bacterial strains were growing on pesticide substrates between 0.01 and 50 mg liter
−1
. We simultaneously measured substrate concentrations by means of high-performance liquid chromatography with UV detection (HPLC-UV) or mass spectrometry (MS) and cell densities by means of flow cytometry. Our data demonstrate that substrate utilization kinetic parameters estimated from high-concentration experiments can be used to predict substrate utilization at low concentrations under AOC-restricted conditions. Further, restricting AOC in our experiments enabled accurate and direct measurement of microbial growth yields at environmentally relevant concentrations for the first time. These are critical measurements for evaluating the degradation potential of natural or engineered remediation systems. Our work provides novel insights into the kinetics of biodegradation processes and growth yields at low substrate concentrations.
Nonredundant Roles for Cytochrome
c
2
and Two High-Potential Iron-Sulfur Proteins in the Photoferrotroph Rhodopseudomonas palustris TIE-1
Authors: Bird Lina J. , Saraiva Ivo H. , Park Shannon , Calçada Eduardo O. , Salgueiro Carlos A. , Nitschke Wolfgang , Louro Ricardo O. , Newman Dianne K.
Published: December 2013

The purple bacterium
Rhodopseudomonas palustris
TIE-1 expresses multiple small high-potential redox proteins during photoautotrophic growth, including two high-potential iron-sulfur proteins (HiPIPs) (PioC and Rpal_4085) and a cytochrome
c
2
. We evaluated the role of these proteins in TIE-1 through genetic, physiological, and biochemical analyses. Deleting the gene encoding cytochrome
c
2
resulted in a loss of photosynthetic ability by TIE-1, indicating that this protein cannot be replaced by either HiPIP in cyclic electron flow. PioC was previously implicated in photoferrotrophy, an unusual form of photosynthesis in which reducing power is provided through ferrous iron oxidation. Using cyclic voltammetry (CV), electron paramagnetic resonance (EPR) spectroscopy, and flash-induced spectrometry, we show that PioC has a midpoint potential of 450 mV, contains all the typical features of a HiPIP, and can reduce the reaction centers of membrane suspensions in a light-dependent manner at a much lower rate than cytochrome
c
2
. These data support the hypothesis that PioC linearly transfers electrons from iron, while cytochrome
c
2
is required for cyclic electron flow. Rpal_4085, despite having spectroscopic characteristics and a reduction potential similar to those of PioC, is unable to reduce the reaction center. Rpal_4085 is upregulated by the divalent metals Fe(II), Ni(II), and Co(II), suggesting that it might play a role in sensing or oxidizing metals in the periplasm. Taken together, our results suggest that these three small electron transfer proteins perform different functions in the cell.
Cell Growth Inhibition upon Deletion of Four Toxin-Antitoxin Loci from the Megaplasmids of Sinorhizobium meliloti
Authors: Milunovic Branislava , diCenzo George C. , Morton Richard A. , Finan Turlough M.
Published: December 2013

Toxin and antitoxin (TA) gene pairs are addiction systems that are present in many microbial genomes.
Sinorhizobium meliloti
is an N
2
-fixing bacterial symbiont of alfalfa and other leguminous plants, and its genome consists of three large replicons, a circular chromosome (3.7 Mb) and the megaplasmids pSymA (1.4 Mb) and pSymB (1.7 Mb).
S. meliloti
carries 211 predicted type II TA genes, each encoding a toxin or an antitoxin. We constructed defined deletion strains that collectively removed the entire pSymA and pSymB megaplasmids except for their
oriV
regions. Of approximately 100 TA genes on pSymA and pSymB, we identified four whose loss was associated with cell death or stasis unless copies of the genes were supplied in
trans
. Orthologs of three of these loci have been characterized in other organisms (
relB/E
[
sma0471/sma0473
],
Fic
[
DOC
] [
sma2105
], and
VapC
[
PIN
] [
orf2230/sma2231
]), and this report contains the first experimental proof that
RES/Xre
(
smb21127/smb21128
) loci can function as a TA system. Transcriptome sequencing (RNA-seq) analysis did not reveal transcriptional differences between the TA systems to account for why deletion of the four “active” systems resulted in cell toxicity. These data suggest that severe cell growth phenotypes result from the loss of a few TA systems and that loss of most TA systems may result in more subtle phenotypes. These four TA systems do not appear to play a direct role in the
S. meliloti
-alfalfa symbiosis, as strains lacking these TA systems had a symbiotic N
2
fixation phenotype that was indistinguishable from the wild type.
Structural Modeling and Physicochemical Characterization Provide Evidence that P66 Forms a β-Barrel in the Borrelia burgdorferi Outer Membrane
Authors: Kenedy Melisha R. , Luthra Amit , Anand Arvind , Dunn Joshua P. , Radolf Justin D. , Akins Darrin R.
Published: December 2013

The
Borrelia burgdorferi
outer membrane (OM) contains numerous surface-exposed lipoproteins but a relatively low density of integral OM proteins (OMPs). Few membrane-spanning OMPs of
B. burgdorferi
have been definitively identified, and none are well characterized structurally. Here, we provide evidence that the borrelial OMP P66, a known adhesin with pore-forming activity, forms a β-barrel in the
B. burgdorferi
OM. Multiple computer-based algorithms predict that P66 forms a β-barrel with either 22 or 24 transmembrane domains. According to our predicted P66 topology, a lysine residue (K487) known to be sensitive to trypsin cleavage is located within a surface-exposed loop. When we aligned the mature P66 amino acid sequences from
B. burgdorferi
and
B. garinii
, we found that K487 was present only in the
B. burgdorferi
P66 protein sequence. When intact cells from each strain were treated with trypsin, only
B. burgdorferi
P66 was trypsin sensitive, indicating that K487 is surface exposed, as predicted. Consistent with this observation, when we inserted a c-Myc tag adjacent to K487 and utilized surface localization immunofluorescence, we detected the loop containing K487 on the surface of
B. burgdorferi
. P66 was examined by both Triton X-114 phase partitioning and circular dichroism, confirming that the protein is amphiphilic and contains extensive (48%) β-sheets, respectively. Moreover, P66 also was able to incorporate into liposomes and form channels in large unilamellar vesicles. Finally, blue native PAGE (BN-PAGE) revealed that under nondenaturing conditions, P66 is found in large complexes of ∼400 kDa and ∼600 kDa. Outer surface lipoprotein A (OspA) and OspB both coimmunoprecipitate with P66, demonstrating that P66 associates with OspA and OspB in
B. burgdorferi
. The combined computer-based structural analyses and supporting physicochemical properties of P66 provide a working model to further examine the porin and integrin-binding activities of this OMP as they relate to
B. burgdorferi
physiology and Lyme disease pathogenesis.
Identification of 3-Sulfinopropionyl Coenzyme A (CoA) Desulfinases within the Acyl-CoA Dehydrogenase Superfamily
Authors: Schürmann Marc , Demming Rebecca Michaela , Krewing Marco , Rose Judith , Wübbeler Jan Hendrik , Steinbüchel Alexander
Published: December 2013

In a previous study, the essential role of 3-sulfinopropionyl coenzyme A (3SP-CoA) desulfinase acyl-CoA dehydrogenase (Acd) in
Advenella mimigardefordensis
strain DPN7
T
(Acd
DPN7
) during degradation of 3,3′-dithiodipropionic acid (DTDP) was elucidated. DTDP is a sulfur-containing precursor substrate for biosynthesis of polythioesters (PTEs). Acd
DPN7
showed high amino acid sequence similarity to acyl-CoA dehydrogenases but was unable to catalyze a dehydrogenation reaction. Hence, it was investigated in the present study whether 3SP-CoA desulfinase activity is an uncommon or a widespread property within the acyl-CoA dehydrogenase superfamily. Therefore, proteins of the acyl-CoA dehydrogenase superfamily from
Advenella kashmirensis
WT001,
Bacillus cereus
DSM31,
Cupriavidus necator
N-1,
Escherichia coli
BL21,
Pseudomonas putida
KT2440,
Burkholderia xenovorans
LB400,
Ralstonia eutropha
H16,
Variovorax paradoxus
B4,
Variovorax paradoxus
S110, and
Variovorax paradoxus
TBEA6 were expressed in
E. coli
strains. All purified acyl-CoA dehydrogenases appeared as homotetramers, as revealed by size exclusion chromatography. Acd
S110
, Acd
B4
, Acd
H16
, and Acd
KT2440
were able to dehydrogenate isobutyryl-CoA. Acd
KT2440
additionally dehydrogenated butyryl-CoA and valeryl-CoA, whereas Acd
DSM31
dehydrogenated only butyryl-CoA and valeryl-CoA. No dehydrogenation reactions were observed with propionyl-CoA, isovaleryl-CoA, succinyl-CoA, and glutaryl-CoA for any of the investigated acyl-CoA dehydrogenases. Only Acd
TBEA6
, Acd
N-1
, and Acd
LB400
desulfinated 3SP-CoA and were thus identified as 3SP-CoA desulfinases within the acyl-CoA dehydrogenase family, although none of these three Acds dehydrogenated any of the tested acyl-CoA thioesters. No appropriate substrates were identified for Acd
BL21
and Acd
WT001
. Spectrophotometric assays provided apparent

K
m

and
V
max
values for active substrates and indicated the applicability of phylogenetic analyses to predict the substrate range of uncharacterized acyl-CoA dehydrogenases. Furthermore,
C. necator
N-1 was found to utilize 3SP as the sole source of carbon and energy.
Regulation of the Response Regulator Gene
degU
through the Binding of SinR/SlrR and Exclusion of SinR/SlrR by DegU in Bacillus subtilis
Authors: Ogura Mitsuo , Yoshikawa Hirofumi , Chibazakura Taku
Published: December 2013

Bacillus subtilis
DegU is a response regulator of the DegS-DegU two-component regulatory system. Phosphorylated DegU (DegU-P) controls many genes and biological processes, such as exoprotease and γ-polyglutamic acid production, in addition to the
degU
gene, by binding to target gene promoters. Nonphosphorylated DegU and low levels of DegU-P are required for swarming motility and genetic competence. The DNA-binding repressors SinR and SlrR are part of a double-negative feedback loop and comprise the epigenetic switch governing biofilm formation. In this study, we found that SinR repressed
degU
. Furthermore, SlrR, which interacts with SinR through protein-protein interaction, seems to have an active role in
degU
expression in
in vivo lacZ
analysis. An
in vitro
transcription assay supported this observation. An electrophoretic mobility shift assay (EMSA) showed that SinR bound to the
degU
promoter and that SlrR formed a complex with SinR on the
degU
promoter. In EMSA, DegU-P excluded the SinR/SlrR complex but not SinR from the
degU
promoter in the presence of RNA polymerase. These findings suggest that DegU-P interacts with SlrR. In support of this hypothesis, disruption of the
slrR
gene resulted in decreased
degU
expression. This newly identified regulatory mechanism for
degU
is considered to be sequential transcription factor replacement.
Acupuncture for Acute Non-Specific Low Back Pain: A Randomised, Controlled, Double-Blind, Placebo Trial
Authors: Hasegawa Tatiana Molinas , Baptista Andréia Salvador , de Souza Marcelo Cardoso , Yoshizumi Alexandre Massao , Natour Jamil
Published: December 2013

Objective

To assess the efficacy of Yamamoto's acupuncture method on pain, drug intake, functional capacity and quality of life for the treatment of acute non-specific low back pain (ANLBP).

Methods

A prospective, randomised, parallel-group, double-blind, placebo-controlled trial was performed in 80 men and women with ANLBP who were randomly assigned to five acupuncture sessions (intervention group (IG), n=40) and to five non-penetrating acupuncture sessions (sham group (SG), n=40). Patients were evaluated at baseline and at 3, 7, 14, 21 and 28 days. The measurements used were: visual analogue scale (VAS) for cumulative pain (before intervention, VAS1) and immediate pain (after intervention, VAS2); function (Roland–Morris Disability Questionnaire (RM)); quality of life (SF-36); improvement rating; and number of anti-inflammatory tablets taken. The primary endpoint was a decrease of at least 2 cm in VAS1.

Results

Pain VAS improved significantly in the IG from day 14 onwards compared with the SG, but the difference did not reach the prespecified clinically relevant value of 2 cm. The IG was significantly superior to the SG in the following outcomes: cumulative pain, function, pain (SF-36) and vitality (SF-36) at days 14, 21 and 28 (p<0.05); limitation in physical aspects (SF-36) at all times (p=0.007 and p=0.02); and functional capacity (SF-36) at days 21 and 28 (p<0.05). The IG also took significantly fewer anti-inflammatory tablets than the SG (p=0.004) at all evaluation times and the improvement rating was better than the SG (p<0.001).

Conclusions

Yamamoto's new scalp acupuncture was more effective than sham treatment with regard to decrease in pain and anti-inflammatory intake as well as improving functional status and quality of life for patients with ANLBP.

ClinicalTrials.gov

NCT 01124955.
Hyperexcitability to Electrical Stimulation and Accelerated Muscle Fatiguability of Taut Bands in Rats
Authors: Wang Yong-Hui , Yin Ming-Jing , Fan Zhen-Zhen , Arendt-Nielsen Lars , Ge Hong-You , Yue Shou-Wei
Published: December 2013

Objective

Myofascial trigger points contribute significantly to musculoskeletal pain and motor dysfunction and may be associated with accelerated muscle fatiguability. The aim of this study was to investigate the electrically induced force and fatigue characteristics of muscle taut bands in rats.

Methods

Muscle taut bands were dissected out and subjected to trains of electrical stimulation. The electrical threshold intensity for muscle contraction and maximum contraction force (MCF), electrical intensity dependent fatigue and electrical frequency dependent fatigue characteristics were assessed in three different sessions (n=10 each) and compared with non-taut bands in the biceps femoris muscle.

Results

The threshold intensity for muscle contraction and MCF at the 10th, 15th and 20th intensity dependent fatigue stimuli of taut bands were significantly lower than those of non-taut bands (all p<0.05). The MCF at the 15th and 20th intensity dependent fatigue stimuli of taut bands were significantly lower than those at the 1st and 5th stimuli (all p<0.01). The MCF in the frequency dependent fatigue test was significantly higher and the stimulus frequency that induced MCF was significantly lower for taut bands than for non-taut bands (both p<0.01).

Conclusions

The present study demonstrates that the muscle taut band itself was more excitable to electrical stimulation and significantly less fatigue resistant than normal muscle fibres.
Lack of knowledge of physical activity guidelines: can physical activity promotion campaigns do better?
Authors: Knox Emily C L , Esliger Dale W , Biddle Stuart J H , Sherar Lauren B
Published: December 2013

Objectives

To identify the prevalence of knowledge of the current UK physical activity guidelines which were introduced in 2011 and prior physical activity guidelines (30 min on 5 days each week) within two large samples of UK adult's. To investigate whether knowledge of physical activity guidelines differs according to demographics such as ethnicity, age, education and employment status.

Design

Descriptive cross-sectional study comparing two distinctive adult samples.

Setting

National survey and online-administered survey conducted in England.

Participants

The 2007 Health Survey for England provides data on knowledge of physical activity guidelines from 2860 UK adults (56% women, 89% white, 63% under 45 years old). In 2013, an online survey was disseminated and data were collected from 1797 UK adults on knowledge of the most recent physical activity guidelines. The 2013 sample was 70% women, 92% white and 57% under 45 years old. All adults in both samples were >18 years old and without illnesses/disorders likely to restrict physical activity.

Main outcomes

Knowledge of physical activity guidelines in 2007 and 2013. Demographic correlates of knowledge of moderate-to-vigorous physical activity guidelines.

Results

18% of the 2013 sample accurately recalled the current physical activity guidelines compared with 11% of the 2007 sample who accurately recalled the previous guidelines. The differences in knowledge of physical activity guidelines existed for marital status, gender, age, education and employment status within both 2007 and 2013 samples (p<0.05). Men with lower education and employment status (unemployed including student and retired) and older adults were less likely to know physical activity guidelines (p<0.05). Knowledge of physical activity guidelines remained higher in the 2013 sample after controlling for demographic differences (p<0.05).

Conclusions

Disadvantaged population groups are less knowledgeable about physical activity guidelines. Although knowledge of physical activity guidelines appears to have increased in recent years demographic disparities are still evident. Efforts are needed to promote health information among these groups.
Rounding of birth weights in a neonatal intensive care unit over 20 years: an analysis of a large cohort study
Authors: Emmerson Anthony J , Roberts Stephen A
Published: December 2013

Objective

To determine the frequency of birth weight digit preference for infants admitted to a large neonatal intensive care unit (NICU), the scale of rounding and its dependence on birth weight, and time and the impact on prescribing accuracy.

Design

A consecutive cohort of birth weights extracted retrospectively from a single clinical database.

Setting and participants

Birth weights from 9170 inborn infants recorded on an electronic prescribing database admitted to NICU over 20 years.

Statistical approach

Data are presented for the frequency of each of the possible pairs of final digits. A statistical model of digit preference assuming rounding is used to quantify the proportions rounding to specific accuracy levels. These proportions are compared between those <1000 g and those above and over the 20-year time period.

Results

From a population of 9170 infants admitted over 20 years, there was a highly statistically significant digit bias with an increased prevalence of multiples of 100 (p<0.0001), 50 (p=0.007), 20 (p<0.0001), 10 (p<0.0001), 5 (p<0.0001) and 2 (p=0.0005). There was clear evidence of a reduced 100 g digit bias for infants 500 and 1000 g (0%) compared with those between 1000 and 4500 g (3.7%). The maximum birth weight error due to digit bias for all infants was 5%. There was clear evidence of an improvement in accuracy over 20 years.

Conclusions

Digit bias in birth weights over 20 years in a tertiary NICU is highly significant at the 100, 50, 20, 10, 5 and 2-digit levels. There has been a substantial improvement in the accuracy of birth weight measurements over 20 years. The likely maximum error due to birth weight digit bias is 5% and is within an acceptable tolerance for drug dosing even at very low birth weights.
A case–control study of incident rheumatological conditions following acute gastroenteritis during military deployment
Authors: DeYoung Kathryn H , Riddle Mark S , May Larissa , Porter Chad K
Published: December 2013

Objectives

The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis.

Design

This case–control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population.

Setting

We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment.

Participants

Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008–2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population.

Main outcome measures

The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population.

Results

We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter's diseasei(3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates.

Conclusions

Incident rheumatological conditions, even those classified as ‘non-specific,’ are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions.
Association between limiting longstanding illness in mothers and their children: findings from the UK Millennium Cohort Study
Authors: Šumilo Dana , Kurinczuk Jennifer J , Redshaw Maggie E , Gray Ron
Published: December 2013

Objective

To explore the association between maternal disability as measured by the presence of a limiting longstanding illness (LLI) 9 months postpartum and subsequent child health at the age of 7 years.

Design

Nationally representative prospective longitudinal study.

Setting

England, Scotland, Wales and Northern Ireland.

Participants

Secondary analysis of data on 11 807 mother–child pairs recruited to the UK Millennium Cohort Study. Baseline interviews with mothers were carried out in 2001–2002. When the children were 7 years old, the follow-up survey included questions about limiting longstanding health conditions in the child.

Primary outcome measure

Any longstanding condition that was reported to limit the children's activities in any way.

Results

Nearly 7% of all children were reported to have an LLI at the age of 7 years. The majority (88.1%, 95% CI 85.6% to 90.2%) of children whose mother was disabled did not have an LLI themselves. The children of disabled mothers, however, had higher odds of LLI (OR=1.9, 95% CI 1.5 to 2.5) independently of different maternal, pregnancy and birth characteristics and breast feeding duration. Inclusion of poverty measures in the model did not significantly affect the odds (OR=1.8, 95% CI 1.4 to 2.4), suggesting that maternal LLI around the time of birth increases the odds of child LLI at the age of 7 years independently of starting life in poverty.

Conclusions

There is a strong positive association between maternal and child LLI. Health professionals should work together with social care and other relevant service providers to identify the individual needs of disabled parents and provide adequate support throughout the pregnancy and after the child is born. Further research is important to clarify the exact nature of the associations for different types of maternal and child disability.
Using data and quality monitoring to enhance maternity outcomes: a qualitative study of risk managers’ perspectives
Authors: Simms Rebecca A , Yelland Andrew , Ping Helen , Beringer Antonia J , Draycott Timothy J , Fox Robert
Published: December 2013

Introduction

Risk management is a core part of healthcare practice, especially within maternity services, where litigation and societal costs are high. There has been little investigation into the experiences and opinions of those staff directly involved in risk management: lead obstetricians and specialist risk midwives, who are ideally placed to identify how current implementation of risk management strategies can be improved.

Methods

A qualitative study of consultant-led maternity units in an English region. Semistructured interviews were conducted with the obstetric and midwifery risk management leads for each unit. We explored their approach to risk management, particularly their opinions regarding quality monitoring and related barriers/issues. Interviews were recorded, transcribed and thematically analysed.

Results

Twenty-seven staff from 12/15 maternity units participated. Key issues identified included: concern for the accuracy and validity of their local data, potential difficulties related to data collation, the negative impact of external interference by national regulatory bodies on local clinical priorities, the influence of the local culture of the maternity unit on levels of engagement in the risk management process, and scepticism about the value of benchmarking of maternity units without adjustment for population characteristics.

Conclusions

Local maternity risk managers may provide valuable, clinically relevant insights into current issues in clinical data monitoring. Improvements should focus on the accuracy and ease of data collation with a need for an agreed maternity indicators set, populated from validated databases, and not reliant on data collection systems that distract clinicians from patient activity and quality improvement. It is clear that working relationships between risk managers, their own clinical teams and external national bodies require improvement and alignment. Further discussion regarding benchmarking between maternity units is required prior to implementation. These findings are likely to be relevant to other clinical specialties.
Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm
Authors: Youshani Amir Saam , Mehta Bimal , Davies Katharine , Beer Helen , De Sujata
Published: December 2013

Objective

We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals.

Patients and methods

A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House–Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery.

Results

The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals.

Conclusions

At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.
Is there a diurnal difference in mortality of severely injured trauma patients?
Authors: Dybdal Bitten , Svane Christian , Hesselfeldt Rasmus , Steinmetz Jacob , Sørensen Anne Marie , Rasmussen Lars S
Published: December 2013

Background

Mortality may be higher for admissions at odd hours than during daytime, although for trauma patients results are conflicting. The objective of this study was to assess whether diurnal differences in mortality among severely injured trauma patients in Denmark were present.

Methods

This observational cohort study was conducted between 1 December 2009 and 30 April 2011 involving one level 1 trauma centre and seven local emergency departments in eastern Denmark. Patients were consecutively included if received by a designated trauma team. Night-time patients (20:00–07:59) were compared with daytime patients (20:00–07:59). An injury severity score (ISS) >15 defined severe injury. Patients with burns and patients who upon arrival were declared non-trauma patients were not included. The primary outcome measure was 30-day mortality.

Results

A total of 1985 patients were recorded, of whom 576 were admitted at night-time, 1369 at daytime and 40 not included due to missing data. There were 142 patients with ISS >15 in the daytime group and 64 at night-time. The 30-day mortality was 14.1% for admittance at night-time versus 21.3% at daytime (p=0.22). Logistic regression analysis revealed that odd-hour admission was not a significant predictor of mortality for patients with ISS >15 when adjusted for age, ISS and initial treatment facility (OR 0.71 (95% CI 0.27 to 1.90); p=0.50).

Conclusions

In conclusion, we found no diurnal differences in 30-day mortality for severely injured trauma patients.
Predictive performance of universal termination of resuscitation rules in an Asian community: are they accurate enough?
Authors: Chiang Wen-Chu , Ko Patrick Chow-In , Chang Anna Marie , Liu Sot Shih-Hung , Wang Hui-Chih , Yang Chih-Wei , Hsieh Ming-Ju , Chen Shey-Ying , Lai Mei-Shu , Ma Matthew Huei-Ming
Published: December 2013

Introduction

Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS).

Methods

We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated.

Results

Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2–63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups.

Conclusions

Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9–4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.
The pecking order
Authors: Bulstrode Chris
Published: December 2013

This paper explores the idea that courtesy and respect between health professionals at each stage of the admission process of a patient to hospital would make life much easier and more pleasant for all staff.
Quantitative flow cytometric identification of aberrant T cell clusters in erythrodermic cutaneous T cell lymphoma. Implications for staging and prognosis
Authors: Horna Pedro , Deaver Darcie M , Qin Dahui , Moscinski Lynn C , Sotomayor Eduardo M , Glass L Frank , Sokol Lubomir
Published: December 2013

Aims

Assessment of peripheral blood tumour burden for staging of cutaneous T cells lymphoma is most often accomplished by flow cytometry (FC) using various non-standarised strategies. We report the results of calculating absolute Sezary cell counts (SCCs) by FC, based on the identification of aberrant T cell clusters on a virtual 6-dimensional space and independently of the expected immunophenotype (6D-FC SCC).

Methods

6D-FC SCCs were calculated on 65 peripheral blood specimens from 28 patients with erythrodermic cutaneous T cells lymphoma (stage III or IV). Comparisons were made with recommended FC strategies and correlations with overall mortality were studied.

Results

At first visit, 17 of 28 patients (61%) had 6D-FC SCCs meeting current criteria for Stage IV disease (≥1000 SC/μL); while only 2 patients (7%) met Stage IV criteria on other tissues. As defined by comprehensive staging using clinicomorphological criteria and 6D-FC SCCs, Stage IV disease identified a subgroup of patients with worse overall survival (p=0.0227). Residual non-aberrant CD4 T cells were markedly decreased in Stage IV disease (p=0.018). Among 65 specimens, discrepancies were observed between 6D-FC SCCs and usual FC thresholds for Stage IV disease, namely a CD4:CD8 ratio ≥10:1 (9 discrepancies, 14%), and ≥40% aberrant CD4 T cells (4 discrepancies, 6%). Surprisingly, 8 cases (12%) from 6 patients exhibited two distinctively separate clusters of aberrant CD4 T cells with different CD7 and/or CD26 expression.

Conclusions

Visual 6-dimensional identification of aberrant T cell clusters by FC allows for the calculation of clinically significant SCCs. Simplified gating strategies and relative quantitative values might underestimate the immunophenotypical complexity of Sezary cells.
Seizure control for intracranial arteriovenous malformations is directly related to treatment modality: a meta-analysis
Authors: Baranoski Jacob F , Grant Ryan A , Hirsch Lawrence J , Visintainer Paul , Gerrard Jason L , Günel Murat , Matouk Charles C , Spencer Dennis D , Bulsara Ketan R
Published: December 2013

Object

Seizures are a common presenting sign of intracranial arteriovenous malformations (AVMs). The object of this meta-analysis was to determine if the modality selected to treat AVMs affects the rate of seizure outcomes.

Methods

All published data describing seizure status as an outcome goal over the past 20 years were included in this study. Seizure outcomes following microsurgery (MS), endovascular embolization for cure (EVE), or stereotactic radiosurgery (SRS) were compared using a validated random effect logistic regression approach.

Results

24 studies, with a total of 1157 patients, were analyzed. Overall, the microsurgical group had the best seizure control (p<0.01), with the relative predicted rates of seizure outcome as follows: MS 78.3% (95% CI 70.1% to 85.8%); SRS 62.8% (95% CI 55.0% to 70.0%); and EVE 49.3% (95% CI 32.1% to 66.6%). Patients in the SRS group who had complete obliteration of their AVMs achieved the highest rate of seizure control (85.2% (95% CI 79.1% to 91.2%); p<0.01). The development of new onset seizures occurred more frequently in patients undergoing EVE (39.4% (95% CI 8.1% to 67.8%)) compared with MS (9.1% (95% CI 5.0% to 13.1%)) and SRS (5.4% (95% CI 3.0% to 7.8%)) (p<0.3 and p<0.01, respectively).

Conclusions

This is the first meta-analysis designed to study relative rates of seizure outcomes following the currently utilized AVM treatment modalities. In general, MS results in the highest proportion of seizure control. However, if SRS results in successful obliteration of the AVM, then this modality is the most effective in achieving seizure control.
AVM Management Equipoise Survey: physician opinions regarding the management of brain arteriovenous malformations
Authors: Cockroft Kevin M , Chang Ki-Eun , Lehman Erik B , Harbaugh Robert E
Published: December 2013

Introduction

Management of unruptured brain arteriovenous malformations (AVMs) is controversial, and conducting clinical trials in this area has been a challenge. We sought to determine which, if any, patient/AVM characteristics were most likely to influence clinicians’ decisions regarding management and clinical trial enrollment.

Methods

We performed an online survey (Survey Monkey) of members of the American Association of Neurological Surgeons (AANS) (n=4836) and Society of NeuroInterventional Surgeons (SNIS) (n=512). Physicians were asked to rate the likelihood that various patient/AVM characteristics would influence their treatment decisions and recommendations for clinical trial enrollment. 10 hypothetical case vignettes were also provided, and respondents were asked to select a management recommendation.

Results

277 (5.2%) responses were received. Characteristics that the majority (>50%) of respondents felt should lead to treatment included size <3 cm, superficial or cerebellar location, single draining vein, age <30 years, venous aneurysm, prior AVM hemorrhage, poorly controlled seizures, intranidal aneurysm, and patient's desire for treatment. However, a significant minority (>30%) felt that six of these same characteristics should lead to observation or should not influence treatment decisions. Characteristics that the majority (>50%) of respondents felt should lead to clinical trial enrollment included size > 6cm, deep or eloquent location, and age 51–70 years. The only characteristic that the majority felt should not lead to enrollment was the presence of an intranidal aneurysm. For the 10 vignettes, the majority of respondents (>50%) favored a specific course of management in only five cases.

Conclusions

Clinicians’ opinions on which patient/AVM characteristics are important for decisions regarding treatment or trial enrollment vary widely. These results suggest that there is no uniform opinion of clinical equipoise with regard to the management of brain AVMs.
Prognosis and management of chronic kidney disease (CKD) at the end of life
Authors: Davison Rachel , Sheerin Neil S
Published: December 2013

The prevalence of chronic kidney disease (CKD) increases with age. As people are living longer, nephrologists are responsible for a progressively older cohort of patients with substantial comorbidities. Patients with CKD have a significant symptom burden and can benefit from intervention and symptom control from an early stage in the illness. It is also increasingly recognised that renal replacement therapy may not always offer an improvement in symptoms or a survival advantage to older patients with high levels of comorbidity. For these reasons, non-dialytic (conservative) management and end-of-life care is becoming part of routine nephrology practice. Such patients will also frequently be encountered in other specialities, requiring generalists to have some renal-specific skills and knowledge. Although there have been significant advances in this field in recent years, the optimum model of care and some of the care preferences of patients remain challenges that need to be addressed.
Plant Interactions with Multiple Insect Herbivores: From Community to Genes
Authors: Stam Jeltje M. , Kroes Anneke , Li Yehua , Gols Rieta , van Loon Joop J.A. , Poelman Erik H. , Dicke Marcel
Published: December 2013

Every plant is a member of a complex insect community that consists of tens to hundreds of species that belong to different trophic levels. The dynamics of this community are critically influenced by the plant, which mediates interactions between community members that can occur on the plant simultaneously or at different times. Herbivory results in changes in the plant's morphological or chemical phenotype that affect interactions with subsequently arriving herbivores. Changes in the plant's phenotype are mediated by molecular processes such as phytohormonal signaling networks and transcriptomic rearrangements that are initiated by oral secretions of the herbivore. Processes at different levels of biological complexity occur at timescales ranging from minutes to years. In this review, we address plant-mediated interactions with multiple species of the associated insect community and their effects on community dynamics, and link these to the mechanistic effects that multiple attacks have on plant phenotypes.
Male Sterility and Fertility Restoration in Crops
Authors: Chen Letian , Liu Yao-Guang
Published: December 2013

In plants, male sterility can be caused either by mitochondrial genes with coupled nuclear genes or by nuclear genes alone; the resulting conditions are known as cytoplasmic male sterility (CMS) and genic male sterility (GMS), respectively. CMS and GMS facilitate hybrid seed production for many crops and thus allow breeders to harness yield gains associated with hybrid vigor (heterosis). In CMS, layers of interaction between mitochondrial and nuclear genes control its male specificity, occurrence, and restoration of fertility. Environment-sensitive GMS (EGMS) mutants may involve epigenetic control by noncoding RNAs and can revert to fertility under different growth conditions, making them useful breeding materials in the hybrid seed industry. Here, we review recent research on CMS and EGMS systems in crops, summarize general models of male sterility and fertility restoration, and discuss the evolutionary significance of these reproductive systems.
Heterotrimeric G Protein–Coupled Signaling in Plants
Authors: Urano Daisuke , Jones Alan M.
Published: December 2013

Investigators studying G protein–coupled signaling—often called the best-understood pathway in the world owing to intense research in medical fields—have adopted plants as a new model to explore the plasticity and evolution of G signaling. Much research on plant G signaling has not disappointed. Although plant cells have most of the core elements found in animal G signaling, differences in network architecture and intrinsic properties of plant G protein elements make G signaling in plant cells distinct from the animal paradigm. In contrast to animal G proteins, plant G proteins are self-activating, and therefore regulation of G activation in plants occurs at the deactivation step. The self-activating property also means that plant G proteins do not need and therefore do not have typical animal G protein–coupled receptors. Targets of activated plant G proteins, also known as effectors, are unlike effectors in animal cells. The simpler repertoire of G signal elements in Arabidopsis makes G signaling easier to manipulate in a multicellular context.
Resolution of Acute Inflammation in the Lung
Authors: Levy Bruce D. , Serhan Charles N.
Published: December 2013

Acute inflammation in the lung is essential to health. So too is its resolution. In response to invading microbes, noxious stimuli, or tissue injury, an acute inflammatory response is mounted to protect the host. To limit inflammation and prevent collateral injury of healthy, uninvolved tissue, the lung orchestrates the formation of specialized proresolving mediators, specifically lipoxins, resolvins, protectins, and maresins. These immunoresolvents are agonists for resolution that interact with specific receptors on leukocytes and structural cells to blunt further inflammation and promote catabasis. This process appears to be defective in several common lung diseases that are characterized by excess or chronic inflammation. Here, we review the molecular and cellular effectors of resolution of acute inflammation in the lung.
Inducible nitric oxide synthase inhibits oxygen consumption in collateral-dependent myocardium
Authors: Chen Yingjie , Zhang Ping , Li Jingxin , Xu Xin , Bache Robert J.
Published: December 2013

Following coronary artery occlusion growth of collateral vessels can provide an effective blood supply to the dependent myocardium. The ischemia, which results in growth of collateral vessels, recruits an inflammatory response with expression of cytokines and growth factors, upregulation of endothelial nitric oxide (NO) synthase (eNOS) in vascular endothelial cells, and expression of inducible nitric oxide synthase (iNOS) in both vessels and cardiac myocytes. Because NO is a potent collateral vessel dilator, this study examined whether NO derived from iNOS or constitutive NOS regulates myocardial blood flow (MBF) in the collateral region. Nonselective NOS inhibition with NG-nitro-l-arginine (LNA) caused vasoconstriction with a significant decrease in MBF to the collateral region during exercise. In contrast, the highly selective iNOS inhibitor 1400W caused a 21 ± 5% increase of MBF in the collateral region. This increase in MBF following selective iNOS blockade was proportionate to an increase in myocardial O2 consumption (MV̇o2). The results suggest that NO produced by iNOS inhibits MV̇o2 in the collateralized region, so that the increase in MBF following iNOS blockade was the result of metabolic vasodilation secondary to an increase in MV̇o2. Thus the coordinated expression of iNOS to restrain MV̇o2 and eNOS to maintain collateral vasodilation act to optimize the O2 supply-demand relationship and protect the collateralized myocardium from ischemia.
Aerobic exercise training increases plasma Klotho levels and reduces arterial stiffness in postmenopausal women
Authors: Matsubara Tomoko , Miyaki Asako , Akazawa Nobuhiko , Choi Youngju , Ra Song-Gyu , Tanahashi Koichiro , Kumagai Hiroshi , Oikawa Satoshi , Maeda Seiji
Published: December 2013

The Klotho gene is a suppressor of the aging phenomena, and the secretion as well as the circulation of Klotho proteins decrease with aging. Although habitual exercise has antiaging effects (e.g., a decrease in arterial stiffness), the relationship between Klotho and habitual exercise remains unclear. In the present study, we investigated the effect of habitual exercise on Klotho, with a particular focus on arterial stiffness. First, we examined the correlation between plasma Klotho concentration and arterial stiffness (carotid artery compliance and β-stiffness index) or aerobic exercise capacity [oxygen uptake at ventilatory threshold (VT)] in 69 healthy, postmenopausal women (50–76 years old) by conducting a cross-sectional study. Second, we tested the effects of aerobic exercise training on plasma Klotho concentrations and arterial stiffness. A total of 19 healthy, postmenopausal women (50–76 years old) were divided into two groups: control group and exercise group. The exercise group completed 12 wk of moderate aerobic exercise training. In the cross-sectional study, plasma Klotho concentrations positively correlated with carotid artery compliance and VT and negatively correlated with the β-stiffness index. In the interventional study, aerobic exercise training increased plasma Klotho concentrations and carotid artery compliance and decreased the β-stiffness index. Moreover, the changes in plasma Klotho concentration and arterial stiffness were found to be correlated. These results suggest a possible role for secreted Klotho in the exercise-induced modulation of arterial stiffness.