bluuebunny/crossref_metadata_2025 huggingface dataset:
Blunted sympathetic neurovascular transduction during normotensive pregnancy
Authors: Steinback Craig D. , Fraser Graham M. , Usselman Charlotte W. , Reyes Laura M. , Julian Colleen G. , Stickland Michael K. , Chari Radha S. , Khurana Rshmi , Davidge Sandra T. , Davenport Margie H.
Published: May 2019

Key points

Normotensive pregnancy is associated with elevated sympathetic nervous system activity yet normal or reduced blood pressure. It represents a unique period of apparent healthy sympathetic hyperactivity.

The present study models the blood pressure and heart rate (ECG R–R interval) responses to fluctuations in sympathetic nervous system activity aiming to understand neurocardiovascular transduction.

The reported data clearly demonstrate that transduction of sympathetic nervous system signalling to systemic cardiovascular outcomes is reduced in normotensive pregnancy.

These data are important for understanding how blood pressure regulation adapts during normotensive pregnancy and set the foundation for exploring similar mechanisms in hypertensive pregnancies.

Previously, we described sympathetic nervous system hyperactivity yet decreased blood pressure responses to stress in normotensive pregnancy. To address the hypothesis that pregnant women have blunted neurocardiovascular transduction we assessed the relationship between spontaneous bursts of sympathetic nerve activity (SNA) and fluctuations in mean arterial blood pressure and R–R interval. Resting SNA, blood pressure and ECG were obtained in pregnant (third trimester, n = 18) and non‐pregnant (n = 18) women matched for age and pre‐/non‐pregnant body mass index. Custom software modelled beat‐by‐beat pressure (photoplethysmography) and R–R interval in relation to sequences of SNA bursts and non‐bursts (peroneal microneurography). Sequences were grouped by the number of bursts and non‐bursts [singlets, doublets, triplets and quadruplet (four or more)] and mean blood pressure and R–R interval were tracked for 15 subsequent cardiac cycles. Similar sequences were overlaid and averaged. Peak mean pressure in relation to sequences of SNA was reduced in pregnant vs. non‐pregnant women (doublets: 1.6 ± 1.1 mmHg vs. 3.6 ± 3.1 mmHg, P < 0.05; triplets: 2.4 ± 1.2 mmHg vs. 3.4 ± 2.1 mmHg, P < 0.05; quadruplets: 3.0 ± 1.0 mmHg vs. 5.5 ± 3.7 mmHg, P < 0.05). The nadir R–R interval following burst sequences was also smaller in pregnant vs. non‐pregnant women (singlets: −0.01 ± 0.01 s vs. −0.04 ± 0.04 s, P < 0.05; doublets: −0.02 ± 0.03 s vs. −0.05 ± 0.04 s, P < 0.05; triplets: −0.02 ± 0.01 s vs. −0.07 ± 0.04 s, P < 0.05; quadruplets: −0.01 ± 0.01 s vs. −0.09 ± 0.09 s, P < 0.05). There were no differences between groups in the mean arterial pressure and R–R interval responses to non‐burst sequences. Our data clearly indicate blunted systemic neurocardiovascular transduction during normotensive pregnancy. We propose that blunted transduction is a positive adaptation protecting pregnant women from the cardiovascular consequences of sympathetic hyperactivity.
Wave Interaction With Floating Elastic Plate Based on the Timoshenko–Mindlin Plate Theory
Authors: Praveen K. M. , Karmakar D. , Guedes Soares C.
Published: May 2019

In the present study, the wave interaction with the very large floating structures (VLFSs) is analyzed considering the small amplitude wave theory. The VLFS is modeled as a 2D floating elastic plate with infinite width based on Timoshenko–Mindlin plate theory. The eigenfunction expansion method along with mode-coupling relation is used to analyze the hydroelastic behavior of VLFSs in finite water depth. The contour plots for the plate covered dispersion relation are presented to illustrate the complexity in the roots of the dispersion relation. The wave scattering behavior in the form of reflection and transmission coefficients are studied in detail. The hydroelastic performance of the elastic plate interacting with the ocean wave is analyzed for deflection, strain, bending moment, and shear force along the elastic plate. Further, the study is extended for shallow water approximation, and the results are compared for both Timoshenko–Mindlin plate theory and Kirchhoff’s plate theory. The significance and importance of rotary inertia and shear deformation in analyzing the hydroelastic characteristics of VLFSs are presented. The study will be helpful for scientists and engineers in the design and analysis of the VLFSs.
Calcium phosphate nanoparticles as intrinsic inorganic antimicrobials: In search of the key particle property
Authors: Uskoković Vuk , Tang Sean , Nikolić Marko G. , Marković Smilja , Wu Victoria M.
Published: May 2019

One of the main goals of materials science in the 21st century is the development of materials with rationally designed properties as substitutes for traditional pharmacotherapies. At the same time, there is a lack of understanding of the exact material properties that induce therapeutic effects in biological systems, which limits their rational optimization for the related medical applications. This study sets the foundation for a general approach for elucidating nanoparticle properties as determinants of antibacterial activity, with a particular focus on calcium phosphate nanoparticles. To that end, nine physicochemical effects were studied and a number of them were refuted, thus putting an end to frequently erred hypotheses in the literature. Rather than having one key particle property responsible for eliciting the antibacterial effect, a complex synergy of factors is shown to be at work, including (a) nanoscopic size; (b) elevated intracellular free calcium levels due to nanoparticle solubility; (c) diffusivity and favorable electrostatic properties of the nanoparticle surface, primarily low net charge and high charge density; and (d) the dynamics of perpetual exchange of ultrafine clusters across the particle/solution interface. On the positive side, this multifaceted mechanism is less prone to induce bacterial resistance to the therapy and can be a gateway to the sphere of personalized medicine. On a more problematic side, it implies a less intense effect compared to single-target molecular therapies and a difficulty of elucidating the exact mechanisms of action, while also making the rational design of theirs for this type of medical application a challenge.
The Two Chemotaxis Clusters in Caulobacter crescentus Play Different Roles in Chemotaxis and Biofilm Regulation
Authors: Berne Cécile , Brun Yves V.
Published: May 2019

Chemosensory systems constitute major signal transduction pathways in bacteria. These systems are involved in chemotaxis and other cell responses to environment conditions, such as the production of adhesins to enable irreversible adhesion to a surface and surface colonization. The
C. crescentus
genome encodes two complete chemotaxis clusters. Here, we characterized the second novel chemotaxis-like cluster. While only the major chemotaxis cluster is involved in chemotaxis, both chemotaxis systems modulate
C. crescentus
adhesion by controlling expression of the holdfast synthesis inhibitor HfiA. Here, we identify a new level in holdfast regulation, providing new insights into the control of adhesin production that leads to the formation of biofilms in response to the environment.
Cholesterol Binding to the Transmembrane Region of a Group 2 Hemagglutinin (HA) of Influenza Virus Is Essential for Virus Replication, Affecting both Virus Assembly and HA Fusion Activity
Authors: Hu Bodan , Höfer Chris Tina , Thiele Christoph , Veit Michael
Published: May 2019

The glycoprotein HA is a major pathogenicity factor of influenza viruses. Whereas the structure and function of HA’s ectodomain is known in great detail, similar data for the membrane-anchoring part of the protein are missing. Here, we demonstrate that the transmembrane region of a group 2 HA interacts with cholesterol, the major lipid of the plasma membrane and the defining element of the viral budding site nanodomains of the plasma membrane. The cholesterol binding motif is essential for virus replication. Its partial removal affects various steps of the viral life cycle, such as assembly of new virus particles and their subsequent cell entry via membrane fusion. A cholesterol binding pocket in group 2 HAs might be a promising target for a small lipophilic drug that inactivates the virus.
Mycofactocin Is Associated with Ethanol Metabolism in Mycobacteria
Authors: Krishnamoorthy Gopinath , Kaiser Peggy , Lozza Laura , Hahnke Karin , Mollenkopf Hans-Joachim , Kaufmann Stefan H. E.
Published: May 2019

Tuberculosis is caused by
Mycobacterium tuberculosis
, and the increasing emergence of multidrug-resistant strains renders current treatment options ineffective. Although new antimycobacterial drugs are urgently required, their successful development often relies on complete understanding of the metabolic pathways—e.g., cholesterol assimilation—that are critical for persistence and for pathogenesis of
M. tuberculosis
. In this regard, mycofactocin (MFT) function appears to be important because its biosynthesis genes are predicted to be essential for
M. tuberculosis
in vitro
growth in cholesterol. In determining the metabolic basis of this genetic requirement, our results unexpectedly revealed the essential function of MFT in ethanol metabolism. The metabolic dysfunction thereof was found to affect the mycobacterial growth in cholesterol which is solubilized by ethanol. This knowledge is fundamental in recognizing the bona fide function of MFT, which likely resembles the pyrroloquinoline quinone-dependent ethanol oxidation in acetic acid bacteria exploited for industrial production of vinegar.
Mycobacterial SigA and SigB Cotranscribe Essential Housekeeping Genes during Exponential Growth
Authors: Hurst-Hess Kelley , Biswas Rajesh , Yang Yong , Rudra Paulami , Lasek-Nesselquist Erica , Ghosh Pallavi
Published: May 2019

All mycobacteria encode a group II sigma factor, σ
B
, closely related to the group I principal housekeeping sigma factor, σ
A
. Group II sigma factors are widely believed to play specialized roles in the general stress response and stationary-phase transition in the bacteria that encode them. Contrary to this widely accepted view, we show an additional housekeeping function of σ
B
that complements the function of σ
A
in logarithmically growing cells. These findings implicate a novel and dynamic partnership between σ
A
and σ
B
in maintaining the expression of housekeeping genes in mycobacteria and can perhaps be extended to other bacterial species that possess multiple group II sigma factors.
The Synthetic Phenotype of Δ
bamB
Δ
bamE
Double Mutants Results from a Lethal Jamming of the Bam Complex by the Lipoprotein RcsF
Authors: Hart Elizabeth M. , Gupta Meera , Wühr Martin , Silhavy Thomas J.
Published: May 2019

Protein assembly into lipid bilayers is an essential process that ensures the viability of diverse organisms. In Gram-negative bacteria, the heteropentomeric β-barrel assembly machine (Bam) folds and inserts proteins into the outer membrane. Due to its essentiality, outer membrane protein (OMP) assembly by the Bam complex is an attractive target for antibiotic development. Here, we show that the conditional lethal phenotype of a mutant lacking two of the three nonessential lipoproteins, BamB and BamE, is caused by lethal jamming of the stripped-down Bam complex by a normally surface-exposed lipoprotein, RcsF. The heterotrimeric Bam complex (BamA, BamD, BamC) is nearly as efficient as the wild-type complex in OMP assembly if RcsF is removed. Our study highlights the importance of BamB and BamE in regulating the interaction between BamA and BamD and expands our understanding of the role of the Bam complex in outer membrane biogenesis.
Culturing the Uncultured: Risk versus Reward
Authors: Thrash J. Cameron
Published: May 2019

Isolation of new microorganisms is challenging, but cultures are invaluable resources for experimental validation of phenotype, ecology, and evolutionary processes. Although the number of new isolates continues to grow, the majority of cultivars still come from a limited number of phylogenetic groups and environments, necessitating investment in new cultivation efforts.
Elemental Composition, Phosphorous Uptake, and Characteristics of Growth of a SAR11 Strain in Batch and Continuous Culture
Authors: Grant Scott R. , Church Matthew J. , Ferrón Sara , Laws Edward A. , Rappé Michael S.
Published: May 2019

While SAR11 bacteria contribute a significant fraction to the total picoplankton biomass in the ocean and likely are major players in organic C and nutrient cycling, the cellular characteristics and metabolic features of most lineages have either only been hypothesized from genomes or otherwise not measured in controlled laboratory experimentation. The dearth of data on even the most basic characteristics for what is arguably the most abundant heterotroph in seawater has limited the specific consideration of SAR11 in ocean ecosystem modeling efforts. In this study, we provide measures of cellular P, N, and C, aerobic respiration, and bacterial production for a SAR11 strain growing in natural seawater medium that can be used to directly relate these features of SAR11 to biogeochemical cycling in the oceans. Through the development of a chemostat system to measure nutrient uptake during steady-state growth, we have also documented inorganic P uptake rates that allude to the importance of organic phosphorous to meet cellular P demands, even in the presence of nonlimiting PO
4
3−
concentrations.
MetatarsalSalmonella enteritidisosteomyelitis in a healthy child
Authors: Limão Sara , Carvalho Tânia , Sousa Helena , Cunha Florbela
Published: May 2019

Non-typhoidalSalmonellaosteomyelitis in healthy children is a very rare condition. A previously healthy 7-year-old boy presented with foot pain following a small injury. Local inflammatory signs of the foot were observed, with a normal radiograph. Two weeks before, he had had gastroenteritis. Assuming cellulitis, flucloxacillin was began. Early during admission, surgical subcutaneous abscess drainage was performed andSalmonella enteritidiswas identified. According to bacterial susceptibility, antibiotherapy was changed to ceftriaxone. A foot radiograph and an MRI scan, performed on the 9th and the 12th days, revealed findings suggestive of osteomyelitis of the metaphysis of the fifth metatarsal. Clinical worsening persisted and surgical extensive debridement was needed. A 6-week antibiotic treatment was completed, with a good outcome. Osteomyelitis with a poor evolution in children with risk factors (prior gastrointestinal illness, warm weather and previous exposure to antibiotics) can raise the possibility of a non-typhoidalSalmonellainfection.
Factors associated with renal dysfunction in hepatitis C-related cirrhosis and its correlation with Child-Pugh score
Authors: Bhatti Hamza Waqar , Tahir Umama , Chaudhary Noman Ahmed , Bhatti Sania , Hafeez Muhammad , Rizvi Zuhair Ali
Published: May 2019

Objectives

To assess factors associated with renal dysfunction (RD) in hepatitis C virus (HCV) cirrhosis, correlate renal parameters with Child-Pugh score (CPS) and find a cut-off value of CPS to determine RD.

Materials and methods

It was a cross-sectional study that included 70 cases of liver cirrhosis secondary to HCV from a period of 6 months at Combined Military Hospital, Multan. Diagnosis of HCV was confirmed by serological assay and liver cirrhosis by ultrasonography. CPS was determined and lab reports were taken. Patients were divided into two groups as not having RD (serum creatinine≤1.5 mg/dL) and having RD (serum creatinine≥1.5 mg/dL). Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Data were analyzed using SPSS V.23.0. χ2, Kruskal-Wallis test and Pearson coefficient of correlation were applied. ROC curve was drawn to evaluate cut-off value of CPS for the presence of RD. Level of significance was set at p<0.05.

Results

Patients with CP grade B or C develop RD as compared to patients with CP grade A (p=0.000). Mean age, urea, creatinine and eGFR varies significantly among patients who develop RD and patients who do not (p=0.02, p=0.000, p=0.000 and p=0.000, respectively). eGFR negatively correlates with CPS (r=−0.359, p=0.002). Creatinine, urea and ALBI score positively correlates with CPS (r=+0.417, p=0.000; r=+0.757, p=0.000; r=+0.362, p=0.002, respectively).

Conclusion

Ascites and encephalopathy are associated with RD in HCV cirrhosis.
Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India
Authors: Shidhaye Rahul , Baron Emily , Murhar Vaibhav , Rathod Sujit , Khan Azaz , Singh Abhishek , Shrivastava Sanjay , Muke Shital , Shrivastava Ritu , Lund Crick , Patel Vikram
Published: May 2019

Introduction

Programme for Improving Mental Health Care (PRIME) designed a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India. The objective of this paper is to describe the findings of the district-level impact evaluation of the MHCP.

Methods

Repeat community-based CS were conducted to measure change in population-level contact coverage for depression and alcohol use disorders (AUD), repeat FDS were conducted to assess change in detection and initiation of treatment for depression and AUD, and the effect of treatment on patient outcomes was assessed using disorder-specific prospective cohort studies.

Results

PRIME MHCP did not have any impact on contact coverage/treatment seeking for depression (14.8% at the baseline and 10.5% at the follow-up) and AUD (7.7% at the baseline and 7.3% at the follow-up) and had a small impact on detection and initiation of treatment for depression and AUD (9.7% for depression and 17.8% for AUD compared with 0% for both at the baseline) in the health facilities. Patients with depression who received care as part of the MHCP had higher rates of response (52.2% in the treatment group vs 26.9% in the comparison/usual care group), early remission (70.2% in the treatment group vs 44.8% in the comparison/usual care group) and recovery (56.1% in the treatment group vs 28.5% in the comparison/usual care group), but there was no impact of treatment on their functioning.

Conclusions

While dedicated human resources (eg, Case Managers) and dedicated space for mental health clinics (eg, Mann-Kaksha) strengthen the ‘formal’ healthcare platform, without substantial additional investments in staff, such as Community Health Workers/Accredited Social Health Activists to improve community level processes and provision of community-based continuing care to patients, we are unlikely to see major changes in coverage or clinical outcomes.
Role of socioeconomic status and housing conditions in geriatric depression in rural China: a cross-sectional study
Authors: Fang Mingwang , Mirutse Gebremeskel , Guo Ling , Ma Xiao
Published: May 2019

Objectives

The primary aim of this study was to describe the socioeconomic status (SES), housing conditions and depression of the elderly in rural China, as well as to examine the associations between depression and SES and housing conditions using the China Health and Retirement Longitudinal Study (CHARLS).

Design

This is a cross-sectional study.

Setting

A nationally representative sample of elderly in rural China.

Participants

A total of 4585 elderly adults in 2015 in rural China.

Outcome measures

Prevalence and risk factors of depression among rural elderly.

Results

Among the participants in this study, approximately 46.15% (2116/4585) reported depressive symptoms (10-item Center for Epidemiologic Studies Depression Scale [CESD-10] score >10) in rural China. The results revealed significant associations between higher scores on CESD-10 (indicating more symptoms of depression) and lowest personal annual income (OR=1.63, 95% CI 1.290 to 2.060), polluting cooking fuel (OR=1.16, 95% CI 1.018 to 1.321), toilet without seat (OR=1.273, 95% CI 1.056 to 1.535), as well as having no bath facility (OR=1.172, 95% CI 1.025 to 1.341) after adjustment for confounders.

Conclusion

Elderly in rural China experienced severe depressive symptoms. Lowest personal annual income, polluting cooking fuel, toilet without seat and having no bath facility were significantly associated with more depressive symptoms. Caution needs to be taken in generalising the findings of this study to the rest of the population in China since its highly selected sample.
Spatio-temporal comparison of pertussis outbreaks in Olmsted County, Minnesota, 2004–2005 and 2012: a population-based study
Authors: Wi Chung-Il , Wheeler Philip H , Kaur Harsheen , Ryu Euijung , Kim Dohyeong , Juhn Young
Published: May 2019

Objective

Two pertussis outbreaks occurred in Olmsted County, Minnesota, during 2004–2005 and 2012 (5–10 times higher than other years), with significantly higher incidence than for the State. We aimed to assess whether there were similar spatio-temporal patterns between the two outbreaks.

Setting

Olmsted County, Minnesota, USA

Participants

We conducted a population-based retrospective cohort study of all Olmsted County residents during the 2004–2005 and 2012 outbreaks, including laboratory-positive pertussis cases.

Primary outcome measure

For each outbreak, we estimated (1) age-specific incidence rate using laboratory-positive pertussis cases (numerator) and the Rochester Epidemiology Project Census (denominator), a medical record-linkage system for virtually all Olmsted County residents, and (2) pertussis case density using kernel density estimation to identify areas with high case density. To account for population size, we calculated relative difference of observed density and expected density based on age-specific incidence.

Results

We identified 157 and 195 geocoded cases in 2004–2005 and 2012, respectively. Incidence was the highest among adolescents (ages 11 to <14 years) for both outbreaks (9.6 and 7.9 per 1000). The 2004–2005 pertussis outbreak had higher incidence in winter (52% of cases) versus summer in 2012 (53%). We identified a consistent area with higher incidence at the beginning (ie, first quartile) of two outbreaks, but it was inconsistent for later quartiles. The relative difference maps for the two outbreaks suggest a greater role of neighbourhood population size in 2012 compared with 2004–2005.

Conclusions

Comparing spatio-temporal patterns between two pertussis outbreaks identified a consistent geographical area with higher incidence of pertussis at the beginning of outbreaks in this community. This finding can be tested in future outbreaks, and, if confirmed, can be used for identifying epidemiological risk factors clustered in such areas for geographically targeted intervention.
A cross-sectional study of predatory publishing emails received by career development grant awardees
Authors: Wilkinson Tracey A , Russell Christopher J , Bennett William E , Cheng Erika R , Carroll Aaron E
Published: May 2019

Objective

To investigate the scope of academic spam emails (ASEs) among career development grant awardees and the factors associated with the amount of time spent addressing them.

Design

A cross-sectional survey of career development grant investigators via an anonymous online survey was conducted. In addition to demographic and professional information, we asked investigators to report the number of ASEs received each day, how they determined whether these emails were spam and time they spent per day addressing them. We used bivariate analysis to assess factors associated with the amount of time spent on ASEs.

Setting

An online survey sent via email on three separate occasions between November and December 2016.

Participants

All National Institutes of Health career development awardees funded in the 2015 fiscal year.

Main outcome measures

Factors associated with the amount of time spent addressing ASEs.

Results

A total of 3492 surveys were emailed, of which 206 (5.9%) were returned as undeliverable and 96 (2.7%) reported an out-of-office message; our overall response rate was 22.3% (n=733). All respondents reported receiving ASEs, with the majority (54.4%) receiving between 1 and 10 per day and spending between 1 and 10 min each day evaluating them. The amount of time respondents reported spending on ASEs was associated with the number of peer-reviewed journal articles authored (p<0.001), a history of publishing in open access format (p<0.01), the total number of ASEs received (p<0.001) and a feeling of having missed opportunities due to ignoring these emails (p=0.04).

Conclusions

ASEs are a common distraction for career development grantees that may impact faculty productivity. There is an urgent need to mitigate this growing problem.
Obstetric and non-obstetric surgery during pregnancy: A 20-year Danish population-based prevalence study
Authors: Rasmussen Anne Staub , Christiansen Christian Fynbo , Uldbjerg Niels , Nørgaard Mette
Published: May 2019

Objectives

Population-based studies on use of non-obstetric and obstetric surgical procedures during pregnancy are sparse. Therefore, our objective was to estimate the prevalence of surgery during pregnancy, including potential time trends, overall and by trimester and describe the characteristics of pregnant women undergoing surgery.

Design

This study is a large nationwide cohort study.

Setting

From administrative and medical databases, we obtained information about all pregnancies ending in a live birth, a stillbirth or an abortion (spontaneous and induced) in Denmark during 1996–2015. Procedures (excluding caesarean sections) conducted during pregnancy were categorised as a non-obstetric or obstetric surgery and further divided into laparoscopic or non-laparoscopic procedures.

Main outcome measure

Main outcome measure is prevalence of surgery during pregnancy.

Results

We included 1 687 176 pregnancies of which 108 502 (6.4%) received 117 424 surgical procedures. The prevalence of non-obstetric surgery was almost stable (1.5% in 1996–1999 to 1.6% in 2012–2015), whereas non-obstetric abdominal or gynaecological laparoscopic procedures increased from 0.5% to 0.8%. For appendectomies, the proportion of laparoscopic surgery increased from 4.2% to 79.2% during the study period. In 49 pregnancies, surgery for internal herniation was conducted in 2012–2015 versus none in 1996–1999. The prevalence of obstetric surgery, excluding invasive diagnostic tests, increased from 0.2% to 0.8%. High multiplicity, smoking, increasing age, body mass index (BMI) and parity were factors associated with a high prevalence of surgery during pregnancy.

Conclusions

The increase in the prevalence of laparoscopic surgery during pregnancy may reflect a decreased restraint concerning conductance of these surgical procedures during pregnancy. The increasing proportion of laparoscopic procedures complies with clinical recommendations, and the prevalence of surgery during pregnancy varied by multiplicity, smoking status, parity, age and BMI.
Long-term unmet needs after stroke: systematic review of evidence from survey studies
Authors: Chen Ting , Zhang Bo , Deng Yan , Fan Jing-Chun , Zhang Liansheng , Song Fujian
Published: May 2019

Objectives

To synthesise evidence on longer term unmet needs perceived by stroke survivors, and psychometric properties of the tools used to evaluate unmet care needs after stroke.

Design

Systematic review.

Setting

Community or patients’ home.

Participants

Stroke survivors.

Methods

We searched PubMed, PsycINFO, CINAHL, EMBASE from inception to 31 March 2018 to identify survey studies that evaluated unmet needs perceived by stroke survivors after hospital discharge. Reported unmet needs were categorised under three domains: body functioning, activity/participation and environmental factors. Ranges of prevalence rates of unmet needs reported in studies were presented.

Results

We included 19 eligible studies, with considerable heterogeneity in patients, survey methods and results. Psychometric properties of two stroke-specific tools were formally evaluated, indicating their moderate reliability and content/concurrent validity. The median number of reported unmet needs per stroke survivor was from two to five, and the proportion of stroke survivors with at least one unmet needs was on average 73.8% (range 19.8%– 91.7%). Unmet needs perceived by stroke survivors included 55 records of unmet body functioning needs, 47 records of unmet activities/participatory needs and 101 records of unmet environmental needs. Common unmet service needs were unmet information needs (3.1%– 65.0%), transport (5.4%–53.0%), home help/personal care (4.7%–39.3%) and therapy (2.0%–35.7%).

Conclusions

The prevalence of unmet long-term needs is high among stroke survivors, and there is considerable heterogeneity in type and frequency of specific unmet needs. More research is required to link regular assessment of long-term unmet needs of stroke survivors with the provision of cost-effective patient-centred health and social care services.
Is the IdyllaEGFRMutation Assay feasible on archival stained cytological smears? A pilot study
Authors: De Luca Caterina , Conticelli Floriana , Leone Alvaro , Gragnano Gianluca , Salatiello Maria , Galasso Pasqualina , Pisapia Pasquale , Grillo Lucia Rosalba , Iaccarino Antonino , Vigliar Elena , Bellevicine Claudio , Malapelle Umberto , Troncone Giancarlo
Published: May 2019

Aim

The rapid and fully automated IdyllaEGFRMutation Assay has been specifically designed to process formalin-fixed, paraffin-embedded sections without requiring preliminary DNA extraction. This study evaluates whether this approach can also process archival smears from patients with non–small cell lung cancer (NSCLC) by scraping the stained cellular material directly into the cartridge.

Methods

The study was divided into two parts. In the first part, we carried out IdyllaEGFRMutation Assay on archival stained smears from 39 patients with NSCLC. Among these, 14 cases harboured a mutation in either exon 19 (n=11) or exon 21 (n=3), previously detected on DNA extracts by fragment length and TaqMan assays. In the second part, we evaluated whether de-staining of the smears could reduce background fluorescence.

Results

The IdyllaEGFRMutation Assay confirmed the presence ofEGFRmutation in 11 instances (78.6%). However, concordance was higher for exon 19 deletions (10/11) than for exon 21 p.L858R assessments. Raw data showed a high background fluorescence in channel 2, where theEGFRexon 21 p.L858R mutation was detected. This interference, due to dye residues from the original staining, was partially reduced by de-staining the cytological material.

Conclusions

Our data, although preliminary, show that the IdyllaEGFRMutation Assay can reliably process most archival smears without requiring preliminary DNA extraction. Results may be further improved by de-staining the cellular material before insertion into the cartridge.
Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial
Authors: Bechman Katie , Sin Fang En , Ibrahim Fowzia , Norton Sam , Matcham Faith , Scott David Lloyd , Cope Andrew , Galloway James
Published: May 2019

Background

Tapering of anti-tumour necrosis factor (TNF) therapy appears feasible, safe and effective in selected patients with rheumatoid arthritis (RA). Depression is highly prevalent in RA and may impact on flare incidence through various mechanisms. This study aims to investigate if psychological states predict flare in patients’ dose tapering their anti-TNF therapy.

Methods

This study is a post-hoc analysis of the Optimizing TNF Tapering in RA trial, a multicentre, randomised, open-label study investigating anti-TNF tapering in RA patients with sustained low disease activity. Patient-reported outcomes (Health Assessment Questionnaire, EuroQol 5-dimension scale, Functional Assessment of Chronic Illness Therapy fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36)) were collected at baseline. The primary outcome was flare, defined as an increase in 28-joint count Disease Activity Score (DAS28) ≥0.6 and ≥1 swollen joint. Discrete-time survival models were used to identify patient-reported outcomes that predict flare.

Results

Ninety-seven patients were randomised to taper their anti-TNF dose by either 33% or 66%. Forty-one patients flared. Higher baseline DAS28 score was associated with flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01). Disability (SF-36 physical component score), fatigue (FACIT-F) and mental health (SF-36 mental health subscale (MH)) predicted flare in unadjusted models. In multivariate analyses, only SF-36 MH remained a statistically significant predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60 to 0.93), p=0.01).

Conclusions

Baseline DAS28 and mental health status are independently associated with flare in patients who taper their anti-TNF therapy. Fatigue and function also associate with flare but the effect disappears when adjusting for confounders. Given these findings, mental health and functional status should be considered in anti-TNF tapering decisions in order to optimise the likelihood of success.

Trial registration numbers

EudraCT Number: 2010-020738-24;ISRCTN28955701; Post-results.
Step-up approach for the management of pancreatic necrosis: a review of the literature
Authors: Sion Melanie Kay , Davis Kimberly A
Published: May 2019

Infected necrotizing pancreatitis is a challenging condition to treat because of the profound inflammatory response these patients undergo which can then be exacerbated by interventions. Treatment of this condition has evolved in timing of intervention as well as method of intervention and includes less invasive options for treatment such as percutaneous drainage and endoscopic drainage, in addition to less invasive endoscopic and video-assisted or laparoscopic debridements. The precise optimal treatment strategy for these patients is an ongoing topic of discussion and may be different for each patient as this is a heterogenous condition.
CkLR Algorithm for Improvement of Data Prediction and Accuracy Based on Clustering Data
Authors: Jung Se-Hoon , Kim Jong-Chan
Published: May 2019

In this paper, we proposed the CkLR algorithm to build a model to analyze the response variables of clustered outcomes with a K-means algorithm to categorize and analyze unstructured data such as SNS and assess the prediction rate of clustering and its accuracy rate after the entry of new data. CkLR performs a neural network algorithm based on the clustering outcomes of the data classified in the previous stage. The CkLR model applies a neural network to reflect the entire form of data learning methods rather than stepwise data learning based on clustering data, and conducts research to select a neural network model and analyze variables through learning by clustering. The datasets of the input clustering outcomes are adjusted at certain percentages (learning, testing, and evaluation) to check the prediction rate of input outcomes. The study also proposed a CkLR algorithm based on an LSTM recurrent neural network to compensate for the problem of determining the size of input and output value data for each repetition in a single training session. The training structure of the proposed prediction model, based on a neural network, would calculate the loss values of training, minimize them, and select an optimal model reflecting weights in case of clustering sequential data. The performance evaluation results demonstrate that it recorded prediction and accuracy rates that were 3.65% higher than the old single neural network structure through individual neural networks.
Slow exhumation of the Greater Himalaya in the Yadong region, the transition between the Central and Eastern Himalaya, during the Late Neogene
Authors: Wang An , Min Kyoungwon , Wang Guocan , Cao Kai , Shen Tianyi , Jiang Pengfei , Wei Jiangwei
Published: May 2019

The Yadong area, at the geographic boundary between the Central and Eastern Himalaya, contains the largest along-strike structural discontinuity in the Himalaya. We conducted zircon fission track (ZFT)and apatite (U–Th)/He (AHe) dating along a 50 km transect of the Greater Himalaya Sequence (GHS) to investigate the cooling and exhumation of this structural discontinuity. New ZFT (14.0–8.2 Ma) and AHe (11.1–4.2 Ma) data suggest fast tectonic exhumation of the GHS in the Middle Miocene. After this pulse of rapid exhumation, the area remained in a long-term slower and steady state of exhumation (
c.
0.32 km/Ma since
c.
7.7 Ma). New stream topographic analysis also confirms this slow surface erosion in the hinterlands whereas the frontal range underwent enhanced erosion, possibly due to southward upthrusting along the Main Boundary Thrust and Main Frontal Thrust. Our data underline distinctive exhumation patterns between the Eastern and Central Himalaya and suggest that exhumation of the Himalaya was primarily driven by tectonics associated with the underlying Main Himalaya Thrust (MHT). The long-term, slow and steady exhumation in the Yadong area and the Eastern Himalaya hinterland since the Late Neogene is consistent with the gentle dip of the MHT supporting a slab tear of the subducting Indian Plate.
A Unified Framework for Compression and Compressed Sensing of Light Fields and Light Field Videos
Authors: Miandji Ehsan , Hajisharif Saghi , Unger Jonas
Published: May 2019

In this article we present a novel dictionary learning framework designed for compression and sampling of light fields and light field videos. Unlike previous methods, where a single dictionary with one-dimensional atoms is learned, we propose to train a Multidimensional Dictionary Ensemble (MDE). It is shown that learning an ensemble in the native dimensionality of the data promotes sparsity, hence increasing the compression ratio and sampling efficiency. To make maximum use of correlations within the light field data sets, we also introduce a novel nonlocal pre-clustering approach that constructs an Aggregate MDE (AMDE). The pre-clustering not only improves the image quality but also reduces the training time by an order of magnitude in most cases. The decoding algorithm supports efficient local reconstruction of the compressed data, which enables efficient real-time playback of high-resolution light field videos. Moreover, we discuss the application of AMDE for compressed sensing. A theoretical analysis is presented that indicates the required conditions for exact recovery of point-sampled light fields that are sparse under AMDE. The analysis provides guidelines for designing efficient compressive light field cameras. We use various synthetic and natural light field and light field video data sets to demonstrate the utility of our approach in comparison with the state-of-the-art learning-based dictionaries, as well as established analytical dictionaries.
A Study on Supply Chain Emission Reduction Level Based on Carbon Tax and Consumers’ Low‐Carbon Preferences under Stochastic Demand
Authors: Wang Liang , Xu Tingjia , Qin Longhao
Published: May 2019

This article focuses on the level of supply chain emission reduction, taking into account consumers’ low‐carbon preferences, stochastic market demand, and carbon tax policy. By introducing the emission reduction penalty mechanism and adopting reverse derivation method, it derives the revenue model of the retailer and the manufacturer in decentralized and centralized supply chain when the supply chain reduces emissions or is not under stochastic market demand. The research results are as follows. (i) The optimal retailer’s revenue is strictly monotonous increasing with respect to the consumers’ low‐carbon preferences in the decentralized supply chain. However, in the centralized supply chain, the optimal revenue of the retailer and the manufacturer are strictly monotonously decreasing of the consumers’ low‐carbon preferences respectively. (ii) The retailer’s revenue is a concave function of the order quantity, and there exists a unique order quantity that can maximize retailer’s revenue. The manufacturer’s revenue is a concave function of the wholesale price, and there exists a unique wholesale price that can maximize manufacturer’s revenue. (iii) When consumers’ low‐carbon preferences are given, there is an optimal emission reduction level that maximizes the overall revenue of the supply chain. Furthermore, as the carbon tax increases, the optimal emission reduction level gradually rises. (iv) As the level of emission reduction in the supply chain increases, the range of the revenue sharing coefficient becomes larger, and it is easier for supply chain members to reach a revenue sharing contract. However, when consumers’ low‐carbon preferences and carbon tax increase, the opposite is true.
Upper Gastrointestinal Crohn’s Disease: Literature Review and Case Presentation
Authors: Aggarwal Soorya N. , Cavanagh Yana , Wang Lan , Akmal Amer , Grossman Matthew A.
Published: May 2019

Upper gastrointestinal tract predominant Crohn’s Disease (CD) remains an elusive clinical entity, manifesting limited or vague symptomatology, eluding clinical suspicion, and delaying subsequent diagnostic evaluation. As a result, it has not been widely described and there is a lack of clear recommendations for diagnosis or management. Standard IBD evaluation including serologic testing, imaging, and endoscopy may initially not be fruitful. Furthermore, endoscopic evaluation may be grossly normal in patients without long standing-disease. We describe an 18-year-old male who presented with only unexplained, persistent iron-deficiency anemia. Extensive outpatient testing including multiple endoscopic evaluations with standard biopsies was unfruitful. Ultimately, a positive fecal calprotectin prompted enteroscopy with endoscopic mucosal resection (EMR) in an effort to obtain a larger, deeper tissue specimen. Grossly cobblestoned mucosa along with histopathology revealing focal crypt abscesses, chronic inflammation in the lamina propria, and superficial foveolar epithelial regenerative changes were consistent with CD. This patient’s case illustrates the need for a high degree of suspicion for CD in patients with unexplained or persistent iron deficiency anemias. Persistent investigation yielded an elevation in fecal calprotectin suggesting underlying gastrointestinal inflammation and prompted advanced endoscopic evaluation with EMR. Waxing and waning tissue findings are characteristic of CD and pose a unique challenge in patients with upper gastrointestinal predominant pathology. As such, diligent workup including laboratory evaluation, imaging, and serial endoscopy is critical to establish pathology and dictate subsequent management in IBD, especially upper gastrointestinal tract predominant CD.
Serum Vascular Endothelial Growth Factor Levels before and after Intravitreous Ranibizumab Injection for Retinopathy of Prematurity
Authors: Chen Xuting , Zhou Lin , Zhang Qi , Xu Yu , Zhao Peiquan , Xia Hongping
Published: May 2019

Background. Retinopathy of prematurity (ROP) is one of the common complications of prematurity. Intravitreal injection of ranibizumab (IVR), an antivascular endothelial growth factor (VEGF) drug, showed significant benefit for ROP. However, there are concerns about systemic complications of anti-VEGF therapy in preterm infants. Objectives. To evaluate serum VEGF level in the systemic circulation after IVR and the complications associated with IVR for the premature infants with ROP. Methods. This prospective investigation assessed the serum concentrations of VEGF in ROP patients before and after IVR therapy. All the infants had binocular retinopathy and received IVR 0.25 mg per eye as the primary treatment. Serum samples were collected 1 day prior to injection and 1 day, 3 days, and 7 days after IVR treatment. Serum VEGF level was measured by the enzyme-linked immunosorbent assay (ELISA). Results. Fifteen infants (6 girls and 9 boys) were enrolled. The serum concentrations of VEGF 1 day before and 1 day, 3 days, and 7 days after a total of 0.5 mg intravitreal injections of ranibizumab were 226.9 (198.4, 272.4), 12.8 (7.0, 22.4), 16 (12.0, 20.8), and 33.7 (24.0, 48.0) pg/ml, respectively. Serum VEGF levels decreased significantly at 1 day, 3 days, and 7 days after IVR treatment compared with pretreatment concentration (P<0.05). Compared to days 1 and 3 after IVR, serum VEGF level at 7 days after IVR treatment increased significantly (P<0.05). Conclusion. Serum VEGF levels in patients with ROP were suppressed for at least 7 days after IVR treatment. Although the clinical significance of this phenomenon is uncertain, its safety profile requires further investigation.
The Important Role of Dendritic Cell (DC) in iNKT-Mediated Modulation of NK Cell Function in Chlamydia pneumoniae Lung Infection
Authors: Zhao Lei , Gao Xiaoling , Bai Hong , Joyee Antony George , Wang Shuhe , Yang Jie , Zhao Weiming , Yang Xi
Published: May 2019

Chlamydia pneumoniae(Cpn) infection causes multiple acute and chronic human diseases. The role of DCs in host defense against Cpn infection has been well documented. The same is true for invariant natural killer T (iNKT) cells and NK cells, but the interaction among cells is largely unknown. In this study, we investigated the influence and mechanism of iNKT cell on the differentiation and function of NK cell inCpnlung infection and the role played by DCs in this process. We found that expansion of IFN-γ-producing NK cells quickly happened after the infection, but this response was altered in iNKT knockout (KO) mice. The expression of activation markers and the production of IFN-γby different NK subsets were significantly lower in KO mice than wild-type (WT) mice. Using in vitro DC-NK coculture and in vivo adoptive transfer approaches, we further examined the role of DCs in iNKT-mediated modulation of NK cell function. We found that NK cells expressed lower levels of activation markers and produced less IFN-γwhen they were cocultured with DCs from KO mice than WT mice. More importantly, we found that the adoptive transfer of DCs from the KO mice induced less NK cell activation and IFN-γproduction. The results provided evidence on the modulating effect of iNKT cell on NK cell function, particularly the critical role of DCs in this modulation process. The finding suggests the complexity of cellular interactions inCpnlung infection, which should be considered in designing preventive and therapeutic approaches for diseases and infections.