bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-year follow-up status of emergency department patients with chest pain: Was it panic disorder?
Authors: Fleet Richard P. , Lavoie Kim L. , Martel Jean-Pierre , Dupuis Gilles , Marchand André , Beitman Bernard D.
Published: July 2016

Objectives:

We previously reported that 25% (108/441) of consecutive patients presenting to the emergency department (ED) of the Montreal Heart Institute with a chief complaint of chest pain suffered from panic disorder (PD). The purpose of the present study was to re-examine these patients (with and without PD) 2 years after their initial ED visit to determine their psychiatric and psychosocial status.

Methods:

An interviewer, who was kept blind to patients’ initial medical and psychiatric diagnoses, attempted to contact all patients who participated in the initial study by phone. Patients who completed the phone interview were sent a battery of psychological questionnaires by mail.

Results:

A total of 301 (70%) patients completed the phone interview, and 228 (52%) patients completed the self-report questionnaires. Participants and non-participants did not differ with respect to age, gender, initial self-report scores, or initial cardiac or psychiatric diagnoses. At follow-up, significantly (p < 0.05) more PD+ than non-PD (PD–) patients reported: 1) chest pains in the last month (57% vs. 31%); 2) one or more ED consultations in the past year for chest pain (40% vs. 14%); 3) one or more hospitalizations in the past year (31% vs. 11%); and 4) perceiving their general health as “poor” (22% vs. 9%). PD+ patients displayed a significant (p < 0.05) worsening of their panic symptoms, agoraphobic avoidance, depression, and trait anxiety, and reported significantly (p < 0.05) greater suicidal ideation compared to PD– patients (32% vs. 9%). Of all PD+ patients, only 22% (18/82) reported receiving some form of mental health treatment for their symptoms.

Conclusions:

Unrecognized and untreated PD has a chronic and disabling course. Greater efforts should be made to screen for PD in patients complaining of chest pain in EDs.
Implementation of an automated, real-time public health surveillance system linking emergency departments and health units: rationale and methodology
Authors: Moore Kieran M. , Edgar Bronwen L. , McGuinness Donald
Published: July 2016

In September 2004, Kingston, Frontenac, Lennox and Addington (KFL&A) Public Health, in collaboration with the Public Health Division of the Ontario Ministry of Health and Long-Term Care, Queen's University, the Public Health Agency of Canada, Kingston General Hospital and Hotel Dieu Hospital, began a 2-year pilot project to implement and evaluate an emergency department (ED) chief complaint syndromic surveillance system. Our objective was to evaluate a comprehensive and readily deployable real-time regional syndromic surveillance program and to determine its ability to detect gastrointestinal or respiratory outbreaks well in advance of traditional reporting systems. In order to implement the system, modifications were made to the University of Pittsburgh's Real-time Outbreak and Disease Surveillance (RODS) system, which has been successfully integrated into public health systems, and has enhanced communication and collaboration between them and EDs. This paper provides an overview of a RODS-based syndromic surveillance system as adapted for use at a public health unit in Kingston, Ontario. We summarize the technical specifications, privacy and security considerations, data capture, classification and management of the data streams, alerting and public health response. We hope that the modifications described here, including the addition of unique data streams, will provide a benchmark for future Canadian syndromic surveillance systems.
Énoncé de position de l’ACMU sur le contrôle des armes à feu
Authors: Snider Carolyn E. , Ovens Howard , Drummond Alan , Kapur Atul K.
Published: July 2016

Les blessures et les décès par armes à feu continuent d'être un problème important au Canada. Depuis les années 90, les médecins d'urgence du Canada ont milité en faveur du contrôle des armes à feu. Cet article actualise la position de l'Association canadienne des médecins d'urgence (ACMU) à l'égard du contrôle des armes à feu.

Même si la couverture des médias porte généralement sur les homicides, la majorité des décès par balle est en réalité le résultat de suicides. Moins de 40 % des blessures par armes à feu sont infligées intentionnellement par une autre personne. Depuis la mise en application du Registre des armes à feu en 1995 au Canada, on a constaté une réduction importante des suicides par balle et des homicides par un conjoint. La proposition d'assouplir la législation sur les armes à feu au Canada aura des répercussions importantes sur les décès et les blessures par balle. Il faut plutôt élargir les programmes axés sur la prévention du suicide, de la violence conjugale et de la violence liée aux gangs de rue.

La majorité des blessures par armes à feu intentionnelles ou non intentionnelles impliquent une infraction aux règles d'entreposage ou de maniement sécuritaire de ces armes. Le potentiel de préjudice futur en raison de l'entreposage ou du maniement non sécuritaire des armes à feu ou d'actes de vengeance perpétrés par des gangs de rue corrobore notre position voulant que les établissements de soins de santé déclarent obligatoirement à la police les blessures par balle (BPB). Par ailleurs, il faut mettre en application un système de surveillance national pour appuyer la recherche et orienter les futures politiques publiques et la législation.

En tant que médecins d'urgence, nous devons plaider en faveur du contrôle des blessures. Toutes les blessures et tous les décès par balle sont évitables, et nous devons préconiser une stratégie multidimensionnelle afin de réduire au minimum ce risque pour nos patients.
Physician workload and the Canadian Emergency Department Triage and Acuity Scale: the Predictors of Workload in the Emergency Room (POWER) Study
Authors: Dreyer Jonathan F. , McLeod Shelley L. , Anderson Chris K. , Carter Michael W. , Zaric Gregory S.
Published: July 2016

Introduction:

The Canadian Emergency Department Triage and Acuity Scale (CTAS) is a 5-level triage tool used to determine the priority by which patients should be treated in Canadian emergency departments (EDs). To determine emergency physician (EP) workload and staffing needs, many hospitals in Ontario use a case-mix formula based solely on patient volume at each triage level. The purpose of our study was to describe the distribution of EP time by activity during a shift in order to estimate the amount of time required by an EP to assess and treat patients in each triage category and to determine the variability in the distribution of CTAS scoring between hospital sites.

Methods:

Research assistants directly observed EPs for 592 shifts and electronically recorded their activities on a moment-by-moment basis. The duration of all activities associated with a given patient were summed to derive a directly observed estimate of the amount of EP time required to treat the patient.

Results:

We observed treatment times for 11 716 patients in 11 hospital-based EDs. The mean time for physicians to treat patients was 73.6 minutes (95% confidence interval [CI] 63.6–83.7) for CTAS level 1, 38.9 minutes (95% CI 36.0–41.8) for CTAS-2, 26.3 minutes (95% CI 25.4–27.2) for CTAS-3, 15.0 minutes (95% CI 14.6–15.4) for CTAS-4 and 10.9 minutes (95% CI 10.1–11.6) for CTAS-5. Physician time related to patient care activities accounted for 84.2% of physicians' ED shifts.

Conclusion:

In our study, EPs had very limited downtime. There was significant variability in the distribution of CTAS scores between sites and also marked variation in EP time related to each triage category. This brings into question the appropriateness of using CTAS alone to determine physician staffing levels in EDs.
Saddle pulmonary emboli: an unusual presentation
Authors: Kothari Truptesh H. , Kothari Shivangi , Pandey Mahima , Khara Harshit , Dhungel Nishant
Published: July 2016

A 38-year-old man with a history of polyposis syndrome diagnosed 3 years previously, with poor compliance for follow-up, presented to the emergency department with symptoms of retrosternal chest pain associated with dizziness and shortness of breath. His blood pressure was 94/43 mm Hg, his pulse was 123 beats/min and he had an oxygen saturation of 84% on room air. The patient’s initial laboratory results showed a hemoglobin of 80 g/L and blood gas with a pH of 7.23. He had a normal chest radiograph and electrocardiogram, but had an elevated troponin I at 0.12 μg/L. He was given acetylsalicylic acid for suspicion of acute coronary syndrome. On physical examination, the patient was found to have right calf tenderness. With this finding and the presenting symptoms, he underwent computed tomography angiography (CTA) of the chest. The chest CTA showed a massive saddle embolus with a filling defect completely occluding the right pulmonary artery and extending through the main pulmonary artery segment to involve the left pulmonary artery. There were also diffuse filling defects involving bilateral pulmonary segmental arteries (Fig. 1 and Fig. 2). The patient received alteplase and underwent a workup for a hypercoagulable state. His workup revealed positive anticardiolipin antibodies and factor V Leiden. The Doppler ultrasound of his lower extremities showed an extensive thrombus measuring more than 6 cm extending in the right superficial femoral vein. The patient was then referred for placement of an inferior vena cava filter.
Presentations to emergency departments for chronic obstructive pulmonary disease in Alberta: a population-based study
Authors: Rosychuk Rhonda J. , Voaklander Donald C. , Senthilselvan Ambikaipakan , Klassen Terry P. , Marrie Thomas J. , Rowe Brian H.
Published: July 2016

Objective:

Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta.

Methods:

Administrative databases were used to examine all ED encounters for COPD from April 1999 to March 2005 in Alberta. Data included demographics of patients and timing of ED visits. Data analysis included descriptive summaries and age–sex directly standardized visit rates (DSVRs).

Results:

There were 85 330 ED visits for acute COPD made by 38 638 patients 55 years of age or older during the study period. More men (53.2%) presented, and the mean age at presentation was 72 years. The age–sex DSVRs remained stable from 2000/01 (24.4/1000) to 2004/05 (25.6/1000). Presentation rates differed among population subgroups. Overall, 67% of visits resulted in discharge from the ED.

Conclusion:

Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.
Treatment variability and outcome differences in the emergency department management of alcohol withdrawal
Authors: Kahan Meldon , Borgundvaag Bjug , Midmer Deana , Borsoi Diane , Edwards Carol , Ladhani Noor
Published: July 2016

Objective:

Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments.

Methods:

A structured chart audit was performed for patients with alcohol-related problems who presented to 2 Toronto hospitals over a 2-year period.

Results:

A total of 209 emergency department charts were audited. Patient characteristics were similar in both hospitals. None of the patients had been assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Patients at one hospital received substantially higher mean diazepam doses (64 mg v. 26 mg;p< 0.001) than did the patients at the other hospital, and the patients at the first hospital had fewer seizures during their emergency department stay (1% v. 9%;p= 0.012). Patients spent an average of 9 hours and 40 minutes in the emergency department.

Conclusion:

There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.
Patient Expectations of Emergency Department Care: Phase II – A Cross-Sectional Survey
Authors: Cooke Timothy , Watt Denise , Wertzler William , Quan Hude
Published: July 2016

Objectives:

To explore emergency department (ED) patient expectations regarding staff communication with patients, wait times, the triage process and information management.

Methods:

We conducted a cross-sectional English-language telephone survey among patients aged 18 years or older who visited the EDs in the Calgary Health Region in 2002. Survey items were based on a preceding qualitative study.

Results:

Of the 941 surveys, 837 were analyzed. Patients placed the highest importance on the explanation of test results (96.5%), a description of circumstances that would require the patient to return to the ED (94.4%), the use of plain language (92.1%) and the reason for the tests (90.8%). Seventy-six percent of patients felt that ED staff should update patients every 30 minutes or less, 51.3% expected patients with non-life threatening problems should wait <1 hour, and 58.3% expected that the tests should be done within 1 hour. Almost two-thirds of the patients (64.4%) believed that the most serious patients should be seen first; 59.3% felt that the seriousness of medical concern should be determined by a triage nurse, and 63.9% thought that their personal health records should be immediately available to the emergency physician without their consent. The actual length of stay was significantly longer than expected length of stay for all patient groups, withCanadian Emergency Department Triage and Acuity ScaleLevels IV and V patients expecting a shorter wait than patients in more urgent triage groups. Triage level effects on other expectations were not observed.

Conclusions:

ED patient expectations appear to be similar across all triage levels. Patients value effective communication and short wait times over many other aspects of care. They have expectations for short wait times that are met infrequently and are currently unattainable in many Canadian EDs. Although it may be neither feasible nor desirable to meet all patient expectations, increased focus on wait times and staff communication may increase both ED efficiency and patient satisfaction.
Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients
Authors: Cheung Ka Wai , Green Robert S. , Magee Kirk D.
Published: July 2016

Objective:

Several randomized controlled trials have suggested that mild induced hypothermia may improve neurologic outcome in comatose cardiac arrest survivors. This systematic review of randomized controlled trials was designed to determine if mild induced hypothermia improves neurologic outcome, decreases mortality, or is associated with an increased incidence of adverse events.

Data sources:

The following databases were reviewed: Cochrane Controlled Trials Register (Issue 4, 2005), MEDLINE (January 1966 to November 2005), EMBASE (1980 to November 2005), CINAHL (1982 to November 2005) and Web of Science (1989 to November 2005). For each included study, references were reviewed and the primary author contacted to identify any additional studies.

Study selection:

Studies that met inclusion criteria were randomized controlled trials of adult patients (>18 years of age) with primary cardiac arrest who remained comatose after return of spontaneous circulation. Patients had to be randomized to mild induced hypothermia (32°C-34°C) or normothermia within 24 hours of presentation. Only studies reporting pre-determined outcomes including discharge neurologic outcome, mortality or significant treatment-related adverse events were included. There were no language or publication restrictions.

Data synthesis:

Four studies involving 436 patients, with 232 cooled to a core temperature of 32°C-34°C met inclusion criteria. Pooled data demonstrated that mild hypothermia decreased inhospital mortality (relative ratio [RR] 0.75; 95% confidence interval [CI], 0.62-0.92) and reduced the incidence of poor neurologic outcome (RR 0.74; 95% CI, 0.62-0.84). Numbers needed to treat were 7 patients to save 1 life, and 5 patients to improve neurologic outcome. There was no evidence of treatment-limiting side effects.

Conclusions:

Therapeutically induced mild hypothermia decreases in-hospital mortality and improves neurologic outcome in comatose cardiac arrest survivors. The possibility of treatment-limiting side effects cannot be excluded.
A survey of one CCFP-EM program’s graduates: their background, intended type of practice and actual practice
Authors: Shepherd Lisa G. , Burden Julia K.
Published: July 2016

Objectives:

Our primary objective was to survey the graduates of one residency program with respect to anticipated versus actual medical practice.

Methods:

Using a modified Dillman technique, we surveyed all 83 physicians who had completed one year of residency training that led to certification of special competency in Emergency Medicine (CCFP-EM) at the University of Western Ontario (UWO) from 1982–2004. Respondents were asked what type of medicine they had thought they would practise before beginning their emergency medicine training. They were then asked to describe their employment from graduation to present time. Additional demographic information was collected. Correlation between demographic factors and other selected factors of influence upon career decisions was analyzed.

Results:

Our response rate was 87% (72/83), with 71% (51/72) respondents being male. At the start of their CCFP-EM residency training, 50% of respondents intended to practise emergency medicine exclusively and 47% intended to blend family and emergency medicine. For each of the respondents' first 4 positions of employment, the greatest percentage were practising emergency medicine only (ranging from 72% in position 1 to 53% in position 4), while the number engaging in a blended family/emergency medicine practice never exceeded 20%. No demographic factors surveyed had significant correlation with intended or actual practice. In all positions of employment, “type of practice” was ranked as the most influential factor in choosing that position.

Conclusion:

Most graduates of the UWO CCFP-EM program practise in emergency medicine only positions. Less than 20% are engaged in a blended family/emergency medicine practice. At training onset, one-half of the residents intended to practise emergency medicine exclusively. None of the demographic factors surveyed significantly correlated with intended or actual practice. Further examination of the practice patterns of all emergency medicine residency program graduates is an essential part of future planning for the specialty of Emergency Medicine in Canada.
Impact of a standardized communication system on continuity of care between family physicians and the emergency department
Authors: Afilalo Marc , Lang Eddy , Léger Ruth , Xue Xiaoqing , Colacone Antoinette , Soucy Nathalie , Vandal Alain , Boivin Jean-François , Unger Bernard
Published: July 2016

Objective:

It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care.

Methods:

We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate.

Results:

We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6–3.79), found the information more useful (OR 5.1, 95% CI 3.49–7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12–7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02–2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36–1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97–1.61).

Conclusion:

The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.
Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department
Authors: Homier Valérie , Bellavance Colette , Xhignesse Marianne
Published: July 2016

Objective:

Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context.

Methods:

We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit.

Results:

Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%).

Conclusion:

Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.
Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries
Authors: Merchant Roland C. , Zabbo Christopher P. , Mayer Kenneth H. , Becker Bruce M.
Published: July 2016

Objectives:

Evidence and consensus on best practices on the management of human bite injuries is lacking. Our objective was to identify factors that are associated with delay to emergency department (ED) presentation, antibiotic usage and patient admission.

Methods:

We present a retrospective chart review of adults treated for human bites. Multivariable logistic regression models used demographic characteristics and bite circumstances and characteristics as factors associated with ED presentation more than 24 hours after the bite, antibiotic usage and hospital admission.

Results:

Of the 388 patients evaluated for a human bite, 66.5% were bitten during an altercation; 23.8% presented more than 24 hours after the bite; 50.3% were bitten on the hands or fingers, 23.5% on an extremity and 17.8% on the head or neck. Only 7.7% of all patients sustained closed-fist injuries; the majority had occlusional or other kinds of bites. The majority of patients (77.3%) received antibiotics and 11.1% were admitted to hospital. Patients who had greater odds of presenting more than 24 hours after the bite were black (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.02–3.13), Hispanic (OR 2.68, 95% CI 1.22–5.89) and those who had a non-occupational bite (OR 3.87, 95% CI, 1.68–8.90). Patients had a greater chance of receiving antibiotics if they were bitten during an altercation (OR 1.87, 95% CI, 1.09–3.20) and were bitten on the hands or fingers (OR 2.23, 95% CI 1.31-3.80). Patients had a greater chance of being admitted to the hospital if they were bitten during an altercation (OR 4.91, 95% CI 1.65–14.64), bitten on the hands or fingers (OR 5.26, 95% CI, 1.74–15.87) and if they presented ≥ 24 hours after the bite.

Conclusion:

Most patients presented to the ED within 24 hours of their injury and received antibiotics. The circumstances surrounding the bite appeared to be associated with delay to ED presentation, receipt of antibiotics and admission to the hospital. There are ethnic background differences in delay to ED presentation. ED clinicians in our study favour antibiotic usage and admission based on the body location of the bite, despite little evidence to support these practices.
Defensive Responses to Early Memories with Peers: a Possible Pathway to Disordered Eating
Authors: Ferreira Cláudia , Marta-Simões Joana , Trindade Inês A.
Published: July 2016

Childhood and early adolescence experiences, specifically those that provide an adulthood enriched with warm and safe memories, are consistently stated in literature as powerful emotional regulators. In contrast, individuals who scarcely recall positive experiences may begin to believe that others see the self as inferior, inadequate and unattractive. In order to cope with a perceived loss of social desirability and achieve other’s acceptance, individuals may become submissive, and women, particularly, may resort to the presentation of a perfect body image. Both mechanisms are defensive responses suggested to be associated with mental health difficulties, particularly disordered eating behaviors. The present study aimed at exploring the association between early memories of warmth and safeness with peers and eating psychopathology. Also, a path analysis was conducted to investigate the mediator role of submissiveness and perfectionistic self-presentation focused on body image on this association, in a sample of 342 female students. Results revealed that the absence of early positive memories with peers holds a significant effect over eating psychopathology’s severity, and also that this effect is mediated through submissiveness and body image-related perfectionistic self-presentation. This model accounted for 13%, 19% and 51% of submissiveness, perfectionistic self-presentation of body image and eating psychopathology’s variances, respectively, and showed excellent model fit.
Endovascular treatment of ischaemic stroke patients - new evidence and old challenges
Authors: Gerber Johannes , Puetz Volker , Bodechtel Ulf , Kitzler Hagen , von Kummer Ruediger , Linn Jennifer
Published: July 2016

Abstract. An overwhelming benefit from endovascular treatment of ischaemic stroke could be shown in recent clinical trials, making it the new evidence-based standard of care for ischaemic stroke due to large vessel occlusion. To provide all eligible stroke patients with this therapy at any time, stroke networks and hospitals should streamline their workflow to rapidly image, select, and treat stroke patients. Interdisciplinary cooperation is vital for effective emergency endovascular stroke treatment, which is one of the most complex multidisciplinary functions a hospital can undertake.
Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches
Authors: Jeanneret Christina , Beier Konstantin , von Weymarn Alexander , Traber Jürg
Published: July 2016

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.
Management of lymphoedema
Authors: Yüksel Ahmet , Gürbüz Orçun , Velioğlu Yusuf , Kumtepe Gencehan , Şenol Sefa
Published: July 2016

Abstract. Lymphoedema is a common and progressive disease which causes deterioration of the quality of life of patients. It is divided into two groups: primary and secondary lymphoedema. Nowadays, the majority of patients with lymphoedema are associated with a malignancy or its treatment modalities, such as cancer surgery and radiation therapy. Accurate diagnosis and effective treatment are crucial for alleviating the symptoms, preventing progression and reducing the potential risks of lymphoedema. This report provides an overview of the management of lymphoedema.
MicroRNA-26a inhibits osteosarcoma cell proliferation by targeting IGF-1
Authors: Tan Xinyu , Fan Shicai , Wu Wen , Zhang Yin
Published: July 2016

There are still controversies about the roles of microRNA-26a (miR-26a) in human malignancies, as it is a tumor suppressor in breast cancer, gastric cancer, and hepatocellular carcinoma, but is an oncogene in glioma and cholangiocarcinoma. Until now, the function of miR-26a in osteosarcoma remains largely elusive. Here, we found that miR-26a was downregualted in osteosarcoma tissues. Using in vitro and in vivo assays, we confirmed that miR-26a could inhibit the abilities of in vitro proliferation and suppress in vivo tumor growth in mouse model. Furthermore, we identified insulin-like growth factor 1 (IGF-1) as a novel and direct target of miR-26a and revealed that miR-26a exerted its tumor-suppressor function, at least in part, by inhibiting IGF-1 expression. These findings contribute to our understanding of the functions of miR-26a in osteosarcoma.
Metagenomic covariation along densely sampled environmental gradients in the Red Sea
Authors: Thompson Luke R , Williams Gareth J , Haroon Mohamed F , Shibl Ahmed , Larsen Peter , Shorenstein Joshua , Knight Rob , Stingl Ulrich
Published: July 2016

Oceanic microbial diversity covaries with physicochemical parameters. Temperature, for example, explains approximately half of global variation in surface taxonomic abundance. It is unknown, however, whether covariation patterns hold over narrower parameter gradients and spatial scales, and extending to mesopelagic depths. We collected and sequenced 45 epipelagic and mesopelagic microbial metagenomes on a meridional transect through the eastern Red Sea. We asked which environmental parameters explain the most variation in relative abundances of taxonomic groups, gene ortholog groups, and pathways—at a spatial scale of <2000 km, along narrow but well-defined latitudinal and depth-dependent gradients. We also asked how microbes are adapted to gradients and extremes in irradiance, temperature, salinity, and nutrients, examining the responses of individual gene ortholog groups to these parameters. Functional and taxonomic metrics were equally well explained (75–79%) by environmental parameters. However, only functional and not taxonomic covariation patterns were conserved when comparing with an intruding water mass with different physicochemical properties. Temperature explained the most variation in each metric, followed by nitrate, chlorophyll, phosphate, and salinity. That nitrate explained more variation than phosphate suggested nitrogen limitation, consistent with low surface N:P ratios. Covariation of gene ortholog groups with environmental parameters revealed patterns of functional adaptation to the challenging Red Sea environment: high irradiance, temperature, salinity, and low nutrients. Nutrient-acquisition gene ortholog groups were anti-correlated with concentrations of their respective nutrient species, recapturing trends previously observed across much larger distances and environmental gradients. This dataset of metagenomic covariation along densely sampled environmental gradients includes online data exploration supplements, serving as a community resource for marine microbial ecology.
Reversible switching between pressure-induced amorphization and thermal-driven recrystallization in VO2(B) nanosheets
Authors: Wang Yonggang , Zhu Jinlong , Yang Wenge , Wen Ting , Pravica Michael , Liu Zhenxian , Hou Mingqiang , Fei Yingwei , Kang Lei , Lin Zheshuai , Jin Changqing , Zhao Yusheng
Published: July 2016

Pressure-induced amorphization (PIA) and thermal-driven recrystallization have been observed in many crystalline materials. However, controllable switching between PIA and a metastable phase has not been described yet, due to the challenge to establish feasible switching methods to control the pressure and temperature precisely. Here, we demonstrate a reversible switching between PIA and thermally-driven recrystallization of VO2(B) nanosheets. Comprehensive in situ experiments are performed to establish the precise conditions of the reversible phase transformations, which are normally hindered but occur with stimuli beyond the energy barrier. Spectral evidence and theoretical calculations reveal the pressure–structure relationship and the role of flexible VOx polyhedra in the structural switching process. Anomalous resistivity evolution and the participation of spin in the reversible phase transition are observed for the first time. Our findings have significant implications for the design of phase switching devices and the exploration of hidden amorphous materials.
The methyltransferase Suv39h1 links the SUMO pathway to HP1α marking at pericentric heterochromatin
Authors: Maison Christèle , Bailly Delphine , Quivy Jean-Pierre , Almouzni Geneviève
Published: July 2016

The trimethylation of histone H3 on lysine 9 (H3K9me3) – a mark recognized by HP1 that depends on the Suv39h lysine methyltransferases (KMTs) – has provided a basis for the reader/writer model to explain HP1 accumulation at pericentric heterochromatin in mammals. Here, we identify the Suv39h1 paralog, as a unique enhancer of HP1α sumoylation both in vitro and in vivo. The region responsible for promoting HP1α sumoylation (aa1–167) is distinct from the KMT catalytic domain and mediates binding to Ubc9. Tethering the 1–167 domain of Suv39h1 to pericentric heterochromatin, but not mutants unable to bind Ubc9, accelerates the de novo targeting of HP1α to these domains. Our results establish an unexpected feature of Suv39h1, distinct from the KMT activity, with a major role for heterochromatin formation. We discuss how linking Suv39h1 to the SUMO pathway provides conceptual implications for our general view on nuclear domain organization and physiological functions.
Activation of the Met kinase confers acquired drug resistance in FGFR-targeted lung cancer therapy
Authors: Kim S-M , Kim H , Yun M R , Kang H N , Pyo K-H , Park H J , Lee J M , Choi H M , Ellinghaus P , Ocker M , Paik S , Kim H R , Cho B C
Published: July 2016

Aberrant fibroblast growth factor receptor (FGFR) activation/expression is a common feature in lung cancer (LC). In this study, we evaluated the antitumor activity of and the mechanisms underlying acquired resistance to two potent selective FGFR inhibitors, AZD4547 and BAY116387, in LC cell lines. The antitumor activity of AZD4547 and BAY1163877 was screened in 24 LC cell lines, including 5 with FGFR1 amplification. Two cell lines containing FGFR1 amplifications, H1581 and DMS114, were sensitive to FGFR inhibitors (IC50<250 nm). Clones of FGFR1-amplified H1581 cells resistant to AZD4547 or BAY116387 (H1581AR and H1581BR cells, respectively) were established. Receptor tyrosine kinase (RTK) array and immunoblotting analyses showed strong overexpression and activation of Met in H1581AR/BR cells, compared with that in the parental cells. Gene set enrichment analysis against the Kyoto Encyclopedia of Genes and Genomes (KEGG) database showed that cytokine–cytokine receptor interaction pathways were significantly enriched in H1581AR/BR cells, with Met contributing significantly to the core enrichment. Genomic DNA quantitative PCR and fluorescent in situ hybridization analyses showed MET amplification in H1581AR, but not in H1581BR, cells. Met amplification drives acquired resistance to AZD4547 in H1581AR cells by activating ErbB3. Combination treatment with FGFR inhibitors and an anaplastic lymphoma kinase (ALK)/Met inhibitor, crizotinib, or Met-specific short interfering RNA (siRNA) synergistically inhibited cell proliferation in both H1581AR and H1581BR cells. Conversely, ectopic expression of Met in H1581 cells conferred resistance to AZD4547 and BAY1163877. Acquired resistance to FGFR inhibitors not only altered cellular morphology, but also promoted migration and invasion of resistant clones, in part by inducing epithelial-to-mesenchymal transition. Taken together, our data suggest that Met activation is sufficient to bypass dependency on FGFR signaling. Concurrent inhibition of the Met and FGFR pathways may have synergistic clinical benefits when targeting FGFR-dependent LC.
Non-invasive detection of animal nerve impulses with an atomic magnetometer operating near quantum limited sensitivity
Authors: Jensen Kasper , Budvytyte Rima , Thomas Rodrigo A. , Wang Tian , Fuchs Annette M. , Balabas Mikhail V. , Vasilakis Georgios , Mosgaard Lars D. , Stærkind Hans C. , Müller Jörg H. , Heimburg Thomas , Olesen Søren-Peter , Polzik Eugene S.
Published: July 2016

Magnetic fields generated by human and animal organs, such as the heart, brain and nervous system carry information useful for biological and medical purposes. These magnetic fields are most commonly detected using cryogenically-cooled superconducting magnetometers. Here we present the first detection of action potentials from an animal nerve using an optical atomic magnetometer. Using an optimal design we are able to achieve the sensitivity dominated by the quantum shot noise of light and quantum projection noise of atomic spins. Such sensitivity allows us to measure the nerve impulse with a miniature room-temperature sensor which is a critical advantage for biomedical applications. Positioning the sensor at a distance of a few millimeters from the nerve, corresponding to the distance between the skin and nerves in biological studies, we detect the magnetic field generated by an action potential of a frog sciatic nerve. From the magnetic field measurements we determine the activity of the nerve and the temporal shape of the nerve impulse. This work opens new ways towards implementing optical magnetometers as practical devices for medical diagnostics.
Exogenous feeding of immediate precursors reveals synergistic effect on picroside-I biosynthesis in shoot cultures of Picrorhiza kurroa Royle ex Benth
Authors: Kumar Varun , Sharma Neha , Sood Hemant , Chauhan Rajinder Singh
Published: July 2016

In the current study, we asked how the supply of immediate biosynthetic precursors i.e. cinnamic acid (CA) and catalpol (CAT) influences the synthesis of picroside-I (P-I) in shoot cultures of P. kurroa. Our results revealed that only CA and CA+CAT stimulated P-I production with 1.6-fold and 4.2-fold, respectively at 2.5 mg/100 mL concentration treatment. Interestingly, feeding CA+CAT not only directed flux towards p-Coumaric acid (p-CA) production but also appeared to trigger the metabolic flux through both shikimate/phenylpropanoid and iridoid pathways by utilizing more of CA and CAT for P-I biosynthesis. However, a deficiency in the supply of either the iridoid or the phenylpropanoid precursor limits flux through the respective pathways as reflected by feedback inhibition effect on PAL and decreased transcripts expressions of rate limiting enzymes (DAHPS, CM, PAL, GS and G10H). It also appears that addition of CA alone directed flux towards both p-CA and P-I production. Based on precursor feeding and metabolic fluxes, a current hypothesis is that precursors from both the iridoid and shikimate/phenylpropanoid pathways are a flux limitation for P-I production in shoot cultures of P. kurroa plants. This work thus sets a stage for future endeavour to elevate production of P-I in cultured plant cells.
Control of magnetite nanocrystal morphology in magnetotactic bacteria by regulation of mms7 gene expression
Authors: Yamagishi Ayana , Tanaka Masayoshi , Lenders Jos J. M. , Thiesbrummel Jarla , Sommerdijk Nico A. J. M. , Matsunaga Tadashi , Arakaki Atsushi
Published: July 2016

Living organisms can produce inorganic materials with unique structure and properties. The biomineralization process is of great interest as it forms a source of inspiration for the development of methods for production of diverse inorganic materials under mild conditions. Nonetheless, regulation of biomineralization is still a challenging task. Magnetotactic bacteria produce chains of a prokaryotic organelle comprising a membrane-enveloped single-crystal magnetite with species-specific morphology. Here, we describe regulation of magnetite biomineralization through controlled expression of the mms7 gene, which plays key roles in the control of crystal growth and morphology of magnetite crystals in magnetotactic bacteria. Regulation of the expression level of Mms7 in bacterial cells enables switching of the crystal shape from dumbbell-like to spherical. The successful regulation of magnetite biomineralization opens the door to production of magnetite nanocrystals of desired size and morphology.
Relational Network for Knowledge Discovery through Heterogeneous Biomedical and Clinical Features
Authors: Chen Huaidong , Chen Wei , Liu Chenglin , Zhang Le , Su Jing , Zhou Xiaobo
Published: July 2016

Biomedical big data, as a whole, covers numerous features, while each dataset specifically delineates part of them. “Full feature spectrum” knowledge discovery across heterogeneous data sources remains a major challenge. We developed a method called bootstrapping for unified feature association measurement (BUFAM) for pairwise association analysis and relational dependency network (RDN) modeling for global module detection on features across breast cancer cohorts. Discovered knowledge was cross-validated using data from Wake Forest Baptist Medical Center’s electronic medical records and annotated with BioCarta signaling signatures. The clinical potential of the discovered modules was exhibited by stratifying patients for drug responses. A series of discovered associations provided new insights into breast cancer, such as the effects of patient’s cultural background on preferences for surgical procedure. We also discovered two groups of highly associated features, the HER2 and the ER modules, each of which described how phenotypes were associated with molecular signatures, diagnostic features and clinical decisions. The discovered “ER module”, which was dominated by cancer immunity, was used as an example for patient stratification and prediction of drug responses to tamoxifen and chemotherapy. BUFAM-derived RDN modeling demonstrated unique ability to discover clinically meaningful and actionable knowledge across highly heterogeneous biomedical big data sets.
Thiolate–Protected Gold Nanoparticles Via Physical Approach: Unusual Structural and Photophysical Characteristics
Authors: Ishida Yohei , Akita Ikumi , Sumi Taiki , Matsubara Masaki , Yonezawa Tetsu
Published: July 2016

Here we report a novel physical approach for thiolate–protected fluorescent gold nanoparticles with a controlled size of the order of a few nanometers. This approach is based on a sputtering of gold into a liquid matrix containing thiolate ligand as a stabilizer at various concentrations, thus no reductant was used. The size of the gold nanoparticles was successfully controlled to range from 1.6 to 7.4 nm by adjusting the thiol concentrations. Surface plasmon absorption was observed in larger nanoparticles, but it was not observed in smaller ones. Such smaller nanoparticles fluoresced at around 670 nm with a small spectral shift according to their size, however, the diameter (1.6–2.7 nm) was very strange to show such red emission compared with photophysical characteristics of reported gold cluster or nanoparticles synthesized by chemical method. By detailed investigations using TEM, HAADF-STEM, XPS and TGA and size fractionation by size exclusion chromatography, we finally arrived at the plausible mechanism for the origin of unusual fluorescence property; the obtained gold nanoparticles are not single-crystal and are composed of aggregates of very small components such as multinuclear gold clusters or complexes.
Sphenopalatine Ganglion Acupuncture Improves Nasal Ventilation and Modulates Autonomic Nervous Activity in Healthy Volunteers: A Randomized Controlled Study
Authors: Wang Kuiji , Chen Luquan , Wang Yang , Wang Chengshuo , Zhang Luo
Published: July 2016

The study aimed to assess the effects of Sphenopalatine ganglion (SPG) acupuncture on nasal ventilation function and autonomic nervous system in health volunteers. 39 healthy subjects were randomly assigned to either active SPG acupuncture group (AA group) or sham-SPG acupuncture group (SA group). All subjects were assessed for self-reported nasal ventilation, nasal patency (nasal airway resistance (NAR) and nasal cavity volume (NCV), exhaled nasal nitric oxide (nNO), and neuropeptides (substance P(SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY)) in nasal secretions at baseline, 30 minutes, 2 hours, and 24 hours after acupuncture. Significantly more subjects in AA group reported improvements in nasal ventilation at all time points after acupuncture, compared to SA group. NAR and NCV were also significantly lower in AA group than SA group. The level of nNO in AA group was significantly decreased after 24 hours compared to SA group. The level of NPY was significantly increased in AA group at 30 minutes and 2 hours compared to baseline and SA group. The levels of SP and VIP were not significantly different in the two groups. We concluded that SPG acupuncture could help to improve nasal ventilation by increasing sympathetic nerve excitability in healthy volunteers.