bluuebunny/crossref_metadata_2025 huggingface dataset:
Psolusosides C3 and D2-D5, Five Novel Triterpene Hexaosides From the Sea Cucumber Psolus fabricii (Psolidae, Dendrochirotida): Chemical Structures and Bioactivities
Authors: Silchenko Alexandra S. , Avilov Sergey A. , Kalinovsky Anatoly I. , Kalinin Vladimir I. , Andrijaschenko Pelageya V. , Dmitrenok Pavel S. , Popov Roman S. , Chingizova Ekaterina A. , Kasakin Marat F.
Published: July 2019

Five new triterpene glycosides, psolusosides C3 (1), D2 (2), D3 (3), D4 (4), and D5 (5), have been isolated from the sea cucumber Psolus fabricii. The structures of these glycosides were elucidated by 2-dimensional nuclear magnetic resonance spectroscopy and high-resolution mass spectrometry. All the compounds contain hexasaccharide carbohydrate chains, differing from each other in the third monosaccharide residue: xylose was found in psolusosides of group C and glucose in group D. Aglycones of the isolated compounds belong to the holostane type, contain 9(11)-double bond and 16-keto-group and have different side chains. The hemolytic activity against mouse erythrocytes and cytotoxic activity against mouse Ehrlich carcinoma cells (ascite form) and neuroblastoma Neuro 2A cells of 1 to 5 as well as the psolusosides isolated by us earlier, C1, C2, and D1, 26-nor-25-oxo-holotoxin A1, and holotoxin A1, have been studied. Psolusosides C2, D1, and D2 (2) having the aglycones without hydroxy group in the side chain showed the strongest hemolytic action in this series. Psolusoside D3 (3) containing a peroxide group in the side chain of its aglycone was surprisingly highly cytotoxic in all the tests.
Cone-Beam Computed Tomography Allows Accurate Registration to Surgical Navigation Systems: A Multidevice Phantom Study
Authors: Talks Benjamin J. , Jolly Karan , Burton Hanna , Koria Hitesh , Ahmed Shahzada K.
Published: July 2019

Background

Cone-beam computed tomography (CBCT) is a fast imaging technique with a substantially lower radiation dosage than conventional multidetector computed tomography (MDCT) for sinus imaging. Surgical navigation systems are increasingly being used in endoscopic sinus and skull base surgery, reducing perioperative morbidity.

Objective

To investigate CBCT as a low-radiation imaging modality for use in surgical navigation.

Methods

The required field of view was measured from the tip of the nose to the posterior clinoid process anteroposteriorly and the nasolabial angle to the roof of the frontal sinus superoinferiorly on 50 consecutive MDCT scans (male = 25; age = 17–85 years). A phantom head was manufactured by 3-dimensional printing and imaged using 3 CBCT scanners (Carestream, J Morita, and NewTom), a conventional MDCT scanner (Siemens), and highly accurate laser scanner (FARO). The phantom head was registered to 3 surgical navigation systems (Brainlab, Stryker, and Medtronic) using scans from each system.

Results

The required field of view (mean ± standard deviation) was measured as 107 ± 7.6 mm anteroposteriorly and 90.3 ± 9.6 mm superoinferiorly. Image error deviations from the laser scan (median ± interquartile range) were comparable for MDCT (0.19 ± 0.09 mm) and CBCT (CBCT 1: 0.15 ± 0.11 mm; CBCT 2: 0.33 ± 0.18 mm; and CBCT 3: 0.13 ± 0.13 mm) scanners. Fiducial registration error and target registration error were also comparable for MDCT- and CBCT-based navigation.

Conclusion

CBCT is a low-radiation preoperative imaging modality suitable for use in surgical navigation.
Physical therapy treatment in children with cerebral palsy after single-event multilevel surgery: a qualitative systematic review. A first step towards a clinical guideline for physical therapy after single-event multilevel surgery
Authors: van Bommel Esther E.H. , Arts Marieke M.E. , Jongerius Peter H. , Ratter Julia , Rameckers Eugene A.A.
Published: July 2019

Background:

The aim of this study was to review available evidence for physical therapy treatment (PTT) after single-event multilevel surgery (SEMLS), and to realize a first step towards an accurate and clinical guideline for developing effective PTT for children with cerebral palsy (CP) after SEMLS.

Methods:

A qualitative systematic review (PubMed, Medline, Embase, CINAHL, and the Cochrane Library) investigating a program of PTT after SEMLS in children aged 4–18 years with CP classified by Gross Motor Function Classification System level I–III.

Results:

Six articles meeting the inclusion criteria were selected. The selected studies provide only incomplete descriptions of interventions, and show no consensus regarding PTT after SEMLS. Neither do they show any consensus on the outcome measures or measuring instruments.

Conclusions:

Based on the results of this literature review in combination with our best practice, we propose a preliminary protocol of PTT after SEMLS.
Communicating off the record
Authors: Dimitrov Roumen
Published: July 2019

This article pursues three major goals. The first is a critical one. It confronts the widespread bias that off-the-record communication briefings are inferior – including professionally and ethically – to other techniques of communication, especially to its counterpart of on-the-record communication. The second goal is a practical one. Discussed are cases of both failed and successful off-the-record strategies, from which basic rules – prerequisites for such interaction – are extracted. And the third goal is a theoretical one. Off-the-record is conceptualised as more indirect and, in this sense, more strategic mode of communication than its counterpart. Affinity rather than trust is the core quality of the source-media relations here. A new distinction is made between advertising and public relations. On the record, one controls the message but due to the obvious self-interest of the source – attributable or unattributable – its credibility is low. Off the record, one cannot control the message, but other and more credible influencers take ownership of it and increase its impact. On the record is advertising; off the record is public relations.
The Footy Girls of Tumblr: How Women Found Their Niche in the Online Football Fandom
Authors: Kunert Jessica
Published: July 2019

This study examines how female football (soccer) fans use the social media platform Tumblr to interact and talk about their fandom, what purposes Tumblr serves for them, and why they prefer it to other social media platforms. As women are often marginalised in offline and online sports discourse, Tumblr’s football fandom was chosen to investigate how women experience their fandom on a platform with a mostly female and young user population. The results of 14 in-depth qualitative interviews with heavily invested female Tumblr users show that the fandom’s communication culture allows fans to interact in a variety of creative ways that involve the use of a specialist vocabulary. This Tumblr fandom is overwhelmingly female, which makes the interviewees feel that they can talk freely about football. Thus, Tumblr has the potential to serve as a safe space for female fans. Yet, its highly opinionated discussions and rivalries mirror those in the traditional football fandom. This study contributes to the literature that explores how women express their sports fandom online and demonstrates how they have found a niche in which to discuss their favourite sport on their own terms.
Analysis of the Impact of Antiretroviral Drug Changes on Survival of Patients with Advanced-Stage AIDS with Multidrug-Resistant HIV Infection
Authors: Ma Rui , Jung Tae Hyun , Peduzzi Peter N. , Brown Sheldon T. , Kyriakides Tassos C.
Published: July 2019

Objectives:

This article aims to elucidate the relationship between antiretroviral (ARV) medication changes and all-cause mortality using a total of 368 patients recruited from the United States (78%), United Kingdom (11%), and Canada (11%).

Methods:

Data sources included demographic characteristics, ARV treatment history and modifications, and clinical biomarker data from the completed OPTions In Management with Antiretrovirals clinical trial. Descriptive analysis and graphical trajectory representation of ARV drug modifications and biomarker changes were undertaken. Three hypotheses aimed at assessing the impact of ARV modification parameters on clinical outcomes were tested. Kaplan-Meier survival techniques as well as Cox proportional hazard regression models were employed.

Results:

Results from the analyses suggest that (1) switching therapy strategy from an intensified ARV regimen to a less intense one or vice versa, (2) having a moderate number (up to 2) of ARV drug changes per 6 months, and (3) changes based on clinical/HIV-related reasons or nonclinical reasons compared to ARV drug regimen changes due to clinical non-HIV reasons improved survival.

Conclusion:

Modifications in the ARV regimens of HIV-infected patients with multidrug resistance are associated with improved survival.
Applying Quality Improvement Strategies to Health Services for HIV-Affected Mother–Baby Pairs in Rural Kenya
Authors: Kinyua Kevin , Muange Prisca , Makenzi Benard , Kimani Charles , Amoah Aurora O.
Published: July 2019

The Partnership for HIV-Free Survival (PHFS) was piloted in rural Kenya using a quality improvement approach to integrate nutrition with prevention of mother-to-child transmission (PMTCT) of HIV services. Data were collected in a preintervention baseline (January 2013 to August 2013) and 3 periods during implementation (September 2013 to June 2016). Integration of nutrition assessment, counseling, and support (NACS) in PMTCT and retention of mother–baby pairs (MBPs) in care showed significant increase over time: The MBPs receiving NACS increased from a baseline median of 15% to 88% ( P ≤ .05), and the proportion of MBPs retained in active care increased from a baseline median of 19% to a median of 66% ( P ≤ .01). Declines observed in the number of HIV-exposed infants who tested positive for HIV at 18 months were not statistically significant. The PHFS was successful in integrating NACS into PMTCT services and increasing retention of MBPs in care in Kenya.
Has the Promise of the Internet Been Realized? Internet Access and Collective Invention among Independent and Organizational Patent Inventors
Authors: Dahlin Eric , Dufur Mikaela , Flake Dallan
Published: July 2019

The Internet provides individuals with new avenues for knowledge sharing and collaboration, two key ingredients for the production of novelty. Despite the unprecedented access to information and potential collaborators provided by the Internet, however, organizations remain the preeminent site of invention, presumably due to the tremendous resources, technology, and expertise at their disposal. Given the presumption that improved access to the Internet cultivates connectivity and novelty among individuals, on one hand, and the resources organizations can leverage to create novelty, on the other hand, we ask whether Internet access plays a role in the incidence of collective invention for independent inventors and organizational inventors in the knowledge economy. Regression models based on a sample of metropolitan areas in the United States predict that increases in household Internet access increases collective invention for organizational patent inventors, but not independent patent inventors.
Implementation of the Whole Child Assessment to Screen for Adverse Childhood Experiences
Authors: Marie-Mitchell Ariane , Lee Joshua , Siplon Christopher , Chan Francis , Riesen Sharon , Vercio Chad
Published: July 2019

Pediatricians are encouraged to screen for adverse childhood experiences (ACEs). The current study developed and implemented a tool to screen for Child-ACEs at a pediatric resident clinic in San Bernardino, California. Development of the tool, named the Whole Child Assessment (WCA), was based on an iterative process that incorporated triangulation of references, patient data, and physician feedback. Implementation of the WCA occurred over the course of 6 improvement cycles that involved obtaining and responding to stakeholder feedback, streamlining paperwork and workflow, and providing physician education. Over the course of our study, we reviewed 1100 charts from well-child visits. We demonstrated that use of the WCA increased identification of multiple Child-ACEs compared with no screening and that reports of multiple Child-ACEs increased with age. These results suggest that use of the WCA provides an acceptable and feasible way to screen for Child-ACEs during routine pediatric practice.
A Pilot Study on Resident and Pediatrician Knowledge and Confidence in the Diagnosis of Slipped Capital Femoral Epiphysis
Authors: Mofidi Jessica , Sarkisova Natalya , Andras Lindsay M. , Goldstein Rachel Y. , Zaslow Tracy L. , Edison Bianca R. , Skaggs David L. , Bent Melissa A.
Published: July 2019

Introduction. The purpose of this study was to identify deficiencies in pediatric residents’ and pediatricians’ knowledge and confidence in diagnosing slipped capital femoral epiphysis (SCFE). Methods. Pediatricians and residents at our institution answered an anonymous 12-question survey on knowledge and confidence in SCFE diagnosis. Results. Twenty pediatricians and 30 pediatric residents participated in the survey. Of 30 residents, 22 (77%) reported low confidence ordering radiographs evaluating for SCFE in patients with hip pain. Four of 20 pediatricians (20%) reported low confidence ordering radiographs for patients with hip pain. Forty percent (8/20) of pediatricians did not feel comfortable diagnosing a SCFE based on radiographs, which was significantly different from 80% (24/30) of residents who did not feel comfortable diagnosing a SCFE based on radiographs ( P = .004). There was a significant difference between residents and pediatricians in comfort ordering and diagnosing radiographs ( P < .01). There was no significance between pediatrician and resident scores for knowledge-based questions ( P = .50). Discussion. Despite scoring well on knowledge-based questions, more than half of pediatricians and pediatric residents felt uncomfortable ordering radiographs to evaluate for SCFE in patients with hip or knee pain. This may be one factor contributing to the continued delay in SCFE diagnosis.
Sensing others: Empty buildings and sensory worlds in Detroit
Authors: Caverly Nicholas L
Published: July 2019

In recent years, tens of thousands of empty buildings have been demolished in Detroit. Alongside visual appearances like collapsed roofs and broken windows, unoccupied structures gather noxious smells, sporadic fires, gunshots, accounts of disappeared neighbors, and fears that such buildings might consume children and entire neighborhoods. The looks, smells, sounds, and other emissions of vacant structures impinge on the lives of adjacent residents, as much as they do provisions of the municipality’s property maintenance code. In so doing, unused buildings become the shared grounds for neighbors, building inspectors, and others to grapple with the felt effects of racialized political economic change. This article focuses on how articulations between embodied experiences and statutory norms enable efforts to locate, historicize, and expel buildings from the city’s landscape. Specifically, I examine how the elaboration of sensory distress provokes the seizure of privately owned buildings from corporate owners. By tracing this elaboration through backyard conversations, municipal codebooks, and demolition hearings, I take note of how sensory experiences cohere a potent platform for spatial politics. At the same time, as corporate entities shake loose of disciplinary strictures mobilized by state actors and neighbors alike, they reveal how those who profit from others’ distress can do so by refusing implication in shared sensory worlds.
Trait-based analysis of the human skin microbiome
Authors: Bewick Sharon , Gurarie Eliezer , Weissman JL , Beattie Jess , Davati Cyrus , Flint Rachel , Thielen Peter , Breitwieser Florian , Karig David , Fagan William F.
Published: July 2019

Background

The past decade of microbiome research has concentrated on cataloging the diversity of taxa in different environments. The next decade is poised to focus on microbial traits and function. Most existing methods for doing this perform pathway analysis using reference databases. This has both benefits and drawbacks. Function can go undetected if reference databases are coarse-grained or incomplete. Likewise, detection of a pathway does not guarantee expression of the associated function. Finally, function cannot be connected to specific microbial constituents, making it difficult to ascertain the types of organisms exhibiting particular traits—something that is important for understanding microbial success in specific environments. A complementary approach to pathway analysis is to use the wealth of microbial trait information collected over years of lab-based, culture experiments.

Methods

Here, we use journal articles and Bergey’s Manual of Systematic Bacteriology to develop a trait-based database for 971 human skin bacterial taxa. We then use this database to examine functional traits that are over/underrepresented among skin taxa. Specifically, we focus on three trait classes—binary, categorical, and quantitative—and compare trait values among skin taxa and microbial taxa more broadly. We compare binary traits using a Chi-square test, categorical traits using randomization trials, and quantitative traits using a nonparametric relative effects test based on global rankings using Tukey contrasts.

Results

We find a number of traits that are over/underrepresented within the human skin microbiome. For example, spore formation, acid phosphatase, alkaline phosphatase, pigment production, catalase, and oxidase are all less common among skin taxa. As well, skin bacteria are less likely to be aerobic, favoring, instead, a facultative strategy. They are also less likely to exhibit gliding motility, less likely to be spirillum or rod-shaped, and less likely to grow in chains. Finally, skin bacteria have more difficulty at high pH, prefer warmer temperatures, and are much less resilient to hypotonic conditions.

Conclusions

Our analysis shows how an approach that relies on information from culture experiments can both support findings from pathway analysis, and also generate new insights into the structuring principles of microbial communities.
Endoscopic removal of ectopic sinonasal teeth: A systematic review
Authors: Levin Marc , Sommer Doron D.
Published: July 2019

Introduction

Ectopic sinonasal teeth are uncommon. The classic approach to removal of such foreign bodies was the Caldwell-Luc. In recent years however, endoscopic approaches have become increasingly utilized. Despite this, there is a dearth of literature and consensus regarding the endoscopic removal of ectopic sinonasal teeth. As such, we conducted a systematic review on all cases of endoscopic removal of ectopic sinonasal teeth in the literature. With an understanding of the literature, clinical and technical decision making for patients with this pathology may be elucidated.

Methods

Systematic review of the Ovid Medline, EMBASE Classic and Pubmed databases were conducted using PRISMA guidelines.

Results

Our search identified 100 articles. Final inclusion consisted of 23 studies with a total of 27 patient cases. The majority of the patients included were male (70.4%) with a mean age of 27.06 years. Patients presented with a multitude of symptoms, with nasal obstruction (48.14%), rhinorrhea (22.2%), facial pain (22.2%) and epistaxis (22.2%) being most common. Surgeons mostly reported using a 0° endoscope (22.2%) and performing a maxillary antrostomy/uncinectomy (37%) and simple extraction under general anesthetic (41%).

Conclusions

This systematic review analyzed important epidemiological, clinical and technical information regarding patients with endoscopic removal of sinonasal ectopic teeth. Further research is needed to promote implementation of such data into clinical practice.
Somatic PRKACA Mutations: Association With Transition From Pituitary-Dependent to Adrenal-Dependent Cushing Syndrome
Authors: Di Dalmazi Guido , Timmers Henri J L M , Arnaldi Giorgio , Küsters Benno , Scarpelli Marina , Bathon Kerstin , Calebiro Davide , Beuschlein Felix , Hermus Ad , Reincke Martin
Published: July 2019

Context

Prolonged adrenal stimulation by corticotropin, as in long-standing Cushing disease (CD), leads to diffuse to nodular hyperplasia. Adrenal functional autonomy has been described in a subset of patients with CD, leading to the hypothesis of transition from ACTH-dependent to ACTH-independent hypercortisolism.

Objective

With the consideration that the catalytic α subunit of protein kinase A (PKA; PRKACA) somatic mutations are the most common finding in adrenal adenomas associated with ACTH-independent Cushing syndrome, our aim was to analyze PRKACA mutations in adrenals of patients with persistent/long-standing CD.

Design

Cross-sectional.

Setting

University hospital.

Patients

Two patients with long-standing CD and suspicion of coexistence of autonomous adrenal hyperfunction, according to pre and postoperative evaluations, were selected for this study, following an intensive literature search and patient-chart reviewing.

Intervention

Clinical data were analyzed. DNA was extracted from adrenal tissue for PRKACA sequencing. PKA activity was assayed.

Main Outcome Measure

PRKACA somatic mutations.

Results

Both patients showed mutations of PRKACA in the macronodule in the context of micronodular adrenal hyperplasia. One patient harbored the previously described p.Leu206Arg substitution, whereas a p.Ser213Arg missense variation was detected in the adrenal nodule of the second patient. No mutations were detected in the adjacent adrenal cortex of the second patient. In silico analysis predicts that p.Ser213Arg can interfere with the interaction between the regulatory and catalytic subunits of PKA.

Conclusions

Our study shows that PRKACA somatic mutations can be found in adrenal nodules of patients with CD. These genetic alterations could represent a possible mechanism underlying adrenal nodule formation and autonomous cortisol hyperproduction in a subgroup of patients with long-standing CD.
Nivolumab in Metastatic Adrenocortical Carcinoma: Results of a Phase 2 Trial
Authors: Carneiro Benedito A , Konda Bhavana , Costa Rubens B , Costa Ricardo L B , Sagar Vinay , Gursel Demirkan B , Kirschner Lawrence S , Chae Young Kwang , Abdulkadir Sarki A , Rademaker Alfred , Mahalingam Devalingam , Shah Manisha H , Giles Francis J
Published: July 2019

Context

Systemic treatment of metastatic adrenocortical carcinoma (ACC) remains limited to chemotherapy and mitotane. Preliminary evidence suggesting that antitumor immune responses can be elicited in ACC has fostered interest in checkpoint inhibitors such as anti–PD-1 nivolumab.

Objective

The primary endpoint was objective response rate according to the response evaluation criteria in solid tumors. Secondary endpoints were progression-free survival (PFS), overall survival, and safety.

Design

Single-arm, multicenter, phase 2 clinical trial with two-stage design.

Setting

Comprehensive cancer center.

Patients

Ten adult patients with metastatic ACC previously treated with platinum-based chemotherapy and/or mitotane as well as patients who declined front-line chemotherapy.

Intervention

Nivolumab (240 mg) IV every 2 weeks.

Results

Ten patients with metastatic ACC were enrolled between March and December 2016. The median number of doses of nivolumab administered was two. Three patients only received one treatment [one died of disease progression, one discontinued due to adverse events (AEs), one withdrew after beginning treatment]. The median PFS was 1.8 months. The median follow-up was 4.5 months (range, 0.1 to 25.6 months). Two patients had stable disease for a duration of 48 and 11 weeks, respectively. One patient had an unconfirmed partial response but discontinued the study due to an AE. Most AEs were grade 1/2. The most common grade 3/4 treatment-related AEs were aspartate aminotransferase and alanine aminotransferase elevations, mucositis, and odynophagia.

Conclusion

Nivolumab demonstrated modest antitumor activity in patients with advanced ACC. The nivolumab safety profile was consistent with previous clinical experience without any unexpected AEs in this population.
Gene Expression in Granulosa Cells From Small Antral Follicles From Women With or Without Polycystic Ovaries
Authors: Owens Lisa Ann , Kristensen Stine Gry , Lerner Avi , Christopoulos Georgios , Lavery Stuart , Hanyaloglu Aylin C , Hardy Kate , Yding Andersen Claus , Franks Stephen
Published: July 2019

Context

Polycystic ovary syndrome (PCOS) is the most common cause of anovulation. A key feature of PCOS is arrest of follicles at the small- to medium-sized antral stage.

Objective and Design

To provide further insight into the mechanism of follicle arrest in PCOS, we profiled (i) gonadotropin receptors; (ii) characteristics of aberrant steroidogenesis; and (iii) expression of anti-Müllerian hormone (AMH) and its receptor in granulosa cells (GCs) from unstimulated, human small antral follicles (hSAFs) and from granulosa lutein cells (GLCs).

Setting

GCs from hSAFs were collected at the time of cryopreservation of ovarian tissue for fertility preservation and GLCs collected during oocyte aspiration before in vitro fertilization/intracytoplasmic sperm injection.

Participants

We collected hSAF GCs from 31 women (98 follicles): 10 with polycystic ovaries (PCO) and 21 without. GLCs were collected from 6 women with PCOS and 6 controls undergoing IVF.

Main Outcome Measures

Expression of the following genes: LHCGR, FSHR, AR, INSR, HSD3B2, CYP11A1, CYP19, STAR, AMH, AMHR2, FST, INHBA, INHBB in GCs and GLCs were compared between women with PCO and controls.

Results

GCs in hSAFs from women with PCO showed higher expression of LHCGR in a subset (20%) of follicles. Expression of FSHR (P < 0.05), AR (P < 0.05), and CYP11A1 (P < 0.05) was lower, and expression of CYP19A1 (P < 0.05), STAR (P < 0.05), HSD3B2 (P = NS), and INHBA (P < 0.05) was higher in PCO GCs. Gene expression in GL cells differed between women with and without PCOS but also differed from that in GCs.

Conclusions

Follicle arrest in PCO is characterized in GCs by differential regulation of key genes involved in follicle growth and function.
Improvement but no normalization of quality of life and cognitive functioning after treatment for Cushing’s syndrome
Authors: Broersen Leonie H A , Andela Cornelie D , Dekkers Olaf M , Pereira Alberto M , Biermasz Nienke R
Published: July 2019

Background

Cushing’s syndrome is characterized by glucocorticoid excess, which induces physical and mental symptoms, impairments in functional status and perceived health, resulting in impaired quality of life. Biochemical remission is urgently required; however, quality of life and cognitive function may remain impaired.

Objective

To perform a systematic review and meta-analysis evaluating changes in health-related quality of life and cognitive functioning in patients with Cushing’s syndrome after treatment.

Methods

Eight electronic databases were searched in March 2017, and PubMed again in May 2018, to identify potentially relevant articles. Eligible studies were (randomized controlled) trials, cohort studies, and cross-sectional studies assessing quality of life or cognitive functioning in patients treated for Cushing’s syndrome. Differences were expressed as standardized mean difference, and reported with 95% confidence intervals. We compared patients before and after treatment (improvement), and patients after treatment and healthy controls (normalization).

Results

We included 47 articles with 2,643 patients. Most patients had Cushing’s disease and were in remission after treatment. Quality of life and cognitive functioning improved after treatment in all studied domains. Compared to a healthy control population, quality of life did not normalize. Cognitive functioning normalized in part, but not all, of the studied domains.

Conclusions

Treatment of Cushing’s syndrome improves quality of life and cognitive functioning. As normalization was not achieved in quality of life and in some aspects of cognitive functioning, special and continuous attention should be given to these aspects for patients after treatment. Effective interventions for further improvement and possibly normalization are urgently needed.
Short-term, but not long-term, increased day time workload leads to decreased night time energetics in a free living song bird
Authors: Visser Marcel E. , van Dooremalen Coby , Tomotani Barbara M. , Bushuev Andrey , Meijer Harro A. J. , te Marvelde Luc , Gienapp Phillip
Published: July 2019

Reproduction is energetically expensive and to obtain sufficient energy, animals can either alter their metabolic system over time to increase energy intake (increased-intake hypothesis), or reallocate energy from maintenance processes (compensation hypothesis). The first hypothesis predicts a positive relationship between basal metabolic rate (BMR) and energy expenditure (DEE) because of the higher energy demands of the metabolic system in rest. The second hypothesis predicts a trade-off between different body functions, with a reduction of the BMR as a way to compensate for increased daytime energetic expenditure. We experimentally manipulated the workload of wild pied flycatchers by adding or removing chicks when chicks were 2 and 11 days old. We then measured the feeding frequency (FF), DEE and BMR at day 11, allowing us to assess both short- and long-term effects of increased workload. The manipulation at day 2 caused an increase in FF when broods were enlarged, but no response in DEE or BMR, while the manipulation at day 11 caused an increase in FF, no change in DEE and a decrease in BMR in birds with more chicks. Our results suggest that pied flycatchers adjust their workload but that this does not lead to a higher BMR at night (no support for the increased-intake hypothesis). In the short-term we find that birds reallocate energy with a consequent reduction of BMR (evidence for the compensation hypothesis). Birds thus resort to short-term strategies to increase energy expenditure, which could explain why energy expenditure and hard-work are not always correlated in birds.
Congenital heart disease frequency in children undergoing MDCT angiography; a 4-year tertiary care hospital experience from Kabul, Afghanistan
Authors: Alam Tariq , Munir Muhammad Khurram , Hamidi Hidayatullah
Published: July 2019

Objectives:

Echocardiography and cardiac angiography are two main imaging modalities used for evaluating congenital heart diseases (CHDs). Evaluation of CHDs is now possible with Multidetector CT (MDCT) angiography in Afghanistan. To the best of researchers' knowledge, no published data is available on frequency of CHDs among children undergoing chest MDCT angiography in Afghanistan; hence, this study is first of its nature to be conducted in this context. To describe the frequency of CHDs among children who underwent chest MDCT angiography in radiology department at French Medical Institute for Mothers and Children (FMIC) from April 2010 to July 2014.

Methods & materials:

A retrospective, cross-sectional descriptive study was conducted at radiology department FMIC in Kabul, Afghanistan. The study population consisted of all paediatric patients (aged 1 day–17 years) who underwent chest MDCT angiography at radiology department FMIC from April 2010 to July 2014. All examinations were performed in arterial phase by 128 slice Siemens scanner after intravenous administration of non-ionic water-soluble contrast material (Omnipaque 350) at a volume of 2 ml/Kg. CT setup included non-electrocardiogram gated CT, CT dose index 5–10 and dose–length product 120–200, with post-processing following initial scan. CT reports were reviewed from Radiology Information System. Data collection tool was developed and data were analysed using SPSS v. 22. Frequencies and proportion were calculated for various CHDs.

Results:

A total of 942 cases of contrast enhanced chest MDCT examinations were performed during this period. Out of these, 212 cases with CHDs were recruited, from which 29 cases were excluded because of undergoing previous surgical procedures or had incomplete CT reports. Remaining 183 cases (n = 183) of CHDs were included for further analysis. A total of 107 patients (58.5%) were male and 76 (41.5%) were female. The patients aged 1 day–17 years (mean age 4.47 + 4.76 standard deviation). A total of 87 patients (47.5%) had solitary anomalies while 96 patients (52.5%) had more than one defect. In terms of location, 20 cases (10.9%) were isolated intracardiac anomalies, 116 cases (63.4%) were isolated extracardiac anomalies and 47 cases (25.7%) had mixed intra- and extracardiac anomalies.

Conclusion:

Given the frequency, it is clear that CHDs is a complex health problem in Afghan paediatric population. MDCT angiography can be considered as a non-invasive, readily available diagnostic tool in evaluation of complex cardiac anomalies after initial evaluation.

Advances in knowledge:

MDCT evaluation of CHD as an alternative to echo/angiography has become more important in a country where there is severe shortage of interventional cardiologists.
Difference in the artefacts production and the performance of the metal artefact reduction (MAR) tool between the buccal and lingual cortical plates adjacent to zirconium dental implant
Authors: Nascimento Eduarda Helena Leandro , Fontenele Rocharles Cavalcante , Santaella Gustavo Machado , Freitas Deborah Queiroz
Published: July 2019

Objectives:

To quantify the artefacts production and the performance of the metal artefact reduction (MAR) tool, enabled before or after the acquisition, in cortical plates (buccal and lingual) and other regions adjacent to zirconium implants.

Methods:

Cone beam CT scans were acquired using the OP300 Maxio unit before (control group) and after (implant group) the insertion of a zirconium implant into the posterior region of a dry mandible. Three conditions of MAR tool were tested: “without MAR”, with “MAR activated after acquisition”, and with “MAR activated before acquisition”. The standard deviation (SD), contrast-to-noise ratio (CNR) and voxel values were calculated in the buccal and lingual cortical plates, medullary bone and water region, close to the implant. The structural bone analysis was performed in the medullary bone close to the implant.

Results:

Overall, in control and implant groups, the lingual cortical had higher SD, lower CNR and lower voxel values than the buccal cortical, regardless of the MAR condition (p < 0.05). Implant caused higher SD values and lower voxel values in adjacent regions “without MAR” (p < 0.05). MAR activation decreased SD and changed voxel values when the implant was present, regardless of MAR activation mode (p < 0.05). The activation of MAR increased the trabecular thickness values for the implant group (p < 0.05).

Conclusion:

The expression of artefacts adjacent to zirconium implants is greater in the lingual than in the buccal cortical. The greater the expression of artefacts in this region, the greater the effectiveness of the MAR tool in homogenizing the grey values, regardless of the time of its activation.
Central venous catheter based closed thoracic drainage in the treatment of tuberculous pleuritis
Authors: Song Ling , Zhang Yueling , Jia Qiong
Published: July 2019

Objective: To explore the clinical effect of central venous catheter closed thoracic drainage in the treatment of tuberculous pleurisy.

Methods: One hundred and four patients with tuberculous pleurisy who were admitted to Binzhou People’s Hospital from August 2016 to August 2017 were divided into a control group and a treatment group according to random number table method, 52 each. The control group was treated with conventional pleural puncture and drainage, while the treatment group was treated with closed central venous catheter based thoracic drainage. The clinical efficacy, improvement time of clinical symptoms, total volume of drainage, pleural thickness, and improvement of quality of life and occurrence of adverse reactions were compared between the two groups.

Results: Pleural effusion, fever and chest tightness of the treatment group disappeared earlier (P<0.05); the hospitalization time in the treatment group was less than that in the control group (P<0.05); the total amount of drainage in the treatment group was lower than that in the control group (P<0.05); the pleural thickness of the treatment group was higher than that in the control group (P<0.05); the quality of life score in the treatment group was significantly higher than that in the control group (P<0.05). The total effective rates of the treatment group and the control group were 93.5% and 85%, respectively, with a significant difference (P<0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group, with a significant difference (P<0.05).

Conclusion: Central venous catheter based closed thoracic drainage is more effective than conventional thoracic puncture and drainage in the treatment of tuberculous pleurisy. It can accelerate the improvement of clinical symptoms, improve the quality of life of patients, and reduce the incidence of complications. It is worth popularizing and applying.

doi: https://doi.org/10.12669/pjms.35.4.63

How to cite this:Song L, Zhang Y, Jia Q. Central venous catheter based closed thoracic drainage in the treatment of tuberculous pleuritis. Pak J Med Sci. 2019;35(4):1024-1029. doi: https://doi.org/10.12669/pjms.35.4.63

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A process evaluation of the quality improvement collaborative for a community-based family planning learning site in Uganda
Authors: Kim Christine , Kirunda Ramadhan , Mubiru Frederick , Rakhmanova Nilufar , Wynne Leigh
Published: July 2019

Background: High-quality family planning (FP) services have been associated with increased FP service demand and use, resulting in improved health outcomes for women. Community-based family planning (CBFP) is a key strategy in expanding access to FP services through community health workers or Village Health Team (VHTs) members in Uganda. We established the first CBFP learning site in Busia district, Uganda, using a quality improvement collaborative (QIC) model. This process evaluation aims to understand the QIC adaptation process, supportive implementation factors and trends in FP uptake and retention.

Methods:We collected data from two program districts: Busia (learning site) and Oyam (scale-up). We used a descriptive mixed-methods process evaluation design: desk review of program documents, program monitoring data and in-depth interviews and focus group discussions.

Results:The quality improvement (QI) process strengthened linkages between health services provided in communities and health centers. Routine interaction of VHTs, clients and midwives generated improvement ideas. Participants reported increased learning through midwife mentorship of VHTs, supportive supervision, monthly meetings, data interpretation and learning sessions. Three areas for potential sustainability and institutionalization of the QI efforts were identified: the integration of QI into other services, district-level plans and support for the QIC and motivation of QI teams. Challenges in the replication of this model include the community-level capacity for data recording and interpretation, the need to simplify QI terminology and tools for VHTs and travel reimbursements for meetings. We found positive trends in the number of women on an FP method, the number of returning clients and the number of couples counseled.

Conclusions:A QIC can be a positive approach to improve VHT service delivery. Working with VHTs on QI presents specific challenges compared to working at the facility level. To strengthen the implementation of this CBFP QIC and other community-based QICs, we provide program-relevant recommendations.
Emerging trends in contraceptive use, transitions and preferences among female sex workers screened for an HIV prevention clinical trial in Kisumu, Kenya: a cross-sectional study
Authors: Oketch Dismas , Kaguiri Eunice C. , Orinda Joseph O. , Mboya Grace , Ogutu Phoebe , Lando Richard , Juma Carolyne , Ndivo Richard , Ontieri Daniel O. , Madiega Philister A. , Oloo Fredrick , Oruko Jecinter , Akello Rosemary , Wandera Kelvin , Odipo Evans , Greene Elizabeth , Andrew Philip , Mudhune Victor , Akelo Victor
Published: July 2019

Background: Globally about 210 million women conceive annually and 38% of these pregnancies are unintended. Female sex workers (FSWs) are at increased risk of both unintended pregnancy and acquiring HIV, which could lead to adverse sexual and reproductive health (SRH) outcomes. We sought to assess contraceptive use or non-use, preferences and determinants among a cohort of FSWs screened for an HIV prevention clinical trial in Kisumu, Kenya.

Methods: A cross sectional study of healthy FSWs referred for possible recruitment into the Antibody Mediated HIV Prevention (AMP) Study was conducted between December 2016 and September 2018. Potentially eligible participants were screened for HIV and data on social-demographic, contraceptive use and other SRH characteristics were collected. Those not on a method recorded their contraceptive preferences.  

Results: Data on 210 FSWs with a median age of 24.5 years (interquartile range, IQR 22-26) are presented. Of these, 187 (89.1%) had two children or fewer; only 56 (26.7%) had completed secondary or higher education. At the time of the interview, 18 (8.6%) were HIV-infected and 181 (86.2%) were using a modern contraceptive. Implants (48.6%) and depot injections (37.6%) were the most commonly used methods. Most (41.4%) of those not on family planning preferred oral pills. Respondents who had two or more children were three times more likely than their primiparous and nulliparous counterparts to report use of a contraceptive. Use of modern contraception methods did not differ by respondent’s ownership of a medical insurance cover or other occupation.

Conclusion: There is high use of modern contraception among FSWs in Kisumu with the majority using subdermal implants. Reproductive health programs should implement targeted SRH interventions for specific populations and risk groups. Effective contraceptive counselling and interventions among FSWs should consider the client’s parity and level of education.
Family planning awareness and service accessibility among women living with HIV in Myanmar
Authors: Lwin Hnin Hnin , Soe Kyaw Thu , San Moh Moh , Aung Khin Sandar , Soe May Sabai
Published: July 2019

Background: Accessibility and availability of family planning services is critical for improvement in maternal health. There is limited information on awareness and accessibility to family planning services among women living with HIV in Myanmar.

Methods: A mixed-methods cross-sectional descriptive study was conducted from Feb-March, 2018 at two antiretroviral therapy (ART) centers in Myanmar.

Results: This study included 184 women living with HIV. The mean (SD) age was 38 (9) years. In total, 90 women (49%) were married, 10 (5%) were single. Among the respondents, 124 (67%) have never received health education on family planning, and 64 (35%) didn’t know any source of information for family planning services. In the last six months, 55 (30%) of them have used any type of contraception. Among married women, 16 (29%) intended to have a child. One-fourth of women with HIV responded that transmission of HIV from mother to child cannot be preventable. Perceived geographical accessibility to any type of family planning services was measured, and only 7% had high accessibility. The main barriers to accessing family planning information and services among women living with HIV were also explored. Most participants responded that they had poor knowledge and received insufficient information on the family planning services. Some of them mentioned they had financial constraints to access modern contraceptive methods. Key informant interviews with public service providers revealed that there was the lack of referral system, and poor linkage between ART teams and maternal and reproductive health teams for women living with HIV to provide the quality family planning services.

Conclusions: This study highlighted the need for awareness raising among women living with HIV about family planning, and effective referral system between maternal and reproductive health unit, and HIV/AIDS care unit in Myanmar.
ELK1 has a dual activating and repressive role in human embryonic stem cells
Authors: Prise Ian , Sharrocks Andrew D.
Published: July 2019

Background: The ERK MAPK pathway plays a pivotal role in regulating numerous cellular processes during normal development and in the adult but is often deregulated in disease scenarios. One of its key nuclear targets is the transcription factor ELK1, which has been shown to play an important role in controlling gene expression in human embryonic stem cells (hESCs). ELK1 is known to act as a transcriptional activator in response to ERK pathway activation but repressive roles have also been uncovered, including a putative interaction with the PRC2 complex.

Methods: Here we probe the activity of ELK1 in hESCs by using a combination of gene expression analysis in hESCs and during differentiation following ELK1 depletion and also analysis of chromatin occupancy of transcriptional regulators and histone mark deposition that accompany changes in gene expression.

Results: We find that ELK1 can exert its canonical activating activity downstream from the ERK pathway but also possesses additional repressive activities. Despite its co-binding to PRC2 occupied regions, we could not detect any ELK1-mediated repression at these regions. Instead, we find that ELK1 has a repressive role at a subset of co-occupied SRF binding regions.

Conclusions: ELK1 should therefore be viewed as a dichotomous transcriptional regulator that can act through SRF to generate both activating and repressing properties at different genomic loci.
Variation in pre-therapy levels of selected Mycobacterium tuberculosis transcripts in sputum and their relationship with 2-month culture conversion
Authors: Rockwood Neesha , Lai Rachel P.J. , Seldon Ronnett , Young Douglas B. , Wilkinson Robert J.
Published: July 2019

Background:The abundance of transcripts arising fromMycobacterium tuberculosis(MTB) in sputum pre-chemotherapy may enhance our understanding of factors influencing treatment response. We hypothesized that differences in the prevalence of pre-existing slowly metabolizing MTB in sputum may be partially responsible for differences in the rate of sputum clearance during treatment.

Methods:Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to characterize a selected limited transcription profile of MTB in sputum pre-chemotherapy and assess inter-individual variation. The difference in cycle threshold (Ct) per gene, normalized to 16S, between exponential/stationary phase culture and sputum was calculated and stratified by 2-month culture converter status.

Results:HIV-1 uninfected patients with rifampicin-susceptible tuberculosis provided sputum pre-chemotherapy; 11 patients were negative for MTB culture after two months of therapy and 8 remained culture-positive.

Increasedicl1andprpDandrpsN2:rpsN1in sputum relative to culture suggested cholesterol utilization and a low-zinc environment respectively. IncreasedhspXand decreasedatpAandnuoGrelative to exponential culture suggested a slowly metabolizing subpopulation of MTB. While the thehspXhiatpAlonuoGlosignal varied, we did not observe statistically significant enrichment of this phenotype in the non-converter population nor an association with MTB-lineage.

Conclusion:Differential abundance of selected informative transcripts suggested a metabolically less-active subpopulation with a prevalence that varied between individual untreated patients.