bluuebunny/crossref_metadata_2025 huggingface dataset:
Restoring a Mediterranean‐climate shrub community with perennial species reduces future invasion
Authors: Bell Michael D. , Lulow Megan E. , Balazs Kathleen R. , Huxman Kimberly A. , McCollum Johannah R. , Huxman Travis E. , Kimball Sarah
Published: June 2018

Successful restoration of an invaded landscape to a diverse, invasion‐resistant native plant community requires determining the optimal native species mix to add to the landscape. We manipulated native seed mix (annuals, perennials, or a combination of the two), while controlling the growth of non‐native species to test the hypothesis that altering native species composition can influence native establishment and subsequent non‐native invasion. Initial survival of native annuals and perennials was higher when seeded in separate mixes than when combined, and competition between the native perennials and annuals led to lower perennial cover in year 2 of mixed‐seeded plots. The plots with the highest perennial cover had the highest resistance to invasion by Brassica nigra. To clarify interactions among different functional groups of natives and B. nigra, we measured competitive interactions in pots. We grew one native annual, one native perennial, and B. nigra alone or with different competitors and measured biomass after 12 weeks. Brassica nigra was the strongest competitor, limiting the growth of all native species, and was not impacted by competition with native annuals or perennial seedlings. Results from the potted plant experiment demonstrated the strong negative influence of B. nigra on native seedlings. Older native perennials were the strongest competitors against invasive species in the field, yet perennial seedling survival was limited by competition with native annuals and B. nigra. Management action that maximizes perennial growth in early years may lead to a relatively more successful restoration and the establishment of an invasion‐resistant community.
Comprehensive cross‐genome survey and phylogeny of glycoside hydrolase family 16 members reveals the evolutionary origin of EG16 and XTH proteins in plant lineages
Authors: Behar Hila , Graham Sean W. , Brumer Harry
Published: June 2018

Carbohydrate‐active enzymes (CAZymes) are central to the biosynthesis and modification of the plant cell wall. An ancient clade of bifunctional plant endo‐glucanases (EG16 members) was recently revealed and proposed to represent a transitional group uniting plant xyloglucan endo‐transglycosylase/hydrolase (XTH) gene products and bacterial mixed‐linkage endo‐glucanases in the phylogeny of glycoside hydrolase family 16 (GH16). To gain broader insights into the distribution and frequency of EG16 and other GH16 members in plants, the PHYTOZOME, PLAZA, NCBI and 1000 PLANTS databases were mined to build a comprehensive census among 1289 species, spanning the broad phylogenetic diversity of multiple algae through recent plant lineages. EG16, newly identified EG16‐2 and XTH members appeared first in the green algae. Extant EG16 members represent the early adoption of the β‐jellyroll protein scaffold from a bacterial or early‐lineage eukaryotic GH16 gene, which is characterized by loop deletion and extension of the N terminus (in EG16‐2 members) or C terminus (in XTH members). Maximum‐likelihood phylogenetic analysis of EG16 and EG16‐2 sequences are directly concordant with contemporary estimates of plant evolution. The lack of expansion of EG16 members into multi‐gene families across green plants may point to a core metabolic role under tight control, in contrast to XTH genes that have undergone the extensive duplications typical of cell‐wall CAZymes. The present census will underpin future studies to elucidate the physiological role of EG16 members across plant species, and serve as roadmap for delineating the closely related EG16 and XTH gene products in bioinformatic analyses of emerging genomes and transcriptomes.
The prevalence of dynamic pharyngeal collapse is high in brachycephalic dogs undergoing videofluoroscopy
Authors: Pollard Rachel E. , Johnson Lynelle R. , Marks Stanley L.
Published: June 2018

The aim of this retrospective study was to determine the frequency of pharyngeal collapse in a large group of brachycephalic dogs undergoing videofluoroscopic assessment of swallowing or airway diameter. We hypothesized that brachycephalic dogs would have pharyngeal collapse more frequently than dolichocephalic or mesocephalic dogs with or without airway collapse. The medical records database was searched for brachycephalic dogs undergoing videofluoroscopy of swallowing or airway diameter between January 1, 2006 and December 31, 2015. A cohort of dolichocephalic/mesocephalic dogs with videofluoroscopically confirmed airway collapse was age and time matched for comparison. A control group of dolichocephalic/mesocephalic dogs that did not have documented airway collapse was also evaluated. All fluoroscopic studies were assessed by a board certified veterinary radiologist for the presence and degree of pharyngeal collapse. Results demonstrate that pharyngeal collapse was significantly more common in brachycephalic dogs (58/82; 72%) than in nonbrachycephalic dogs with (7/25; 28%) and without (2/30; 7%) airway collapse. Pharyngeal collapse is more prevalent in brachycephalic dogs undergoing videofluoroscopy than in dolichocephalic/mesocephalic dogs with or without airway collapse.
Promoting early expression of breast milk in mothers of preterm infants in a neonatal unit: a best practice implementation project
Authors: Goodchild Louise , Hussey Lee , McPhee Andrew J. , Lizarondo Lucylynn , Gillis Jennifer , Collins Carmel T.
Published: June 2018

Objectives:

The aim of this implementation project was to optimize lactation success in mothers of preterm infants by ensuring early (as soon as possible and within six hours) and frequent (eight to 12 times/day) milk expression.

Introduction:

Evidence suggests that breast milk improves enteral feeding tolerance and neurodevelopmental outcomes and decreases the risk of necrotising enterocolitis and late onset sepsis in preterm infants. It is widely accepted that breast milk expression should commence as soon as possible and within six hours of delivery.

Results:

Following implementation of the breast milk expression information pack and staff education program, compliance to clinical guideline recommendations improved considerably. An increase from 5/20 (25%) to 17/20 (85%) of women expressing milk within six hours of delivery was observed. The average expression times also increased: from 2.6 (2.0) to 6.1 (2.7) times in the first 24 hours and from 4.6 (1.7) to 7.8 (1.7) times between 24–48 hours. The compliance rate for milk expression within six hours of delivery and expression of eight to 12 times daily in the first 48 hours increased from 1/20 (5%) at baseline to 10/20 (50%) in the follow-up audit.

Conclusion:

The implementation of the breast milk information pack and staff education led to improvements in the milk expression practices of mothers who had preterm infants. As a result of this project, the information packs are now routinely given to all women at risk of delivering preterm or who have babies in the neonatal unit. Further audits will be undertaken in the future to determine sustainability of practice changes.
Improved brachial artery shear patterns and increased flow‐mediated dilatation after low‐volume high‐intensity interval training in type 2 diabetes
Authors: Ghardashi Afousi Alireza , Izadi Mohammad Reza , Rakhshan Kamran , Mafi Farnoosh , Biglari Soheil , Gandomkar Bagheri Habiballah
Published: June 2018

New Findings

What is the central question of this study?

Can low‐volume high‐intensity interval training and continuous moderate‐intensity exercise modulate oscillatory and retrograde shear, blood flow and flow‐mediated arterial dilatation in patients with type 2 diabetes?

What is the main finding and its importance?

Low‐volume high‐intensity interval training, by increasing anterograde shear and decreasing retrograde shear and oscillatory index, can increase nitric oxide production and consequently result in increased flow‐mediated dilatation and outward arterial remodelling in patients with type 2 diabetes.

Atherosclerosis in patients with type 2 diabetes is characterized by endothelial dysfunction associated with impaired flow‐mediated dilatation (FMD) and increases retrograde and oscillatory shear. The present study investigated endothelium‐dependent vasodilatation and shear rate in patients with type 2 diabetes at baseline and follow‐up after 12 weeks of low‐volume high‐intensity interval training (LV‐HIIT) or continuous moderate‐intensity training (CMIT). Seventy‐five sedentary patients with type 2 diabetes and untreated pre‐ or stage I hypertension were randomly divided into LV‐HIIT, CMIT and control groups. The LV‐HIIT group intervention was 12 intervals of 1.5 min at 85–90% maximal heart rate (HRmax) and 2 min at 55–60% HRmax. The CMIT group intervention was 42 min of exercise at 70% HRmax for three sessions per week during 12 weeks. High‐resolution Doppler ultrasound was used to measure FMD, arterial diameter, anterograde and retrograde blood flow, and shear rate patterns. Brachial artery FMD increased significantly in the LV‐HIIT group (3.83 ± 1.13 baseline, 7.39 ± 3.6% follow‐up), whereas there was no significant increase in the CMIT group (3.45 ± 0.97 baseline, 4.81 ± 2.36% follow‐up) compared to the control group (3.16 ± 0.78 baseline, 4.04 ± 1.28% follow‐up) (P < 0.05). Retrograde shear in the LV‐HIIT group decreased significantly (P < 0.05), and no significant decrease in retrograde shear was seen in the CMIT group. Anterograde shear after LV‐HIIT increased significantly (P < 0.05) but was unchanged in the CMIT group. However, oscillatory shear index in both exercise groups decreased significantly (P = 0.029). Nitrite/nitrate (NOx) level increased in both exercise groups, but the increase was greater in the LV‐HIIT group (P < 0.001). The results indicate that by increasing NOx, HIIT decreases the oscillatory shear‐induced improvement in FMD and outward artery remodelling in patients with type 2 diabetes.
Uncertainty of speech level parameters measured with a contact-sensor-based device and a headworn microphone
Authors: Astolfi Arianna , Castellana Antonella , Carullo Alessio , Puglisi Giuseppina Emma
Published: June 2018

This work estimates the uncertainty contributions of speech level parameters measured with a contact-sensor-based device and a headworn microphone. Four contributions are considered: (1) instrumental uncertainty, related to device calibration; (2) method repeatability and (3) reproducibility, estimated through repeated measurements without and with device repositioning, respectively; (4) source reproducibility, due to the variability of human speech. To ascertain changes in speech production, differences between measures should be at least higher than the expanded uncertainty. In the case of device repositioning, the expanded uncertainty combines contributions (1), (3), and (4). When the device is not repositioned, it combines contributions (2) and (4).
A binaural auditory steering strategy based hearing-aid algorithm design
Authors: Piechowiak Tobias , Ma Changxue , de Vries Rob , Dittberner Andrew
Published: June 2018

Beamforming techniques are widely used in hearing aids to enhance the intelligibility of speech from a target direction, but they tend to isolate the listener from their acoustic environment and distort spatial cues. The main reason for this is that a typical beamformer method alters the head-related transfer function of the individual users' ears and functions under monaural assumptions instead of a binaural model. In this letter, a binaural auditory steering strategy (BASS) is proposed for the design of asymmetrically presented spatial filters which improves awareness of the surrounding acoustic environment while preserving intelligibility from a target direction. Additionally, an objective metric and the results of a subjective study to evaluate the effectiveness of the BASS are presented.
Low temperature rates for key steps of interstellar gas-phase water formation
Authors: Kumar Sunil S. , Grussie Florian , Suleimanov Yury V. , Guo Hua , Kreckel Holger
Published: June 2018

Combined experimental-theoretical study suggests facile formation of water in diffuse interstellar media.
TEM-184, a Novel TEM-Derived Extended-Spectrum β-Lactamase with Enhanced Activity against Aztreonam
Authors: Piccirilli Alessandra , Perilli Mariagrazia , Amicosante Gianfranco , Conte Viola , Tascini Carlo , Rossolini Gian Maria , Giani Tommaso
Published: June 2018

TEM-184, a novel TEM-derived extended-spectrum β-lactamase (ESBL), was isolated from an
Escherichia coli
ST354 clinical strain. Compared to TEM-1, TEM-184 contains the mutations Q6K, E104K, I127V, R164S, and M182T.
Roles of Two Glutathione-Dependent 3,6-Dichlorogentisate Dehalogenases in Rhizorhabdus dicambivorans Ndbn-20 in the Catabolism of the Herbicide Dicamba
Authors: Li Na , Tong Ren-Lei , Yao Li , Chen Qing , Yan Xin , Ding De-Rong , Qiu Ji-Guo , He Jian , Jiang Jian-Dong
Published: June 2018

Dicamba is an important herbicide, and its use and leakage into the environment have dramatically increased since the large-scale planting of genetically modified (GM) dicamba-resistant crops in 2015. However, the complete catabolic pathway of dicamba has remained unknown, which limits ecotoxicological studies of this herbicide. Our previous study revealed that 3,6-DCGA was an intermediate of dicamba degradation in strain Ndbn-20. In this study, we identified two glutathione-dependent 3,6-DCGA dehalogenases, DsmH1 and DsmH2, and demonstrated that DsmH2 is physiologically responsible for the 6-dechlorination of 3,6-DCGA in strain Ndbn-20. GSTs play an important role in the detoxification and degradation of a variety of endogenous and exogenous toxic compounds. On the basis of their sequence identities, phylogenetic status, and functions, the four bacterial GSH-dependent dehalogenases (PcpC, LinD, DsmH1, and DsmH2) were reclassified as a new eta class of GSTs. This study helps us to elucidate the microbial catabolism of dicamba and enhances our understanding of the diversity and functions of GSTs.
Ornithodoros savignyi, the Tick Vector of “Candidatus Borrelia kalaharica” in Nigeria
Authors: Cutler Sally J. , Idris Jibrin M. , Ahmed Akeem O. , Elelu Nusirat
Published: June 2018

Endemic tick-borne relapsing fever (TBRF) has not been documented in Nigeria, yet clinically compatible cases have been described, and soft tick species are endemic in surrounding countries. Consequently, our aim was to investigate if TBRF-associated
Borrelia
is present in Nigeria.
Modified Protein Misfolding Cyclic Amplification Overcomes Real-Time Quaking-Induced Conversion Assay Inhibitors in Deer Saliva To Detect Chronic Wasting Disease Prions
Authors: Davenport Kristen A. , Hoover Clare E. , Denkers Nathaniel D. , Mathiason Candace K. , Hoover Edward A.
Published: June 2018

Chronic wasting disease (CWD), a fatal neurodegenerative prion disease of cervids, has spread across North America and has been detected in The Republic of Korea, Finland, and Norway. CWD appears to spread by horizontal transmission, and prions shed in saliva, feces, and urine are thought to contribute.
Utilizing sequence stratigraphy to develop a depositional model for Silurian (Niagaran) reefs in the Michigan Basin
Authors: Ritter Audrey , Grammer G. Michael
Published: June 2018

Based upon the construction of a high-resolution sequence stratigraphic framework, this paper interprets the evolution of Niagaran (Silurian) reefs in the Michigan Basin as being characterized by episodic reef growth in response to three distinct, third-order-scale, eustatic sea-level fluctuations. The fluctuations are observed in both the northern and southern reef trends and are interpreted to coincide with Silurian eustatic sea-level fluctuations defined at a global scale. The resulting episodic reef growth model, based upon subsurface core and wireline log analysis, is characterized by at least two orders of stratigraphic cyclicity (probably third and fourth order) that likely formed in response to eustatic sea-level change as well as relative sea-level variations.

A detailed sequence stratigraphic analysis of the reefs utilizing facies stacking patterns and identification of key surfaces highlights the punctuated growth of these reefs and provides insight into the lateral and vertical facies variability observed in the subsurface. The sequence hierarchy is manifested by thicker (third- and fourth-order) sequences (tens of meters thick) controlled by globally recognized sea-level changes, and thinner (fifth-order) cycles (few meters thick) driven by relative sea-level variations. Local changes in relative sea level were likely controlled by the combination of higher-frequency eustatic variations along with subsidence and autocyclic mechanisms related to reef growth. The higher-frequency (fourth-order) cyclicity, likely due to eustatic sea-level change, played a major role in controlling the lateral and vertical heterogeneity of reservoir facies in these reefs.

Understanding of the growth of these reefs utilizing a modern sequence stratigraphic approach provides new insight into the development of the Niagaran reefs while providing evidence for a complex and episodic depositional model that explains the variability observed in the stratigraphic architecture of these reefs.
Middle Devonian Sylvania Sandstone, Michigan Basin, USA
Authors: Pollard Katherine , Rock Farsheed , Barnes David A.
Published: June 2018

The Middle Devonian Sylvania Sandstone in the Michigan Basin, United States, is noteworthy for its mixed, cherty dolomitic carbonate, limestone, and sandstone composition and excellent reservoir quality and fluid-flow properties in many areas of the basin. Substantial commercial brine production was initiated in the middle twentieth century, and liquid waste disposal continues today in the Sylvania Sandstone, although little or no hydrocarbon production is known from this unit. The Sylvania Sandstone pinches out to the south and west in the basin and overlies either the Bass Islands Group at the regional base Kaskaskia unconformity to the south or the Bois Blanc Formation, with which it is proposed to be in facies relationship to the northeast. The Sylvania Sandstone is overlain by and apparently interfingers with the Meldrum Member of the Amherstburg Formation throughout the basin. The Sylvania unit predominantly consists of siliciclastic rocks in the southeastern Michigan Basin and in outcrop in Ohio, but it is transitional to predominantly cherty carbonate in the northwest along a depositional hinge striking from southeast to northwest through the central basin. This hinge zone is dominated by mixed carbonate and siliciclastic strata deposited in normal-salinity, tidally influenced paralic and shallow-marine environments. Excellent reservoir quality is present in quartz sandstones and, especially, mixed sandy dolomite lithofacies in the central basin. Cherty facies may also possess significant porosity, but typically with low permeability. Limestone lithofacies are commonly non-reservoir-quality facies. Multiple high-frequency, low-magnitude relative sea-level cycles within the Sylvania Sandstone are suggested from regional stratigraphic analysis. The Sylvania Sandstone in the Michigan Basin is interpreted as a mixed carbonate and siliciclastic, basin-margin facies assemblage deposited in an overall transgressive systems tract above the base Kaskaskia unconformity and in conformable relationship with more basinal facies of the Bois Blanc Formation.
Predicted distribution and burden of podoconiosis in Cameroon
Authors: Deribe Kebede , Cano Jorge , Njouendou Abdel Jelil , Eyong Mathias Esum , Beng Amuam Andrew , Giorgi Emanuele , Pigott David M , Pullan Rachel L , Noor Abdisalan M , Enquselassie Fikre , Murray Christopher J L , Hay Simon I , Newport Melanie J , Davey Gail , Wanji Samuel
Published: June 2018

Introduction

Understanding the number of cases of podoconiosis, its geographical distribution and the population at risk are crucial to estimating the burden of this disease in endemic countries. We assessed each of these using nationwide data on podoconiosis prevalence in Cameroon.

Methods

We analysed data arising from two cross-sectional surveys in Cameroon. The dataset was combined with a suite of environmental and climate data and analysed within a robust statistical framework, which included machine learning-based approaches and geostatistical modelling. The environmental limits, spatial variation of predicted prevalence, population at risk and number of cases of podoconiosis were each estimated.

Results

A total of 214 729 records of individuals screened for podoconiosis were gathered from 748 communities in all 10 regions of Cameroon. Of these screened individuals, 882 (0.41%; 95% CI 0.38 to 0.44) were living with podoconiosis. High environmental suitability for podoconiosis was predicted in three regions of Cameroon (Adamawa, North West and North). The national population living in areas environmentally suitable for podoconiosis was estimated at 5.2 (95% CI 4.7 to 5.8) million, which corresponds to 22.3% of Cameroon’s population in 2015. Countrywide, in 2015, the number of adults estimated to be suffering from podoconiosis was 41 556 (95% CI, 1170 to 240 993). Four regions (Central, Littoral, North and North West) contributed 61.2% of the cases.

Conclusion

In Cameroon, podoconiosis is more widely distributed geographically than was initially expected. The number of cases and the population at risk are considerable. Expanding morbidity management and follow-up of cases is of utmost necessity. Promotion of footwear use and regular foot hygiene should be at the forefront of any intervention plan.
Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis
Authors: Ng-Kamstra Joshua S , Arya Sumedha , Greenberg Sarah L M , Kotagal Meera , Arsenault Catherine , Ljungman David , Yorlets Rachel R , Agarwal Arnav , Frankfurter Claudia , Nikouline Anton , Lai Francis Yi Xing , Palmqvist Charlotta L , Fu Terence , Mahmood Tahrin , Raju Sneha , Sharma Sristi , Marks Isobel H , Bowder Alexis , Pi Lebei , Meara John G , Shrime Mark G
Published: June 2018

Introduction

The LancetCommission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country’s surgical system. Despite its widespread use in high-income settings, few studies have described procedure-specific POMR across low-income and middle-income countries (LMICs). We aimed to estimate POMR across a wide range of surgical procedures in LMICs. We also describe how POMR is defined and reported in the LMIC literature to provide recommendations for future monitoring in resource-constrained settings.

Methods

We did a systematic review of studies from LMICs published from 2009 to 2014 reporting POMR for any surgical procedure. We extracted select variables in duplicate from each included study and pooled estimates of POMR by type of procedure using random-effects meta-analysis of proportions and the Freeman-Tukey double arcsine transformation to stabilise variances.

Results

We included 985 studies conducted across 83 LMICs, covering 191 types of surgical procedures performed on 1 020 869 patients. Pooled POMR ranged from less than 0.1% for appendectomy, cholecystectomy and caesarean delivery to 20%–27% for typhoid intestinal perforation, intracranial haemorrhage and operative head injury. We found no consistent associations between procedure-specific POMR and Human Development Index (HDI) or income-group apart from emergency peripartum hysterectomy POMR, which appeared higher in low-income countries. Inpatient mortality was the most commonly used definition, though only 46.2% of studies explicitly defined the time frame during which deaths accrued.

Conclusions

Efforts to improve access to surgical care in LMICs should be accompanied by investment in improving the quality and safety of care. To improve the usefulness of POMR as a safety benchmark, standard reporting items should be included with any POMR estimate. Choosing a basket of procedures for which POMR is tracked may offer institutions and countries the standardisation required to meaningfully compare surgical outcomes across contexts and improve population health outcomes.
Emergency admissions and long-term conditions during transition from paediatric to adult care: a cross-sectional study using Hospital Episode Statistics data
Authors: Wijlaars Linda Petronella Martina Maria , Hardelid Pia , Guttmann Astrid , Gilbert Ruth
Published: June 2018

Objective

To determine whether changes in emergency admission rates during transition from paediatric to adult hospital services differed in children and young people (CYP) with and without underlying long-term conditions (LTCs).

Design

Cross-sectional study.

Setting

Emergency admissions between 2009 and 2011 recorded in the Hospital Episode Statistics Admitted Patient Care data in England.

Participants

763 199 CYP aged 10–24 years with and without underlying LTCs (LTCs were defined using the International Classification of Diseases, 10th Revision codes recorded in the past 5 years).

Primary and secondary outcome measures

We calculated emergency admission rates before (10–15 years) and after transition (19–24 years), stratified by gender, LTC and primary diagnosis. We used negative binomial regression to estimate adjusted incidence rate ratios (IRRs).

Results

We included 1 109 978 emergency admissions, of which 63.2% were in children with LTCs. The emergency admission rate increased across the age of transition for all CYP, more so for those with LTCs (IRRLTC: 1.55, 99% CI 1.47 to 1.63), compared with those without (IRRnoLTC: 1.21, 99% CI 1.18 to 1.23). The rates increased most rapidly for CYP with mental health problems, MEDReG (metabolic, endocrine, digestive, renal, genitourinary) disorders, and multiple LTCs (both genders) and respiratory disorders (female only). Small or no increased rates were found for CYP without LTCs and for those with cancer or cardiovascular disease. Increases in length of stay were driven by long admissions (10+ days) for a minority (1%) of CYP with mental health problems and potentially psychosomatic symptoms. Non-specific symptoms related to abdominal pain (girls only), gastrointestinal and respiratory problems were the most frequent primary diagnoses.

Conclusions

The increased rates and duration of emergency admissions and predominance of non-specific admission diagnoses during transition in CYP with underlying LTCs may reflect unmet physical or mental health needs.
Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP)
Authors: Cui Jian-Wei , Xu Yinyan , Wang Yibo , Gao Yan-Xia , Guo Shigong , Wang Meng , Lu Xin , Yu Shiyuan , Ma Yong , Yuan Ding , Che Lu , Sun Pei , Yu Xuezhong , Zhu Huadong , Li Yi
Published: June 2018

Introduction

Paraquat (PQ) is a widely used herbicide which is inexpensive and easily accessible for people in rural areas. A small amount of PQ ingestion could be lethal, yet currently, the optimal treatment is still controversial. Extracorporeal therapies (ECTR) have been practised in PQ poisoning management, though limited evidence could be obtained to suggest its superiority over conservative therapy. Haemodialysis (HD) and haemoperfusion (HP) are most commonly used, while some institutions also choose HP–HD concurrent therapy. The object of the present trial is to investigate whether haemopurification therapy can reduce mortality compared with conservative therapy.

Methods and analysis

This is a planned single-centre, non-blinded, randomised controlled trial. Acute PQ poisoned adults who have orally ingested PQ within 24 hours would be recruited. A total of 360 patients would be recruited and randomly assigned to four groups, that is, HP, HD, concurrent HP–HD and control, at a 1:1:1:1 ratio. Subjects would be also stratified by their urine dithionite test results. Primary outcome is 28-day all-cause mortality. Secondary outcomes include survival time, all-cause mortality at the 3rd, 7th and 60th day, rate of major complications, Acute Physiologic and Chronic Health Evaluation score and Poisoning Severity Score, etc.

Ethics and dissemination

The protocol and informed consent documents have been approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University in September 2017 (approval number: 2017-KY-10). The result of this trial would be submitted to peer-reviewed journal.

Trial registration number

NCT03314909; Pre-results.
Overweight and obesity management strategies in survivors of paediatric acute lymphoblastic leukaemia: a systematic review protocol
Authors: Ladhani Salma , Empringham Brianna , Wang Kuan-Wen , Portwine Carol , Banfield Laura , de Souza Russell J , Thabane Lehana , Samaan M Constantine
Published: June 2018

Introduction

Acute lymphoblastic leukaemia is the most common paediatric cancer. Survivors of childhood acute lymphoblastic leukaemia (SALL) are at risk of obesity and related cardiometabolic diseases including type 2 diabetes, hypertension, stroke and cardiovascular events. Therefore, it is important to address obesity in this population as this may help mitigate future cardiometabolic comorbidities. In this systematic review, we aim to assess current treatment strategies including lifestyle interventions, pharmacotherapy and bariatric surgery to manage overweight and obesity in SALL.

Methods and analysis

We will search the following databases for primary studies: CINAHL, SPORTDiscus, EMBASE, MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. In addition, unpublished primary studies will be searched in ClinicalTrials.gov as well as conference proceedings, presentations, abstracts, editorials and ProQuest Dissertations and Theses A&I. Reviewers will perform title, abstract, and full-text screening as well as data abstraction and risk of bias assessment independently with a third reviewer to be consulted to resolve disagreements. Searches will be run and updated through May 1st, 2018. The overall quality of the evidence will be determined using the Grading of Recommendations, Assessment, Development, and Evaluation criteria for each outcome. A meta-analysis will be performed if two studies deploying similar interventions, populations, and design and outcomes are identified.

Ethics and dissemination

As individual patient data will not be included, we do not require ethics approval. This review will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42016051031.
Additional simulation training: does it affect students’ knowledge acquisition and retention?
Authors: Cecilio-Fernandes Dario , Brandão Carolina Felipe Soares , de Oliveira Davi Lopes Catanio , Fernandes Glória Celeste V Rosário , Tio René A
Published: June 2018

Introduction

Teaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging. In this study, we investigated whether adding a simulation training before the clinical rotation would improve students’ acquisition and retention of knowledge.

Methods

Two subsequent cohorts were compared. Group A followed the traditional curriculum without additional simulation training. Group B attended an additional simulation training, in which history taking, physical examination and procedures for the primary survey in emergency situations were taught. Both groups answered the same knowledge test before entering their clinical rotation and after 6 months. To analyse students’ scores over time, we conducted a repeated measure analysis of variance. To investigate the difference between knowledge, we conducted a t-test.

Results

Group B scored significantly higher in both tests and all subscores, except in the Trauma topic in the first measurement point. Students in group A showed decay in knowledge whereas group B showed an increase in knowledge.

Conclusions

Adding a simulation training, before students entered their clinical rotation, improves students’ knowledge acquisition and retention compared with those who did not receive the additional simulation training.
Incidence of faecal occult blood test interval cancers in population-based colorectal cancer screening: a systematic review and meta-analysis
Authors: Wieten Els , Schreuders Eline H , Grobbee Esmée J , Nieboer Daan , Bramer Wichor M , Lansdorp-Vogelaar Iris , Bruno Marco J , Kuipers Ernst J , Spaander Manon C W
Published: June 2018

Objective

Faecal immunochemical tests (FITs) are replacing guaiac faecal occult blood tests (gFOBTs) for colorectal cancer (CRC) screening. Incidence of interval colorectal cancer (iCRC) following a negative stool test result is not yet known. We aimed to compare incidence of iCRC following a negative FIT or gFOBT.

Design

We searched Ovid Medline, Embase, Cochrane Library, Science Citation Index, PubMed and Google Scholar from inception to 12 December 2017 for citations related to CRC screening based on stool tests. We included studies on FIT or gFOBT iCRC in average-risk screening populations. Main outcome was pooled incidence rate of iCRCs per 100 000 person-years (p-y). Pooled incidence rates were obtained by fitting random-effect Poisson regression models.

Results

We identified 7 426 records and included 29 studies. Meta-analyses comprised data of 6 987 825 subjects with a negative test result, in whom 11 932 screen-detected CRCs and 5 548 gFOBT or FIT iCRCs were documented. Median faecal haemoglobin (Hb) positivity cut-off used was 20 (range 10–200) µg Hb/g faeces in the 17 studies that provided FIT results. Pooled incidence rates of iCRC following FIT and gFOBT were 20 (95% CI 14 to 29; I2=99%) and 34 (95% CI 20 to 57; I2=99%) per 100 000 p-y, respectively. Pooled incidence rate ratio of FIT versus gFOBT iCRC was 0.58 (95% CI 0.32 to 1.07; I2=99%) and 0.36 (95% CI 0.17 to 0.75; I2=10%) in sensitivity analysis. For every FIT iCRC, 2.6 screen-detected CRCs were found (ratio 1:2.6); for gFOBT, the ratio between iCRC and screen-detected CRC was 1:1.2. Age below 60 years and the third screening round were significantly associated with a lower iCRC rate.

Conclusion

A negative gFOBT result is associated with a higher iCRC incidence than a negative FIT. This supports the use of FIT over gFOBT as CRC screening tool.
Human gut microbiome: hopes, threats and promises
Authors: Cani Patrice D
Published: June 2018

The microbiome has received increasing attention over the last 15 years. Although gut microbes have been explored for several decades, investigations of the role of microorganisms that reside in the human gut has attracted much attention beyond classical infectious diseases. For example, numerous studies have reported changes in the gut microbiota during not only obesity, diabetes, and liver diseases but also cancer and even neurodegenerative diseases. The human gut microbiota is viewed as a potential source of novel therapeutics. Between 2013 and 2017, the number of publications focusing on the gut microbiota was, remarkably, 12 900, which represents four-fifths of the total number of publications over the last 40 years that investigated this topic. This review discusses recent evidence of the impact of the gut microbiota on metabolic disorders and focus on selected key mechanisms. This review also aims to provide a critical analysis of the current knowledge in this field, identify putative key issues or problems and discuss misinterpretations. The abundance of metagenomic data generated on comparing diseased and healthy subjects can lead to the erroneous claim that a bacterium is causally linked with the protection or the onset of a disease. In fact, environmental factors such as dietary habits, drug treatments, intestinal motility and stool frequency and consistency are all factors that influence the composition of the microbiota and should be considered. The cases of the bacteria Prevotella copri and Akkermansia muciniphila will be discussed as key examples.
Essential thrombocythaemia with mutation inMPL: clinicopathological correlation and comparison withJAK2V617F-mutated andCALR-mutated genotypes
Authors: Alvarez-Larran Alberto , Martínez Daniel , Arenillas Leonor , Rubio Ariadna , Arellano-Rodrigo Eduardo , Hernández Boluda Juan Carlos , Papaleo Natalia , Caballero Gonzalo , Martínez Clara , Ferrer-Marín Francisca , Mata María Isabel , Pérez-Encinas Manuel , Durán María Antonia , Alonso José María , Carreño-Tarragona Gonzalo , Alonso Juan Manuel , Noya Soledad , Magro Elena , Pérez Raúl , López-Guerra Mónica , Pastor-Galán Irene , Cervantes Francisco , Besses Carlos , Colomo Luis , Rozman María
Published: June 2018

Aim

To characterise the clinical and histological features ofMPL-mutated essential thrombocythaemia (ET).

Patients and methods

Bone marrow biopsies of 175 patients with ET were centrally reviewed according to the 2016 WHO classification, including 42 cases withMPLmutation, 98JAK2V617F-mutated and 35CALR-mutated. Clinical and histological features were compared among the three genotypes included in the current 2016 WHO classification and among the different types ofMPLmutations.

Results

Patients withMPL-mutated ET were significantly older than those with the other genotypes. Haematological values at diagnosis were similar amongMPL-mutated andCALR-mutated ET, with both genotypes showing higher platelet counts and lower haemoglobin values than ET withJAK2V617F genotype. In the bone marrow, the median number of megakaryocytes was higher inMPLandCALRthan inJAK2V617F genotype (16, 19 and 14 megakaryocytes per ×20 power field, respectively, p=0.004). Histological features of prefibrotic myelofibrosis were rarely observed inMPLgenotype, whereas sinusoidal hyperplasia, dense clusters of megakaryocytes and reticulin fibrosis were more frequent inCALR-mutated ET, with 11% of such cases fulfilling WHO 2016 histological criteria of prefibrotic myelofibrosis. With a median follow-up of 3.5 years, no significant differences were seen among genotypes regarding survival, vascular complications or myelofibrotic transformation. There were no significant differences in the clinical data or in the histological characteristics depending on the type ofMPLmutation.

Conclusion

MPLandCALRET genotypes share clinical and histological characteristics. In contrast toCALRgenotype, features of prefibrotic myelofibrosis are uncommon inMPL-mutated ET.
Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants
Authors: Ndlovu Ntombizodwa , Musenge Eustasius , Park Sung Kyun , Girdler-Brown Brendan , Richards Guy , Murray Jill
Published: June 2018

Objective

We investigated trends and determinants of pulmonary tuberculosis (PTB) in deceased South African miners.

Methods

Statutory autopsies are performed on miners for occupational lung disease compensation, irrespective of cause of death. Data were extracted from the PATHAUT (Pathology Automation System) autopsy database. PTB trends were analysed and explanatory variables (year of autopsy, age at death, gold employment duration, silicosis and HIV) were evaluated using binary logistic regression modelling. Analyses were stratified by population group because of racial differences in socioeconomic status, employment patterns and access to facilities for autopsies. The analyses were segmented to represent the pre-HIV (1975–1989), rapid HIV spread (1990–2004) and antiretroviral therapy (2005–2014) periods.

Results

The proportions of men with PTB at autopsy increased from 4.62% in 1975 to 27.18% in 2014 in black miners, and from 2.07% to 5.19% in white miners, with peaks in 2007 (43.12% and 9.51%, respectively). The magnitude and significance of adjusted ORs of determinants differed by population group and calendar period. PTB was largely associated with silicosis, increasing gold employment duration and year of autopsy (a surrogate for unmeasured confounders, such as unknown HIV status and tuberculosis transmission).

Conclusions

Changes in PTB time trends and determinants reflect the complex social and political environment in which mining occurs. Silica dust reduction remains a key intervention for tuberculosis reduction, together with tuberculosis and HIV treatment and management. The autopsy data provide reliable information to monitor progress towards the achievement of industry and national targets to reduce tuberculosis.
What is a noncommutative topos?
Authors: Cvetko-Vah Karin , Hemelaer Jens , Le Bruyn Lieven
Published: June 2018

In [Cvetko-Vah, Non-commutative frames, J. Algebra Appl. (2018), https://doi.org/10.1142/S0219498819500117 ] noncommutative frames were introduced, generalizing the usual notion of frames of open sets of a topological space. In this paper, we extend this notion to noncommutative versions of Grothendieck topologies and their associated noncommutative toposes of sheaves of sets.
Oxygen availability and skeletal muscle oxidative capacity in patients with peripheral artery disease: implications from in vivo and in vitro assessments
Authors: Hart Corey R. , Layec Gwenael , Trinity Joel D. , Le Fur Yann , Gifford Jayson R. , Clifton Heather L. , Richardson Russell S.
Published: June 2018

Evidence suggests that the peak skeletal muscle mitochondrial ATP synthesis rate ( Vmax) in patients with peripheral artery disease (PAD) may be attenuated due to disease-related impairments in O2 supply. However, in vitro assessments suggest intrinsic deficits in mitochondrial respiration despite ample O2 availability. To address this conundrum, Doppler ultrasound, near-infrared spectroscopy, phosphorus magnetic resonance spectroscopy, and high-resolution respirometry were combined to assess convective O2 delivery, tissue oxygenation, Vmax, and skeletal muscle mitochondrial capacity (complex I + II, state 3 respiration), respectively, in the gastrocnemius muscle of 10 patients with early stage PAD and 11 physical activity-matched healthy control (HC) subjects. All participants were studied in free-flow control conditions (FF) and with reactive hyperemia (RH) induced by a period of brief ischemia during the last 30 s of submaximal plantar flexion exercise. Patients with PAD repeated the FF and RH trials under hyperoxic conditions (FF + 100% O2 and RH + 100% O2). Compared with HC subjects, patients with PAD exhibited attenuated O2 delivery at the same absolute work rate and attenuated tissue reoxygenation and Vmax after relative intensity-matched exercise. Compared with the FF condition, only RH + 100% O2 significantly increased convective O2 delivery (~44%), tissue reoxygenation (~54%), and Vmax (~60%) in patients with PAD ( P < 0.05), such that Vmax was now not different from HC subjects. Furthermore, there was no evidence of an intrinsic mitochondrial deficit in PAD, as assessed in vitro with adequate O2. Thus, in combination, this comprehensive in vivo and in vitro investigation implicates O2 supply as the predominant factor limiting mitochondrial oxidative capacity in early stage PAD.

NEW & NOTEWORTHY Currently, there is little accord as to the role of O2 availability and mitochondrial function in the skeletal muscle dysfunction associated with peripheral artery disease. This is the first study to comprehensively use both in vivo and in vitro approaches to document that the skeletal muscle dysfunction associated with early stage peripheral artery disease is predominantly a consequence of limited O2 supply and not the impact of an intrinsic mitochondrial defect in this pathology.
BMP7 Signaling in TGFBR2-Deficient Stromal Cells Provokes Epithelial Carcinogenesis
Authors: Eikesdal Hans Petter , Becker Lisa M. , Teng Yingqi , Kizu Akane , Carstens Julienne L. , Kanasaki Keizo , Sugimoto Hikaru , LeBleu Valerie S. , Kalluri Raghu
Published: June 2018

Deregulated transforming growth factor-β (TGFβ) signaling is a common feature of many epithelial cancers. Deletion of TGFβ receptor type 2 (TGFBR2) in fibroblast specific protein-1 (FSP1)-positive stromal cells induces squamous cell carcinoma in the murine forestomach, implicating fibroblast-derived hepatocyte growth factor (HGF) as the major driver of the epithelium carcinogenesis. Prior to cancer development, hyperproliferative FSP1+ fibroblasts lacking TGFBR2 accumulate in the forestomach, disrupting the regulatory signaling cross-talk with the forestomach epithelium. Here, concurrent loss in TGFBR2 and SMAD4 completely abrogates the development of forestomach cancer. Bone morphogenic protein-7 (BMP7) was highly upregulated in forestomach cancer tissue, activating Smad1/5/8 signaling, cell proliferation, and HGF production in TGFBR2-deficient FSP1+ fibroblasts. This stimulation by BMP7 was lost in the combined TGFBR2 and SMAD4 double knockout fibroblasts, which included a profound decrease in HGF expression. Thus, Smad4-mediated signaling is required to initiate epithelial carcinogenesis subsequent to TGFBR2 deletion in FSP1+ fibroblasts.

Implications: These findings reveal a complex cross-talk between epithelial cells and the stroma, wherein Smad4 is required to elicit squamous cell carcinomas in the forestomach of mice with TGFBR2-deficient stromal cells. Mol Cancer Res; 16(10); 1568–78. ©2018 AACR.
Unruptured Saccular Aneurysm Arising from the Fenestrated A1 Segment of the Anterior Cerebral Artery: Report of 2 Cases
Authors: Iwabuchi Naoya , Saito Atsushi , Fujimoto Kentaro , Nakamura Taigen , Sasaki Tatsuya
Published: June 2018

Some cases of aneurysms originating from the fenestrated A1 segment of the anterior cerebral artery (ACA) have been reported, but the pitfalls of the surgical procedure have not been well determined. We herein report 2 cases of a saccular aneurysm arising from the fenestrated A1 segment. Case 1 was a 72-year-old man incidentally diagnosed with an unruptured left ACA aneurysm on magnetic resonance imaging (MRI). Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the left A1 segment. He underwent surgical clipping via the left pterional approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one small fenestrated trunk, preserving the other fenestrated trunk and perforators around the fenestration. Case 2 was a 73-year-old man incidentally diagnosed with an unruptured ACA aneurysm on MRI. Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the fenestrated left A1 segment. He underwent surgical clipping via the interhemispheric approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one hypoplastic fenestrated trunk, preserving the other fenestrated trunk and perforators around the aneurysm. Detailed intraoperative evaluations of the anatomical structure and hemodynamics around the fenestration are important. The intentional obliteration of a fenestrated trunk and application of fenestrated clips need to be considered in difficult cases in order to expose the aneurysmal neck.
Gastroparesis in a Patient with Gastric AL Amyloidosis
Authors: Hoscheit Matthew , Kamal Afrin , Cline Michael
Published: June 2018

Systemic amyloidosis is a group of complex disorders characterized by the extracellular deposition of nonbranching fibrils in various tissues, ultimately leading to a variety of clinical presentations including isolated or multiorgan dysfunction. Amyloid involvement of the gastrointestinal tract is common depending on the subtype of this disease; light chain primary amyloidosis (AL) and secondary amyloidosis (AA) affect the gastrointestinal tract in unique ways due to differing pathophysiology. A case is reported of gastroparesis associated with AL amyloidosis diagnosed by esophagogastroduodenoscopy and study of gastric emptying, then subsequently confirmed by Congo red staining performed on endoscopic biopsies.