bluuebunny/crossref_metadata_2025 huggingface dataset:
Growing season moisture drives interannual variation in woody productivity of a temperate deciduous forest
Authors: Helcoski Ryan , Tepley Alan J. , Pederson Neil , McGarvey Jennifer C. , Meakem Victoria , Herrmann Valentine , Thompson Jonathan R. , Anderson‐Teixeira Kristina J.
Published: May 2019

The climate sensitivity of forest ecosystem woody productivity (ANPPstem) influences carbon cycle responses to climate change. For the first time, we combined long‐term annual growth and forest census data of a diverse temperate broadleaf deciduous forest, seeking to resolve whether ANPPstem is primarily moisture‐ or energy‐limited and whether climate sensitivity has changed in recent decades characterised by more mesic conditions and elevated CO2.

We analysed tree‐ring chronologies across 109 yr of monthly climatic variation (1901–2009) for 14 species representing 97% of ANPPstem in a 25.6 ha plot in northern Virginia, USA.

Radial growth of most species and ecosystem‐level ANPPstem responded positively to cool, moist growing season conditions, but the same conditions in the previous May–July were associated with reduced growth. In recent decades (1980–2009), responses were more variable and, on average, weaker.

Our results indicated that woody productivity is primarily limited by current growing season moisture, as opposed to temperature or sunlight, but additional complexity in climate sensitivity may reflect the use of stored carbohydrate reserves. Overall, while such forests currently display limited moisture sensitivity, their woody productivity is likely to decline under projected hotter and potentially drier growing season conditions.
Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures
Authors: Long Tao , Li Kai‐nan , Gao Jin‐hua , Liu Tian‐hu , Mu Jian‐song , Wang Xue‐jun , Peng Chao , He Zhi‐yong
Published: May 2019

Objectives

To analyze the curative effect of TiRobot surgical robotic navigation and location system‐assisted percutaneous sacroiliac screw fixation and percutaneous sacroiliac screw by traditional fluoroscopy, and to summarize the safety and benefits of TiRobot.

Methods

A total of 91 patients with pelvic posterior ring fractures from December 2015 to February 2018 were included in this study. According to the surgical methods selected by the patients, the patients were divided into a TiRobot surgical robotic navigation and location system group (TiRobot group) and a percutaneous sacroiliac screw fixation group (traditional group). Statistical indicators included the number of sacroiliac screws, the time of planning the sacroiliac screw path, fluoroscopy frequency, fluoroscopy time, operation time, length of incision, blood loss, anesthesia time, the healing process of skin incisions, and fracture healing time. Fracture reduction was evaluated according to the maximum displacement degree at the inlet and outlet view X‐ray or CT. Matta standard was used to evaluate fracture reduction. At the last follow‐up, the Majeed function system was used to evaluate the function.

Results

All patients were followed up for 8 to 32 months. A total of 66 sacroiliac screws were implanted in the TiRobot group. A total of 43 sacroiliac screws were implanted in the traditional group. There were statistically significant differences in terms of fluoroscopy frequency, fluoroscopy time, operation time, incision length, anesthesia time, and blood loss between the two groups; the TiRobot group was superior to the traditional group. The healing time of the TiRobot group and the traditional group was 4.61 ± 0.68 months (range, 3.5–6.3 months) and 4.56 ± 0.78 months (range, 3.4–6.2 months), respectively, and there was no statistical difference. Postoperatively, by Matta standard, the overall excellent and good rate of fracture reduction was 89.28% and 88.57%, respectively. At the last follow‐up, by Majeed function score, the overall excellent and good rate was 91.07% and 91.43%. There was no statistical difference between the two groups.

Conclusion

Sacroiliac screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures has the characteristics of less trauma, shorter operation time, and less blood loss. TiRobot has the characteristics of high safety and accuracy and has great clinical application value.
The development of an opioid sparing anesthesia protocol for pediatric ambulatory tonsillectomy and adenotonsillectomy surgery—A quality improvement project
Authors: Franz Amber M. , Dahl John P. , Huang Henry , Verma Shilpa T. , Martin Lynn D. , Martin Lizabeth D. , Low Daniel King‐Wai
Published: May 2019

Pain management following pediatric tonsillectomy and adenotonsillectomy surgery is challenging and traditionally involves perioperative opioids. However, the recent national opioid shortage compelled anesthesiologists at Bellevue Surgery Center to identify an alternative perioperative analgesic regimen that minimizes opioids yet provides effective pain relief. We assembled an interdisciplinary quality improvement team to trial a series of analgesic protocols using the Plan‐Do‐Study‐Act cycle. Initially, we replaced intraoperative morphine and acetaminophen (M/A protocol) with intraoperative dexmedetomidine and preoperative ibuprofen (D/I protocol). However, when results were not favorable, we rapidly transitioned to intraoperative ketorolac and dexmedetomidine (D/K protocol). The following measures were evaluated using statistical process control chart methodology and interpreted using Shewhart's theory of variation: maximum pain score in the postanesthesia care unit, postoperative morphine rescue rate, postanesthesia care unit length of stay, total anesthesia time, postoperative nausea and vomiting rescue rate, and reoperation rate within 30 days of surgery. There were 333 patients in the M/A protocol, 211 patients in the D/I protocol, and 196 patients in the D/K protocol. With the D/I protocol, there were small increases in maximum pain score and postanesthesia care unit length of stay, but no difference in morphine rescue rate or total anesthesia time compared to the M/A protocol. With the D/K protocol, postoperative pain control and postanesthesia care unit length of stay were similar compared to the M/A protocol. Both the D/I and D/K protocols had reduced nausea and vomiting rescue rates. Reoperation rates were similar between groups. In summary, we identified an intraoperative anesthesia protocol for pediatric tonsillectomy and adenotonsillectomy surgery utilizing dexmedetomidine and ketorolac that provides effective analgesia without increasing recovery times or reoperation rates.
The effect of suprainguinal fascia iliaca block on the recovery of patients after arthroscopic hip surgery
Authors: Alrayashi Walid , Zurakowski David , Sullivan Cornelius Arthur , Berde Charles B. , Askins Nissa , Sinnott Sean , Cravero Joseph P.
Published: May 2019

Background

Adolescent and young adult patients undergoing arthroscopic hip surgery experience significant pain in the immediate postoperative period. There is a small body of evidence that indicates suprainguinal fascia iliaca blocks can improve comfort during recovery from this intervention. Our hypothesis was that patients undergoing hip surgery would consume fewer opioids and have less pain in the perioperative time frame if they received the block as part of their analgesic regimen.

Methods

In this study, we evaluated the outcomes of 716 patients, including 275 who received a suprainguinal fascia iliaca block, and 441 who did not have a block. Inclusion criteria included all age groups and American Society of Anesthesiologists, functional classes 1‐2. Patients who received other concurrent procedures or those with incomplete data sets were excluded. We utilized a regional anesthesia database that combined data from various repositories into one web‐based relational system. The primary outcomes were total opioid consumption and pain scores in the recovery room. Secondary outcomes included opioid side effects, block‐related complications, and total recovery room time. Multivariable logistic regression analysis was used to evaluate opioid consumption, side effects, and total recovery times. Pearson chi‐square was applied to assess the level of pain between the two groups.

Results

Total opioid consumption was significantly less in the block group compared to those not receiving a block (0.28 mg/kg vs 0.35 mg/kg, P < 0.001, 95% CI of difference in medians 0.04‐0.10 mg/kg), but there was no statistical difference in pain scores. Patients with the regional block had a lower frequency of emesis in the PACU (0.7% vs 4.3%; P < 0.005, 95% CI of difference: 2‐25) and shorter PACU times (93 vs 108 minutes, P < 0.001, 95% CI of difference: 8‐23 minutes).

Conclusion

Our study supports the clinical effectiveness of suprainguinal fascia iliaca blocks in young patients undergoing arthroscopic hip surgery.
Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2‐year prospective cohort study
Authors: Shimada Takeshi , Ohori Manami , Inagaki Yusuke , Shimooka Yuko , Ishihara Ikuyo , Sugimura Naoya , Tanaka Sachie , Kobayashi Masayoshi
Published: May 2019

Aim

We examined the effect of individualized occupational therapy (IOT) compared to the usual group occupational therapy (GOT) on the rehospitalization of patients with schizophrenia.

Methods

A prospective cohort study included patients with schizophrenia who were discharged within 1 year from a psychiatric hospital. Time to rehospitalization by treatment group (GOT + IOT or GOT‐alone) was evaluated with Kaplan–Meier survival analysis. The impact of demographics and clinical factors associated with rehospitalization was investigated using Cox proportional hazards models.

Results

Of the 111 patients who met the criteria, 54 were in the GOT + IOT group and 57 in the GOT‐alone group. Over the 2 years from discharge, the overall rehospitalization rate was 51.376% (56 patients); the GOT + IOT group demonstrated a significantly lower rehospitalization rate with 16 patients rehospitalized compared to 40 patients from the GOT‐alone group. Time to rehospitalization was significantly longer for the GOT + IOT group compared to those in the GOT‐alone group (P < 0.001). The multivariate Cox proportional hazards models showed that type of occupational therapy (hazard ratio [HR] = 0.543), medication adherence (HR = 0.343), access to resident support persons (HR = 0.450), and executive function at discharge (HR = 0.740) were all significantly associated with rehospitalization.

Conclusion

Our results provide support for the prolonging effects of IOT in relation to rehospitalization and the reduction of rehospitalization risk compared to patients with schizophrenia who receive GOT alone, in addition to supporting good cognition at discharge and favorable medication adherence.
Autism spectrum disorder: Trends in research exploring etiopathogenesis
Authors: Gyawali Shreeya , Patra Bichitra Nanda
Published: May 2019

Autism spectrum disorder is a neurodevelopmental condition in which affected individuals have difficulties while interacting and communicating socially, and repetitive behaviors. It has a multifactorial etiology. Various risk factors, including genetic and environmental influences, have been explored while trying to understand its causation. As older evidence was suggestive of a high heritability, a majority of research focused on finding the underlying genetic causes of autism. Due to these efforts, there have been advances in the knowledge of some of the genetic factors associated with autism. But a recent trend also shows an increasing interest in exploration of various potential environmental triggers. These efforts have brought us closer to understanding the elusive disorder more so than ever before. The current review discusses the recent trends in research exploring the etiopathogenesis of autism spectrum disorder.
Automatic classification of major depression disorder using arterial spin labeling MRI perfusion measurements
Authors: Ramasubbu Rajamannar , Brown Elliot Clayton , Marcil Lorenzo Daniel , Talai Aron Sahand , Forkert Nils Daniel
Published: May 2019

Aim

Neuroimaging‐based multivariate pattern‐recognition methods have been successfully used to develop diagnostic algorithms to distinguish patients with major depressive disorder (MDD) from healthy controls (HC). We developed and evaluated the accuracy of a multivariate classification method for the differentiation of MDD and HC using cerebral blood flow (CBF) features measured by non‐invasive arterial spin labeling (ASL) MRI.

Methods

Twenty‐two medication‐free patients with the diagnosis of MDD based on DSM‐IV criteria and 22 HC underwent pseudo‐continuous 3‐D‐ASL imaging to assess CBF. Using an atlas‐based approach, regional CBF was determined in various brain regions and used together with sex and age as classification features. A linear kernel support vector machine was used for feature ranking and selection as well as for the classification of patients with MDD and HC. Permutation testing was used to test for significance of the classification results.

Results

The automatic classifier based on CBF features showed a statistically significant accuracy of 77.3% (P = 0.004) with a specificity of 80% and sensitivity of 75% for classification of MDD versus HC. The features that contributed to the classification were sex and regional CBF of the cortical, limbic, and paralimbic regions.

Conclusion

Machine‐learning models based on CBF measurements are capable of differentiating MDD from HC with high accuracy. The use of larger study cohorts and inclusion of other imaging measures may improve the performance of the classifier to achieve the accuracy required for clinical application.
Reduced premovement positivity during the stimulus‐response interval precedes errors: Using single‐trial and regression ERPs to understand performance deficits in ADHD
Authors: Burwell Scott J. , Makeig Scott , Iacono William G. , Malone Stephen M.
Published: May 2019

Brain mechanisms linked to incorrect response selections made under time pressure during cognitive task performance are poorly understood, particularly in adolescents with attention‐deficit hyperactivity disorder (ADHD). Using subject‐specific multimodal imaging (electroencephalogram, magnetic resonance imaging, behavior) during flanker task performance by a sample of 94 human adolescents (mean age = 15.5 years, 50% female) with varying degrees of ADHD symptomatology, we examined the degree to which amplitude features of source‐resolved event‐related potentials (ERPs) from brain‐independent component processes within a critical (but often ignored) period in the action selection process, the stimulus‐response interval, were associated with motor response errors (across trials) and error rates (across individuals). Response errors were typically preceded by two smaller peaks in both trial‐level and trial‐averaged ERP projections from posterior medial frontal cortex (pMFC): a frontocentral P3 peaking about 390 ms after stimulus onset, and a premovement positivity (PMP) peaking about 110 ms before the motor response. Separating overlapping stimulus‐locked and response‐locked ERP contributions using a “regression ERP” approach showed that trial errors and participant error rates were primarily associated with smaller PMP, and not with frontocentral P3. Moreover, smaller PMP mediated the association between larger numbers of errors and ADHD symptoms, suggesting the possible value of using PMP as an intervention target to remediate performance deficits in ADHD.
A Unit Level Small Area Model with Misclassified Covariates
Authors: Arima Serena , Polettini Silvia
Published: May 2019

Model-based small area estimation relies on mixed effects regression models that link the small areas and borrow strength from similar domains. When the auxiliary variables that are used in the models are measured with error, small area estimators that ignore the measurement error may be worse than direct estimators. Alternative small area estimators accounting for measurement error have been proposed in the literature but only for continuous auxiliary variables. Adopting a Bayesian approach, we extend the unit level model to account for measurement error in both continuous and categorical covariates. For the discrete variables we model the misclassification probabilities and estimate them jointly with all the unknown model parameters. We test our model through a simulation study. The effect of the model proposed is emphasized through application to data from the Ethiopia Demographic and Health Survey where we focus on the women’s malnutrition issue: a dramatic problem in developing countries and an important indicator of the socio-economic progress of a country.
Estimating the Number of Serious Road Injuries Per Vehicle Type in the Netherlands by using Multiple Imputation of Latent Classes
Authors: Boeschoten Laura , Waal Ton , Vermunt Jeroen K.
Published: May 2019

Statistics that are published by official agencies are often generated by using population registries, which are likely to contain classification errors and missing values. A method that simultaneously handles classification errors and missing values is multiple imputation of latent classes (MILC). We apply the MILC method to estimate the number of serious road injuries per vehicle type in the Netherlands and to stratify the number of serious road injuries per vehicle type into relevant subgroups by using data from two registries. For this specific application, the MILC method is extended to handle the large number of missing values in the stratification variable ‘region of accident’ and to include more stratification covariates. After applying the extended MILC method, a multiply imputed data set is generated that can be used to create statistical figures in a straightforward manner, and that incorporates uncertainty due to classification errors and missing values in the estimate of the total variance.
From sink to volcanic source: Unravelling missing terrestrial eruption records by characterization and high‐resolution chronology of lacustrine volcanic density flow deposits, Lake Inawashiro‐ko, Fukushima, Japan
Authors: Kataoka Kyoko S. , Nagahashi Yoshitaka
Published: May 2019

Eruption records in the terrestrial stratigraphy are often incomplete due to erosion after tephra deposition, limited exposure and lack of precise dating owing to discontinuity of strata. A lake system and sequence adjacent to active volcanoes can record various volcanic events such as explosive eruptions and subaqueous density flows being extensions of eruption triggered and secondary triggered lahars. A lacustrine environment can constrain precise ages of such events because of constant and continuous background sedimentation. A total of 71 subaqueous density flow deposits in a 28 m long core from Lake Inawashiro‐ko reveals missing terrestrial volcanic activity at Adatara and Bandai volcanoes during the past 50 kyr. Sedimentary facies, colour, grain size, petrography, clay mineralogy, micro X‐ray fluorescence analysis and chemistry of included glass shards characterize the flow event deposits and clarify their origin: (i) clay‐rich grey hyperpycnites, extended from subaerial cohesive lahars at Adatara volcano, with sulphide/sulphate minerals and high sulphur content which point to a source from hydrothermally altered material ejected by phreatic eruptions; and (ii) clay‐rich brown density flow deposits, induced by magmatic hydrothermal eruptions and associated edifice collapse at Bandai volcano, with the common presence of fresh juvenile glass shards and low‐grade hydrothermally altered minerals; whereas (iii) non‐volcanic turbidites are limited to the oldest large slope failure and the 2011 Tohoku‐oki earthquake events. The high‐resolution chronology of volcanic activity during the last 50 kyr expressed by lacustrine event deposits shows that phreatic eruption frequency at Adatara has roughly tripled and explosive eruptions at Bandai have increased by ca 50%. These results challenge hikers, ski‐fields and downstream communities to re‐evaluate the increased volcanic risks from more frequent eruptions and far‐reaching lahars, and demonstrate the utility of lahar and lacustrine volcanic density flow deposits to unravel missing terrestrial eruption records, otherwise the recurrence rate may be underestimated at many volcanoes.
Evaluation of rainfall kinetic energy and erosivity in northern Taiwan using kriging with climate characteristics
Authors: Liao Kuo‐Wei , Guo Jia‐Jun , Fan Jen‐Chen , Lee Cheng‐Chun , Huang Chien Lin
Published: May 2019

A localized rainfall kinetic energy (E) equation and an erosivity map were developed, and the suitability of the universal soil loss equation (USLE) for assessing the soil erosion of a non‐US region was investigated. After accurately measuring and gathering data regarding raindrop size using disdrometers in four northern Taiwan locations, this study investigated the drop size distribution under different conditions by categorizing the rainfall patterns to develop regression equations for estimating the unit volume‐specific kinetic energy (KEmm) and the unit time‐specific kinetic energy (KEtime) of northern Taiwan. Climate zoning, which is not considered in currently used designs, was then implemented along with two‐stage cluster analysis to construct a rainfall erosivity (R) distribution map using the kriging model. The binary polynomial regression function of KEtime, which had the highest correlation (R2 = 0.98), was suggested to estimate E in northern Taiwan. It was found that the pattern and intensity (I) of rainfall will slightly affect E. The climatic influence on the root mean square of the semivariogram was significant, which suggests that climate zoning can help estimate the rainfall erosivity (R). The outcomes were extended to estimate R in areas without rainfall stations.
Multiple downy mildew effectors target the stress‐related NAC transcription factor LsNAC069 in lettuce
Authors: Meisrimler Claudia‐Nicole , Pelgrom Alexandra J. E. , Oud Bart , Out Suzan , Van den Ackerveken Guido
Published: May 2019

To cause disease in lettuce, the biotrophic oomycete Bremia lactucae secretes potential RxLR effector proteins. Here we report the discovery of an effector‐target hub consisting of four B. lactucae effectors and one lettuce protein target by a yeast‐two‐hybrid (Y2H) screening. Interaction of the lettuce tail‐anchored NAC transcription factor, LsNAC069, with B. lactucae effectors does not require the N‐terminal NAC domain but depends on the C‐terminal region including the transmembrane domain. Furthermore, in Y2H experiments, B. lactucae effectors interact with Arabidopsis and potato tail‐anchored NACs, suggesting that they are conserved effector targets. Transient expression of RxLR effector proteins BLR05 and BLR09 and their target LsNAC069 in planta revealed a predominant localization to the endoplasmic reticulum. Phytophthora capsici culture filtrate and polyethylene glycol treatment induced relocalization to the nucleus of a stabilized LsNAC069 protein, lacking the NAC‐domain (LsNAC069ΔNAC). Relocalization was significantly reduced in the presence of the Ser/Cys‐protease inhibitor TPCK indicating proteolytic cleavage of LsNAC069 allows for relocalization. Co‐expression of effectors with LsNAC069ΔNAC reduced its nuclear accumulation. Surprisingly, LsNAC069 silenced lettuce lines had decreased LsNAC069 transcript levels but did not show significantly altered susceptibility to B. lactucae. In contrast, LsNAC069 silencing increased resistance to Pseudomonas cichorii bacteria and reduced wilting effects under moderate drought stress, indicating a broad role of LsNAC069 in abiotic and biotic stress responses.
Stable native RIP9 complexes associate with C‐to‐U RNA editing activity, PPRs, RIPs, OZ1, ORRM1 and ISE2
Authors: Sandoval Rafael , Boyd Robert D. , Kiszter Alena N. , Mirzakhanyan Yeva , Santibańez Paola , Gershon Paul D. , Hayes Michael L.
Published: May 2019

The mitochondrial and chloroplast mRNAs of the majority of land plants are modified through cytidine to uridine (C‐to‐U) RNA editing. Previously, forward and reverse genetic screens demonstrated a requirement for pentatricopeptide repeat (PPR) proteins for RNA editing. Moreover, chloroplast editing factors OZ1, RIP2, RIP9 and ORRM1 were identified in co‐immunoprecipitation (co‐IP) experiments, albeit the minimal complex sufficient for editing activity was never deduced. The current study focuses on isolated, intact complexes that are capable of editing distinct sites. Peak editing activity for four sites was discovered in size‐exclusion chromatography (SEC) fractions ≥ 670 kDa, while fractions estimated to be approximately 413 kDa exhibited the greatest ability to convert a substrate containing the editing site rps14 C80. RNA content peaked in the ≥ 670 kDa fraction. Treatment of active chloroplast extracts with RNase A abolished the relationship of editing activity with high‐MW fractions, suggesting a structural RNA component in native complexes. By immunoblotting, RIP9, OTP86, OZ1 and ORRM1 were shown to be present in active gel filtration fractions, though OZ1 and ORRM1 were mainly found in low‐MW inactive fractions. Active editing factor complexes were affinity‐purified using anti‐RIP9 antibodies, and orthologs to putative Arabidopsis thaliana RNA editing factor PPR proteins, RIP2, RIP9, RIP1, OZ1, ORRM1 and ISE2 were identified via mass spectrometry. Western blots from co‐IP studies revealed the mutual association of OTP86 and OZ1 with native RIP9 complexes. Thus, RIP9 complexes were discovered to be highly associated with C‐to‐U RNA editing activity and other editing factors indicative of their critical role in vascular plant editosomes.
Comparison of RNA isolation and library preparation methods for small RNA sequencing of canine biofluids
Authors: Chu Candice P. , Nabity Mary B.
Published: May 2019

Background

Small RNA sequencing (RNA‐seq) of biofluids is challenging due to the relative scarcity of microRNAs (miRNAs), limited sample volumes, and the lack of a gold standard isolation method. Additionally, few comparisons exist for the RNA isolation and sequencing methods of biofluids.

Objectives

We aimed to compare the performance of six commercial RNA isolation kits and two library preparation methods for small RNA‐seq using canine serum and urine.

Methods

Serum and urine were collected from seven dogs with protein‐losing nephropathy, and the samples were pooled. Total RNA from serum (2 mL) and urine (10 mL) was isolated in triplicate using three methods each for serum (Zymo Direct‐zol, mirVana PARIS, miRCURY Biofluids) and urine (Qiagen exoRNeasy, Norgen Urine Exosome, miRCURY Exosome). For each sample type, the two kits yielding the highest RNA concentration were selected, and small RNA‐seq was performed using TruSeq and NEXTflex library preparations. Data were analyzed by CPSS 2.0 and DESeq2.

Results

For serum, Zymo Direct‐zol combined with NEXTflex was the only combination that enabled successful library preparation, while for urine, Qiagen exoRNeasy combined with NEXTflex outperformed other combinations for detecting miRNAs. The total number of miRNAs detected in serum and urine was 198 and up to 115, respectively. miRNA expression in serum was distinct from urine. Furthermore, the library preparation method introduced a higher variation of urine results than the RNA isolation method.

Conclusions

Different isolation and library preparation methods show significant differences in miRNA results that could affect biomarker discovery. Small RNA‐seq provides an unbiased, global assessment to compare these methods in canine biofluids.
Circulating pig‐specific DNA as a novel biomarker for monitoring xenograft rejection
Authors: Zhou Ming , Lu Ying , Zhao Chengjiang , Zhang Junfang , Cooper David K. C. , Xie Chongwei , Song Zongpei , Gao Hanchao , Qu Zepeng , Lin Shan , Deng YangYang , Hara Hidetaka , Zhan Yongqiang , Jiang Zhengda , Dai Yifan , Wu Changyou , Cai Zhiming , Mou Lisha
Published: May 2019

Monitoring for immune rejection is crucial for long‐term survival of pig xenografts. Circulating DNA is a promising non‐invasive biomarker for either organ injury or response to therapy. In this study, circulating pig‐specific DNA (cpsDNA) was monitored during xenograft rejection. Potential targets of cpsDNA were selected by in silico analysis, and species specificity of selected primers was confirmed by PCR. Subsequently, cpsDNA as a biomarker was evaluated using a complement‐dependent cytotoxicity (CDC) assay in vitro. Then, early diagnosis and response to rapamycin were assessed by an in vivo imaging model of pig‐to‐mouse cell transplantation. Finally, cpsDNA was monitored in a pig‐to‐monkey artery patch transplantation model. The results showed that (a) a method of cpsDNA quantitation was established for application in mouse and nonhuman primate models; (b) cpsDNA reflected CDC in vitro; (c) cpsDNA in vivo mirrored xenograft rejection, and correlated with xenograft loss in pig‐to‐mouse cell transplantation; (d) cpsDNA was significantly reduced when rapamycin was administered; and (e) dynamic cpsDNA was detectable in pig‐to‐monkey artery patch transplantation. In conclusion, measurement of cpsDNA could prove to be a less invasive, but more specific and sensitive low‐cost biomarker enabling monitoring of xenograft rejection and the response to immunosuppressive therapy.
Bordetella pertussis Can Be Motile and Express Flagellum-Like Structures
Authors: Hoffman Casandra L. , Gonyar Laura A. , Zacca Federico , Sisti Federico , Fernandez Julieta , Wong Ting , Damron F. Heath , Hewlett Erik L.
Published: May 2019

This report provides evidence for motility and expression of flagella by
B. pertussis
, a bacterium that has been reported as nonmotile since it was first isolated and studied. As with
B. bronchiseptica
,
B. pertussis
cells can express and assemble a flagellum-like structure on their surface, which in other organisms has been implicated in several important processes that occur
in vivo
. The discovery that
B. pertussis
is motile raises many questions, including those regarding the mechanisms of regulation for flagellar gene and protein expression and, importantly, the role of flagella during infection. This novel observation provides a foundation for further study of
Bordetella
flagella and motility in the contexts of infection and transmission.
Combined bipedicled latissimus dorsi and groin flap for anterior chest wall reconstruction
Authors: Boonipat Thanapoom , Ji Lou , Manrique Oscar J , Chen Hung-Chi
Published: May 2019

We provide a case report of reconstruction of a massive chest wall defect after recurrent phyllodes tumour resections. The reconstruction used a bipedicled groin and latissimus dorsi flap, with composite rib autologous reconstruction. The patient successfully recovered from the operation. Our case illustrates the applicability of this flap in the armamentarium of anterior chest wall reconstructive options.
Evacuation of a large traumatic vulvar haematoma with an intravaginal cosmetic approach
Authors: Yadav Ghanshyam S , Marashi Amir
Published: May 2019

A healthy youngwoman presented 3 days after a jet ski accident with a large left vulvar haematoma measuring 12 cm. Immediately postinjury, she was managed conservatively in the emergency room of another hospital. However, the haematoma continued to slowly expand. She presented to our clinic with difficulty walking and severe discomfort. Decision was made to drain the haematoma surgically. The patient was sceptical to have scarring on her vulva. Thus, the haematoma was evacuated by a vertical incision on the left vaginal sidewall. After evacuation and achieving haemostasis, the was closed with two interrupted sutures. Edges of the incision were secured similar to marsupialisation with five interrupted sutures to allow continual drainage. Her discomfort resolved immediately postsurgery and she had an uncomplicated postoperative course. The intravaginal approach yielded superior aesthetic result with no scarring on the external vulva.
Maternal uniparental disomy of the chromosome 14: need for growth hormone provocative tests also when a deficiency is not suspected
Authors: Tortora Anna , La Sala Domenico , Lonardo Fortunato , Vitale Mario
Published: May 2019

Uniparental disomy (UPD) is a congenital disease characterised by the presence of two homologous chromosomes inherited from one parent in a diploid offspring. Maternal UPD of the chromosome 14 (UPD(14)mat, Temple syndrome) is a rare disorder with heterogeneous clinical presentation. Here, we report a case of UPD(14)mat with a small supernumerary marker chromosome in a 6-year-old baby girl, presenting endocrinological disorders and incomplete clinical presentation. She came to our attention because of precocious beginning of pubarche and normal stature. Most of Temple syndrome signs were lacking. Provocative tests diagnosed incomplete growth hormone (GH) response and confirmed precocious puberty. One year treatment with recombinant human GH and gonadotropin-releasing hormone (GnRH) agonists proved successful, increasing height and arresting puberty. We recommend provocative tests for GH in UPD(14)mat as a GH deficiency can be hidden by a concurrent precocious puberty. Concomitant human GH and GnRH analogue treatment can be pursued.
Enabling individualised health in learning healthcare systems
Authors: Wongvibulsin Shannon , Zeger Scott L.
Published: May 2019

The rising burden of healthcare costs suggests that the healthcare system could benefit from novel methods that allow for continuous learning to provide more data-driven, individualised care at lower costs and with improved outcomes. Here, we present our synergistic Learning approach for Prediction, Interpretation/Inference and Communication (Learning PIC) framework to address the challenges hindering the successful implementation of learning healthcare systems and to enable the effective delivery of evidence-based medicine.
Comparing neck extensor muscle function in asymptomatic Canadian adults and adults with tension-type headache: a cross-sectional study
Authors: Marchand Andrée-Anne , Houle Mariève , Girard Marie-Pier , Hébert Marie-Ève , Descarreaux Martin
Published: May 2019

Aim

To further the understanding of the pathophysiological mechanisms underlying tension-type headache (TTH) by comparing the endurance and strength of neck extensor muscles under acute muscle fatigue in participants with TTH and asymptomatic participants.

Methods

We conducted a cross-sectional analysis of neck extensor muscle performance. Asymptomatic participants and participants with TTH were recruited via social media platforms and from the Université du Québec à Trois-Rivières community and employees. A total of 44 participants with TTH and 40 asymptomatic participants took part in an isometric neck extensor endurance task performed at 60% of their maximum voluntary contraction. Inclusion criteria for the headache group were to be older than 18 years old and to fulfil the International Headache Society classification’s criteria for either frequent episodic or chronic TTH. Clinical (self-efficacy, anxiety, neck disability and kinesiophobia) and physical parameters (neck extensors maximum voluntary contraction, endurance time, muscle fatigue) as well as characteristics of headache episodes (intensity, frequency and associated disability) were collected for all participants. Surface electromyography was used to document upper trapezius, splenius capitis and sternocleidomastoids muscle activity and muscle fatigue.

Results

Both groups displayed similar neck extensor muscle endurance capacity with a mean difference of 6.2 s (p>0.05) in favour of the control group (control=68.1±32.3; TTH=61.9±20.1). Similarly, participants in the headache group showed comparable neck extensor muscle strength (95.9±30.4 N) to the control group (111.3±38.7 N). Among participants with TTH, those scoring as severely incapacitated by headaches were the ones with higher neck-related disability (F[1,44]=10.77; p=0.002), the more frequent headache episodes (F[1,44]=6.70; p=0.01) and higher maximum headache intensity (F[1,44]=10.81; p=0.002).

Conclusion

A fatigue task consisting of isometric neck extension cannot efficiently differentiate participants with TTH from asymptomatic participants.
Is neighbourhood social cohesion associated with subjective well-being for older Chinese people? The neighbourhood social cohesion study
Authors: Yu Ruby , Cheung Osbert , Leung Jason , Tong Cecilia , Lau Kevin , Cheung Johnny , Woo Jean
Published: May 2019

Objectives

To evaluate the psychometric properties of the Hong Kong version of Neighbourhood Cohesion Instrument (HK-NCI) and examine whether neighbourhood social cohesion as measured using HK-NCI would be associated with evaluative, hedonic and eudaemonic well-being.

Design

A validation analysis followed by a cross-sectional analysis of a community-based survey.

Setting

Communities in two districts (Sha Tin and Tai Po) in Hong Kong.

Participants

301 community-dwelling Chinese men and women aged 60 years and older normally residing in Sha Tin or Tai Po for not less than six consecutive months at the time of participation in the study were interviewed.

Measurements

Neighbourhood social cohesion was measured using the 15-item HK-NCI. The Social Cohesion Scale (SCS) and the Brief Sense of Community Scale (BSCS) were administered for assessing the validity of the HK-NCI. Evaluative (life satisfaction), hedonic (feelings of happiness) and eudaemonic well-being (sense of purpose and meaning in life) were examined. Socio-demographic characteristics, lifestyle and health behaviours, medical history, and neighbourhood characteristics were used as covariates.

Results

For homogeneity, internal consistency of HK-NCI (α=0.813) was good. For stability (test–retest reliability), the averages of mean scores of the 15 items suggested an acceptable repeatability with an intra-class correlation coefficient=0.701(95% CI 0.497 to 0.832). HK-NCI was correlated with SCS (r=0.515–0.635, p<0.001) and BSCS (r=0.500–0.612, p<0.001). Neighbourhood social cohesion was positively and independently associated with life satisfaction, feelings of happiness and sense of purpose and meaning in life (all p values <0.05). Stratified analyses indicated that neighbourhood social cohesion was more strongly associated with all dimensions of subjective well-being in ‘young-old’ subgroup, and with sense of purpose and meaning in life for women.

Conclusion

The HK-NCI has adequate levels of internal consistency and test–retest reliability. In addition, higher levels of neighbourhood social cohesion were associated with better subjective well-being among older Chinese people.
What works best when implementing a physical activity intervention for teenagers? Reflections from the ACTIVE Project: a qualitative study
Authors: James Michaela , Christian Danielle , Scott Samantha , Todd Charlotte , Stratton Gareth , Demmler Joanne , McCoubrey Sarah , Halcox Julian , Audrey Suzanne , Ellins Elizabeth A , Irvine Elizabeth , Brophy Sinead
Published: May 2019

Objective

This paper explores what aspects of a multicomponent intervention were deemed strengths and weaknesses by teenagers and the local council when promoting physical activity to young people.

Design

Qualitative findings at 12 months from a mixed method randomised control trial.

Methods

Active Children Through Incentive Vouchers—Evaluation (ACTIVE) gave teenagers £20 of activity enabling vouchers every month for a year. Peer mentors were also trained and a support worker worked with teenagers to improve knowledge of what was available. Semistructured focus groups took place at 12 months to assess strengths and weaknesses of the intervention. Eight focus groups (n=64 participants) took place with teenagers and one additional focus group was dedicated to the local council’s sport development team (n=8 participants). Thematic analysis was used to analyse the data.

Results

Teenagers used the vouchers on three main activities: trampolining, laser tag or the water park. These appeal to both genders, are social, fun and require no prior skill or training. Choice and financial support for teenagers in deprived areas was considered a strength by teenagers and the local council. Teenagers did not engage with a trained peer mentor but the support worker was considered helpful.

Conclusions

The ACTIVE Project’s delivery had both strengths and weakness that could be used to underpin future physical activity promotion. Future interventions should focus on improving access to low cost, fun, unstructured and social activities rather than structured organised exercise/sport. The lessons learnt from this project can help bridge the gap between what is promoted to teenagers and what they actually want from activity provision.

Trial registration number

ISRCTN75594310
Associations between anthropometric indicators and both refraction and ocular biometrics in a cross-sectional study of Chinese schoolchildren
Authors: Ye Sheng , Liu Shengxin , Li Wenlei , Wang Qifan , Xi Wei , Zhang Xin
Published: May 2019

Objective

To identify associations between anthropometric indicators (height, weight and body mass index (BMI)) and both refraction and ocular biometrics in Chinese schoolchildren in Tianjin, China.

Design

Cross-sectional study.

Participants

A total of 482 (86.07%) students (6–15 years old) with no history of ocular or systemic pathologies were enrolled in this study.

Methodology

Height and weight were measured using standardised protocols. Ocular biometrics (axial length (AL), vitreous chamber depth (VCD) and corneal curvature (CC)) were measured by a low-coherence optical reflectometry device. Cycloplegic refraction was measured using autorefraction. The AL/CC ratio and spherical equivalent refraction (SER) were calculated. Myopia was defined as SER ≤−0.50 dioptres (D). Multiple linear regression analysis was performed to explore the associations between anthropometric indicators (height, weight and BMI) and both refraction and ocular biometrics.

Results

The overall prevalence of myopia was 71.16%. Overall, only height was associated with ALs, VCDs, AL/CC ratios and refractions after controlling for age, gender, parental myopia, family income, reading and writing distance and time spent outdoors. Furthermore, age-specific results demonstrated that height and weight were independently associated with refraction in participants aged 6–8 years and 9–11 years participants. Higher heights in schoolchildren were associated with longer ALs (regression coefficientb=+0.25 for each 10 cm difference in height, p<0.01), deeper VCDs (b=+0.23, p<0.01), higher AL/CC ratios (b=+0.04, p<0.01) and more negative refractions (b=−0.48, p<0.01). Heavier weights were also associated with longer ALs (+0.29 mm, p<0.01), deeper VCDs (+0.29 mm, p<0.01), higher AL/CC ratios (+0.04, p<0.01) and more negative refractions (−0.48 D, p<0.01).

Conclusions

Height and weight remained independently related to refraction and various ocular biometrics during the early adolescent growth period after adequately controlling for covariates, which could support the idea that a shared mechanism may regulate the coordinated growth of body and eye size in children.
Protocol for a systematic review on interventions for caregivers of persons with mild cognitive impairment and early dementia: does early stage intervention improve caregiver well-being and ability to provide care?
Authors: Bayly Melanie , Morgan Debra , Kosteniuk Julie , Elliot Valerie , Froehlich Chow Amanda , Peacock Shelley , McLean Allen , O’Connell Megan E
Published: May 2019

Introduction

Caregivers of persons with dementia and mild cognitive impairment (MCI) are at risk of decreased well-being. While many interventions for caregivers exist, evidence is sparse regarding intervention timing and effectiveness at an early stage of cognitive decline. Our systematic review aims to answer the following questions: (1) Do interventions for caregivers of persons with early stage dementia or MCI affect their well-being and ability to provide care? (2) Are particular types of caregiver interventions most effective during early stage cognitive decline? (3) How does effectiveness differ when early and later interventions are directly compared? (4) Do effects of early stage caregiver intervention vary based on care recipient and caregiver characteristics (eg, sex, type of dementia)?

Methods and analysis

The databases MEDLINE, EMBASE, PSYCINFO and CINAHL, as well as grey literature databases, will be searched for English language studies using search terms related to caregiver interventions and dementia/MCI. Abstracts and full texts will be screened by two independent reviewers; included studies must assess the effects of an intervention for caregivers of persons with early stage dementia or MCI on caregiver well-being or ability to provide care. Intervention, study and participant characteristics will be extracted by two independent reviewers, along with outcome data. Risk of bias will be assessed using the Cochrane risk of bias tool (for controlled trials with and without randomisation). Interventions will be grouped by type (eg, psychoeducational) and a narrative synthesis is planned due to expected heterogeneity, but a meta-analysis will be performed where possible. The Grading of Recommendations, Assessment, Development and Evaluations approach will be used to inform conclusions regarding the quality of evidence for each type of intervention.

Ethics and dissemination

Findings from this review will be disseminated via conferences and peer-reviewed publication, and a summary will be provided to the Alzheimer Society.

PROSPERO registration number

CRD42018114960.
Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation
Authors: Alway Peter , Brooke-Wavell Katherine , Langley Ben , King Mark , Peirce Nicholas
Published: May 2019

Objectives

Since much of the previous epidemiological research into lumbar stress fracture was conducted, there has been a marked increase in the amount of cricket being played. The aims were to determine the incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers between 2010 and 2016, determine the association with match bowling workload and observe seasonal variation in workload and injury.

Methods

Lumbar stress fracture incidence and prevalence rates were calculated using new international methods for epidemiology in 368 professional English fast bowlers from 2010 to 2016. Workload variables were compared between lumbar stress fracture case and non-injured control groups, before entry in a logistic regression.

Results

Fifty-seven lumbar stress fractures (mean age 22.81) were reported. Injury was most common in July and September. Match incidence was 0.16 lumbar stress fractures per 10 000 deliveries, annual incidence was 2.46 lumbar stress fractures per 100 fast bowlers and annual prevalence of lumbar stress fractures was 1.67% of squad days. Significant workload variables were observed between cases and controls. A peak 7-day workload of greater than 234 deliveries significantly increased the odds of sustaining a lumbar stress fracture 11-fold compared with bowling fewer than 197 deliveries.

Conclusion

Lumbar stress fractures are common in young fast bowlers possibly due to immaturity of the lumbar spine. The condensed early and late-season schedule may be causing periods of overuse, resulting in an increase in incidence of lumbar stress fracture. Reduction of workload in young fast bowlers is needed to reduce incidence.