bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of Nontuberculous Mycobacteria in French Polynesia
Authors: Phelippeau Michael , Aboubaker Osman Djaltou , Musso Didier , Drancourt Michel
Published: September 2015

As few data are available in the Pacific countries and territories of the Oceania region regarding nontuberculous mycobacteria, we retrospectively identified 87 such isolates from French Polynesia from 2008 to 2013 by hybridization using DNA-strip, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and partialrpoBgene sequencing. PartialrpoBgene sequencing classified 42/87 (48.3%) isolates in theMycobacterium fortuitumcomplex, 28 (32.2%) in theMycobacterium abscessuscomplex, 8 (9.2%) in theMycobacterium mucogenicumcomplex, and 5 (5.7%) in theMycobacterium aviumcomplex. Two isolates were identified asMycobacterium acapulcensisandMycobacteriumcosmeticumby partial 16S rRNA gene sequencing. One isolate, unidentified by MALDI-TOF MS and yielding less than 92% and 96% sequence similarity withrpoBandhsp65reference sequences, respectively, was regarded as a potentially new species. Samples from three patients exhibiting ≥2Mycobacterium porcinumisolates and from one patient with emphysema and a lung abscess exhibiting 2Mycobacterium senegalenseisolates fulfilled the American Thoracic Society microbiological criteria for nontuberculous mycobacterial lung infection. Remote geographic areas, such as French Polynesia, are potential sources for the discovery of new mycobacterial species.
General Molecular Strategy for Development of Arenavirus Live-Attenuated Vaccines
Authors: Iwasaki Masaharu , Ngo Nhi , Cubitt Beatrice , Teijaro John R. , de la Torre Juan C.
Published: September 2015

Hemorrhagic fever arenaviruses (HFA) pose important public health problems in regions where they are endemic. Thus, Lassa virus (LASV) infects several hundred thousand individuals yearly in West Africa, causing a large number of Lassa fever cases associated with high morbidity and mortality. Concerns about human-pathogenic arenaviruses are exacerbated because of the lack of FDA-licensed arenavirus vaccines and because current antiarenaviral therapy is limited to an off-label use of ribavirin that is only partially effective. The Mopeia virus (MOPV)/LASV reassortant (ML29) is a LASV candidate live-attenuated vaccine (LAV) that has shown promising results in animal models. Nevertheless, the mechanism of ML29 attenuation remains unknown, which raises concerns about the phenotypic stability of ML29 in response to additional mutations. Development of LAVs based on well-defined molecular mechanisms of attenuation will represent a major step in combatting HFA. We used the prototypic arenavirus lymphocytic choriomeningitis virus (LCMV) to develop a general molecular strategy for arenavirus attenuation. Our approach involved replacement of the noncoding intergenic region (IGR) of the L genome segment with the IGR of the S genome segment to generate a recombinant LCMV, rLCMV(IGR/S-S), that was highly attenuated
in vivo
but induced protection against a lethal challenge with wild-type LCMV. Attenuation of rLCMV(IGR/S-S) was associated with a stable reorganization of the control of viral gene expression. This strategy can facilitate the rapid development of LAVs with the antigenic composition of the parental HFA and a mechanism of attenuation that minimizes concerns about increased virulence that could be caused by genetic changes in the LAV.

IMPORTANCE
Hemorrhagic fever arenaviruses (HFA) cause high morbidity and mortality, and pose important public health problems in the regions where they are endemic. Implementation of live-attenuated vaccines (LAV) will represent a major step in combatting HFA. Here we have used the prototypic arenavirus LCMV to document a general molecular strategy for arenavirus attenuation that can facilitate the rapid development of safe and effective, as well as stable, LAV to combat HFA.
Replication-Competent Influenza B Reporter Viruses as Tools for Screening Antivirals and Antibodies
Authors: Fulton Benjamin O. , Palese Peter , Heaton Nicholas S.
Published: September 2015

Influenza B virus is a human pathogen responsible for significant health and economic burden. Research into this pathogen has been limited by the lack of reporter viruses. Here we describe the development of both a replication-competent fluorescent influenza B reporter virus and bioluminescent influenza B reporter virus. Furthermore, we demonstrate these reporter viruses can be used to quickly monitor viral growth and permit the rapid screening of antiviral compounds and neutralizing antibodies.
Single Neutralizing Monoclonal Antibodies Targeting the VP1 GH Loop of Enterovirus 71 Inhibit both Virus Attachment and Internalization during Viral Entry
Authors: Ku Zhiqiang , Ye Xiaohua , Shi Jinping , Wang Xiaoli , Liu Qingwei , Huang Zhong
Published: September 2015

Antibodies play a critical role in immunity against enterovirus 71 (EV71). However, how EV71-specific antibodies neutralize infections remains poorly understood. Here we report the working mechanism for a group of three monoclonal antibodies (MAbs) that potently neutralize EV71. We found that these three MAbs (termed D5, H7, and C4, respectively) recognize the same conserved neutralizing epitope within the VP1 GH loop of EV71. Single MAbs in this group, exemplified by D5, could inhibit EV71 infection in cell cultures at both the pre- and postattachment stages in a cell type-independent manner. Specifically, MAb treatment resulted in the blockade of multiple steps of EV71 entry, including virus attachment, internalization, and subsequent uncoating and RNA release. Furthermore, we show that the D5 and C4 antibodies can interfere with EV71 binding to its key receptors, including heparan sulfate, SCARB2, and PSGL-1, thus providing a possible explanation for the observed multi-inhibitory function of the MAbs. Collectively, our study unravels the mechanism of neutralization by a unique group of anti-EV71 MAbs targeting the conserved VP1 GH loop. The findings should enhance our understanding of MAb-mediated immunity against enterovirus infections and accelerate the development of MAb-based anti-EV71 therapeutic drugs.

IMPORTANCE
Enterovirus 71 (EV71) is a major causative agent of hand, foot, and mouth disease (HFMD), which has caused significant morbidities and mortalities in young children. Neither a vaccine nor an antiviral drug is available. Neutralizing antibodies are major protective components in EV71 immunity. Here, we unraveled an unusual mechanism of EV71 neutralization by a group of three neutralizing monoclonal antibodies (MAbs). All of these MAbs bound the same conserved epitope located at the VP1 GH loop of EV71. Interestingly, mechanistic studies showed that single antibodies in this MAb group could block EV71 attachment and internalization during the viral entry process and interfere with EV71 binding to heparan sulfate, SCARB2, and PSGL-1 molecules, which are key receptors involved in different steps of EV71 entry. Our findings greatly enhance the understanding of the interplays among EV71, neutralizing antibodies, and host receptors, which in turn should facilitate the development of an MAb-based anti-EV71 therapy.
Antiviral RNA Interference against Orsay Virus Is neither Systemic nor Transgenerational in Caenorhabditis elegans
Authors: Ashe Alyson , Sarkies Peter , Le Pen Jérémie , Tanguy Mélanie , Miska Eric A.
Published: September 2015

Antiviral RNA-mediated silencing (RNA interference [RNAi]) acts as a powerful innate immunity defense in plants, invertebrates, and mammals. In
Caenorhabditis elegans
, RNAi is systemic; i.e., RNAi silencing signals can move between cells and tissues. Furthermore, RNAi effects can be inherited transgenerationally and may last for many generations. Neither the biological relevance of systemic RNAi nor transgenerational RNAi is currently understood. Here we examined the role of both pathways in the protection of
C. elegans
from viral infection. We studied the Orsay virus, a positive-strand RNA virus related to
Nodaviridae
and the first and only virus known to infect
C. elegans
. Immunity to Orsay virus infection requires the RNAi pathway. Surprisingly, we found that genes required for systemic or transgenerational RNAi did not have a role in antiviral defense. Furthermore, we found that Orsay virus infection did not elicit a systemic RNAi response even when a target for RNAi was provided by using transgenes. Finally, we show that viral siRNAs, the effectors of RNAi, are not inherited to a level that provides any significant resistance to viral infection in the next generation. We conclude that systemic or transgenerational RNAi does not play a role in the defense against natural Orsay virus infection. Furthermore, our data suggest that there is a qualitative difference between experimental RNAi and antiviral RNAi. Our data are consistent with a model of systemic and transgenerational RNAi that requires a nuclear or germ line component that is lacking in almost all RNA virus infections.

IMPORTANCE
Since its discovery in
Caenorhabditis elegans
, RNAi has proven a valuable scientific tool in many organisms. In
C. elegans
, exogenous RNAi spreads throughout the organism and can be passed between generations; however, there has been controversy as to the endogenous role(s) that the RNAi pathway plays. One endogenous role for which spreading both within the infected organism and between generations would be advantageous is a role in viral defense. In plants, antiviral RNAi is systemic and the spread of RNAi between cells provides protection against subsequent viral infection. Here we investigated this by using the only naturally occurring virus known to infect
C. elegans
, Orsay virus, and surprisingly found that, in contrast to the exogenous RNAi pathway, the antiviral RNAi response targeted against this virus does not spread systemically throughout the organism and cannot be passed between generations. These results suggest that there are differences between the two pathways that remain to be discovered.
Carcinoma of the oesophagus, with multiple cutaneous metastases
Authors: Khurana Rohini , Mishra Himanshu , Malhotra Kiran Preet , Shukla Saumya
Published: September 2015

A 42-year-old woman was referred, for adjuvant treatment, by an oncosurgeon (outside our centre) after a transhiatal oesophagectomy and gastric pull-up for middle one-third squamous cell carcinoma of the oesophagus pT3N1M0. She underwent adjuvant chemoradiotherapy (CRT) to the tumour bed, regional nodes and scar. RT dose planned was 45 Gy in 25 fractions over 5 weeks. During the second week of RT, a painful nodule was observed over the lower back and cytology was positive for squamous cell carcinoma. Hypofractionated radiotherapy (RT) was planned for this skin nodule as 30 Gy in 10 fractions over 2 weeks using electron beams for pain palliation. Two months later, another nodule developed at the surgical scar on the anterior abdominal wall along with lung and liver metastases. This nodule was also given palliative RT. The patient tolerated the treatment well and had partial pain relief, and, in view of poor prognosis, was advised best supportive care.
Automated external defibrillators in public places: position statement from the Faculty of Sport and Exercise Medicine UK
Authors: Iqbal Zafar , Somauroo John
Published: September 2015

Position statements published by the Faculty of Sport and Exercise Medicine UK are quick reference or information documents and include up to 10 short points of clinical relevance for the Sport and Exercise Medicine community as well as for general practitioners and health professionals. The Faculty of Sport and Exercise Medicine (FSEM) UK has published a statement to create greater awareness that the survival rate from Sudden Cardiac Arrest could improve with prompt access to an automated external defibrillator (AED).
Improving preparedness of medical students and junior doctors to manage patients with diabetes
Authors: Kelly Narcie A A , Brandom Kevin G , Mattick Karen L
Published: September 2015

Objective

New medical graduates are the front-line staff in many hospital settings and manage patients with diabetes frequently. Prescribing is an area of concern for junior doctors, however, with insulin prescribing reported as a particular weakness. This study aimed to produce an educational intervention which aimed to improve preparedness to manage patients with diabetes and evaluate it using a mixed methods approach.

Research design and methods

An e-resource (http://www.diabetesscenariosforjuniordoctors.co.uk) was created to contain commonplace and authentic diabetes decision-making scenarios. –32 junior doctors (n=20) and year 5 students (n=12) in South West England worked through the scenarios while ‘thinking aloud’ and then undertook a semistructured interview. Qualitative data were transcribed verbatim and analyzed thematically. Participant confidence to manage patients with diabetes before, immediately after, and 6 weeks after the educational intervention was also measured using a self-rating scale.

Results

Participants reported that patients with diabetes were daunting to manage because of the wide array of insulin products, their lack of confidence with chronic disease management and the difficulty of applying theory to practice. The e-resource was described as authentic, practical, and appropriate for the target audience. Junior doctors’ self-rated confidence to manage patients with diabetes increased from 4.7 (of 10) before using the e-resource, to 6.4 immediately afterwards, and 6.8 6 weeks later. Medical students’ confidence increased from 5.1 before, to 6.4 immediately afterwards, and 6.4 6 weeks later.

Conclusions

Providing opportunities to work with authentic scenarios in a safe environment can help to ameliorate junior doctors’ lack of confidence to manage patients with diabetes.
Using an internet intervention to support self-management of low back pain in primary care: protocol for a randomised controlled feasibility trial (SupportBack)
Authors: Geraghty Adam W A , Stanford Rosie , Little Paul , Roberts Lisa , Foster Nadine E , Hill Jonathan C , Hay Elaine , Stuart Beth , Turner David , Yardley Lucy
Published: September 2015

Introduction

Low back pain (LBP) is a prevalent and costly condition. The majority of patients experiencing LBP are managed in primary care, where first-line care recommendations consist of advice to self-manage and remain active. Internet interventions present a potential means of providing patients with tailored self-management advice and evidence-based support for increasing physical activity.

Methods/analysis

This protocol describes a single-blind, randomised controlled feasibility trial of an internet intervention developed to support the self-management of LBP in primary care. Patients are being randomised to 1 of 3 groups receiving either usual primary care, usual primary care with the addition of an internet intervention or an internet intervention with physiotherapist telephone support. Patients are followed up at 3 months. Primary outcomes are the feasibility of (1) the trial design/methods, (2) the delivery of the internet intervention and (3) the provision of telephone support by physiotherapists. Secondary outcomes will include exploratory analysis of estimates and variation in clinical outcomes of pain and disability, in order to inform a future main trial.

Ethics/dissemination

This feasibility trial has undergone ethical scrutiny and been approved by the National Health Service (NHS) Research Ethics Committee, REC Reference 13/SC/0202. The feasibility findings will be disseminated to the research community through presentations at conferences and publication in peer review journals. Broader dissemination will come following a definitive trial.

Trial registration number

ISRCTN 31034004.
A 4-Node Co-Rotational Quadrilateral Composite Shell Element
Authors: Li Z. X. , Zheng T. , Vu-Quoc L. , Izzuddin B. A.
Published: September 2015

A 4-node co-rotational quadrilateral composite shell element is presented. The local coordinate system of the element is a co-rotational framework defined by the two bisectors of the diagonal vectors generated from the four corner nodes and their cross product. Thus, the element rigid-body rotations are excluded in calculating the local nodal variables from the global nodal variables. Compared with other existing co-rotational finite-element formulations, the present element has two features: (i) The two smallest components of the mid-surface normal vector at each node are defined as the rotational variables, leading to the desired additive property for all nodal variables in a nonlinear incremental solution procedure; (ii) both element tangent stiffness matrices in the local and global coordinate systems are symmetric owing to the commutativity of the nodal variables in calculating the second derivatives of strain energy with respect to the local nodal variables and, through chain differentiation with respect to the global nodal variables. In the modeling of composite structures, the first-order shear deformable laminated plate theory is adopted in the local element formulation, where both the thickness deformation and the normal stress in the direction of the shell thickness are ignored, and an assumed strain method is employed to alleviate the membrane and shear locking phenomena. Several examples involving composite plates and shells with large displacements and large rotations are presented to testify to the reliability and convergence of the present formulation.
Advanced electron microscopic techniques provide a deeper insight into the peculiar features of podocytes
Authors: Burghardt Tillmann , Hochapfel Florian , Salecker Benjamin , Meese Christine , Gröne Hermann-Josef , Rachel Reinhard , Wanner Gerhard , Krahn Michael P. , Witzgall Ralph
Published: September 2015

Podocytes constitute the outer layer of the glomerular filtration barrier, where they form an intricate network of interdigitating foot processes which are connected by slit diaphragms. A hitherto unanswered puzzle concerns the question of whether slit diaphragms are established between foot processes of the same podocyte or between foot processes of different podocytes. By employing focused ion beam-scanning electron microscopy (FIB-SEM), we provide unequivocal evidence that slit diaphragms are formed between foot processes of different podocytes. We extended our investigations of the filtration slit by using dual-axis electron tomography of human and mouse podocytes as well as of Drosophila melanogaster nephrocytes. Using this technique, we not only find a single slit diaphragm which spans the filtration slit around the whole periphery of the foot processes but additional punctate filamentous contacts between adjacent foot processes. Future work will be necessary to determine the proteins constituting the two types of cell-cell contacts.
Muscle deoxygenation in the quadriceps during ramp incremental cycling: Deep vs. superficial heterogeneity
Authors: Okushima Dai , Poole David C. , Rossiter Harry B. , Barstow Thomas J. , Kondo Narihiko , Ohmae Etsuko , Koga Shunsaku
Published: September 2015

Muscle deoxygenation (i.e., deoxy[Hb + Mb]) during exercise assesses the matching of oxygen delivery (Q̇o2) to oxygen utilization (V̇o2). Until now limitations in near-infrared spectroscopy (NIRS) technology did not permit discrimination of deoxy[Hb + Mb] between superficial and deep muscles. In humans, the deep quadriceps is more highly vascularized and oxidative than the superficial quadriceps. Using high-power time-resolved NIRS, we tested the hypothesis that deoxygenation of the deep quadriceps would be less than in superficial muscle during incremental cycling exercise in eight males. Pulmonary V̇o2 was measured and muscle deoxy[Hb + Mb] was determined in the superficial vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF-s) and the deep rectus femoris (RF-d). deoxy[Hb + Mb] in RF-d was significantly less than VL at 70% (67.2 ± 7.0 vs. 75.5 ± 10.7 μM) and 80% (71.4 ± 11.0 vs. 79.0 ± 15.4 μM) of peak work rate (WRpeak), but greater than VL and VM at WRpeak (87.7 ± 32.5 vs. 76.6 ± 17.5 and 75.1 ± 19.9 μM). RF-s was intermediate at WRpeak (82.6 ± 18.7 μM). Total hemoglobin and myoglobin concentration and tissue oxygen saturation were significantly greater in RF-d than RF-s throughout exercise. The slope of deoxy[Hb + Mb] increase (proportional to Q̇o2/V̇o2) in VL and VM slowed markedly above 70% WRpeak, whereas it became greater in RF-d. This divergent deoxygenation pattern may be due to a greater population of slow-twitch muscle fibers in the RF-d muscle and the differential recruitment profiles and vascular and metabolic control properties of specific fiber populations within superficial and deeper muscle regions.
Pericyte response to contraction mode-specific resistance exercise training in human skeletal muscle
Authors: Farup Jean , De Lisio Michael , Rahbek Stine Klejs , Bjerre Jonas , Vendelbo Mikkel Holm , Boppart Marni D. , Vissing Kristian
Published: September 2015

Skeletal muscle satellite cells (SCs) are important for muscle repair and hypertrophy in response mechanical stimuli. Neuron-glial antigen 2-positive (NG2+) and alkaline phosphatase-positive (ALP+) pericytes may provide an alternative source of myogenic progenitors and/or secrete paracrine factors to induce Pax7+ SC proliferation and differentiation. The purpose of this study was to investigate NG2+ and ALP+ cell quantity, as well as SC content and activation, in human skeletal muscle following prolonged concentric (Conc) or eccentric (Ecc) resistance training. Male subjects engaged in unilateral resistance training utilizing isolated Ecc or Conc contractions. After 12 wk, muscle biopsies were analyzed for NG2+ and ALP+ pericytes, total Pax7+ SCs, activated SCs (Pax7+MyoD+), and differentiating myogenic cells (Pax7− MyoD+). NG2+ cells localized to CD31+ vessels and the majority coexpressed ALP. NG2+ pericyte quantity decreased following both Conc and Ecc training ( P < 0.05). ALP+ pericyte quantity declined following Conc ( P < 0.05) but not Ecc training. Conversely, total Pax7+ SC content was elevated following Conc only ( P < 0.001), while Pax7+MyoD+ SC content was increased following Conc and Ecc ( P < 0.001). Follow up analyses demonstrated that CD90+ and platelet-derived growth factor receptor-α (PDGFRα)+ mononuclear cell proliferation was also increased in response to both Conc and Ecc training ( P < 0.01). In summary, resistance training results in a decline in pericyte quantity and an increase in mesenchymal progenitor cell proliferation, and these events likely influence SC pool expansion and increased activation observed posttraining.
Role of Psychosocial Variables on Chemotherapy-Induced Nausea and Vomiting and Health-Related Quality of Life among Cancer Patients: A European Study
Authors: Grassi Luigi , Berardi Maria Alejandra , Ruffilli Federica , Meggiolaro Elena , Andritsch Elisabeth , Sirgo Agustina , Caruso Rosangela , Juan Linares Eva , Bellé Marta , Massarenti Sara , Nanni Maria Giulia ,   IOR-IRST Psycho-Oncology and UniFE Psychiatry Co-Authors
Published: September 2015

Background: Chemotherapy-induced nausea and vomiting (CINV) continue to be a distressing problem still reported by cancer patients, with negative consequences on quality of life (QoL). Aims: To prospectively explore the association of psychosocial variables, including emotional distress, maladaptive coping styles and the doctor-patient relationship, with CINV and QoL among cancer outpatients. Methods: A prospective study was conducted on 302 consecutive cancer patients (response rate 80.9%) in Austria, Italy and Spain. The Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC), and the Patient Satisfaction with Doctor Questionnaire (PSQ) were used to assess psychosocial variables before chemotherapy. In the 5 days after chemotherapy, CINV was examined by using a daily diary, and the Functional Living Index for Emesis (FLIE) was used to assess QoL. Results: More than half of the patients reported nausea (54%), and a small percentage reported vomiting (14%). CINV had a negative impact on QoL (FLIE caseness, p < 0.01). Maladaptive coping (i.e. hopelessness-helplessness and anxious preoccupation) and emotional distress were associated with CINV (p < 0.05) and poorer QoL (p < 0.05). In logistic regression analysis, nausea was predicted by Mini-MAC/H (OR = 1.1, p = 0.03) and younger age (OR = 0.97, p = 0.04); negative impact on QoL was predicted by grade of chemotherapy emetogenesis (OR = 1.7, p < 0.01) and Mini-MAC/H (OR = 1.2, p = 0.04). Conclusions: Screening and assessment of psychological variables, especially coping, could help in identifying cancer patients at risk for chemotherapy-induced nausea, in spite of the use of antiemetic treatment.
Screening for C9orf72 Expansion Mutation in Serbian Patients with Early-Onset Dementia
Authors: Mandic-Stojmenovic Gorana , Stefanova Elka , Dobricic Valerija , Novakovic Ivana , Stojkovic Tanja , Jesic Aleksandar , Kostic Vladimir
Published: September 2015

Background: Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia (EOD), characterized by behavioral changes (behavioral variant; bvFTD) or language deficits. A hexanucleotide repeat expansion in a noncoding region of chromosome 9 open reading frame 72 (C9orf72) has been proved to be a major cause of both familial and sporadic amyotrophic lateral sclerosis or FTD, with or without concomitant motor neuron disease (MND). Methods: The aim of this study was to assess the frequency of the C9orf72 hexanucleotide expansion in a cohort of 117 Serbian patients with EOD and to report phenotypic features of identified carriers. Results: We identified 4 of 117 (3.4%) patients with EOD to have C9orf72 hexanucleotide expansions. All patients were classified in the FTD disease spectrum group (8.2%): 3 patients fulfilled the criteria for bvFTD, and 1 patient had FTD-MND. None of the patients with the C9orf72 hexanucleotide expansion fulfilled the diagnostic criteria for language variants of FTD, FTD-progressive supranuclear palsy overlap syndrome, dementia with Lewy bodies or Alzheimer's dementia. Conclusion: In a cohort of consecutive patients with EOD, 3.4% had the C9orf72 hexanucleotide expansion with clinical phenotypes of bvFTD or an overlap of bvFTD and MND.
Randomised Controlled Trial of Cognitive Behaviour Therapy Delivered in Groups of Patients with Chronic Fatigue Syndrome
Authors: Wiborg Jan F. , van Bussel Jose , van Dijk Agaat , Bleijenberg Gijs , Knoop Hans
Published: September 2015

Background: Meta-analyses have been inconclusive about the efficacy of cognitive behaviour therapies (CBTs) delivered in groups of patients with chronic fatigue syndrome (CFS) due to a lack of adequate studies. Methods: We conducted a pragmatic randomised controlled trial with 204 adult CFS patients from our routine clinical practice who were willing to receive group therapy. Patients were equally allocated to therapy groups of 8 patients and 2 therapists, 4 patients and 1 therapist or a waiting list control condition. Primary analysis was based on the intention-to-treat principle and compared the intervention group (n = 136) with the waiting list condition (n = 68). The study was open label. Results: Thirty-four (17%) patients were lost to follow-up during the course of the trial. Missing data were imputed using mean proportions of improvement based on the outcome scores of similar patients with a second assessment. Large and significant improvement in favour of the intervention group was found on fatigue severity (effect size = 1.1) and overall impairment (effect size = 0.9) at the second assessment. Physical functioning and psychological distress improved moderately (effect size = 0.5). Treatment effects remained significant in sensitivity and per-protocol analyses. Subgroup analysis revealed that the effects of the intervention also remained significant when both group sizes (i.e. 4 and 8 patients) were compared separately with the waiting list condition. Conclusions: CBT can be effectively delivered in groups of CFS patients. Group size does not seem to affect the general efficacy of the intervention which is of importance for settings in which large treatment groups are not feasible due to limited referral.
Hypohidrosis in Individuals with Exertional Heat Injury: A Prospective Open Cohort Study
Authors: Lim Joel Hua-Liang , Kok Wai Leong , Bin Ali Noreffendy , Chong Wei-Sheng , Tey Hong Liang
Published: September 2015

Background: Hypohidrosis is a risk factor for developing heat-related illnesses. Objective: To determine the prevalence of hypohidrosis in heat injury. Methods: Soldiers from the Singapore Armed Forces who developed heat injury between January 1, 2012 and December 31, 2013 were invited to participate in the study. Subjects were induced to sweat through exercising in a temperature- and humidity-regulated room, and then atomized starch-iodine powder was administered over their whole body to detect hypohidrosis. If this was found to be present, investigations to elucidate the cause of anhidrosis were performed. Results: Out of 65 males, 30 consented to participation. One was excluded because an exogenous cause resulted in heat injury. Nine (31%) demonstrated hypohidrosis. Of these, 1 (11%) had miliaria profunda, 2 (22%) had acquired idiopathic generalized anhidrosis and 6 (67%) manifested a new phenotype which we termed acquired symmetrical hypohidrosis (ASH). Conclusion: Thirty-one percent of healthy soldiers who developed heat injury had hypohidrosis. Concurrently, a new clinical phenotype of ASH was identified.
Endovascular Treatment versus Sonothrombolysis for Acute Ischemic Stroke
Authors: Reinhard Matthias , Taschner Christian A. , Hörsch Nicole , Allignol Arthur , Maurer Christoph J. , Niesen Wolf-Dirk , Lambeck Johann , Wallesch Claus W. , Urbach Horst , Weiller Cornelius , Schuchardt Volker , Griesser-Leute Hans-Jörg
Published: September 2015

Background: Currently, there are 2 strategies to increase the effect of systemic thrombolysis with alteplase (rtPA) in acute major stroke: endovascular treatment via stent retrieval and ultrasound enhancement (sonothrombolysis). This study compares these 2 approaches in patients with proximal intracranial occlusion of the anterior circulation. Methods: Consecutive data on the treatment outcome of acute middle cerebral artery (M1) or carotid T occlusion were collected from 2 stroke centers: one center used rtPA plus endovascular stent retrieval as standard treatment and the other rtPA plus ultrasound (sonothrombolysis). The primary outcome was functional independence (modified Rankin scale (mRS) 0-2) after neurorehabilitation. Results: A total of 132 patients were assessed (n = 73 endovascular, n = 59 sonothrombolysis). The rate of functional independence was higher for endovascular treatment (adjusted OR 3.89 (95% CI 1.36-12.58)). Additionally, ordinal mRS analysis favored the endovascular strategy (adjusted common OR 1.70 (95% CI 0.88-3.31)). Subgroup analysis showed that endovascular treatment was superior for carotid T occlusion (adjusted common OR 5.61 (95% CI 1.60-20.93)), but not for middle cerebral artery occlusion (adjusted common OR 1.07 (95% CI 0.47-2.43)). Symptomatic intracerebral hemorrhage occurred in 3 patients from the endovascular group. Conclusions: This observational study suggests that endovascular treatment of acute major anterior circulation stroke is superior to sonothrombolysis in terms of functional outcome. This benefit seems to pertain primarily to patients with carotid T occlusion, whereas patients with M1 occlusion seem to profit in a similar way from both methods. (Clinical Trial Registration: URL: http://www.germanctr.de. Unique identifier: DRKS0000​5305.)
Short-Term Effect of High-Dose Vitamin D on the Level of Interleukin 10 in Patients with Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial
Authors: Ashtari Fereshteh , Toghianifar Nafiseh , Zarkesh-Esfahani Sayyed Hamid , Mansourian Marjan
Published: September 2015

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Vitamin D has been related to the prevention of MS and to modulating its course. Recent studies have shown the safety of high-dose vitamin D in MS. Objective: This study compared the effects of high-dose vitamin D on interleukin 10 (IL-10) levels in MS patients in a double-blind, randomized clinical trial. Methods: Ninety-four patients with relapsing remitting MS (RRMS) were randomized into a treatment and a placebo group. Both groups received conventional MS treatment. The intervention group received 50,000 IU of vitamin D every 5 days for 3 months. IL-10 was measured at baseline and after 3 months. Results: Serum levels of IL-10 were (median ± IQR): 12.58 ± 11.97 and 10.97 ± 9.97 pg/ml in the intervention and placebo groups, respectively, at baseline (p = 0.161); after 3 months, these levels were 13.76 ± 18.95 and 11.31 ± 19.63 pg/ml, respectively (p = 0.158). The IL-10 level increased significantly after receiving high-dose vitamin D for 3 months (β = 0.737, p = 0.015 and R2 = 0.91). Conclusion: IL-10 levels increased significantly in RRMS patients after taking high-dose vitamin D3 for 3 months. High-dose vitamin D might be useful in promoting an anti-inflammatory state in RRMS patients.
Rapamycin Improves Mortality Following Intestinal Ischemia-Reperfusion via the Inhibition of Remote Lung Inflammation in Mice
Authors: Iida Takaya , Takagi Tomohisa , Katada Kazuhiro , Mizushima Katsura , Fukuda Wataru , Kamada Kazuhiro , Uchiyama Kazuhiko , Handa Osamu , Ichikawa Hiroshi , Naito Yuji , Itoh Yoshito
Published: September 2015

Background/Aims: Acute-phase intestinal ischemia-reperfusion (I-R) injury can result in multiple organ failure, which may sometimes be fatal. However, no reliable treatment for this clinical state is available. Rapamycin has been reported to protect heart, brain and kidney against I-R injury. The aim of this study was to examine whether rapamycin could protect mice against I-R-induced intestinal and remote organ injury. Methods: Ischemia was induced in the intestine of C57BL/6 mice by occluding the superior mesenteric artery for 1 h. Mice received rapamycin at a dose of 5 mg/kg or vehicle by the intraperitoneal injection 1 h before ischemia. The survival rate, inflammatory responses in the intestine and the lung, bacteria cultured from lung tissue and the phagocytic capacity of alveolar macrophages were examined. Results: Treatment with rapamycin improved survival rate after intestinal I-R. Histological and biochemical parameters of I-R-induced intestinal injury/inflammation were similar in both rapamycin-treated and untreated mice. However, signs of lung injury/inflammation were significantly attenuated in rapamycin-treated mice compared to control mice. The reduction of lung bacteria and the increase in phagocytic activity were accompanied in mice treated with rapamycin. Conclusion: Rapamycin improved mortality following intestinal I-R via the inhibition of remote lung inflammation in mice.
Clinical Significance of Para-Aortic Lymph Node Dissection for Advanced or Metastatic Colorectal Cancer in the Current Era of Modern Chemotherapy
Authors: Arimoto Atsuki , Uehara Keisuke , Kato Takehiro , Nakamura Hayato , Kamiya Tadahiro , Nagino Masato
Published: September 2015

Background/Aims: Surgical resection is not generally indicated for para-aortic lymph node (PALN) metastasis from colorectal cancer. However, the clinical significance of PALN dissection (PALND) in the current era of modern chemotherapy has not been fully discussed. Methods: Between November 2006 and February 2013, 14 patients underwent PALND for colorectal cancer and were proven as having pathological PALN metastasis. The median follow-up was 33.2 months. Results: Primary location was the right-colon in 2 patients, and the left-colon or rectum in 12 patients. The timing of metastasis was metachronous in 5 patients and synchronous in 9 patients. Eleven patients (79%) received perioperative aggressive modern chemotherapy. Neoadjuvant chemotherapy with targeted drugs was introduced in 9 patients (64%) and 6 patients received adjuvant chemotherapy. Recurrence after PALND occurred in 12 patients (86%). The most common site was the lung in 6 patients (43%). The 1- and 3-year disease-free survivals were 39.3 and 7.9%, respectively. The 3-year overall survival were 41.2%. Conclusion: The recurrence rate after PALND for strictly selected patients was quite high even in the current era of modern chemotherapy. However, some patients achieved long-term survival or could be cured. Therefore, we should re-evaluate the efficacy of PALND in a larger prospective study.
Участь нейтрофільних гранулоцитів у розвитку морфологічних змін у легенях при гострому їх пошкодженні в експерименті
Authors: ОРЕЛ Ю. М.
Published: September 2015

За допомогою комплексу клініко-лабораторних та морфологічних методів досліджували роль нейтрофільних гранулоцитів у розвитку структурних змін тканини легень при їх гострому пошкодженні, відтвореному в експерименті. Уточнено окремі аспекти патогенезу гострого пошкодження легень, зокрема підтверджено важливу роль у пусковому механізмі даного патологічного стану активованих нейтрофілів, які утворюють та вивільняють кисневі радикали, секреторні дегранулянти, що зумовлює пряму пошкоджувальну дію на ендотеліоцити. Визначено окремі морфометричні критерії ремоделювання судинного русла легень при досліджуваній патології. Доведено, що морфологічні зміни у респіраторному відділі легень при їх гострому пошкодженні реалізуються комплексом патологічних процесів, зокрема регіонарною секвестрацією нейтрофілів у легенях та гіперпродукцією ними активних форм кисню, що приводить до дистрофічних змін структурної організації легень.
Гігантська міксома заочеревинного простору малої миски та лівої сідниці: опис клінічного випадку
Authors: ГЕРИЧ І. Д. , БАРВІНСЬКА А. С. , РОМАНЧАК Д. Л. , ЯРЕМКЕВИЧ Р. В.
Published: September 2015

Проаналізовано літературні дані про пухлиноподібні утвори великих розмірів заочеревинного простору, малої миски і сідниць та екстракардіальні міксоми. Наведено рідкісний клінічний випадок гігантської міксоми заочеревинного простору малої миски і лівої сідниці. Особливості полягали у тривалості захворювання (44 роки), об’ємі кісти (1865 мл), поширенні процесу, застосуванні всіх доступних діагностичних методів та нетиповій лікувальній тактиці — хірургічне втручання в два етапи з формуванням декомпресійної нориці.
Нестандартная ситуация в трансплантологии при поликистозе почек
Authors: ПУСТОВОЙТ П. И. , ГОРЯЧИЙ В. В. , МИЩЕНКО В. В. , САГАТОВИЧ В. А. , ХАРЬКОВСКИЙ С. И.
Published: September 2015

Трансплантология относится к сложным разде-лам медицины в связи с не до конца решенными медицинскими, социальными и морально-правовыми проблемами. В Украине пересадка почки осуществляется в основном от близкородственных доноров. Несмотря на тщательно продуманную и проводимую пред-, интра- и послеоперационную тактику ведения пациентов, встречаются непредвиденные осложнения, требующие нестандартного решения.
Інтенсивна терапія тяжкої поєднаної травми з превалюванням торакальної травми у пацієнта віком 26 років
Authors: КРУШЕЛЬНИЦЬКИЙ С. В. , КРЕНЬОВ К. Ю.
Published: September 2015

Травми є частою причиною смерті людей працездатного віку в економічно розвинутих країнах [2, 6]. Торакальна травма в структурі політравм складає близько 70-90 %, за механізмом це: автодорожня - 60 %, побутова - 10 %, спортивна - 10 %, 15 % складають інші причини і 5 % - суїцид. У комбінації з іншими ушкодженнями частка тора-кальної травми в летальності складає 25 %, обтяжує прогноз таких пацієнтів гіпоксемія внаслідок порушення вентиляційно-перфузійних співвідношень, супутня контузія серця, подальший розвиток ГРДС та відстрочені гнійні ускладнення - емпієма, абсцеси, сепсис [6]. Утворення флотуючого сегмента грудної клітки при двобічних переломах ребер є невідкладним станом, який швидко змінює механіку та фізіологію дихання, потребує швидких заходів для стабілізації пацієнта (продовжена ШВЛ, аналгезія, адекватна санація трахеобронхіального дерева, стабілізація ребер стрижневими апаратами за необхідності)
Protocolo de experimentação patogenética homeopática em humanos
Authors: Teixeira Marcus Zulian
Published: September 2015

A experimentação ou ensaio patogenético homeopático (EPH) é o método de investigação clínico-farmacológica utilizado pela homeopatia para conhecer as manifestações patogenéticas (sinais e sintomas) que as substâncias despertam nos seres humanos, possibilitando a aplicação do princípio da similitude terapêutica. Instrumento indispensável na assistência, na pesquisa e no ensino da homeopatia, apresenta modelos de aplicação diversos ao longo destes dois séculos de prática homeopática, através dos quais milhares de substâncias foram experimentadas em indivíduos humanos sadios e tiveram suas manifestações sintomáticas descritas nas Matérias Médicas Homeopáticas. Apesar da sua importância no desenvolvimento da episteme homeopática, a Homeopatia Brasileira carece, na atualidade, de protocolos de pesquisa patogenética condizentes com as exigências da metodologia científica moderna, que tornariam os testes mais confiáveis e facilitariam sua aprovação perante os comitês de ética em pesquisa das instituições que pretendam executá-los. Este protocolo de experimentação patogenética homeopática foi desenhado com o intuito de suprir esta demanda, seguindo os passos e as exigências necessárias à elaboração de um projeto de pesquisa clínica em humanos, a fim de disponibilizar uma sistemática que permita a uniformização do procedimento e sua aplicação nas diversas instâncias que se proponham a realizar pesquisa patogenética homeopática. A possibilidade da publicação deste protocolo numa revista indexada e de livre acesso, permitindo a ampla divulgação de um tema imprescindível ao entendimento e ao progresso da homeopatia, facilita o esclarecimento da racionalidade científica homeopática perante a classe médica e a disseminação da proposta perante o movimento homeopático brasileiro.
O uso do ATLS nos complexos traumas de artéria axilar, vencendo esse desafio – relato de caso e revisão da literatura
Authors: Polly Matheus , Arrais Marília , Coelho Bruna Queiroz , Saba Gabriela Tognini , Fürst Rafael , Polimonti Afonso César , Correa João Antonio
Published: September 2015

INTRODUÇAO: O trauma das artérias subclávia e axilar é incomum, mas potencialmente grave. Os ferimentos penetrantes por projétil de arma de fogo e por arma branca constituem o mecanismo habitual. A complexidade anatômica torna desafiador o tratamento destas lesões. O seguimento adequado do protocolo ATLS é o principal responsável pelo bom prognóstico nos traumas de grande potencial de mortalidade como os traumas arteriais dessa topografia. O acesso para abordagem da artéria axilar depende da extensão e localização da lesão. Na maior parte dos casos, uma incisã o supra e/ou infraclavicular é suficiente para a abordagem entretanto o controle proximal da artéria subclávia pode ser necessário. Nesse caso, o acesso cirúrgico geralmente envolve a esternotomia mediana – para lesões do lado direito – e a toracotomia ântero- lateral para lesões do lado esquerdo. Neste contexto, o trauma da artéria axilar é uma lesã o desafiadora. Relata-se um caso singular que recebeu tratamento inicial de acordo com o protocolo ATLS com ligadura da artéria axilar. Métodos/Paciente: Este trabalho analisa a conduta cirúrgica e de trauma de um paciente do sexo masculino, 23 anos que deu entrada com ferimento por arma de fogo em topografia infra-clavicular esquerda e choque hipovolêmico. Na drenagem pleural houve saída de mais de 2000 ml de sangue submetendo-o à toracotomia e ligadura de artéria axilar. Foi encaminhado para serviço de atenção terciária e realizada a revascularizaçã o com enxerto de veia safena. RESULTADOS: A conduta de atendimento ao Trauma pelo ATLS foi realizada de maneira correta, com a rápida identificação de lesão grave com potencial elevado de morbimortalidade e necessidade de transferência que permitiu a revascularização do paciente alcançando um ótimo prognóstico com sobrevivência do paciente e manutenção da função do membro. CONCLUSÃO: As lesões de artéria axilar são graves, com potencial letal elevado e necessitam de um tratamento rápido e bem planejado. O paciente deve receber o tratamento inicial pelo protocolo ATLS com estabilizaçã o do quadro e posterior transferência tratamento definitivo se necessário.
O encontro com o crack: inicio, tempo, quantidade diária e formas de uso
Authors: Leite Suelen Cardoso , Oliveira Michele Mandagará de , Cruz Vania Dias
Published: September 2015

O objetivo desta pesquisa foi conhecer as trajetrias de uso, assim como o padro de consumo da substncia entre pessoas que consomem crack. Trata-se de um estudo descritivo-exploratrio com abordagem qualitativa, realizado por meio de entrevista semiestruturada, com 14 pessoas acompanhadas pela Estratgia de Reduo de Danos da cidade de Pelotas/RS. Os resultados apontam que a maioria dos usurios teve o primeiro contato com drogas ilcitas utilizando a maconha e outras formas de administrao da cocana at elegerem o crack como droga de escolha. Embora o uso de crack seja de forma compulsiva h aqueles que conseguem fazer um uso controlado da substncia.
Did the Global Financial Crisis of 2007-2009 Impact Economic Growth in North Africa?
Authors: Aly Hassan Y. , Strazicich Mark C.
Published: September 2015

Abstract

In this paper, we utilize time series tests with structural breaks to test for evidence of an impact on economic growth rates in North African countries following the 2007−2009 U.S. and global financial crisis. One or two breaks in economic growth are identified in each country, except for Morocco where no break is found. However, breaks that coincide with the financial crisis are found in only two of the six countries (Libya and Mauritania), while other breaks coincide most often with earlier U.S. and EU recessions. To further examine the impact of shocks, impulse response functions are estimated from Vector Auto-Regression models with structural breaks. We again find no evidence that shocks from the financial crisis had a significant impact on economic growth in North Africa. We conclude that shocks from the 2007−2009 financial crisis had only a temporary and relatively small impact on economic growth rates in North Africa.
The Father Lemański Affair
Authors: Smolenski Natalie
Published: September 2015

Under the People’s Republic of Poland, the Polish clergy often assumed the power to speak on behalf of ‘its’ laity. However, the Church’s foray into democratic politics in the 1990s opened up a profound moral and ideological divide between itself and many Poles who now reject the Church’s institutional pronouncements as immoral and nonrepresentative. This article compares two paradigms of resistance to oppressive institutions by people affiliated with the Church in light of this change. The first, under late Stalinism, reflected hierarchy-initiated efforts to combat state oppression. The second, in contemporary Poland, reflects efforts by a small town priest (Father Wojciech Lemański) and his parishioners to resist oppression at the hands of Church institutions. I argue that the locus of the ‘enemy other’ has shifted, for many Poles, from the state to the Church. Most importantly, I show that sanctity continues to be experienced and sought after in contemporary Poland, but that its social profile has shifted from more institutional to more personal forms in light of increasing suspicion of the institutional Church.