bluuebunny/crossref_metadata_2025 huggingface dataset:
Unexpected connections between type VI-B CRISPR-Cas systems, bacterial natural competence, ubiquitin signaling network and DNA modification through a distinct family of membrane proteins
Authors: Makarova Kira S , Gao Linyi , Zhang Feng , Koonin Eugene V
Published: April 2019

In addition to core Cas proteins, CRISPR-Cas loci often encode ancillary proteins that modulate the activity of the respective effectors in interference. Subtype VI-B1 CRISPR-Cas systems encode the Csx27 protein that down-regulates the activity of Cas13b when the type VI-B locus is expressed in Escherichia coli. We show that Csx27 belongs to an expansive family of proteins that contain four predicted transmembrane helices and are typically encoded in predicted operons with components of the bacterial natural transformation machinery, multidomain proteins that consist of components of the ubiquitin signaling system and proteins containing the ligand-binding WYL domain and a helix-turn-helix domain. The Csx27 family proteins are predicted to form membrane channels for ssDNA that might comprise the core of a putative novel, Ub-regulated system for DNA uptake and, possibly, degradation. In addition to these associations, a distinct subfamily of the Csx27 family appears to be a part of a novel, membrane-associated system for DNA modification. In Bacteroidetes, subtype VI-B1 systems might degrade nascent transcripts of foreign DNA in conjunction with its uptake by the bacterial cell. These predictions suggest several experimental directions for the study of type VI CRISPR-Cas systems and distinct mechanisms of foreign DNA uptake and degradation in bacteria.
Bias in common catch-curve methods applied to age frequency data from fish surveys
Authors: Nelson Gary A
Published: April 2019

Catch curve analysis is often used in data-limited fisheries stock assessments to estimate total instantaneous mortality (Z). There are now six catch-curve methods available in the literature: the Chapman–Robson, linear regression, weighted linear regression, Heincke, generalized Poisson linear, and random-intercept Poisson linear mixed model. An assumption shared among the underyling probability models of these estimators is that fish collected for ageing are sampled from the population by simple random sampling. This type of sampling is nearly impossible in fisheries research because populations are sampled in surveys that use gears that capture individuals in clusters and often fish for ageing are selected from multi-stage sampling. In this study, I explored the effects of multi-stage cluster sampling on the bias of the estimates of Z and their associated standard errors. I found that the generalized Poisson linear model and the Chapman–Robson estimators were the least biased, whereas the random-intercept Poisson linear mixed model was the most biased under a wide range of simulation scenarios that included different levels of recruitment variation, intra-cluster correlation, sample sizes, and methods used to generate age frequencies. Standard errors of all estimators were under-estimated in almost all cases and should not be used in statistical comparisons.
Reduced ceftazidime and ertapenem susceptibility due to production of OXA-2 in Klebsiella pneumoniae ST258
Authors: Iovleva Alina , Mettus Roberta T , McElheny Christi L , Mustapha Mustapha M , Van Tyne Daria , Shields Ryan K , Pasculle A William , Cooper Vaughn S , Doi Yohei
Published: April 2019

Background

OXA-2 is a class D β-lactamase that confers resistance to penicillins, as well as narrow-spectrum cephalosporins. OXA-2 was recently reported to also possess carbapenem-hydrolysing activity. Here, we describe a KPC-2-encoding Klebsiella pneumoniae isolate that demonstrated reduced susceptibility to ceftazidime and ertapenem due to production of OXA-2.

Objectives

To elucidate the role of OXA-2 production in reduced ceftazidime and ertapenem susceptibility in a K. pneumoniae ST258 clinical isolate.

Methods

MICs were determined by the agar dilution method. WGS was conducted to identify and compare resistance genes between isolates. Expression of KPC-2 was quantified by quantitative RT–PCR and immunoblotting. OXA-2 was expressed in Escherichia coli TOP10, as well as in K. pneumoniae ATCC 13883, to define the relative contribution of OXA-2 in β-lactam resistance. Kinetic studies were conducted using purified OXA-2 enzyme.

Results

K. pneumoniae 1761 belonged to ST258 and carried both blaKPC-2 and blaOXA-2. However, expression of blaKPC-2 was substantially reduced due to an IS1294 insertion in the promoter region. K. pneumoniae 1761, K. pneumoniae ATCC 13883 and E. coli TOP10 carrying blaOXA-2-harbouring plasmids showed reduced susceptibility to ertapenem and ceftazidime, but meropenem, imipenem and cefepime were unaffected. blaOXA-2 was carried on a 2910 bp partial class 1 integron containing aacA4-blaOXA-2-qacEΔ1-sul1 on an IncA/C2 plasmid, which was not present in the earlier ST258 isolates possessing blaKPC-2 with intact promoters. Hydrolysis of ertapenem by OXA-2 was confirmed using purified enzyme.

Conclusions

Production of OXA-2 was associated with reduced ceftazidime and ertapenem susceptibility in a K. pneumoniae ST258 isolate.
Activity of imipenem/relebactam against MDR Pseudomonas aeruginosa in Europe: SMART 2015–17
Authors: Lob Sibylle H , Karlowsky James A , Young Katherine , Motyl Mary R , Hawser Stephen , Kothari Nimmi D , Gueny Melinda E , Sahm Daniel F
Published: April 2019

Objectives

Relebactam is a diazabicyclooctane non-β-lactam inhibitor of Ambler class A and C β-lactamases that is in clinical development in combination with imipenem/cilastatin. The current study evaluated the in vitro activity of imipenem/relebactam against 5447 isolates of Pseudomonas aeruginosa submitted to the SMART global surveillance programme in 2015–17 by 67 clinical laboratories in 22 European countries.

Methods

MICs were determined using the CLSI broth microdilution reference method (Eleventh Edition: M07, 2018). Relebactam was tested at a fixed concentration of 4 mg/L in combination with doubling dilutions of imipenem. MICs were interpreted using EUCAST clinical breakpoints (version 8.1); imipenem breakpoints were applied to imipenem/relebactam.

Results

Rates of susceptibility to imipenem and imipenem/relebactam (MIC ≤4 mg/L) were 69.4% and 92.4%, respectively, for all isolates of P. aeruginosa. Over one-third of all isolates (34.9%, 1902/5447) were MDR; lower respiratory tract isolates (38.3%, 1327/3461) were more frequently MDR than were intraabdominal (28.5%, 355/1245) or urinary tract (29.7%, 212/714) isolates. Of all MDR isolates, 78.2% were susceptible to imipenem/relebactam, a rate that was 50–77 percentage points higher than the rate of susceptibility to imipenem or any other β-lactam tested; rates of susceptibility to imipenem/relebactam were similar for MDR isolates from lower respiratory tract (77.8% susceptible), intraabdominal (80.3%) and urinary tract (76.4%) infections. Overall, relebactam restored imipenem susceptibility to 75.2% (1254/1668) of imipenem-non-susceptible isolates of P. aeruginosa and to 69.6% (947/1361) of imipenem-non-susceptible isolates with an MDR phenotype.

Conclusions

Relebactam restored in vitro susceptibility to imipenem for most imipenem-non-susceptible and MDR clinical isolates of P. aeruginosa from European patients.
Identification of novel genes that promote persister formation by repressing transcription and cell division in Pseudomonas aeruginosa
Authors: Long Yuqing , Fu Weixin , Li Shouyi , Ren Huan , Li Mei , Liu Chang , Zhang Buyu , Xia Yushan , Fan Zheng , Xu Chang , Liu Jianfeng , Jin Yongxin , Bai Fang , Cheng Zhihui , Liu Xiaoyun , Jin Shouguang , Wu Weihui
Published: April 2019

Objectives

Bacterial persisters are a small subpopulation of cells that are highly tolerant of antibiotics and contribute to chronic and recalcitrant infections. Global gene expression in Pseudomonas aeruginosa persister cells and genes contributing to persister formation remain largely unknown. The objective of this study was to examine the gene expression profiles of the persister cells and those that regained growth in fresh medium, as well as to identify novel genes related to persister formation.

Methods

P. aeruginosa persister cells and those that regrew in fresh medium were collected and subjected to RNA sequencing analysis. Genes up-regulated in the persister cells were overexpressed to evaluate their roles in persister formation. The functions of the persister-contributing genes were assessed with pulse–chase assay, affinity chromatography, fluorescence and electron microscopy, as well as a light-scattering assay.

Results

An operon containing PA2282–PA2287 was up-regulated in the persister cells and down-regulated in the regrowing cells. PA2285 and PA2287 play key roles in persister formation. PA2285 and PA2287 were found to bind to RpoC and FtsZ, which are involved in transcription and cell division, respectively. Pulse–chase assays demonstrated inhibitory effects of PA2285 and PA2287 on the overall transcription. Meanwhile, light-scattering and microscopy assays demonstrated that PA2285 and PA2287 interfere with cell division by inhibiting FtsZ aggregation. PA2285 and PA2287 are conserved in pseudomonads and their homologous genes in Pseudomonas putida contribute to persister formation.

Conclusions

PA2285 and PA2287 are novel bifunctional proteins that contribute to persister formation in P. aeruginosa.
Diagnostic performance of 18F-fluciclovine PET/CT for regional lymph node metastases in patients with primary prostate cancer: a multicenter phase II clinical trial
Authors: Suzuki Hiroyoshi , Jinnouchi Seishi , Kaji Yasushi , Kishida Takeshi , Kinoshita Hidefumi , Yamaguchi Seiji , Tobe Toyofusa , Okamura Takehiko , Kawakita Mutsushi , Furukawa Junya , Otaka Akiharu , Kakehi Yoshiyuki
Published: April 2019

18F-fluciclovine PET/CT was evaluated in the diagnosis of lymph node metastases. Of 40 lymph nodes, metastasis was confirmed by pathology in seven, and four were positive for metastasis by 18F-fluciclovine.
National survey on total-body irradiation prior to reduced-intensity stem cell transplantation in Japan: The Japanese Radiation Oncology Study Group
Authors: Kawaguchi Hiroki , Soejima Toshinori , Ishibashi Naoya , Akiba Takeshi , Hasegawa Masatoshi , Isobe Kouichi , Ito Hitoshi , Imai Michiko , Ejima Yasuo , Hata Masaharu , Sasai Keisuke , Shimoda Emiko , Oguchi Masahiko , Akimoto Tetsuo
Published: April 2019

Reduced-intensity stem cell transplantation (RIST) minimizes the adverse effects of traditional hematopoietic stem cell transplantation, and low-dose total-body irradiation (TBI) is administered over a short period prior to RIST (TBI–RIST). Different institutes adopt different approaches for the administration of TBI–RIST, and since no study had previously investigated this issue, a survey of the TBI schedules in Japan was conducted. In October 2015, the Japanese Radiation Oncology Study Group initiated a national survey of TBI–RIST procedures conducted between 2010 and 2014. Of 186 institutions performing TBI, 90 (48%) responded to the survey, 78 of which performed TBI–RIST. Of 2488 patients who underwent TBI for malignant disease at these institutions, 1412 (56.8%) patients were treated for leukemia, 477 (19.2%) for malignant lymphoma, 453 (18.2) for myelodysplastic syndrome, 44 (1.8%) for multiple myeloma, and 102 (4.1%) for other malignant diseases. Further, 206 (52.0%) of 396 patients (a high proportion of patients) who underwent TBI for benign disease had aplastic anemia. The TBI–RIST equipment and treatment methods were similar to those used for myeloablative regimens. Routinely shielded organs included the lungs (43.6%), eyes (50.0%) and kidneys (10.2%). The ovaries (14.1%), thyroid (6.4%) and testicles (16.7%) were also frequently shielded, possibly reflecting an emphasis on shielding reproductive organs in children. TBI–RIST was performed more frequently than myeloablative conditioning in patients with benign disease. Genital and thyroid shielding were applied more frequently in patients treated with TBI–RIST than in patients treated with myeloablative conditioning. In conclusion, this study indicates the status of TBI–RIST in Japan and can assist future efforts to standardize TBI–RIST treatment methods and to design a future multicenter collaborative research study.
Mapping of transgenic alleles in soybean using a nanopore-based sequencing strategy
Authors: Li Shengjun , Jia Shangang , Hou Lili , Nguyen Hanh , Sato Shirley , Holding David , Cahoon Edgar , Zhang Chi , Clemente Tom , Yu Bin
Published: April 2019

Transgenic technology was developed to introduce transgenes into various organisms to validate gene function and add genetic variations >40 years ago. However, the identification of the transgene insertion position is still challenging in organisms with complex genomes. Here, we report a nanopore-based method to map the insertion position of a Ds transposable element originating in maize in the soybean genome. In this method, an oligo probe is used to capture the DNA fragments containing the Ds element from pooled DNA samples of transgenic soybean plants. The Ds element-enriched DNAs are then sequenced using the MinION-based platform of Nanopore. This method allowed us to rapidly map the Ds insertion positions in 51 transgenic soybean lines through a single sequencing run. This strategy is high throughput, convenient, reliable, and cost-efficient. The transgenic allele mapping protocol can be easily translated to other eukaryotes with complex genomes.
Research advances in cytochrome P450-catalysed pharmaceutical terpenoid biosynthesis in plants
Authors: Zheng Xiaoyan , Li Ping , Lu Xu
Published: April 2019

Advances in the role of cytochrome P450s in pharmaceutical terpenoid biosynthesis are reviewed, and different cloning strategies to identify new cytochrome P450 genes in the biosynthesis of natural terpenoids are summarized.
Systemic signalling through translationally controlled tumour protein controls lateral root formation in Arabidopsis
Authors: Branco Rémi , Masle Josette
Published: April 2019

The plant body plan and primary organs are established during embryogenesis. However, in contrast to animals, plants have the ability to generate new organs throughout their whole life. These give them an extraordinary developmental plasticity to modulate their size and architecture according to environmental constraints and opportunities. How this plasticity is regulated at the whole-organism level is elusive. Here we provide evidence for a role for translationally controlled tumour protein (TCTP) in regulating the iterative formation of lateral roots in Arabidopsis. AtTCTP1 modulates root system architecture through a dual function: as a general constitutive growth promoter enhancing root elongation and as a systemic signalling agent via mobility in the vasculature. AtTCTP1 encodes mRNAs with long-distance mobility between the shoot and roots. Mobile shoot-derived TCTP1 gene products act specifically to enhance the frequency of lateral root initiation and emergence sites along the primary root pericycle, while root elongation is controlled by local constitutive TCTP1 expression and scion size. These findings uncover a novel type for an integrative signal in the control of lateral root initiation and the compromise for roots between branching more profusely or elongating further. They also provide the first evidence in plants of an extracellular function of the vital, highly expressed ubiquitous TCTP1.
A Principle-Based Approach to Psychotherapy Integration
Authors: Eubanks Catherine F. , Goldfried Marvin R.
Published: April 2019

A principle-based approach to integration provides a framework for identifying common change processes that may exist among different theoretical orientations. This chapter identifies five change principles that are common across orientations and are supported by outcome research: fostering the patient’s hope, positive expectations, and motivation; facilitating the therapeutic alliance; increasing the patient’s awareness and insight; encouraging corrective experiences; and emphasizing ongoing reality testing. By focusing on these change principles, therapists have the flexibility to select a variety of techniques that are responsive to the client’s individual needs and preferences. The chapter also provides examples of techniques that support each principle and illustrates principle-based psychotherapy with a case example. The authors concludes by reviewing the research evidence and suggesting future directions for this approach.
Assimilative Psychodynamic Psychotherapy
Authors: Stricker George , Gold Jerry
Published: April 2019

Assimilative psychodynamic psychotherapy maintains a relational psychodynamic focus and methodology but assimilates interventions from other orientations seamlessly when it might help to facilitate treatment for the patient. In order to understand the potential value of these interventions drawn from other orientations, accommodation is necessary. This is done by means of an expanded three-tier model. The importance of the therapeutic relationship, particularly with regard to providing a corrective emotional experience, and the value of self-understanding is stressed. An illustrative case is presented, research summarizing the equivalent efficacy of psychodynamic psychotherapy is presented, and directions for future development are suggested.
Integrating Self-Help and Psychotherapy
Authors: Edwards-Stewart Amanda , Norcross John C.
Published: April 2019

Psychotherapy integration typically refers to the synthesis of diverse methods and schools of psychotherapy. This chapter expands that definition to consider the combination of psychotherapy with self-help materials. Clinicians frequently desire to integrate self-help into psychotherapy but question how and what to do with clients. The authors address types of self-help resources, their effectiveness with and without psychotherapy, and ways to seamlessly integrate them into formal treatment. The chapter considers a variety of self-help (e.g., self-help books, websites, mobile apps, commercial films). The clinician’s behavior can significantly enhance the effectiveness of recommended self-help and can produce a broader integration of effective change methods.
MISIM v2.0: a web server for inferring microRNA functional similarity based on microRNA-disease associations
Authors: Li Jianwei , Zhang Shan , Wan Yanping , Zhao Yingshu , Shi Jiangcheng , Zhou Yuan , Cui Qinghua
Published: April 2019

MicroRNAs (miRNAs) are one class of important small non-coding RNA molecules and play critical roles in health and disease. Therefore, it is important and necessary to evaluate the functional relationship of miRNAs and then predict novel miRNA-disease associations. For this purpose, here we developed the updated web server MISIM (miRNA similarity) v2.0. Besides a 3-fold increase in data content compared with MISIM v1.0, MISIM v2.0 improved the original MISIM algorithm by implementing both positive and negative miRNA-disease associations. That is, the MISIM v2.0 scores could be positive or negative, whereas MISIM v1.0 only produced positive scores. Moreover, MISIM v2.0 achieved an algorithm for novel miRNA-disease prediction based on MISIM v2.0 scores. Finally, MISIM v2.0 provided network visualization and functional enrichment analysis for functionally paired miRNAs. The MISIM v2.0 web server is freely accessible at http://www.lirmed.com/misim/.
Genome Sequencing Verifies Relapsed Infection of Helicobacter cinaedi
Authors: Sawada Osamu , Gotoh Yasuhiro , Taniguchi Takako , Furukawa Shota , Yoshimura Dai , Sasaki Satomi , Shida Haruki , Kusunoki Yoshihiro , Yamamura Tsuyoshi , Furuya Ken , Itoh Takehiko , Horita Tetsuya , Hayashi Tetsuya , Misawa Naoaki
Published: April 2019

Background

Recurrent infections of Helicobacter cinaedi are often reported, and long-term antimicrobial treatment is empirically recommended to prevent such infections. However, there have been no studies examining whether recurrent infections are relapses of former infections or reinfections with different clones.

Methods

A 69-year-old woman presented with recurrent H cinaedi bacteremia-associated cellulitis after a 51-day interval. We isolated 10 colonies from the blood cultures obtained during each of the 2 episodes and subjected them to whole-genome sequencing (WGS). High-confidence single-nucleotide polymorphisms (SNPs) were identified by an assembly based method. Heterogeneous SNP sites were identified by read mapping. The susceptibility of a representative isolate to 14 antimicrobials was also examined.

Results

Whole-genome sequence analysis revealed only 6 SNP sites among the 20 isolates at the whole-genome level. Based on the 6 SNPs, 5 within-host variants (referred to as genotypes) were identified. All 5 genotypes were detected in the first infection; however, only 2 genotypes were detected in the second infection. Although the H cinaedi clone showed a higher minimum inhibitory concentration to fluoroquinolones and macrolides and responsible mutations were identified, none of the 6 SNPs appeared related to additional resistance.

Conclusions

The second infection analyzed here was a relapse of the first infection. A certain level of within-host genomic heterogeneity of the H cinaedi clone was already present in the first infection. Our results suggest the importance of longer treatment courses to eradicate H cinaedi for preventing the relapse of its infection.
The Origin of Carbonatites from Amba Dongar within the Deccan Large Igneous Province
Authors: Chandra Jyoti , Paul Debajyoti , Stracke Andreas , Chabaux François , Granet Mathieu
Published: April 2019

There are disparate views about the origin of global rift- or plume-related carbonatites. The Amba Dongar carbonatite complex, Gujarat, India, which intruded into the basalts of the Deccan Large Igneous Province (LIP), is a typical example. On the basis of new comprehensive major and trace element and Sr–Nd–Pb isotope data, we propose that low-degree primary carbonated melts from off-center of the Deccan–Réunion mantle plume migrate upwards and metasomatize part of the subcontinental lithospheric mantle (SCLM). Low-degree partial melting (∼2%) of this metasomatized SCLM source generates a parental carbonated silicate magma, which becomes contaminated with the local Archean basement during its ascent. Calcite globules in a nephelinite from Amba Dongar provide evidence that the carbonatites originated by liquid immiscibility from a parental carbonated silicate magma. Liquid immiscibility at crustal depths produces two chemically distinct, but isotopically similar magmas: the carbonatites (20% by volume) and nephelinites (80% by volume). Owing to their low heat capacity, the carbonatite melts solidified as thin carbonate veins at crustal depths. Secondary melting of these carbonate-rich veins during subsequent rifting generated the carbonatites and ferrocarbonatites now exposed at Amba Dongar. Carbonatites, if formed by liquid immiscibility from carbonated silicate magmas, can inherit a wide range of isotopic signatures that result from crustal contamination of their parental carbonated silicate magmas. In rift or plume-related settings, they can, therefore, display a much larger range of isotope signatures than their original asthenosphere or mantle plume source.
Dolbeault cohomology of complex nilmanifolds foliated in toroidal groups
Authors: Fino Anna , Rollenske Sönke , Ruppenthal Jean
Published: April 2019

It is conjectured that the Dolbeault cohomology of a complex nilmanifold $X$ is computed by left-invariant forms. We prove this under the assumption that $X$ is suitably foliated in toroidal groups and deduce that the conjecture holds in real dimension up to six. Our approach generalizes previous methods, where the existence of a holomorphic fibration was a crucial ingredient.
Racial Reconciliation as a Suppressive Frame in Evangelical Multiracial Churches
Authors: Oyakawa Michelle
Published: April 2019

This article analyzes interviews with evangelical multiracial church pastors from the Religious Leadership and Diversity Project (RLDP), drawing on the framing literature from social movements. While a small number of evangelical pastors in the sample utilize a racial justice frame to understand and address racial issues, consistent with prior research, the data indicates that most evangelical multiracial church pastors use a racial reconciliation frame. This frame holds that racial conflict can be eliminated through shared faith, which allows churches to avoid politics and prioritize internal unity. However, findings reveal that the racial reconciliation can function as a suppressive frame that precludes discussions about racial inequality and discourages collective action to promote racial justice. The article discusses the implications of this for social change and cross-racial solidarity.
Lucent Lesions of Vertebral Body: Differential Diagnosis
Authors: Olubiyi Olutayo Ibukunolu , Brown Fraser , Teytelboym Oleg M.
Published: April 2019

Each vertebra has an anteriorly located body of cancellous bone, with a thin layer of surrounding cortical bone; and posterior elements, which are composed largely of cortical bone (pedicles, laminae, and spinous and transverse processes). The spinal canal is between these two components (Figure 1). Cancellous bone lesions often localize in the vertebral bodies, whereas cortical bone lesions preferentially affect the posterior elements. However, some bone lesions may show no preference for either of the two vertebral parts.
New Drugs 2019, part 2
Authors: Hussar Daniel A.
Published: April 2019

This article reviews eight drugs recently approved by the FDA, including indications, precautions, adverse reactions, and nursing considerations.
Evolution of the national opioid crisis
Authors: Morland Rebecca
Published: April 2019

Opioid use disorder (OUD), addiction, and overdose have become a national public health and socioeconomic crisis. This article explores the evolution of substance abuse in the US, specifically OUD.
Home and Birth Center Birth in the United States
Authors: Caughey Aaron B. , Cheyney Melissa
Published: April 2019

There has been a small, but significant, increase in community births (home and birth-center births) in the United States in recent years. The rate increased by 20% from 2004 to 2008, and another 59% from 2008 to 2012, though the overall rate is still low at less than 2%. Although the United States is not the only country with a large majority of births occurring in the hospital, there are other high-resource countries where home and birth-center birth are far more common and where community midwives (those attending births at home and in birth centers) are far more central to the provision of care. In many such countries, the differences in perinatal outcomes between hospital and community births are small, and there are lower rates of maternal morbidity in the community setting. In the United States, perinatal mortality appears to be higher for community births, though there has yet to be a national study comparing outcomes across settings that controls for planned place of birth. Rates of intervention, including cesarean delivery, are significantly higher in hospital births in the United States. Compared with the United States, countries that have higher rates of community births have better integrated systems with clearer national guidelines governing risk criteria and planned birth location, as well as transfer to higher levels of care. Differences in outcomes, systems, approaches, and client motivations are important to understand, because they are critical to the processes of person-centered care and to risk reduction across all birth settings.
The Effectiveness of Interventions to Maintain Exercise and Physical Activity in Post-Cardiac Rehabilitation Populations
Authors: Martinello Novella , Saunders Stephanie , Reid Robert
Published: April 2019

Purpose:

Cardiac rehabilitation is a medically supervised program addressing health behavior changes and promoting self-management among individuals with heart disease. This includes initiation of regular physical activity. However, long-term physical activity after cardiac rehabilitation among this population remains a challenge.

Methods:

This study was a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials were identified by searching multiple databases and were selected if they evaluated an intervention with a physical activity or exercise component among individuals who completed cardiac rehabilitation. A descriptive synthesis was performed for all studies and means and standard deviations were used for meta-analysis when possible. Risk of bias, heterogeneity, and publication bias were assessed.

Results:

Twenty-five studies met the inclusion criteria and 19 were included in the meta-analysis. The mean age of participants across studies was 60 yr and 80% were male. Descriptive synthesis of the studies combined with meta-analysis results provided evidence of increased physical activity among intervention groups compared with control groups at follow-up.

Conclusion:

There is evidence to support the effectiveness of interventions aimed at maintaining physical activity and exercise among adults who have completed cardiac rehabilitation.
Referral to Cardiac Rehabilitation and Outcomes for Patients With Takotsubo Cardiomyopathy
Authors: Wu Carolyn M. , McKeon John , Abbott J. Dawn , Jiang Lan , Wu Wen-Chih
Published: April 2019

Purpose:

The aim of this study was to determine participation rates and outcomes for patients with Takotsubo cardiomyopathy (TC) in a cardiac rehabilitation (CR) program.

Methods:

Patients at 2 academic medical centers with a discharge diagnosis of TC from January 2008 to March 2015 were retrospectively identified. Patients meeting the Mayo Clinic criteria for TC were cross-matched to the CR center affiliated with the hospitals to determine the referral rate and outcomes after completion of the program.

Results:

In total, 380 unique patients were identified who survived the index hospitalization. Eighteen patients (5%) were referred to CR, 15 enrolled, and of those enrolled, 10 patients (67%) completed the program. Patients undergoing percutaneous coronary intervention of a nonculprit vessel at the time of diagnosis was the only predictor for referral to CR (11% vs 1%, P = .01). The 10 patients who completed CR attended 33 ± 6 (range, 20-36) sessions. Weight and body mass index reduction were 2.8 ± 3.5 lb and 0.6 ± 0.7 kg/m2 (P = .04, both), respectively. Post-CR exercise duration was 37 ± 4 min/session, which improved by 13 ± 6 min/session from baseline (P < .01). Two patients entered the phase III maintenance program. One-year cardiac readmission rates were comparable among patients who completed CR and those who were referred but did not attend or complete CR (0% vs 13%, P = .47).

Conclusions:

Referral for the TC population was low; however, enrollment and completion rates were adequate, with percutaneous coronary intervention in nonculprit vessel as the only predictor of CR referral. Limited data showed CR may help with weight reduction and improve exercise duration.
Measuring cardiac output at the bedside
Authors: Huang Stephen J.
Published: April 2019

Purpose of review

Bedside cardiac output (CO) measurement is an important part of routine hemodynamic monitoring in the differential diagnosis of circulatory shock and fluid management. Different choices of CO measurement devices are available. The purpose of this review is to review the importance of CO [or stroke volume (SV)] measurement and to discuss the various methods (devices) used in determination of CO.

Recent findings

CO measurement devices can be classified into two types: those use simple physical principles with minimal assumptions, and those predicting CO via mathematical modelling with a number of assumptions. Both have pros and cons, with the former being more accurate but with limited continuous monitoring capability whereas the latter less accurate but usually equipped with continuous monitoring functionality. With frequent updates in mathematical models, research data constantly become outdated in this area. Recent data suggest devices based on mathematical modelling have limited accuracies and poor precisions.

Measurement of CO or SV is important in critically ill patients. Most devices have accuracy and reliability issues. The choice of device should depend on the purpose of measurement. For diagnostic purposes, devices based on simple physical principles, especially thermodilution and transthoracic echocardiography are more reliable due to accuracy.
Experience of the management of coronary artery bypass graft only on moderate ischemic mitral regurgitation
Authors: Wang Weitie , Li Bo , Wang Yong , Piao Hulin , Zhu Zhicheng , Xu Rihao , Li Dan , Liu Kexiang
Published: April 2019

To summary the impact of off-pump coronary artery bypass grafting (CABG) only on patients with moderate ischemic mitral regurgitation and survival.

We retrospectively analyzed 109 patients with coronary artery disease (CAD) complicated by moderate mitral regurgitation, from January, 2008 to December, 2014, in the Department of Cardiovascular Surgery at the No. 2 Hospital of Jilin University undergoing off pump CABG only. Preoperative clinical characteristics, complications after surgery, and outcome (survivor or death) were assessed. We observed the degree of mitral valve regurgitation, left ventricular ejection fraction (LVEF), left ventricular and left atrial size, left ventricular end-diastolic volume (LVEDV) preoperative, and New York Heart Association (NYHA) functional class, postoperative 10 days before discharge, and 6 months and longer after surgery. The statistical data were processed by SPSS 19 software with computer; statistical significant difference with P < .05.

Overall in-hospital mortality was 2.75% (3 patients). Patients had lower mean LVEF in the postoperative compared with the preoperative period, but all the patients had higher LVEF since 6 months than preoperative period (P < .001). Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular and atrial size and LVEDV postoperative 10 days before discharge, 6 months and more longer after surgery reduced significantly (P < .001). Rapid atrial fibrillation occurred in 19 cases during perioperative and returned to normal before discharge. The symptom of angina was disappeared in all patients before discharge. The mean follow-up time was 60.16 ± 17.98 months (range 36–96 months). Two patients died of major adverse cardiac events including heart failure and ventricular fibrillation. Three patients died of lung cancer, and 2 patients died of stroke during the longer follow-up.

Off-pump CABG can be performed safely in patients with CAD complicated by moderate mitral regurgitation. The efficacy of CABG only is well demonstrated by the significant improvement of LVEF and NYHA functional class, and by the decrease of left ventricular and atrial size, LVEDV, and mitral regurgitation grade.
Inferior vena cava diameter measurements and BUN/creatinine values to determine dehydration in patients with hip fractures preoperatively
Authors: Kaydu Ayhan , Gokcek Erhan
Published: April 2019

Dehydration is a common problem in patients undergoing hip fracture surgery. Sonographic inferior vena cava (IVC) diameter measurement evaluates to estimate volume status. The aim of the study to evaluate the relationship between IVC measurements (expiratory diameter of IVC, collabsibility index [CI], inspiratory diameter of IVC) and blood urea nitrogen (BUN)/creatinine ratio in patients undergoing hip fracture surgery. Ultrasonography of IVC was performed on 35 patients underwent hip fracture surgery. The end-expiratory diameter of IVC, end-inspiratory diameter of IVC, and CI were assessed preoperatively. The patients were classified as group 1 for BUN/Cr ratio <20, group 2 for BUN/Cr ratio of >20. Sonographic IVC measurement was not successful in 14.2% of patients and 30 patients remained. The mean age was 80.43 ± 11.10 (58–95) years. The IVC diameter values had no discriminatory value for the prediction of dehydration according to BUN/creatinine ratio (P > .05). Receiver operating characteristic curve indicated that area under the curve (AUC) for CI: 49.5%, (95% CI 26.5–72.5) P > .05; for IVC inspiratory diameter: AUC: 43.3%, (95% CI, 19.9–66.6) P > .05; for IVC expiratory diameter: AUC: 45.5%, (95% CI, 26.6–65.4) P > .05. No correlations of BUN/creatinine ratio with CI and IVC expiratory diameter were found (as r = −0.262 [P = .163]; [r = 0.206, P = .274]; respectively). There were not any correlation in linear regression analysis model between BUN/Cr ratio according to independent variables (Age, CI, IVCmax, IVCmin) (P = .108, P = .419, P = .282, P = .257; respectively). No discriminatory relationship was found between the bedside ultrasonographic measurement of IVC parameters and BUN/creatinine ratio in patients underwent hip fracture surgery to predict the preoperative dehydration.
Partial response after treatment with Conversion chemotherapy
Authors: Bu Zhaoting , Lu Cheng , Yang Xu , Lai Hao , Jiang Yuting , Li Yicheng , Lin Yuan , Qin Yuzhou , Xiao Minxi , Cheng Chunfeng , Liu Qi
Published: April 2019

Rationale:

Many studies have reported radical resection for liver metastasis and the primary tumor could represent an important prognostic factor in patients affected by colorectal liver metastases (CRLM). However, resection of huge liver metastases from colon cancer has been seldom reported.

Patient Concerns:

A 58-year-old man presented with huge liver metastases from colon cancer. Laboratory tests revealed elevated tumor markers and a wild-type mutation in the K-RAS gene. A computed tomography scan demonstrated unresectable liver masses with a 16.5-cm maximum diameter and intrahepatic duct dilatation due to compression by the liver metastases.

Diagnosis:

The patient was diagnosed with stage IV descending colon carcinoma with multiple huge hepatic metastases.

Interventions:

He was administered 3 treatment courses, including 9 cycles of combined chemotherapy with mFOLFOX6 plus cetuximab (mFOLFOX6 + Cet), and the liver masses reduced. After a preoperative assessment by a multidisciplinary team when the 9 cycles of systemic chemotherapy had been completed, the patient underwent hepatectomy, followed 4 months later by a laparoscopic colectomy. We used a reverse strategy (liver-first) for the patient.

Outcomes:

In this case, liver-first treatment (systemic chemotherapy of mFOLFOX6 + Cet) was an effective treatment for unresectable CRLM. No postoperative complications occurred. The patient continued to receive postoperative chemotherapy (mFOLFOX6 + Cet) at the latest follow-up. During the 17 months of follow-up, tumor recurrence was un-noted.

Lessons:

Treating colorectal cancer patients with huge hepatic metastases is possible, and surgeons should consider various treatment options in the management of these patients.
Use of Neoveil or TachoSil to prevent pancreatic fistula following pancreaticoduodenectomy
Authors: Kwon Hye Eun , Seo Hyung-Il , Yun Sung Pil
Published: April 2019

The aim of this study was to evaluate the effectiveness of using Neoveil and TachoSil sponges at the pancreaticojejunostomy anastomosis site in reducing the rate and severity of postoperative pancreatic fistula (POPF).

In this study, we retrospectively evaluated data that were prospectively collected on pancreaticoduodenectomy (PD) procedures. Patients were divided into 3 groups: no patch application, Neoveil patch application, and TachoSil patch application. Demographic and surgical data were analyzed.

Around 165 patients with PD were enrolled in this study and were divided into 3 groups. In the standard group (n = 43), no patch was applied, while in the Neoveil and TachoSil groups (n = 84 and n = 38, respectively), the pancreaticojejunostomy anastomosis site was covered with Neoveil and TachoSil patches, respectively. POPF grade B or above occurred in 37.2% (16/43), 14.3% (12/84), and 18.8% (6/38) of patients in the standard, Neoveil and TachoSil groups, respectively, with a significant difference between patients with and without patch application (P = .004). On multivariate logistic analysis of predictive factors for POPF, male sex, patch application, and hospital day were found to be the significant independent predictors of POPF grade B or above.

Significant independent predictors of POPF were male sex and patch application. This study demonstrated that the use of Neoveil or TachoSil patches may reduce the incidence of POPF after PD.
A randomized controlled trial on the impact of moderate-intensity continuous aerobic exercise on the depression status of middle-aged patients with congestive heart failure
Authors: Abdelbasset Walid Kamal , Alqahtani Bader A.
Published: April 2019

Background:

Depression prevalence rates in congestive heart failure (CHF) patients have increased in the last few years. Depression is a leveled and independent risk factor for hospital readmission, decreased function, and patient mortality for patients with CHF. Major depressive disorder can be diagnosed in CHF patients who frequently suffer from sleeplessness, fatigue, and neurovegetative manifestations that extend to depressed patients.

Objectives:

The aim of this study was to investigate the influence of moderate-intensity continuous aerobic exercise (MICAE) on the depression status in patients with CHF.

Methods:

Between June and September 2017, 46 patients with CHF who suffered from depression were selected for this study. These patients aged 40 to 60 years, were medically diagnosed with CHF-related illnesses, and physical disabilities. The participating patients were selected from the psychological medicine unit of the University Hospitals. They were randomly classified into 2 groups, each group included 23 patients. The study group underwent MICAE (MICAE) 3 times weekly for 12 weeks, whereas the control group received traditional intervention without any physical exercise.

Results:

There were no significant differences between the 2 groups regarding baseline characteristics (P 
>.05). Patients in both groups had a significant decrease in their depression levels. The study group had a greater reduction of 80.9% (P <.05) when compared to a reduction in the control group 46.46% (P <.05).

Conclusions:

According to the study outcomes, it was concluded that 12 weeks of MICAE has positive effects on the depression status in patients with CHF. The study group who underwent moderate-intensity aerobic exercise had a greater decrease in the depression status of CHF patients when compared to the control group.
Socioeconomic status impacts outcomes following pediatric anterior cruciate ligament reconstruction
Authors: Patel Akash R. , Sarkisova Natalya , Smith Ryan , Gupta Kavish , VandenBerg Curtis D.
Published: April 2019

Previous research has shown that delays in pediatric anterior cruciate ligament (ACL) reconstruction are associated with increased prevalence of concomitant knee injuries and worse outcomes following surgery. However, few studies have described factors that may contribute to these delays and adverse outcomes. This study seeks to determine the effect of socioeconomic status on clinical outcomes following ACL reconstruction.

A retrospective review of patients who underwent primary ACL reconstruction at a tertiary pediatric hospital between 2009 and 2015 was conducted. Variables included chronologic, demographic, and socioeconomic data, and postoperative complications. Socioeconomic status was measured using health insurance type and median household income levels derived from 2009 to 2015 US Census Bureau.

A total of 127 patients (69 male, 58 female) were included. The mean age at time of surgery was 15.0 years. Overall, 68 patients had commercial insurance and 59 patients had government-assisted insurance. The mean household median income for patients with commercial insurance was $87,767 compared to $51,366 for patients with government-assisted insurance. Patients with government-assisted insurance plans demonstrated greater delays in time from injury to initial orthopaedic evaluation (P = .0003), injury to magnetic resonance imaging (MRI) examination (P = .021), injury to surgery (P < .0001), initial orthopaedic evaluation to surgery (P = .0036), and injury to return to play clearance, P = .044. Median household income was significantly related to time from injury to MRI examination (P = .0018), injury to surgery (P = .0017), and initial orthopaedic evaluation to surgery (P = .039). Intraoperatively, 81% of patients with government-assisted insurance had concomitant meniscal injuries compared 65% of patients with commercial insurance, P = .036. Postoperatively, 22% of patients with government-assisted insurance were found to have decreased knee range of motion (“stiffness”) compared to 9% of patients with commercial insurance, P = .034.

Pediatric patients who have government-assisted plans may experience delays in receiving definitive injury management and be at risk for postoperative complications. Our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and postoperative complications between government and commercial insurance types.

Level of Evidence: III
A cohort study of age and sex specific risk of pyogenic liver abscess incidence in patients with type 2 diabetes mellitus
Authors: Ko Ming-Chung , Lin Wei-Hung , Martini Santi , Chang Ya-Hui , Chiu Chang-Ta , Li Chung-Yi
Published: April 2019

To investigate the age-sex-specific incidence and relative risk of pyogenic liver abscess (PLA) in patients with type 2 diabetes mellitus (T2DM), and to assess the joint effects of T2DM and other clinical risk factors for PLA on PLA incidence. We used a population-based cohort design with Taiwan's National Health Insurance claim data. Study subjects included 613,921 T2DM patients and 614,613 controls identified in 2000 and were followed to the end of 2010. Cox regression model was employed to calculate the hazard ratio (HR) and 95% confidence interval (CI) of PLA in relation to T2DM. Over an 11-year follow-up, 5336 T2DM and 1850 controls were admitted for PLA, representing a cumulative incidence of 0.87% and 0.30%, respectively. T2DM was significantly associated with increased hazard of PLA (HR, 2.88; 95% CI, 2.73–3.04). We also found that age and gender may significantly modify the relationship between T2DM and PLA, with a higher HR noted in males patients and those aged <45 years. Biliary tract diseases (HR, 8.60; 95% CI, 7.87–9.40) and liver cirrhosis (HR, 7.52; 95% CI, 6.58–8.59) may add substantially additional risk to the incidence of PLA in T2DM patients. The increased risk of PLA in T2DM was greater in male and younger patients. Careful management of biliary tract diseases and liver cirrhosis may also help reduce the incidence of PLA in T2DM patients.