bluuebunny/crossref_metadata_2025 huggingface dataset:
SalmonellaEnteritidis breast abscess: an unusual cause of breast abscess in the UK
Authors: Al-Ishaq Zaid , Sikdar Oishi , Dobie Donald , Sircar Tapan
Published: October 2018

Breast abscess is a common clinical condition mostly caused byStaphylococcus aureus. However, infections due to mixed organisms are observed in non-lactational women, mostly in smokers.Salmonellainfection causing breast abscess is extremely rare in developed countries. We report a case ofSalmonella entericasubspenterica(I) serovar Enteritidis breast abscess in a 48-year-old woman, a UK citizen, who had recently travelled abroad. She was treated successfully with a combination of surgery and ciprofloxacin. Unusual causative organisms should be kept in mind in patients with recent travel abroad and pus should be sent for microbiology. Mastitis caused bySalmonellaspp can present with a severely indurated area that may take a few weeks to resolve. Complete assessment with biopsy of the indurated area and breast imaging is mandatory to exclude malignancy.
Ileal schwannoma causing intussusception in an adult
Authors: Roulston Gary , Elwan Hani , Obeid Noor , Lirosi Francesca
Published: October 2018

Ileal schwannomas are extremely rare tumours. Very few cases have been previously reported. Most cases present with abdominal pain and gastrointestinal bleeding; intussusception is a rare presentation. Due to limitations in imaging modalities, arriving at a diagnosis preoperatively can be challenging. The only reliable method of diagnosis, and treatment, is resection of the tumour, followed by histological and immunohistochemical testing. This report details the rare case of intussusception as the presenting feature of an ileal schwannoma.
Maternal-fetal transmission and adverse perinatal outcomes in pregnant women infected with Zika virus: prospective cohort study in French Guiana
Authors: Pomar Léo , Vouga Manon , Lambert Véronique , Pomar Céline , Hcini Najeh , Jolivet Anne , Benoist Guillaume , Rousset Dominique , Matheus Séverine , Malinger Gustavo , Panchaud Alice , Carles Gabriel , Baud David
Published: October 2018

Objectives

To estimate the rates of maternal-fetal transmission of Zika virus, adverse fetal/neonatal outcomes, and subsequent rates of asymptomatic/symptomatic congenital Zika virus infections up to the first week of life.

Design

Cohort study with prospective data collection and subsequent review of fetal/neonatal outcomes.

Settings

Referral centre for prenatal diagnosis of the French Guiana Western Hospital.

Participants

Pregnant women at any stage of pregnancy with a laboratory confirmed symptomatic or asymptomatic Zika virus infection during the epidemic period in western French Guiana. The cohort enrolled 300 participants and prospectively followed their 305 fetuses/newborns.

Main outcome measures

Rate of maternal-fetal transmission of Zika virus (amniotic fluid, fetal and neonatal blood, urine, cerebrospinal fluid, and placentas); clinical, biological, and radiological outcomes (blindly reviewed); and adverse outcomes defined as moderate signs potentially related to congenital Zika syndrome (CZS), severe complications compatible with CZS, or fetal loss. Associations between a laboratory confirmed congenital Zika virus infection and adverse fetal/neonatal outcomes were evaluated.

Results

Maternal-fetal transmission was documented in 26% (76/291) of fetuses/newborns with complete data. Among the Zika virus positive fetuses/newborns, 45% (34/76) presented with no signs/complications at birth, 20% (15/76) with moderate signs potentially related to CZS, 21% (16/76) with severe complications compatible with CZS, and 14% (11/76) with fetal loss. Compared with the Zika virus positive fetuses/neonates, those that were identified as negative for Zika virus (215/291) were less likely to present with severe complications (5%; 10/215) or fetal loss (0.5%; 1/215; relative risk 6.9, 95% confidence interval 3.6 to 13.3). Association between a positive Zika virus test and any adverse fetal/neonatal outcome was also significant (relative risk 4.4, 2.9 to 6.6). The population attributable fraction estimates that a confirmed congenital Zika virus infection contributes to 47% of adverse outcomes and 61% of severe adverse outcomes observed.

Conclusion

In cases of a known maternal Zika virus infection, approximately a quarter of fetuses will become congenitally infected, of which a third will have severe complications at birth or fetal loss. The burden of CZS might be lower than initially described in South America and may not differ from other congenital infections.
Examining the efficacy of a multicomponent m-Health physical activity, diet and sleep intervention for weight loss in overweight and obese adults: randomised controlled trial protocol
Authors: Duncan Mitch J , Brown Wendy J , Burrows Tracy L , Collins Clare E , Fenton Sasha , Glozier Nicholas , Kolt Gregory S , Morgan Philip J , Hensley Michael , Holliday Elizabeth G , Murawski Beatrice , Plotnikoff Ronald C , Rayward Anna T , Stamatakis Emmanuel , Vandelanotte Corneel
Published: October 2018

Introduction

Traditional behavioural weight loss trials targeting improvements in physical activity and diet are modestly effective. It has been suggested that sleep may have a role in weight loss and maintenance. Improving sleep health in combination with physical activity and dietary behaviours may be one strategy to enhance traditional behavioural weight loss trials. Yet the efficacy of a weight loss intervention concurrently targeting improvements in physical activity, dietary and sleep behaviours remains to be tested.

Methods and analysis

The primary aim of this three-arm randomised controlled trial is to examine the efficacy of a multicomponent m-Health behaviour change weight loss intervention relative to a waitlist control group. The secondary aims are to compare the relative efficacy of a physical activity, dietary behaviour and sleep intervention (enhanced intervention), compared with a physical activity and dietary behaviour only intervention (traditional intervention), on the primary outcome of weight loss and secondary outcomes of waist circumference, glycated haemoglobin, physical activity, diet quality and intake, sleep health, eating behaviours, depression, anxiety and stress and quality of life. Assessments will be conducted at baseline, 6 months (primary endpoint) and 12 months (follow-up). The multicomponent m-Health intervention will be delivered using a smartphone/tablet ‘app’, supplemented with email and SMS and individualised in-person dietary counselling. Participants will receive a Fitbit, body weight scales to facilitate self-monitoring, and use the app to access educational material, set goals, self-monitor and receive feedback about behaviours. Generalised linear models using an analysis of covariance (baseline adjusted) approach will be used to identify between-group differences in primary and secondary outcomes, following an intention-to-treat principle.

Ethics and dissemination

The Human Research Ethics Committee of The University of Newcastle Australia provided approval: H-2017–0039. Findings will be disseminated via publication in peer-reviewed journals, conference presentations, community presentations and student theses.

Trial registration number

ACTRN12617000735358; UTN1111-1219-2050.
Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
Authors: Jones Lorelei , Pomeroy Linda , Robert Glenn , Burnett Susan , Anderson Janet E , Morris Stephen , Capelas Barbosa Estela , Fulop Naomi J
Published: October 2018

Background

Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.

Methods

We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.

Results

Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of ‘slack’—expressed by participants as the ‘space to think’ and ‘someone to do the doing’—and the presence of a functioning board.

Conclusions

Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.
Ten tips for advancing a culture of improvement in primary care
Authors: Kiran Tara , Ramji Noor , Derocher Mary Beth , Girdhari Rajesh , Davie Samantha , Lam-Antoniades Margarita
Published: October 2018

Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.
Social support and trajectories of body mass index and waist to hip ratio from mid-adulthood to old age
Authors: Tymoszuk Urszula , Kumari Meena , Batterham Rachel , Stafford Mai
Published: October 2018

Background

Although social networks’ influence on obesity has been increasingly recognised, it remains unclear if different dimensions of social support, for example, emotional or practical support, received from one’s closest relationship are associated with weight outcomes over mid-life and old age.

Methods

Using linear mixed models we examined whether person-level body mass index (BMI) and waist to hip ratio (WHR) trajectories vary according to levels of emotional, practical and negative aspects of social support in a large UK-based cohort of healthy civil servant workers (n=5460) with objectively measured anthropometry data on five occasions over two decades (1989–1990 to 2012–2013).

Results

We found that gender modified the associations, with more consistent patterns found in men. In men, high negative aspects of support compared with low were consistently associated with steeper increase in BMI (0.024, 95% CI 0.001 to 0.047 kg/m2) and WHR (0.00020, 95% CI −0.00001 to 0.00040) after adjustment for demographic and socioeconomic covariates, mental health, health behaviours and long-standing illness. We found that low emotional support, compared with high, was associated with steeper BMI gain in men (0.024, 95% CI 0.0001 to 0.047 kg/m2).

Conclusions

Low levels of negative aspects of the relationships with the closest person and high levels of emotional support may be protective against weight gain over time, particularly in men. If replicated in other studies, these results would suggest that the quality of social support in close relationships has been an overlooked risk factor for weight gain in an ageing population.
Natural killer cells in lung transplantation
Authors: Calabrese Daniel R , Lanier Lewis L , Greenland John R
Published: October 2018

Natural killer (NK) cells are innate lymphoid cells that have been increasingly recognised as important in lung allograft tolerance and immune defence. These cells evolved to recognise alterations in self through a diverse set of germline-encoded activating and inhibitory receptors and display a broad range of effector functions that play important roles in responding to infections, malignancies and allogeneic tissue. Here, we review NK cells, their diverse receptors and the mechanisms through which NK cells are postulated to mediate important lung transplant clinical outcomes. NK cells can promote tolerance, such as through the depletion of donor antigen-presenting cells. Alternatively, these cells can drive rejection through cytotoxic effects on allograft tissue recognised as ‘non-self’ or ‘stressed’, via killer cell immunoglobulin-like receptor (KIR) or NKG2D receptor ligation, respectively. NK cells likely mediate complement-independent antibody-mediated rejection of allografts though CD16A Fc receptor-dependent activation induced by graft-specific antibodies. Finally, NK cells play an important role in response to infections, particularly by mediating cytomegalovirus infection through the CD94/NKG2C receptor. Despite these sometimes-conflicting effects on allograft function, enumeration of NK cells may have an important role in diagnosing allograft dysfunction. While the effects of immunosuppression agents on NK cells may currently be largely unintentional, further understanding of NK cell biology in lung allograft recipients may allow these cells to serve as biomarkers of graft injury and as therapeutic targets.
Effect of dietary supplementation of fermented garlic by Leuconostoc mesenteroides KCCM35046, on growth performance, blood constituents, nutrient digestibility, fecal microflora, and fecal scores in sows and their piglets
Authors: Yun H.M. , Nyachoti C.M. , Kim I.H.
Published: October 2018

Eighteen lactating sows (Landrace × Yorkshire) were used in an experiment to determine the effects of fermented garlic by Leuconostoc mesenteroides KCCM35046 on growth performance, blood constituents, nutrient digestibility, fecal microflora, and fecal scores in sows and their piglets. The experiment was started before farrowing 30 d to weaning, and sows were randomly assigned to the following dietary treatments: control basal diet (CON) and the CON + 0.1% or 0.2% fermented garlic (FG). During the lactation period, sows had free access to feed and water. At farrowing day and weaning (day 28), body weight (BW) loss of sows reduced linearly (P = 0.042; P = 0.006, respectively) in FG diets. There was a linear improvement in piglets’ BW with increasing dietary FG levels at weaning (P = 0.033). Piglets fed the diets with the FG linearly increased the average daily gain (ADG) at the 3rd and 4th weeks (P = 0.041; P = 0.002, respectively). Overall, the ADG of piglets linearly increased when lactating sows fed the diets with FG supplementation (P = 0.004). Red blood cell concentrations linearly decreased (P = 0.004) in sows fed dietary FG supplementation at the weaning day. Dietary inclusion of the FG tended to increase the fecal Lactobacillus population and decrease Escherichia coli population of piglets at weanling day (P = 0.075; P = 0.051, respectively). In conclusion, the results of this study indicated that dietary supplementation of FG (0.1% and 0.2%) improved growth performance in sows and their piglets.
Halonatospora gen. nov. with H. pansihalos comb. nov. and Glomus bareae sp. nov. (Glomeromycota; Glomeraceae)
Authors: Błaszkowski Janusz , Niezgoda Piotr , Goto Bruno T. , Kozłowska Anna
Published: October 2018

We established single-species pot cultures of the former Glomus pansihalos, a member of the Glomeraceae, and obtained sequences of the SSU–ITS–LSU nrDNA segment and the RPB1 gene of the species. Phylogenetic analyses of the sequences indicated that G. pansihalos represents a separate clade at the rank of genus in the Glomeraceae. Consequently, the new genus was named Halonatospora, and G. pansihalos was renamed Halonatospora pansihalos comb. nov. We also grew an AMF that produced clusters with glomoid spores in single-species cultures and obtained SSU–ITS–LSU and RPB1 sequences of the fungus. Studies of pot cultures, morphological and histochemical characters of the spores, as well as phylogenetic analyses of the sequences proved that it is an undescribed species of the genus Glomus sensu stricto, which is associated with roots of Ammophila arenaria colonizing maritime sand dunes located in north-western Poland.
Benzyladenine and gibberellic acid pulses improve flower quality and extend vase life of cut dahlias
Authors: Bergmann Ben A. , Ahmad Iftikhar , Dole John M.
Published: October 2018

A 24-h pulse of cut dahlias in a solution containing both benzyladenine and gibberellic acid at 10–20 mg L−1 improved flower quality after 4 d in the vase and prolonged vase life regardless of handling method (dry packed or held in water from harvest through delivery).
A Kernel Bayesian Adaptive Resonance Theory with A Topological Structure
Authors: Masuyama Naoki , Loo Chu Kiong , Wermter Stefan
Published: October 2018

This paper attempts to solve the typical problems of self-organizing growing network models, i.e. (a) an influence of the order of input data on the self-organizing ability, (b) an instability to high-dimensional data and an excessive sensitivity to noise, and (c) an expensive computational cost by integrating Kernel Bayes Rule (KBR) and Correntropy-Induced Metric (CIM) into Adaptive Resonance Theory (ART) framework. KBR performs a covariance-free Bayesian computation which is able to maintain a fast and stable computation. CIM is a generalized similarity measurement which can maintain a high-noise reduction ability even in a high-dimensional space. In addition, a Growing Neural Gas (GNG)-based topology construction process is integrated into the ART framework to enhance its self-organizing ability. The simulation experiments with synthetic and real-world datasets show that the proposed model has an outstanding stable self-organizing ability for various test environments.
Extraction of drug–drug interaction using neural embedding
Authors: Hou Wen Juan , Ceesay Bamfa
Published: October 2018

Information on changes in a drug’s effect when taken in combination with a second drug, known as drug–drug interaction (DDI), is relevant in the pharmaceutical industry. DDIs can delay, decrease, or enhance absorption of either drug and thus decrease or increase their action or cause adverse effects. Information Extraction (IE) can be of great benefit in allowing identification and extraction of relevant information on DDIs. We here propose an approach for the extraction of DDI from text using neural word embedding to train a machine learning system.

Results show that our system is competitive against other systems for the task of extracting DDIs, and that significant improvements can be achieved by learning from word features and using a deep-learning approach. Our study demonstrates that machine learning techniques such as neural networks and deep learning methods can efficiently aid in IE from text. Our proposed approach is well suited to play a significant role in future research.
Cloud-BS: A MapReduce-based bisulfite sequencing aligner on cloud
Authors: Choi Joungmin , Park Yoonjae , Kim Sun , Chae Heejoon
Published: October 2018

In recent years, there have been many studies utilizing DNA methylome data to answer fundamental biological questions. Bisulfite sequencing (BS-seq) has enabled measurement of a genome-wide absolute level of DNA methylation at single-nucleotide resolution. However, due to the ambiguity introduced by bisulfite-treatment, the aligning process especially in large-scale epigenetic research is still considered a huge burden. We present Cloud-BS, an efficient BS-seq aligner designed for parallel execution on a distributed environment. Utilizing Apache Hadoop framework, Cloud-BS splits sequencing reads into multiple blocks and transfers them to distributed nodes. By designing each aligning procedure into separate map and reducing tasks while an internal key-value structure is optimized based on the MapReduce programming model, the algorithm significantly improves alignment performance without sacrificing mapping accuracy. In addition, Cloud-BS minimizes the innate burden of configuring a distributed environment by providing a pre-configured cloud image. Cloud-BS shows significantly improved bisulfite alignment performance compared to other existing BS-seq aligners. We believe our algorithm facilitates large-scale methylome data analysis. The algorithm is freely available at https://paryoja.github.io/Cloud-BS/ .
A novel graph kernel on chemical compound classification
Authors: Jiang Qiangrong , Ma Jiajia
Published: October 2018

Considering the classification of compounds as a nonlinear problem, the use of kernel methods is a good choice. Graph kernels provide a nice framework combining machine learning methods with graph theory, whereas the essence of graph kernels is to compare the substructures of two graphs, how to extract the substructures is a question. In this paper, we propose a novel graph kernel based on matrix named the local block kernel, which can compare the similarity of partial substructures that contain any number of vertexes. The paper finally tests the efficacy of this novel graph kernel in comparison with a number of published mainstream methods and results with two datasets: NCI1 and NCI109 for the convenience of comparison.
Fidelity-based measurement-induced nonlocality over two-sided measurements
Authors: Muthuganesan R. , Sankaranarayanan R.
Published: October 2018

In this paper, we introduce fidelity-based measurement-induced nonlocality for bipartite quantum state to capture the nonlocal effects due to two-sided von Neumann projective measurements. We identify that all the properties of this quantity are reflected from that of One-sided measurement. We compute this quantity for arbitrary pure and mixed bipartite states. As an illustration, we have studied the nonlocality of Bell diagonal state.
A Tour of My Soft Matter Garden: From Shining Globules and Soap Bubbles to Cell Aggregates
Authors: Brochard-Wyart Françoise
Published: October 2018

Like The Magic Flute, my career has been paved by wonderful and unexpected stories played by enthusiastic and talented students, in close contact with experiments and industry. I participated in the birth of soft matter physics under the impulse of Pierre-Gilles de Gennes: polymers, liquid crystals, colloids, and wetting, which I later applied to the study of living matter. By teaching in the early days at the Institut Universitaire de Technologies d'Orsay, I came into contact with industry, which gave me the chance to collaborate with several companies: Rhône-Poulenc, Dior, Saint-Gobain, Rhodia, and Michelin. These partners have not only largely financed my research in physical chemistry but they also offered a wealth of innovative research topics. In 1996, when Professor Jacques Prost became the director of the Physico-Chimie Curie laboratory, in the Pavillon Curie built for Marie Curie, I turned to biophysics. I initiated collaborations with biologists, applying soft matter physics to the mechanics of cells and tissues. Pierre-Gilles de Gennes has been a wonderful guide throughout this scientific adventure to build my soft matter garden.
New Hope for Therapeutic Cancer Vaccines in the Era of Immune Checkpoint Modulation
Authors: Curran Michael A. , Glisson Bonnie S.
Published: October 2018

The driver and passenger mutations accumulated in the process of malignant transformation offer an adequate spectrum of immune visible alterations to the cellular proteome and resulting peptidome to render these cancers targetable—and, in theory, rejectable—by the host T cell immune response. In addition, cancers often overexpress tissue-specific and developmental antigens to which immune tolerance is incomplete. Sometimes, virally transferred oncogenes drive malignant transformation and remain expressed throughout the cancer. Despite this state of antigenic sufficiency, cancer grows progressively and overcomes all efforts of the host immune system to contain it. While therapeutic cancer vaccination can mobilize high frequencies of tumor-specific T cells, these responses remain subject to intratumoral attenuation. Antibody modulation of T cell function through checkpoint blockade or costimulatory activation can restore survival, proliferation, and effector function to these tumor-infiltrating T cells and convert otherwise subtherapeutic vaccines into potentially curative cancer immunotherapeutics.
Unexpected Roles for the Second Brain: Enteric Nervous System as Master Regulator of Bowel Function
Authors: Schneider Sabine , Wright Christina M. , Heuckeroth Robert O.
Published: October 2018

At the most fundamental level, the bowel facilitates absorption of small molecules, regulates fluid and electrolyte flux, and eliminates waste. To successfully coordinate this complex array of functions, the bowel relies on the enteric nervous system (ENS), an intricate network of more than 500 million neurons and supporting glia that are organized into distinct layers or plexi within the bowel wall. Neuron and glial diversity, as well as neurotransmitter and receptor expression in the ENS, resembles that of the central nervous system. The most carefully studied ENS functions include control of bowel motility, epithelial secretion, and blood flow, but the ENS also interacts with enteroendocrine cells, influences epithelial proliferation and repair, modulates the intestinal immune system, and mediates extrinsic nerve input. Here, we review the many different cell types that communicate with the ENS, integrating data about ENS function into a broader view of human health and disease. In particular, we focus on exciting new literature highlighting relationships between the ENS and its lesser-known interacting partners.
Physiological and behavioral reactivity to social exclusion: a functional infrared thermal imaging study in patients with psoriasis
Authors: Ponsi Giorgia , Monachesi Bianca , Panasiti Vincenzo , Aglioti Salvatore Maria , Panasiti Maria Serena
Published: October 2018

Recent studies have shown that sympathetic nervous system (SNS) activity can be heavily impacted not only by basic threats to survival but also by threats to social bonds. In this study we explored the behavioral and physiological consequences of social exclusion/inclusion in patients with psoriasis, a disease frequently associated with the experience of being ostracized and with deficient emotion regulation skills. We employed a virtual ball-tossing game (Cyberball) to induce the experience of social exclusion/inclusion. We then used a Trust Game to measure the effects of this social modulation on trust. During Cyberball, infrared thermal imaging was used to record participants’ facial temperature and thus obtain an online measure of SNS activation. Behavioral data showed that social exclusion shifted participants’ trust toward unfamiliar players who had not previously excluded them. Physiological data indicated that in control participants, social exclusion triggered higher SNS activation than inclusion. No such effect was found in patients with psoriasis, whose SNS activity was the same during inclusion as it was during exclusion, suggesting that they benefit less from inclusive experiences than control participants. In addition, in patients but not in controls, higher SNS activation during social exclusion was linked to higher monetary investment toward unfamiliar players, a result in keeping with the social reconnection hypothesis, according to which emotions triggered by social rejection can be regulated by investing in new social interactions. We also found that an increase in periorbital temperature is accompanied by a decrease in happiness ratings after social exclusion was experienced during the Cyberball game.

NEW & NOTEWORTHY Previous research on emotional processes in psoriasis has mainly employed self-report measures. In this study we used thermal imaging to obtain an online measure of the sympathetic nervous system (SNS) activity during social exclusion and tested how this experience influenced subsequent trust. We found that being included was a less positive experience for patients compared with controls and that SNS activity during exclusion had a stronger influence on subsequent trust in patients than in controls.
A Comparative Study of 0.25% Levobupivacaine, 0.25% Ropivacaine, and 0.25% Bupivacaine in Paediatric Single Shot Caudal Block
Authors: Sharma Jagdeep , Gupta Ruchi , Kumari Anita , Mahajan Lakshmi , Singh Jasveer
Published: October 2018

Aim. There are limited data comparing levobupivacaine, ropivacaine, and bupivacaine in paediatric patients. So, this study was performed to evaluate the caudal effectiveness of all the three drugs in paediatric patients undergoing infraumbilical surgeries and associated complications with these drugs. Material and Methods. 90 patients of ASA grade I and II posted for elective infraumbilical surgeries were randomly divided into three groups of 30 each. A standardized anaesthetic protocol was used. Patients received 0.25% levobupivacaine in group 1, 0.25% ropivacaine in group 2, and 0.25% bupivacaine in group 3. The effectiveness of block was assessed using caudal effectiveness score. Postoperative pain relief was assessed with modified Hannallah pain score. Haemodynamic parameter monitoring was done. The duration of analgesia and associated complications were studied. Statistical analysis was done using the chi-square test for nonparametric data. Parametric data were analysed using ANOVA for intergroup comparison and Tukey’s HSD for intragroup comparison. Results. Demographic data were comparable. Haemodynamic parameters remained within normal range. Mean caudal effectiveness score in all the three groups was statistically insignificant (p>0.05). The duration of analgesia provided by bupivacaine (145.31 ± 26.17 min) was longer than levobupivacaine (126.15 ± 15.15 min) and ropivacaine (114.68 ± 11.32 min) (p<0.01). Mean postoperative pain scores were lower in group 3 as compared to group 1 and group 2. Conclusion. We conclude that levobupivacaine and ropivacaine provide similar intraoperative quality with minimal haemodynamic variability and shorter duration of postoperative analgesia without any significant complications when compared with racemic bupivacaine. This trial is registered with CTRI/2018/03/012402.
Clinical Overview of GIST and Its Latest Management by Endoscopic Resection in Upper GI: A Literature Review
Authors: Marcella Cicilia , Shi Rui Hua , Sarwar Shakeel
Published: October 2018

Aims. To review the clinical presentation, diagnosis, assessment of risk of malignancy, and recent advances in management (mainly focusing on the role of endoscopic resection) of gastrointestinal stromal tumors (GISTs) in upper GI.Method. We searched Embase, Web of science, and PubMed databases from 1993 to 2018 by using the following keywords: “gastrointestinal stromal tumors,” “GIST,” “treatment,” and “diagnosis.” Additional papers were searched manually from references of the related articles.Findings. The improvement of endoscopic techniques in treating upper gastrointestinal subepithelial tumors especially gastrointestinal tumors has reduced the need for invasive surgery in patients unfit for surgery. Many studies have concluded that modified endoscopic treatments are effective and safe. These treatments permit minimal tissue resection, better dissection control, and high rates of en bloc resection with an acceptable rate of complications.
Computational Fluid Dynamics Modeling of Respiratory Airflow in Tracheobronchial Airways of Infant, Child, and Adult
Authors: Tsega Endalew Getnet
Published: October 2018

During human growth and development from infancy to adulthood, dramatic changes occur in the respiratory system. It is important to understand respiratory airflow in different age groups in age-specific treatment of respiratory disorders. This study numerically investigated the age-related effects on inspiratory and expiratory airflow dynamics in four-generation lung airway models under normal breathing conditions. Tracheobronchial airway models of infant (6 month old), child (5 years old), and adult (25 years old) from sixth to ninth generations were constructed for the study. Computational fluid dynamics (CFD) was used to solve the equations governing the airflow. Results of this study indicate that as age increases, airflow velocity, pressure, and wall shear stress decrease for both inspiration and expiration in this particular subregion of the respiratory tract. During inspiration, the splitting of velocity streamlines at bifurcations increases with age. The opposite situation merging happens during expiration, and it also increases with age. The level of splitting and merging of streamlines here reflects the influence of respiratory mechanics in the age groups. The computational models provide new information on characteristics and patterns of age-dependent respiratory airflow in the sixth to ninth generations of tracheobronchial airways and can be applied in other generations.
How Not to Be Turned into a Zombie
Authors: Catania Kenneth C.
Published: October 2018

The emerald jewel wasp (Ampulex compressa) is renowned for its ability to zombify the American cockroach (Periplaneta americana) with a sting to the brain. When the venom takes effect, the cockroach becomes passive and can be led by its antenna into a hole, where the wasp deposits an egg and then seals the exit with debris. The cockroach has the ability to walk, run, or fly if properly stimulated, but it does not try to escape as it is slowly eaten alive by the developing wasp larva. Although the composition and effects of the wasp’s venom have been investigated, no studies have detailed how cockroaches might prevent this grim fate. Here it is shown that many cockroaches deter wasps with a vigorous defense. Successful cockroaches elevated their bodies, bringing their neck out of reach, and kicked at the wasp with their spiny hind legs, often striking the wasp’s head multiple times. Failing this, the elevated, “on-guard” position allowed cockroaches to detect and evade the wasp’s lunging attack. If grasped, the cockroaches parried the stinger with their legs, used a “stiff-arm” defense to hold back the stinger, and could stab at, and dislodge, the wasp with tibial spines. Lastly, cockroaches bit at the abdomen of wasps delivering the brain sting. An aggressive defense from the outset was most successful. Thus, for a cockroach not to become a zombie, the best strategy is: be vigilant, protect your throat, and strike repeatedly at the head of the attacker.
Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification
Authors: Li Jiahui , Li Aili , Wang Jiali , Zhang Yu , Zhou Ying
Published: October 2018

Purpose: Cardiac valve calcification (VC) is very common in patients on hemodialysis. However, the definite effect of VC on left ventricular (LV) geometry and function in this population is unknown, especially when LV ejection fraction (LVEF) is normal. The aim of this study was to determine the effect of VC on LV geometry and function in long-term hemodialysis patients by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). Methods: A total of 47 hemodialysis patients (2–3 times weekly for 5 years or more) were enrolled in this study. Cardiac VC was defined as bright echoes of more than 1 mm on one or more cusps of the aortic valve or mitral valve or mitral annulus using echocardiography as the screening method. LV longitudinal global strain (GLS) was assessed on the apical four-chamber view and calculated as the mean strain of 6 segments. LV global circumferential strain was acquired on the LV short axis view at the level of papillary muscles. Results: Twenty-five patients with VC had higher mean values of interventricular septum thickness, LV posterior wall thickness, LV mass index, relative wall thickness, and LV mass/end-diastolic volume than 22 patients without VC (p < 0.05, respectively), indicating more obvious LV hypertrophy (LVH). VC patients had higher mitral annular E/E′ values, especially at the septal side representing increased LV filling pressure compatible with diastolic dysfunction, while only the E/E′ ratio of the septal side was significantly different between the 2 groups (16.7 ± 4.1 vs. 12.3 ± 4.4, p < 0.01). When assessed by GLS, LV longitudinal systolic function was also lower in in patients with VC compared with those without VC (–0.18 ± 0.03 vs. –0.25 ± 0.04; p < 0.01). Conclusions: Cardiac VC diagnosed by echocardiography when it occurs in long-term hemodialysis patients may indicate more severe LVH, myocardial damage, and worse heart function in comparison to those without VC. Tissue Doppler imaging and 2D-STE can detect the subtle change of heart function in this population in the early stage of LV dysfunction when LVEF is normal.
The Impact of Upward versus Downward Movement Patterns on Memory Characteristics of Depressed Individuals
Authors: Michalak Johannes , Chatinyan Ani , Chourib Helena , Teismann Tobias
Published: October 2018

Background/Aims: Basic research on embodiment has demonstrated that manipulating the motoric system has broad effects on cognitive and emotional processes. The aim of the present study was to investigate the effects of an embodiment manipulation on the affective memory bias and specificity of autobiographic memories of depressed individuals. Methods: Forty currently depressed patients practiced either an upward-opening Qi Gong movement, which runs counter to the habitual slumped and downward depressive movement style, or a downward-closing Qi Gong movement. They were required to retrieve specific personal memories to positive or negative cue words during movement. Moreover, an incidental recall of the cue words was conducted. Results: Patients in the upward-opening movement condition in contrast to the downward-closing movement condition showed a more positively biased recall of affective words and recalled more specific autobiographical memories. Conclusions: Results indicate that the motoric system and key maintaining cognitive factors in depressive disorders are closely interrelated.
Perforated Meckel’s Diverticulum in an Adult
Authors: Camelo Rita , Santos Paula , Mateus Marques Rui
Published: October 2018

Meckel’s diverticulum is the commonest congenital anomaly of the gastrointestinal tract. Its complications have an extensive variety of clinical and imaging manifestations, extending from benign and indolent findings to acute life-threatening conditions. Complicated Meckel’s diverticulum often constitutes a challenging diagnosis for both the clinician and the radiologist. Therefore, imaging techniques play an important role in this condition in evaluating its complications, determining decision making. We describe a case of a 49-year-old man suffering from right abdominal pain with fever and constipation, during the past 5 days. Laboratory data revealed C-reactive protein of 306 mg/L and leukocytosis. Contrast-enhanced CT features were highly suggestive of perforated Meckel’s diverticulum. The purpose of this article is to emphasize that besides its rarity, Meckel’s diverticulum complications can occur in adult patients.
The Effect of the MicroRNA-183 Family on Hair Cell-Specific Markers of Human Bone Marrow-Derived Mesenchymal Stem Cells
Authors: Mahmoudian-Sani Mohammad-Reza  , Jami Mohammad-Saeid , Mahdavinezhad Ali , Amini Razieh , Farnoosh Gholamreza  , Saidijam Massoud
Published: October 2018

Hearing loss is considered the most common sensory disorder across the world. Nowadays, a cochlear implant can be an effective treatment for patients. Moreover, it is often believed that sensorineural hearing loss in humans is caused by loss or disruption of the function of hair cells in the cochlea. In this respect, mesenchymal cells can be a good candidate for cell-based therapeutic approaches. To this end, the potential of human bone marrow-derived mesenchymal stem cells to differentiate into hair cells with the help of transfection of microRNA in vitro was investigated. MicroRNA mimics (miRNA-96, 182, and 183) were transfected to human bone marrow-derived mesenchymal stem cells using Lipofec­tamine as a common transfection reagent following the manufacturer’s instructions at 50 nM for microRNA mimics and 50 nM for the scramble. The changes in cell morphology were also observed under an inverted microscope. Then, the relative expression levels of SOX2, POU4F3, MYO7A, and calretinin were assayed using real-time polymerase chain reaction according to the ΔΔCt method. The ATOH1 level was similarly measured via real-time polymerase chain reaction and Western blotting. The results showed that increased expression of miRNA-182, but neither miRNA-96 nor miRNA-183, could lead to higher expression levels in some hair cell markers. The morphology of the cells also did not change in this respect, but the evaluation of gene expression at the levels of mRNA could promote the expression of the ATOH1, SOX2, and POU4F3 markers. Furthermore, miRNA-182 could enhance the expression of ATOH1 at the protein level. According to the results of this study, it was concluded that miRNA-182 could serve as a crucial function in hair cell differentiation by the upregulation of SOX2, POU4F3, and ATOH1 to promote a hair cell’s fate.
Preoperative Timing of Intravitreal Bevacizumab Injection for Proliferative Diabetic Retinopathy Patients
Authors: Feng Jing , Li Bing , Wen Jing , Jiang Yanrong
Published: October 2018

Objective: To evaluate the changes in aqueous concentrations of inflammatory cytokines and fibrosis-related factors, and to detect the expression of vascular endothelial growth factor (VEGF) and proliferating cells in fibrovascular membranes (FVMs) of patients with proliferative diabetic retinopathy (PDR) after injection of intravitreal bevacizumab (IVB). Methods: Forty-two eyes of 42 patients with PDR, including 28 eyes that received IVB (1.25 mg) 2, 5, and 14 days before pars plana vitrectomy (PPV), and 14 eyes without IVB, were enrolled, in addition to 10 eyes of 10 patients with nondiabetic ocular diseases. Aqueous concentrations of inflammatory cytokines and fibrosis-related factors were analyzed by a multiplex bead assay. Fluorescence immunostaining was performed to examine the expression of VEGF and proliferating cells in the excised epiretinal membranes. Results: PDR eyes without IVB had the highest vitreous VEGF levels, and the level was statistically significant compared with that of PDR eyes that received IVB 2 days before surgery, PDR eyes that received IVB 5 days before surgery, and nondiabetic eyes (p = 0.011, p = 0.012, and p < 0.001, respectively). The expression of fibroblastic cells and connective tissue growth factor increased in epiretinal FVMs of the IVB group 21 days after treatment. Conclusions: IVB injection may lead to a decrease in the intraocular concentrations of VEGF after 2–5 days and induce the formation of proliferation after 21 days, which suggests that PPV in PDR patients should take place within 1 week of the administration of preoperative IVB.
Acute Liver Failure with Diffuse Liver Metastasis from Breast Cancer, Not Detected by Computed Tomography: 2 Case Reports
Authors: Ogata Takatsugu , Kikawa Yuichiro , Ogata Misato , Satake Hironaga , Hatachi Yukimasa , Yasui Hisateru
Published: October 2018

Diffuse liver metastasis is a rare pattern of liver metastasis that is associated with hepatic failure and poor prognosis. We experienced 2 cases of acute liver failure due to diffuse metastasis that could not be detected using computed tomography. In case 1, it was difficult to differentiate diffuse metastasis from alcoholic hepatitis. In case 2, it was difficult to diagnose diffuse liver metastasis because the patient had no history of malignancy. When liver enzyme levels are elevated, it is necessary to consider liver metastasis as a potential cause, regardless of computed tomography findings.
Onychomatricoma of the Nail Bed
Authors: Mello Cristina Diniz Borges Figueira , Noriega Leandro Fonseca , Gioia Di Chiacchio Nilton , Ocampo-Garza Jorge , Di Chiacchio Nilton
Published: October 2018

Onychomatricoma is a rare and specific benign tumor of the nail complex, with uncertain etiology. The avulsion of the nail plate reveals cavitations and orifices in its proximal extremity. These are associated with villous tumor formations generating digitiform projections at the nail matrix – typical intraoperative findings. We report a rare case of onychomatricoma in which the nail bed was predominantly affected and show evidence of its clinical, intraoperative, and histopathological presentation. The various descriptions of the disease report that its origin is restricted to the nail matrix, leading to secondary changes in the nail plate.
Angiotensin II Type I Receptor Agonistic Autoantibody Induces Podocyte Injury via Activation of the TRPC6- Calcium/Calcineurin Pathway in Pre-Eclampsia
Authors: Yu Ying , Zhang Lihong , Xu Guang , Wu Zhenghong , Li Qian , Gu Yong , Niu Jianying
Published: October 2018

Background/Aims: Angiotensin II type I receptor agonistic autoantibody (AT1-AA) is closely related to pre-eclampsia, which is characterized by proteinuria and hypertension. AT1-AA has been shown to enhance the effect of AngII in pre-eclampsia, such as production of endothelin-1, activation of ROS, and vasoconstriction, which are considered to be associated with hypertension; however, whether or not AT1-AA participates in podocyte damage leading to the generation of proteinuria has not been reported. In this study we investigated the role of pre-eclamptic serum AT1-AA on podocytes and the mechanism underlying the generation of proteinuria. Methods: The levels of AT1-AA isolated from pre-eclamptic sera were determined by an enzyme-linked immunosorbent assay. Human podocytes were cultured in vitro and treated with various concentrations of AT1-AA. Whether or not an ERK1/2 inhibitor and TRPC6 siRNA inhibit the effect of AT1-AA on podocytes was determined. Western blot was used to detect the expression of podocyte-specific proteins (nephrin, synaptopodin, and podocin) and the phosphorylation of ERK1/2 and TRPC6. The arrangement of F-actin was observed by immunofluorescence. A Calcineurin Cellular Activity Assay Kit was used to detect calcineurin activity. Changes in the intracellular Ca2+ concentration was determined by confocal laser. Results: AT1-AA induced a decrease in podocyte-specific protein expression and calcineurin activity and increased expression of p-ERK1/2 and TRPC6 protein and the intracellular Ca2+ concentration. Immunofluorescence revealed rearrangement of F-actin. PD98059, an inhibitor of ERK1/2, and TRPC6 siRNA attenuated the decreased expression of podocyte-specific proteins and decreased intracellular Ca2+ concentration. The expression of TRPC6 was reduced following the addition of ERK1/2 inhibitor. Conclusion: AT1-AA induced podocyte damage in a dose-dependent manner. The underlying mechanism might involve activation of the TRPC6 –calcium/calcineurin pathway. This study provides new details regarding podocyte injury and the mechanism underlying the generation of proteinuria in pre-eclampsia.