bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of von Willebrand Disease in the South Moravian Population (Czech Republic): Results from the BRNO-VWD Study
Authors: Vangenechten Inge , Smejkal Petr , Zapletal Ondrej , Michiels Jan Jacques , Berneman Zwi , Zavrelova Jiri , Blatný Jan , Penka Miroslav , Gadisseur Alain
Published: February 2019

Background von Willebrand disease (VWD) is an inherited bleeding disorder caused by a quantitative (type 1 and 3) or qualitative (type 2) defect of von Willebrand factor (VWF). The heterogeneity of laboratory phenotyping makes diagnosing difficult.

Objective A cross-sectional, family-based VWD study in a collaboration between University Hospital Brno (Czech Republic) and Antwerp University Hospital (Belgium) to improve the understanding of laboratory phenotype/genotype correlation.

Patients and Methods A total of 205 patients with suspected VWD were identified from historical records. Complete laboratory analysis was established using all available VWD assays including VWF multimers and genetic analysis.

Results Based on the current International Society of Thrombosis and Haemostasis (ISTH) – Scientific and Standardization Committee VWD classification and type 2A sub-division into 2A/IIA, IID, IIC and IIE, the majority was characterized as a type 1 VWD, followed by type 2. Proposed laboratory phenotypes were confirmed by their multimeric pattern within 98% of this cohort. All type 2, 3 and 75% of type 1 VWD patients were confirmed by underlying causative mutations. Forty-six different causal mutations (117 not previously described in the literature) could be identified. Fifty per cent of all cases was represented by eight individual mutations, mainly p.Pro812ArgfsX31. Thirteen patients had a large heterozygous gene alteration.

Conclusion Although an extensive panel of tests was used, VWD classification and (sub)typing remains difficult and fluid. This study provides a cross-sectional overview of the VWD population in the Czech Republic and provides important data to the ISTH/European Association for Haemophilia and Allied Disorders VWD mutation database in linking causal mutations with unique VWD (sub)types. It also identifies new, as not previously described in the literature, causal mutations.
Entanglement rates for Rényi, Tsallis, and other entropies
Authors: Vershynina Anna
Published: February 2019

We provide an upper bound on the maximal entropy rate at which the entropy of the expected density operator of a given ensemble of two states changes under nonlocal unitary evolution. A large class of entropy measures in considered, which includes Rényi and Tsallis entropies. The result is derived from a general bound on the trace-norm of a commutator, which can be expected to find other implementations. We apply this result to bound the maximal rate at which quantum dynamics can generate entanglement in a bipartite closed system with Rényi and Tsallis entanglement entropies taken as measures of entanglement in the system.
Study on bright-dim hollow hexagonal superlattice pattern in dielectric barrier discharge
Authors: Li Caixia , Dong Lifang , Feng Jianyu , Huang Yongping
Published: February 2019

We report on the investigation of the bright-dim hollow hexagonal superlattice pattern (BDHHSP) in dielectric barrier discharge (DBD) for the first time. It bifurcates from a hexagon pattern as the applied voltage increases. The spatiotemporal structure investigated by using an intensified charge device and a lens-aperture photomultiplier tube system shows that the BDHHSP is an interleaving of three different sub-lattices, which are bright spots, dim spots, and halos, respectively, and dim spots are located at the center of the triangle formed by three bright spots. But not all the centers of each triangle have a dim spot. The formation mechanism of the phenomenon called selectively insert discharge is discussed. The results have significance for the selective mechanism of discharge position in the DBD system.
Random surface statistical associating fluid theory: Adsorption of n-alkanes on rough surface
Authors: Aslyamov Timur , Pletneva Vera , Khlyupin Aleksey
Published: February 2019

Adsorption properties of chain fluids are of interest from both fundamental and industrial points of view. Density Functional Theory (DFT) based models are among the most appropriate techniques allowing to describe surface phenomena. At the same time, Statistical Associating Fluid Theory (SAFT) successfully describes bulk pressure-volume-temperature properties of chain-fluids. In this study, we have developed a novel version of the SAFT-DFT approach entitled Random Surface (RS)-SAFT which is capable of describing adsorption of short hydrocarbons on geometrically rough surfaces. A major advantage of our theory is the application to adsorption on natural rough surfaces with normal and lateral heterogeneity. For this reason, we have proposed a workflow where the surface of a real solid sample is analyzed using a theoretical approach developed in our previous work [T. Aslyamov and A. Khlyupin, J. Chem. Phys. 147, 154703 (2017)] and experimentally by means of low temperature adsorption isotherm measurements for simple fluids. As a result, RS-SAFT can predict adsorption properties of chain fluids taking into account the geometry of the surface sample under consideration. In order to test our workflow, we have investigated hexane adsorption on carbon black with the initially unknown geometry. Theoretical predictions for hexane adsorption at 303 K and 293 K fit corresponding experimental data well.
Phonon scattering processes in molybdenum disulfide
Authors: Cao Zi-Yu , Chen Xiao-Jia
Published: February 2019

Compared with graphene, 2H-MoS2 possesses a non-zero bandgap and thus has an unlimited potential for electronic, spintronic, and optoelectronic applications. Understanding of the phonon scattering mechanisms is crucial to its device applications because the heat flow and transport are the basic processes functioning at various temperatures. So far, the knowledge of the phonon anharmonicity of 2H-MoS2 is limited due to the availability from a narrow temperature range and the absence of the low frequency phonon information. Here, we report an experimental study on the temperature dependence of the frequency and linewidth of 2H-MoS2 by Raman scattering over a wide temperature range from 2.2 to 1000 K and down to the wavenumber of 10 cm−1. The cubic anharmonicity is found to be dominant at low temperatures, and quartic anharmonicity predominates at high temperatures. The obtained shear mode seems insensitive to the anharmonic effects. The damping effects are discussed based on the available experimental data. These phonon scattering behaviors of 2H-MoS2 are of great help to the future nanodevice developments and applications.
Robustness of partially interdependent networks under combined attack
Authors: Liu Yangyang , Zhao Chengli , Yi Dongyun , Eugene Stanley H.
Published: February 2019

We thoroughly study the robustness of partially interdependent networks when suffering attack combinations of random, targeted, and localized attacks. We compare analytically and numerically the robustness of partially interdependent networks with a broad range of parameters including coupling strength, attack strength, and network type. We observe the first and second order phase transition and accurately characterize the critical points for each combined attack. Generally, combined attacks show more efficient damage to interdependent networks. Besides, we find that, when robustness is measured by the critical removing ratio and the critical coupling strength, the conclusion drawn for a combined attack is not always consistent.
Reaction of Australian durum, common wheat and triticale genotypes to Karnal bunt (Tilletia indica) infection under artificial inoculation in the field
Authors: Emebiri Livinus , Singh Pawan K. , Tan Mui Keng , Fuentes-Davila Guillermo , He Xinyao , Singh Ravi P.
Published: February 2019

Karnal bunt is a seedborne disease of wheat caused by the fungus Tilletia indica Mitra and is a major biosecurity threat for the Australian wheat industry. Host-plant resistance is an effective means of controlling this disease. This study has identified Australian wheat genotypes with durable resistance should the pathogen enter Australia and become established. These genotypes provide a basis for breeding adapted genotypes that can be recommended for growers. In the study, 196 genotypes comprising 177 common (bread) wheat (hexaploid, Triticum aestivum), eight durum (tetraploid, T. durum) and 11 triticale (× Triticosecale) genotypes were evaluated in the field for their reaction to infection by the fungus. Six experiments were carried out at CIMMYT’s research station at Obregon, Mexico, during three consecutive cropping seasons (2014–15, 2015–16 and 2016–17) and at two planting dates. In each experiment, the genotypes were screened for resistance to Karnal bunt by injecting an inoculum suspension with a hypodermic syringe into the boot at awn emergence. Disease incidence averaged 14.7% infection in 2015, 21.7% in 2016 and 25.6% in 2017. Resistant triticale genotypes, Tuckerbox, Berkshire and Hawkeye, were identified, along with three resistant wheat genotypes, Batavia, Pelsart and RAC-655, and two moderately resistant durum genotypes, Hyperno and Saintly. Stability analysis showed that RAC-655, Hyperno, Tuckerbox and Berkshire were consistently resistant to infection in different seasonal conditions and unaffected by the environment.
Effect of stubble height and irrigation management on the growth, botanical composition and persistence of perennial ryegrass, tall fescue and chicory swards in cool-temperate Tasmania
Authors: Langworthy Adam D. , Rawnsley Richard P. , Freeman Mark J. , Corkrey Ross , Pembleton Keith G. , Harrison Matthew T. , Lane Peter A. , Henry David A.
Published: February 2019

The profitability of dairying in south-eastern Australia can be improved by increasing pasture production during summer–autumn, when growth rates for the existing perennial ryegrass (Lolium perenne L.) feedbase are low. A study undertaken in cool-temperate north-west Tasmania examined the effect of stubble height and irrigation management on swards of perennial ryegrass, continental (summer-active) tall fescue (Festuca arundinacea Schreb.) and chicory (Cichorium intybus L.). Irrigation treatments included full irrigation (~20mm applied at every 20mm precipitation deficit), deficit irrigation (~20mm applied at alternate full-irrigation events) and rainfed (no irrigation). All species achieved greater summer–autumn yields when repeatedly defoliated to stubble heights of 35 or 55mm than when defoliated to 115mm, irrespective of irrigation treatment. Swards were managed under a common defoliation schedule of nine defoliation events in 12 months. Under full irrigation, second-year tall fescue achieved a greater summer–autumn yield than perennial ryegrass (by 10%, or 0.7 t DM ha–1), highlighting the potential role of tall fescue in north-west Tasmania. This was further demonstrated by the high marginal irrigation water-use index values (1.6–2.7 t DM ML–1) of tall fescue. By contrast, summer–autumn growth achieved by chicory was less than or equal to perennial ryegrass.
Citizen science frontiers: Efficiency, engagement, and serendipitous discovery with human–machine systems
Authors: Trouille Laura , Lintott Chris J. , Fortson Lucy F.
Published: February 2019

Citizen science has proved to be a unique and effective tool in helping science and society cope with the ever-growing data rates and volumes that characterize the modern research landscape. It also serves a critical role in engaging the public with research in a direct, authentic fashion and by doing so promotes a better understanding of the processes of science. To take full advantage of the onslaught of data being experienced across the disciplines, it is essential that citizen science platforms leverage the complementary strengths of humans and machines. ThisPerspectivespiece explores the issues encountered in designing human–machine systems optimized for both efficiency and volunteer engagement, while striving to safeguard and encourage opportunities for serendipitous discovery. We discuss case studies from Zooniverse, a large online citizen science platform, and show that combining human and machine classifications can efficiently produce results superior to those of either one alone and how smart task allocation can lead to further efficiencies in the system. While these examples make clear the promise of human–machine integration within an online citizen science system, we then explore in detail how system design choices can inadvertently lower volunteer engagement, create exclusionary practices, and reduce opportunity for serendipitous discovery. Throughout we investigate the tensions that arise when designing a human–machine system serving the dual goals of carrying out research in the most efficient manner possible while empowering a broad community to authentically engage in this research.
Enabling creative collaboration for all levels of learning
Authors: Kim Youngmoo E. , Morton Brandon G. , Gregorio Jeff , Rosen David S. , Edouard Kareem , Vallett Richard
Published: February 2019

A potential path for enabling greater creativity and collaboration is through increased arts and science, technology, engineering, and mathematics (STEM) integration in education and research. This approach has been a growing discussion in US national forums and is the foundation of the science, technology, engineering, and mathematics plus arts and design (STEAM) education movement. Developing authentic artistic integrations with STEM fields (or vice versa) is challenging, particularly in higher education, where traditional disciplinary structures and incentives can impede the creation of integrated programs. Measuring and assessing the outcomes of such integration efforts can be even more challenging, since traditional metrics do not necessarily capture new opportunities created for students and faculty, and the greatest impact may occur over a long period (a career). At Drexel University, we created the Expressive & Creative Interaction Technologies (ExCITe) Center as a standalone institute to pursue and enable such transdisciplinary arts–STEM collaborations, particularly with external arts and education partners. In this perspectives paper, we highlight a range of projects and outcomes resulting from such external collaborations, including graduate research with professional artists, undergraduate student work experiences, and STEAM-based education programs for kindergarten through 12th-grade (K-12) students. While each project has its own specific objectives and outcomes, we believe that they collectively demonstrate this integrated transdisciplinary approach to be impactful and potentially transformative for all levels of learning.
Monarch butterfly and milkweed declines substantially predate the use of genetically modified crops
Authors: Boyle J. H. , Dalgleish H. J. , Puzey J. R.
Published: February 2019

Monarch butterfly (Danaus plexippus) decline over the past 25 years has received considerable public and scientific attention, in large part because its decline, and that of its milkweed (Asclepiasspp.) host plant, have been linked to genetically modified (GM) crops and associated herbicide use. Here, we use museum and herbaria specimens to extend our knowledge of the dynamics of both monarchs and milkweeds in the United States to more than a century, from 1900 to 2016. We show that both monarchs and milkweeds increased during the early 20th century and that recent declines are actually part of a much longer-term decline in both monarchs and milkweed beginning around 1950. Herbicide-resistant crops, therefore, are clearly not the only culprit and, likely, not even the primary culprit: Not only did monarch and milkweed declines begin decades before GM crops were introduced, but other variables, particularly a decline in the number of farms, predict common milkweed trends more strongly over the period studied here.
SraL sRNA interaction regulates the terminator by preventing premature transcription termination of
rho
mRNA
Authors: Silva Inês Jesus , Barahona Susana , Eyraud Alex , Lalaouna David , Figueroa-Bossi Nara , Massé Eric , Arraiano Cecília Maria
Published: February 2019

Transcription termination is a critical step in the control of gene expression. One of the major termination mechanisms is mediated by Rho factor that dissociates the complex mRNA-DNA-RNA polymerase upon binding with RNA polymerase. Rho promotes termination at the end of operons, but it can also terminate transcription within leader regions, performing regulatory functions and avoiding pervasive transcription. Transcription of
rho
is autoregulated through a Rho-dependent attenuation in the leader region of the transcript. In this study, we have included an additional player in this pathway. By performing MS2-affinity purification coupled with RNA sequencing (MAPS),
rho
transcript was shown to directly interact with the small noncoding RNA SraL. Using bioinformatic in vivo and in vitro experimental analyses, SraL was shown to base pair with the 5′-UTR of
rho
mRNA upregulating its expression in several growth conditions. This base pairing was shown to prevent the action of Rho over its own message. Moreover, the results obtained indicate that both ProQ and Hfq are associated with this regulation. We propose a model that contemplates the action of
Salmonella
SraL sRNA in the protection of
rho
mRNA from premature transcription termination by Rho. Note that since the interaction region between both RNAs corresponds to a very-well-conserved sequence, it is plausible to admit that this regulation also occurs in other enterobacteria.
Increased gene copy number of
DEFA1/DEFA3
worsens sepsis by inducing endothelial pyroptosis
Authors: Chen QiXing , Yang Yang , Hou JinChao , Shu Qiang , Yin YiXuan , Fu WeiTao , Han Feng , Hou TingJun , Zeng CongLi , Nemeth Elizabeta , Linzmeier Rose , Ganz Tomas , Fang XiangMing
Published: February 2019

Significance

Genetic copy number variations (CNVs) are the most common mechanism of structural genetic diversity, playing a key role in human health and common diseases. However, because of a lack of relevant experimental models, little is known about how rare CNVs contribute to the risk of complex phenotypes. We show that transgenic mice with high copy number of
DEFA1/DEFA3
[encoding human neutrophil peptides 1–3 (HNP1–3)] suffer from more severe sepsis because of more extensive endothelial barrier dysfunction and endothelial cell pyroptosis. Functional blockade of HNP1–3 rescues the mice from lethal sepsis. These findings exemplify how CNVs modulate disease development in appropriate animal models and explore a paradigm for the precision treatment of sepsis tailored by individual genetic information.
Structural hierarchy confers error tolerance in biological materials
Authors: Michel Jonathan A. , Yunker Peter J.
Published: February 2019

Significance

Structural hierarchy is ubiquitous in nature and an emerging trend in engineered materials. Despite their many virtues, hierarchical materials also add complexity and dramatically increase the opportunities for random errors in assembly. Nonetheless, highly hierarchical tissues have evolved many times in diverse lineages; this prevalence suggests a common source of mechanical robustness. In this work, we introduce a tractable, model hierarchical lattice with controllable attributes on each length scale. We find, contrary to intuition, that adding additional levels of structure actually reduces the relative variation in mechanical properties, despite an increase in assembly errors. This finding informs our understanding of the emergence of hierarchically structured biological materials, while also offering a practical heuristic in materials design.
High ambient temperature dampens adaptive immune responses to influenza A virus infection
Authors: Moriyama Miyu , Ichinohe Takeshi
Published: February 2019

Significance

Although half of the world’s population could face severe food crisis as a result of global warming by the end of this century, the effects of environmental temperature and host nutritional status in host defense to viral infection in vivo are less clear. Here, we demonstrated that exposure of mice to the high ambient temperature of 36 °C reduced their food intake and impaired adaptive immune responses to influenza virus infection. In addition, we found that administration of glucose or dietary short-chain fatty acids restored influenza virus-specific adaptive immune responses in high heat-exposed mice. Our results imply possible public health problems and concerns that outside temperature and host nutritional status may be critical determinants of viral pathogenesis or vaccine efficacy.
Magnesium-sensitive upstream ORF controls PRL phosphatase expression to mediate energy metabolism
Authors: Hardy Serge , Kostantin Elie , Wang Shan Jin , Hristova Tzvetena , Galicia-Vázquez Gabriela , Baranov Pavel V. , Pelletier Jerry , Tremblay Michel L.
Published: February 2019

Significance

The phosphatases of regenerative liver (PRL) have been shown to interact with the CNNM magnesium transport regulators. Through this protein complex, PRL controls the levels of intracellular magnesium. Our study uncovers a remarkable posttranscriptional feedback mechanism by which magnesium controls PRL expression in mammalian cells. Here we show that regulation of PRL mRNA translation by magnesium depends on a 5′UTR-located upstream ORF, which is conserved among all vertebrates, proposing an evolutionary molecular mechanism of action by a divalent ion. This magnesium-sensing mechanism, which also involves the key metabolic sensor AMPK, is thus central to maintain cellular homeostasis in mammalian cells.
TrkB-expressing neurons in the dorsomedial hypothalamus are necessary and sufficient to suppress homeostatic feeding
Authors: Liao Guey-Ying , Kinney Clint E. , An Juan Ji , Xu Baoji
Published: February 2019

Significance

The dorsomedial hypothalamus (DMH) is well known for its role in the regulation of energy expenditure; however, its role in the control of appetite is less defined. Our study identifies TrkB-expressing DMH neurons that potently suppress appetite and efficiently maintain physiological satiety when they are activated. Furthermore, because ablating the TrkB receptor in these neurons increased appetite and reduced energy expenditure, our study indicates that BDNF could act in part on the DMH to control body weight. These results suggest that activation of DMH TrkB neurons could be a powerful way to treat obesity because it will not only greatly reduce appetite but also overcome a potent counterregulatory mechanism by which food restriction-induced weight loss disproportionately reduces energy expenditure.
Regulatory cascade involving transcriptional and N-end rule pathways in rice under submergence
Authors: Lin Chih-Cheng , Chao Ya-Ting , Chen Wan-Chieh , Ho Hsiu-Yin , Chou Mei-Yi , Li Ya-Ru , Wu Yu-Lin , Yang Hung-An , Hsieh Hsiang , Lin Choun-Sea , Wu Fu-Hui , Chou Shu-Jen , Jen Hao-Chung , Huang Yung-Hsiang , Irene Deli , Wu Wen-Jin , Wu Jian-Li , Gibbs Daniel J. , Ho Meng-Chiao , Shih Ming-Che
Published: February 2019

The riceSUB1A-1gene, which encodes a group VII ethylene response factor (ERFVII), plays a pivotal role in rice survival under flooding stress, as well as other abiotic stresses. InArabidopsis, five ERFVII factors play roles in regulating hypoxic responses. A characteristic feature ofArabidopsisERFVIIs is a destabilizing N terminus, which functions as an N-degron that targets them for degradation via the oxygen-dependent N-end rule pathway of proteolysis, but permits their stabilization during hypoxia for hypoxia-responsive signaling. Despite having the canonical N-degron sequence, SUB1A-1 is not under N-end rule regulation, suggesting a distinct hypoxia signaling pathway in rice during submergence. Herein we show that two other riceERFVIIsgene,ERF66andERF67, are directly transcriptionally up-regulated by SUB1A-1 under submergence. In contrast to SUB1A-1, ERF66 and ERF67 are substrates of the N-end rule pathway that are stabilized under hypoxia and may be responsible for triggering a stronger transcriptional response to promote submergence survival. In support of this, overexpression of ERF66 or ERF67 leads to activation of anaerobic survival genes and enhanced submergence tolerance. Furthermore, by using structural and protein-interaction analyses, we show that the C terminus of SUB1A-1 prevents its degradation via the N-end rule and directly interacts with the SUB1A-1 N terminus, which may explain the enhanced stability of SUB1A-1 despite bearing an N-degron sequence. In summary, our results suggest thatSUB1A-1,ERF66, andERF67form a regulatory cascade involving transcriptional and N-end rule control, which allows rice to distinguish flooding from other SUB1A-1–regulated stresses.
Dynamics of DNA replication in a eukaryotic cell
Authors: Kelly Thomas , Callegari A. John
Published: February 2019

Significance

All eukaryotic cells initiate DNA replication at multiple genomic sites. For most cell types these sites lack a well-defined sequence signature, so it is not understood how they are selected. To analyze the factors that influence initiation site selection and determine the dynamics of replication throughout the genome, we developed an integrative computational model of DNA replication in the model organism
Schizosaccharomyces pombe
. This analysis showed that the locations of initiation sites are determined not only by the sequence preferences of the
S. pombe
origin recognition complex (ORC), but also by the interference of transcription with the formation of prereplication complexes. Our findings suggest that transcription has influenced evolution of the binding properties of ORC and replication dynamics in eukaryotes.
Functional/Aesthetic Measures of Patient Satisfaction After Rhinoplasty: A Review
Authors: Xiao Hong , Zhao Yanan , Liu Liu , Xiao Minqin , Qiu Wei , Liu Yin
Published: February 2019

Multiple patient-reported outcome measures (PROMs) are available to assess patient satisfaction after rhinoplasty. These self-assessment measures can be divided into 3 categories: measures for functional outcomes, aesthetic outcomes, and both. Although Barone et al have discussed this classification, a recently developed scale was not featured. We performed a PubMed search for publications in English that described patient satisfaction post-rhinoplasty, utilizing PROMs that facilitate both functional and aesthetic self-assessment. PROMs, including the Rhinoplasty Outcomes Evaluation, the Functional Rhinoplasty Outcome Inventory 17, the Rhinoplasty Health Inventory and Nasal Outcomes scale, the FACE-Q Rhinoplasty module, and the Standardized Cosmesis and Health Nasal Outcomes Survey, were reviewed and critically appraised in terms of their content, ease of use, and analysis parameters. This review highlights the benefit of using multi-functional PROMs after rhinoplasty instead of single-purpose PROMs and enables surgeons and researchers to choose the most appropriate measure for their purpose.
Miso: an R package for multiple isotope labeling assisted metabolomics data analysis
Authors: Dong Yonghui , Feldberg Liron , Aharoni Asaph
Published: February 2019

Motivation

The use of stable isotope labeling is highly advantageous for structure elucidation in metabolomics studies. However, computational tools dealing with multiple-precursor-based labeling studies are still missing. Hence, we developed Miso, an R package providing automated and efficient data analysis workflow to detect the complete repertoire of labeled molecules from multiple-precursor-based labeling experiments.

Results

The capability of Miso is demonstrated by the analysis of liquid chromatography-mass spectrometry data obtained from duckweed plants fed with one unlabeled and two differently labeled tyrosine (unlabeled tyrosine, tyrosine-2H4 and tyrosine-13C915N1). The resulting data matrix generated by Miso contains sets of unlabeled and labeled ions with their retention time, m/z values and number of labeled atoms that can be directly utilized for database query and biological studies.

Availability and implementation

Miso is publicly available on the CRAN repository (https://cran.r-project.org/web/packages/Miso). A reproducible case study and a detailed tutorial are available from GitHub (https://github.com/YonghuiDong/Miso_example).

Supplementary information

Supplementary data are available at Bioinformatics online.
Clinical Spectrum of Primaquine-induced Hemolysis in Glucose-6-Phosphate Dehydrogenase Deficiency: A 9-Year Hospitalization-based Study From the Brazilian Amazon
Authors: Brito-Sousa Jose Diego , Santos Thalie C , Avalos Sara , Fontecha Gustavo , Melo Gisely C , Val Fernando , Siqueira André M , Alecrim Graça C , Bassat Quique , Lacerda Marcus V G , Monteiro Wuelton M
Published: February 2019

Despite glucose-6-phosphate dehydrogenase (G6PD) deficiency prevalence of 5% in the Amazon, primaquine is administered without G6PD screening. This is an important cause of hospitalization among Plasmodium vivax–infected individuals, leading to life-threatening anemia and acute renal failure across endemic areas. In Manaus, the frequency of primaquine-induced hemolysis was 85.2 cases per 100 000 primaquine users.
Safety of direct true lumen cannulation after venous exsanguination: a study in a surviving porcine model†
Authors: Mustonen Caius , Honkanen Hannu-Pekka , Lehtonen Siri , Tuominen Hannu , Mäkelä Tuomas , Kaakinen Timo , Yannopoulos Fredrik , Anttila Vesa , Juvonen Tatu
Published: February 2019

OBJECTIVES

Type A aortic dissection requires immediate surgery. Traditional cannulation methods such as the central aortic cannulation with the Seldinger technique and axillary cannulation are primary choices. Yet in the presence of tamponade or severe cardiogenic shock, these can be too time-consuming to complete. Direct true lumen cannulation after venous exsanguination not only avoids this issue but also leads to transient global ischaemia. We studied the safety of direct true lumen cannulation from the aspect of global ischaemia in a surviving porcine model.

METHODS

Twelve pigs were randomized to either control or intervention groups (6 + 6). The intervention group underwent simulated direct true lumen cannulation by exsanguination and circulatory arrest for 5 min at 35°C before cardiopulmonary bypass (CPB). Both groups underwent CPB cooling to 25°C followed by a 25-min arrest period and subsequent warming to 36°C. Neuron-specific enolase levels were measured at 6 time-points from blood samples. Near-infrared spectroscopy was used to determine brain oxygenation. The neurological recovery was evaluated daily during a 7-day follow-up, and the brain was harvested for a histopathological analysis after euthanization.

RESULTS

All pigs recovered their normal neurological behaviour. The neurobehavioural total score on postoperative day 2 reached borderline statistical significance, thus favouring the intervention group [(9 (8.75–9) vs 6.5 (5.5–9), P = 0.06]. Near-infrared spectroscopy values and neuron-specific enolase levels slightly favoured the control group during the cooling period, but the difference was not clinically significant. The histopathological analysis showed no difference between the groups.

CONCLUSIONS

A 5-min period of normothermic global ischaemia before CPB does not impair the neurological outcome following hypothermic circulatory arrest in a surviving porcine model.
Mechanisms of recurrent regurgitation after transapical off-pump mitral valve repair with neochord implantation†
Authors: Colli Andrea , Besola Laura , Bizzotto Eleonora , Fiocco Alessandro , Denas Gentian , Bellu Roberto , Pradegan Nicola , Nadali Matteo , Gregio Alessandro , Pittarello Demetrio , Gerosa Gino
Published: February 2019

OBJECTIVES

The aim of this study was to describe possible mechanisms of recurrent mitral regurgitation (MR) in patients who have been treated with the NeoChord procedure.

METHODS

Patients presenting with recurrent severe or moderate MR were categorized as Not Expected Surgical-Like Result (NESLR)-Redo and NESLR-MR2 [NESLR reintervention or moderate MR (2+), respectively]. NESLR patients were stratified by onset (intraoperative, perioperative 24 h–30 days, or early 30 days to follow-up), by MR jet direction (central or eccentric) and by jet orientation (anterior or posterior). Specific mechanisms of NESLR were analysed.

RESULTS

Fifty-two patients were identified with 13 (25%) categorized as NESLR-Redo, and 39 (75%) as NESLR-MR2. NESLR-Redo patient stratification included: intraoperative = 2 patients (1.2%), both eccentric anteriorly directed jets; perioperative = 7 patients (4.2%), all eccentric with 3 anteriorly and 4 posteriorly directed jets; and early = 4 patients (2.4%), 1 central, 3 eccentric, 2 posteriorly and 1 anteriorly directed jets. NESLR-MR2 patient stratification included: perioperative = 2 patients (5.1%), both eccentric, 1 anteriorly and 1 posteriorly directed jets; and early = 37 patients (94.9%), 4 central, 33 eccentric, 22 anteriorly and 11 posteriorly directed jets. Possible mechanisms of recurrent MR were identified as: patient selection (17.3%), technical issues (28.8%), progression of baseline disease (15.4%), left ventricle reverse remodelling (1.9%), excessive over-tensioning (35.8%) and PML curling (30.8%).

CONCLUSIONS

The mechanisms of recurrent MR after the NeoChord procedure can be determined. Understanding recurrent MR mechanisms has led to improvements in procedural standardization and ad hoc prevention strategies that have been widely adopted since our initial clinical experience.
Effect of Reactive Balance Training Involving Repeated Slips and Trips on Balance Recovery Among Older Adults: A Blinded Randomized Controlled Trial
Authors: Okubo Yoshiro , Sturnieks Daina L , Brodie Matthew A , Duran Lionne , Lord Stephen R
Published: February 2019

Background

This study examined whether reactive balance training (exposures to slips and trips) could improve balance recovery and reduce perturbation-induced falls among older adults.

Methods

Forty-four community-dwelling older adults participated in a parallel, blinded randomized controlled trial conducted in a research institute in Sydney, Australia in 2017–2018 (ACTRN12617000564358). The intervention group (n = 22) underwent three 40 minutes sessions (total 120 minutes) that exposed them to (1) 20 trips, (2) 20 slips, and (3) 10 trips and 10 slips in mixed order, over 2 days. The control group (n = 22) received one 40 minutes session of sham training. The primary outcome was falls (>30% body weight in harness) when exposed to trips and slips at post-assessment.

Results

At post-assessment, a total of 51 falls (23 and 27 falls from induced slips and trips, respectively) were recorded in the laboratory. Relative to the control group, the intervention group experienced fewer total falls (rate ratio [RR] = 0.40, 95% confidence interval [CI] = 0.22–0.76), slip falls (RR = 0.33, 95% CI = 0.12–0.90) and trip falls (RR = 0.49, 95% CI = 0.21–1.12). Eight participants reported adverse events (5 in the intervention group and 3 in the control group) which were related mainly to discomfort caused by a suboptimal harness used in the initial stages of the trial.

Conclusions

The reactive balance training reduced perturbation-induced falls by 60% indicating improved balance recovery from trips and slips. A comfortable safety harness system is essential to prevent discomfort. Reactive balance training may complement traditional exercise programs in fall prevention interventions.
Tracking Multimorbidity Changes in Diverse Racial/Ethnic Populations Over Time: Issues and Considerations
Authors: Quiñones Ana R , Allore Heather G , Botoseneanu Anda , Newsom Jason T , Nagel Corey L , Dorr David A
Published: February 2019

Multimorbidity is widely recognized as having adverse effects on health and wellbeing and may threaten the ability of older adults to live independently. Much of what is known about multimorbidity rests on research that has largely focused on one point in time, or from a static perspective. Given that there remains a lack of agreement in the field on how to standardize multimorbidity definitions and measurement, it is not surprising that analyzing and predicting multimorbidity development, progression over time, and its impact are still largely unaddressed. As a result, there are important gaps and challenges to measuring and studying multimorbidity in a longitudinal context. This Research Practice perspective summarizes pressing challenges and offers practical steps to move the field forward.
Assessment of Lymph Node Stromal Cells as an Underlying Factor in Age-Related Immune Impairment
Authors: Masters April R , Hall Alexxus , Bartley Jenna M , Keilich Spencer R , Lorenzo Erica C , Jellison Evan R , Puddington Lynn , Haynes Laura
Published: February 2019

Aging negatively impacts immunity, resulting in inefficient responses to vaccinations and infections. Fibroblastic reticular cells (FRCs) are the major stromal cell subset in lymph nodes (LNs) and play an intricate role in the orchestration and control of adaptive immune responses. Although stromal cells have a major impact on immune responses, the impact of aging on LN stromal cells remains unclear. Quantitative analysis of LN stromal cells by flow cytometry revealed that there are no significant differences in the number of stromal cells in young and aged LN at steady state but after influenza infection aged FRCs have delayed expansion as a result of reduced proliferation. Aged LNs also produce reduced levels of homeostatic chemokines, which correlates with reduced homing of naive T cells. Image analysis reveals that young and aged T-cell zone FRCs have similar morphology at steady state and after infection. Furthermore, aged FRCs did not appear to be a contributing factor in the reduced proliferation of young T cells transferred into aged LNs after influenza infection. These results demonstrate that aging alters LN stromal cell response to challenge and these age-related changes may be an underlying contributor to impaired immune responses in the elderly people.
Disaster Planning and Research Continuity in Responsible Animal Research
Authors: Petervary Nicolette , Pullium Jennifer K
Published: February 2019

Disaster preparedness for research facilities can be a daunting task. The purpose of this review is to introduce basic preparedness concepts and terminology so that facilities may begin to develop customized plans for their specific needs. Regulatory requirements are reviewed and an overview of the Incident Command System, National Preparedness System Planning Frameworks, and fundamental terms is provided. Important concepts for successful planning are then explored. Good planning involves fostering a culture of preparedness, resilience, and understanding the interactions and partnerships with other groups that are essential for core functions and incident response. Methods to gain institutional support and set up an advisory committee are examined in detail. Next, the steps to develop and carry out a plan are outlined. Risk assessments using an all hazards approach and tools such as risk indices and risk matrices are explained, and tips to design and test plans, train personnel, and evaluate improvement are discussed. Finally, special challenges unique to animal research facilities are considered along with ways to address them. Examples and information are drawn from a wide variety of organizations both to underscore themes common to all preparedness plans and to introduce new concepts that may be adapted for use in research institutions.
Communicating Hydrocephalus
Authors: Han Rowland , Limbrick David D.
Published: February 2019

Communicating hydrocephalus results from an imbalance between cerebrospinal fluid (CSF) production and reabsorption. It is attributed to impaired absorption of CSF through arachnoid villi, elevated cranial venous sinus pressure, or excessive CSF production. Communicating hydrocephalus is radiologically characterized by dilation of the entire ventricular system and patency of the foramina of Monro, cerebral aqueduct, and fourth ventricular outlets. Surgical intervention should be considered in the setting of clinical or radiographic progression in order to optimize neurologic outcome, provide symptomatic relief, and avoid neurologic deficits. Treatment options include definitive CSF diversion with a CSF shunt or endoscopic third ventriculostomy with or without choroid plexus cauterization. There is a need for standardized care pathways for children with communicating hydrocephalus.
Prematurity and Intraventricular Hemorrhage
Authors: Mazzola Catherine A. , Sikorskyj Tatiana Huk
Published: February 2019

Intraventricular hemorrhage caused by bleeding in the germinal matrix is a complication often seen in premature infants. Variations in cerebral blood flow may lead to rupture of the fragile, immature blood vessels due to their inability to autoregulate or accommodate changes in cerebral perfusion. Post-hemorrhagic hydrocephalus (PHH) may lead to significant neurologic compromise and can be diagnosed by assessing for symptoms and signs of infantile hydrocephalus, followed by radiologic imaging. Treatment options may include temporary and permanent cerebrospinal fluid diversion. Head ultrasound is a common imaging modality used for hydrocephalus surveillance in infants during their postnatal hospital stay in the neonatal intensive care unit. Evidence-based guidelines for the treatment of PHH have been published by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.
Posterior Fossa Ependymoma
Authors: Boop Frederick A. , Chuang Jimmy Ming-Jung
Published: February 2019

Pediatric posterior fossa ependymomas are typically well-delineated masses with heterogenous enhancement arising from the floor, lateral aspect, or roof of the fourth ventricle. Growth of tumor into the posterior fossa subarachnoid spaces, particularly into the foramen of Magendie and the cerebellopontine angles via the foramen of Luschka, is a radiological hallmark of this tumor. Clinical findings of elevated intracranial pressure and obstructive hydrocephalus are common at presentation. The current standard of care for children with ependymoma consists of gross total resection with subsequent focal radiotherapy. The extent of resection is the single most important determinant of outcome. Hydrocephalus typically resolves after resection, and it is uncommon to require cerebrospinal shunt placement after tumor removal.
Teaching for Humanism
Authors: Piemonte Nicole M. , Kumagai Arno K.
Published: February 2019

The introduction of the humanities—literature, history, the fine arts, and philosophy—is becoming increasingly popular in medical education. However, the overall role and educational purpose of the humanities in medical education are not clear. The oft-expressed assumption that “exposure to humanities makes one more humanistic,” is a truism that has been justifiably challenged. In fact, introducing the humanities into a context in which their importance and “efficacy” in creating humanistic doctors is assessed by the same means as that assessing biomedical or clinical knowledge and skills (e.g., standardization, observable outcomes, fulfillment of competencies, simulations) arguably risks compromising the very value that the humanities bring to explorations of the human dimensions of illness and care. This chapter is devoted to an exploration of the aims of engaging the humanities in medical education and a discussion of specific pedagogical approaches in educating physicians for humanistic practice. In particular, the role of stories, dialogues, and reflection on the moral, existential, and interpersonal dimensions of medicine will be considered; and examples of specific educational practices from the authors’ own experiences will be used to illustrate how educational and social theory may be used to design learning activities that foster an orientation toward a practice of medicine that embodies excellence, compassion, and justice.
Resemblance, Diversity, and Making Age Studies Matter
Authors: Charise Andrea
Published: February 2019

The resurgence of grass-roots activism around race (#BlackLivesMatter) and class (anti-austerity, Occupy) has highlighted how matters of age collide with other significant determinants of health and illness, such as gender, sexuality, race, ethnicity, and class. Clearly, what it means to grow old is deeply contingent upon far-reaching disciplinary and contextual factors that shape students’ understanding of health well before they step into the classroom. Part one of this chapter unpacks key problems currently facing age studies pedagogy by asking, How can age studies be taught to better reflect these crucial diversities, encourage the growth of this field, and establish the value of age studies for students from a range of academic backgrounds and with assorted, often uncertain, career paths? Part two expands this proposition through elaborating a case study of teaching age studies as part of the health humanities curriculum at the University of Toronto Scarborough. The author outlines ways in which striking but conventional age studies material (e.g., Shakespeare’s King Lear) might be repurposed to respond meaningfully both to the locality of a multicultural teaching environment and to students who may possess very different frames of reference. The purpose of the chapter is to (1) articulate the need for greater diversity in age studies (lessons reflected in health humanities more generally) and (2) provide concrete ways to embolden such diversification within the classroom by engaging students—and charging educators—in the expansion of what humanistic studies of aging might entail.
The Baptism and the Butterfly
Authors: Brennan Marcia
Published: February 2019

Teaching classes that engage end-of-life subject matter can present any number of pedagogical challenges, not least of all because the themes in play can be so vast and so vital that they are nearly unimaginable and undiscussable. When addressing these issues in the courses “Life at the End of Life” and “The Humanities of Care” at Rice University, the author presents vivid case studies drawn directly from clinical experiences as a literary Artist In Residence in the Department of Palliative Care and Rehabilitation Medicine at the University of Texas M. D. Anderson Cancer Center. Interweaving patient-centered narratives with analytical classroom discussions can help students to find language to address a diverse range of practical concerns, concrete experiences, subtle insights, and ineffable themes. With the increasing emphases on medical technologies, the demographics of an aging population, and shifts in policies toward end-of-life planning at the national level, the need to cultivate such a humanistic perspective in medicine—and in the broader cultural sphere—remains both timely and pressing. Just as end-of-life narratives exemplify some of the ways in which the reach of the humanities can extend into difficult areas of modern life, so too can the stories promote students’ abilities to re-envision the relations between the familiar and the extraordinary domains as they find language to express the links between lived experience and metaphysical presence.
Art as Disruption in Global Health Humanities
Authors: Stewart Kearsley A. , Ingold Rachel , de Bruyn Maria , Swain Kelley K.
Published: February 2019

Narrative learning and reflective writing have been shown to enhance physicians’ empathy, improve clinical interview skills, and help practitioners understand patients’ illness experiences. This chapter describes a global health humanities workshop that taught students to use an art technique (A Humument by Tom Phillips) to process materials from a sexual and reproductive health archive, culminating in reflective writing and public presentations. The workshop was developed through an interdisciplinary collaboration among a global health educator, a library archival curator, and a poet. The chapter describes the archival context, pedagogical goals, student learning, lessons learned, and future plans for using this approach.