bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysregulation of solute carrier transporters in malaria‐infected pregnant mice
Authors: Najjar Najwa , McColl Eliza R. , Weckman Andrea , Kain Kevin C. , Piquette‐Miller Micheline
Published: January 2019

Aims

Malaria in pregnancy (MiP) alters the expression of ATP‐binding cassette efflux transporters in maternal and foetal tissues, as well as the placenta. Malaria induces oxidative stress, and pregnancy is associated with arginine deficiency. We hypothesized that reducing oxidative stress during MiP by supplementation with L‐arginine, aNOprecursor, would attenuate transcriptional changes in a second superfamily of transporters, solute carrier (SLC) transporters, and improve pregnancy outcomes.

Methods and Results

PregnantBALB/c mice receiving L‐arginine (1.2%) in water, or water alone, were infected withPlasmodium bergheiANKAon gestational day 13 and sacrificed on gestational day 19. Compared to controls, themRNAof numerousSLCtransporters was downregulated in maternal and foetal tissues, as well as in the placentas of infected mice. While supplementation with L‐arginine did improve foetal viability, it did not improve themRNAexpression of oxidative stress markers, transporters nor other indices of foetal and maternal health. Moreover, amino acid uptake transporters were downregulated upon infection, which could potentially contribute to decreased foetal birthweight.

Conclusions

Malaria in pregnancy significantly alters the expression ofSLCtransporters in maternal and foetal tissues as well as the placenta, regardless of L‐arginine supplementation. Further studies to investigate methods of reducing oxidative stress in MiP are warranted.
Interoceptive accuracy predicts nonplanning trait impulsivity
Authors: Herman Aleksandra M. , Rae Charlotte L. , Critchley Hugo D. , Duka Theodora
Published: January 2019

Influential theories concerning personality argue that many impulsive individuals show physiological underarousal at rest. This interoceptive state is proposed to be egodystonic, motivating impulsive maladaptive actions to enhance arousal. However, there is little empirical research on this matter. The current study tested the relationship between physiological markers of arousal, measures of interoceptive (in)sensitivity, and trait impulsivity in a nonclinical sample of young adults. Experiment 1 investigated whether individuals (N = 31) with high trait impulsivity show decreased resting measures of arousal (indexed from heart rate, heart rate variability, and sympathetic electrodermal activity). Experiment 2 assessed whether trait impulsivity is linked to interoceptive abilities (N = 60). Overall, our results do not provide any compelling support for the underarousal theory of impulsivity. However, impaired interoceptive (cardiac discrimination) accuracy predicted the degree of Barratt nonplanning impulsivity, such that individuals with a better ability to distinguish between internal (bodily) and external signals manifest lower levels of nonplanning trait impulsivity. These findings open an avenue for potential novel interventions aimed at improving planning abilities via better interoceptive discrimination.
Modifiable risk factors for community‐acquired pneumonia in children under 5 years of age in resource‐poor settings: a case–control study
Authors: Ngocho James Samwel , de Jonge Marien Isaäk , Minja Linda , Olomi Gaudencia Alois , Mahande Michael Johnson , Msuya Sia Emmanueli , Mmbaga Blandina Theophile
Published: January 2019

Objective

Despite the availability of vaccines and antibiotics, pneumonia remains the leading cause of mortality among children under 5 years of age. The objective of this study was to identify modifiable risk factors for community‐acquired pneumonia (CAP) in children under 5 years of age in a vaccinated population.

Methods

A case–control study was conducted between January and December 2017. The cases included children aged 2–59 months with X‐ray‐confirmed pneumonia, whereas the controls were children from the community with no history of respiratory infection. A multivariable logistic regression model was used to determine the modifiable risk factors forCAP.

Results

A total of 113 children with X‐ray‐confirmed pneumonia and 350 healthy children were enrolled in this study. The median ages for the cases and controls were 13.7 (IQR = 7.2–25.3) and 13.4 (IQR = 6.0–24.8) months respectively. One (0.9%) child died after the enrolment. The independent predictors ofCAPincluded a lack of exclusive breastfeeding for 6 months (aOR = 1.7, 95%CI = 1.0–2.9), underweight (aOR = 2.1, 95%CI = 1.0–4.5), unclean cooking fuel (aOR = 1.8, 95%CI = 1.0–3.3) and low income (aOR = 2.9, 95%CI = 1.6–5.4). No association was found between vaccination status and CAP.

Conclusion

In addition to a lack of exclusive breastfeeding, children from families of low‐economic status were at risk of contractingCAP. Since the risk factors are complex, the study results call for more concerted efforts by and collaboration among the health, agriculture and development sectors to address mortality caused byCAP.
Effects of aid for trade on extensive and intensive margins of greenfield FDI
Authors: Ly‐My Dung , Lee Hyun‐Hoon
Published: January 2019

Using a panel dataset of 105 developing countries for the period 2003–15, this paper assesses the effects of Aid for Trade (AfT) on greenfield FDI flows to the aid‐recipient countries. Particularly, this paper classifies the total dollar value of greenfield FDI flows to each recipient country in terms of four different layers: the extensive and intensive margins of projects as well as the extensive and intensive margins of source countries. Applying the system GMM estimator, this paper finds that AfT not only increases the dollar value of FDI flows to the recipient countries but also helps diversify the greenfield projects and source countries. In addition, this paper finds that AfT has a greater effect for greenfield FDI from donor (developed) countries than from non‐donor (developing) countries. Among the three components of AfT, aid for trade‐related infrastructure and aid for trade policy regulations are found to have positive links with greenfield FDI, irrespective of source‐country groups, yet their effects are larger for developed source countries. In contrast, aid for building productive capacity hinders greenfield FDI flows from non‐donor countries, while it promotes greenfield FDI from donor countries. We offer some explanations for this finding.
The effects of environmental antidepressants on macroinvertebrates: a mini review
Authors: Shaliutina‐Kolešová Anna , Shaliutina Olena , Nian Rui
Published: January 2019

Pharmaceuticals and personal care products constitute one of the most common groups of contaminants in surface waters, and little is known about their impact on aquatic wildlife. The antidepressant fluoxetine is among more prevalent categories of pharmaceuticals detected in the aquatic environment. Typical surface water concentrations are in a wide range that can lead to alterations in life of aquatic macroinvertebrates. Because the mode of fluoxetine action is thought to be by modulation of the neurotransmitter serotonin, macroinvertebrates that possess relevant transporters and receptors sensitive are potentially affected by this pharmaceutical. Available information of how this emerging contaminant may affect macroinvertebrate communities is limited. This review describes the influence of pharmaceuticals on aquatic fauna in general and reports the environmental concentrations of some widely used antidepressants. Additionally, we highlighted the effects of fluoxetine as an antidepressant of concern, because of its abundance and potential for toxicity to aquatic macroinvertebrates.
Distributed Observer Type Protocol for Flocking of Linear Second-Order Multi-Agent Systems Subject to External Disturbance
Authors: Yazdani Sahar , Haeri Mohammad
Published: January 2019

This paper studies the leader–follower flocking of multi-agent systems for the linear second-order dynamics, subject to the external disturbance problem. It is assumed that the dynamic of the leader is Lipschitz-type. Also, the velocity is the output of the system, and full-state information is not available for feedback. A distributed full-order observer is employed to estimate every agent's states and external disturbance. A control protocol for each agent is designed based on the measurement of its output/velocity and relative velocity of its neighbors. Under the proposed protocol, the velocity convergence of whole agents to the velocity of the virtual leader is guaranteed as well as the connectivity of network and collision avoidance among agents are ensured. Finally, a simulation example is provided to show the effectiveness of the results.
Implementing Anaerobic Speed Reserve Testing in the Field: Validation of vVO2max Prediction From 1500-m Race Performance in Elite Middle-Distance Runners
Authors: Sandford Gareth N. , Rogers Simon A. , Sharma Avish P. , Kilding Andrew E. , Ross Angus , Laursen Paul B.
Published: January 2019

Purpose: Anaerobic speed reserve (ASR), defined as the speed range from velocity associated with maximal oxygen uptake (vVO2max) to maximal sprint speed, has recently been shown to be an important tool for middle-distance coaches to meet event surge demands and inform on the complexity of athlete profiles. To enable field application of ASR, the relationship between gun-to-tape 1500-m average speed (1500v) and the vVO2max for the determination of lower landmark of the ASR was assessed in elite middle-distance runners. Methods: A total of 8 national and 4 international middle-distance runners completed a laboratory-measured vVO2max assessment within 6 wk of a nonchampionship 1500-m gun-to-tape race. ASR was calculated using both laboratory-derived vVO2max (ASR-LAB) and 1500v (ASR-1500v), with maximal sprint speed measured using radar technology. Results: 1500v was on average +2.06 ± 1.03 km/h faster than vVO2max (moderate effect, very likely). ASR-LAB and ASR-1500v mean differences were −2.1 ± 1.5 km/h (large effect, very likely). 1500v showed an extremely large relationship with vVO2max, r = .90 ± .12 (most likely). Using this relationship, a linear-regression vVO2max-estimation equation was derived as vVO2max (km/h) = (1500v [km/h] − 14.921)/0.4266. Conclusions: A moderate difference was evident between 1500v and vVO2max in elite middle-distance runners. The present regression equation should be applied for an accurate field prediction of vVO2max from 1500-m gun-to-tape races. These findings have strong practical implications for coaches lacking access to a sports physiology laboratory who seek to monitor and profile middle-distance runners.
No Improvement in Running Time to Exhaustion at 100% VO2max in Recreationally Active Male Runners With a Preexercise Single-Carbohydrate Mouth Rinse
Authors: Rossato Luana T. , Fernandes Camila T.M. , Vieira Públio F. , de Branco Flávia M.S. , Nahas Paula C. , Puga Guilherme M. , de Oliveira Erick P.
Published: January 2019

Background: Carbohydrate (CHO) mouth rinse has been used as an ergogenic strategy due to its central effect; however, the effects of this intervention during short-duration high-intensity exercises are not fully understood. Purpose: To investigate the effect of CHO mouth rinse on time to exhaustion in a short-duration high-intensity exercise performed on a treadmill. Methods: A randomized double-blind, placebo-controlled, crossover study was conducted with 10 (24.1 [4.3] y) recreationally active male runners. The protocol consisted of a warm-up at 65% of VO2max for 5 min followed by 3 min passive rest. At the end of this rest period, the individuals performed their mouth rinse either with CHO (maltodextrin, 6%) or with placebo (industrialized noncaloric juice with the same taste). Immediately after mouth rinse, the subjects ran at velocity equivalent to 100% of individual VO2max until voluntary exhaustion. The perceived effort was obtained through a Borg scale. Blood lactate was quantified before and after the protocol, and heart rate was evaluated during the protocol. Results: No difference was found (P = .90) in time to exhaustion between placebo (193.9 [46.5] s) and CHO mouth rinse (195.1 [51.8] s). Blood lactate, heart rate, and perception of effort increased in both groups, but with no differences (all variables, P > .05) between groups. Conclusion: The findings showed that a preexercise single-CHO mouth rinse was ineffective to improve running time to exhaustion at velocity equivalent to 100% VO2max on a treadmill in recreationally active male runners.
Task-agnostic self-modeling machines
Authors: Kwiatkowski Robert , Lipson Hod
Published: January 2019

A robot modeled itself without prior knowledge of physics or its shape and used the self-model to perform tasks and detect self-damage.
Soft robot perception using embedded soft sensors and recurrent neural networks
Authors: Thuruthel Thomas George , Shih Benjamin , Laschi Cecilia , Tolley Michael Thomas
Published: January 2019

Recurrent neural networks with an unstructured redundant soft sensor topology allow robust multimodal proprioceptive capabilities.
Eyes are faster than hands: A soft wearable robot learns user intention from the egocentric view
Authors: Kim Daekyum , Kang Brian Byunghyun , Kim Kyu Bum , Choi Hyungmin , Ha Jeesoo , Cho Kyu-Jin , Jo Sungho
Published: January 2019

We present a learning-based intention detection methodology using a first-person-view camera for wearable hand robots.
Dynamics of circulating TNF during adalimumab treatment using a drug-tolerant TNF assay
Authors: Berkhout Lea C. , l’Ami Merel J. , Ruwaard Jill , Hart Margreet H. , Heer Pleuni Ooijevaar-de , Bloem Karien , Nurmohamed Michael T. , van Vollenhoven Ronald F. , Boers Maarten , Alvarez Daniel F. , Smith Catherine H. , Wolbink Gerrit J. , Rispens Theo
Published: January 2019

TNF concentrations stabilize in patients with rheumatoid arthritis during long-term adalimumab therapy and are associated with antidrug antibodies.
Inhibition of polyamine synthesis and uptake reduces tumor progression and prolongs survival in mouse models of neuroblastoma
Authors: Gamble Laura D. , Purgato Stefania , Murray Jayne , Xiao Lin , Yu Denise M. T. , Hanssen Kimberley M. , Giorgi Federico M. , Carter Daniel R. , Gifford Andrew J. , Valli Emanuele , Milazzo Giorgio , Kamili Alvin , Mayoh Chelsea , Liu Bing , Eden Georgina , Sarraf Sara , Allan Sophie , Di Giacomo Simone , Flemming Claudia L. , Russell Amanda J. , Cheung Belamy B. , Oberthuer Andre , London Wendy B. , Fischer Matthias , Trahair Toby N. , Fletcher Jamie I. , Marshall Glenn M. , Ziegler David S. , Hogarty Michael D. , Burns Mark R. , Perini Giovanni , Norris Murray D. , Haber Michelle
Published: January 2019

MYCN regulates polyamines in neuroblastoma, and combined inhibition of polyamine synthesis and transport has therapeutic effects in mouse models.
In Silico
Serotyping Based on Whole-Genome Sequencing Improves the Accuracy of
Shigella
Identification
Authors: Wu Yun , Lau Henry K. , Lee Teresa , Lau David K. , Payne Justin
Published: January 2019

Shigella
causes diarrheal disease with serious public health implications. However, conventional
Shigella
identification methods are laborious and time-consuming and can be erroneous due to the high similarity between
Shigella
and enteroinvasive
Escherichia coli
(EIEC) and cross-reactivity between serotyping antisera. Further, serotype interpretation is complicated for inexperienced users. To develop an easier method with higher accuracy based on whole-genome sequencing (WGS) for
Shigella
serotyping, we systematically examined genomic information of
Shigella
isolates from 53 serotypes to define rules for differentiation and serotyping. We created ShigaTyper, an automated pipeline that accurately and rapidly excludes non-
Shigella
isolates and identifies 59
Shigella
serotypes using Illumina paired-end WGS reads. A serotype can be unambiguously predicted at a data processing speed of 538 MB/min with 98.2% accuracy from a regular laptop. Once it is installed, training in bioinformatics analysis and
Shigella
genetics is not required. This pipeline is particularly useful to general microbiologists in field laboratories.
Enhanced Nitrogen Fixation in a
glgX
-Deficient Strain of
Cyanothece
sp. Strain ATCC 51142, a Unicellular Nitrogen-Fixing Cyanobacterium
Authors: Liberton Michelle , Bandyopadhyay Anindita , Pakrasi Himadri B.
Published: January 2019

Cyanobacteria are oxygenic photosynthetic bacteria that are found in a wide variety of ecological environments, where they are important contributors to global carbon and nitrogen cycles. Genetic manipulation systems have been developed in a number of cyanobacterial strains, allowing both the interruption of endogenous genes and the introduction of new genes and entire pathways. However, unicellular diazotrophic cyanobacteria have been generally recalcitrant to genetic transformation. These cyanobacteria are becoming important model systems to study diurnally regulated processes. Strains of the
Cyanothece
genus have been characterized as displaying robust growth and high rates of nitrogen fixation. The significance of our study is in the establishment of a genetic modification system in a unicellular diazotrophic cyanobacterium, the demonstration of the interruption of the
glgX
gene in
Cyanothece
sp. strain ATCC 51142, and the characterization of the increased nitrogen-fixing ability of this strain.
Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese Children’s Cancer Group
Authors: Cai Jiaoyang , Yu Jie , Zhu Xiaofan , Hu Shaoyan , Zhu Yiping , Jiang Hua , Li Chunfu , Fang Yongjun , Liang Changda , Ju Xiuli , Tian Xin , Zhai Xiaowen , Hao Jinjin , Hu Qun , Wang Ningling , Jiang Hui , Sun Lirong , Li Chi Kong , Pan Kaili , Yang Minghua , Shen Shuhong , Cheng Cheng , Ribeiro Raul C , Pui Ching-Hon , Tang Jingyan
Published: January 2019

Objectives

Before 2003, most children with acute lymphoblastic leukaemia (ALL) abandoned treatment, with only approximately 30% treated in China. With the development of national insurance for underprivileged patients, we assessed the current frequency and causes of treatment abandonment among patients with ALL who were enrolled in the Chinese Children’s Cancer Group ALL protocol between 2015 and 2016.

Methods

Demographic, clinical and laboratory data on patients who abandoned treatment, as well as economic and sociocultural data of their families were collected and analysed. General health-related statistics were retrieved from publicly accessible databanks maintained by the Chinese government.

Results

At a median follow-up of 119 weeks, 83 (3.1%, 95% CI 2.5% to 3.8%) of the 2641 patients abandoned treatment. Factors independently associated with abandonment included standard/high-risk ALL (OR 2.62, 95% CI 1.43 to 4.77), presence of minimal residual disease at the end of remission induction (OR 3.57, 95% CI 1.90 to 6.74) and low-income economic region (OR 3.7, 95% CI 1.89 to 7.05). According to the family members, economic constraints (50.6%, p=0.0001) were the main reason for treatment abandonment, followed by the belief of incurability, severe side effects and concern over late complications.

Conclusions

The rate of ALL treatment abandonment has been greatly reduced in China. Standard/high-risk ALL, residence in a low-income region and economic difficulties were associated with treatment abandonment.

Clinical trial registration number

ChiCTR-IPR-14005706, pre-results.
Fusobacterium necrophorumsepsis after tonsillitis/pharyngitis
Authors: Sheehan Micheal , McLoughlin Darren , O’Sullivan Ronan
Published: January 2019

Fusobacterium necrophorumis a rare infection most notable for causing Lemierre’s syndrome. This consists of a primary oropharyngeal infection and septic thrombophlebitis, and one or more metastatic focus. Prior to the widespread use of antibiotics, Lemierre’s syndrome commonly followed a rapidly progressing course, with a high mortality. We describe a case of a previously well 18-month-old boy who presented to the emergency department with a 3-week history of progressive, right-sided, painful neck swelling and systemic sepsis. He was initially treated conservatively with intravenous antibiotics, but ultimately required surgical drainage. Lemierre’s syndrome is a rare condition with increasing incidence which can have significant adverse outcomes including death. Early recognition and treatment are essential, but identifying Lemierre’s disease is challenging.
Emergency management of massive haemoptysis
Authors: Heijkoop Bridget , Gillespie Heather , Kiroff George
Published: January 2019

In this manuscript, we present a rare case of massive haemoptysis secondary to rupture of a pulmonary artery aneurysm, which was unusual for having occurred in the absence of tuberculosis or a vasculitis. We describe the emergency management of this that ultimately resulted in the patient’s survival from both an anaesthetic and surgical perspective, as well as discuss the role of interventional radiology in this situation.
Congenital lateral cleft palate with unilateral craniofacial microsomia and lateral ankyloglossia
Authors: Baş Soysal , Baş Vildan , Irmak Fatih , Karşıdağ Semra Hacıkerim
Published: January 2019

Craniofacial microsomia is a group of anomalies that occur due to developmental defects in the first and second branchial arches during the embryological period. The disease has various craniofacial and extracraniofacial presentation patterns. Lateral cleft palate is distinct from the most common palate clefts because it is located lateral to the uvula. The presence of a lateral cleft palate has been very rarely reported in the literature, and the aetiopathogenesis of the disease is still not well understood. We aimed to report a case of the coexistence of lateral cleft palate and craniofacial microsomia and discuss the aetiopathogenesis of these diseases.
Headache and inflammatory bowel disease: think cerebral vein!
Authors: Orfei Martina , Gasparetto Marco , Torrente Franco
Published: January 2019

Cerebral vein thrombosis is a severe complication of inflammatory bowel disease, can cause non-specific symptoms and hence lead to delay in diagnosis. We report the case of an adolescent with inflammatory bowel disease who developed extensive cerebral vein thrombosis requiring a ventriculoperitoneal shunt. Diagnosis was markedly delayed due to repeated misinterpretation of clinical signs and laboratory findings and the lack of reconsidering the working diagnosis despite the involvement of several medical subspecialties. The patient does not suffer from any neurological impairment. This case report highlights the need for clinicians to maintain vigilance for complications of chronic disease and encourages to cast doubt on the working diagnosis constantly.
Persistent sciatic artery resembles a soft-tissue sarcoma in presentation
Authors: Almadani Hana Kamal
Published: January 2019

Persistent sciatic artery (PSA) is a rare vascular anomaly with estimated incidence of 0.03%–0.06%. It has high incidence of complications including aneurysmal formation and ischaemia that may lead to amputation. During early embryonic development, the sciatic artery (which usually supply fetal lower buds and caudal part) disappears when the superficial femoral artery develops properly and the lower limbs grow. On clinical examination, usually a pulsating gluteal mass (the aneurysm) is appreciated with weak or absent femoral artery (Cowie’s sign). However, our patient had presented in a different way. She was referred from peripheral clinic as a case of possible liposarcoma in the gluteal region. On examination, there was obvious asymmetry between both buttocks. The affected side was hard, firm in consistency with no appreciable pulsation. Nevertheless, on auscultation there was a bruit of low grade. Peripheral pulses were palpable. Our clinical impression was towards a sarcoma namely a liposarcoma. MRI was requested to evaluate the mass. The radiology report suggested that most probably it is an angiosarcoma with slim possibility of being a cavernous haemangioma. The trucut biopsy was deferred, in view of the high vascular nature of the lesion. The plan was as follow: To do angiography and embolisation of the main feeding vessels, with the possibility of biopsy in a second incident if indicated.During the conventional angiography, the pathology revealed itself. The patient was type 3 according to Pillet-Gauffre classification (PSA is limited to gluteal area and the popliteal artery arising from the femoral artery) associated with huge arteriovenous malformation. Embolisation with different materials including coils, beads and foam was ineffective. Finally, the radiologist excluded the root of the sciatic artery by a stent bridging from common iliac to external iliac artery. This successfully occluded the PSA.
Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis
Authors: Dolapsakis Christodoulos , Kranidioti Eleftheria , Katsila Sofia , Samarkos Michael
Published: January 2019

We report a case of septic thrombosis of the right cavernous sinus in a diabetic woman in her late 70’s due to ipsilateral sphenoid sinusitis. The diagnosis was delayed and made only after the abrupt and dramatic appearance of the manifestations of sinus thrombosis. The patient developed, among the other symptoms, right peripheral facial palsy, which is a very rare manifestation in cavernous sinus thrombosis (CST). She was treated with broad-spectrum antibiotics and enoxaparin. The day of the scheduled drainage of sphenoid sinus—24 hours after the initiation of anticoagulation—she developed fatal subarachnoid haemorrhage. Our case demonstrates the difficulty of timely diagnosis of acute sphenoid sinusitis which has emerged as the most common primary infectious source potentially leading in CST. It also underscores the uncertainty concerning the use of anticoagulation in cerebral sinus thrombosis of infectious origin.
Congenital adrenal hyperplasia with salt-wasting crisis and arrhythmia: a case study
Authors: Canlas Johnny Figueroa , Ponmani Caroline
Published: January 2019

We report a case of a 10-day-old male infant who presented to the emergency department with severe electrolyte imbalance and life-threatening arrhythmia. The parents reported a 3-day history of poor feeding and lethargy. On examination, he was bradycardic (heart rate of 65 beats/min) with signs of dehydration. His ECG showed broad complex bradycardia. Blood gas showed metabolic acidosis with hyponatraemia and hyperkalaemia. A probable diagnosis of congenital adrenal hyperplasia (CAH) with salt-wasting crisis was made and treatment was commenced. He was given saline bolus, nebulised salbutamol, calcium gluconate and hydrocortisone. Following the above interventions, his heart rate rose to 150 beats/min with a regular sinus rhythm within a period of 40 min. The diagnosis of CAH secondary to 21-hydroxylase deficiency with mutation in CYP21A2 was confirmed by genetic studies. He was discharged home with hydrocortisone, fludrocortisone and sodium chloride.
Synovial sarcoma in an HIV-positive pregnant woman and review of literature
Authors: Akhanoba Folasade , Zill-E-Huma Rabia , Pollock Rob , Edwards Sarah J E
Published: January 2019

We present a first case of synovial sarcoma in an HIV-positive pregnant woman. This 28-year-old woman was diagnosed with synovial sarcoma, a high-grade malignant soft tissue sarcoma, involving her left thigh during the first trimester of her pregnancy. She underwent surgical treatment in the form of hip disarticulation at 30 weeks’ gestation. She was subsequently delivered by emergency caesarean section (CS) at 34 weeks’ gestation when she presented with wound sepsis and a scan revealed static growth in a small for gestational age fetus. Prompt diagnosis and treatment of this aggressive tumour is important and should involve a multidisciplinary approach, with a balanced consideration of the maternal and fetal outcomes.
Bacteraemia and multiple liver abscesses due toFusobacterium nucleatumin a patient with oropharyngeal malignancy
Authors: Garcia-Carretero Rafael
Published: January 2019

Fusobacteriuminfections can have a wide clinical spectrum, ranging from mild infections to severe sepsis and abscess formation. This range depends partly on the patient’s underlying conditions, such as immunosuppression or malignancy. Fusobacteria are commensal rods in the oropharyngeal cavity and digestive tract, but should mucosal barrier disruption occur, in the presence of the above-mentioned predisposing conditions, fusobacteria can spread and cause infections in the soft tissues, liver and so on. An elderly woman was admitted with an altered level of consciousness (lethargy). The ensuing workup revealed a posterior oral cavity tumour (squamous cell carcinoma),Fusobacterium nucleatumbacteraemia and liver abscesses. Due to the severe sepsis, the patient was referred to our intensive care unit, but she passed away despite antibiotic treatment.
Association of human antigen class I genes with cold medicine-related Stevens-Johnson syndrome with severe ocular complications in a Korean population
Authors: Jun Ikhyun , Rim John Hoon , Kim Mee Kum , Yoon Kyung-Chul , Joo Choun-Ki , Kinoshita Shigeru , Seo Kyoung Yul , Ueta Mayumi
Published: January 2019

Background/aims

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are a spectrum of diseases that cause an acute vesiculobullous reaction in the skin and mucous membranes. The occurrence of these diseases is associated with various drugs, a large proportion of which is comprised cold medicines (CM). We try to investigate the association between human leucocyte antigen (HLA) class I genes and CM-related SJS/TEN (CM-SJS/TEN) with severe ocular complications (SOC) in the Korean population.

Methods

This multicentre case-control study enrolled 40 Korean patients with CM-SJS/TEN with SOC and 120 age-matched and sex-matched Korean healthy volunteers between January 2012 and May 2014. HLA genotyping was performed using PCR followed by hybridisation with sequence-specific oligonucleotide probes.

Results 

The carrier frequency and gene frequency of HLA-A*02:06 were 37.5 % and 20.0 %, respectively, in patients, and 16.7 % and 9.6 %, respectively, in controls (p=0.018). The carrier frequency of HLA-C*03:04 was 30 % in patients and 10.8 % in controls, and gene frequency of HLA-C*03:04 was 15 % in patients and 5.4 % in controls (p=0.003). The carrier frequency and gene frequency of HLA-C*03:03 were 2.5 % and 1.3 %, respectively, in patients, and 20 % and 10.4 %, respectively, in controls (p=0.006).

Conclusions 

As per our results, we suggest that HLA-A*02:06 and HLA-C*03:04 might be positive markers for CM-SJS/TEN with SOC, and HLA-C*03:03 might be an indicator of protection against CM-SJS/TEN with SOC in the Korean population.
Peripartum cardiomyopathy
Authors: Honigberg Michael C , Givertz Michael M
Published: January 2019

Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.
Task shifting to improve the provision of integrated chronic care: realist evaluation of a lay health worker intervention in rural South Africa
Authors: Limbani Felix , Thorogood Margaret , Gómez-Olivé Francesc Xavier , Kabudula Chodziwadziwa , Goudge Jane
Published: January 2019

Introduction

Task shifting is a potential solution to the shortage of healthcare personnel in low/middle-income countries, but contextual factors often dilute its effectiveness. We report on a task shifting intervention using lay health workers to support clinic staff in providing chronic disease care in rural South Africa, where the HIV epidemic and an ageing population have increased demand for care.

Methods

We conducted a realist evaluation in a cluster randomised controlled trial. We conducted observations in clinics, focus group discussions, in-depth interviews and patient exit interviews, and wrote weekly diaries to collect data.

Results

All clinic managers had to cope with an increasing but variable patient load and unplanned staff shortages, insufficient space, poorly functioning equipment and erratic supply of drugs. These conditions inevitably generated tension among staff. Lay health workers relieved the staff of some of their tasks and improved care for patients, but in some cases the presence of the lay health worker generated conflict with other staff. Where managers were able to respond to the changing circumstances, and to contain tension among staff, facilities were better able to meet patient needs. This required facility managers to be flexible, consultative and willing to act on suggestions, sometimes from junior staff and patients. While all facilities experienced an erratic supply of drugs and poorly maintained equipment, facilities where there was effective management, teamwork and sufficient space had better chronic care processes and a higher proportion of patients attending on their appointed day.

Conclusion

Lay health workers can be valuable members of a clinic team, and an important resource for managing increasing patient demand in primary healthcare. Task shifting will only be effective if clinic managers respond to the constantly changing system and contain conflict between staff. Strengthening facility-level management and leadership skills is a priority.

Trial registration number

ISRCTN12128227.
Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka
Authors: Beane Abi , De Silva Ambepitiyawaduge Pubudu , Athapattu Priyantha Lakmini , Jayasinghe Saroj , Abayadeera Anuja Unnathie , Wijerathne Mandika , Udayanga Ishara , Rathnayake Shriyananda , Dondorp Arjen M , Haniffa Rashan
Published: January 2019

Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north–south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work.
Large care gaps in primary care management of asthma: a longitudinal practice audit
Authors: Price Courtney , Agarwal Gina , Chan David , Goel Sanjeev , Kaplan Alan G , Boulet Louis-Philippe , Mamdani Muhammad M , Straus Sharon E , Lebovic Gerald , Gupta Samir
Published: January 2019

Objectives

Care gaps in asthma may be highly prevalent but are poorly characterised. We sought to prospectively measure adherence to key evidence-based adult asthma practices in primary care, and predictors of these behaviours.

Design

One-year prospective cohort study employing an electronic chart audit.

Setting

Three family health teams (two academic, one community-based) in Ontario, Canada.

Participants

884 patients (72.1% female; 46.0±17.5 years old) (4199 total visits; 4.8±4.8 visits/patient) assigned to 23 physicians (65% female; practising for 10.0±8.6 years).

Main outcome measures

The primary outcome was the proportion of visits during which practitioners assessed asthma control according to symptom-based criteria. Secondary outcomes included the proportion of: patients who had asthma control assessed at least once; visits during which a controller medication was initiated or escalated; and patients who received a written asthma action plan. Behavioural predictors were established a priori and tested in a multivariable model.

Results

Primary outcome: Providers assessed asthma control in 4.9% of visits and 15.4% of patients. Factors influencing assessment included clinic site (p=0.019) and presenting symptom, with providers assessing control more often during visits for asthma symptoms (35.0%) or any respiratory symptoms (18.8%) relative to other visits (1.6%) (p<0.01). Secondary outcomes: Providers escalated controller therapy in 3.3% of visits and 15.4% of patients. Factors influencing escalation included clinic site, presenting symptom and prior objective asthma diagnosis. Escalation occurred more frequently during visits for asthma symptoms (21.0%) or any respiratory symptoms (11.9%) relative to other visits (1.5%) (p<0.01) and in patients without a prior objective asthma diagnosis (3.5%) relative to those with (1.3%) (p=0.025). No asthma action plans were delivered.

Conclusions

Major gaps in evidence-based asthma practice exist in primary care. Targeted knowledge translation interventions are required to address these gaps, and can be tailored by leveraging the identified behavioural predictors.

Trial registration number

NCT01070095; Pre-results.
Fatty liver disease and the risk of erosive oesophagitis in the Korean population: a cross-sectional study
Authors: Choi Ja Sung , Kim Hee Man , Yang Yun-Jung , Lee Sangheun , Jeong Seok-Hoo , Han Ki Jun
Published: January 2019

Objectives

To investigate an association between fatty liver disease (FLD) and erosive oesophagitis.

Design and setting

This was a cross-sectional study of subjects selected from examinees who underwent health check-up, including oesophagogastroduodenoscopy in one hospital between 2004 and 2011. Erosive oesophagitis was classified according to the Los Angeles classification and FLD was diagnosed with ultrasonography. The anthropometric and laboratory data of the subjects were analysed using χ2test and multivariate logistic regression. Additionally, we have analysed our data with two-stage least square estimation using the Baltagi-Chang one-way model to clarify unobserved confounding variable.

Primary outcome measure

The effect of FLD on erosive oesophagitis.

Results

Among the 14 723 eligible subjects, 4232 (28.7%) subjects diagnosed with FLD were classified into the fatty liver group and 10 491 (71.3%) subjects without FLD were classified into the non-fatty liver group. The incidence rate of erosive oesophagitis was significantly higher in the fatty liver group than in the non-fatty liver group (10.4%vs6.1%, p<0.0001). The multivariate analysis revealed that the fatty liver group was significantly associated with erosive oesophagitis (OR 1.19, 95% CI 1.03 to 1.37, p=0.016).

Conclusion

FLD diagnosed by ultrasonography is an independent risk factor of erosive oesophagitis. It suggests that FLD-related metabolic abnormality may be associated with erosive oesophagitis.
Prevalence and determinants of serological evidence of atrophic gastritis among Arab and Jewish residents of Jerusalem: a cross-sectional study
Authors: Muhsen Khitam , Sinnreich Ronit , Merom Dafna , Beer-Davidson Gany , Nassar Hisham , Cohen Dani , Kark Jeremy D
Published: January 2019

Objective

Understanding the correlates of premalignant gastric lesions is essential for gastric cancer prevention. We examined the prevalence and correlates of serological evidence of atrophic gastritis, a premalignant gastric condition, using serum pepsinogens (PGs) in two populations with differing trends in gastric cancer incidence.

Methods

In a cross-sectional study, using ELISA we measured serum PGI and PGII concentrations (Biohit, Finland),Helicobacter pyloriserum IgG and cytotoxin-associated gene A (CagA) antigen IgG antibodies in archived sera of 692 Jews and 952 Arabs aged 25–78 years, randomly selected from Israel’s population registry in age–sex and population strata. Multivariable logistic regression analyses were performed.

Results

Using cut-offs of PGI <30µg/L  or PGI:PGII <3.0, the prevalence of atrophic gastritis was higher among Arab than Jewish participants: 8.8% (95% CIs 7.2% to 10.8%) vs 5.9% (95% CI 4.4% to 7.9%), increasing with age in both groups (p<0.001 for trend). Among Jewish participants, infection withH. pyloriCagA phenotype was positively related to atrophic gastritis: adjusted OR (aOR) 2.16 (95% CI 0.94 to 4.97), but not to non-CagA infections aOR 1.17 (95% CI 0.53 to 2.55). The opposite was found among Arabs: aOR 0.09 (95% CI 0.03 to 0.24) for CagA positive and aOR 0.15 (95% CI 0.06 to 0.41) for Cag A negative phenotypes (p<0.001 for interaction). Women had a higher atrophic gastritis prevalence than men. Obesity and smoking were not significantly related to atrophic gastritis; physical activity tended to be inversely associated in Arabs (p=0.08 for interaction).

Conclusions

The prevalence of atrophic gastritis was higher among Arabs than Jews and was differently associated with the CagA phenotype.
Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study
Authors: Wang Jinjiao , Dietrich Mary S , Bell Susan P , Maxwell Cathy A , Simmons Sandra F , Kripalani Sunil
Published: January 2019

Objectives

(1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period.

Design

Secondary analysis of longitudinal data from a cohort study.

Participants and setting

834 older (≥65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121).

Outcome

Vulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching.

Results

Overall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=−1.34(–2.07, –0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%–16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year.

Conclusion

After adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.
Short email with attachment versus long email without attachment when contacting authors to request unpublished data for a systematic review: a nested randomised trial
Authors: Godolphin Peter J , Bath Philip M , Montgomery Alan A
Published: January 2019

Objective

Systematic reviews often rely on the acquisition of unpublished analyses or data. We carried out a nested randomised trial comparing two different approaches for contacting authors to request additional data for a systematic review.

Participants

Participants were authors of published reports of prevention or treatment trials in stroke in which there was central adjudication of events. A primary and secondary research active author were selected as contacts for each trial.

Interventions

Authors were randomised to be sent either a short email with a protocol of the systematic review attached (‘Short’) or a longer email that contained detailed information and without the protocol attached (‘Long’). A maximum of two emails were sent to each author to obtain a response. The unit of analysis was trial, accounting for clustering by author.

Primary and secondary outcome measures

The primary outcome was whether a response was received from authors. Secondary outcomes included time to response, number of reminders needed before a response was received and whether authors agreed to collaborate.

Results

88 trials with 76 primary authors were identified in the systematic review, and of these, 36 authors were randomised to Short (trials=45) and 40 to Long (trials=43). Responses were received for 69 trials. There was no evidence of a difference in response rate between trial arms (Short vs Long, OR 1.10, 95% CI 0.36 to 3.33). There was no evidence of a difference in time to response between trial arms (Short vs Long, HR 0.91, 95% CI 0.55 to 1.51). In total, 27% of authors responded within a day and 22% of authors never responded.

Conclusions

There was no evidence to suggest that email format had an impact on the number of responses received when acquiring data for a systematic review involving stroke trials or the time taken to receive these responses.