bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of tillage and crop management on runoff, soil erosion and organic carbon loss
Authors: Chowaniak Maciej , Głąb Tomasz , Klima Kazimierz , Niemiec Marcin , Zaleski Tomasz , Zuzek Dagmara
Published: May 2020

Proper management of soil organic matter is an important issue in the context of sustainable agriculture. The intensification of production and the loss of organic carbon associated with agriculture reduce the efficiency of production and the quality of the environment, especially in relation to areas exposed to erosion. The aim of this study was to determine the impact of specific tillage systems and plant cover on the organic carbon losses, as well as on runoff and soil losses, over a 6‐year study period following the introduction of no‐till. The first factor in the experiment was the tillage system: conventional tillage (CT) and no‐till (NT). The second factor was plant cover: horse bean, spring wheat and winter oilseed rape. The results showed that runoff was 4.3 ± 0.6% higher under NT than under CT, while soil loss was 66.8 ± 2.7% lower under NT than under CT. Compared to CT, NT limited the total organic carbon losses by an average of 46.0 ± 2.9% and organic carbon bound with sediment losses by 53.2 ± 0.7%, whereas for dissolved organic carbon, there were no significant differences for the tillage systems. The anti‐erosion effectiveness of NT was lower in the first year, but it increased in subsequent years after the introduction of this tillage system. Plant cover also had a significant impact on organic carbon losses and soil protection. The crops were ranked according to runoff, soil losses and organic carbon losses in the following order from lower to higher losses: winter oilseed rape > spring wheat > horse bean.
CONSTITUTIVELY PHOTOMORPHOGENIC1 promotes ABA‐mediated inhibition of post‐germination seedling establishment
Authors: Yadukrishnan Premachandran , Rahul Puthan Valappil , Ravindran Nevedha , Bursch Katharina , Johansson Henrik , Datta Sourav
Published: May 2020

Under acute stress conditions, precocious seedling development may result in the premature death of young seedlings, before they switch to autotrophic growth. The phytohormone abscisic acid (ABA) inhibits seed germination and post‐germination seedling establishment under unfavorable conditions. Various environmental signals interact with the ABA pathway to optimize these early developmental events under stress. Here, we show that light availability critically influences ABA sensitivity during early seedling development. In dark conditions, the ABA‐mediated inhibition of post‐germination seedling establishment is strongly enhanced. COP1, a central regulator of seedling development in the dark, is necessary for this enhanced post‐germination ABA sensitivity in darkness. Despite their slower germination, cop1 seedlings establish faster than wild type in the presence of ABA in both light and dark. PHY and CRY photoreceptors that inhibit COP1 activity in light modulate ABA‐mediated inhibition of seedling establishment in light. Genetically, COP1 acts downstream to ABI5, a key transcriptional regulator of ABA signaling, and does not influence the transcriptional and protein levels of ABI5 during the early post‐germination stages. COP1 promotes post‐germination growth arrest independent of the antagonistic interaction between ABA and cytokinin signaling pathways. COP1 facilitates the binding of ABI5 on its target promoters and the ABA‐mediated upregulation of these target genes is reduced in cop1‐4. Together, our results suggest that COP1 positively regulates ABA signaling to inhibit post‐germination seedling establishment under stress.
Gender Non-traditional High School Study: Reasons for Choice and Evaluation of Experience
Authors: Smetáčková Irena , Pavlík Petr
Published: May 2020

Career choices of most pupils at the end of the primary school conform to gender norms. Only a few of them continue to study in a field traditionally considered appropriate for the opposite sex. The qualitative study presented here maps the reasons for such choices based on a sample of 25 female and 31 male students who study gender-atypical secondary school program for one to three years. The data were collected using a questionnaire with open-ended items and analysed using the qualitative thematic analysis. The results revealed that the reasons for school choices of boys and girls differ to certain extent. Their situation also differs with respect to the support they receive from their close ones and the acceptance by their classmates. The parents of girls disapproved of their choices more often than the parents of boys. Girls were also ridiculed more frequently by their peer groups.
Hamas
Authors: Jordan Jenna
Published: May 2020

Chapter 5 examines Israeli attempts to capture or kill Hamas leaders from 1988 to 2014. It first looks at changes in the frequency and lethality of both conventional and suicide attacks in order to determine whether leadership targeting has affected Hamas’s operational capacity. Hamas’s bureaucratic hierarchy has increased its organizational stability and ability to withstand leadership attacks. The high degree of Palestinian support for Hamas has increased not only its strength and resilience to decapitation but also its legitimacy. The data shows that Palestinian support has increased over time, making Hamas even more resilient to leadership attacks. Finally, ideology is a critical factor. Hamas is both a separatist and a religious organization, which also plays a role in its ability to withstand repeated attacks on its leadership.
The Land of the Dead
Authors: Needell Jeffrey D.
Published: May 2020

This chapter provides the urban context and describes the socioeconomic and political milieu of the movement. Its major points include the prospects for Afro-Brazilian political mobilization, reviewing the latter up through 1871 and taking into account religious brotherhoods, urban festivals and culture, and mutual aid and labor organizations. It also reviews Afro-Brazilian divisions and creolization, with the end of the African trade, the ebb of African ethnicities, and the potential of religious synthesis. It concludes with an overview of the imperial political structure, highlighting the emperor’s increasing impact on cabinets and policy, and particularly the divisive Conservative passage of the gradualist abolitionist law of 1871 and the debate’s significance in terms of state-elite relations and slavery’s prospects.
The Alliance with the Future
Authors: Needell Jeffrey D.
Published: May 2020

This chapter analyzes the movement’s origins and takes the narrative up to the 1881 electoral defeat. It reviews the 1871 law’s failure and the slaveholders’ assessments, with the Conservative recovery and fall, and explains the Liberals’ ascent and their perennial divisions over policy (with the supremacy of the moderate wing). It then explains the Liberal reformists’ position, the significance of their urban base and its perspective, the importance of the Vintém Revolt of 1880, and the reformists’ decision to emphasize gradualist abolition. It analyzes the movement’s parliamentary origins, the initial leadership in and out of parliament, the activists mobilizing the Afro-Brazilian masses, and Abolitionist parliamentary marginalization. It discusses public mobilization, with an emphasis on press support, initial public organization, and the critical role of middle-class and mass Afro-Brazilian identification and solidarity with the slaves. In concludes with the movement’s electoral defeat in 1881 and Nabuco’s self-exile.
The Fate of the Black Race
Authors: Needell Jeffrey D.
Published: May 2020

This chapter analyzes the radicalization of the cabinet and Abolitionist positions, the Abolitionists’ triumph, and why the crown changed cabinets. Cotegipe began with repression of the Abolitionists and by weakening the 1885 law. The latter responded radically, combining urban demonstrations and press and parliamentary attacks on crown and cabinet with dramatic moves to destabilize rural slave labor by means of underground railroads, organized mass flights from plantations, and urban fugitive settlements. Between 1886 and 1887, the cabinet lost credibility, with parliamentary opposition, a reform that ended slave flogging, the emperor’s illness and medical leave, the military’s opposition and threats, Nabuco’s triumphant reelection, and finally, Conservative parliamentary mutiny, calling for quicker phased program of abolition with indemnification. In early 1888 the princess regent compelled Cotegipe’s resignation and appointed the reformist Conservative João Alfredo. The chapter concludes with an assessment of Abolitionist successes and the central role of Afro-Brazilian mobilization.
Introduction
Authors: Breen Richard , Müller Walter
Published: May 2020

This chapter sets out the main goal of the volume: to examine the role of education in shaping rates and patterns of intergenerational social mobility among men and women during the twentieth century. This is a particularly timely question given the concerns of politicians and policy makers with intergenerational mobility and their belief that the solution lies in education. The chapter explains what we mean by social mobility and the distinction between absolute and relative mobility, and it sets out the reasons why we expect changes to the educational system to lead to changes in both absolute and relative mobility. The chapter discusses the reasons for choosing the eight countries on which we focus: the United States, Sweden, Germany, France, the Netherlands, Italy, Spain, and Switzerland. The operationalization of our main variables is explained and the questions to be addressed in each of the subsequent country chapters are set out.
Social Mobility in the Twentieth Century in Europe and the United States
Authors: Breen Richard , Müller Walter
Published: May 2020

Summarizing the findings of the country chapters, this chapter addresses the question: How did intergenerational social mobility change over cohorts born in the first two-thirds of the twentieth century? What role, if any, did education play in this? As education expanded, its association to class origins weakened, especially among earlier-born cohorts—a strong indication that growing education equalization may have been important in increasing social fluidity. There is also a strong link between upward mobility and social fluidity, the former mostly driven by the expansion of higher-level white-collar jobs. Educational expansion, equalization, and rapid structural change in the US and European economies all contributed to greater social fluidity among people born before the middle of the century. For people born later, rates of downward mobility have increased: however, despite the lack of further educational equalization and less-pronounced structural change, social fluidity has remained unchanged.
In the “Twilight Warzone”
Authors: Rider Toby C.
Published: May 2020

During the early Cold War years, the US government created a sprawling propaganda machinery that developed along overt and covert lines. This essay focuses on the sporting dimension of this propaganda offensive. In particular, it explores how US strategists used sport in an overt global information campaign to advertise American culture and also how covert operators helped Hungarian athletes defect to America after the 1956 Olympic Games.
“No Quarrel with Them Vietcong”
Authors: Gorn Elliott J.
Published: May 2020

When Cassius Clay became heavyweight boxing champion in 1964, no one expected him to take political stands. Yet he joined the controversial Nation of Islam and, within a few years, refused to be drafted into the US Army, for which he was convicted in federal court. Ali’s opposition to the Vietnam War grew out of his acute awareness of American racism and his support for decolonization movements overseas. He was stripped of his title and barred from the prize ring for four years, until the US Supreme Court unanimously overturned his conviction.
Action in the Era of Stagnation
Authors: Prozumenshikov Mikhail
Published: May 2020

After the Soviet Union’s successful second-place result in the 1952 Olympic Summer Games, its sports officials began to dream of hosting the great mega-event in Moscow. Able leaders like Konstantin Andrianov and Nikolai Romanov repeatedly pushed the party leadership to go along with their plans but to no avail. Joseph Stalin, who departed the world in 1953, had little interest in sport, and his successor, Nikita Khrushchev, was hostile. Everything changed when Leonid Brezhnev came to power. He was an ardent fan of sport who had supported teams and clubs in all the localities through which he passed on the way to the top of the Soviet hierarchy in 1964. Ten years later, after numerous false starts, the Soviet capital was awarded the Games. In this case, a single individual in an authoritarian state had a profound effect.
Sports, Politics, and “Wild Doping” in the East German Sporting “Miracle”
Authors: Dennis Mike
Published: May 2020

Although the German Democratic Republic is well known for its highly centralized and clandestine doping program, the elite sports edifice was not the orderly mechanism associated with the Communist dictatorship. Recent research has uncovered intrinsic operational malfunctions, divergent group interests, and rivalries as clubs and national associations pursued status and material rewards. Despite elaborate internal controls, one of the outcomes was widespread “wild doping,” exceeding officially prescribed norms on the level and types of dosages administered to athletes who received unauthorized experimental steroid substances by coaches and physicians, posing potentially serious health threats to both youngsters and adults.
“The Most Beautiful Face of Socialism”
Authors: Timm Annette F.
Published: May 2020

East German figure skater Katarina Witt’s enormously successful career included gold-medal performances at the 1984 and 1988 Olympics, turning her into an ambassador for her country and a worldwide media star. Backed by a regime that saw sport as a form of soft politics, Witt and her coach consciously cultivated her fame by increasing the sexual tension of her performances. Timm provides cultural context for the resulting collision between politics, sex, and sport. While certainly not a dupe of her handlers, relaxed East German attitudes toward nudity likely left Witt unable to appreciate how her image intertwined with popular culture images of the Cold War “honey pot.”
Negotiating Colonial Repression
Authors: Cleveland Todd
Published: May 2020

The political dimensions of African soccer players’ immigration to dictatorial Portugal came under increasing pressure from Socialist nations and newly independent African states. Even the United States privately implored Lisbon to relax controls in the empire. This pressure prompted Portugal to waive a host of travel and labor restrictions to facilitate the employment and relocation of African soccer players and showcase them as part of a multiracial national team. African players were able to ply their skills in the metropole, while the regime’s revised policies remained highly restrictive. The unflinching apoliticism of the vast majority of these players limited their political utility for both the regime and for the liberation movements in its colonies.
Dynamic right and left ventricular interactions in the pig
Authors: Pinsky Michael R.
Published: May 2020

New Findings

What is the central question of this study?

Are the mechanisms that cause ventricular interdependence different when due to primary right to left ventricular pressure loading?

What is the main finding and its importance?

An instantaneous selective increase in aortic pressure causes an immediate increase in right ventricular end‐systolic pressure independent of the pericardium, whereas a selective increase in pulmonary artery pressure decreases left ventricular diastolic compliance owing to a subsequent increasing right ventricular end‐diastolic volume as a function of an intact pericardium limiting biventricular volume. Changes in contraction synchrony of either ventricle do not appear to be causing these effects.

I characterized the dynamic factors determining ventricular interdependence with and without the pericardium. I measured right (RV) and left ventricular (LV) pressures and volumes simultaneously using conductance catheters in seven pentobarbitone‐anaesthetized open‐chested 5‐ to 7‐week‐old piglets. I studied these effects during apnoea, inferior vena caval occlusion and rapid partial aortic and pulmonary arterial occlusions. Conductance catheter‐defined long‐axis regional volumes were assessed to define regional contractile synchrony. Closed‐pericardium measures were made from an initial (baseline) volume, then after two 20 ml kg−1 fluid loads followed by an open‐pericardium step. Baseline RV and LV volumes were similar. Aortic occlusion increased LV pressures and volumes and RV end‐systolic pressure such that RV end‐systolic elastance increased without changes in RV contraction synchrony, not affected by the pericardium. Pulmonary artery occlusion increased RV end‐systolic pressure but not end‐systolic volume. On the subsequent beat, RV end‐diastolic pressure increased, whereas LV end‐diastolic volume and diastolic compliance decreased. These effects were attenuated by opening the pericardium. Contraction synchrony across longitudinal segments was unaltered by either aortic or pulmonary artery occlusion. I conclude that the determinants of systolic and diastolic ventricular interdependence are different. Increasing RV pressures causes diastolic RV‐to‐LV interdependence, decreasing LV diastolic compliance and dependent on an intact pericardium. An increase in LV end‐systolic pressure increases RV end‐systolic elastance independent of the pericardium and has a minimal effect on RV diastolic function or contraction synchrony.
Utilizing plasma modified SnO2 paper gas sensors to better understand gas-surface interactions at low temperatures
Authors: Hiyoto Kimberly A. M. , Fisher Ellen R.
Published: May 2020

Developing low temperature, low cost metal oxide gas sensors remains a critical but elusive goal. Additionally, a better understanding of gas-metal oxide interactions during sensing is required to achieve this goal as well as improving the performance of these devices. Here, the authors describe a paper-based gas sensor (PGS) utilizing SnO2 nanoparticles to detect ethanol, CO, and benzene. Proof-of-concept sensor data indicate that the response was increased and viable operating temperature was lowered (≤50 °C) via plasma surface modification techniques using an Ar/O2 gas mixture at a range of applied rf powers and precursor pressures. Temperature dependent response also demonstrates that sensor selectivity can be tuned with plasma treatment parameters. Ethanol response and recovery behavior at operating temperatures ≤50 °C indicate that sensors demonstrate real-time response at relatively low temperatures. Additionally, although the resistance of the PGS does not fully recover postgas exposure, the signal stability and continued response to ethanol with subsequent exposures indicate that sensors could potentially be used multiple times. Optical emission spectroscopy identified species involved in plasma surface modification processes and x-ray photoelectron spectroscopy elucidated how these changes in surface chemistry correlate to PGS performance. The combination of these techniques provides insight into the driving factors controlling the gas detection process. This approach to produce PGSs shows great promise for the fabrication of flexible, inexpensive devices capable of operating at much lower temperatures than current metal-oxide based sensors.
New insights into ToF-SIMS imaging in osteoporotic bone research
Authors: Kern Christine , Ray Seemun , Gelinsky Michael , Bellew Allen T. , Pirkl Alexander , Rohnke Marcus
Published: May 2020

The present work focuses on the application of time-of-flight secondary ion mass spectrometry (ToF-SIMS) in osteoporotic bone research. In order to demonstrate the benefit, the authors present concrete application examples of ToF-SIMS in three different areas of bone research. ToF-SIMS as a mass spectrometric imaging technique allows simultaneous visualization of mineralized and nonmineralized bone tissue as well as implanted biomaterials and bone implant interphases. In the first example, the authors show that it is possible to study the incorporation and distribution of different components released from bone filler materials into bone with a single mass spectrometric measurement. This not only enables imaging of nonstained bone cross sections but also provides further insights beyond histologically obtained information. Furthermore, they successfully identified several mass fragments as markers for newly formed cartilage tissue and growth joint in bone. Different modes of ToF-SIMS as well as different SIMS instruments (IONTOF's TOF.SIMS 5 and M6 Hybrid SIMS, Ionoptika's J105) were used to identify these mass signals and highlight the high versatility of this method. In the third part, bone structure of cortical rat bone was investigated from bone sections embedded in technovit (polymethyl methacrylate, PMMA) and compared to cryosections. In cortical bone, they were able to image different morphological features, e.g., concentric arrangement of collagen fibers in so-called osteons as well as Haversian canals and osteocytes. In summary, the study provides examples of application and shows the strength of ToF-SIMS as a promising analytical method in the field of osteoporotic bone research.
The Péclet number of a casino: Diffusion and convection in a gambling context
Authors: Gommes Cedric J. , Tharakan Joe
Published: May 2020

The Péclet number is used to characterize the relative importance of convection over diffusion in transport phenomena. We explore an alternative yet equivalent interpretation of that classical dimensionless number in terms of the observation scale. At a microscopic scale, all phenomena are necessarily diffusive because of the randomness of molecular motion. Convection is a large-scale phenomenon, which emerges when the randomness is averaged out on a large number of microscopic events. That perspective considerably broadens the scope of the Péclet number beyond convection and diffusion: it characterizes how efficient an averaging procedure is at reducing fluctuations at a considered scale. We discuss this by drawing on a rigorous analogy with gambling: the gains and losses of an individual gambler are governed by chance, but those of a casino—the accumulated gains and losses of many gamblers—can be predicted with quasi-certainty. The Péclet number captures these scale-dependent qualitative differences.
T cells with dysfunctional mitochondria induce multimorbidity and premature senescence
Authors: Desdín-Micó Gabriela , Soto-Heredero Gonzalo , Aranda Juan Francisco , Oller Jorge , Carrasco Elisa , Gabandé-Rodríguez Enrique , Blanco Eva Maria , Alfranca Arantzazu , Cussó Lorena , Desco Manuel , Ibañez Borja , Gortazar Arancha R. , Fernández-Marcos Pablo , Navarro Maria N. , Hernaez Bruno , Alcamí Antonio , Baixauli Francesc , Mittelbrunn María
Published: May 2020

Inflammaging? Blame T cells!

Mitochondrial dysfunction in various tissues is a prominent characteristic of age-related deterioration, but it is unclear how mitochondrial dysfunction in particular cell types contributes to this process. Desdín-Micó
et al.
generated mice with T cells that were specifically deficient in a mitochondrial DNA–stabilizing protein. These animals exhibited multiple features associated with aging, including neurological, metabolic, muscular, and cardiovascular impairments. The defective T cells initiated an inflammatory program similar to that observed in older animals, a process called “inflammaging.” Blocking the cytokine tumor necrosis factor–α or administering precursors of the cofactor nicotinamide adenine dinucleotide restored many of these symptoms of senescence. These findings may potentially inform future therapies for age-associated diseases, as well as cachexia and cytokine-release syndrome.

Science
, this issue p.
1371
Bumble bees damage plant leaves and accelerate flower production when pollen is scarce
Authors: Pashalidou Foteini G. , Lambert Harriet , Peybernes Thomas , Mescher Mark C. , De Moraes Consuelo M.
Published: May 2020

Bumble bee gardeners

Bumble bees rely heavily on pollen resources for essential nutrients as they build their summer colonies. Therefore, we might expect that annual differences in the availability of these resources must simply be tolerated, but Pashalidou
et al.
made observations suggesting that bees may have strategies to cope with irregular seasonal flowering (see the Perspective by Chittka). When faced with a shortage of pollen, bumble bees actively damaged plant leaves in a characteristic way, and this behavior resulted in earlier flowering by as much as 30 days. Experimenters were not able to fully replicate the results with their own damage, suggesting that there is a distinct method that the bees use to stimulate earlier flowering.

Science
, this issue p.
881
; see also p.
824
DNA-directed nanofabrication of high-performance carbon nanotube field-effect transistors
Authors: Zhao Mengyu , Chen Yahong , Wang Kexin , Zhang Zhaoxuan , Streit Jason K. , Fagan Jeffrey A. , Tang Jianshi , Zheng Ming , Yang Chaoyong , Zhu Zhi , Sun Wei
Published: May 2020

DNA bricks build nanotube transistors

Semiconducting carbon nanotubes (CNTs) are an attractive platform for field-effect transistors (FETs) because they potentially can outperform silicon as dimensions shrink. Challenges to achieving superior performance include creating highly aligned and dense arrays of nanotubes as well as removing coatings that increase contact resistance. Sun
et al.
aligned CNTs by wrapping them with single-stranded DNA handles and binding them into DNA origami bricks that formed an array of channels with precise intertube pitches as small as 10.4 nanometers. Zhao
et al.
then constructed single and multichannel FETs by attaching the arrays to a polymer-templated silicon wafer. After adding metal contacts across the CNTs to fix them to the substrate, they washed away all of the DNA and then deposited electrodes and gate dielectrics. The FETs showed high on-state performance and fast on-off switching.

Science
, this issue p.
874
, p.
878
Restoring vision to the blind
Authors: Dowling John E.
Published: May 2020

Ideas abound to restore vision to people blinded by retinal disease
Aligned, high-density semiconducting carbon nanotube arrays for high-performance electronics
Authors: Liu Lijun , Han Jie , Xu Lin , Zhou Jianshuo , Zhao Chenyi , Ding Sujuan , Shi Huiwen , Xiao Mengmeng , Ding Li , Ma Ze , Jin Chuanhong , Zhang Zhiyong , Peng Lian-Mao
Published: May 2020

Aligning dense carbon nanotube arrays

Although semiconducting carbon nanotubes (CNTs) are promising candidates to replace silicon in transistors at extremely small dimensions, their purity, density, and alignment must be improved. Liu
et al.
combined a multiple dispersion sorting process, which improves purity, and a dimension-limited self-alignment process to produce well-aligned CNT arrays on a 10-centimeter silicon wafer. The density is sufficiently high (100 to 200 CNTs per micrometer) that large-scale integrated circuits could be fabricated. With ionic liquid gating, the performance metrics exceeded those of conventional silicon transistors with similar dimensions.

Science
, this issue p.
850
Global solutions to a silent poison
Authors: Zheng Yan
Published: May 2020

Modeling arsenic in domestic well water highlights large data gaps in testing
Simulating the Influence of Conjugative-Plasmid Kinetic Values on the Multilevel Dynamics of Antimicrobial Resistance in a Membrane Computing Model
Authors: Campos Marcelino , San Millán Álvaro , Sempere José M. , Lanza Val F. , Coque Teresa M. , Llorens Carlos , Baquero Fernando
Published: May 2020

Bacterial plasmids harboring antibiotic resistance genes are critical in the spread of antibiotic resistance. It is known that plasmids differ in their kinetic values, i.e., conjugation rate, segregation rate by copy number incompatibility with related plasmids, and rate of stochastic loss during replication. They also differ in cost to the cell in terms of reducing fitness and in the frequency of compensatory mutations compensating plasmid cost. However, we do not know how variation in these values influences the success of a plasmid and its resistance genes in complex ecosystems, such as the microbiota.
An 1,4-α-Glucosyltransferase Defines a New Maltodextrin Catabolism Scheme in Lactobacillus acidophilus
Authors: Andersen Susan , Møller Marie S. , Poulsen Jens-Christian N. , Pichler Michael J. , Svensson Birte , Lo Leggio Leila , Goh Yong Jun , Abou Hachem Maher
Published: May 2020

The degradation of starch in the small intestine generates short linear and branched α-glucans. The latter are poorly digestible by humans, rendering them available to the gut microbiota, e.g., lactobacilli adapted to the small intestine and considered beneficial to health. This study unveils a previously unknown scheme of maltooligosaccharide (MOS) catabolism via the concerted activity of an 1,4-α-glucosyltransferase together with a classical hydrolase and a phosphorylase. The intriguing involvement of a glucosyltransferase likely allows the fine-tuning of the regulation of MOS catabolism for optimal harnessing of this key metabolic resource in the human small intestine. The study extends the suite of specificities that have been identified in GH13_31 and highlights amino acid signatures underpinning the evolution of 1,4-α-glucosyl transferases that have been recruited in the MOS catabolism pathway in lactobacilli.
Benefits of effective multidisciplinary teamwork: catheter ablation of premature ventricular ectopics
Authors: Daveney John , Nguyen Thomas , Wright Matt
Published: May 2020

The case concerns a difficult but successful right ventricular outflow tract ectopy catheter ablation in a fit and well 33-year-old man with a 16-year history of symptomatic premature ventricular contractions (PVCs). Beta blockade medication had become ineffective in suppressing the PVCs, and a 24-hour Holter monitor revealed a high burden of ectopy (10%). An echocardiogram and cardiac MRI showed a structurally normal heart. During the procedure, it became impossible to uncurve the catheter, and it lodged in the patient’s right femoral artery. Immediate collaboration with interventional cardiology and interventional radiology was required to resolve the issue. The case demonstrates that excellent teamwork and calling rapidly on input from subspecialties are integral to overcoming unexpected events and to achieve a safe and successful outcome. The patient involved was a medical student at the time and as one of the coauthors offers a unique insight.
Acute ischaemic stroke following cisplatin-based chemotherapy for testicular cancer
Authors: Kanjanapan Yada , Gilbourd Daniel , Pranavan Ganesalingam
Published: May 2020

Cisplatin is a widely used chemotherapeutic agent for many cancer types. Its toxicity profile includes drug-induced vascular damage. Clinicians should be aware of its varied presentation, including acute and chronic vascular events involving the arterial and venous system. This is a case of an otherwise well 32-year-old man with testicular cancer who received bleomycin/etoposide/cisplatin, and presented following two cycles of chemotherapy with homonymous hemianopia secondary to acute stroke. Acute arterial complications are rare, but clinicians should maintain a high index of suspicion for such events, even in a patient who otherwise has no vascular risk factors. Primary and secondary prevention measures including lifestyle modifications (smoking cessation, diet and exercise), blood pressure and cholesterol management, and antiplatelet therapy should be considered in patients exposed to cisplatin, during and following their treatment.
Delayed diagnosis of an upper cervical epidural abscess masked due to crowned dens syndrome
Authors: Sugimoto Hiroshi , Hayashi Takuji , Nakadomari Shun , Sugimoto Keisuke
Published: May 2020

An 87-year-old Japanese man presented to our hospital with a 5-day history of fever and neck pain. On physical examination, his stiff neck indicated restricted movement, especially on rotation. CT of the head revealed calcification of the atlantoaxial joint consistent with crowned dens syndrome, and celecoxib was started. Four days later, he returned to our emergency department as his neck pain and fever had not improved. Pneumonia and a urinary tract infection were suspected. The day following admission, blood culture results were positive for methicillin-resistantStaphylococcus aureus. A contrast-enhanced CT revealed an upper cervical epidural abscess at the level of C1–C2. He was discharged following 8 weeks of antibiotic treatment.
Oral fluconazole use in the first trimester and risk of congenital malformations: population based cohort study
Authors: Zhu Yanmin , Bateman Brian T , Gray Kathryn J , Hernandez-Diaz Sonia , Mogun Helen , Straub Loreen , Huybrechts Krista F
Published: May 2020

Objective

To examine the risk of congenital malformations associated with exposure to oral fluconazole at commonly used doses in the first trimester of pregnancy for the treatment of vulvovaginal candidiasis.

Design

Population based cohort study.

Setting

A cohort of pregnancies publicly insured in the United States, with data from the nationwide Medicaid Analytic eXtract 2000-14.

Participants

Pregnancies of women enrolled in Medicaid from three or more months before the last menstrual period to one month after delivery, and infants enrolled for three or more months after birth.

Interventions

Use of fluconazole and topical azoles was established by requiring one or more prescriptions during the first trimester of pregnancy.

Main outcome measures

Risk of musculoskeletal malformations, conotruncal malformations, and oral clefts (primary outcomes), associated with exposure to oral fluconazole, diagnosed during the first 90 days after delivery, were examined.

Results

The study cohort of 1 969 954 pregnancies included 37 650 (1.9%) pregnancies exposed to oral fluconazole and 82 090 (4.2%) pregnancies exposed to topical azoles during the first trimester. The risk of musculoskeletal malformations was 52.1 (95% confidence interval 44.8 to 59.3) per 10 000 pregnancies exposed to fluconazole versus 37.3 (33.1 to 41.4) per 10 000 pregnancies exposed to topical azoles. The risks of conotruncal malformations were 9.6 (6.4 to 12.7) versus 8.3 (6.3 to 10.3) per 10 000 pregnancies exposed to fluconazole and topical azoles, respectively; risks of oral clefts were 9.3 (6.2 to 12.4) versus 10.6 (8.4 to 12.8) per 10 000 pregnancies, respectively. The adjusted relative risk after fine stratification of the propensity score was 1.30 (1.09 to 1.56) for musculoskeletal malformations, 1.04 (0.70 to 1.55) for conotruncal malformations, and 0.91 (0.61 to 1.35) for oral clefts overall. Based on cumulative doses of fluconazole, the adjusted relative risks for musculoskeletal malformations, conotruncal malformations, and oral clefts overall were 1.29 (1.05 to 1.58), 1.12 (0.71 to 1.77), and 0.88 (0.55 to 1.40) for 150 mg of fluconazole; 1.24 (0.93 to 1.66), 0.61 (0.26 to 1.39), and 1.08 (0.58 to 2.04) for more than 150 mg up to 450 mg of fluconazole; and 1.98 (1.23 to 3.17), 2.30 (0.93 to 5.65), and 0.94 (0.23 to 3.82) for more than 450 mg of fluconazole, respectively.

Conclusions

Oral fluconazole use in the first trimester was not associated with oral clefts or conotruncal malformations, but an association with musculoskeletal malformations was found, corresponding to a small adjusted risk difference of about 12 incidents per 10 000 exposed pregnancies overall.
Problem with patient decision aids
Authors: Zadro Joshua R , Traeger Adrian C , Décary Simon , O'Keeffe Mary
Published: May 2020

Patient decision aids are evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. Research shows that patient decision aids increase knowledge, accuracy of risk perceptions, alignment of care with patient values and preferences, and patient involvement in decision making. Some patient decision aids can reduce the use of invasive and potentially low-value procedures. On this basis, clinical practice guidelines and international organisations have begun to recommend the use of patient decision aids and shared decision making as a strategy to reduce medical overuse. Although patient decision aids hold promise for improving healthcare, there are fundamental issues with patient decision aids that need to be addressed before further progress can be made. The problems with patient decision aids are: (1) Guidelines for developing patient decision aids may not be sufficient to ensure developers select the best available evidence and present it appropriately; (2) Biased presentation of low-certainty evidence is common and (3) Biased presentation of low-certainty evidence is misleading, and could inadvertently support, low-value care. We explore these issues in the article and present a case study of online patient decision aids for musculoskeletal pain. We suggest ways to ensure patient decision aids help patients understand the evidence and, where possible, support high-quality care.
Protecting the health of responders: Team Health
Authors: Ross David
Published: May 2020

The rise in humanitarian disasters has led to more volunteers responding to deploy with humanitarian organisations. Those organisations that use these volunteers have a responsibility for the health of these teams of workers. This personal view outlines the three phases of ‘Team Health’—prepare, sustain and recover. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue ofBMJ Military Health.
Reflux symptoms and oesophageal acidification in treated achalasia patients are often not reflux related
Authors: Ponds Fraukje A , Oors Jacobus M , Smout André J P M , Bredenoord Albert J
Published: May 2020

Objective

After treatment, achalasia patients often develop reflux symptoms. Aim of this case–control study was to investigate mechanisms underlying reflux symptoms in treated achalasia patients by analysing oesophageal function, acidification patterns and symptom perception.

Design

Forty treated achalasia patients (mean age 52.9 years; 27 (68%) men) were included, 20 patients with reflux symptoms (RS+; Gastro-Oesophageal Reflux Disease Questionnaire (GORDQ) ≥8) and 20 without reflux symptoms (RS−: GORDQ <8). Patients underwent measurements of oesophagogastric junction distensibility, high-resolution manometry, timed barium oesophagogram, 24 hours pH-impedance monitoring off acid-suppression and oesophageal perception for acid perfusion and distension. Presence of oesophagitis was assessed endoscopically.

Results

Total acid exposure time during 24 hours pH-impedance was not significantly different between patients with (RS+) and without (RS−) reflux symptoms. In RS+ patients, acid fermentation was higher than in RS− patients (RS+: mean 6.6% (95% CI 2.96% to 10.2%) vs RS−: 1.8% (95% CI −0.45% to 4.1%, p=0.03) as well as acid reflux with delayed clearance (RS+: 6% (95% CI 0.94% to 11%) vs RS−: 3.4% (95% CI −0.34% to 7.18%), p=0.051). Reflux symptoms were not related to acid in both groups, reflected by a low Symptom Index. RS+ patients were highly hypersensitive to acid, with a much shorter time to heartburn perception (RS+: 4 (2–6) vs RS−:30 (14-30) min, p<0.001) and a much higher symptom intensity (RS+: 7 (4.8–9) vs RS−: 0.5 (0–4.5) Visual Analogue Scale, p<0.001) during acid perfusion. They also had a lower threshold for mechanical stimulation.

Conclusion

Reflux symptoms in treated achalasia are rarely caused by gastro-oesophageal reflux and most instances of oesophageal acidification are not reflux related. Instead, achalasia patients with post-treatment reflux symptoms demonstrate oesophageal hypersensitivity to chemical and mechanical stimuli, which may determine symptom generation.
Personalized neoantigen-based immunotherapy for advanced collecting duct carcinoma: case report
Authors: Zeng Yongyi , Zhang Wei , Li Zhenli , Zheng Youshi , Wang Yingchao , Chen Geng , Qiu Liman , Ke Kun , Su Xiaoping , Cai Zhixiong , Liu Jingfeng , Liu Xiaolong
Published: May 2020

Background

Collecting duct carcinoma (CDC) of the kidney is a rare and highly aggressive malignant tumor with the worst prognosis among all renal cancers. Nevertheless, the first-line treatments, including chemotherapy and target therapy, usually show poor response to CDC. Recent studies have suggested that immunotherapy targeting personal tumor-specific neoantigens could be a promising strategy for several solid cancers. However, whether it has therapeutic potential in CDC remains unclear.

Case presentation

Here, we report a case of an Asian patient who underwent personalized neoantigen-based immunotherapy. The patient was diagnosed with metastatic CDC and suffered extensive tumor progression following sorafenib treatment. Based on the patient’s own somatic mutational profile, a total of 13 neoantigens were identified and corresponding long-peptide vaccine and neoantigen-reactive T cells (NRTs) were prepared. After six cycles of neoantigen-based vaccination and T-cell immunotherapy, the patient was reported with stable disease status in tumor burden and significant alleviation of bone pain. Ex vivo interferon-γ enzyme-linked immunospot assay proved the reactivity to 12 of 13 neoantigens in peripheral blood mononuclear cells collected after immunotherapy, and the preferential reactivity to mutant peptides compared with corresponding wild-type peptides was also observed for 3 of the neoantigens. Surprisingly, biopsy sample collected from CDC sites after 3 months of immunotherapy showed decreased mutant allele frequency corresponding to 92% (12/13) of the neoantigens, indicating the elimination of tumor cells carrying these neoantigens.

Conclusions

Our case report demonstrated that the combined therapy of neoantigen peptide vaccination and NRT cell infusion showed certain efficacy in this CDC case, even when the patient carried only a relatively low tumor mutation burden. These results indicated that the personalized neoantigen-based immunotherapy was a promising new strategy for advanced CDC.

Trial registration number

ChiCTR1800017836.
Mutation in the MICOS subunit gene APOO (MIC26) associated with an X-linked recessive mitochondrial myopathy, lactic acidosis, cognitive impairment and autistic features
Authors: Benincá Cristiane , Zanette Vanessa , Brischigliaro Michele , Johnson Mark , Reyes Aurelio , Valle Daniel Almeida do , J. Robinson Alan , Degiorgi Andrea , Yeates Anna , Telles Bruno Augusto , Prudent Julien , Baruffini Enrico , S. F. Santos Mara Lucia , R. de Souza Ricardo Lehtonen , Fernandez-Vizarra Erika , J. Whitworth Alexander , Zeviani Massimo
Published: May 2020

Background

Mitochondria provide ATP through the process of oxidative phosphorylation, physically located in the inner mitochondrial membrane (IMM). The mitochondrial contact site and organising system (MICOS) complex is known as the ‘mitoskeleton’ due to its role in maintaining IMM architecture. APOO encodes MIC26, a component of MICOS, whose exact function in its maintenance or assembly has still not been completely elucidated.

Methods

We have studied a family in which the most affected subject presented progressive developmental delay, lactic acidosis, muscle weakness, hypotonia, weight loss, gastrointestinal and body temperature dysautonomia, repetitive infections, cognitive impairment and autistic behaviour. Other family members showed variable phenotype presentation. Whole exome sequencing was used to screen for pathological variants. Patient-derived skin fibroblasts were used to confirm the pathogenicity of the variant found in APOO. Knockout models in Drosophila melanogaster and Saccharomyces cerevisiae were employed to validate MIC26 involvement in MICOS assembly and mitochondrial function.

Results

A likely pathogenic c.350T>C transition was found in APOO predicting an I117T substitution in MIC26. The mutation caused impaired processing of the protein during import and faulty insertion into the IMM. This was associated with altered MICOS assembly and cristae junction disruption. The corresponding mutation in MIC26 or complete loss was associated with mitochondrial structural and functional deficiencies in yeast and D. melanogaster models.

Conclusion

This is the first case of pathogenic mutation in APOO, causing altered MICOS assembly and neuromuscular impairment. MIC26 is involved in the assembly or stability of MICOS in humans, yeast and flies.
Lower limb venous and arterial peripheral diseases and work conditions: systematic review
Authors: Huo Yung Kai Samantha , Ferrières Jean , Carles Camille , Turpin Marion , Lapébie François-Xavier , Dutheil Frederic , Bura-Rivière Alessandra , Esquirol Yolande
Published: May 2020

Objectives

The individual peripheral vascular disease risk factors are well documented, but the role of work conditions remains equivocal. This systematic review aims to assess relationships between lower limb peripheral venous diseases (lower limb varicose veins (LLVV), venous thromboembolism (VTE) comprising deep vein thrombosis and pulmonary embolism), peripheral arterial disease (intermittent claudication, aortic dissection, aortic aneurysm) and occupational constraints among working adults.

Methods

Several databases were systematically searched until February 2019 for observational studies and clinical trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used for article selection. Quality assessment and risk of bias were evaluated using Strengthening the Reporting of Observational Studies in Epidemiology and Newcastle-Ottawa scales.

Results

Among the 720 screened articles, 37 remained after full-text evaluation. Among the 21 studies on LLVV, prolonged standing was significantly associated to a higher risk of varicose veins with a threshold probably around >3 to 4 hours/day but exposure duration in years was not sufficiently considered. Seated immobility was often observed in workers, with no sufficient evidence to prove that prolonged sitting at work is related to VTE. Carrying heavy loads, stress at work and exposure to high temperatures have emerged more recently notably in relation to varicose veins but need to be better explored. Only three studies discussed the potential role of work on peripheral arterial disease development.

Conclusions

Although some observational studies showed that prolonged standing can be related to varicose veins and that seated immobility at work could be linked to VTE, very little is known about peripheral arterial disease and occupational constraints. Clinical trials to determine preventive strategies at work are needed.

PROSPERO registration number

CRD42019127652.
Simple, fast and affordable triaging pathway for COVID-19
Authors: Eggleton Elizabeth Jane
Published: May 2020

Coronavirus disease 2019 has caused a global pandemic. The majority of patients will experience mild disease, but others will develop a severe respiratory infection that requires hospitalisation. This is causing a significant strain on health services. Patients are presenting at emergency departments with symptoms of dyspnoea, dry cough and fever with varying severity. The appropriate triaging of patients will assist in preventing health services becoming overwhelmed during the pandemic. This is assisted through clinical assessment and various imaging and laboratory investigations, including chest X-ray, blood analysis and identification of viral infection with SARS-CoV-2. Here, a succinct triaging pathway that aims to be fast, reliable and affordable is presented. The hope is that such a pathway will assist health services in appropriately combating the pandemic.