bluuebunny/crossref_metadata_2025 huggingface dataset:
An awn typology for Australian native grasses (Poaceae)
Authors: Cavanagh Annette M. , Godfree Robert C. , Morgan John W.
Published: August 2019

Australia has a large diversity of native grasses. The diaspores of many species possess awns that vary considerably in their number and shape. Some variations of awn shape have been found to be effective at diaspore dispersal. Although morphological descriptions of awns exist for most native grass species, the number of species that possess awns and the extent of awn variation is unknown. This makes it difficult to determine the evolutionary importance of awns and the potential function of the various morphologies. The aim of this study was to construct an awn typology based on morphological descriptions collated from published flora databases that will quantify the awn type diversity of all native grass species in Australia, and will inform awn type relationships and help to clarify the role of differing awn morphologies in diaspore dispersal. We found that 42.1% of 1000 Australian native grasses with a single awn type were determined to have a ‘significant’ awn. These could be classified into one of 20 awn types, the most common being (1) single, apical, geniculate (once-sharply bent) awns (93 species; 28 genera, especially Iseilema), (2) three, apically-attached, straight awns (59 species, mainly Aristida) and (3) single, apical, bigeniculate (twice-sharply bent) awns (46 species, mainly Austrostipa). Among Australian grasses, slightly (though significantly) more C3 species (49.2%) had awns than C4 species (39.9%), although the most common awn types in both contained sharply bent awns (bigeniculate and geniculate respectively). Our classification system will help to improve our understanding of the amount of awn morphological variation in Australian grasses and will enable further investigation into the important ecological role of awns in species fitness.
Epithelial delamination is protective during pharmaceutical-induced enteropathy
Authors: Espenschied Scott T. , Cronan Mark R. , Matty Molly A. , Mueller Olaf , Redinbo Matthew R. , Tobin David M. , Rawls John F.
Published: August 2019

Intestinal epithelial cell (IEC) shedding is a fundamental response to intestinal damage, yet underlying mechanisms and functions have been difficult to define. Here we model chronic intestinal damage in zebrafish larvae using the nonsteroidal antiinflammatory drug (NSAID) Glafenine. Glafenine induced the unfolded protein response (UPR) and inflammatory pathways in IECs, leading to delamination. Glafenine-induced inflammation was augmented by microbial colonization and associated with changes in intestinal and environmental microbiotas. IEC shedding was a UPR-dependent protective response to Glafenine that restricts inflammation and promotes animal survival. Other NSAIDs did not induce IEC delamination; however, Glafenine also displays off-target inhibition of multidrug resistance (MDR) efflux pumps. We found a subset of MDR inhibitors also induced IEC delamination, implicating MDR efflux pumps as cellular targets underlying Glafenine-induced enteropathy. These results implicate IEC delamination as a protective UPR-mediated response to chemical injury, and uncover an essential role for MDR efflux pumps in intestinal homeostasis.
Fast contribution to the activation energy of a glass-forming liquid
Authors: Hecksher Tina , Olsen Niels Boye , Dyre Jeppe C.
Published: August 2019

Significance

One of the main questions in glass science is what causes the spectacular temperature dependence of the dynamics of a supercooled liquid. Answering this would establish the fundamental physics of glass-forming liquids and, in particular, settle the long-standing controversy about whether or not the relaxation time diverges at a finite temperature. This paper reports experiments on a glass-forming silicone oil, monitoring how the system equilibrates after temperature jumps carried out just below the glass-transition temperature. We find that the high-frequency shear modulus

G

∞

and the activation energy of the relaxation time are proportional throughout the approach to equilibrium. Since

G

∞

cannot diverge, this indicates that the relaxation time is finite at all temperatures.
Melanin-dot–mediated delivery of metallacycle for NIR-II/photoacoustic dual-modal imaging-guided chemo-photothermal synergistic therapy
Authors: Sun Yue , Ding Feng , Chen Zhao , Zhang Ruiping , Li Chonglu , Xu Yuling , Zhang Yi , Ni Ruidong , Li Xiaopeng , Yang Guangfu , Sun Yao , Stang Peter J.
Published: August 2019

Significance

Clinical applications of Pt(II)-based anticancer agents have been hampered because of drug resistance, severe side effects, and lack of precise guidance for the therapeutic procedure. To address these issues, we use molecular-dye–modified melanin dots as a multifunctional drug delivery platform to effectively deliver a Pt(II) metallacycle to tumor sites via an enhanced permeability and retention effect. In vivo studies show that nano-agent 1 displays strong NIR-II fluorescence and photoacoustic signals from tumors with a high signal-to-background ratio and successfully guides chemo-photothermal therapy with a superior antitumor performance and reduced side effects. These promising results will provide an opportunity for the design of novel multimodal and synergistic therapeutic agents for biomedical applications.
When non-renditions are not the exception
Authors: Vargas-Urpi Mireia
Published: August 2019

This article seeks to explore the nature and function of non-renditions in a corpus of transcriptions of 55 authentic interpreted court proceedings from Barcelona (the TIPp corpus). By doing so, it establishes a dialogue with Cheung’s (2017) contribution about non-renditions in court interpreting in Hong Kong. The transcriptions of the TIPp corpus were annotated using the software EXAMARALDA following Wadenjsö’s (1998) distinction between “talk as text” and “talk as activity”. Non-renditions were considered a part of “talk as activity”. A distinction was made between justified non-renditions, i.e. those that were used to ask for a pause to interpret, to ask for clarification, to confirm possibly misheard information and to retrieve parts of the original message in case of a lapsus, and unjustified non-renditions, e.g. when interpreters give advice to the defendants or warn them, when they answer on behalf of defendants, or when they supply information not provided in the original utterances. The findings reveal alarming averages of non-renditions in the bilingual parts of the trial (58.3 per bilingual hour), with a higher ratio of unjustified non-renditions. These findings have a clear correlation with the poor working conditions of court interpreters in Spain and reveal an urgent need for professionalisation of this practice in this country.
Lipid droplet size directs lipolysis and lipophagy catabolism in hepatocytes
Authors: Schott Micah B. , Weller Shaun G. , Schulze Ryan J. , Krueger Eugene W. , Drizyte-Miller Kristina , Casey Carol A. , McNiven Mark A.
Published: August 2019

Lipid droplet (LD) catabolism in hepatocytes is mediated by a combination of lipolysis and a selective autophagic mechanism called lipophagy, but the relative contributions of these seemingly distinct pathways remain unclear. We find that inhibition of lipolysis, lipophagy, or both resulted in similar overall LD content but dramatic differences in LD morphology. Inhibition of the lipolysis enzyme adipose triglyceride lipase (ATGL) resulted in large cytoplasmic LDs, whereas lysosomal inhibition caused the accumulation of numerous small LDs within the cytoplasm and degradative acidic vesicles. Combined inhibition of ATGL and LAL resulted in large LDs, suggesting that lipolysis targets these LDs upstream of lipophagy. Consistent with this, ATGL was enriched in larger-sized LDs, whereas lipophagic vesicles were restricted to small LDs as revealed by immunofluorescence, electron microscopy, and Western blot of size-separated LDs. These findings provide new evidence indicating a synergistic relationship whereby lipolysis targets larger-sized LDs to produce both size-reduced and nascently synthesized small LDs that are amenable for lipophagic internalization.
The influence of the temperature of hydro-pneumatic spring into the state of tracked vehicle
Authors: Jiang Mang
Published: August 2019

Based on the multi-body dynamics model, the influence of the temperature of the hydro-pneumatic spring on the state of a lighted tracked vehicle under several driving conditions is studied. A multi-body dynamics model of chassis and body of a tracked vehicle is established, and verified with simulation and experimental results in the relevant literatures. Typical driving conditions are studied including running on a flat road with constant velocity, passing a semi-round obstacle with the radius of 200 mm, and running on a sinusoidal surface with wavelength of 2 m and amplitude of 100 mm. Some responses of the vehicle are compared and analyzed, so as to obtain the influence of the temperature of hydro-pneumatic spring. The numerical analysis results show that the temperature of hydro-pneumatic spring has a significant effect on the vehicle’s responses including height of centroid, vertical acceleration of centroid, pitch angle, track tension and gas pressure of the springs.
Operational Efficiency Improvement of Ply Cutting Machine for Aircraft Tires
Authors: Eaknipitsari Kulanit , Chutima Parames
Published: August 2019

This research focuses on the operational efficiency improvement of ply cutting machines for aircraft tires by implementing the design of experiments (DOE) and Single Minute Exchange of Die (SMED) methods to decrease loss time caused by machine stoppages found at let-off and splicer processes. The problem comes from high loss time because the system’s parameters are not set properly and high setup time of the machine. Therefore, the operations efficiency improvement has been conducted by setting a suitable flow rate at the splicer and changing activities of the operator in order to reduce waiting time. Improved efficiency is implemented in the Ply cutting machine from July 2018 to August 2018. The result shows the increase in the average production from 23 rolls/shift to 28 rolls/shift. Furthermore, a cost saving for efficiency improvement is equal to 36M baht per year.
Energy Output Efficiency of Shielded Mild Detonation Cord in Cylinder Structures
Authors: Feng Lina , Li Dong , Tian Jiandong , Hu Zhenxing , Sun Jing
Published: August 2019

Expanding tube separation device is a commonly used linear separation device, whose energy resource is a shielded mild detonation cord (SMDC). In this research, the SMDC is a mild detonation cord sheathed in flat polyethylene. Two experiments were achieved to discuss the energy output efficiency of the SMDC. In the first experiment, the SMDC was inserted into 1060 aluminum cylinder directly. While in the other experiment, the SMDC was insert into aluminum cylinder after contained within a flat steel tube. The velocity and displacement of the characteristic points on the outer surface of the aluminum cylinder during explosion were measured by photonic Doppler velocimetry (PDV). The simulation results with Ls-dyna fluid-solid coupling algorithm correspond well with the experimental results. According to the simulation analysis, the distribution of total energy of explosives were obtained. The plastic strain energy of the aluminum cylinder corresponds to the ability of the SMDC to do external work. The result shows that, 39.3% of the total energy in the explosive is output to aluminum cylinder with SMDC acting on it directly, while the energy output efficiency turns to 20.8% after passing through the flat tube.
Prediction of superplastic forming of 7475 aluminium alloy sheets
Authors: Yang J , Giraud E , Dal Santo P , Boude S , Lebrun J-L
Published: August 2019

Superplastic forming is mainly used in the aeronautic and astronautic domains and to fabricate the complex shape parts with the materials hard to process. The numerical simulation is used to predict the superplastic forming process due to the difficulty to predict a forming pressure by a traditional trial and error method. In the article, the superplastic behaviour of a 7475 aluminium alloy has been investigated. Uniaxial tensile tests over a wide range of temperatures and strain rates have been performed. An Arrhenius-type model using strain compensation has been identified. A failure criterion based on the evolution of fracture work is also proposed. This material model has been implemented by user subroutine in numerical simulations (ABAQUS) to predict the ability of the material to form a complex revolution part by superplastic forming. A pressure control algorithm has been developed to minimize the pressure instability and decrease the simulation CPU time. The numerical results, in terms of thickness evolution in the formed component and location of damage-risk zones, have finally been compared to experimental results after the realization of some bulging experiments using the generated pressure cycle.
Parametric Study for Calculating Surface Deflection Using the Method of Images
Authors: An Y , Zhang R , Li P , Luo D , Jin X
Published: August 2019

The solution of the elastic field for inclusions in an elastic half space has been applied widely in many contact analyses and engineering designs. A popular method to solve the half-space inclusion problem resorts to the method of images, where the solution is decomposed into 3 components consisting of the full space inclusion, mirrored inclusion, and the surface traction cancellation. In the process of cancelling the redundant surface tractions determined from a full space inclusion problem, the computation domain is supposed to be limited in a finite size and there is inevitably truncation error. It has not been quantitatively investigated how the truncation error will influence the accuracy of the numerical computations based on the method of images. This work studies the deflection of the boundary surface of a half-space containing an Eshelby inclusion. Errors due to mesh refinement and domain truncation are quantitatively analyzed. Parametric studies are performed for a systematic examination of surface redundant tractions and their influences.
Non-destructive testing Techniques based on Failure Analysis of Steam Turbine Blade
Authors: Tian Li , Hai Yan , Qingyue Zeng , Qin Yin
Published: August 2019

Turbine blades are core components in turbine. It is of great significance to diagnose the blade failures at early stage and regularly inspect them at run time. Based on the analysis of blade failures, a comprehensive application summarize of different non-destructive testing techniques in blade inspection was made in this paper. The non-destructive testing techniques include visual testing, liquid penetrant testing, magnetic particle testing, radiological testing, conventional ultrasonic testing, ultrasonic phased array testing, eddy current testing and metal magnetic memory testing. The applicability and limitation of different methods were demonstrated through comparison and analysis.
Concordance Between Rapid On-Site Evaluation and Final Cytologic Diagnosis in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Non-Small Cell Lung Cancer Staging
Authors: Caupena Cristina , Esteban Lluis , Jaen Angels , Barreiro Bienvenido , Albero Raquel , Perez-Ochoa Francisco , Pontes De Souza Patricia , Gibert Oriol , Ferrer Carme , Forcada Pilar , García Federico , Tarroch Xavier , Sanz-Santos José
Published: August 2019

Objectives

In patients with lung cancer undergoing mediastinal staging through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), decisions are based on rapid on-site evaluation (ROSE) findings. We aimed to analyze the concordance rate between ROSE diagnosis and final diagnosis.

Methods

A prospective study was carried out in patients undergoing EBUS-TBNA for lung cancer staging. Diagnosis concordance was defined as cases where lymph nodes (LNs) presented the same diagnosis in ROSE and final diagnosis. Determinants of concordance were analyzed.

Results

Sixty-four patients were included and 637 LNs sampled. ROSE diagnosis was concordant with final diagnosis in 612 (96.1%) LNs and nonconcordant in 25 (3.9%). Differences in the concordance rate were found between pathologists, ROSE diagnoses, presence of cell block, number of passes, and number of slides. The staging status was changed between ROSE and the final diagnosis in three (4.6%) patients.

Conclusions

ROSE diagnosis has a high concordance with the final diagnosis.
Genome-phenome explorer (GePhEx): a tool for the visualization and interpretation of phenotypic relationships supported by genetic evidence
Authors: Farré Xavier , Spataro Nino , Haziza Frederic , Rambla Jordi , Navarro Arcadi
Published: August 2019

Motivation

Association studies based on SNP arrays and Next Generation Sequencing technologies have enabled the discovery of thousands of genetic loci related to human diseases. Nevertheless, their biological interpretation is still elusive, and their medical applications limited. Recently, various tools have been developed to help bridging the gap between genomes and phenomes. To our knowledge, however none of these tools allows users to retrieve the phenotype-wide list of genetic variants that may be linked to a given disease or to visually explore the joint genetic architecture of different pathologies.

Results

We present the Genome-Phenome Explorer (GePhEx), a web-tool easing the visual exploration of phenotypic relationships supported by genetic evidences. GePhEx is primarily based on the thorough analysis of linkage disequilibrium between disease-associated variants and also considers relationships based on genes, pathways or drug-targets, leveraging on publicly available variant-disease associations to detect potential relationships between diseases. We demonstrate that GePhEx does retrieve well-known relationships as well as novel ones, and that, thus, it might help shedding light on the patho-physiological mechanisms underlying complex diseases. To this end, we investigate the potential relationship between schizophrenia and lung cancer, first detected using GePhEx and provide further evidence supporting a functional link between them.

Availability and implementation

GePhEx is available at: https://gephex.ega-archive.org/.

Supplementary information

Supplementary data are available at Bioinformatics online.
An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease
Authors: Chandrasekaran Anita , Groven Shauna , Lewis James D , Levy Susan S , Diamant Caroline , Singh Emily , Konijeti Gauree Gupta
Published: August 2019

Background

Prior studies suggest dietary modification may improve clinical response or remission rates in patients with inflammatory bowel disease (IBD). Our aim was to examine whether an autoimmune protocol diet improves quality of life in patients with active Crohn disease (CD) and ulcerative colitis (UC).

Methods

We conducted an uncontrolled clinical trial of the autoimmune protocol diet in adult patients with active IBD (Harvey–Bradshaw Index ≥ 5 for CD or partial Mayo score ≥ 3 for UC, and erosions/ulcers on endoscopy and/or elevated fecal calprotectin). The dietary intervention consisted of a 6-week elimination phase, followed by a 5-week maintenance phase. Short Inflammatory Bowel Disease Questionnaire (SIBDQ) was completed at baseline, and weeks 3, 6, 9, and 11.

Results

The final cohort included 6 UC and 9 CD participants. Mean SIBDQ score improved significantly from baseline (46.5) to weeks 3 (54.0, P = 0.02), 6 (53.3, P = 0.02), 9 (62.0, P = 0.03), and 11 (60.5, P = 0.05). Among participants completing all 5 surveys, mean SIBDQ increased from 46.5 to 61.5 by week 11 (P = 0.03). By week 3, participants experienced significant improvements in bowel movement frequency (36%, P = 0.04), stress (28%, P = 0.01), and ability to perform leisure/sport activities (29%, P = 0.02). Effects were not significantly different between CD and UC participants.

Conclusions

Dietary modification can improve quality of life as early as week 3 in patients with active IBD. Larger randomized controlled trials are needed to examine dietary interventions in IBD.
Strategies and Tools to Embrace Prevention with Upstream Programs: A Novel Pilot Program for Enhancing Social and Emotional Protective Factors in Middle School Students
Authors: Knight M Amaris , Haboush-Deloye Amanda , Goldberg Pamela M , Grob Kelly
Published: August 2019

Social–emotional learning (SEL) programs can be considered upstream, or primary prevention, because they focus on providing students with the life skills necessary to navigate situations and relationships from which problem behaviors may arise to prevent a crisis situation. Strategies & Tools to Embrace Prevention with Upstream Programs (SEL@MS, formerly known as STEP UP) is a comprehensive SEL curriculum for middle school students aimed at promoting universal prevention strategies for healthy populations. SEL@MS enhances protective factors against negative behaviors by reinforcing multilevel approaches to strengthening community, interpersonal, and individual attributes with lesson plans that can be integrated into school curricula. This quasi-experimental pilot study was conducted over the course of two years with 59 middle school students assigned to either the intervention (n = 27) or control (n = 32) group. Analyses demonstrated significant improvements among students in the intervention group in self-regulation, responsibility, social competence, and empathy. Results of this study suggest that SEL@MS is a promising approach to enhance social and emotional protective factors that, when fostered over time, have the potential to improve overall mental health.
Acute coronary syndrome registry enrolment status: differences in patient characteristics and outcomes and implications for registry data use (ANZACS-QI 36)
Authors: Earle Nikki J , Kerr Andrew J , Legget Malcolm , Wu Billy P , Doughty Robert N , Poppe Katrina K
Published: August 2019

Aims

Clinical registry-derived data are widely used to represent patient populations. In New Zealand (NZ), a national registry—the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry—aims to include all patients undergoing coronary angiography; other acute coronary syndrome (ACS) patients are also registered but without complete capture. This study compares national hospitalization data of all first-time ACS admissions in NZ with patients in the ANZACS-QI registry, to investigate the use of clinical registry-derived data in research and in assessing clinical care.

Methods and results

Patients admitted with first-time ACS in the NZ National Hospitalisation Dataset between 1 January 2015 and 31 December 2016 were included. Clinical characteristics and time to 12-month clinical outcomes were compared between patients captured and not-captured in the registry. A total of 16 569 patients were admitted with first-time ACS, median age 69 years, 61% male; 60% (n = 9918) were enrolled in ANZACS-QI. Registry-captured patients were younger, more often male, and with a lower comorbidity burden than non-captured patients. Overall, 16% patients died within 12 months, 15% experienced a non-fatal cardiovascular (CV) readmission, and 28% either died or were readmitted. Patients not captured in the registry were more than twice as likely to have experienced death or a non-fatal CV readmission within 12 months as captured patients.

Conclusions

First-time ACS patients captured in the ANZACS-QI registry had very different clinical characteristics and outcomes than those not captured. Cardiovascular registry-derived data are dependent on registry design and may not be representative of the wider patient population; this must be considered when using registry-derived data.
Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate. Dental arch relationships in 8 year-olds
Authors: Heliövaara Arja , Skaare Pål , Küseler Annelise , Shaw William , Mølsted Kirsten , Karsten Agneta , Marcusson Agneta , Brinck Eli , Rizell Sara , Sæle Paul , Najar Chalien Midia , Bellardie Haydn , Mooney Jeanette , Eyres Phil , Semb Gunvor
Published: August 2019

Background and trial design

The Scandcleft intercentre study evaluates the outcomes of four surgical protocols for treatment of children with unilateral cleft lip and palate (UCLP). Originally 10 cleft centres in Denmark, Finland, Norway, Sweden, and the UK participated in a set of three randomized trials of primary surgery. Three groups of centres (Trials 1, 2, and 3) tested their traditional local surgical protocols (Arms B, C, and D) against a common protocol (Arm A).

Objectives

To evaluate dental arch relationships at age 8 years after four different protocols of primary surgery for UCLP. These results are secondary outcomes of the overall trial.

Methods

Study models of 411 children (270 boys, 141 girls) with non-syndromic UCLP at a mean age of 8.1 (range 7.0–10.0) years were available. Dental arch relationships were analysed using the GOSLON Yardstick by a blinded panel of 11 orthodontists. To assess reliability, Kappa statistics were calculated. The trials were tested statistically with t-tests.

Results

Comparisons within each trial showed no statistically significant differences in the mean 8-year index scores or their distributions between the common protocol and the local team protocol. The mean index scores were Trial 1: Arm A 3.03, Arm B 2.82, Trial 2: Arm A 2.78, Arm C 2.64, and Trial 3: Arm A 3.06, Arm D 3.08. Comparisons between the trials detected a significantly (P < 0.005) better mean index score Trial 2 Arm C than in Trial 3 Arm D. The intra- and inter-rater reliabilities were acceptable.

Conclusion

The results of these three trials do not provide evidence that one surgical protocol is better than the others.

Trial registration

ISRCTN29932826
Determinants of left atrium thrombi in scheduled cardioversion: an ENSURE-AF study analysis
Authors: Merino Jose L , Lip Gregory Y H , Heidbuchel Hein , Cohen Aron-Ariel , De Caterina Raffaele , de Groot Joris R , Ezekowitz Michael D , Le Heuzey Jean-Yves , Themistoclakis Sakis , Jin James , Melino Michael , Winters Shannon M , Merkely Béla , Goette Andreas
Published: August 2019

Aims

ENSURE-AF (NCT 02072434) was the largest prospective randomized clinical trial of anticoagulation for cardioversion in atrial fibrillation (AF), which also provides the largest prospective dataset for transoesophageal echocardiography (TOE) prior to cardioversion. This ancillary analysis investigated determinants of TOE-detected left atrium thrombi (LAT) in patients scheduled for electrical cardioversion (ECV).

Methods and results

The ENSURE-AF multicentre PROBE evaluation trial compared edoxaban 60 mg once daily (QD) with enoxaparin/warfarin in 2199 subjects undergoing ECV of non-valvular AF. Patients were stratified by the use of TOE, anticoagulant experience, and selected edoxaban dose. Electrical cardioversion was cancelled or deferred when TOEdetected LAT. In total, 1183 subjects were stratified to the TOE arm and LAT was reported in 91 (8.2%). In univariate analysis, age ≥75 years (26.4% vs. 16.9%, P = 0.0308), lower weight (86.5 ± 15.0 vs. 90.7 ± 18.0 kg, P = 0.0309), lower creatinine clearance (80.1 ± 30.6 vs. 93.2 ± 33.9 mL/min, P = 0.0007), heart failure (59.3% vs. 43.0%, P = 0.0029), and diuretic treatment (53.9% vs. 40.1%, P = 0.0141) were more prevalent in the LAT group. Non-significant trends were seen for higher mean CHA2DS2-VASc score (3.0 ± 1.41 vs. 2.7 ± 1.48, P = 0.0571) and more prevalent anticoagulation use prior to enrolment (60.4% vs. 50.3%, P = 0.0795) in the LAT group. In logistic regression analysis, age (P = 0.0202) and heart failure (P = 0.0064) were independently associated with LAT.

Conclusion

Elective ECV is commonly cancelled or deferred due to TOE-detected LAT in patients with non-valvular AF. Age ≥75 years and heart failure were associated with the presence of LAT.
Viruses of fungi and oomycetes in the soil environment
Authors: Sutela Suvi , Poimala Anna , Vainio Eeva J
Published: August 2019

Soils support a myriad of organisms hosting highly diverse viromes. In this minireview, we focus on viruses hosted by true fungi and oomycetes (members of Stamenopila, Chromalveolata) inhabiting bulk soil, rhizosphere and litter layer, and representing different ecological guilds, including fungal saprotrophs, mycorrhizal fungi, mutualistic endophytes and pathogens. Viruses infecting fungi and oomycetes are characterized by persistent intracellular nonlytic lifestyles and transmission via spores and/or hyphal contacts. Almost all fungal and oomycete viruses have genomes composed of single-stranded or double-stranded RNA, and recent studies have revealed numerous novel viruses representing yet unclassified family-level groups. Depending on the virus–host combination, infections can be asymptomatic, beneficial or detrimental to the host. Thus, mycovirus infections may contribute to the multiplex interactions of hosts, therefore likely affecting the dynamics of fungal communities required for the functioning of soil ecosystems. However, the effects of fungal and oomycete viruses on soil ecological processes are still mostly unknown. Interestingly, new metagenomics data suggest an extensive level of horizontal virus transfer between plants, fungi and insects.
Aerobic catabolism of sterols by microorganisms: key enzymes that open the 3-ketosteroid nucleus
Authors: Kreit Joseph
Published: August 2019

Aerobic degradation of the sterol tetracyclic nucleus by microorganisms comprises the catabolism of A/B-rings, followed by that of C/D-rings. B-ring rupture at the C9,10-position is a key step involving 3-ketosteroid Δ1-dehydrogenase (KstD) and 3-ketosteroid 9α-hydroxylase (KstH). Their activities lead to the aromatization of C4,5-en-containing A-ring causing the rupture of B-ring. C4,5α-hydrogenated 3-ketosteroid could be produced by the growing microorganism containing a 5α-reductase. In this case, the microorganism synthesizes, in addition to KstD and KstH, a 3-ketosteroid Δ4-(5α)-dehydrogenase (Kst4D) in order to produce the A-ring aromatization, and consequently B-ring rupture. KstD and Kst4D are FAD-dependent oxidoreductases. KstH is composed of a reductase and a monooxygenase. This last component is the catalytic unit; it contains a Rieske-[2Fe-2S] center with a non-haem mononuclear iron in the active site. Published data regarding these enzymes are reviewed.
Non-intubated subxiphoid uniportal video-assisted thoracoscopic thymectomy
Authors: Liu Zhengcheng , Yang Rusong , Sun Yang
Published: August 2019

This report describes a non-intubated, subxiphoid, uniportal approach to video-assisted thoracoscopic thymectomy. A laryngeal mask was used as a safety precaution for ventilatory management, and thymectomy was accomplished through a single transverse incision below the lower edge of the xiphoid. Patients were uneventfully discharged with fast recovery. This novel surgical approach may merge the potential benefits of a subxiphoid incision for treatment of anterior mediastinum lesion and adoption of a non-intubated anaesthesia protocol.
Metabolic and Diffuse Encephalopathies: Disruption of the Internal Milieu
Authors: Posner Jerome B. , Saper Clifford B. , Schiff Nicholas D. , Claassen Jan
Published: August 2019

Chapter 5 examines the broad range of metabolic causes of unconsciousness and the specific treatments they require. The main feature distinguishing diffuse or metabolic impairment of consciousness is that it is normally not associated with focal neurological findings that would suggest a structural lesion of the brain. However, there are some features of the neurological examination of patients with metabolic encephalopathies that can help to pinpoint the cause of the disturbance. In addition, there are some findings on examination that may appear to be due to focal lesions, but which can be due to diffuse or metabolic disease. The chapter first examines the diagnostic features of metabolic encephalopathies. It then looks at the internal metabolic milieu in which the brain functions normally. It also considers specific types of metabolic and diffuse disturbances of that internal milieu that can cause encephalopathy. Finally, it considers various endogenous and exogenous toxins that produce toxic encephalopathies.
Management of Frequently Encountered Causes of Unconsciousness
Authors: Posner Jerome B. , Saper Clifford B. , Schiff Nicholas D. , Claassen Jan
Published: August 2019

This chapter presents a diagnostic and management outline to approach commonly encountered conditions associated unconsciousness. Once the specific cause is identified, attention should turn to dealing with the set of problems inherent to the underlying disorder. As it is not possible to cover all aspects of treatment of all possible causes of stupor and coma comprehensively, this chapter focuses instead on the management of frequently encountered pathologies within each of the main categorical clinical diagnoses: supratentorial or infratentorial compressive lesions; supratentorial or infratentorial destructive lesions; metabolic, diffuse, or multifocal coma. Management of psychogenic coma is discussed in Chapter 6.
Barriers to Deprescribing
Authors: Gupta Swapnil , Miller Rebecca , Cahill John D.
Published: August 2019

This chapter identifies the possible barriers to deprescribing, and presents suggestions for strategies to overcome them. Although deprescribing has the potential to streamline medication regimens, minimize side effects, cut costs, improve patient adherence, and strengthen the relationship between the patient and the prescribing professional, barriers may originate from the patient, physician, and/or the institution, both local and the larger medical institution. Barriers related to prescriber-related factors such as the physician’s illusion and fear of litigation, are discussed. Potential patient- and environment-related barriers are also discussed, including sociocultural factors which may emerge in the process of initiating a course of deprescribing. Included in this chapter is a discussion of the possibility of relapse, colloquially defined, and the patient’s and provider’s fears for rehospitalization. Possible strategies for overcoming each of these barriers are discussed.
The Process of Deprescribing
Authors: Gupta Swapnil , Miller Rebecca , Cahill John D.
Published: August 2019

Deprescribing of psychotropic medications introduces additional complexities related to the specific context of psychiatric disorders and their cultural meaning. This chapter expands on the process of deprescribing as it relates specifically to psychiatry, taking the five essential steps of deprescribing in general medicine and elaborating on them for use in psychiatry. These include a detailed decision-making process, psychoeducation of both the patient and friends or family, and close monitoring and adaptation during medication reduction. Given the current absence of guidelines in this area, documentation is a key element of the process and is discussed in this chapter. Included are suggested templates to support accurate documentation, including the decision-making process, the patient’s response to medication changes, medication lists with their indications, and the appearance and management of withdrawal symptoms and/or relapse.
Deprescribing Antipsychotic Medications
Authors: Gupta Swapnil , Miller Rebecca , Cahill John D.
Published: August 2019

This chapter discusses some of reasons for considering a deprescribing intervention with neuroleptic medications, including clear instances such as irrational antipsychotic polypharmacy and off-label use, as well as other situations driven by stakeholder pressures or medical comorbidity. The indefinite prescription of antipsychotic medications for psychotic disorders such as schizophrenia is commonly considered a recommended practice, although some uncertainty remains. The confidence of treatment recommendations also hinges on the accuracy of diagnoses—syndromes and classifications which typically evolve over time. This chapter describes a collaborative process of decision-making about the long-term use of antipsychotic medications as many patients wishing to attempt to decrease or discontinue these medications may do so without support of the prescriber, risking harm. The ability of current data to identify which patients may need long-term medication management versus those who may not is lacking. Considering the potential serious neurological and metabolic side effects of these medications, a patient’s preferences versus risks must be carefully weighed. Nonpharmacological interventions that may support the reduction of antipsychotic medications (but should not yet be presented as validated alternatives, alone) include psychoeducation, strategies for early identification and management of relapse, cognitive behavioral therapy for psychosis, and open dialogue are reviewed. The process is illustrated by case examples at the end of the chapter.
Cardiovascular therapy techniques
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses cardiovascular therapy techniques and includes discussion on defibrillation, temporary cardiac pacing, intra-aortic balloon counterpulsation pump, cardiac assist devices, and targeted temperature management.
Renal therapy techniques
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses renal therapy techniques and includes discussion on haemodialysis (showing principles of renal replacement therapies (RRTs) and complications of haemodialysis), haemo(dia)filtration (discussing indications to start RRT, indications to stop RRT, principles of renal replacement, choice of mode, and practical RRT prescription), and peritoneal dialysis (PD) (discussing peritoneal membrane structure and solute transfer, access, techniques, dialysate, PD as RRT, management of acute renal failure by PD, and management of the continuous ambulatory PD patient with critical illness).
Nutrition
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses nutrition and includes discussion on enteral nutrition (including discussion on enteral nutrition versus parenteral nutrition, how to feed, what to feed, and complications), nutritional assessment and requirements (including the role of the multidisciplinary team, nutritional assessment, and nutritional requirements), and parenteral nutrition (including when to start, how to feed, what to feed, and when to stop).
Tissue perfusion monitoring
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

Over the past few years, the haemodynamic management of critically ill patients is moving from the stabilization of microcirculatory parameters (such as arterial pressure, heart rate, or cardiac output) to resaturation and maintenance of tissue perfusion parameters. This change of paradigm is necessary as we now know that normalization of microcirculatory parameters does not necessarily mean normal tissue perfusion. For that reason, in this edition we include a chapter dedicated to tissue perfusion monitoring. This includes discussion on mixed venous oxygen saturation (including physiology, equivalence of mixed venous oxygen saturation and central venous oxygen saturation, interpretation, and use as a therapeutic or prognostic target), pCO2 arterial-venous gap (physiology, interpretation, and use as therapeutic target), lactate concentration (metabolism of glucose to lactate, lactate and shock, parameters of tissue hypoperfusion and tissue hypoxia, persistent hyperlactataemia, and practical approach), and the videoscopy of microcirculation (describing a definition and physiological background, haemodynamic coherence, techniques and technologies, and clinical applications).
Neurological monitoring
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

Dealing with neurological critically ill patients is one of the most challenging situations in intensive care. The range of conditions can go from carbon dioxide narcosis to status epilepticus or hypoxic or traumatic brain injuries. The key difficulty is the neurological assessment of these patients while they require general anaesthesia. This chapter discusses neurological monitoring and includes discussion on intracranial pressure (ICP) monitoring (including indications for ICP monitoring, methods of measuring ICP, complications of ICP monitoring, and ICP in normal and pathological conditions), intracranial perfusion (regulation of cerebral perfusion and measurement of cerebral blood flow), electroencephalogram (EEG) and cerebral function analysing monitoring (CFAM) (EEG, cerebral function monitors (CFM)/CFAM, EEG terminology, and clinical use in the intensive care unit), and other forms of neurological monitoring (tissue metabolism, cerebral blood flow and metabolism, and peripheral nerve and muscle electrophysiology).
Cardiovascular drugs
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

Haemodynamic instability is one of the main reasons for admission to critical care. Often patients will require medication to provide cardiovascular support. This chapter discusses cardiovascular drugs and includes discussion on β‎-adrenergic agonists, phosphodiesterase inhibitors, vasodilators, vasopressors, antiarrhythmics in intensive care, chronotropes, antianginal agents, antiplatelet agents, diuretics and the critically ill, and levosimendan. These medications are part of the daily practise in intensive care. Knowledge of the indications, interactions, and adverse effects is essential.
Gastrointestinal drugs
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses gastrointestinal drugs and includes discussion on H2 blockers and proton pump inhibitors (including discussion on physiology of acid secretion, pharmacology, pathophysiology of stress ulcers, stress ulcer prophylaxis, and treatment of acute bleeding after endoscopy), antiemetics (including discussion on mechanisms of nausea and vomiting, antiemetic drugs, and clinical approach), gut motility agents (indications, erythromycin, erythromycin versus metoclopramide, metoclopramide, domperidone, cisapride, neostigmine, and alternative treatment strategies), antidiarrhoeals (risk factors and causes of diarrhoea, antidiarrhoeal drugs, and enteral supplements), and constipation in critical care. This includes pathophysiology of and risk factors for constipation, treatments including bulk-forming, stimulating, osmotic, and emollient laxatives, as well as suppositories and enemas, motility agents, and opioid antagonists. It also outlines special circumstances, including palliative care, spinal cord injury, and liver failure patients.
Neurological drugs
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses neurological drugs and includes discussion on opioid and non-opioid analgesics in the intensive care unit (ICU; describing usage of opioid analgesics and non-opioid analgesics), sedation management in the ICU (including sedative agents), muscle relaxants (discussing physiology, depolarizing blockers, non-depolarizing blockers, the suxamethonium versus rocuronium debate, clinical use of prolonged muscular blockade, monitoring, problems, and complications), antiepileptic drugs (first-, second-, third-line drugs), neuroprotective agents (pharmacological neuroprotection and hypothermia), and mannitol and hypertonic saline. It aims to provide a summary of neurological and neuromuscular drugs commonly used in the ICU, although it is not exhaustive. Owing to variations in formulations and bioequivalence, drug doses should always be checked against local protocols before being administered to patients.
Resuscitation
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses resuscitation in critical care and includes discussion on basic and advanced resuscitation (including prevention of cardiac arrests, in-hospital resuscitation, risks to the rescuer, high-quality cardiopulmonary resuscitation [CPR], advanced life support, the use of automated mechanical chest compression devices, extracorporeal CPR, postresuscitation care, outcome, and CPR on the intensive care unit), postcardiac arrest management (the postcardiac arrest syndrome, airway and ventilation, circulation, disability, temperature control, prognostication, rehabilitation, and cardiac arrest centres), and fluid challenge (rationale, the problem with a fluid bolus therapy, clinical indicators of hypovolaemia, performing a fluid challenge, type of fluid, and the future).
Respiratory disorders
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses respiratory disorders and includes definitions, pathophysiology, and management strategies of upper airway obstruction, respiratory failure, pulmonary collapse and atelectasis, chronic obstructive pulmonary disease, and acute respiratory distress syndrome (diagnosis, general, and ventilatory management strategies). It also includes sections detailing pathophysiology and management of pneumothoraces, empyema, haemoptysis, inhalation injury, pulmonary thromboembolism, community-acquired pneumonia, hospital-acquired pneumonia, and pulmonary hypertension.
Gastrointestinal disorders
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses gastrointestinal (GI) disorders and includes discussion on vomiting and gastric stasis/gastroparesis, gastric erosions, diarrhoea, upper GI haemorrhage (non-variceal), bleeding varices, intestinal perforation, intestinal obstruction, lower GI bleeding, colitis, pancreatitis, acute acalculous cholecystitis, splanchnic ischaemia, and abdominal hypertension (IAH) and abdominal compartment syndrome. The aim is to provide a summary of the extensive complex abdominal pathologies that can present to an intensive care clinician. Where appropriate, descriptions are provided on clinical presentation, epidemiology, diagnosis (including investigations), and management. Of note, the conditions covered can arise on the ward environment with subsequent requirement for intensive care, but they can also arise de novo on the intensive care unit itself, highlighting the need for intensive care clinicians to maintain a broad knowledge and understanding of their presentation and management.
Hepatic disorders
Authors: Waldmann Carl , Rhodes Andrew , Soni Neil , Handy Jonathan
Published: August 2019

This chapter discusses hepatic disorders and includes discussion on jaundice, acute liver failure (including discussion on liver transplantation and liver support systems), hepatic encephalopathy (and management of hepatic encephalopathy in acute and chronic liver failure), chronic liver failure (and management of decompensated cirrhosis on the intensive care unit), and abnormal liver function tests. The epidemiology, diagnosis (including history and examination findings), investigations, and management of different types of liver failure are discussed in the relevant sections; in addition, a detailed section on biochemistry is included which discusses the background and interpretation of ‘standard’ laboratory tests of liver function, as well as dynamic tests.