bluuebunny/crossref_metadata_2025 huggingface dataset:
Reverse triage: more than just another method
Authors: Pollaris Gwen , Sabbe Marc
Published: October 2015

Reverse triage is a way to rapidly create inpatient surge capacity by identifying hospitalized patients who do not require major medical assistance for at least 96 h and who only have a small risk for serious complications resulting from early discharge. Electronic searches were conducted in the MEDLINE, TRIP, Cochrane Library, CINAHL, EMBASE, Web of Science, and SCOPUS databases to identify relevant publications published from 2004 to 2014. The reference lists of all relevant articles were screened for additional relevant studies that might have been missed in the primary searches. There will always be small individual differences in the reverse triage decision process, influencing the potential effect on surge capacity, but at most, 10–20% of hospital total bed capacity can be made available within a few hours. Reverse triage could be a response to Emergency Department (ED) crowding, as it gives priority to ED patients with urgent needs over inpatients who can be discharged with little to no health risks. The early discharge of inpatients entails negative consequences. They often return to the ED for further assessment, treatment, and even readmission. When time to a medical referral or bed is less than 4–6 h, 100 additional lives per annum are predicted to be potentially saved. The results of our systematic review identified only a small number of publications addressing reverse triage, indicating that reverse triage and surge capacity are relatively new subjects of research within the medical field. Not all research questions could be fully answered.
On the distribution and function of synaptic clusters in dendrites
Authors: Cazé Romain D. , Foust Amanda J. , Clopath Claudia , Schultz Simon R.
Published: October 2015

Local non-linearities in dendrites render neuronal output dependent on the spatial distribution of synapses. A neuron will activate differently depending on whether active synapses are spatially clustered or dispersed. While this sensitivity can in principle expand neuronal computational capacity, it has thus far been employed in very few learning paradigms. To make use of this sensitivity, groups of correlated neurons need to make contact with distinct dendrites, and this requires a mechanism to ensure the correct distribution of synapses contacting from distinct ensembles. To address this problem, we introduce the requirement that on a short time scale, a pre-synaptic neuron makes a constant number of synapses with the same strength on a post-synaptic neuron. We find that this property enables clusters to distribute correctly and guarantees their functionality. Furthermore, we demonstrate that a change in the input statistics can reshape the spatial distribution of synapses. Finally, we show under which conditions clusters do not distribute correctly, e.g. when cross-talk between dendrites is too strong. As well as providing insight into potential biological mechanisms of learning, this work paves the way for new learning algorithms for artificial neural networks that exploit the spatial distribution of synapses.
Bivariate spatial point patterns in the retina: a reproducible review
Authors: Eglen Stephen J.
Published: October 2015

In this article I present a reproducible review of recent research to investigate the spatial positioning of neurons in the nervous system. In particular, I focus on the relative spatial positioning of pairs of cell types within the retina. I examine three different cases by which two types of neurons might be arranged relative to each other. (1) Cells of different type might be effectively independent of each other. (2) Cells of one type are randomly assigned one of two labels to create two related populations. (3) Interactions between cells of different type generate functional dependencies. I show briefly how spatial statistic techniques can be applied to investigate the nature of spatial interactions between two cell types. Finally, I have termed this article a ‘reproducible review’ because all the data and computer code are integrated into the manuscript so that others can repeat the analysis presented here. I close the review with a discussion of this concept.
A preferred curvature-based continuum mechanics framework for modeling embryogenesis with application toDrosophilamesoderm invagination
Authors: Khairy K. , Lemon W. , Amat F. , Keller P. J.
Published: October 2015

Mechanics plays a key role in the development of higher organisms. However, working towards an understanding of this relationship is complicated by the fact that it has proven difficult to model the link between local forces generated at the subcellular level, and tissue deformation at the whole-embryo level. Here we propose an approach first developed for lipid bilayers and cell membranes, in which force-generation at the cytoskeletal level only enters the shape mechanics calculation in the form of local changes in preferred tissue curvature. This allows us to formulate the continuum mechanics problem purely in terms of tissue strains. Relaxing the system by lowering its mechanical energy yields global morphogenetic predictions that accommodate the tendency towards this local preferred curvature, without explicitly modeling force-generating mechanisms at the molecular level. Our computational framework, which we call SPHARMMECH, extends a three-dimensional spherical harmonics parameterization known as SPHARM to combine this level of abstraction with a sparse shape representation. The integration of these two principles allows computer simulations to be performed in three dimensions, on highly complex shapes, gene expression patterns, and mechanical constraints.

We demonstrate our approach by modeling mesoderm invagination in the fruit-fly embryo, where local forces generated by the acto-myosin meshwork in the region of the future mesoderm lead to formation of a ventral tissue fold. The process is accompanied by substantial changes in cell shape and long-range cell movements. Applying SPHARM-MECH to whole-embryo live imaging data acquired with light-sheet microscopy reveals significant correlation between calculated and observed tissue movements. Our analysis predicts the observed cell shape anisotropy on the ventral side of the embryo and suggests an active mechanical role of mesoderm invagination in supporting the onset of germ-band extension.
Changes in the milk metabolome of the giant panda (Ailuropoda melanoleuca) with time after birth: Three phases in early lactation and progressive individual differences
Authors: Zhang Tong , Zhang Rong , Zhang Liang , Zhang Zhihe , Hou Rong , Wang Hairui , Loeffler Kati , Watson David G , Kennedy Malcolm W
Published: October 2015

Ursids (bears) in general, and giant pandas in particular, are highly altricial at birth. The components of bear milks and their changes with time may be uniquely adapted to nourish relatively immature neonates, protect them from pathogens, and support the maturation of neonatal digestive physiology. Serial milk samples collected from three giant pandas in early lactation were subjected to untargeted metabolite profiling and multivariate analysis. Changes in milk metabolites with time after birth were analysed by Principal Component Analysis, Hierarchical Cluster Analysis and further supported by Orthogonal Partial Least Square-Discriminant Analysis, revealing three phases of milk maturation: days 1-6 (Phase 1), days 7-20 (Phase 2), and beyond day 20 (Phase 3). While the compositions of Phase 1 milks were essentially indistinguishable among individuals, divergences emerged during the second week of lactation. OPLS regression analysis positioned against the growth rate of one cub tentatively inferred a correlation with changes in the abundance of a trisaccharide, isoglobotriose, previously observed to be a major oligosaccharide in ursid milks. Three artificial milk formulae used to feed giant panda cubs were also analysed, and were found to differ markedly in component content from natural panda milk. These findings have implications for the dependence of the ontogeny of all species of bears, and potentially other members of the Carnivora and beyond, on the complexity and sequential changes in maternal provision of micrometabolites in the immediate period after birth.
The time-resolved and extreme conditions XAS (TEXAS) facility at the European Synchrotron Radiation Facility: the general-purpose EXAFS bending-magnet beamline BM23
Authors: Mathon O. , Beteva A. , Borrel J. , Bugnazet D. , Gatla S. , Hino R. , Kantor I. , Mairs T. , Munoz M. , Pasternak S. , Perrin F. , Pascarelli S.
Published: October 2015

BM23 is the general-purpose EXAFS bending-magnet beamline at the ESRF, replacing the former BM29 beamline in the framework of the ESRF upgrade. Its mission is to serve the whole XAS user community by providing access to a basic service in addition to the many specialized instruments available at the ESRF. BM23 offers high signal-to-noise ratio EXAFS in a large energy range (5–75 keV), continuous energy scanning for quick-EXAFS on the second timescale and a micro-XAS station delivering a spot size of 4 µm × 4 µm FWHM. It is a user-friendly facility featuring a high degree of automation, online EXAFS data reduction and a flexible sample environment.
Temperature‐associated habitat selection in a cold‐water marine fish
Authors: Freitas Carla , Olsen Esben M. , Knutsen Halvor , Albretsen Jon , Moland Even
Published: October 2015

Habitat selection is a complex process, which involves behavioural decisions guided by the multiple needs and constraints faced by individuals. Climate‐induced changes in environmental conditions may alter those trade‐offs and resulting habitat use patterns.

In this study, we investigated the effect of sea temperature on habitat selection and habitat use of acoustically tagged Atlantic cod (Gadus morhua) at the Norwegian Skagerrak coast.

Significant relationships between ocean temperature and habitat selection and use were found. Under favourable sea temperature thresholds (<16 °C), cod selected vegetated habitats, such as eelgrass and macroalgae beds, available in shallow areas. Selection for those habitats was especially high at night, when cod tended to ascend to shallower areas, presumably to feed. Selection and use of those habitats decreased significantly as temperature rose. Under increased sea surface temperature conditions, cod were absent from vegetated shallow habitats, both during the day and night, and selected instead non‐vegetated rocky bottoms and sand habitats, available in deeper, colder areas.

This study shows the dynamic nature of habitat selection and strongly suggests that cod in this region have to trade off food availability against favourable temperature conditions. Future increases in ocean temperature are expected to further influence the spatial behaviour of marine fish, potentially affecting individual fitness and population dynamics.
Resource type influences the effects of reserves and connectivity on ecological functions
Authors: Yabsley Nicholas A. , Olds Andrew D. , Connolly Rod M. , Martin Tyson S. H. , Gilby Ben L. , Maxwell Paul S. , Huijbers Chantal M. , Schoeman David S. , Schlacher Thomas A.
Published: October 2015

Connectivity is a pivotal feature of landscapes that affects the structure of populations and the functioning of ecosystems. It is also a key consideration in conservation planning. But the potential functional effects of landscape connectivity are rarely evaluated in a conservation context.

The removal of algae by herbivorous fish is a key ecological function on coral reefs that promotes coral growth and recruitment. Many reef herbivores are harvested and some use other habitats (like mangroves) as nurseries or feeding areas. Thus, the effects of habitat connectivity and marine reserves can jointly promote herbivore populations on coral reefs, thereby influencing reef health.

We used a coral reef seascape in eastern Australia to test whether seascape connectivity and reserves influence herbivory. We measured herbivore abundance and rates of herbivory (on turf algae and macroalgae) on reefs that differed in both their level of connectivity to adjacent mangrove habitats and their level of protection from fishing.

Reserves enhanced the biomass of herbivorous fish on coral reefs in all seascape settings and promoted consumption of turf algae. Consumption of turf algae was correlated with the biomass of surgeonfish that are exploited outside reserves. By contrast, both reserve status and connectivity influenced herbivory on macroalgae. Consumption of macroalgae was greatest on fished reefs that were far from mangroves and was not strongly correlated with any fish species.

Our findings demonstrate that landscape connectivity and reserve status can jointly affect the functioning of ecosystems. Moreover, we show that reserve and connectivity effects can differ markedly depending on resource type (in this case turf algae vs. macroalgae). The effectiveness of conservation initiatives will therefore depend on our ability to understand how these multiple interactive effects structure the distribution of ecological functions. These findings have wider implications for the spatial conservation of heterogeneous environments and strengthen the case that the impact of conservation on ecosystem functioning is contingent on how reserves are positioned in landscapes.
The role of maternal nutrition, metabolic function and the placenta in developmental programming of renal dysfunction
Authors: Richter VFI , Briffa JF , Moritz KM , Wlodek ME , Hryciw DH
Published: October 2015

The intrauterine environment is critical for the development of the foetus. Barker and colleagues were the first to identify that adverse perturbations during foetal development are associated with an increased risk of developing diseases in adulthood, including cardiorenal disease. Specifically for the kidney, perturbations in utero can lead to nephron deficits and renal dysfunction by a number of mechanisms. Altered programming of nephron number is associated with an increased risk of developing kidney disease via glomerular hypertrophy and reduced vasodilative capacity of the renal blood vessels; both of which would contribute to hypertension in adulthood, with males being more susceptible to disease outcomes. Additionally, alterations in the renin‐angiotensin system (RAS) such as an upregulation or downregulation of specific receptors, depending on the nature of the insult, have also been implicated in the development of renal dysfunction. Sex‐specific differences in the expression of the RAS during late gestation and in the early postnatal environment have also been identified. Extensive research has demonstrated that both uteroplacental insufficiency and maternal malnutrition alter renal development in utero. Equally, exposure to maternal diabetes and maternal obesity during development are also associated with an increased risk of developing renal disease, however, the mechanism behind this association is poorly understood. Therefore, identifying the link between an adverse intrauterine environment and the programmed kidney disease risk in adulthood may facilitate the development of strategies to alleviate the epidemics of cardiorenal disease worldwide, in addition to understanding why males are more susceptible to adult‐onset cardiovascular diseases.
Navigating the field of temporally framed care in the Danish home care sector
Authors: Tufte Pernille , Dahl Hanne Marlene
Published: October 2015

The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in‐depth perspective on the broader feminist literature on the dilemmas of care.
Shedding light on microbial dark matter: a TM6 bacterium as natural endosymbiont of a free‐living amoeba
Authors: Delafont Vincent , Samba‐Louaka Ascel , Bouchon Didier , Moulin Laurent , Héchard Yann
Published: October 2015

The TM6 phylum belongs to the so‐called microbial dark matter that gathers uncultivated bacteria detected only via DNA sequencing. Recently, the genome sequence of a TM6 bacterium (TM6SC1) has led to suggest that this bacterium would adopt an endosymbiotic life. In the present paper, free‐living amoebae bearing a TM6 strain were isolated from a water network. The amoebae were identified as Vermamoeba vermiformis and the presence of a TM6 strain was detected by polymerase chain reaction and microscopy. The partial sequence of its 16S rRNA gene showed this strain to be closely related to the sequenced TM6SC1 strain. These bacteria displayed a pyriform shape and were found within V. vermiformis. Therefore, these bacteria were named Vermiphilus pyriformis. Interactions studies showed that V. pyriformis was highly infectious and that its relation with V. vermiformis was specific and highly stable. Finally, it was found that V. pyriformis inhibited the encystment of V. vermiformis. Overall, this study describes for the first time an endosymbiotic relationship between a TM6 bacterium and a free‐living amoeba in the environment. It suggests that other bacteria of the TM6 phylum might also be endosymbiotic bacteria and may be found in other free‐living amoebae or other organisms.
Disturbance of the bacterial cell wall specifically interferes with biofilm formation
Authors: Bucher Tabitha , Oppenheimer‐Shaanan Yaara , Savidor Alon , Bloom‐Ackermann Zohar , Kolodkin‐Gal Ilana
Published: October 2015

In nature, bacteria communicate via chemical cues and establish complex communities referred to as biofilms, wherein cells are held together by an extracellular matrix. Much research is focusing on small molecules that manipulate and prevent biofilm assembly by modifying cellular signalling pathways. However, the bacterial cell envelope, presenting the interface between bacterial cells and their surroundings, is largely overlooked. In our study, we identified specific targets within the biosynthesis pathways of the different cell wall components (peptidoglycan, wall teichoic acids and teichuronic acids) hampering biofilm formation and the anchoring of the extracellular matrix with a minimal effect on planktonic growth. In addition, we provide convincing evidence that biofilm hampering by transglycosylation inhibitors and D‐Leucine triggers a highly specific response without changing the overall protein levels within the biofilm cells or the overall levels of the extracellular matrix components. The presented results emphasize the central role of the Gram‐positive cell wall in biofilm development, resistance and sustainment.
Aeromonas chitinase degrades chironomid egg masses
Authors: Laviad Sivan , Golan Amnon , Shaked Tamar , Vaizel‐Ohayon Dalit , Halpern Malka , Pick Elah
Published: October 2015

Chironomids are freshwater insects that undergo a complete metamorphosis of four life stages. Chironomid egg masses can be degraded by Vibrio cholerae and some Aeromonas species. Egg mass degradation by V. cholerae requires haemagglutinin protease activity. Our aim was to identify the egg mass degrading (EMD) factor secreted by Aeromonas dhkanesis 3K1C15. Following the hypothesis that the EMD factor of A. dhkanesis is also a protease, secreted proteases were screened, but none of them proved to have the same properties as the EMD factor. Using conventional protein purification methods, we found that the active fraction included chitinases. We further confirmed chitin as a building block of the egg masses. Interestingly, by supplementing bacterial growth media with chitin, we observed unexpected EMD factor activity in Aeromonas isolates that initially were not able to degrade egg masses. Accordingly, we concluded that although strain 3K1C15 secretes chitinases constitutively, most Aeromonas strains secrete chitinases inductively. Induction of chitinases in nature presumably occurs when bacteria are attached to the egg mass habitat, in which chitin is abundant. Considering that chitinases are highly conserved across bacteria phyla, we assume that the role of this enzyme in the bacteria–insect interplay could be wider than is currently thought.
The influence of comorbid disorders on the episodicity of bipolar disorder in youth
Authors: Yen S. , Stout R. , Hower H. , Killam M. A. , Weinstock L. M. , Topor D. R. , Dickstein D. P. , Hunt J. I. , Gill M. K. , Goldstein T. R. , Goldstein B. I. , Ryan N. D. , Strober M. , Sala R. , Axelson D. A. , Birmaher B. , Keller M. B.
Published: October 2015

Objective

Bipolar disorder (BP) frequently co‐occurs with other psychiatric disorders. We examine whether course of anxiety disorders (ANX), attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), and substance use disorders (SUD) influence likelihood of recovery and recurrence of depression and mania in BP youth.

Method

Weekly ratings of psychiatric disorder intensity were obtained from 413 participants of the Course and Outcome of BP Youth project, followed for an average of 7.75 years. Multiple‐event Cox proportional hazards regression analyses examined worsening of comorbid disorders as predictors of mood episode recovery and recurrence.

Results

Increased severity in ANX and SUD predicted longer time to recovery and less time to next depressive episode, and less time to next manic episode. Multivariate models with ANX and SUD found that significant effects of ANX remained, but SUD only predicted longer time to depression recovery. Increased severity of ADHD and DBD predicted shorter time to recurrence for depressive and manic episodes.

Conclusion

There are significant time‐varying relationships between the course of comorbid disorders and episodicity of depression and mania in BP youth. Worsening of comorbid conditions may present as a precursor to mood episode recurrence or warn of mood episode protraction.
Clinical risk factors for death after release from prison in Washington State: a nested case–control study
Authors: Binswanger Ingrid A. , Stern Marc F. , Yamashita Traci E. , Mueller Shane R. , Baggett Travis P. , Blatchford Patrick J.
Published: October 2015

Background and aims

While mortality rates after prison release are high, little is known about clinical risk factors for death. We sought to identify risk and protective factors for all‐cause and accidental poisoning (overdose) death.

Design

Nested case–control study of people released from prison.

Setting

Washington State Department of Corrections, Washington, USA.

Participants

Cases (699 all‐cause deaths, of which 88 were among women, and 196 additional overdose deaths, of which 76 were among women) between 1999 and 2009 matched 1 : 1 to controls on sex, age and year of release using risk set sampling.

Measurements

Prison medical charts were abstracted for clinical information. Independent associations between clinical characteristics and all‐cause and overdose mortality were assessed using conditional logistic regression.

Findings

Key independent risk factors for all‐cause mortality included homelessness [odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.06, 2.23], injection drug use (OR = 1.54, 95% CI = 1.16, 2.06), tobacco use (OR = 1.51, 95% CI = 1.07, 2.13), cirrhosis (OR = 4.42, 95% CI = 1.63, 11.98) and psychiatric medications before release (OR = 2.38, 95% CI = 1.71, 3.30). Independent risk factors for overdose mortality included substance use disorder (OR = 2.33, 95% CI = 1.32, 4.11), injection drug use (OR = 2.43, 95% CI = 1.53, 3.86), panic disorder (OR = 3.87, 95% CI = 1.62, 9.21), psychiatric prescriptions before release (OR = 2.44, 95% CI = 1.55, 3.85) and problems with opiates/sedatives (OR = 2.81, 95% CI = 1.40, 5.63). Substance use disorder treatment during the index incarceration was protective for all‐cause (OR = 0.67, 95% CI = 0.49, 0.91) and overdose (OR = 0.57, 95% CI = 0.36, 0.90) mortality.

Conclusions

Injection drug use and substance use disorders are risk factors for death after release from prison. In‐prison substance use disorder treatment services may reduce the risk.
Increasing compliance with alcohol service laws in a developing country: intervention trial in the Kingdom of Bhutan
Authors: Dorji Gampo , DeJong William , Bor Jacob , DeSilva Mary Bachman , Sabin Lora , Feeley Frank Rich , Udon Pema , Wangchuk Nima , Wangdi Ugyen , Choden Tshering , Gurung Mongal Singh , Chogyel Tandin , Wangchuk Dorji , Kypri Kypros
Published: October 2015

Aim

Bhutan is a low‐middle income country that, like many others, experiences significant alcohol‐related harm and low compliance with laws restricting availability and promotion. This study assessed changes in compliance of alcohol outlets with sales restrictions following a multi‐sector programme aimed at improving this.

Design

Pre–post design with covert observation of service practices.

Setting

Thimphu, Bhutan, June–November 2013. Alcohol is not permitted for sale except from 1 to 10 p.m. Wednesday–Monday. Serving minors (< 18 years old) or intoxicated patrons is illegal.

Participants

Seventy‐one outlets selected randomly from all 209 on‐premises outlets in downtown Thimphu.

Intervention

Multi‐sector programme involving visits to outlets, education of owners and staff, a toolkit and implementation checks.

Measurements

Ten mystery‐shopper visits were made to each outlet both before and after the intervention. We assessed compliance in five purchasing scenarios: (1) before 1 p.m., (2) after 10 p.m., (3) on Tuesdays and (4) shoppers who appeared to be underage or (5) intoxicated. Changes in compliance rates were assessed using multi‐variable logistic regression models.

Findings

Overall compliance increased from 20 to 34% [difference: 14%; 95% confidence interval (CI) = 7–22%]. Improvement was found in refusals of service before 1 p.m.: 10–34% (differenceadj = 24%; 95% CI = 12–37%) and on Tuesdays: 43–58% (differenceadj = 14%; 95% CI = 1–28%). Differences in refusal to serve alcohol: after 10 p.m. (differenceadj = 15%; 95% CI = –8 to 37%); to underage patrons (differenceadj = –5%; 95% CI = 14 to 4%); and to intoxicated patrons (differenceadj = 7%; 95% CI = –7–20%) were not statistically significant. Younger servers, stand‐alone bars and outlets permitting indoor smoking were each less likely to comply with the alcohol service laws.

Conclusion

A multi‐sector programme to improve compliance with legal restrictions on serving alcohol in Bhutan appeared to have a modest effect but even after the programme, in two‐thirds of the occasions tested, the laws were broken.
Hepatitis C virus infections in oral lichen planus: a systematic review and meta‐analysis
Authors: Alaizari NA , Al‐Maweri SA , Al‐Shamiri HM , Tarakji B , Shugaa‐Addin B
Published: October 2015

Background

A role for hepatitis C virus in oral lichen planus has been postulated. This systematic review and meta‐analysis of the existing epidemiological studies was conducted to determine if there is a correlation between oral lichen planus and hepatitis C virus infection.

Methods

We examined the association between hepatitis C virus and oral lichen planus by conducting a systematic review and meta‐analysis of case‐control studies that examined the prevalence of anti‐HCV antibodies in the serum of cases and controls. We searched PubMed, Embase and The Cochrane Library databases from 2005 to January 2015. Associations were measured using random‐effect odds ratios (ORs) combined with 95% confidence intervals.

Results

Nineteen eligible studies, encompassing 1807 cases of OLP and 2519 controls, were retrieved and included in this review. The summary estimate OR for all studies was 6.07 (95% CI: 2.73–13.48), showing a statistically significant difference in the proportion of HCV seropositivity among oral lichen planus patients, compared with controls and substantial heterogeneity between studies (I2= 65%) as a result of a variety of geographical distributions.

Conclusions

The association of hepatitis C virus infection with oral lichen planus emphasizes the importance of hepatitis C virus screening in oral lichen planus patients.
Volatile organic compounds in asthma diagnosis: a systematic review and meta‐analysis
Authors: Cavaleiro Rufo J. , Madureira J. , Oliveira Fernandes E. , Moreira A.
Published: October 2015

We aimed to assess the value and classification rate of exhaled volatile organic compounds (VOCs) in asthma diagnosis. A PRISMA‐oriented systematic search for published studies regarding exhaled VOCs in asthma diagnosis was conducted based on predefined criteria. Studies presenting sensitivity and specificity values for the test were included in the meta‐analysis. Pooled diagnosis odds ratios (DOR), area under the curve (AUC) and positive and negative likelihood ratios (LR) for exhaled VOC profiles were calculated; and publication bias, threshold effect and heterogeneity were estimated. Eighteen studies were selected for the qualitative analysis and six met the criteria for inclusion in the quantitative analysis. Mean (95% CI) pooled DOR, positive and negative LR were 49.3 (15.9–153.3), 5.86 (3.07–11.21) and 0.16 (0.10–0.26), respectively. The AUC value was 0.94. Only three of the 18 reviewed studies performed an external validation of the model using a different data set. The results from the revised studies suggest that exhaled VOCs are promising biomarkers for asthma diagnosis and that several compounds, mainly alkanes, may be significantly associated with asthma inflammation. However, there are still various constraints associated with standardization and externally validated studies are needed to introduce exhaled VOC profiling in a clinical scenario.
Geniposide Attenuates the Phosphorylation of Tau Protein in Cellular and Insulin‐deficient APP/PS1 Transgenic Mouse Model of Alzheimer's Disease
Authors: Zhang Yonglan , Yin Fei , Liu Jianhui , Liu Zixuan
Published: October 2015

Our previous studies have shown that geniposide plays an essential role in glucose‐stimulated insulin secretion from pancreatic β cells and also regulates the metabolism of Aβ and its deposition in neurons. In this study, we reported that insulin deficiency induced significant increase of tau phosphorylation. Administration of geniposide for 4 weeks significantly decreased the phosphorylated level of tau and the acceleration of GSK‐3β phosphorylation in the brain of APP/PS1 transgenic mice induced by insulin deficiency. We also observed that geniposide decreased the phosphorylation of tau protein directly and increased the phosphorylation of Akt in primary cultured cortical neurons. Furthermore, geniposide enhanced the role of insulin on the phosphorylation of Akt, GSK‐3β, and tau in primary cultured cortical neurons. And these effects of geniposide in cortical neurons could be prevented by preincubation with LY294002, an inhibitor of PI3K. Taken together, our findings provide a mechanistic and perhaps a foundational link between diabetes and Alzheimer's disease and are consistent with the notion that geniposide might play an essential role on the phosphorylation of tau protein via enhancing insulin signaling and may convey a therapeutic benefit in Alzheimer's disease.
The influence of peri‐implant keratinized mucosa on brushing discomfort and peri‐implant tissue health
Authors: Souza André B. , Tormena Mariana , Matarazzo Flávia , Araújo Maurício G.
Published: October 2015

Objective

The aim of this study was to compare the level of brushing discomfort (BD) during oral hygiene and peri‐implant clinical variables between patients presenting implant sites with a band ≥2 mm and <2 mm of keratinized mucosa (KM).

Materials and Methods

Participating patients were recruited during routine maintenance follow‐up visits from January to October 2013. Based on the presence of KM, patients were allocated into two groups: implant sites with ≥2 mm of KM (Wide Group); and implant sites with <2 mm of KM (Narrow Group). Patients were clinically assessed, and plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP) data were collected from three sites at the buccal aspect of each implant. Subsequently, patients received standardized oral hygiene instructions and cleaning devices and were asked to clean around the experimental implant sites. All patients reported on the level of BD using the visual analog scale (VAS). Non‐paired Student's t‐test, Wilcoxon's signed‐rank test, and chi‐square tests were performed to analyze the outcome variables (P < 0.05).

Results

Eighty patients with a total of 270 implant sites were included. Implant sites in the Narrow Group exhibited higher levels of BD (P < 0.001), PI (P = 0.0021), and BoP (P = 0.017) than implant sites in the Wide Group.

Conclusion

Implant sites with a band of <2 mm of KM were shown to be more prone to brushing discomfort, plaque accumulation, and peri‐implant soft tissue inflammation when compared to implant sites with ≥2 mm of KM.
Differential characteristics of pediatric sinusitis in patients who underwent endoscopic sinus surgery: children vs. adolescents
Authors: Min H.J. , Chung H.J. , Seong S.Y. , Sim N.S. , Yoon J.‐H. , Lee J.‐G. , Kim C.‐H. , Cho H.‐J.
Published: October 2015

Objectives

We hypothesised that paediatric chronic sinusitis patients might have various clinical characteristics, depending on age, compared symptoms, physical findings and clinical features in younger children and older adolescent patients who underwent endoscopic sinus surgery.

Design

A retrospective review of medical records.

Setting

A total of 195 paediatric patients who underwent Endoscopic sinus surgery were enrolled and medical records were reviewed.

Participants

The subjects were divided into children (age < 12 years, n = 70, mean age = 9.6 years) and adolescents (age ≥ 12 years, n = 125, mean age = 14.7 years).

Main outcome measures

Subjective symptoms, physical findings, CT images and clinical features were compared in children and adolescent groups.

Results

Cough and nasal obstruction were more common in adolescents, and sleep disturbance was more common in children. Nasal mucosal injection was more common in adolescents, whereas tonsils were larger in children. Septal deviation was a more common finding in adolescents, and total CT score and serum total IgE levels were higher in children. There was no statistical difference in rate of recurrence after endoscopic sinus surgery.

Conclusion

The clinical features of paediatric chronic sinusitis differed between the younger and older groups. Symptomatic, anatomical and clinical differences between these two groups suggest that further study of paediatric chronic sinusitis should stratify patients by age to better understand the effects of treatment on each age group.
Long‐term results following an anatomically based surgical technique for resection of colon cancer: a comparison with results from complete mesocolic excision
Authors: Bokey L. , Chapuis P. H. , Chan C. , Stewart P. , Rickard M. J. F. X. , Keshava A. , Dent O. F.
Published: October 2015

Aim

Complete mesocolic excision (CME) has been advocated as likely to improve the long‐term oncological outcome of colon cancer resection, although there is a paucity of long‐term results in the literature. The aim of this study was to supplement our previously published results on colon cancer resection based on a standardized technique of precise dissection along anatomical planes with high vascular ligation and to compare our long‐term results with those of recent European studies of CME.

Method

Data were drawn from a prospective hospital registry of consecutive resections for colon cancer between 1996 and 2007, including follow‐up to the end of 2012. The principal outcomes from potentially curative resections were 5‐year Kaplan–Meier rates of local recurrence, systemic recurrence, overall survival and cancer‐specific survival. Secondary outcomes for all resections were postoperative complications, number of lymph nodes retrieved and R0 status.

Results

For 779 potentially curative resections the local recurrence rate was 2.1% (95% CI 1.3–3.4), the systemic recurrence rate was 10.2% (95% CI 8.1–12.7), the 5‐year overall survival rate was 76.2% (95% CI 73.0–79.0) and the cancer‐specific survival rate was 89.8% (95% CI 87.3–91.9). For all 905 resections, rates of 14 surgical complications were low and not dissimilar to those in a comparable study. The median lymph node count was 15 (range 0–113). R0 status was confirmed in 883/905 patients (97.6%; 95% CI 96.4–98.5).

Conclusion

For colon cancer, meticulous dissection along anatomical planes together with high vascular ligation results in few complications, a high R0 rate, low recurrence and high survival.
Recurrence of rectal prolapse following rectopexy: a pooled analysis of 532 patients
Authors: Bishawi M. , Foppa C. , Tou S. , Bergamaschi R. ,   the Rectal Prolapse Recurrence Study Group
Published: October 2015

Aim

The study was designed to address the unanswered question of the influence of the extent of rectal mobilization, the type of rectal fixation and the surgical access (openvslaparoscopic) on recurrence rates following abdominal surgery for full‐thickness rectal prolapse (FTRP).

Method

Individual patient data were pooled and data merging was performed following comparison of variable definitions to ensure similarity in definitions. Recurrence after rectopexy was defined as the presence of FTRP on physical examination. The impact of categorical factors on recurrence was assessed using Fisher's exact and the chi‐squared tests. Recurrence‐free survival curves were generated for patients and differences in time to recurrence were compared using the log rank test. Factors passing univariate screening with aPvalue < 0.1 were included in a multivariate model.

Results

After data matching and merging, 532 patients were included. The duration of follow‐up ranged from 12 to 235 months. There were 46 (8.6%) recurrences at a median follow‐up of 60 months. Mean age was 53.6 ± 17 years, 359 (67.5%) were female, the mean length of external prolapse was 6.3 ± 4 cm, and previous abdominal surgery had taken place in 33.7%. Four variables were identified on initial univariate screening as being related to recurrence. They included a history of incontinence (P = 0.09), constipation (P = 0.018), the extent of rectal mobilization (P = 0.004) and the role of sigmoid resection (P = 0.057). Using multivariate analysis, only the degree of mobilization was independently associated with recurrence (P = 0.026).

Conclusion

Circumferential rectal mobilization during rectopexy was associated with a decreased long‐term recurrence rate. The type of rectal fixation and the type of surgical access did not influence recurrence.
Ligation of the intersphincteric fistula tract for the treatment of fistula‐in‐ano: experience of a tertiary care centre in South India
Authors: Parthasarathi R. , Gomes R. M. , Rajapandian S. , Sathiamurthy R. , Praveenraj P. , Senthilnathan P. , Palanivelu C.
Published: October 2015

Aim

Ligation of the intersphincteric fistula tract (LIFT) is a new sphincter‐sparing surgical technique increasingly used to treat fistulae‐in‐ano yielding good results. The aim of this study was to evaluate its effectiveness in the treatment of complex fistulae‐in‐ano and to determine factors associated with recurrence and its subsequent management.

Method

A prospective observational study was performed of 167 patients with complex fistula‐in‐ano treated by LIFT from June 2013 to January 2014. In all patients a LIFT with partial core‐out of the fistula tract was performed.

Results

There were 167 patients of mean age 43.6 ± 12.8 years. Thirty‐three fistulae were recurrent. 150 were trans‐sphincteric, 16 were intersphincteric and one was a suprasphincteric fistula. The median postoperative stay was 2 (range: 1–14) days (mean = 2.4 days). At follow up there was no change in continence. The median healing time was 4 (range: 1–8) weeks. Two patients developed an intersphincteric abscess needing surgical drainage healing uneventfully. The mean follow up was 12.8 [median = 12 (range: 4–22)] months. The healing rate was 94.1%. Ten (5.9%) patients developed a recurrent fistula that was managed by a second LIFT procedure in seven, a sinus tract excision with curettage in two and seton placement in one. Recurrence was significantly associated with diabetes mellitus and perianal collections and showed an increased incidence with tract abscesses and multiple tracts.

Conclusion

LIFT has a high success rate in complex fistulae‐in‐ano. Recurrence is related to diabetes mellitus, perianal collections, tract abscesses and multiple tracts and a second LIFT procedure may be feasible and efficient.
Effects of neuromuscular electrical stimulation on cytokines in peripheral blood for healthy participants: a prospective, single‐blinded Study
Authors: Truong Alexander D. , Kho Michelle E. , Brower Roy G. , Feldman Dorianne R. , Colantuoni Elizabeth , Needham Dale M.
Published: October 2015

Introduction

The effect of exercise on cytokines may improve muscle strength. Neuromuscular electrical stimulation (NMES) is a muscle‐preserving therapy that benefits patients unable to participate in active exercise. How NMES alters cytokines is unclear. The aim of this study was to study the effects of 1 NMES session on cytokines associated with protein metabolism during exercise.

Methods

We evaluated the effects of NMES on IL‐1, IL‐6, IL‐10 and TNF‐α levels in peripheral blood. Participants received NMES to bilateral lower extremity muscles (quadriceps, tibialis anterior, gastrocnemius) for 30 min. Blood samples immediately pre‐ and post‐NMES were drawn at 15‐min intervals to 2‐h follow‐up, and the mean values of pre‐NMES levels were compared to peak and trough post‐NMES levels. For cytokines with significant changes, we conducted a repeated‐measures linear regression analysis. We also measured post‐NMES lactate and creatine kinase levels.

Results

We enrolled nine eligible participants. There was a significant increase in peak IL‐6 from the mean pre‐NMES value [0·65 (0·89) to 1·04 (0·89) pg ml−1, P = 0·001] and a significant decrease in trough IL‐1 [0·08 (0·07) to 0·02 (0·02) pg ml−1, P = 0·041] and TNF‐α [2·42 (0·54) to 2·16 (0·59) pg ml−1, P = 0·021]. In repeated‐measures regression analysis, we identified significantly higher mean IL‐6 values throughout the full 120 min post‐NMES period, and a significantly higher mean IL‐1 value at 30 min post‐NMES. There were no significant differences in peak IL‐10, trough IL‐6, lactate, or creatine kinase values.

Conclusions

In nine healthy humans, 30 min of NMES was temporally associated with changes in cytokines similar to the effects of active exercise and may mediate NMES' observed effects on reducing muscle weakness.
Evaluation of water content around airway in obstructive sleep apnea patients using peripharyngeal mucosal T2 magnetic resonance imaging
Authors: Rahmawati Anita , Chishaki Akiko , Ohkusa Tomoko , Hashimoto Sonomi , Adachi Kazuo , Nagao Michinobu , Konishi Nishizaka Mari , Ando Shin‐ichi
Published: October 2015

Introduction

Obstructive sleep apnea (OSA) is common sleep disorder characterized by repetitive episodes of airway closure which usually occurs in the retropalatal region of the oropharynx. It has been known that upper airway mucosa in OSA patients is described as edematous, but not fully clarified.

Objectives

This study aimed to investigate and establish magnetic resonance imaging (MRI) parameter to estimate tissue water content at retropalatal level and its relationship with sleep parameters in OSA patients.

Methods

Forty‐eight subjects with OSA underwent overnight polysomnography and cervical MRI with 1.5‐tesla [mean (SD) age 55 (14) years and apnea‐hypopnea index (AHI) 45.2 (26.1) events/hour, 79.2% male]. On the axial T2‐weighted images from epipharynx to oropharynx, the signal intensities of masseter muscle and peripharyngeal mucosa [T2 mucous‐to‐masseter intensity ratio (T2MMIR)], was used as water content estimation in the retropalatal region. Partial correlation analysis was performed to examine the correlation between T2MMIR and polysomnography parameters.

Results

We found that there were strong and positive correlations between the T2MMIR and AHI (r = 0.545, P < 0.05), supine AHI (r = 0.553, P < 0.05) and REM AHI (r = 0.640, P < 0.01) by partial correlation analysis. Besides, in patients with less efficient sleep who had more stage 1 sleep, significantly higher T2MMIR was noted (r = 0.357, P < 0.05).

Conclusions

This study confirmed that peripharyngeal T2MMIR can be a simple parameter representing peripharyngeal tissue water contents related to severe OSA.
Feasibility of deep sedation with a combination of propofol and dexmedetomidine hydrochloride for esophageal endoscopic submucosal dissection
Authors: Nonaka Takashi , Inamori Masahiko , Miyashita Tetsuya , Harada Shinsuke , Inoh Yumi , Kanoshima Kenji , Matsuura Mizue , Higurashi Takuma , Ohkubo Hidenori , Iida Hiroshi , Endo Hiroki , Kusakabe Akihiko , Maeda Shin , Gotoh Takahisa , Nakajima Atsushi
Published: October 2015

Background and Aim

The aim of the present study was to evaluate the efficacy and safety of sedation with a combination of propofol (PF) and dexmedetomidine (DEX) compared with sedation with benzodiazepines in esophageal endoscopic submucosal dissection (ESD).

Methods

We retrospectively reviewed clinical data for 40 consecutive patients who had undergone esophageal ESD at the Yokohama City University Hospital between July 2012 and August 2014. Of these patients, 20 were sedated with benzodiazepines (conventional group) and another 20 patients were sedated with a combination of PF and DEX (combination group). Parameters for efficacy and safety of sedation were evaluated by comparisons between the two groups.

Results

Median procedural times in the combination group were shorter than those in the conventional group (61 min vs 89 min, P = 0.03), and the percentage of patients who showed restlessness in the combination group was significantly lower than that in the conventional group (25% vs 65%, P = 0.025). Incidences of hypotension and bradycardia in the combination group were higher than those in the conventional group (60% vs 15%, P = 0.008, and 60% vs 15%, P = 0.008, respectively).

Conclusion

This retrospective study suggests that a combination of PF and DEX may provide stable deep sedation with less body movement than benzodiazepines during esophageal ESD.