bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of the effect of site-specific histone acetylation on chromatin transcription rate
Authors: Wakamori Masatoshi , Okabe Kohki , Ura Kiyoe , Funatsu Takashi , Takinoue Masahiro , Umehara Takashi
Published: June 2019

Eukaryotic transcription is epigenetically regulated by chromatin structure and post-translational modifications (PTMs). For example, lysine acetylation in histone H4 is correlated with activation of RNA polymerase I-, II-, and III-driven transcription from chromatin templates, which requires prior chromatin remodeling. However, quantitative understanding of the contribution of particular PTM states to the sequential steps of eukaryotic transcription has been hampered partially because reconstitution of a chromatin template with designed PTMs is difficult. In this study, we reconstituted a di-nucleosome with site-specifically acetylated or unmodified histone H4, which contained two copies of theXenopussomatic 5S rRNA gene with addition of a unique sequence detectable by hybridization-assisted fluorescence correlation spectroscopy. Using aXenopusoocyte nuclear extract, we analyzed the time course of accumulation of nascent 5S rRNA-derived transcripts generated on chromatin templatesin vitro.Our mathematically described kinetic model and fitting analysis revealed that tetra-acetylation of histone H4 at K5/K8/K12/K16 increases the rate of transcriptionally competent chromatin formation ~3-fold in comparison with the absence of acetylation. We provide a kinetic model for quantitative evaluation of the contribution of epigenetic modifications to chromatin transcription.
Catalytically important damage-free structures of a copper nitrite reductase obtained by femtosecond X-ray laser and room-temperature neutron crystallography
Authors: Halsted Thomas P. , Yamashita Keitaro , Gopalasingam Chai C. , Shenoy Rajesh T. , Hirata Kunio , Ago Hideo , Ueno Go , Blakeley Matthew P. , Eady Robert R. , Antonyuk Svetlana V. , Yamamoto Masaki , Hasnain S. Samar
Published: June 2019

Copper-containing nitrite reductases (CuNiRs) that convert NO2−to NO via a CuCAT–His–Cys–CuETproton-coupled redox system are of central importance in nitrogen-based energy metabolism. These metalloenzymes, like all redox enzymes, are very susceptible to radiation damage from the intense synchrotron-radiation X-rays that are used to obtain structures at high resolution. Understanding the chemistry that underpins the enzyme mechanisms in these systems requires resolutions of better than 2 Å. Here, for the first time, the damage-free structure of the resting state of one of the most studied CuNiRs was obtained by combining X-ray free-electron laser (XFEL) and neutron crystallography. This represents the first direct comparison of neutron and XFEL structural data for any protein. In addition, damage-free structures of the reduced and nitrite-bound forms have been obtained to high resolution from cryogenically maintained crystals by XFEL crystallography. It is demonstrated that AspCATand HisCATare deprotonated in the resting state of CuNiRs at pH values close to the optimum for activity. A bridging neutral water (D2O) is positioned with one deuteron directed towards AspCAT Oδ1and one towards HisCAT N∊2. The catalytic T2Cu-ligated water (W1) can clearly be modelled as a neutral D2O molecule as opposed to D3O+or OD−, which have previously been suggested as possible alternatives. The bridging water restricts the movement of the unprotonated AspCATand is too distant to form a hydrogen bond to the O atom of the bound nitrite that interacts with AspCAT. Upon the binding of NO2−a proton is transferred from the bridging water to the Oδ2atom of AspCAT, prompting electron transfer from T1Cu to T2Cu and reducing the catalytic redox centre. This triggers the transfer of a proton from AspCATto the bound nitrite, enabling the reaction to proceed.
Elongated horizontal and vertical receivers in three‐dimensional electromagnetic modelling and inversion
Authors: Patzer Cedric , Tietze Kristina , Ritter Oliver
Published: June 2019

Electromagnetic geophysical methods often rely on measurements of naturally occurring or artificially impressed electric fields. It is technically impossible, however, to measure the electric field directly. Instead, the electric field is approximated by recording the voltage difference between two electrodes and dividing the obtained voltage by the distance between the electrodes. Typically, modelling and inversion algorithms assume that the electric fields are obtained over infinitely short point‐dipoles and thus measured fields are assigned to a single point between the electrodes. Such procedures imply several assumptions: (1) The electric field between the two electrodes is regarded as constant or being a potential field and (2) the receiver dimensions are negligible compared to the dimensions of the underlying modelling grid. While these conditions are often fulfilled for horizontal electric fields, borehole sensors for recordings of the vertical electric field have dimensions in the order of ≈100 m and span several modelling grid cells. Observations from such elongated borehole sensors can therefore only be interpreted properly if true receiver dimensions and variations of electrical conductivity along the receiver are considered. Here, we introduce a numerical solution to include the true receiver geometry into electromagnetic modelling schemes, which does not rely on such simplifying assumptions. The algorithm is flexible, independent of the chosen numerical method to solve Maxwell's equations and can easily be implemented in other electromagnetic modelling and inversion codes. We present conceptual modelling results for land‐based controlled source electromagnetic scenarios and discuss consideration of true receiver geometries for a series of examples of horizontal and vertical electric field measurements. Comparison with Ez data measured in an observation borehole in a producing oil field shows the importance of both considering the true length of the receiver and also its orientation. We show that misalignment from the vertical axis as small as 0.1° may seriously distort the measured signal, as horizontal electric field components are mapped into the desired vertical component. Adequate inclusion of elongated receivers in modelling and inversion can also help reducing effects of static shift when interpreting (natural source) magnetotelluric data.
Income Smoothing and the Usefulness of Earnings for Monitoring in Debt Contracting
Authors: Demerjian Peter , Donovan John , Lewis‐Western Melissa F.
Published: June 2019

We investigate whether income smoothing affects the usefulness of earnings for contracting through the monitoring role of earnings‐based debt covenants. First, we examine initial contract design and predict that income smoothing will increase (decrease) the use of earnings‐based covenants if income smoothing improves (reduces) the usefulness of earnings to monitor borrowers. We find that private debt contracts to borrowers with greater income smoothing are more likely to include earnings‐based covenants. A structural model that explores the cause of this relationship provides evidence that smoothing improves the ability of earnings to reflect credit risk. Second, we examine technical default following contract inception. We find that income smoothing is associated with a lower likelihood of spurious technical default (when the borrower's economic performance has not declined but the loan nevertheless enters technical default). In contrast, we find no association between income smoothing and performance technical default (when the borrower's economic performance has declined). Collectively, this evidence is consistent with income smoothing improving the effectiveness of earnings‐based information in monitoring borrowers.
Biomarkers and clinical characteristics of autoimmune chronic spontaneous urticaria: Results of the PURIST Study
Authors: Schoepke Nicole , Asero Riccardo , Ellrich André , Ferrer Marta , Gimenez‐Arnau Ana , E. H. Grattan Clive , Jakob Thilo , Konstantinou George N. , Raap Ulrike , Skov Per Stahl , Staubach Petra , Kromminga Arno , Zhang Ke , Bindslev‐Jensen Carsten , Daschner Alvaro , Kinaciyan Tamar , Knol Edward F. , Makris Michael , Marrouche Nadine , Schmid‐Grendelmeier Peter , Sussman Gordon , Toubi Elias , Church Martin K. , Maurer Marcus
Published: June 2019

Background

Autoimmune chronic spontaneous urticaria (aiCSU) is an important subtype of chronic spontaneous urticaria (CSU) in which functional IgG autoantibodies to IgE or its high‐affinity receptor (FcεRI) induces mast cell degranulation and subsequent symptom development. However, it has not been tightly characterized. This study aimed to better define the clinical and immunological features and to explore potential biomarkers of aiCSU.

Methods

This was a multinational, multicenter study of 182 CSU patients. The clinical features studied included: urticaria activity and impact (UAS7 and quality of life); autologous serum skin test (ASST); IgG anti‐FcεRI and IgG anti‐IgE; IgG‐anti‐thyroperoxidase (IgG anti‐TPO); total serum IgE; and basophil reactivity (BASO) using the basophil activation test (BAT) and basophil histamine release assay (BHRA).

Results

Of the 182 patients, 107 (59%) were ASST+, 46 (25%) were BASO+, and 105 (58%) were IgG anti‐FcεRI+/IgE+. Fifteen patients (8%) fulfilled all three criteria of aiCSU. aiCSU patients appeared more severe (UAS7 21 vs 9 P < 0.016) but showed no other clinical or demographic differences from non‐aiCSU patients. aiCSU patients also had markedly lower total IgE levels (P < 0.0001) and higher IgG anti‐TPO levels (P < 0.001). Of biomarkers, positive BAT and BHRA tests were 69% and 88% predictive of aiCSU, respectively.

Conclusions

aiCSU is a relatively small but immunologically distinct subtype of CSU that cannot be identified by routine clinical parameters. Inclusion of BHRA or BAT in the diagnostic workup of CSU patients may aid identification of aiCSU patients, who may have a different prognosis and benefit from specific management.
Noncoding RNA transcription at enhancers and genome folding in cancer
Authors: Isoda Takeshi , Morio Tomohiro , Takagi Masatoshi
Published: June 2019

Changes of nuclear localization of lineage‐specific genes from a transcriptionally inert to permissive environment are a crucial step in establishing the identity of a cell. Noncoding RNA transcription‐mediated genome folding and activation of target gene expression have been found in a variety of cell types. Noncoding RNA ThymoD (thymocyte differentiation factor) transcription at superenhancers is essential for mouse T‐cell lineage commitment. The cessation of ThymoD transcription abolishes transcription‐mediated demethylation, recruiting looping factors such as the cohesin complex, CCCTC‐binding factor (CTCF), ultimately leading to the phenotype of severe combined immunodeficiency and T‐cell leukemia/lymphoma. In this review, we describe the functional role of RNA polymerase II‐mediated transcription at enhancers and in genome folding. We also highlight the involvement of faulty activation or suppression of enhancer transcription and enhancer‐promoter interaction in cancer development.
Effects of repetitive transcranial magnetic stimulation on children with low‐function autism
Authors: Kang Jian‐Nan , Song Jia‐Jia , Casanova Manuel F. , Sokhadze Estate M. , Li Xiao‐Li
Published: June 2019

Background

Autism spectrum disorder (ASD) is a very complex neurodevelopmental disorder, characterized by social difficulties and stereotypical or repetitive behavior. Some previous studies using low‐frequency repetitive transcranial magnetic stimulation (rTMS) have proven of benefit in ASD children.

Methods

In this study, 32 children (26 males and six females) with low‐function autism were enrolled, 16 children (three females and 13 males; mean ± SD age: 7.8 ± 2.1 years) received rTMS treatment twice every week, while the remaining 16 children (three females and 13 males; mean ± SD age: 7.2 ± 1.6 years) served as waitlist group. This study investigated the effects of rTMS on brain activity and behavioral response in the autistic children.

Results

Peak alpha frequency (PAF) is an electroencephalographic measure of cognitive preparedness and might be a neural marker of cognitive function for the autism. Coherence is one way to assess the brain functional connectivity of ASD children, which has proven abnormal in previous studies. The results showed significant increases in the PAF at the frontal region, the left temporal region, the right temporal region and the occipital region and a significant increase of alpha coherence between the central region and the right temporal region. Autism Behavior Checklist (ABC) scores were also compared before and after receiving rTMS with positive effects shown on behavior.

Conclusion

These findings supported our hypothesis by demonstration of positive effects of combined rTMS neurotherapy in active treatment group as compared to the waitlist group, as the rTMS group showed significant improvements in behavioral and functional outcomes as compared to the waitlist group.
The time course of ineffective sham‐blinding during low‐intensity (1 mA) transcranial direct current stimulation
Authors: Greinacher Robert , Buhôt Larissa , Möller Lisa , Learmonth Gemma
Published: June 2019

Studies using transcranial direct current stimulation (tDCS) typically compare an active protocol relative to a shorter sham (placebo) protocol. Both protocols are presumed to be perceptually identical on the scalp, and thus represent an effective method of delivering double‐blinded experimental designs. However, participants often show above‐chance accuracy when asked which condition involved active/sham retrospectively. We assessed the time course of sham‐blinding during active and sham tDCS. We predicted that participants would be aware that the current is switched on for longer in the active versus sham protocol. Thirty‐two adults were tested in a preregistered, double‐blinded, within‐subjects design. A forced‐choice reaction time task was undertaken before, during and after active (10 min 1 mA) and sham (20 s 1 mA) tDCS. The anode was placed over the left primary motor cortex (C3) to target the right hand, and the cathode on the right forehead. Two probe questions were asked every 30 s: “Is the stimulation on?” and “How sure are you?”. Distinct periods of non‐overlapping confidence intervals were identified between conditions, totalling 5 min (57.1% of the total difference in stimulation time). These began immediately after sham ramp‐down and lasted until the active protocol had ended. We therefore show a failure of placebo control during 1 mA tDCS. These results highlight the need to develop more effective methods of sham‐blinding during transcranial electrical stimulation protocols, even when delivered at low‐intensity current strengths.
A new DTAR (diversity–time–area relationship) model demonstrated with the indoor microbiome
Authors: Ma Zhanshan (Sam)
Published: June 2019

Aim

The spatio‐temporal distribution of biodiversity is a core field of biogeography, and the so‐termed species–time–area relationship (STAR), together with its siblings, that is the SAR (species–area relationship) and STR (species–time relationship), has achieved the rare status of classic laws in ecology and biogeography. Traditionally, the STAR or its recent generalization DTAR (diversity–time–area relationship) has been described with the bivariate power law (BPL) model or more recently with Whittaker, Triantis, and Ladle (2008, Journal of Biography; 35: 18) general dynamic model (GDM). We propose to extend the classic BPL into a more flexible DTAR model, which offers new quantitative methods for estimating maximal global diversity and charactering the relationship between local and regional diversity.

Location

Indoor microbiome.

Taxon

Microbes.

Method

We revise the BPL model by introducing two taper‐off (cut‐off) parameters or BPLEC (bivariate power law with exponential cutoffs) model, which eventually overwhelms the unsaturated increase of diversity over time and/or space and consequently can offer more realistic modelling of the joint spatio‐temporal distribution of biodiversity. Based on the BPLEC model, we further define three new concepts for DTAR: maximal accrual diversity (MAD) profile, local‐to‐regional diversity (LRD) ratio profile and local‐to‐global diversity (LGD) ratio profile.

Results

We introduce and demonstrate the new BPLEC model with the indoor microbiome datasets (Lax et al., 2014, Science; 345: 1048–1052). The new model fitted to the microbiome datasets equally well or slightly better than existing BPL and GDM models, but it possesses two advantages stated below.

Main conclusion

First, the new BPLEC model overcomes the unlimited diversity accrual in temporal and/or spatial dimensions and hence offers more realistic modelling to the DTAR. Second, the MAD and LRD/LGD offer useful methods for estimating the “dark” or “potential” diversity, which accounts for the species locally absent but present in a habitat‐specific regional species pool.
Outcomes of visual tooth shade selection performed by operators with different experience
Authors: Yılmaz Begüm , Irmak Özgür , Yaman Batu Can
Published: June 2019

Objective

To evaluate the effect of professional experience and lighting conditions on visual shade selection on natural teeth and comparing the visual‐shade‐selection results with those of instrumental methods.

Materials and Methods

Shade selection was performed on five maxillary central incisors. The 25 observers were divided into five groups according to their professional experience. Observers performed visual‐shade‐selection using shade guide (Vita 3D Master, Vita Zahnfabrik, Bad Säckingen, Germany) under two lighting conditions (4000 and 6500 K) from the cervical, middle and incisal thirds of the teeth. Same teeth were measured using an intraoral scanner (Trios 3Shape, Copenhagen, Denmark) and spectrophotometer (Vita Easyshade Compact, Vita Zahnfabrik, Bad Säckingen, Germany), under the same two lighting conditions.

Results

Visual‐shade‐selection outcomes were not affected by professional experience under both lighting conditions (P < .05). Outcomes of visual‐shade‐selection and intraoral scanner were not significantly different than that of spectrophotometer (P > .05). Lighting conditions had no effect on the shade measurement outcomes of visual shade selection, Vita Easyshade Compact, and Trios 3Shape (P > .05).

Conclusions

Shade measurement outcomes were not affected by the lighting conditions (4000 and 6500 K). The shade measurement feature of the T‐3S could be an alternative to V‐ES and VSS.

Clinical significance

This study suggests professional experience and lighting conditions has no effect on visual shade selection. Trios 3Shape could be used for shade determination as an alternative to a Vita Easyshade Compact spectrophotometer.
Sex‐related differences in symptoms of temporomandibular disorders and structural changes in the lateral pterygoid muscle after whiplash injury
Authors: Lee Yeon‐Hee , Lee Kyung Mi , Auh Q‐Schick , Hong Jyung‐Pyo
Published: June 2019

Whiplash injury is an initiating or aggravating factor of temporomandibular disorder (TMD). Although there are sex‐related differences in the mechanism of pain perception and pain control, there is a lack of research on differences in TMD after whiplash injury. We aimed to evaluate sex‐related differences in the clinical symptoms and magnetic resonance imaging (MRI) findings of patients with TMD attributed to whiplash injury. This retrospective, cross‐sectional study included 100 patients (50 women; 50 men; mean age, 37.60 years) who visited our oro‐facial pain clinic with symptoms of TMD after whiplash injury. All patients underwent detailed evaluations for history of trauma, and their clinical and MRI findings were comprehensively assessed. Women with TMD after whiplash injury perceived more pain and presented more tenderness upon palpation than did men with TMD. In addition, women showed higher volume (58% vs 26%) and signal changes (54% vs 20%) in the lateral pterygoid muscle (LPM) and more anterior disc displacement without reduction (ADDWoR) (40% vs 20%) than did men. The presence of ADDWoR (odds ratio, 10.58; P = 0.007) and condylar degeneration (odds ratio, 9.30; P = 0.015) predicted LPM volume; stressful conditions (beta = 1.34; P = 0.011) correlated with increased visual analogue scale scores, and sleep problem was associated with an increased palpation index (PI) (beta = 0.42; P < 0.001) and neck PI (beta = 0.49; P < 0.001) scores only in women. Our results showed sex‐specific differences in pain intensity, distribution of clinical and abnormal MRI findings, and their relationships, and these differences should be considered when treating patients with TMD.
What evidence‐based strategies have been shown to improve breastfeeding rates in preterm infants?
Authors: Hilditch Cathie , Howes Alexander , Dempster Natalie , Keir Amy
Published: June 2019

Breast milk is the preferred form of nutrition for all infants and has been shown to reduce morbidity and improve health outcomes in preterm infants. However, mothers of preterm infants face many challenges initiating and sustaining breastfeeding within the neonatal unit. This scoping review examines evidence‐based practices which aim to improve breastfeeding rates in preterm infants at the time of hospital discharge. A literature review identified 17 articles which are included in this review. Supporting evidence was found for the implementation of kangaroo mother care and/or skin‐to‐skin care, peer counsellors, provision of oropharyngeal colostrum in early infancy and use of donor human milk banks. However, overall it is apparent that high quality research including systematic review and data synthesis in the form of meta‐analysis is required in this area to reach sound conclusions regarding recommendations of different interventions. This scoping review provides an important foundation for further research into this area.
Effect of glycerol on the physicochemical properties of films based on legume protein concentrates: A comparative study
Authors: Hopkins Erin J. , Stone Andrea K. , Wang Jiapei , Korber Darren R. , Nickerson Michael T.
Published: June 2019

The overall goal of this research was to examine the mechanical, water vapor barrier properties and opacity of films prepared using legume protein concentrates (faba bean, pea, lupin, lentil, and soy) as a function of glycerol concentration (50, 75, or 100% [wt/wt]—relative to the protein weight). Overall, tensile strength (TS) decreased with increasing glycerol concentration, whereas tensile elongation (TE) and water vapor permeability (WVP) increased with increasing glycerol concentration. Film opacity was independent of glycerol concentration. The effect of protein‐type varied considerably depending on the functional property of the film being measured; TS was greatest with faba bean and lowest with lupin, whereas TE was highest for pea, and lowest for soy. Lentil protein films had considerably higher WVP, at the 100% glycerol concentration, as compared to the other protein concentrates. Findings from this study indicate that legume protein concentrates are capable of forming biodegradable, edible films. Overall, pea protein concentrate films showed the most promise for application in terms of strength, elongation, and moisture barrier properties.
Family history of liver cancer may modify the association between HBV infection and liver cancer in a Chinese population
Authors: Liu Xing , Baecker Aileen , Wu Ming , Zhou Jin‐Yi , Yang Jie , Han Ren‐Qiang , Wang Pei‐Hua , Jin Zi‐Yi , Liu Ai‐Min , Gu Xiaoping , Zhang Xiao‐Feng , Wang Xu‐Shan , Su Ming , Hu Xu , Sun Zheng , Li Gang , Fu Alan , Jung Su Yon , Mu Lina , He Na , Li Liming , Zhao Jin‐Kou , Zhang Zuo‐Feng
Published: June 2019

Background & Aims

The potential interaction between family history of liver cancer and HBV infection on liver cancer has not been fully examined.

Methods

We conducted a population‐based case‐control study composed of 2011 liver cancer cases and 7933 controls in Jiangsu province, China from 2003 to 2010. Data on major risk or protective factors were collected and HBV/HCV sero‐markers were assayed using blood samples. Semi‐Bayes (SB) adjustments were applied to provide posterior estimates.

Results

Both family history of liver cancer (adjusted odds ratios [OR]: 4.32, 95% confidence intervals [CI]: 3.25‐5.73) and hepatitis B surface antigen (HBsAg) positivity (adjusted OR: 9.94, 95% CI: 8.33‐11.87) were strongly associated with liver cancer development. For individuals with different combinations of serological markers, the adjusted ORs were 8.45 (95% CI: 5.16‐13.82) for HBsAg‐ and HBcAb‐positive; 7.57 (95% CI: 4.87‐11.77) for HBsAg‐, HBeAg‐ and HBcAb‐positive; and 3.62 (95% CI: 2.47‐5.31) for HBsAg‐, HBeAb‐ and HBcAb‐positive, compared to all negatives in HBV serological markers. One log increase in HBV DNA level was associated with 17% increased risk (adjusted OR: 1.17, 95% CI: 1.03‐1.32). The SB‐adjusted OR of HBV‐positive individuals with family history of liver cancer was 41.34 (95% posterior interval [PI]: 23.69‐72.12) compared with those HBV‐negative without family history. Relative excess risk due to additive interaction, the attributable proportion and synergy index were 73.13, 0.87 and 8.04 respectively. Adjusted ratio of OR for multiplicative interaction was 2.84 (95% CI: 1.41‐5.75).

Conclusions

Super‐additive and super‐multiplicative interactions may exist between family history of liver cancer and HBV infection on the development of liver cancer.
Neuromelanin‐sensitive MRI in the differential diagnosis of elderly white matter lesion from Parkinson’s disease
Authors: Aiba Yosuke , Sakakibara Ryuji , Tsuyusaki Yohei , Oki Takeshi , Ogata Tsuyoshi , Tateno Fuyuki , Terada Hitoshi
Published: June 2019

Objective

The clinical features of white matter lesion (WML) may mimic those of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). However, no data have been available regarding neuromelanin‐sensitive MRI (NM‐MRI) in WML. We present our data of NM‐MRI in WML and PD/DLB.

Methods

We performed NM‐MRI in 24 patients with WML (12 male, 12 female; mean age 75.2 years), together with 60 PD patients, 39 DLB patients and 69 age‐matched controls.

Results

The difference in the fast spin‐echo T1 values between the substantia nigra pars compacta and tegmentum (SNc − tegmentum) was higher in WML than in patients with PD/DLB (P < 0.05). There was no difference in this value between WML patients and controls. The overall sensitivity and specificity of this value (SNc − tegmentum) in differentiating WML and PD/DLB were 79.2% and 70.7%, respectively.

Conclusion

The results of the present study showed that neuromelanin‐sensitive MRI had good sensitivity and specificity in differentiating WML from PD/DLB.
Taxonomic notes on Isodon (Lamiaceae) in China, III: resurrection of I. brachythyrsus, I. chionanthus and I. kangtingensis
Authors: Chen Ya‐Ping , Xiang Chun‐Lei
Published: June 2019

One of the main reasons that contribute to the taxonomic chaos of Isodon is insufficient field investigation. Based on extensive field observation and specimen examination, the present study aims to clarify the identities of five species of Isodon from southwest China. Our researches reveal that I. brachythyrsus and I. chionanthus, previously treated as synonyms of I. muliensis, and I. kangtingensis, previously treated as a synonym of I. flabelliformis, should be resurrected as distinct species. Taxonomic revision of the five species, including their detailed description, illustrations, as well as distribution information, is carried out.
The Effect of Paravertebral Ozone Injection in the Treatment of Low Back Pain
Authors: Özcan Çağri , Polat Ömer , Çelik Haluk , Uçar Bekir Yavuz
Published: June 2019

Aim

Paravertebral ozone injection is a new treatment method described in the literature for low back pain. The aim of this study was to compare the pre‐ and post‐treatment pain scores of patients undergoing paravertebral ozone/oxygen (O3/O2) injections for low back pain.

Methods

From September 2018 to December 2018, 122 patients who underwent paravertebral ozone injections due to low back pain were examined retrospectively; 62 patients who met the study criteria were included. The patients were injected with 15 µg/mL (50 mL) O3/O2 gas in the paravertebral space. The subjects were treated every 7 days for 6 total session. The VAS and Oswestry Disability Index (ODI) scores were assessed before treatment and after treatment (first and third months). The patients’ body mass indexes (BMIs) were measured before the injections.

Results

There were 12 male patients and 50 female patients. The mean age was 51.9 (range 25 to 71) years. The mean duration of pain was 9.1 (3 to 24) months. Significant improvements were observed in the statistical comparison of VAS and ODI scores between the pre‐injection and first month controls (P < 0.000). There was no significant difference in the statistical comparison of VAS and ODI scores between the first and third months (P < 0.05). There was no statistically significant difference between BMI and pain scores (P > 0.213).

Conclusion

Paravertebral O3/O2 gas is a reliable and effective treatment for the treatment of lumbar disc herniation, radicular pain, and mechanical back pain due to low back pain.
What Prevents Peace? Women and Peacebuilding in Bosnia and Nepal
Authors: Berry Marie E. , Rana Trishna R.
Published: June 2019

There is an emerging consensus that women must play a more substantial role in transformations from violence to stability. The UN Women, Peace, and Security framework recognizes the unique challenges women face during war and affirms the important role they play in the prevention and resolution of conflicts. Despite this framework and other related efforts, peace remains elusive for many who have lived through armed conflict. What prevents formal, internationally led peacebuilding efforts from fostering sustainable peace in ordinary citizens’ lives? Put differently, despite the variety of peacebuilding mechanisms offered, what prevents peace from taking hold, for women in particular? In this paper, we focus on two postwar cases: Bosnia and Nepal. Drawing on interviews with more than seventy women in both countries, we identify five barriers that prevent women from feeling at peace in their daily lives: economic insecurity, competing truths, hierarchies of victimhood, continuums of violence, and spatial and temporal dislocation. We conclude by outlining ways that women in both countries work to overcome those barriers by pioneering innovations in peacebuilding, which may reveal possibilities for future interventions.
Importance of lifestyle change for patients with sleep apnoea
Authors: McEvoy R. Doug
Published: June 2019

See related Article
Successful management of catastrophic peripheral vascular hemorrhage using massive autotransfusion and damage control surgery in a dog
Authors: Ghosal Rita D.K. , Bos Alexandra
Published: June 2019

Objective

To describe a case of massive transfusion using unwashed, non‐anticoagulated, nonsterile autologous blood in a dog with catastrophic hemorrhage from a peripheral vessel during orthopedic surgery. A damage control surgical strategy was also employed.

Case Summary

A 6‐year‐old, 48 kg neutered male Labrador Retriever experienced massive hemorrhage after transection of a large blood vessel while undergoing femoral head and neck osteotomy. Blood was collected from clean, but not sterile, suction canisters and clots were skimmed off. The blood was then transfused back to the dog using a standard in‐line blood filter. Approximately 58% of the dog's blood volume was autotransfused in less than 2 hours, thereby meeting the criteria for massive transfusion. Surgery was aborted after hemostasis was achieved by ligation of the vessel and packing of the surgical site. Two units of fresh frozen plasma were administered postoperatively due to the development of a coagulopathy. Hemoglobinuria developed but resolved within 18 hours. Three days later, completion of the surgical procedure was performed without incident. The dog was discharged 4 days after the initial surgery. Marked swelling of the affected limb developed, but resolved after the sixth day. No other significant complications developed.

New or Unique Information Provided

In this case report, the authors describe the successful management of catastrophic hemorrhage with autotransfusion performed in the absence of sterile collection, cell washing, or anticoagulation. Although not ideal, autotransfusion under these conditions can be lifesaving in situations of massive hemorrhage. This case also highlighted the employment of a damage control surgical strategy.
Using the theoretical domains framework and the behavioural change wheel in an overarching synthesis of systematic reviews
Authors: Richardson Michelle , Khouja Claire Louise , Sutcliffe Katy , Thomas James
Published: June 2019

Objective

Synthesis that can filter the evidence from multiple sources to inform the choice of intervention components is highly desirable yet, at present, there are few examples of systematic reviews that explicitly define this type of synthesis using behaviour change frameworks. Here, we demonstrate how using the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW) made it possible to bring together the findings from a series of three interconnected systematic reviews on the self-care of minor ailments (MAs) to inform the choice of intervention components.

Method

The TDF and the capability, opportunity, motivation model of behaviour at the hub of the BCW were used to synthesise the findings from the three reviews, including syntheses of service-user views in interviews (review 1, 20 studies) and surveys (review 2, 13 studies), and evaluations of a range of interventions and services (review 3, 21 studies).

Results

The TDF and BCW approach provided a systematic, structured and replicable methodology for retrospectively integrating different types of evidence within a series of systematic reviews. Several intervention strategies, grounded in theory and discussed with key stakeholders, were suggested, which can be implemented and tested.

Conclusions

This novel application of the TDF/BCW approach illustrates how it can be used to bring together quantitative and qualitative evidence to better understand self-care behaviour for MAs within a systematic review context. The TDF/BCW approach facilitated exploration of the contradictions and gaps between the separate review syntheses, and supported the identification of possible intervention strategies, grounded in theory. The ongoing development and refinement of this method is supported.

PROSPERO registration number

CRD42017071515
Factors associated with HPV and other self-reported STI coinfections among sexually active Brazilian young adults: cross-sectional nationwide study
Authors: Kops Natalia Luiza , Bessel Marina , Horvath Jaqueline Driemeyer Correia , Domingues Carla , de Souza Flávia Moreno Alves , Benzaken Adele Schwartz , Mendes Pereira Gerson Fernando , Maranhão Ana Goretti Kalume , Villa Luisa Lina , Mello Barbara , Wendland Eliana Marcia
Published: June 2019

Objectives

To analyse factors associated with genital human papillomavirus (HPV) and other self-reported sexually transmitted infection (STI) coinfections among women and men aged 16–25 years from Brazil.

Design

A cross-sectional, nationwide, multicentre study.

Setting

119 primary healthcare centres between September 2016 and November 2017.

Participants

6388 sexually active young adults were enrolled by trained health professionals.

Primary outcome measure

Genital HPV and other self-reported STI coinfections.

Results

Of 3512 participants with valid data for genital HPV and (STI)-positive status, 276 (9.60%, 95% CI 7.82% to 11.36%) had HPV/STI coinfection. Among men, HPV/STI coinfection was more prevalent than HPV infection alone. Among HPV-positive participants, the percentage of subjects who reported having another STI was highest for gonorrhoea at 4.24% (95% CI 2.67% to 5.81%), followed by syphilis, herpes and HIV. Smoking, drug use and ever having a same-sex sexual experience were risk factors that were uniquely associated with HPV/STI coinfection compared with HPV infection alone.

Conclusions

The results identified a low prevalence of self-reported STIs, but in participants with at least one STI, the prevalence of HPV was high. These results reinforce the importance of implementing strategies to prevent risky behaviours among Brazilian young adults.
Longitudinal survey of condom use across a US Navy and Marine Corps shipboard deployment
Authors: Harbertson Judith , De Vera Kimberly , Scott Paul T , Li Yuanzhang , Shaffer Richard A , Michael Nelson L , Hale Braden R
Published: June 2019

Objectives

Condoms are highly effective in preventing sexually transmitted infections (STIs) but implementation is often inconsistent with use rarely examined across travel transition periods. We examined the prevalence of condom use among ship-assigned US military personnel across an overseas deployment cycle and identified factors associated with condom non-use.

Methods

Longitudinal survey data were collected from ship-assigned US Navy/Marine Corps personnel on 11 ships before (T1), during (T2) and after (T3) an overseas deployment. The anonymous, self-completed survey included demographics, condom use at last sex, STI diagnosis, alcohol misuse and drug use with sex. Descriptive and generalised regression model analyses were conducted.

Results

Analysis included 1900 (T1), 549 (T2) and 1168 (T3) personnel who reported age, sex and condom use/non-use at last sex. The proportion reporting condom use was significantly higher during T2 (53%, p<0.0001) than T1 (27%) or T3 (28%), with STI prevalences of 1% (T1), 7% (T2) or 2% (T3), with fewer (29%) sexually active individuals at T2. In adjusted models, condom non-use was associated with hazardous alcohol use (OR 1.44, 95% CI 1.21 to 1.71), or drug use to enhance sex (OR 1.37, 95% CI 1.06 to 1.77), but transactional sex was negatively associated (OR 0.69, 95% CI 0.50 to 0.84).

Conclusions

Condom use was highest during deployment, as was STI prevalence (among non-users), possibly reflecting concentration of high-risk sexual activities/individuals and/or sexual partners more likely to be infected. Higher condom use with transactional sex likely reflects awareness of higher STI risk. These data can be used to facilitate targeted interventions to reduce STI transmission and may extend to similarly aged cohorts travelling outside the US (eg, college students on spring break).
Protect-me: a parallel-group, triple blinded, placebo-controlled randomised clinical trial protocol assessing antenatal maternal melatonin supplementation for fetal neuroprotection in early-onset fetal growth restriction
Authors: Palmer Kirsten R , Mockler Joanne C , Davies-Tuck Miranda L , Miller Suzanne L , Goergen Stacy K , Fahey Michael C , Anderson Peter J , Groom Katie M , Wallace Euan M
Published: June 2019

Introduction

Fetal growth restriction (FGR) is a serious pregnancy complication, associated with increased rates of perinatal death and morbidity among survivors. Most commonly FGR results from placental insufficiency, where the placenta fails to deliver the oxygen and nutrients required for normal fetal growth. This leads to fetal oxidative stress, resulting in organ damage through lipid peroxidation. The early developing brain is particularly susceptible, such that FGR is associated with poorer neurodevelopment, witnessed as cognitive and behavioural dysfunction, and cerebral palsy. Promisingly, melatonin, a lipid soluble antioxidant is neuroprotective in animal models of FGR. We present a protocol outlining a randomised, placebo-controlled trial to explore whether antenatal maternal melatonin supplementation in pregnancies with severe, early-onset FGR can improve neurodevelopment among survivors at 2 years of age.

Methods and analyses

We will recruit 336 women with a singleton pregnancy complicated by FGR between 23+0 and 31+6 weeks gestation. Participants will be randomised, stratified by gestational age, to either 30 mg melatonin per day or a visually identical placebo, continued until birth. Measures of maternal and fetal health will be collected until birth. Timing of birth will be determined by the treating clinical team in discussion with the woman. Neonatal and infant neurodevelopmental assessments will be undertaken, consisting of brain MRI at term corrected age, general movements assessment at term and 3 months’ corrected age, and Bayley Scales of Infant & Toddler Development-III and Infant Toddler Social Emotional Assessment at 2.5 years corrected age. Analyses will be on intention to treat. The primary outcome is a difference of 5 points in the cognitive domain of the Bayley-III. Secondary outcomes address maternal and fetal safety.

Ethics and dissemination

This trial has Monash Health Human Research and Ethics committee approval (17-0000-583A). Findings will be disseminated through peer-reviewed publications, conference presentations and to participants.

Trial registration number

ACTRN12617001515381; Pre-results
Linking world bank development indicators and outcomes of congenital heart surgery in low-income and middle-income countries: retrospective analysis of quality improvement data
Authors: Rahman Sarah , Zheleva Bistra , Cherian K M , Christenson Jan T , Doherty Kaitlin E , de Ferranti David , Gauvreau Kimberlee , Hickey Patricia A , Kumar Raman Krishna , Kupiec Jennifer K , Novick William M , Sandoval Nestor F , Jenkins Kathy J
Published: June 2019

Objective

Many low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies.

Design

Retrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment. Spearman correlation coefficients were calculated.

Setting and participants

The International Quality Improvement Collaborative (IQIC) keeps a volunteer registry of outcomes of CHD surgery programmes in low-resource settings. Inclusion in the IQIC is voluntary enrolment by hospital sites. Patients in the registry underwent congenital heart surgery. Sites that actively participated in IQIC in 2013, 2014 or 2015 and passed a 10% data audit were asked for permission to share data for this study. 31 sites in 17 countries are included.

Outcome measures

In-hospital mortality: standardised mortality ratios were calculated. Risk adjustment for in-hospital mortality uses the Risk Adjustment for Congenital Heart Surgery method, a model including surgical risk category, age group, prematurity, presence of a major non-cardiac structural anomaly and multiple congenital heart procedures during admission.

Results

The IQIC registry includes 24 917 congenital heart surgeries performed in children<18 years of age. The overall in-hospital mortality rate was 5.0%. Country-level congenital heart surgery standardised mortality ratios were negatively correlated with gross domestic product (GDP) per capita (r=−0.34, p=0.18), and health expenditure per capita (r=−0.23, p=0.37) and positively correlated with under-five mortality (r=0.60, p=0.01) and undernourishment (r=0.39, p=0.17). Countries with lower development had wider variation in mortality. GDP per capita is a driver of the association between some other measures and mortality.

Conclusions

Results display a moderate relationship among wealth, healthcare investment and malnutrition, with significant variation, including superior results in many countries with low GDP per capita. These findings provide context and optimism for investment in CHD procedures in low-resource settings.
Communicative characteristics of general practitioner-led and nurse-led telephone triage at two Danish out-of-hours services: an observational study of 200 recorded calls
Authors: Vilstrup Emil , Graversen Dennis Schou , Huibers Linda , Christensen Morten Bondo , Pedersen Anette Fischer
Published: June 2019

Objectives

Out-of-hours (OOH) telephone triage is used to manage patient flow, but knowledge of the communicative skills of telephone triagists is limited. The aims of this study were to compare communicative parameters in general practitioner (GP)-led and nurse-led OOH telephone triage and to discuss differences in relation to patient-centred communication and safety issues.

Design

Observational study.

Setting

Two Danish OOH settings: a large-scale general practitioner cooperative in the Central Denmark Region (n=100 GP-led triage conversations) and Medical Helpline 1813 in the Capital Region of Denmark (n=100 nurse-led triage conversations with use of a clinical decision support system).

Participants

200 audio-recorded telephone triage conversations randomly selected.

Primary and secondary outcome measures

Conversations were compared with regard to length of call, distribution of speaking time, question types, callers’ expression of negative affect, and nurses’ and GPs’ responses to callers’ negative affectivity using the Mann-Whitney U test and the Student’s t-test.

Results

Compared with GPs, nurses had longer telephone contacts (137s vs 264 s, p=0.001) and asked significantly more questions (5 vs 9 questions, p=0.001). In 36% of nurse-led triage conversations, triage nurses either transferred the call to a physician or had to confer the call with a physician. Nurses gave the callers significantly more spontaneous talking time than GPs (23.4s vs 17.9 s, p=0.01). Compared with nurses, GPs seemed more likely to give an emphatic response when a caller spontaneously expressed concern; however, this difference was not statistically significant (36% vs 29%, p=0.6).

Conclusions

When comparing communicative parameters in GP-led and nurse-led triage, several differences were observed. However, the impact of these differences in the perspective of patient-centred communication and safety needs further research. More knowledge is needed to determine what characterises good quality in telephone triage communication.