bluuebunny/crossref_metadata_2025 huggingface dataset:
Cleavage of a pathogen apoplastic protein by plant subtilases activates host immunity
Authors: Wang Shuaishuai , Xing Rongkang , Wang Yan , Shu Haidong , Fu Shenggui , Huang Jie , Paulus Judith K. , Schuster Mariana , Saunders Diane G. O. , Win Joe , Vleeshouwers Vivianne , Wang Yuanchao , Zheng Xiaobo , van der Hoorn Renier A.L. , Dong Suomeng
Published: November 2020

The plant apoplast is a harsh environment in which hydrolytic enzymes, especially proteases, accumulate during pathogen infection. However, the defense functions of most apoplastic proteases remain largely elusive.

We show here that a newly identified small cysteine‐rich secreted protein PC2 from the potato late blight pathogen Phytophthora infestans induces immunity in Solanum plants only after cleavage by plant apoplastic subtilisin‐like proteases, such as tomato P69B.

A minimal 61 amino acid core peptide carrying two key cysteines, conserved widely in most oomycete species, is sufficient for PC2‐induced cell death. Furthermore, we showed that Kazal‐like protease inhibitors, such as EPI1, produced by P. infestans prevent PC2 cleavage and dampen PC2 elicited host immunity.

This study reveals that cleavage of pathogen proteins to release immunogenic peptides is an important function of plant apoplastic proteases.
Arabidopsis SnRK1 negatively regulates phenylpropanoid metabolism via Kelch domain‐containing F‐box proteins
Authors: Wang Bin , Zhao Xianhai , Zhao Yunjun , Shanklin John , Zhao Qiao , Liu Chang‐Jun
Published: November 2020

Phenylpropanoid metabolism represents a substantial metabolic sink for photosynthetically fixed carbon. The evolutionarily conserved Sucrose Non‐Fermenting Related Kinase 1 (SnRK1) is a major metabolic sensor that reprograms metabolism upon carbon deprivation. However, it is not clear if and how the SnRK1‐mediated sugar signaling pathway controls phenylpropanoid metabolism.

Here, we show that Arabidopsis SnRK1 negatively regulates phenylpropanoid biosynthesis via a group of Kelch domain‐containing F‐box (KFB) proteins that are responsible for the ubiquitination and degradation of phenylalanine ammonia lyase (PAL).

Downregulation of AtSnRK1 significantly promoted the accumulation of soluble phenolics and lignin polymers and drastically increased PAL cellular accumulation but only slightly altered its transcription level. Co‐expression of SnRK1α with PAL in Nicotiana benthamiana leaves resulted in the severe attenuation of the latter’s protein level, but protein interaction assays suggested PAL is not a direct substrate of SnRK1. Furthermore, up or downregulation of AtSnRK1 positively affected KFBPALs gene expression, and energy starvation upregulated KFBPAL expression, which partially depends on AtSnRK1.

Collectively, our study reveals that SnRK1 negatively regulates phenylpropanoid biosynthesis, and KFBPALs act as regulatory components of the SnRK1 signaling network, transcriptionally regulated by SnRK1 and subsequently mediate proteasomal degradation of PAL in response to the cellular carbon availability.
Innate promiscuity of the CYP706 family of P450 enzymes provides a suitable context for the evolution of dinitroaniline resistance in weed
Authors: Abdollahi Fatemeh , Alebrahim Mohammad Taghi , Ngov Chheng , Lallemand Etienne , Zheng Yongxiang , Villette Claire , Zumsteg Julie , André François , Navrot Nicolas , Werck‐Reichhart Danièle , Miesch Laurence
Published: November 2020

Increased metabolism is one of the main causes for evolution of herbicide resistance in weeds, a major challenge for sustainable food production. The molecular drivers of this evolution are poorly understood. We tested here the hypothesis that a suitable context for the emergence of herbicide resistance could be provided by plant enzymes with high innate promiscuity with regard to their natural substrates.

A selection of yeast‐expressed plant cytochrome P450 enzymes with well documented narrow to broad promiscuity when metabolizing natural substrates was tested for herbicide metabolism competence. The positive candidate was assayed for capacity to confer herbicide tolerance inArabidopsis thaliana.

Our data demonstrate thatArabidopsis thalianaCYP706A3, with the most promiscuous activity on monoterpenes and sesquiterpenes for flower defence, can also oxidize plant microtubule assembly inhibitors, dinitroanilines. Ectopic overexpression ofCYP706A3confers dinitroaniline resistance. We show, in addition, that the capacity to metabolize dinitroanilines is shared by other members of the CYP706 family from plants as diverse as eucalyptus and cedar.

Supported by three‐dimensional (3D) modelling of CYP706A3, the properties of enzyme active site and substrate access channel are discussed together with the shared physicochemical properties of the natural and exogenous substrates to explain herbicide metabolism.
Unmet medical needs in the treatment of atopic dermatitis in infants: An Expert consensus on safety and efficacy of pimecrolimus
Authors: Luger Thomas , Augustin Matthias , Lambert Julien , Paul Carle , Pincelli Carlo , Torrelo Antonio , Vestergaard Christian , Wahn Ulrich , Werfel Thomas
Published: November 2020

Atopic dermatitis (AD) is a common skin disease during infancy, which imposes a considerable burden on patients, their families, and the society, requiring effective treatment options that result in rapid and sustained symptom relief. Additionally, early treatment may prevent the development of atopic comorbidities by restoring the skin barrier. Currently, topical standard‐of‐care for AD in infants includes emollients and topical corticosteroids (TCS) to treat and reduce the risk of flares. However, only few have been approved for infants and long‐term maintenance therapy with TCS is not indicated due to potential local and systemic side effects, including skin atrophy. Accordingly, the recently updated European guidelines for treatment of AD recommend topical calcineurin inhibitors (TCIs) for long‐term use, treatment of sensitive skin areas, and for use in the pediatric population. Evidence on the use of TCIs for infants has almost been exclusively collected for pimecrolimus, with >4000 infants evaluated in clinical trials, consistently confirming that pimecrolimus is a safe and effective treatment for infants with AD. Nevertheless, its use is still restricted in most countries to children above the age of 2 years due to initial and mostly theoretical safety concerns. Based on a careful review of the available evidence of clinical trials, post‐marketing surveillance, and epidemiological studies, an Expert Panel of European dermatologists and pediatric allergologists concluded that these safety concerns are no longer valid. Therefore, pimecrolimus offers a safe and effective alternative to TCS in infants aged 3 months and above, and labeling restrictions in this age group are no longer justified.
Population genetic structure of four regional populations of the barley pathogen Pyrenophora teres f. maculata in Iran is characterized by high genetic diversity and sexual recombination
Authors: Vasighzadeh Asieh , Sharifnabi Bahram , Javan‐Nikkhah Mohammad , Seifollahi Elaheh , Landermann‐Habetha Doreen , Feurtey Alice , Holtgrewe‐Stukenbrock Eva
Published: November 2020

The leaf spot form of the barley disease net blotch, caused by the fungus Pyrenophora teres f. maculata (PTM), is an increasingly important foliar disease of barley. Studies of population genetic structure and reproductive mode are necessary to make predictions of the evolutionary potential of the pathogen. Sources of resistance to PTM have been found in Iranian landraces, which may have the potential to improve plant breeding efforts. However, little is known about the population genetic structure of this fungus in Iran. In this study, we analysed the frequency of the mating type genes to assess the potential for sexual mating of PTM collected from four provinces—Khuzestan, Hamadan, Golestan, and East Azerbaijan—and we investigated the population genetic structure using seven simple sequence repeat markers. High genotype diversity, linkage equilibrium, and equal ratios of mating types frequencies in the PTM populations at Khuzestan and Hamadan support the occurrence of sexual reproduction in these populations, while in Golestan and East Azerbaijan populations, significant gametic disequilibrium and relatively low genotype diversity suggest a higher incidence of clonality or different demographic histories. Unequal mating type frequencies in Golestan confirm a predominance of asexual reproduction. Finally, we found significant evidence for strong population structure with most of the genetic variation represented within regional populations (89%). Overall, our study provides evidence for high genetic variation in Iranian PTM populations, which may be the basis for rapid adaptive evolution in this pathosystem. This highlights the need for integrated efforts to control the disease.
Spatial perspectives on labor and social movements: Multidisciplinary dialogues and dilemmas
Authors: Roca Beltrán , Díaz‐Parra Iban
Published: November 2020

This article provides an overview of the study of the spatiality of labor and social movements. It describes how the dialogue between social movement research and critical labor studies has enriched our understanding of the spatiality of social conflict. It begins with a description of the theoretical approaches and research interests that arose in the 1980s as a reaction against Marxist and structuralist perspectives; specifically, New Social Movement theory, drawing on constructivist and poststructuralist approaches and the local and community turn in labor studies. In the second part, the article reviews several works that in recent years have developed new approaches to the spatiality of labor and social movements that pay attention to agency, multiscalarity, and the manifold dimensions of space. The article explores how important developments in social movement research and labor studies have nourished from the intersections of both fields of inquiry.
Standardization of post‐operative antimicrobials reduced exposure while maintaining good outcomes in pediatric liver transplant recipients
Authors: Bio Laura L. , Schwenk Hayden T. , Chen Sharon F. , Conlon Sarah , Gallo Amy , Bonham Clark Andy , Gans Hayley A.
Published: November 2020

Infections following orthotopic liver transplant (OLT) result in significant morbidity and mortality, warranting careful consideration of risks associated with antibiotic overuse and benefits of infection prevention. In the absence of specific guidelines for antimicrobial prophylaxis in pediatric OLT, we developed a standardized approach to post‐operative (post‐op) antimicrobial therapy including 48 hours of antibiotics, no vancomycin for post‐op fever within the first 48 hours, and caspofungin only for certain situations. The goal was to reduce antimicrobial utilization and adverse outcomes associated with longer duration of and broader treatment while maintaining good outcomes. The impact of this standardization on antimicrobial utilization and clinical outcomes at the largest pediatric liver transplant center in the United States is described. All individuals receiving an OLT from 1/1/17‐9/30/17 (N = 38) and 3/14/18‐12/13/18 (N = 27) were included in the pre‐intervention (PreI) and post‐intervention (PostI) groups, respectively. The intervention resulted in a significant reduction in individuals receiving post‐op broad‐spectrum gram‐negative antibiotics for >48 hours (76% PreI vs 44% PostI OLT recipients,P = .01) and post‐op vancomycin use (50% PreI, vs 7.4% PostI,P < .001). There were no statistically significant differences between groups for post‐op fever, positive pre‐/post‐operative cultures, receipt of massive transfusion, or hospital length of stay. In conclusion, following the implementation of a standardized approach to post‐op prophylaxis, antimicrobial exposure was significantly reduced without affecting OLT recipient outcomes.
Reading Aloud and First Language Development: A Systematic Review
Authors: Batini Federico , D'Autilia Benedetta , Pera Eleonora , Lucchetti Lucia , Toti Giulia
Published: November 2020

Reading aloud appears to be an important lever for improving language acquisition and development in early childhood, and later in life it strengthens many sub-dimensions of language. However, the availability of numerous variations on reading training, shaped by different methodologies and different lengths of exposure make it difficult to determine the best approaches to follow. The aim of this review is to identify the available literature contributions that examine the association between mediated reading training, first language development and the acquisition of new vocabulary, including other components that could be improved by these interventions, such as cognitive function, emergent literacy and adult-child verbal interactions. The purpose is to compare research highlighting their fundamental characteristics, tools, duration and methodologies used in order to point out the effects that the practice of reading aloud produces on the acquisition and the enhancement of language, particularly in the age of language development. The analysis of the 51 articles included aims to identify the most effective reading strategies in terms of practices, timing and methods, able to produce the most significant gains in the language area.
Acceptability and perceived effectiveness of a single-session mindfulness intervention for medical residents
Authors: Carsley Dana , Sadowski Isabel , Heath Nancy , Montoro Richard , Miller Stella
Published: November 2020

Introduction: Medical residents report high levels of stress, with many work-related demands contributing to their experience of heightened stress. Mindfulness training has been suggested as a beneficial strategy for stress management with residents; however, many mindfulness programs are time-consuming, and compliance with conventional mindfulness training programs becomes challenging given the intense, competing time commitments of residency. The present study sought to evaluate the acceptability and perceived effectiveness of a single-session, mindfulness-based stress management workshop for medical residents.Methods: Residents (n = 142) from family medicine, internal medicine and general surgical residency programs participated in a 1.5-hour mindfulness workshop in 2016 and completed: a measure of workshop satisfaction immediately post-workshop; a measure of adherence to suggested strategies 4–6 weeks post-workshop; and measures of stress, mindfulness and positive and negative affect immediately post-workshop and 4–6 weeks post-workshop.Results: Results revealed high levels of satisfaction with the workshop. Participants who used the recommended strategies over the 4 to 6-week post-workshop period reported significant increases in mindfulness and significant decreases in stress at follow-up.Conclusions: Results suggest single-session mindfulness training can be beneficial for residents who use the strategies effectively; however, ensuring strategy use following training is challenging. Future research is needed to investigate facilitators and barriers to strategy use.
Effects of circumferential stress on tangentially polarized piezoelectric cylinders
Authors: Aikins Eric K. , Aronov Boris S. , Brown David A.
Published: November 2020

This paper investigates the dependence of the electromechanical properties of the tangential polarized (stripe-electroded) cylindrical piezoelements made of the hard (PZT-4 like) and soft (PZT-5A like) ceramics on the compressive circumferential stress produced by hydrostatic pressure. Results are presented for the relative change of the effective dielectric constants, elastic constants, coupling coefficients, and piezoelectric moduli. The sensitivity of dielectric constant and piezoelectric modulus to the compressive stress is shown to be less than radially polarized ceramic.
A harmonic-cancellation-based model to predict speech intelligibility against a harmonic masker
Authors: Prud'homme Luna , Lavandier Mathieu , Best Virginia
Published: November 2020

This work aims to predict speech intelligibility against harmonic maskers. Unlike noise maskers, harmonic maskers (including speech) have a harmonic structure that may allow for a release from masking based on fundamental frequency (F0). Mechanisms, such as spectral glimpsing and harmonic cancellation, have been proposed to explain F0 segregation, but their relative contributions and ability to predict behavioral data have not been explored. A speech intelligibility model was developed that includes both spectral glimpsing and harmonic cancellation. The model was used to fit the data of two experiments from Deroche, Culling, Chatterjee, and Limb [J. Acoust. Soc. Am. 135, 2873–2884 (2014)], in which speech reception thresholds were measured for stationary harmonic maskers varying in their F0 and degree of harmonicity. Key model parameters (jitter in the masker F0, shape of the cancellation filter, frequency limit for cancellation, and signal-to-noise ratio ceiling) were optimized by maximizing the correspondence between the predictions and data. The model was able to accurately describe the effects associated with varying the masker F0 and harmonicity. Across both experiments, the correlation between data and predictions was 0.99, and the mean and largest absolute prediction errors were lower than 0.5 and 1 dB, respectively.
Subdominance in Antibody Responses: Implications for Vaccine Development
Authors: Lindahl Gunnar
Published: November 2020

Vaccines work primarily by eliciting antibodies, even when recovery from natural infection depends on cellular immunity. Large efforts have therefore been made to identify microbial antigens that elicit protective antibodies, but these endeavors have encountered major difficulties, as witnessed by the lack of vaccines against many pathogens. This review summarizes accumulating evidence that subdominant protein regions, i.e., surface-exposed regions that elicit relatively weak antibody responses, are of particular interest for vaccine development.
FatalLactobacillusendocarditis in a patient with transcatheter aortic valve replacement
Authors: Agrawal Saaket , Tuchman Emily S , Bruce Matthew J , Theodorou Maria E
Published: November 2020

Lactobacillusspecies may translocate from the gastrointestinal tract into systemic circulation from ingested probiotics or commensal flora. Their pathogenic potential is still debated.Lactobacillusendocarditis is a rare entity with only around 120 cases reported in the literature. Here, we report the first case of fatalLactobacillusendocarditis with involvement of a transcatheter aortic valve replacement with the following goals: to reaffirm the pathological significance ofLactobacillusspp, to demonstrate the potential limitations of the modified Duke criteria in diagnosing infective endocarditis of transcatheter aortic valve replacement, and to urge clinicians to aggressively search for and consider empiric treatment for endocarditis in patients with prosthetic valves who developLactobacillusbacteraemia.
Salicylate toxicity from chronic bismuth subsalicylate use
Authors: Halani Sheliza , Wu Peter E
Published: November 2020

A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. An initial workup for infectious, metabolic and structural causes was unrevealing. However, further history discovered that he had been ingesting one to two bottles of Pepto-Bismol (bismuth subsalicylate) daily for gastro-oesophageal reflux symptoms. On his second day of admission, the plasma salicylate concentration was 2.08 mmol/L (reference range 1.10–2.20 mmol/L), despite no sources of salicylate in hospital. He was diagnosed with chronic salicylate toxicity and Pepto-Bismol use was discontinued. The patient was treated supportively with isotonic intravenous fluids only and plasma salicylate concentration fell to less than 0.36 mmol/L. Concurrently, all his symptoms resolved. This case highlights the potential adverse effects of over-the-counter medications. The diagnosis of chronic salicylate toxicity is challenging, specifically in the elderly and in undifferentiated presentations, as it can be missed if not suspected.
Dermatological manifestation of metastatic prostate cancer
Authors: Gibb Julia , Babawale Omikunle , Phan Yih Chyn , Karim Omer
Published: November 2020

A 59-year-old man presented to the urology department with increased urinary urgency, frequency, poor urinary flow and unintentional weight loss. He had a 25-year history of idiopathic urticaria episodes which had increased in frequency over the previous 2 months. On investigation, he was found to have a raised prostate-specific antigen level. He was investigated further with a multiparametric MRI, a local anaesthetic transperineal prostate biopsy, a CT scan of chest/abdomen/pelvis with contrast and a nuclear medicine bone scan. He was diagnosed with metastatic adenocarcinoma of the prostate and commenced on a luteinising hormone-releasing hormone antagonist and referred to oncology for further treatment. Since starting treatment, he has experienced no further episodes of urticaria.
Pyogenic granuloma-like Kaposi sarcoma presenting in an HIV-negative man who has sex with men
Authors: Ho Bernard , Rinaldi Giulia , Khan Imran , Szakacs Susanna
Published: November 2020

A 36-year-old immunocompetent man who have sex with men first presented to the plastics team with an ulcerating lesion on his left first toe. The lesion was suggestive of pyogenic granuloma (PG) clinically and histologically. Two years later, the same patient presented to the dermatology clinic with a new erythematous lesion with intermittent bleeding on the left second toe. Clinically, this lesion was suggestive of another PG. However, the histology of the skin curettage revealed part of a PG merging with an atypical spindle cell proliferation with characteristic ‘sieve-like’ appearance in keeping with Kaposi sarcoma. This was confirmed with human herpesvirus-8 immunohistochemistry staining. PG-like Kaposi sarcoma is an uncommon variant of Kaposi sarcoma. Often not considered clinically or histologically, a deep skin biopsy is essential to establish the right diagnosis. Our case highlights the need to consider Kaposi sarcoma as a differential diagnosis in all patients, including HIV-negative individuals, presenting with PG-like lesions.
Non-sebaceous lymphadenoma of the submandibular gland: diagnostic challenges in the head and neck cancer pathway
Authors: Garside Graham , Jaikaransingh Dominic , Pitiyage Gayani , Ofo Enyinnaya
Published: November 2020

Non-sebaceous lymphadenoma (NSLA) is a rare benign salivary gland tumour with lymphoid and epithelial components and without sebaceous differentiation. The large majority of the reported cases arise within the parotid gland. We present an NSLA arising from the submandibular gland. The tumour presented as a painless longstanding neck lump. Ultrasound, fine needle aspiration, MRI and positron emission tomography found features supportive of squamous cell carcinoma. The patient was treated with surgery for oropharyngeal carcinoma of unknown origin, in accordance with local and national guidelines. The final histological assessment revealed the level Ib neck lesion to be NSLA. Although a rare occurrence, these lesions may pose a diagnostic challenge in the head and neck cancer pathway.
Adrenal haemorrhage as a complication of COVID-19 infection
Authors: Sharrack Noor , Baxter Conal Thomas , Paddock Michael , Uchegbu Elizabeth
Published: November 2020

We report an unusual complication of COVID-19 infection in a 53-year-old Caucasian man. He presented with shortness of breath, fever and pleuritic chest pain. A CT pulmonary angiogram (CTPA) demonstrated acute bilateral pulmonary embolism and bilateral multifocal parenchymal ground glass change consistent with COVID-19 (SARS-CoV-2) infection. Right adrenal haemorrhage was suspected on the CTPA which was confirmed on triple-phase abdominal CT imaging. A short Synacthen test revealed normal adrenal function. He was treated initially with an intravenous heparin infusion, which was changed to apixaban with a planned outpatient review in 3 months’ time. He made an uncomplicated recovery and was discharged. Follow-up imaging nearly 5 months later showed near complete resolution of the right adrenal haemorrhage with no CT evidence of an underlying adrenal lesion.
Quality of life in adults with multiple sclerosis: a systematic review
Authors: Gil-González Irene , Martín-Rodríguez Agustín , Conrad Rupert , Pérez-San-Gregorio María Ángeles
Published: November 2020

Objective

In recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL.

Method

The literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised.

Results

The search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL.

Conclusion

Adequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.
Protocol for PD SENSORS: Parkinson’s Disease Symptom Evaluation in a Naturalistic Setting producing Outcome measuRes using SPHERE technology. An observational feasibility study of multi-modal multi-sensor technology to measure symptoms and activities of daily living in Parkinson’s disease
Authors: Morgan Catherine , Craddock Ian , Tonkin Emma L , Kinnunen Kirsi M , McNaney Roisin , Whitehouse Sam , Mirmehdi Majid , Heidarivincheh Farnoosh , McConville Ryan , Carey Julia , Horne Alison , Rolinski Michal , Rochester Lynn , Maetzler Walter , Matthews Helen , Watson Oliver , Eardley Rachel , Whone Alan L
Published: November 2020

Introduction

The impact of disease-modifying agents on disease progression in Parkinson’s disease is largely assessed in clinical trials using clinical rating scales. These scales have drawbacks in terms of their ability to capture the fluctuating nature of symptoms while living in a naturalistic environment. The SPHERE (Sensor Platform for HEalthcare in a Residential Environment) project has designed a multi-sensor platform with multimodal devices designed to allow continuous, relatively inexpensive, unobtrusive sensing of motor, non-motor and activities of daily living metrics in a home or a home-like environment. The aim of this study is to evaluate how the SPHERE technology can measure aspects of Parkinson’s disease.

Methods and analysis

This is a small-scale feasibility and acceptability study during which 12 pairs of participants (comprising a person with Parkinson’s and a healthy control participant) will stay and live freely for 5 days in a home-like environment embedded with SPHERE technology including environmental, appliance monitoring, wrist-worn accelerometry and camera sensors. These data will be collected alongside clinical rating scales, participant diary entries and expert clinician annotations of colour video images. Machine learning will be used to look for a signal to discriminate between Parkinson’s disease and control, and between Parkinson’s disease symptoms ‘on’ and ‘off’ medications. Additional outcome measures including bradykinesia, activity level, sleep parameters and some activities of daily living will be explored. Acceptability of the technology will be evaluated qualitatively using semi-structured interviews.

Ethics and dissemination

Ethical approval has been given to commence this study; the results will be disseminated as widely as appropriate.
Heterogeneity in Danish lung choirs and their singing leaders: delivery, approach, and experiences: a survey-based study
Authors: Kaasgaard Mette , Andersen Ingrid Charlotte , Rasmussen Daniel Bech , Hilberg Ole , Løkke Anders , Vuust Peter , Bodtger Uffe
Published: November 2020

Objectives

Singing is considered a beneficial leisure time intervention for people with respiratory diseases, and lung choirs have gained increasing attention. However, there is no available guideline on preferred methodology, and hence, outcomes, delivery, and benefits are unclear. The present study investigated for the first time ever emerged delivery, approach, and experiences in Danish lung choirs and their singing leaders, hypothesising the array to be heterogeneous, without disease-specific approach, and a challenging field to navigate for the singing leaders.

Setting

An online survey comprising 25 questions was performed individually, May 2017, in Denmark.

Participants

Current singing leaders of Danish lung choirs, identified by hand searches on the internet. In total, 33 singing leaders in formal and informal settings were identified and 20 (67%) responded.

Primary and secondary outcome measures

Distribution in content, delivery, and approach; level of disease-specific knowledge and modification; experience of challenges and benefits. Quantitative variables were counted, and an inductive content analysis approach was used for the qualitative study component.

Results

The lung choirs were heterogeneous concerning setting, duration, and content. The approach was traditional without disease-specific content or physical activity. Most singing leaders held various academic degrees in music, but lacked skills in lung diseases. However, they experienced lung choirs as a highly meaningful activity, and reported that participants benefited both musically, psychosocially, and physically. Singing leaders were enthusiastic regarding potentials in the ‘arts-and-health’ cross-field and experienced an expansion of their role and overall purpose, professionally as well as personally. However, they also experienced insecurity, inadequacy, and isolation, and requested methodological guidelines, formal support, and peer network.

Conclusion

Danish lung choirs are led without any disease-specific guideline or methodological approach. Further studies are needed to develop and distribute a preferred methodological approach.

Trial registration number

This study is linked to clinical trial number NCT03280355 and was performed prior to data collection and results of the clinical trial
Prognostic disclosure and quality of life in palliative care: a systematic review
Authors: Wattanapisit Sanhapan , Wagland Richard , Hunt Katherine
Published: November 2020

Introduction

Prognostic disclosure is an important component of communication in palliative care. Disclosing information on poor prognosis may affect quality of life (QoL) of palliative care patients. However, the effects of prognostic disclosure on QoL across different cultures and countries are unclear.

Objective

To review the effects of prognostic disclosure on QoL of palliative care patients.

Methods

A systematic review was conducted across seven databases (AMED, CINAHL plus, Cochrane Library, Medline (via the PubMed interface), Embase, Scopus and Web of Science). All primary studies, of any design, that explored the effects of prognostic disclosure on QoL of adult palliative care patients were eligible.

Results

A total of 1926 records were screened for eligibility. Twenty-five articles were included (11 cross-sectional, 10 cohort, 3 mixed methods and 1 qualitative study). Studies were conducted in 11 countries. Five studies reported the sources of prognostic disclosure, while 20 studies did not. Emotional QoL was the most reported domain among the studies. The effects of prognostic disclosure on emotional aspects, overall QoL and other domains, including symptoms, physical functions, role functions, social functions and cognitive functions, were inconsistent.

Conclusions

The effects of prognostic disclosure on QoL across cultures and countries are inconsistent. Cultural differences are not sufficient to explain the effects. Future research is needed to explore the association between prognostic disclosure and QoL, and develop tools to support clinicians to share prognostic information in the most sensitive and supportive way.
Antimicrobial use at the end of life: a scoping review
Authors: Fairweather Jack , Cooper Lesley , Sneddon Jacqueline , Seaton R Andrew
Published: November 2020

Objective

To examine antibiotic use in patients approaching end of life, in terms of frequency of prescription, aim of treatment, beneficial and adverse effects and contribution to the development of antimicrobial resistance.

Design

Scoping review

Data sources

An information scientist searched Ovid MEDLINE, Ovid EMBASE, The Cochrane library, PubMed Clinical Queries, NHS Evidence, Epistemonikos, SIGN, NICE, Google Scholar from inception to February 2019 for any study design including, but not limited to, randomised clinical trials, prospective interventional or observational studies, retrospective studies and qualitative studies. The search of Ovid MEDLINE was updated on the 10 June 2020.

Study selection

Studies reporting antibiotic use in patients approaching end of life in any setting and clinicians’ attitudes and behaviour in relation to antibiotic prescribing in this population

Data extraction

Two reviewers screened studies for eligibility; two reviewers extracted data from included studies. Data were analysed to describe antibiotic prescribing patterns across different patient populations, the benefits and adverse effects (for individual patients and wider society), the rationale for decision making and clinicians behaviours and attitudes to treatment with antibiotics in this patient group.

Results

Eighty-eight studies were included. Definition of the end of life is highly variable as is use of antibiotics in patients approaching end of life. Prescribing decisions are influenced by patient age, primary diagnosis, care setting and therapy goals, although patients’ preferences are not always documented or adhered to. Urinary and lower respiratory tract infections are the most commonly reported indications with outcomes in terms of symptom control and survival variably reported. Small numbers of studies reported on adverse events and antimicrobial resistance. Clinicians sometimes feel uncomfortable discussing antibiotic treatment at end of life and would benefit from guidelines to direct care.

Conclusions

Use of antibiotics in patients approaching the end of life is common although there is significant variation in practice. There are a myriad of intertwined biological, ethical, social, medicolegal and clinical issues associated with the topic.
Linkage analysis identifies an isolated strabismus locus at 14q12 overlapping with FOXG1 syndrome region
Authors: Ye Xin (Cynthia) , Roslin Nicole M , Paterson Andrew D , Lyons Christopher J , Pegado Victor , Richmond Phillip , Shyr Casper , Fornes Oriol , Han XiaoHua , Higginson Michelle , Ross Colin J , Giaschi Deborah , Gregory-Evans Cheryl , Patel Millan S , Wasserman Wyeth W
Published: November 2020

Strabismus is a common condition, affecting 1%–4% of individuals. Isolated strabismus has been studied in families with Mendelian inheritance patterns. Despite the identification of multiple loci via linkage analyses, no specific genes have been identified from these studies. The current study is based on a seven-generation family with isolated strabismus inherited in an autosomal dominant manner. A total of 13 individuals from a common ancestor have been included for linkage analysis. Among these, nine are affected and four are unaffected. A single linkage signal has been identified at an 8.5 Mb region of chromosome 14q12 with a multipoint LOD (logarithm of the odds) score of 4.69. Disruption of this locus is known to cause FOXG1 syndrome (or congenital Rett syndrome; OMIM #613454 and *164874), in which 84% of affected individuals present with strabismus. With the incorporation of next-generation sequencing and in-depth bioinformatic analyses, a 4 bp non-coding deletion was prioritised as the top candidate for the observed strabismus phenotype. The deletion is predicted to disrupt regulation ofFOXG1, which encodes a transcription factor of the Forkhead family. Suggestive of an autoregulation effect, the disrupted sequence matches the consensus FOXG1 and Forkhead family transcription factor binding site and has been observed in previous ChIP-seq studies to be bound by Foxg1 in early mouse brain development. Future study of this specific deletion may shed light on the regulation ofFOXG1expression and may enhance our understanding of the mechanisms contributing to strabismus and FOXG1 syndrome.
Role 2 Afloat in a Type 45 destroyer: return to contingency
Authors: Mellor A , Coltman T , Taylor P , Wilkins E , Jones G , Borrough T , Newlands K , Connor D
Published: November 2020

Role 2 Afloat (R2A) is an established part of maritime capability whose teams have provided medical support to a number of deployed operations in the recent past. This article describes the capability and constraints of a limited R2A facility embarked on HMS DIAMOND in order to support Royal Marine and Royal Navy boarding teams during Operation LITTEN. The combination of having experienced medical staff, adjusting the medical equipment carried and planning for a limited scenario enabled a bespoke R2A capability to be established on a previously untested platform at short notice. It provides a model for similar future deployments.
The Maritime Medical Emergency Response Team: what do we really need?
Authors: Mercer S J , Khan M A , Hillman C M , Robin J , Matthews J J , Mercer S J
Published: November 2020

Since 2006, the Defence Medical Services (DMS) pre-hospital care focus has been the Medical Emergency Response Team (MERT), which has enabled the projection of Damage Control Resuscitation (DCR) to the point of wounding as part of consultant-delivered care. Now in a period of contingency operations, the Royal Navy (RN)’s Role 2 medical capability, Role 2 Afloat (R2A) delivers DCR (including surgery) on a maritime platform. This article will focus on the development of the Maritime MERT component of R2A (termed Maritime In Transit Care (MITC) in Maritime Medical Doctrine) and will discuss the requirements based on experience of and preparation for an operation in 2016. Also discussed are the individual competencies and training required to be part of the Maritime MERT; it is hoped that this will simulate debate around this evolving team.
The unexpected challenges for a doctor in the remote operational military environment
Authors: Swain C S
Published: November 2020

The enclosed environment of a warship amplifies many recognised issues within medical practice, such as medical confidentiality, the conflicts within the doctor-patient relationship, and the impact of social interaction with patients, reflection on which can lead to adaptations in personal working practices within the military setting. Initial concerns about those deploying early on in their career may focus on medical knowledge and ability, but it is important to be aware of the unforeseen, multi-factorial, psychosocial and logistical challenges which are more likely to surface in the remote military environment.
The role of the operating department practitioner on board Role 2 Afloat
Authors: Stables A , Seal G , Mercer S J
Published: November 2020

The Role 2 Afloat (R2A) is the Royal Navy (RN)’s Damage Control Resuscitation (DCR), including Damage Control Surgery, capability at sea. There are currently three operating department practitioners (ODP) in the deployed team. This article describes the role of the ODP in this team and the training which is required to fulfil this role.
Conditions of the external and middle ear: an overview of presentation, management and associated complications
Authors: Shukla R , Easto R , Williams R
Published: November 2020

Ear, nose and throat (ENT) presentations to primary care are common and frequently affect military patients. Many patients can be managed in primary care with appropriate treatment, but some presentations require appropriate, timely, and occasionally emergency onward referral for hospital management. This paper discusses the management of common otological presentations including otitis externa (OE), acute otitis media, chronic suppurative otitis media (including cholesteatoma), tympanic membrane (TM) perforations and pinna haematoma.
Reflections on anaesthesia in war at sea during Operation CORPORATE
Authors: Bull P
Published: November 2020

This article provides a summary of the anaesthetic support provided on board Her Majesty’s Hospital Ship (HMHS) UGANDA during Operation CORPORATE in 1982, based on diary entries made during the conflict.
Medical support to Operation CORPORATE
Authors: Penn-Barwell J G , Jolly R , Rickard R
Published: November 2020

This article describes the medical support to Operation CORPORATE, and is derived from a range of sources, including surgical operative logbooks, journals and contemporaneous official reports.

Eight hundred and fifty-five surgical procedures were performed by deployed medical units between 14 May and 13 July 1982 in support of Op CORPORATE. The rate peaked on the busiest day, 12 June 1982, when 86 operations were performed. The vast majority of operations were wound management procedures, although 20 laparotomies, four thoracotomies and six craniotomies were also performed. The four forward Role 2 (R2) surgical facilities at Ajax Bay, Teal Inlet, Fitzroy and on board SS CANBERRA collectively performed 354 operations.

Argentine and British casualties were evacuated from the area of operations on board three Argentine vessels and three British HECLA-class survey ships. Between them, HMSs HECLA, HYDRA and HERALD made a total of nine 1000-NM journeys between the Falkland Islands and Montevideo, Uruguay, caring for a total of 601 patients. From Montevideo, British casualties were transferred by RAF VC-10 back to the UK.

Reflection on how a previous generation supported this operation may inform decision-making when similar challenges are faced in the future.
Femoral neck stress fractures from long distance running: a case series
Authors: Robertson G A J , Arthur C H C
Published: November 2020

Femoral neck stress fractures (FNSFs) comprise 3% of all sport-related fractures, and 8% of military stress fractures. They are associated with significant morbidity; if they develop subsequent avascular necrosis of the femoral head, from late detection and fracture displacement, they require a total hip replacement in a young active individual.

Knowledge of the different patterns of FNSFs, their varying presentations and their different management techniques is key for sports and military health professionals involved in the care of these injuries, to ensure optimal treatment and outcome.

We report four cases of FNSFs from long distance running. Three of the four athletes returned to long distance running following their injury at mean of 7 months; however, despite two athletes participating in marathon running pre-injury, none returned to marathon running post-injury.

All clinicians involved with such patients should always remain vigilant for FNSFs in any patient who presents with exercise-related hip or groin pain.
Chronic exertional compartment syndrome: diagnosis, investigation, management and return to training
Authors: Thomas R L , Hemingway R , Keenan A , Wood A
Published: November 2020

Exercise-induced leg pain is a frequent presenting complaint in military recruits. This has several causes, including chronic exertional compartment syndrome (CECS). The pathophysiology of CECS is debated, but it involves pressure increases in particular compartments and reduced compliance in the epimyseal fascia. Its morbidity and poor outcomes with conservative management lead to extended rehabilitation times, and ultimately to a loss of recruits from training. It has been described in various compartments of the upper and lower limbs, but is most frequently encountered in the leg. It is a condition often encountered in the military recruit, and within this demographic is less common than other causes of exertional lower leg pain. However, its debilitating nature and complicated investigative pathway can cause difficulties, and have notable occupational consequences. This article aims to review the evidence surrounding its diagnosis, treatment, prognosis and the implications for the military patient.
A model for testing topical haemostatic dressings for peripheral extremity haemorrhage following amputation
Authors: Welch M , Barratt J , Martin S , Wright C
Published: November 2020

Aims

To assess the viability of a peripheral extremity amputation and haemorrhage model for testing topical haemostatic dressings, and secondarily to test whether a topical haemostatic dressing would arrest bleeding and maintain haemostasis without a tourniquet in this model.

Methods

An animal model was used during proof of principle model development. Bilateral through-elbow amputations were performed on a single swine under anaesthetic and treated with application of Celox Rapid topical haemostatic dressing (Celox gauze) to the stump after 30 seconds of free bleeding. Following initial haemostasis, the wound sites were bandaged using standard trauma dressings. Vital signs were monitored throughout the study.

Results

The animal survived and, in both amputations, haemorrhage was successfully controlled. There was no evidence of re-bleeding during the 30 minutes post-injury or following removal of the packed Celox gauze from the wound sites.

Conclusion

Topical haemostatic dressings could be considered alongside tourniquets for use as a primary treatment of peripheral extremity haemorrhage due to traumatic amputation. It may be useful in prolonged field care where evacuation is delayed or where tourniquet alone does not provide adequate haemorrhage control.
Non-visible haematuria in a military setting
Authors: O’Brien D , Houlberg K
Published: November 2020

Asymptomatic non-visible haematuria is a common finding at routine military medical examinations. This article briefly reviews the possible causes, which include malignancy, structural causes, exertion haematuria, hereditary nephritis, thin basement membrane disease (TBMD), immunoglobulin A nephropathy (IgAN), tuberculosis (TB) and schistosomiasis. This paper discusses how these conditions may affect potential military recruits as well as currently serving members of the Armed Forces, and offers a general approach to the management of a patient with non-visible haematuria.
Alcohol-related liver disease
Authors: Freshwater D A , Micklewright S
Published: November 2020

Alcohol-related liver disease (ARLD) is the most prevalent cause of advanced liver disease in Europe. The spectrum of disease includes alcohol use disorders, alcohol withdrawal, steatosis, alcoholic hepatitis and cirrhosis of the liver. This article describes these clinical presentations and outlines the appropriate management of alcohol-related liver disease, as well as providing a framework for the management of alcohol use disorders.