bluuebunny/crossref_metadata_2025 huggingface dataset:
An Introduction to the ‘literary person[s]’ of Anne Lister and the Ladies of Llangollen
Authors: Valladares Susan
Published: March 2013

Anne Lister eagerly looked forward to her tour of North Wales in July 1822 – a tour made in the company of a dear aunt, and whose principal highlight would be a visit to Eleanor Butler and Sarah Ponsonby, the celebrated Ladies of Llangollen. Ten days prior to her departure, Lister received a letter from her friend, Isabel Dalton, reassuring her that apparently ‘no introduction’ to the Ladies would be necessary: “Any literary person especially calling on them would be taken as a compliment.” Butler and Ponsonby were accustomed to receiving visits from the best of ‘literary persons’, including William Wordsworth, Caroline Lamb, Edmund Burke, and Sir Walter Scott. While Lister lacked such illustrious renown, she was certainly qualified to make the visit. Her diaries reveal that Halifax Library was one of her regular haunts, that she kept careful note of her reading, regularly perused literary reviews, and enjoyed performing favourite book passages and songs to friends and family. She relied on her literary knowledge to further her amorous intrigues, was generous in her presentation of bound books as gifts and love tokens, and confided in a select few of her ‘ambition in the literary way’ and related wish for ‘a name in the world’. Unsurprisingly then, the Ladies of Llangollen’s ‘rustic library’ made an immediate impression on Lister, who warmly admired their ‘little bookcase with 30 or 40 little volumes [of] chiefly poetry, Spenser, Chaucer, Pope, Cowper, Homer, Shakespeare, etc. –’. For their part, Butler and Ponsonby were ‘always reading’; or, in their own words, indulging in ‘the exquisite pleasures of retirement and the luxury of purchasing books’.

A study of the literary interests and reading practices recorded by Lister and the Ladies of Llangollen offers a valuable extension to our understanding of these fascinating diarists and the importance placed by all three women on the desirability of a literary mindset. In its investigation of the links between textuality and subjectivity, my article considers the meanings associated with different reading spaces, and how the literary pursuits of Anne Lister and the Ladies of Llangollen related to their larger academic interests, attitudes to female education, sexual identity, and financial independence.
Middle English Drama Beyond the Cycle Plays
Authors: Brantley Jessica
Published: March 2013

The study of Middle English drama has long been dominated by discussion of the cycle plays, the sweeping multi‐part pageants of biblical history that were performed yearly in cities such as York. But those cycle plays form only part of a complicated and rich culture of performance in late‐medieval England. This essay seeks to provide a sense of the variety of that culture, attesting to the breadth of medieval English drama in play texts such as Mankind, the Croxton Play of the Sacrament, and the Digby Mary Magdalene, and also in other kinds of performance record, such as dramatic fragments and prose meditations. For the broadening of medieval theater history beyond the cycle plays includes not only other significant genres of dramatic activity, but also performative practices and literary texts that lie relatively far from the stage. A theater history beyond the cycle plays also necessarily becomes a theater history beyond the theater, as scholars write a new history of medieval performance.
The role of autoimmunity in thromboangiitis obliterans (Buerger's disease)
Authors: Ketha Siva S. , Cooper Leslie T.
Published: March 2013

Thromboangiitis obliterans (TAO), or Buerger's disease, is a nonatherosclerotic segmental vasculitis that affects the small‐ and medium‐sized arteries and veins of the extremities and is strongly associated with tobacco exposure. The immunopathogenesis of TAO remains largely unknown. In the acute phase of the disease, macrophages and occasional giant cells are observed in the characteristic intraluminal thrombus with a relatively mild infiltration of CD4+ and CD8+ T cells and macrophages in the internal lamina. VCAM‐1, ICAM‐1, and E‐selectin expression on the surface of vascular endothelial cells is increased. A variety of circulating autoreactive antibodies targeting endothelial cells and vessel wall components are associated with active disease. One recent report suggests that removal of circulating antibodies by immunoadsorption may decrease disease severity. TAO has been associated positively and negatively with various MHC class 1 and 2 genes; however, genetic testing is not currently used for clinical diagnosis or management. The possible links between tobacco exposure and loss of tolerance for vascular tissues, current management strategy for patients with TAO, and opportunities for translational science are discussed.
Long‐Term Outcomes of Ivabradine in Inappropriate Sinus Tachycardia Patients: Appropriate Efficacy or Inappropriate Patients
Authors: BENEZET‐MAZUECOS JUAN , RUBIO JOSÉ M. , FARRÉ JERÓNIMO , QUIÑONES MIGUEL Á. , SANCHEZ‐BORQUE PEPA , MACÍA ESTER
Published: March 2013

Background

Inappropriate sinus tachycardia (IST) is characterized by persistent and disproportional elevation of heart rate (HR). Ivabradine has been successfully used in some patients.

Methods

Twenty‐four patients (18 women, 41 ± 13 year olds) were diagnosed with IST according to current guidelines criteria. Patients were treated with 5–7.5 mg of ivabradine twice a day. Twenty‐four‐hour Holter recordings and the SF‐36 Health Survey were performed at 6 months to evaluate both HR control and clinical status.

Results

Holter recordings before and after 6 months on treatment showed a significant reduction in the average maximal HR of 155 ± 18 beats/min versus 132 ± 16 beats/min, mean HR of 97 ± 6 beats/min versus 79 ± 8 beats/min (mean daytime HR of 103 ± 8 beats/min vs 84 ± 10 beats/min) and minimal HR of 58 ± 12 beats/min versus 48 ± 7 beats/min (Wilcoxon analysis, P < 0.05). The SF‐36 mean score showed a significant improvement on ivabradine treatment (57 ± 23 vs 76 ± 20), with a better physical and mental status scores (56 ± 25 vs 74 ± 22 and 58 ± 24 vs 78 ± 18, respectively) (Wilcoxon analysis, P < 0.001). Mean dose of ivabradine was 5.8 ± 1.4 mg. No episodes of severe bradycardia or syncope were reported. After 1 year, patients were asked to stop treatment to reevaluate the situation. Twenty patients were on treatment and only 10 patients accepted to stop ivabradine. Only two patients (20%) remained on IST criteria.

Conclusions

IST patients treated with ivabradine showed both HR normalization and quality‐of‐life improvement maintained in the long‐term follow‐up. Stopping ivabradine after 1 year unexpectedly showed that HR remained in the normal limits in 80% of the patients.
Usefulness of Transtelephonic Monitoring in Epicardial Pacemaker Systems
Authors: LIBERMAN LEONARDO , SPOTNITZ HENRY M. , HORDOF ALLAN J. , FRIEDMAN RICHARD A. , STARC THOMAS J. , SILVER ERIC S.
Published: March 2013

Background

Transtelephonic monitoring (TTM) of pediatric patients with cardiac pacemakers (PMs) has been shown to have high sensitivity and specificity in identifying PM malfunction. The objective of this study is to determine if there is a difference in the rate of abnormal TTM findings in transvenous versus epicardial PM systems.

Methods

Our TTM database was reviewed. Patients younger than 21 years of age enrolled for TTM between 1990 and 2010 were included. The abnormal TTM recordings (not including elective replacement indicator) were identified. Logistic regression was used for statistical analysis. Note that P < 0.05 was considered significant.

Results

We identified 186 patients. There were 75 (40%) epicardial systems. The mean age at TTM enrollment was 6.8 ± 5.9 years (2 months–20.2 years). There were 41 (22%) patients with abnormal TTM findings. The abnormalities were found in 23/75 (31%) epicardial and 18/111 (16%) transvenous systems (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.13–4.62, P = 0.02). When controlling for age and presence of heart disease the OR for abnormal transmission in epicardial systems compared with transvenous was 2.1 (95% CI: 1.03–4.43, P = 0.04). Patients with epicardial systems were more likely to have capture abnormalities on TTM than transvenous systems (OR: 6.1, 95% CI: 1.9–19.5, P = 0.002).

Conclusion

Pediatric patients with epicardial PM systems are more likely to have abnormal TTM test (particularly capture problems) than patients with transvenous systems regardless of age or presence of heart disease. Consequently, patients with epicardial PM systems should be followed closely with TTM.
T cell subsets in cord blood are influenced by maternal allergy and associated with atopic dermatitis
Authors: Fu Yujing , Lou Hongfei , Wang Chengshuo , Lou Wei , Wang Yang , Zheng Tao , Zhang Luo
Published: March 2013

Background

This study aimed to investigate the influence of maternal allergy on cord blood regulatory and effector T cells and to evaluate their role as a predictor of atopic dermatitis (AD) during the first 2 yr of life.

Methods

Seventy mother–infant pairs were recruited in this prospective birth cohort study (21 allergic and 49 non‐allergic mothers). Cord blood samples were collected and assayed for the percentage of regulatory T cells (Treg), interferon‐γ (IFN‐γ), and interleukin‐4 (IL‐4) producing T cells (Th1 and Th2, respectively) using flow cytometry. Experiments were undertaken to assess the function of cord blood CD4+CD25+CD127− Treg cells by cell proliferation and cytokine responses. Their offspring at the age of 2 yr old were evaluated by dermatologists to determine whether they had AD.

Results

During the first 2 yr of life, 15.7% of the children developed a physician‐diagnosed AD. A significantly increased percentage of Th2 cell was observed in cord blood of newborns with maternal allergy. Treg/Th2 ratio significantly decreased among the offspring of allergic mothers. Treg cell‐associated suppression of Th2 response was attenuated in Der p1‐stimulated CD4+CD25− T cells from the offspring of allergic mothers. Children with reduced Th1/Th2 (p = 0.001, OR = 0.37) and Treg/Th2 (p = 0.001, OR = 0.47) ratio in cord blood had a higher risk of developing AD.

Conclusion

Maternal allergic status is associated with increased percentage of IL‐4+CD4+ T cells and a reduced Treg/Th2 ratio in cord blood at their children's birth, which may predispose to an increased risk for developing AD.
Perceptual Intuitionism
Authors: Cowan Robert
Published: March 2013

In the recent metaethical literature there has been significant interest in the prospects for what I am denoting ‘Perceptual Intuitionism’: the view that normal ethical agents can and do have non‐inferential justification for first‐order ethical beliefs by having ethical perceptual experiences, e.g., Cullison 2010, McBrayer 2010, Vayrynen 2008. If true, it promises to constitute an independent a posteriori intuitionist epistemology, providing an alternative to intuitionist accounts which posit a priori intuition and/or emotion as sources of non‐inferentially justified ethical beliefs. As it is formulated, it is plausible that a necessary condition for the view is the truth of Ethical Perception: normal ethical agents can and do have perceptual experiences (at least some of which are veridical) as of the instantiation of ethical properties. In this paper a sophisticated and promising account of Ethical Perception is offered. Extant objections are shown to fail. However, it will be argued that it is far from obvious that the account of Perceptual Intuitionism which emerges constitutes an independent alternative to other intuitionist accounts. This is because we have reason to think that ethical perceptual experience may be epistemically dependent on other epistemic sources, e.g. a priori intuition or emotion.
Stage determination in sleeping sickness: comparison of two cell counting and two parasite detection techniques
Authors: Mumba Ngoyi Dieudonné , Menten Joris , Pyana Pati Patient , Büscher Philippe , Lejon Veerle
Published: March 2013

Objectives

Diagnosis of the neurological stage of human African trypanosomiasis is performed by examination of cerebrospinal fluid (CSF) for the presence of trypanosomes and numbers of white blood cells (WBC). Both CSF parameters are also used to assess treatment outcome during follow‐up. In view of the importance of CSF examination, and the practical problems encountered with it, we compared the sensitivity of two trypanosome concentration techniques and the repeatability of two cell counting methods, as well as occurrence of systematic differences between them.

Methods

Patients were recruited at Dipumba hospital, in Mbuji‐Mayi in the Democratic Republic of the Congo. In 94 CSF samples, trypanosome detection was performed with modified single centrifugation (MSC) and double centrifugation (DC). On 189 CSF samples with ≤30 cells/μl, cell counting was performed in duplicate in a Fuchs–Rosenthal counting chamber and in a disposable Uriglass counting chamber.

Results

Modified single centrifugation detected trypanosomes in significantly (P < 0.0001) more patients (85) than DC (46). Cell counts did not differ systematically in the two methods. Variability in the differences between duplicate cell counts was significantly higher (P = 0.002) in Uriglass (SD of differences 2.03) than in Fuchs–Rosenthal (SD of differences 1.62).

Conclusions

For analysis of CSF in the context of sleeping sickness stage determination and follow‐up after treatment, we strongly recommend the MSC for parasite detection and the application of disposable counting chambers. When the first cell count is ≤20 cells/μl, we recommend repeating the counting procedure on the same CSF specimen and taking the average of both countings.
Single KATP channel opening in response to stimulation of AMPA/kainate receptors is mediated by Na+ accumulation and submembrane ATP and ADP changes
Authors: Mollajew R. , Toloe J. , Mironov S. L.
Published: March 2013

Key points

KATP channels can suppress overexcitation of CNS neurons after activation of glutamatergic receptors (GluRs), and we examined this functional interaction in the brainstem and hippocampal neurons.

GluR stimulation increased the activity of single KATP channels that was not mediated by intracellular calcium, reactive oxygen species and osmotic stress, and was abolished after inhibition of sodium influx.

ATP and sodium imaging indicated that functional cross‐talk between GluRs and KATP channels is mediated by Na+‐K+‐ATPase.

GluR contributed to KATP channel opening during hypoxia in functionally intact brainstem slices and seizure‐like activity in the hippocampal slices.

We propose that neuronal activity depletes submembrane ATP, and increases ADP levels and promotes KATP channel opening that dampen uncontrolled excitation by glutamate.

Abstract  Excessive stimulation of glutamatergic receptors (GluRs) can overexcite neurons. This can be dampened by KATP channels linking metabolic and neuronal activities, but the cross‐talk has not yet been examined on the single channel level. In the brainstem and hippocampal neurons, GluR agonists augmented the open state probability (Popen) of KATP channels with relative efficacy: kainate ≈ AMPA > NMDA > t‐ACPD. Inhibition of calcium influx and chelation of intracellular calcium did not modify the effects. Kainate did not augment production of reactive oxygen species measured with roGFP1. H2O2 slightly increased Popen, but GluR effects were not modified. GluR actions were abolished in Na+‐free solutions and after blockade of Na+‐K+‐ATPase. KATP channels in open‐cell patch‐clamp measurements were inhibited by ATP, stimulated by ADP, and kainate was effective only in the presence of ATP. GluR stimulation enhanced ATP consumption that decreased submembrane ATP levels, whereas metabolic poisoning diminished bulk ATP. Modelling showed strong ATP depletion and ADP accumulation near the membrane, and both effects contributed to Popen increases after GluR stimulation. Kainate and hypoxia activated KATP channels in the functional brainstem slices. Inhibition of aerobic ATP production and GluR stimulation were about equally effective in KATP channel opening during hypoxia. Induction of seizure‐like activity in hippocampal slices with Mg2+‐free solutions was accompanied by ATP decrease and KATP channel opening. We propose that KATP channels and GluRs are functionally coupled that can regulate long‐lasting changes of neuronal activity in the CNS neurons.
Synthesis, properties, and applications of silicon nanocrystals
Authors: Mangolini Lorenzo
Published: March 2013

Silicon nanocrystals have been widely investigated for several years because of their many interesting properties and their potential use in several applications. This field has grown enormously after the observation of quantum confinement in porous silicon and remains an area of great interest for different reasons. Most importantly, silicon is already widely used in the semiconductor industry, is nontoxic at least in its bulk form, is the second most earth-abundant element in the crust, and is relatively cheap to process. A large number of groups have investigated silicon in the form of nanocrystals, and the authors intend to provide a comprehensive review of their contribution to the field. The author has decided to address first the synthesis and properties of silicon nanocrystals. Several different techniques, such as nucleation in substoichiometric thin films or gas-phase nucleation and growth in silane-containing nonthermal plasmas, have been proposed for the controlled synthesis of silicon nanoparticles. The author outlines the strengths and weaknesses of each approach and identify the research groups that have advanced each particular synthesis technique. The understanding of the properties of silicon nanocrystals has evolved as new synthetic approaches were developed, and for that reason the material properties are discussed together with its production approach. The use of silicon nanocrystals for the development of novel electronic devices, light emitting devices, photovoltaic cells, and for biorelated applications will be discussed. Waste heat recovery and energy storage applications are also discussed.
Improvement of polycrystalline silicon wafer solar cell efficiency by forming nanoscale pyramids on wafer surface using a self-mask etching technique
Authors: Lin Hsin-Han , Chen Wen-Hwa , Hong Franklin C.-N.
Published: March 2013

The creation of nanostructures on polycrystalline silicon wafer surface to reduce the solar reflection can enhance the solar absorption and thus increase the solar-electricity conversion efficiency of solar cells. The self-masking reactive ion etching (RIE) was studied to directly fabricate nanostructures on silicon surface without using a masking process for antireflection purpose. Reactive gases comprising chlorine (Cl2), sulfur hexafluoride (SF6), and oxygen (O2) were activated by radio-frequency plasma in an RIE system at a typical pressure of 120–130 mTorr to fabricate the nanoscale pyramids. Poly-Si wafers were etched directly without masking for 6–10 min to create surface nanostructures by varying the compositions of SF6, Cl2, and O2 gas mixtures in the etching process. The wafers were then treated with acid (KOH:H2O = 1:1) for 1 min to remove the damage layer (100 nm) induced by dry etching. The damage layer significantly reduced the solar cell efficiencies by affecting the electrical properties of the surface layer. The light reflectivity from the surface after acid treatment could be significantly reduced to <10% for the wavelengths between 500 and 900 nm. The effects of RIE and surface treatment conditions on the surface nanostructures and the optical performance as well as the efficiencies of solar cells will be presented and discussed. The authors have successfully fabricated large-area (156 × 156 mm2) subwavelength antireflection structure on poly-Si substrates, which could improve the solar cell efficiency reproducibly up to 16.27%, higher than 15.56% using wet etching.
Mind Games
Authors: Gough Nancy R.
Published: March 2013

Activities that stimulate thinking may prevent symptoms of Alzheimer’s disease by blocking the effects of Aβ.
A
liaF
Codon Deletion Abolishes Daptomycin Bactericidal Activity against Vancomycin-Resistant Enterococcus faecalis
Authors: Munita Jose M. , Tran Truc T. , Diaz Lorena , Panesso Diana , Reyes Jinnethe , Murray Barbara E. , Arias Cesar A.
Published: March 2013

The genetic bases for antibiotic tolerance are obscure. Daptomycin (DAP) is a lipopeptide antibiotic with bactericidal activity against enterococci. Using time-kill assays, we provide evidence for the first time that a deletion of isoleucine in position 177 of LiaF, a member of the three-component regulatory system LiaFSR involved in the cell envelope response to antimicrobials, is directly responsible for a DAP-tolerant phenotype and is likely to negatively affect response to DAP therapy.
Ciprofloxacin Is Actively Transported across Bronchial Lung Epithelial Cells Using a Calu-3 Air Interface Cell Model
Authors: Ong Hui Xin , Traini Daniela , Bebawy Mary , Young Paul M.
Published: March 2013

Ciprofloxacin is a well-established broad-spectrum fluoroquinolone antibiotic that penetrates well into the lung tissues; still, the mechanisms of its transepithelial transport are unknown. The contributions of specific transporters, including multidrug efflux transporters, organic cation transporters, and organic anion-transporting polypeptide transporters, to the uptake of ciprofloxacin were investigated
in vitro
using an air interface bronchial epithelial model. Our results demonstrate that ciprofloxacin is subject to predominantly active influx and a slight efflux component.
Time to Initiation of Antifungal Therapy for Neonatal Candidiasis
Authors: Le Jennifer , Tran Tu T. , Bui Ivilynn , Wang Mike K. , Vo Andrew , Adler-Shohet Felice C.
Published: March 2013

The effect of delayed antifungal therapy in critically ill infants with invasive candidiasis has not been studied. Our objective was to evaluate the effect of time to initiation of antifungal therapy (TIA) on mortality, disseminated disease, and postinfection hospital stay. We conducted a cohort study of critically ill infants with cultures positive for
Candida
from 1990 to 2008. TIA was defined as the number of hours from the collection of the first positive culture until the start of antifungal therapy. Of 96 infants, 57% were male, the median gestational age was 27 weeks (range, 23 to 41 weeks), and the median birth weight was 956 g (range, 415 to 6,191 g). Most subjects received amphotericin B deoxycholate. TIA was ≤24 h for 35% of infants, between 25 and 48 h for 42%, and >48 h for 23%. Eleven subjects died during hospitalization, and 22% had disseminated candidiasis. The median duration of hospital stay postinfection was 53 days (range, 6 to 217 days). Both univariate and multivariate analyses demonstrated that TIA was not associated with mortality, disseminated disease, or hospital stay postinfection. However, ventilator use for >60 days significantly increased the risk of death (odds ratio [OR], 9.5; 95% confidence interval [CI], 2.2 to 66.7;
P
= 0.002). Prolonged candidemia increased the risk of disseminated disease by 10% per day of positive culture (OR, 1.1; 95% CI, 1.08 to 1.2;
P
= 0.007), and low gestational age was associated with increased neonatal intensive care unit (NICU) stay after the first positive
Candida
culture by 0.94 weeks (95% CI, 0.70 to 0.98;
P
< 0.001). The TIA was not associated with all-cause mortality, disseminated candidiasis, and postinfection length of hospital stay.
Rational Design of Engineered Cationic Antimicrobial Peptides Consisting Exclusively of Arginine and Tryptophan, and Their Activity against Multidrug-Resistant Pathogens
Authors: Deslouches Berthony , Steckbeck Jonathan D. , Craigo Jodi K. , Doi Yohei , Mietzner Timothy A. , Montelaro Ronald C.
Published: March 2013

The emergence of multidrug-resistant (MDR) pathogens underscores the need for new antimicrobial agents to overcome the resistance mechanisms of these organisms. Cationic antimicrobial peptides (CAPs) provide a potential source of new antimicrobial therapeutics. We previously characterized a lytic base unit (LBU) series of engineered CAPs (eCAPs) of 12 to 48 residues demonstrating maximum antibacterial selectivity at 24 residues. Further, Trp substitution in LBU sequences increased activity against both
P. aeruginosa
and
S. aureus
under challenging conditions (e.g., saline, divalent cations, and serum). Based on these findings, we hypothesized that the optimal length and, therefore, the cost for maximum eCAP activity under physiologically relevant conditions could be significantly reduced using only Arg and Trp arranged to form idealized amphipathic helices. Hence, we developed a novel peptide series, composed only of Arg and Trp, in a sequence predicted and verified by circular dichroism to fold into optimized amphipathic helices. The most effective antimicrobial activity was achieved at 12 residues in length (WR12) against a panel of both Gram-negative and Gram-positive clinical isolates, including extensively drug-resistant strains, in saline and broth culture and at various pH values. The results demonstrate that the rational design of CAPs can lead to a significant reduction in the length and the number of amino acids used in peptide design to achieve optimal potency and selectivity against specific pathogens.
In Vivo
Efficacy of Daptomycin against Methicillin-Resistant Staphylococcus aureus in a Mouse Model of Hematogenous Pulmonary Infection
Authors: Harada Yosuke , Yanagihara Katsunori , Yamada Koichi , Migiyama Yohei , Nagaoka Kentaro , Morinaga Yoshitomo , Nakamura Shigeki , Imamura Yoshifumi , Hasegawa Hiroo , Miyazaki Taiga , Izumikawa Koichi , Kakeya Hiroshi , Kohno Shigeru
Published: March 2013

Daptomycin is inactivated by pulmonary surfactant, but its effectiveness in hematogenous pulmonary infection has been poorly studied. The potential therapeutic application was evaluated in a methicillin-resistant
Staphylococcus aureus
(MRSA) hematogenous pulmonary infection mouse model. Compared with control results, daptomycin improved survival (
P
< 0.001) and decreased the number of abscesses and bacteria in the lungs (
P
< 0.01). Daptomycin may be an effective therapeutic option for MRSA hematogenous pulmonary infection.
Efficacy of Nitazoxanide against Clinical Isolates of Mycobacterium tuberculosis
Authors: Shigyo Kristina , Ocheretina Oksana , Merveille Yves Mary , Johnson Warren D. , Pape Jean William , Nathan Carl F. , Fitzgerald Daniel W.
Published: March 2013

Nitazoxanide (NTZ) has bactericidal activity against the
H37Rv
laboratory strain of
Mycobacterium tuberculosis
with a MIC of 16 μg/ml. However, its efficacy against clinical isolates of
M. tuberculosis
has not been determined. We found that NTZ's MIC against 50 clinical isolates ranged from 12 to 28 μg/ml with a median of 16 μg/ml and was unaffected by resistance to first- or second-line antituberculosis drugs or a diversity of spoligotypes.
Molecular Characterization and
In Vitro
Antifungal Susceptibility Profile of Schizophyllum commune, an Emerging Basidiomycete in Bronchopulmonary Mycoses
Authors: Chowdhary Anuradha , Kathuria Shallu , Singh Pradeep Kumar , Agarwal Kshitij , Gaur Shailendra N. , Roy Pradip , Randhawa Harbans S. , Meis Jacques F.
Published: March 2013

Schizophyllum commune
(
n
= 30) showed lowest geometric mean MICs of isavuconazole (0.19 μg/ml), itraconazole (0.2 μg/ml), voriconazole (0.24 μg/ml), and amphotericin B (0.29 μg/ml) and high geometric mean MICs of fluconazole (19.39 μg/ml) and flucytosine (17.28 μg/ml). Five cases (of 8) of allergic bronchopulmonary mycosis that were treated with itraconazole had no recrudescence after 6 to 24 months of follow-up. One case each of invasive pulmonary mycosis and fungal ball were treated successfully with voriconazole and itraconazole.
Anti-Pfs25 Human Plasma Reduces Transmission of Plasmodium falciparum Isolates That Have Diverse Genetic Backgrounds
Authors: Da Dari F. , Dixit Saurabh , Sattabonkot Jetsumon , Mu Jianbing , Abate Luc , Ramineni Bhanumati , Ouedraogo Jean Bosco , MacDonald Nicholas J. , Fay Michael P. , Su Xin-zhuan , Cohuet Anna , Wu Yimin
Published: March 2013

Pfs25 is a leading candidate for a malaria transmission-blocking vaccine whose potential has been demonstrated in a phase 1 trial with recombinant Pfs25 formulated with Montanide ISA51. Because of limited sequence polymorphism, the anti-Pfs25 antibodies induced by this vaccine are likely to have transmission-blocking or -reducing activity against most, if not all, field isolates. To test this hypothesis, we evaluated transmission-blocking activities by membrane feeding assay of anti-Pfs25 plasma from the Pfs25/ISA51 phase 1 trial against
Plasmodium falciparum
parasites from patients in two different geographical regions of the world, Thailand and Burkina Faso. In parallel, parasite isolates from these patients were sequenced for the Pfs25 gene and genotyped for seven microsatellites. The results indicate that despite different genetic backgrounds among parasite isolates, the Pfs25 sequences are highly conserved, with a single nonsynonymous nucleotide polymorphism detected in 1 of 41 patients in Thailand and Burkina Faso. The anti-Pfs25 immune plasma had significantly higher transmission-reducing activity against parasite isolates from the two geographical regions than the nonimmune controls (
P
< 0.0001).
CD40 Induces Anti-Toxoplasma gondii Activity in Nonhematopoietic Cells Dependent on Autophagy Proteins
Authors: Van Grol Jennifer , Muniz-Feliciano Luis , Portillo Jose-Andres C. , Bonilha Vera L. , Subauste Carlos S.
Published: March 2013

Toxoplasma gondiiinfects both hematopoietic and nonhematopoietic cells and can cause cerebral and ocular toxoplasmosis, as a result of either congenital or postnatally acquired infections. Host protection likely acts at both cellular levels to control the parasite. CD40 is a key factor for protection against cerebral and ocular toxoplasmosis. We determined if CD40 induces anti-T. gondiiactivity at the level of nonhematopoietic cells. Engagement of CD40 on various endothelial cells including human microvascular brain endothelial cells, human umbilical vein endothelial cells, and a mouse endothelial cell line as well as human and mouse retinal pigment epithelial cells resulted in killing ofT. gondii. CD40 stimulation increased expression of the autophagy proteins Beclin 1 and LC3 II, enhanced autophagy flux, and led to recruitment of LC3 around the parasite. The late endosomal/lysosomal marker LAMP-1 accumulated around the parasite in CD40-stimulated cells. This was accompanied by killing ofT. gondiidependent on lysosomal enzymes. Accumulation of LAMP-1 and killing ofT. gondiiwere dependent on the autophagy proteins Beclin 1 and Atg7. Together, these studies revealed that CD40 induces toxoplasmacidal activity in various nonhematopoietic cells dependent on proteins of the autophagy machinery.
Exacerbated Type II Interferon Response Drives Hypervirulence and Toxic Shock by an Emergent Epidemic Strain of Streptococcus suis
Authors: Lachance Claude , Gottschalk Marcelo , Gerber Pehuén P. , Lemire Paul , Xu Jianguo , Segura Mariela
Published: March 2013

Streptococcus suis, a major porcine pathogen, can be transmitted to humans and cause severe symptoms. A large human outbreak associated with an unusual streptococcal toxic shock-like syndrome (STSLS) was described in China. Albeit an early burst of proinflammatory cytokines following ChineseS. suisinfection was suggested to be responsible for STSLS case severity, the mechanisms involved are still poorly understood. Using a mouse model, the host response toS. suisinfection with a North American intermediately pathogenic strain, a European highly pathogenic strain, and the Chinese epidemic strain was investigated by a whole-genome microarray approach. Proinflammatory genes were expressed at higher levels in mice infected with the Chinese strain than those infected with the European strain. The Chinese strain induced a fast and strong gamma interferon (IFN-γ) response by natural killer (NK) cells. In fact, IFN-γ-knockout mice infected with the Chinese strain showed significantly better survival than wild-type mice. Conversely, infection with the less virulent North American strain resulted in an IFN-β-subjugated, low inflammatory response that might be beneficial for the host to clear the infection. Overall, our data suggest that a highly virulent epidemic strain has evolved to massively activate IFN-γ production, mainly by NK cells, leading to a rapid and lethal STSLS.
Linezolid-induced serotonin syndrome
Authors: Gupta Vishal , Karnik Niteen D , Deshpande Rushikesh , Patil Meenakshi Amit
Published: March 2013

A young drug abuser was admitted to our intensive care unit for organophosphorus poisoning. He required mechanical ventilation and was started empirically on linezolid for suspected nosocomial infection. The patient developed high-grade fever with altered sensorium and clonus. Serotonin syndrome was suspected and the patient was started on cyproheptadine. He recovered within 3 days of withdrawing linezolide and administering cyproheptadine.
Health Needs Assessment in the Nepalese Population in Brunei
Authors: Mitchell NJ
Published: March 2013

The aim of this study was to try to identify significant differences between the current provision of medical care to the Nepalese community in Brunei and the ideal provision taking into account their cultural values. The Nepalese were found to be very willing to accept education on medical matters and a significant gap in their knowledge of modern medicine was confirmed. Their culture and social structure requires thought to be given to the sex of the medical personnel, the provision of joint consultations and the tolerance of traditional medical practices when providing medical care to such a population.
An Analysis of the Emergency Ambulance Workload in the British Eastern Sovereign Base Area of Cyprus May 1995 to April 1998
Authors: Leach Jonathan , Menzies Angus
Published: March 2013

Objective

To assess emergency ambulance workload in terms of patients treated, casemix and whether or not a member of the British Forces Community, between May 1995 and April 1998 within the British Eastern Sovereign Base area in Cyprus.

Methods

Retrospective analysis of all incidents attended within the study period.

Results

A total of 452 patients were treated of which 47% were members of the British Forces Community in Cyprus. 14 Deaths were attended of which 9 were due to road traffic accidents. Of all incidents attended 45% were following a road traffic accident and over three quarters of all patients treated had suffered trauma to some degree.

Conclusion

The British military ambulance and supporting medical services located in the Eastern Sovereign Base Area in Cyprus provide a service to the British Forces Community, but the majority of patients treated are primarily the local Greek Cypriots with a sizeable minority of visiting tourists. Comment is made on the high incidence of morbidity and mortality from road traffic accidents within Cyprus as a whole.
The Provision of Intensive Care and High Dependency Care in the Field
Authors: Roberts MJ , Salmon JB , Sadler PJ
Published: March 2013

The Defence Medical Services aspire to deliver, whenever possible, United Kingdom peacetime standards of care to servicemen injured on active service. This level of medical support calls for the provision of adequate critical care to the severely ill or injured. This paper discusses the role of critical care in the field and how it may be most effectively deployed.
Medico-legal Issues Surrounding Medical Countermeasures Used in the Gulf War - Part 2
Authors: Galbraith S N
Published: March 2013

When the multinational force deployed to the Gulf after Iraq’s invasion of Kuwait in 1990, military intelligence assessed the Iraqis as possessing and being capable of using weapons of mass destruction. There was judged to be a real threat that chemical weapons, especially nerve agents and certain biological weapons would be used. Coalition countries attempted to reduce the effects by the use of medical countermeasures. Since the Gulf conflict a series of medico legal problems from this policy have arisen, some of which have formed the basis of claims against MOD. In the last article I reviewed consent to treatment in a military operational context and looked at potential clinical negligence issues. In this article I shall look at relevant employment law and review how medicine regulatory provision applies to medical countermeasures.
Day Case Rhinoplasty
Authors: Banfield GK , McKiernan D , Hinton AE
Published: March 2013

Rhinoplasty is considered by many to be an inpatient surgical procedure. This may be because the operation is thought to be traumatic with a risk of epistaxis and periorbital haematoma. Since 1992 rhinoplasty surgery at St George’s hospital has been routinely performed on a planned day case basis. The hospital records of 97 patients were examined of which 17 patients (18%) underwent planned admission and 12 (12%) unplanned admission. No patients were re-admitted to hospital after discharge. With the advances in day case surgical practice within the UK we consider that the practice of day case rhinoplasty is likely to have its place. Such surgery should ideally be performed in a dedicated day case unit and provision for admission overnight should be available.
Blast Waves and How They Interact With Structures
Authors: Cullis IG
Published: March 2013

The paper defines and describes blast waves, their interaction with a structure and its subsequent response. Explosions generate blast waves, which need not be due to explosives. A blast wave consists of two parts: a shock wave and a blast wind. The paper explains how shock waves are formed and their basic properties. The physics of blast waves is non-linear and therefore non-intuitive. To understand how an explosion generates a blast wave a numerical modelling computer code, called a hydrocode has to be employed. This is briefly explained and the cAst Eulerian hydrocode is used to illustrate the formation and propagation of the blast wave generated by a 1 kg sphere of TNT explosive detonated 1 m above the ground. The paper concludes with a discussion of the response of a structure to a blast wave and shows that this response is governed by the structures natural frequency of vibration compared to the duration of the blast wave. The basic concepts introduced are illustrated in a second simulation that introduces two structures into the blast field of the TNT charge.
Behind Armour Blunt Trauma - an emerging problem
Authors: Cannon L
Published: March 2013

Behind Armour Blunt Trauma (BABT) is the non-penetrating injury resulting from the rapid deformation of armours covering the body. The deformation of the surface of an armour in contact with the body wall arises from the impact of a bullet or other projectile on its front face. The deformation is part of the retardation and energy absorbing process that captures the projectile. In extreme circumstances, the BABT may result in death, even though the projectile has not perforated the armour. An escalation of the available energy of bullets and the desire of armour designers to minimise the weight and bulk of personal armour systems will increase the risk of BABT in military and security forces personnel.

In order to develop materials that can be interposed between the armour and the body wall to attenuate the transfer of energy into the body, it is essential that the mechanism of BABT is known. There is a great deal of activity within UK and NATO to unravel the interactions; the mechanism is likely to be a combination of stress (pressure) waves generated by the rapid initial motion of the rear of the armour, and shear deformation to viscera produced by gross deflection of the body wall.

Physical and computer model systems are under development to characterise the biophysical processes and provide performance targets for materials to be placed between armours and the body wall in order to attenuate the injuries (trauma attenuating backings - TABs).

The patho-physiological consequences of BABT are being clarified by research, but the injuries will have some of the features of blunt chest trauma observed in road traffic accidents and other forms of civilian blunt impact injury. The injuries also have characteristics of primary blast injury. An overview diagnosis and treatment is described.
The military medical management of missile injury to the spine: A review of the literature and proposal of guidelines
Authors: Buxton N
Published: March 2013

The management of missile injury to the spinal cord is controversial. The literature is reviewed and recommendations made about the management of these injuries. To surgeons in a country that is relatively safe such injuries are rare, this review provides useful information about this condition.
Occupational Health and Safety Issues in Military Field Hospitals
Authors: Bricknell MCM
Published: March 2013

This paper considers the occupational health and safety issues that apply within a military field hospital. It considers NHS occupational health and safety activities and examines how these might be applied within an Army Medical Services unit. Areas that are unique to field hospitals are highlighted in comparison with a static NHS hospital. Some issues for future work are also considered.
Retroperitoneal Gas Gangrene Complicating Elective Inguinal Hernia Repair
Authors: Privitera A , Edwards D P , Cunningham C
Published: March 2013

Gas gangrene is a well recognised complication of contaminated military wounds. A case of Clostridial myonecrosis following elective inguinal hernia repair is described. The pathology, clinical features and management of this life-threatening condition are reviewed.
Heat Illness - Recent Developments
Authors: Booker RJ , Bricknell MCM
Published: March 2013

This paper reviews the literature concerning exertional heat illness in soldiers. It focuses on developments since Bricknell`s two part paper “Heat Illness - A Review of Military Experience” published in this journal in 1996. Recent advances in the understanding of risk factors, pathophysiology and treatment are discussed with a view to reducing the already low incidence of heat illness within the Armed Forces.
Battle Injuries Of The Rectum: Options For The Field Surgeon
Authors: MacFarlane C , Vaizey CJ , Benn CA
Published: March 2013

Historically, battle wounds of the rectum have had high mortality and morbidity. This has improved greatly over several decades as a result of battle experience. This article highlights the value of civilian gunshot experience and its possible use in the military setting. The standard principles of rectal examination, followed by proctosigmoidoscopy after initial resuscitation, remain unchanged. Thereafter, the surgical decisions are made at laparotomy. Rectal injuries commonly have other injuries in association which must also be dealt with. In the stable patient rectal repair may be possible. Where repair is hazardous due to extensive injury (rectum or adjacent structures), the well-proven protective colostomy is used. A loop colostomy with or without distal closure is effective and is used to protect most injuries; possible exceptions being injuries dealt with early, in which there is minimal contamination and repair is easy. Presacral drainage can generally be reserved for severely destructive wounds or those in which repair has not been done. Rectal washout remains an option in patients with inspissated faeces. The basic military surgical principles remain valid, their extent and degree of implementation depending on the anatomical location of injury, degree of damage and any delay in presentation to surgery.
Early Increases In Blood Lactate Following Injury
Authors: Coats TJ , Smith JE , Lockey D , Russell M
Published: March 2013

Current pre-hospital trauma triage systems are based mainly on physiological parameters, but in compensated shock injury severity may not be immediately obvious, as the physiological parameters remain normal for some time. Serum lactate, measured in hospital, is known to be a predictor of injury severity and outcome. The technology for easy field lactate measurement has recently become available. We found that capillary lactate is elevated in trauma patients in the early phase of the response to injury. There is a moderate correlation (R2 = 0.44) between early lactate levels and injury severity, in patients who might otherwise be difficult to triage.

Our aims were:

(a) To determine if lactate levels are elevated in the pre-hospital phase of trauma, and to establish whether there is a correlation between pre-hospital lactate and injury severity.

(b) To determine if there is a relationship between pre-hospital lactate and injury severity in patients with normal blood pressure and Glasgow Coma Score of greater than 12 (“difficult to triage” group).

Methods

Prospective analysis of pre-hospital capillary lactate levels and Injury Severity Score (ISS) in 23 trauma patients attended by the London Helicopter Emergency Medical Service.

Results

Capillary lactate is elevated in trauma patients in the early phase of the response to injury. There is a moderate correlation (R2 = 0.44) between early lactate levels and injury severity, in patients who might otherwise be difficult to triage.

Conclusions

Lactate is elevated in the earliest prehospital phase of injury following trauma. The potential contribution of this biochemical para-meter to field triage requires further evaluation.
The Evolution Of Casualty Evacuation In The British Army 20th Century (Part 1) – Boer War To 1918
Authors: Bricknell MCM
Published: March 2013

This is the first in a series of papers which describe the evolution of the British casualty evacuation system in the 20th Century. This paper describes the formation of the Field Ambulance after the Boer War and the development of the Casualty Clearing Station during the First World War. It also discusses how the effects of an improved understanding of triage, shock and wound infection contributed to changes in the internal organization of hospitals in the field.
An Audit Of Territorial Army Medical Grades On Presentation For Mobilisation And Full Time Reserve Service At RTMC Chilwell
Authors: Wright L J , Owen J P
Published: March 2013

An audit was carried out on a cohort of Territorial Army (TA) personnel passing through RTMC in order to assess the quality of their previous medical assessments compared to that undertaken at the time of their mobilisation. The results confirmed the high downgrading rate (18%) amongst TA personnel compared to previous studies that identified grading error rates of 6–6.5% amongst Regular Army personnel. Errors in the entry medical assessments for TA personnel were also identified in nearly half (44%) of records examined. Possible solutions are identified through improved education of examining medical officers and by increasing the pre-deployment time available to obtain specialist referrals. A case is also made for having improved access to previous medical information, both to improve the quality of the predeployment medical screening and to ensure appropriate continuity of care for deployed TA personnel.
The Evolution of casualty evacuation in the British Army in the 20th Century (Part 2) –1918 to 1945
Authors: Bricknell MCM
Published: March 2013

This is the second in a series of papers that examine the evolution of the military casualty evacuation chain during the 20th century. The Spanish Civil War demonstrated to the world the revolutionary tactic of ‘Blitzkrieg’ developed by the Germans. This and the experience of the British Expeditionary Force in 1940 emphasised the need for mobility in forward medical units. The campaign in the Western Desert led to the creation of a number of new units such as the Field Surgical Unit and the Field Transfusion Unit which were introduced across the British Army as a result of the findings of the Hartgill Committee. The aeroplane transformed the evacuation chain from CCSs to base hospitals and beyond.