bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Phlebotomist-Only Venipuncture and Central Line Avoidance for Blood Culture in a Large Tertiary Care University Hospital
Authors: Santos Carlos A.Q. , Shimasaki Teppei , Kishen Ekta , Won Sarah , Hanson Amy , Marinakos Gigi , Tomich Alexander , Hota Bala , Segreti John
Published: November 2017

Background

Drawing blood for culture from central vascular access sites may increase rates of blood culture contamination and central line–associated bloodstream infection.

Methods

We examined the impact of phlebotomist-only blood draws and central line avoidance for blood culture in a large university hospital that also cares for patients with cancer, stem cell transplants, and solid-organ transplants. Policy enforcement began in September 2013. The preimplementation era was defined from January 2012 to June 2013, and the postimplementation era was defined from January 2014 to September 2015. Outcomes in preimplementation and postimplementation eras were compared using time-series analyses, t tests, and Wilcoxon rank sum tests.

Results

Policy implementation led to 29%, 31%, and 38% decreases in blood culture performance, positivity, and contamination, respectively; an 86% decrease in blood cultures drawn from central lines; and a 66% decrease in central line–associated bloodstream infections. Our policy coincided with an 11% decrease in intravenous vancomycin, daptomycin, or linezolid use, whereas there was no change in piperacillin-tazobactam, cefepime/ceftazidime, or carbapenem use. Hospital lengths of stay and mortality rates were unchanged in the general hospital population and were stable or improved in patients with kidney disease, liver disease, cancer, and abdominal solid-organ transplants.

Conclusions

Our findings suggest that having phlebotomists draw blood for culture almost exclusively by venipuncture resulted in decreased blood culture positivity that did not translate into harm as measured by length of stay or inpatient death even among immunocompromised hosts.
Clinical Manifestations and Seasonality of Pertussis in Azerbaijan, Iran
Authors: Mohammadzadeh Asl Yalda , Akhi Mohammad Taghi , Soroush Mohammad Hossein , Sefidan Fatemeh Yeganeh , Mousapour Jafar , Hejazi Mohammad Esmaeil , Sabbaghi Babak Ghalibaf , Sharifi Akbar , Jabari Yalda , Ghotaslou Reza
Published: November 2017

Background

Nowadays, a shift in age distribution and the increasing incidence of pertussis among adolescents and adults have been reported in the world. The aim of this study was to evaluate the prevalence, clinical characteristics, and seasonality of pertussis in Azerbaijan, Iran.

Methods

A total of 368 nasopharyngeal swabs of 184 patients were taken for culture and polymerase chain reaction (PCR). Simultaneously, 2 blood samples from 111 participants aged 12 to 70 years were obtained to perform enzyme-linked immunosorbent assay (ELISA) test. Whooping cough cases were considered as being the level of anti–pertussis toxin (anti-PT) immunoglobulin G higher than 24 IU/mL or positive culture and PCR positive.

Results

Of 184 patients, the PT gene was detected in 23.37% (43/184) by PCR test, whereas only 4.35% (8/184) by culture were positive. The overall seropositive rate of immunoglobulin G–PT was 62.16% (69/111). The highest positivity of the PCR and ELISA was detected in the age group 31 to 40 years. Paroxysmal cough (100%), inspiratory whoop (63.6%), and posttussive vomiting (45.5%) in children with pertussis were the most frequent symptoms reported. These symptoms in adolescents and adults were prolonged cough (100% and 94.9%, respectively) and gagging (38.5% and 30.5%, respectively).

Conclusions

The most sensitive assay for pertussis detection is the ELISA. The continuous presence of pertussis is alarming to health care professionals. Our findings suggest a high prevalence of pertussis in Azerbaijan indicates that childhood national immunization program may not provide adequate protective immunity in the population. Booster vaccination is necessary in adolescence and adulthood and development of highly efficacious pertussis vaccine.
Back to Basics
Authors: Cole Jennifer L. , Stark Jennifer E.
Published: November 2017

The procalcitonin assay is a popular tool among antimicrobial stewardship programs. There are procalcitonin algorithms and further guidance in the medical literature to aid clinicians in decision making regarding antibiotic therapy initiation and duration. Diagnostic utility of procalcitonin levels is a matter of debate and should be interpreted only in conjunction with the context of the patient's clinical picture. Researchers present a case of ambiguous procalcitonin findings along with a stepwise approach in reviewing the medical literature. Although not listed as a common cause of false-positive procalcitonin results, it was felt that advanced non–Hodgkin lymphoma coupled with worsening renal function was ultimately the cause of this patient's elevated procalcitonin levels.
Lifestyle in Visually Impaired or Blind Massage Therapists: A Preliminary Study
Authors: HUNG Shu-Ling , CHEN Mei-Fang , LIN Yu-Hua , KAO Chia-Chan , CHANG Ya-Wen , CHAN Hui-Shan
Published: November 2017

Background:

Lifestyle is among the most important factors affecting individual health status. Limited access to health information may limit the ability of people with visual impairment or blindness to practice healthy lifestyles. However, no studies have investigated how lifestyle practices affect health specifically in visually impaired and blind populations.

Purpose:

The aim of this study was to investigate the lifestyle behaviors of visually impaired and blind massage therapists (VIBMTs) in Taiwan.

Methods:

This exploratory study used a purposive sampling technique to recruit 50 VIBMTs who were employed at massage stations in southern Taiwan. All of the participants completed the Health-Promoting Lifestyle Profile II (HPLP-II) and a survey of demographic characteristics. Descriptive and inferential statistical tests, including the Mann–Whitney U test and the Kruskal–Wallis H test, were used. Statistical significance was defined as p < .05 in two-tailed tests.

Results:

Fifty participants completed both the HPLP-II and the demographic survey. The mean subscale score for the HPLP-II was 2.52 ± 0.37. The lowest scores were on the physical activity (2.09 ± 0.67) and nutrition (2.35 ± 0.39) subscales, and the highest scores were on the spiritual growth (2.89 ± 0.56) and interpersonal relations (2.79 ± 0.46) subscales. Scores on the stress management and physical activity subscales were significantly higher in men than in women (p < .05). In addition, mean HPLP-II scores were significantly higher in VIBMTs who exercised regularly compared with those who did not (p < .05). Compared with nonsmokers, current smokers had significantly higher scores on the stress management subscale (p < .05).

Conclusions/Implications for Practice:

The low physical activity scores in this population may be improved by developing physical activity programs for the home and workplace and by establishing community recreational and exercise facilities for visually impaired populations. The low scores for nutrition may be improved by establishing nutrition education programs that are designed specifically for VIBMTs to increase their consumption of fresh produce and other healthy foods and by requiring food manufacturers to use labels that may be easily read or understood by visually impaired populations.
Use of Remote Pulmonary Artery Pressure Monitoring (CardioMEMS System) in Total Artificial Heart to Assess Pulmonary Hemodynamics for Heart Transplantation
Authors: Gohar Salman , Taimeh Ziad A. , Morgan Jeffrey A. , Frazier O. H. , A. Arabia Francisco , Civitello Andrew B. , Nair Ajith P.
Published: November 2017

The temporary total artificial heart (TAH-t) has been valuable as a bridge to transplantation in patients with biventricular failure. However, the challenges of accurately assessing pulmonary vascular resistance after TAH-t implantation can preclude these patients from heart transplantation, especially those with pre-existing pulmonary hypertension. The CardioMEMS Heart Failure System (St. Jude’s Medical, Little Canada, MN) comprises a wireless pressure sensor that is implanted percutaneously in the pulmonary artery and transmits real-time measurements of pulmonary artery pressures. Systolic and diastolic pulmonary artery (PA) pressures measurements have been well correlated between the CardioMEMS PA Sensor and traditional Swan-Ganz catheter and between the CardioMEMS PA Sensor and standard echocardiography. Here, we report the use of the CardioMEMS device in a patient with severe pulmonary hypertension supported with a SynCardia TAH-t (Tucson, AZ) during assessment for candidacy for transplantation.
Characterization of the Human Pancreas Side Population as a Potential Reservoir of Adult Stem Cells
Authors: Augstein Petra , Loudovaris Thomas , Bandala-Sanchez Esther , Heinke Peter , Naselli Gaetano , Lee Lily , Hawthorne Wayne J. , Góñez L. Jorge , Neale Alana M. , Vaillant François , Thomas Helen E. , Kay Thomas W. , Banakh Ilia , Harrison Leonard C.
Published: November 2017

Objectives

The side population (SP) contains cells with stem cell/progenitor properties. Previously, we observed that the mouse pancreas SP expanded after pancreatic injury. We aimed to characterize the SP in human pancreas as a potential source of stem cells.

Methods

Human organ donor pancreata were fractionated into islets and exocrine tissue, enriched by tissue culture and dispersed into single cells. Cells were phenotyped by flow cytometry, and the SP was defined by efflux of fluorescent dye Hoechst 33342 visualized by ultraviolet excitation. Cells were flow sorted, and their colony-forming potential measured on feeder cells in culture.

Results

An SP was identified in islet and exocrine cells from human organ donors: 2 with type 1 diabetes, 3 with type 2 diabetes, and 28 without diabetes. Phenotyping revealed that exocrine SP cells had an epithelial origin, were enriched for carbohydrate antigen 19-9+ ductal cells expressing stem cell markers CD133 and CD26, and had greater colony-forming potential than non-SP cells. The exocrine SP was increased in a young adult with type 1 diabetes and ongoing islet autoimmunity.

Conclusions

The pancreatic exocrine SP is a potential reservoir of adult stem/progenitor cells, consistent with previous evidence that such cells are duct-derived and express CD133.
Use of A-scan Ultrasound and Optical Coherence Tomography to Differentiate Papilledema From Pseudopapilledema
Authors: Saenz Roberto , Cheng Han , Prager Thomas C. , Frishman Laura J. , Tang Rosa A.
Published: November 2017

SIGNIFICANCE

Differentiating papilledema from pseudopapilledema reflecting tilted/crowded optic discs or disc drusen is critical but can be challenging. Our study suggests that spectral-domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness and retrobulbar optic nerve sheath diameter (ONSD) measured by A-scan ultrasound provide useful information when differentiating the two conditions.

PURPOSE

To evaluate the use of A-scan ultrasound and spectral-domain OCT retinal nerve fiber layer thickness (RNFLT) in differentiating papilledema associated with idiopathic intracranial hypertension from pseudopapilledema.

METHODS

Retrospective cross-sectional analysis included 23 papilledema and 28 pseudopapilledema patients. Ultrasound-measured ONSD at primary gaze, percent change in ONSD at lateral gaze (30° test), and peripapillary RNFLT were analyzed. Receiver operating characteristic curves were constructed using one eye from each subject.

RESULTS

Compared with pseudopapilledema, papilledema eyes showed larger mean ONSD (5.4 ± 0.6 vs. 4.0 ± 0.3 mm, P < .0001), greater change of ONSD at lateral gaze (22.4 ± 8.4% vs. 2.8 ± 4.8%, P < .0001), and thicker retinal nerve fiber layer (219.1 ± 104.6 vs. 102.4 ± 20.1 μm, P < .0001). Optic nerve sheath diameter and 30° test had the greatest area under the receiver operating characteristic curve, 0.98 and 0.97, respectively; followed by inferior quadrant (0.90) and average RNFLT (0.87). All papilledema eyes with Frisén scale greater than grade II were accurately diagnosed by ONSD, 30° test, or OCT. In mild papilledema (Frisén scale grades I and II, n = 15), area under the receiver operating characteristic curve remained high for ONSD (0.95) and 30° test (0.93) but decreased to 0.61 to 0.71 for RNFLT. At 95% specificity, sensitivities for ONSD, 30° test, and RNFLT were 91.3%, 91.3%, and 56.5%, respectively, for the entire papilledema group and 80.0%, 86.7%, and 13.3% for the mild papilledema subgroup.

CONCLUSIONS

Retinal nerve fiber layer thickness can potentially be used to detect moderate to severe papilledema. A-scan may further assist differentiation of mild papilledema from pseudopapilledema.
The Natural History of Idiopathic Scoliosis During Growth
Authors: Di Felice Francesca , Zaina Fabio , Donzelli Sabrina , Negrini Stefano
Published: November 2017

Objective

The aim of the study was to provide a meta-analysis of current literature concerning the natural history of idiopathic scoliosis during growth.

Design

A comprehensive search of Medline, Embase, And Scopus databases was conducted up to November 2016. Eligible works were prospective or retrospective studies that enrolled patients with infantile idiopathic scoliosis, juvenile idiopathic scoliosis, or adolescent idiopathic scoliosis, followed up without any treatment from the time of detection. A meta-analysis for proportion was performed. The following studies were grouped per diagnosis: infantile idiopathic scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis.

Results

Of the 1797 citations screened, we assessed 61 full-text articles and included 13 of these (2301 participants). Three studies included infantile idiopathic scoliosis patients (347 participants), five studies included a mixed population of juvenile idiopathic scoliosis and adolescent idiopathic scoliosis (1330 participants), and five studies included adolescent idiopathic scoliosis patients only (624 participants). The random pooled estimated progression rate was 49% (95% confidence interval = 1%–97%) for infantile idiopathic scoliosis, 49% in a mixed group of patients affected by juvenile idiopathic scoliosis or adolescent idiopathic scoliosis (95% confidence interval = 19%–79%), and 42% in adolescent idiopathic scoliosis (95% confidence interval = 11%–73%).

Conclusions

During growth, idiopathic scoliosis tends to progress in a high percentage of cases. The progression rate varies according to the age at diagnosis, with infantile scoliosis being the most unpredictable. There are many confounders, such as age, Risser sign and baseline Cobb angles that were not consistent among studies, making the data very heterogeneous.
Alignment Strategy for Constricted Maxillary Dental Arch in Patients With Unilateral Cleft Lip and Palate Using Fixed Orthodontic Appliance
Authors: Park Yoon-Hee , Park Sumin , Baek Seung-Hak
Published: November 2017

The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P < 0.05). Although Group 2 showed more constriction and asymmetry in the maxillary dental arch compared to Group 1 at the T1 stage (inter-second premolar width, greater segment angle [GSA], and lesser segment angle [LSA], all P < 0.05), these problems could be effectively resolved by FOT. As a result, at the stage T2, there was no significant difference in all the variables between the 2 groups. During T1-T2, there was a different pattern in change of variables between Groups 1 and 2 (anterior segment angle in the greater segment [P < 0.05] in Group 1 and U1-SN [P < 0.01], inter-molar width [P < 0.05], GSA [P < 0.05[, and LSA [P < 0.01] in Group 2). Therefore, according to the maxillary dental arch shape, different strategy is necessary to obtain proper alignment by FOT.
Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures
Authors: Asemota Anthony , Santiago Gabriel F. , Zhong Susan , Gordon Chad R.
Published: November 2017

Purpose:

Temporal hollowing deformity (THD) is a visible concavity/convexity in the temporal fossa; a complication often seen following neurosurgical/craniofacial procedures. Although numerous techniques have been described, no study to date has shown the healthcare costs associated with temporal hollowing correction surgery. Thus, the purpose here is to compare and contrast the direct costs related to temporal cranioplasty using various methods including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, prebent, modified titanium mesh implants, and customized cranial implants (CCIs) with dual-purpose design. Understanding the financial implications related to this frequently encountered complication will help to motivate surgeons/healthcare facilities to better prevent and manage THD.

Methods:

This is a single-surgeon, single-institution retrospective review of 23 THD patients randomly selected from between 2008 and 2015. Cost analysis variables include length of hospital stay, facility/professional fees, implant material fees, payer information, reimbursement rate, and net revenue.

Results:

Of the 23 patients, ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with screw fixation. Total facility and/or professional charges ranged from $1978.00 to $126478.00. Average total facility charges per patient with dual-purpose CCIs were $34775.89 (SD ± $22205.09) versus $35826.00 (SD ± $23509.93) for modified titanium mesh implants and $46547.90 (SD ± 81061.70) for liquid PMMA implants with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not differ between implant types (P = 0.387).

Conclusion:

Temporal hollowing deformity is an expensive complication post-neurosurgery, and in the most severe form, requires a revision surgery for definitive correction. Therefore, surgeons should take further initiatives to employ reconstructive methods capable of minimizing risk for costly revision surgery, reducing morbidity related to visible deformity and accompanying social stigmata, and improving overall patient satisfaction.
Cone Beam Computed Tomography Assessment of Accessory Infraorbital Foramen and Determination of Infraorbital Foramen Position
Authors: Ali Ibrahim K. , Sansare Kaustubh , Karjodkar Freny R. , Salve Prashant
Published: November 2017

There is no evidence about evaluating accessory infraorbital foramen by 3-dimensional analysis like multi slice computed tomography or cone beam computed tomography (CBCT) in human subjects. To authors’ best knowledge this is a first study to assess the accessory infraorbital foramen and position of infraorbital foramen in relation to crown of maxillary teeth using CBCT. This study primarily aimed to assess the location and number of accessory infraorbital foramen (AIOF), to measure the distance between main infraorbital foramen and AIOF and secondarily to determine the position of infraorbital foramen in relation to crowns of maxillary second premolar, first molar, and second molar. Cone beam computed tomography volumes of 200 patients were retrieved from the digital imaging and communications in medicine archive folder. Accessory infraorbital foramen was recognized in 29% of the patients among whom 46.6% were present on the right side, 31% on the left side, and 22.4% located bilaterally. The most frequent position of infraorbital foramen was found to be in line with crown of second premolar. The presence of AIOF and inability to recognize it in preoperative evaluation could be considered among the other reasons of failure or incomplete anesthesia.
Relationship Between Sensory Dysfunction and Walking Speed in Patients With Clinically Isolated Syndrome
Authors: Krbot Skorić Magdalena , Crnošija Luka , Gabelić Tereza , Adamec Ivan , Habek Mario
Published: November 2017

Purpose:

The aim of this study was to investigate a relationship between sensory dysfunction examined with somatosensory-evoked potentials of the posterior tibial nerve (tSSEP) and walking speed in patients with clinically isolated syndrome.

Methods:

In 120 patients (mean age 32.2 ± 8.7 years, 84 females), Expanded Disability Status Scale (EDSS), timed 25-foot walk test (T25FW), brain and spinal cord MRI, and tSSEP were performed. P40 latencies and N22a-P40 interlatencies were analyzed, and the z-score for each latency was calculated and combined into total tSSEP z-score.

Results:

T25FW significantly correlated with total tSSEP z-score (rs = 0.211; P = 0.021). When looking at each component of the tSSEP separately, T25FW significantly correlated with z-scores of P40 wave latencies (rs = 0.223; P = 0.014) and N22a-P40 interlatencies (rs = 0.241; P = 0.008) of the left side. There were no significant correlations with N22a wave latencies. Patients who presented with transverse myelitis (N = 41) and patients who had spinal cord lesions on MRI (N = 53) had significantly higher total tSSEP z-score compared with other patients (0.07 vs. −0.28, P = 0.019 and −0.02 vs. −0.38 P = 0.023; respectively). Somatosensory-evoked potentials of the posterior tibial nerve z-score corrected for age, sex, cervical spinal cord MRI lesions, and total number of supratentorial T2 lesions was a statistically significant predictor for T25FW (B = 0.267, P = 0.023).

Conclusions:

Spinal somatosensory dysfunction is one of the factors associated with reduction in walking speed in early patients with multiple sclerosis. Somatosensory-evoked potentials of the posterior tibial nerve may potentially be useful in identifying patients at higher risk for the development of walking impairment in the future.
Reduced tubular degradation of glomerular filtered plasma albumin is a common feature in acute and chronic kidney disease
Authors: Han Yingjie , Ly Nguyen D K , Tesch Greg H , Poronnik Philip , Nikolic‐Paterson David J
Published: November 2017

Tubular epithelial cells take up and degrade plasma albumin filtered by the glomerulus. Tubular damage resulting in reduced albumin uptake or degradation has been suggested as one mechanism contributing to albuminuria in kidney disease. This study investigated whether tubular albumin uptake or degradation is altered in acute and chronic glomerular disease. Mouse models of acute glomerular injury (anti‐GBM disease and LPS‐induced albuminuria) and chronic disease (streptozotocin‐induced diabetes and db/db mice) were examined. Mice were injected intravenously with Alexa‐albumin plus DQ‐albumin and killed 20 minutes later. Tubular uptake of albumin (Alexa‐albumin) and albumin degradation (Dye Quenched (DQ)‐albumin) was assessed in tissue sections via confocal microscopy. Tubular uptake of Alexa‐albumin in the models of diabetic nephropathy was not different to normal mice. However, the fluorescence signal resulting from degradation of DQ‐albumin was significantly reduced in db/db mice, and the ratio of degraded to intact albumin was reduced in both models. The ratio of degraded to intact albumin in tubules was also reduced in the anti‐GBM model. In the LPS model, both tubular uptake and degradation of albumin were significantly reduced, with a substantial reduction in the ratio of degraded to intact albumin in tubules. LPS stimulation of cultured tubular epithelial cells inhibited albumin uptake, indicating a direct role for LPS in modifying tubular handling of albumin. In conclusion, reduced degradation of filtered albumin in the proximal tubule is a common feature of glomerular diseases. This may be a general mechanism whereby tubular dysfunction contributes to the development of albuminuria.
Trehalose, a temperature‐ and salt‐induced solute with implications in pathobiology of Acinetobacter baumannii
Authors: Zeidler Sabine , Hubloher Josephine , Schabacker Kim , Lamosa Pedro , Santos Helena , Müller Volker
Published: November 2017

Acinetobacter baumannii is an opportunistic human pathogen that has become a global threat to healthcare institutions worldwide. A major factor contributing to success of this bacterium is its outstanding ability to survive on dry surfaces. The molecular basis for desiccation resistance is not completely understood. This study focused on growth under osmotic stress and aimed to identify the pool of compatible solutes synthesized in response to these low water activity conditions. A. baumannii produced mannitol as compatible solute, but in contrast to Acinetobacter baylyi, also trehalose was accumulated in response to increasing NaCl concentrations. The genome of A. baumannii encodes a trehalose‐6‐phosphate phosphatase (OtsB) and a trehalose‐6‐phosphate synthase (OtsA). Deletion of otsB abolished trehalose formation, demonstrating that otsB is essential for trehalose biosynthesis. Growth of the mutant was neither impaired at low salt nor at 500 mM NaCl, but it did not grow at high temperatures, indicating a dual function of trehalose in osmo‐ and thermoprotection. This led us to analyse temperature dependence of trehalose formation. Indeed, expression of otsB was not only induced by high osmolarity but also by high temperature. Concurrently, trehalose was accumulated in cells grown at high temperature. Taken together, these data point to an important role of trehalose in A. baumannii beyond osmoprotection.
Characterization of the toxin Plx2A, a RhoA‐targeting ADP‐ribosyltransferase produced by the honey bee pathogen Paenibacillus larvae
Authors: Ebeling Julia , Fünfhaus Anne , Knispel Henriette , Krska Daniel , Ravulapalli Ravikiran , Heney Kayla A. , Lugo Miguel R. , Merrill A. Rod , Genersch Elke
Published: November 2017

The toxin Plx2A is an important virulence factor of Paenibacillus larvae, the etiological agent of American Foulbrood, the most destructive bacterial disease of honey bees. Biochemical and functional analyses as well as the crystal structure of Plx2A revealed that it belongs to the C3 mono‐ADP‐ribosylating toxin subgroup. RhoA was identified as the cellular target of Plx2A activity. The kinetic parameters (KM, kcat) were established for both the transferase and glycohydrolase reactions. When expressed in yeast, Plx2A was cytotoxic for eukaryotic cells and catalytic variants confirmed that the cytotoxicity of Plx2A depends on its enzymatic activity. The crystal structure of Plx2A was solved to 1.65 Å and confirmed that it is a C3‐like toxin, although with a new molecular twist, it has a B‐domain. A molecular model of the ‘active’ enzyme conformation in complex with NAD+ was produced by computational methods based on the recent structure of C3bot1 with RhoA. In murine macrophages, Plx2A induced actin cytoskeleton reorganization while in insect cells, vacuolization and the occurrence of bi‐nucleated cells was observed. The latter is indicative of an inhibition of cytokinesis. All these cellular effects are consistent with Plx2A inhibiting the activity of RhoA by covalent modification.
Inhibiting bacterial quorum sensing arrests coral disease development and disease‐associated microbes
Authors: Certner Rebecca H. , Vollmer Steven V.
Published: November 2017

Among the greatest threats to coral reefs are coral epizootics, which are increasing in frequency and severity across many reef ecosystems. In particular, white band disease (WBD) has devastated Caribbean acroporid populations since its initial outbreak in 1979. However, despite its widespread and damaging effects, the aetiology of WBD remains largely unresolved. Here, we examine the role of quorum sensing within bacterial communities associated with WBD‐infected Acropora cervicornis. Microbial communities isolated from WBD‐infected corals were exposed to quorum sensing inhibitor (QSI) – a N‐acyl homoserine lactone autoinducer antagonist – and then dosed onto healthy test corals. WBD‐associated bacteria supplemented with QSI lost the ability to establish disease, while healthy corals exposed to uninhibited WBD bacterial communities became infected within two days. Microbial 16S rRNA metagenomic sequencing analyses were then used to identify shifts in bacterial communities due to QSI exposure on WBD‐associated bacterial communities. Our results demonstrated that Vibrionaceae and Flavobacteriaceae abundances were strongly inhibited by the addition of QSI to WBD‐infected corals, whereas putative coral symbiont Endozoicomonas and Halomonadaceae abundances decrease dramatically in diseased corals.
Sympatric kelp species share a large portion of their surface bacterial communities
Authors: Lemay Matthew A. , Martone Patrick T. , Keeling Patrick J. , Burt Jenn M. , Krumhansl Kira A. , Sanders Rhea D. , Wegener Parfrey Laura
Published: November 2017

Kelp forest ecosystems are biodiversity hotspots, providing habitat for dense assemblages of marine organisms and nutrients for marine and terrestrial food webs. The surfaces of kelps support diverse microbial communities that facilitate the transfer of carbon from algal primary production to higher trophic levels. We quantified the diversity of bacteria on the surfaces of eight sympatric kelp species from four sites in British Columbia. Kelp‐associated bacterial communities are significantly different from their environment, even though 86% of their bacterial taxa are shared with seawater and 97% are shared with rocky substrate. This differentiation is driven by differences in relative abundance of the bacterial taxa present. Similarly, a large portion of bacterial taxa (37%) is shared among all eight kelp species, yet differential abundance of bacterial taxa underlies differences in community structure among species. Kelp‐associated bacterial diversity does not track host phylogeny; instead bacterial community composition is correlated with the life‐history strategy of the host, with annual and perennial kelps supporting divergent bacterial communities. These data provide the first community‐scale investigation of kelp forest‐associated bacterial diversity. More broadly, this study provides insight into mechanisms that may structure bacterial communities among closely related sympatric host species.
Obligate sugar oxidation in Mesotoga spp., phylum Thermotogae, in the presence of either elemental sulfur or hydrogenotrophic sulfate‐reducers as electron acceptor
Authors: Fadhlaoui Khaled , Ben Hania Wagdi , Armougom Fabrice , Bartoli Manon , Fardeau Marie‐Laure , Erauso Gaël , Brasseur Gaël , Aubert Corinne , Hamdi Moktar , Brochier‐Armanet Céline , Dolla Alain , Ollivier Bernard
Published: November 2017

Mesotoga prima strain PhosAc3 is a mesophilic representative of the phylum Thermotogae comprising only fermentative bacteria so far. We show that while unable to ferment glucose, this bacterium is able to couple its oxidation to reduction of elemental sulfur. We demonstrate furthermore that M. prima strain PhosAc3 as well as M. prima strain MesG1 and Mesotoga infera are able to grow in syntrophic association with sulfate‐reducing bacteria (SRB) acting as hydrogen scavengers through interspecies hydrogen transfer. Hydrogen production was higher in M. prima strain PhosAc3 cells co‐cultured with SRB than in cells cultured alone in the presence of elemental sulfur. We propose that the efficient sugar‐oxidizing metabolism by M. prima strain PhosAc3 in syntrophic association with a hydrogenotrophic sulfate‐reducing bacterium can be extrapolated to all members of the Mesotoga genus. Genome comparison of Thermotogae members suggests that the metabolic difference between Mesotoga and Thermotoga species (sugar oxidation versus fermentation) is mainly due to the absence of the bifurcating [FeFe]‐hydrogenase in the former. Such an obligate oxidative process for using sugars, unusual within prokaryotes, is the first reported within the Thermotogae. It is hypothesized to be of primary ecological importance for growth of Mesotoga spp. in the environments that they inhabit.
Reality or Illusion? The Efficacy of Non‐market Strategy in Institutional Risk Reduction
Authors: Liedong Tahiru Azaaviele , Rajwani Tazeeb , Mellahi Kamel
Published: November 2017

Non‐market strategy researchers have postulated that political and social strategies reduce the exposure of firms to risk, but those arguments have received little empirical attention. In this paper, we integrate social capital and institutional theories to examine the efficacy of managerial political ties (MPTs) and corporate social responsibility (CSR) in institutional risk reduction. Using survey data from 179 firms in Ghana we find that, whereas CSR reduces institutional risk exposure, MPTs do not. We also find that the effect of MPTs on risk exposure is moderated by public affairs functions. Contrary to extant literature, we do not find evidence of complementarity between MPTs and CSR. Altogether, the findings not only show that the proposed efficacy of MPTs in risk reduction is illusive, but they also signal the need for scrutinizing the harmony between non‐market political and social strategies.
Characterization of Whole Grain Pasta: Integrating Physical, Chemical, Molecular, and Instrumental Sensory Approaches
Authors: Marti Alessandra , Cattaneo Stefano , Benedetti Simona , Buratti Susanna , Abbasi Parizad Parisa , Masotti Fabio , Iametti Stefania , Pagani Maria Ambrogina
Published: November 2017

The consumption of whole‐grain food—including pasta—has been increasing steadily. In the case of whole‐grain pasta, given the many different producers, it seems important to have some objective parameters to define its overall quality. In this study, commercial whole‐grain pasta samples representative of the Italian market have been characterized from both molecular and electronic‐senses (electronic nose and electronic tongue) standpoint in order to provide a survey of the properties of different commercial samples. Only 1 pasta product showed very low levels of heat damage markers (furosine and pyrraline), suggesting that this sample underwent to low temperature dry treatment. In all samples, the furosine content was directly correlated to protein structural indices, since protein structure compactness increased with increasing levels of heat damage markers. Electronic senses were able to discriminate among pasta samples according to the intensity of heat treatment during the drying step. Pasta sample with low furosine content was discriminated by umami taste and by sensors responding to aliphatic and inorganic compounds. Data obtained with this multidisciplinary approach are meant to provide hints for identifying useful indices for pasta quality.

Practical Application

As observed for semolina pasta, objective parameters based on heat‐damage were best suited to define the overall quality of wholegrain pasta, almost independently of compositional differences among commercial samples. Drying treatments of different intensity also had an impact on instrumental sensory traits that may provide a reliable alternative to analytical determination of chemical markers of heat damage in all cases where there is a need for avoiding time‐consuming procedures.
Encapsulation of Lactobacillus casei into Calcium Pectinate‐Chitosan Beads for Enteric Delivery
Authors: Bepeyeva Aigerim , de Barros Joao M.S. , Albadran Hanady , Kakimov Aitbek K. , Kakimova Zhaynagul Kh. , Charalampopoulos Dimitris , Khutoryanskiy Vitaliy V.
Published: November 2017

Gel beads were prepared by extrusion of various types of pectin into 0.15 M calcium chloride. Size, morphology, and textural properties of 3 types of beads were evaluated and it was established that the use of 3 w/v % amidated pectin provides the optimal characteristics suitable for encapsulation of live bacteria. Lactobacillus casei NCIMB 30185 (PXN37) was encapsulated into calcium pectinate gel through the extrusion of a live bacteria dispersion in 3 w/v % pectin into a solution of calcium chloride. The capsules were then additionally coated with chitosan. The viability of bacteria within these capsules was studied under model gastrointestinal conditions in vitro (simulated gastric and intestinal juices). It was established that pectin‐chitosan capsules can provide protection to L. casei from the gastric acid and result in high levels of viable bacteria released in the intestine.

Practical Application

Encapsulation of Lactobacillus casei into calcium pectinate beads coated with chitosan provided capsules capable of delivering live probiotic bacteria into the intestine.
Untargeted antifungal therapy in adult patients with complicated intra‐abdominal infection: a systematic review
Authors: Petersen M. W. , Perner A. , Ravn F. , Sjövall F. , Møller M. H.
Published: November 2017

Background

Systematic reviews comparing untargeted antifungal treatment with placebo or no treatment in critically ill patients have provided conflicting results. We aimed to assess patient‐important benefits and harms of untargeted antifungal therapy vs. placebo or no treatment in adult patients with complicated intra‐abdominal infection.

Methods

We conducted a systematic review with meta‐analysis and trial sequential analysis of randomised clinical trials assessing untargeted antifungal therapy compared to placebo or no treatment in adults with complicated intra‐abdominal infection. We used the Cochrane and GRADE methodologies and exclusively assessed patient‐important outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias. We performed conventional meta‐analyses, including sensitivity and subgroup analyses, and trial sequential analysis to assess the risk of random errors and to estimate trial sequential analysis adjusted confidence intervals.

Results

We included six trials (1,067 patients) in the review, and four trials reported data on the predefined outcome measures and were included in the meta‐analysis. Three of the four trials had high risk of bias. We observed no statistically significant difference in mortality (relative risk 0.58, 95% confidence interval 0.24–1.39) or in any of the other patient‐important outcomes between untargeted antifungal treatment and placebo or no treatment (low/very low quality of evidence). Trial sequential analysis demonstrated lack of data and high risk of random errors.

Conclusions

The quantity and quality of evidence supporting untargeted antifungal treatment in adult patients with complicated intra‐abdominal infection are low to very low with no firm evidence for benefit or harm.
Combined transcatheter arterial chemoembolization and radiofrequency ablation in single‐session for solitary hepatocellular carcinoma larger than 7 cm
Authors: Yan Jie‐Yu , Zhang Jin‐Long , Wang Mao‐Qiang , Yuan Kai , Bai Yan‐Hua , Wang Yan , Xin Hai‐Nan , Wang Zhi‐Jun , Liu Feng‐Yong , Duan Feng , Fu Jin‐Xin
Published: November 2017

Aims

To evaluate technical feasibility and treatment results of combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in single‐session for solitary hepatocellular carcinoma (HCC) larger than 7 cm in diameter.

Methods

Institutional review board approved this retrospective study. Written informed consent was obtained from all patients. Between June 2007 and July 2013, 87 patients (75 men, 12 women; mean age, 55.5 years ± 15.0) with solitary HCC with a mean maximum diameter of 9.5 cm ± 2.4 (range, 7.1–13.5 cm) not feasible for surgical resection underwent combined TACE and RFA in a single‐session. Immediately following TACE, RFA was performed under fluoroscopy and CB‐CT guidance. The primary endpoint was overall survival (OS). The secondary endpoints were technical safety and local tumor progression (LTP) rates. OS and time to progression (TTP) were analyzed with the Kaplan–Meier method. Univariate and multivariate analyses were performed to identify prognostic factors affecting OS and TTP.

Results

Technical success of combined TACE and RFA in a single‐session was achieved in all patients (100%). On 1‐month follow‐up MRI, complete response (CR) was observed in 76 of 87 patients (87.4 %), partial response (PR) in 8 and stable disease (SD) in 3 patients. The median follow‐up period was 49.5 months (interquartile range, 30.0–70.0 months). The median OS was 39 months (range, 15–86 months). The cumulative OS rates at 1, 3 and 5 years were 100%, 65.5% and 47.5%, respectively. The estimated 1, 3 and 5 year LTP rates were 0 %, 29.9% and 55.2 %, respectively. Univariate and multivariate analyses showed a tumor larger than 10.0 cm (P < 0.05) and presence of portal vein branch invasion (P < 0.05) led to the worst prognosis. No major complications were noted.

Conclusions

Combined use of TACE and RFA in single‐session is a safe and effective option in the treatment of patients with solitary large HCC (> 7 cm) not amenable to surgery.
Loperamide cardiotoxicity: “A Brief Review”
Authors: Akel Tamer , Bekheit Soad
Published: November 2017

Loperamide is a popular antidiarrheal medication that has been used for many years. It is currently gaining more attention among healthcare professionals due to its increasing potential for side effects. At present, it is considered safe enough to be sold over the counter. In contrast with other opioid agonists, loperamide is a peripherally acting μ‐receptor agonist exerting its effects mainly on the myenteric plexus of the gastrointestinal longitudinal muscle layer. It decreases peristalsis and fluid secretion resulting in longer gastrointestinal transit time. The bioavailability of the drug is extremely low. Moreover, it is actively excluded from the central nervous system; hence, it lacks the central effects of euphoria and analgesia at the recommended dosages. Loperamide abuse has been steadily increasing in the United States. Abusers typically ingest high doses in desire to achieve a satisfactory central nervous system drug penetration. This has made it a potential over the counter substitute for self‐treating opioid withdrawal symptoms and achieving euphoric effects.
Lower risk of pelvic metalware infection with operative repair of concurrent bladder rupture
Authors: Yao Henry H.‐I. , Esser Max , Grummet Jeremy , Atkins Chris , Royce Peter , Hanegbi Uri
Published: November 2017

Background

Patients with traumatic bladder rupture frequently have associated pelvic fracture. With increasing numbers of pelvic fractures fixed internally, there are concerns that conservative management of bladder rupture may increase the risk of pelvic metalware infection. This study aims to determine if operative repair of bladder rupture in comparison to conservative management with catheter drainage alone is associated with a lower rate of infection of internal fixation device for concurrent pelvic fracture.

Methods

This is a retrospective cohort study of level IV evidence. From July 2001 through June 2013, 45 multi‐trauma patients at a level 1 trauma centre were identified to have sustained bladder rupture with concurrent pelvic fracture requiring internal fixation. Clinicopathological data were extracted from the TraumaNET database, medical records and health‐coding database. Patients were stratified into two retrospective cohorts, management with surgical repair and management with catheter drainage alone. Fischer's exact test was used to determine whether the rate of pelvic metalware infection was different in the two cohorts.

Results

Of the 45 patients, 13 had intraperitoneal bladder rupture, 28 had extraperitoneal bladder rupture and four had combined intra‐extraperitoneal bladder rupture. The median age for this cohort was 31. Bladder rupture was surgically repaired in 36 patients and managed conservatively with catheter drainage in nine patients. The rate of pelvic internal fixation device infection was lower in patients managed with surgical repair compared with conservative management (5.6% versus 33.3%, P = 0.047).

Conclusion

Operative repair of bladder rupture is associated with a lower rate of pelvic orthopaedic hardware infection in the presence of concurrent pelvic fracture requiring internal fixation.
GROWTH HORMONE IN HUMAN PREGNANCY
Authors: Eriksson Leif
Published: November 2017

Growth hormone (GH) concentrations in serum were recorded in healthy women at different stages of normal pregnancy. Using a non‐thrombogenic venous catheter and a portable pump, blood samples were collected at 30 min intervals for a period of 24 h. Growth hormone serum profiles were also established in non‐pregnant women, women undergoing legal abortion and cesarean section and during spontaneous labor. A dramatic change in growth hormone secretion was demonstrated during late pregnancy when compared with the non‐pregnant state. The pulsatile pattern, with intermittent high peaks and low or undetectable levels between peaks, characteristic of normal men and non‐pregnant women, was completely suppressed. During late pregnancy, all investigated women evidenced increased, very stable serum levels of GH and there was no evidence of pulsatile activity. Two monoclonal antibodies directed against different epitopes on the GH‐molecule were used in radio‐immunoassays to distinguish the pituitary 22K‐GH from other circulating GH variants. During the second half of pregnancy, a continuous secretion of a new placental GH variant and a concommitant suppression of the pulsatile pituitary GH secretion was demonstrated. The progressive transformation of GH secretion from a pulsatile into a stable, continuous pattern started at the end of the first trimester. After placental removal at cesarean section in late pregnancy there was a rapid fall in serum GH concentration, whereas levels were unaffected after legal abortion in the first trimester. These results and simultaneous measurements of hPL and hCG support the concept that a placental GH variant is produced during pregnancy. Studies on the diurnal variations of thyrotropin, prolactin and cortisol indicate that human pregnancy is associated with selective alterations in the secretion of pituitary hormones.

The biological impact of continuous GH secretion was elucidated in two experimental systems in the rat. The pregnancy‐associated murine protein‐1 (PAMP‐1) in rodents was previously believed to be regulated by sex steroids. However, a continuous infusion of hGH was found to increase the plasma concentration of PAMP‐1 in non‐pregnant, hypophysectomized female rats. On the other hand, intermittent hGH administration or estrogen treatment had no effect on this seemingly ‘steroid‐sensitive’ protein. Steroid sulfatase activity in rat liver microsomes is another sexually differentiated function. Likewise, this system was found to be regulated by the mode of GH administration. A continuous GH secretion during human pregnancy can alter maternal liver metabolism and have important implications for the physiological adjustment to gestation.