bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid heuristic for the location‐inventory‐routing problem in closed‐loop supply chain
Authors: Yuchi Qunli , Wang Nengmin , He Zhengwen , Chen Haoxun
Published: December 2018

This study examines a location‐inventory‐routing problem in a closed‐loop supply chain (LIRP‐CL) that considers random demands, as well as random returns, from customers. In reality, some of the returned products can be remanufactured as new products, and they share the same channel with new products. This practice renders previous models no longer appropriate. We consider this practice in this paper and build a new LIRP‐CL system. To minimize the total costs of the system, this paper determines the locations of distribution centers and remanufacturing centers, the inventory level of the system, and the delivery routes from distribution centers to customers and from customers to remanufacturing centers. A mixed integer nonlinear model was developed to solve this problem. To solve the model, a novel hybrid heuristic algorithm based on tabu search and simulated annealing is proposed. The computational results and sensitivity analysis are presented. In addition, some managerial insights are proposed.
Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study
Authors: Barakat‐Johnson Michelle , Lai Michelle , Gefen Amit , Coyer Fiona
Published: December 2018

This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post‐test design with a historical control group was used in a 54‐bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty‐four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger‐scale study.
The mediating effect of coping styles and self‐efficacy between perceived stress and satisfaction with QOL in Chinese adolescents with type 1 diabetes
Authors: Yang Jundi , Guo Jia , Tang Yujia , Huang Lingling , Wiley James , Zhou Zhiguang , Whittemore Robin
Published: December 2018

Aims

(a) To explore the effect of perceived stress on satisfaction with quality of life (QOL) among Chinese adolescents with type 1 diabetes (T1D); and (b) to determine if coping styles and self‐efficacy are mediators of the association between perceived stress and satisfaction with QOL.

Background

Adolescents with T1D experience ongoing stress related to a complex treatment regimen and live with a condition that differentiates them from their peers. It is important to know how adolescents with T1D cope with the stress and what psychosocial attributes contribute to satisfaction with QOL.

Design

Cross‐sectional study.

Methods

Data were collected from a sample of adolescents with T1D (N = 90) who had enrolled in a randomized control trial (baseline data) and a supplemental sample of N = 59 adolescents with T1D was recruited from a diabetes clinic from January 2016 ‐ December 2016.

Results

The mean age of the participants was 13.91 years (range 8–20 years), the mean diabetes duration was 4.02 years. Approximately one‐quarter of the sample exceeded the criterion score for perceived stress of 26, indicating stress sufficient to have a negative impact on physical and mental health. Adolescents with increased stress reported lower satisfaction with QOL compared with adolescents with less stress. Both externalization coping and self‐efficacy were the mediators of the relationship between perceived stress and satisfaction with QOL.

Conclusions

Many Chinese adolescents with T1D reported elevated stress levels which was associated with decreased satisfaction with QOL. There is a need for culturally relevant interventions to improve coping by limiting the use of externalized coping styles and strengthening self‐efficacy.
Body mass index and the risk of acute pancreatitis by etiology: A prospective analysis of Korean National Screening Cohort
Authors: Choi Ja Sung , Yi Sang‐Wook , Park Jin Woo , Lee Sangheun , Jeong Seok‐Hoo , Yi Jee‐Jeon , Han Ki Jun
Published: December 2018

Background

It is unclear whether obesity increases the incidence of acute pancreatitis (AP) in the general population. Further, no study has prospectively examined the associations of the risk of AP by etiology with measured body mass index (BMI) values.

Methods

A total of 512 928 Korean participants in routine health examinations during 2002–2003 were followed up until 2013 via linkage to national hospital discharge records to assess AP incidence. Multivariable‐adjusted hazard ratios were calculated using BMI measurements.

Results

During 10.5 mean years of follow‐up, 1656 persons developed AP (337 gallstone related and 1319 non‐gallstone related). Nonlinear associations were found: U‐curves for total and non‐gallstone‐related AP and a reverse L‐curve for gallstone‐related AP. Each 5 kg/m2 increment in BMI increased gallstone‐related AP by 123% (95% confidence interval = 48–234%) and non‐gallstone‐related AP by 42% (9–84%) in the range ≥ 25 kg/m2 (Pheterogeneity = 0.068). Obese persons had a doubled risk of gallstone‐related AP compared with normal‐weight persons. In the range < 25 kg/m2, BMI had inverse association with non‐gallstone‐related AP but no association with gallstone‐related AP (Pheterogeneity < 0.001). In subgroup analyses, for non‐gallstone‐related AP, hazard ratios per each 5 kg/m2 BMI increment were 0.50 (men), 0.73 (women), 0.46 (alcohol drinkers), 0.69 (alcohol non‐drinkers), 0.43 (ever smokers), and 0.73 (never smokers).

Conclusions

Gallstone‐related AP and non‐gallstone‐related AP have different nonlinear associations with BMI. Higher BMI increases the risk of both gallstone‐related AP and non‐gallstone‐related AP but more strongly for gallstone‐related AP. For non‐gallstone‐related AP, in the range < 25 kg/m2, BMI has inverse associations that were stronger in men, current alcohol drinkers, and ever smokers than in their counterparts.
Transitional care for patients with surgical pediatric hepatobiliary disease: Choledochal cysts and biliary atresia
Authors: Aspelund Gudrun , Mahdi Elaa M , Rothstein David H , Wakeman Derek S ,   on behalf of the American Academy of Pediatrics Section on Surgery's Delivery of Surgical Care Committee
Published: December 2018

Choledochal cysts (CDCs) and biliary atresia (BA) are rare pediatric hepatobiliary anomalies that require surgical intervention due to increased risk of malignancy and liver failure, respectively. The underlying disease and operative procedures place patients at risk for long‐term complications, which may continue to affect them into adulthood. Lack of a transitional care model in the health‐care system potentiates the challenges they will face following aging out of their pediatric providers' care. We sought to elucidate the long‐term complications and challenges patients with CDCs and BA face, review the current literature regarding transitioning care, and propose guidelines aiding adult providers in continued care and surveillance of these patients. A literature review was performed to assess short‐term and long‐term complications after surgery and the current standards for transitioning care in patients with a history of CDCs and BA. While transitional programs exist for patients with other gastrointestinal diseases, there are few that focus on CDCs or BA. Generally, authors encourage medical record transmission from pediatric to adult providers, ensuring accuracy of information and compliance with treatment plans. Patients with CDCs are at risk for developing biliary malignancies, cholangitis, and anastomotic strictures after resection. Patients with BA develop progressive liver failure, necessitating transplantation. There are no consensus guidelines regarding timing of follow up for these patients. Based on the best available evidence, we propose a schema for long‐term surveillance.
Expression of genes related to liver fatty acid metabolism in fat‐tailed and thin‐tailed lambs during negative and positive energy balances
Authors: Zakariapour Bahnamiri Hossein , Ganjkhanlou Mahdi , Zali Abolfazl , Sadeghi Mostafa , Moradi Shahrbabak Hossein , Nehzati Paghaleh Gholam Ali
Published: December 2018

Fat‐tailed sheep breeds can tolerate periods of negative energy balance without suffering from elevated concentration of plasma non‐esterified fatty acid (NEFA). This ability was attributed to unique metabolism of fat‐tailed adipose depot, whereas role of liver as an influential organ in fatty acid metabolism was not evaluated yet. Hence, current study was conducted to evaluate the effects of negative and positive energy balances on liver expression of genes related to fatty acid metabolism in fat‐tailed and thin‐tailed lambs. Lambs experienced negative (21 days) and positive (21 days) energy balances and were slaughtered at the beginning and end of negative energy balance and at the end of positive energy balance. Real‐time quantitative polymerase chain reaction (RT‐Q‐PCR) was conducted to evaluate changes in gene expression. Expression of diglyceride acyltransferase 1 (DGAT1), 3‐hydroxy‐3‐methylglutaryl‐CoA synthase 2 (HMGCS2) and apolipoprotein B (APOB) was not affected by genotype, energy balance and their interaction. Expression of carnitine palmitoyltransferase 1 (CPT1) was significantly higher in liver of fat‐tailed comparing to thin‐tailed lambs regardless of energy balance (p < 0.02). Catalase mRNA abundance was increased in response to negative energy balance (p < 0.02), and severity of this enhancement was higher in fat‐tailed lambs (p < 0.06). Expression of CPT1 was positively correlated with expression of HMGCS2 in both fat‐tailed (p < 0.05) and thin‐tailed lambs (p < 0.002); however, the correlation was weaker in fat‐tailed lambs (0.72 vs. 0.57, respectively, for thin‐tailed and fat‐tailed lambs). There was a positive correlation between DGAT1 and APOB genes expression in fat‐tailed lambs (0.94; p < 0.001), whereas this correlation was not observed in thin‐tailed lambs. Results demonstrate that liver of fat‐tailed lambs has higher capacity for metabolism of mobilized NEFA exposed to liver during negative energy balance.
Factor Structure, Validity, and Reliability of the Japanese Version of the Balanced Index of Psychological Mindedness (BIPM)
Authors: Takagishi Yukihiro
Published: December 2018

This study examined the measurement properties of the Balanced Index of Psychological Mindedness (BIPM) among the Japanese population. Exploratory factor analysis was conducted to examine the factor structure of the BIPM (Study 1) among 464 university students, and confirmatory factor analysis examined the validity and reliability of the BIPM (Study 2) among 321 university students. Additionally, the mitigation effect of psychological mindedness (PM) for depressive symptoms was examined. The results showed a two‐factor structure (Interest and Insight) similar to the original BIPM. The BIPM was negatively correlated with the alexithymia score and positively correlated with the Psychological Mindedness Scale and Openness. It was also significantly correlated with future depressive symptoms. The BIPM is useful for measuring PM in the Japanese population. Additionally, this study suggests clinical applications of PM in psychotherapy and the treatment effect mechanism of cognitive behavioral therapy.
Greater focus on water pools may improve our ability to understand and anticipate drought‐induced mortality in plants
Authors: Martinez‐Vilalta Jordi , Anderegg William R. L. , Sapes Gerard , Sala Anna
Published: December 2018

Drought‐induced tree mortality has major impacts on ecosystem carbon and water cycles, and is expected to increase in forests across the globe with climate change. A large body of research in the past decade has advanced our understanding of plant water and carbon relations under drought. However, despite intense research, we still lack generalizable, cross‐scale indicators of mortality risk. In this Viewpoint, we propose that a more explicit consideration of water pools could improve our ability to monitor and anticipate mortality risk. Specifically, we focus on the relative water content (RWC), a classic metric in plant water relations, as a potential indicator of mortality risk that is physiologically relevant and integrates different aspects related to hydraulics, stomatal responses and carbon economy under drought. Measures of plant water content are likely to have a strong mechanistic link with mortality and to be integrative, threshold‐prone and relatively easy to measure and monitor at large spatial scales, and may complement current mortality metrics based on water potential, loss of hydraulic conductivity and nonstructural carbohydrates. We discuss some of the potential advantages and limitations of these metrics to improve our capacity to monitor and predict drought‐induced tree mortality.
‘Get paid, get out’: online resistance to call centre labour in Canada
Authors: Johnston Matthew S. , Johnston Genevieve , Sanscartier Matthew D. , Ramsay Mark
Published: December 2018

This qualitative content analysis of 503 anonymous online reviews of 52 Canadian call centres posted on RateMyEmployer.ca explores how forms of resistance, alienation and emotional labour are expressed outside of the workplace. Our study finds that digital publics are producing emotive insurgencies and networks of support within marginalised communities that undermine employers’ attempts at deadening the workforce. The reviews exemplify worker awareness of exploitation as some connect these issues to broader socio‐economic factors that are beyond their control. While many offer tactics to challenge and destabilise their working conditions and culture as well as heartfelt and sarcastic warnings of what one might expect if they pursue call centre employment, others use the online space as a means of venting frustrations, eliciting empathies and expressing sentiments of hope(lessness).
Association of maternal allergy with human milk soluble CD14 and fatty acids, and early childhood atopic dermatitis
Authors: Hua Man‐Chin , Su Hui‐Min , Kuo Ming‐Ling , Chen Chien‐Chang , Yao Tsung‐Chieh , Tsai Ming‐Han , Liao Sui‐Ling , Lai Shen‐Hao , Chiu Chih‐Yung , Su Kuan‐Wen , Chen Li‐Chen , Yeh Kuo‐Wei , Huang Jing‐Long
Published: December 2018

Background

This study aimed to investigate whether maternal allergy is associated with soluble CD14 (sCD14) and fatty acid composition in different stages of lactation and the onset of atopic dermatitis (AD) in early childhood.

Methods

In total, 443 mother‐child groups (445 children) were enrolled in the Prediction of Allergies in Taiwanese Children birth cohort study. Colostrum and mature milk at 2 months postpartum (2‐month HM) were collected from lactating mothers. Information regarding parental allergy histories and physician‐diagnosed atopic diseases was obtained using age‐specific questionnaires (0‐2 years). We compared sCD14 levels and the composition of 30 fatty acids in the colostrum and 2‐month HM, respectively, between allergic and non‐allergic mothers and between children with and without AD by the age of 2 years.

Results

In total, 185 (41.8%) mothers presented with allergies, and 154 (34.6%) children had physician‐diagnosed AD by the age of 2 years. Both in the colostrum and 2‐month HM of 289 lactating mothers, sCD14 levels were significantly lower in allergic mothers whose children presented with AD compared with children who did not (P = 0.015 and 0.044, respectively). Among the children with AD who were born to non‐allergic mothers, sCD14 levels were lower. However, the result was not statistically significant (P = 0.376 and 0.264, respectively). Our data revealed the lack of associations between fatty acid composition and AD (P > 0.05).

Conclusion

Decreased sCD14 levels in the colostrum and 2‐month HM were associated with AD at 2 years of age, particularly among children born to mothers with allergies.
The role of ear environment in postharvest susceptibility of maize to toxigenic Aspergillus flavus
Authors: Mutiga Samuel K. , Chepkwony Nelson , Hoekenga Owens A. , Flint‐Garcia Sherry A. , Nelson Rebecca J.
Published: December 2018

A kernel screening assay (KSA) was used to assess the genetic and environmental effects on the vulnerability of maize to aflatoxin accumulation. Kernels of 26 inbred lines that had been grown in seven environments, and 190 lines of the Intermated B73xMo17 (IBM) population grown in one location in the United States, were inoculated with a toxigenic strain of A. flavus and incubated in the dark at 30°C for 6 days. Percent kernel colonization (PKC), sporulation and aflatoxin were influenced by the maize genotypes (G), the location (“ear environment” or E) and the GxE interactions. Overall, low broad‐sense heritabilities were observed for PKC, sporulation and aflatoxin. PKC was significantly correlated with sporulation in all environments. Aflatoxin was positively correlated with colonization for two and with sporulation for all ear environments. Higher grain sulphur or magnesium in IBM was associated with less colonization or aflatoxin. Postharvest susceptibility of maize to aflatoxin is thus influenced by factors that are modulated by the ear environment. In a KSA, sporulation could be a proxy test for aflatoxin accumulation.
Biology of human melanocyte development, Piebaldism, and Waardenburg syndrome
Authors: Saleem Mohammed D.
Published: December 2018

Melanocyte development is orchestrated by a complex interconnecting regulatory network of genes and synergistic interactions. Piebaldism and Waardenburg syndrome are neurocristopathies that arise from mutations in genes involved in this complex network. Our understanding of melanocyte development, Piebaldism, and Waardenburg syndrome has improved dramatically over the past decade. The diagnosis and classification of Waardenburg syndrome, first proposed in 1992 and based on phenotype, have expanded over the past three decades to include genotype. This review focuses on the current understanding of human melanocyte development and the evaluation and management of Piebaldism and Waardenburg syndrome. Management is often challenging and requires a multidisciplinary approach.
Comprehensive metabolomic, proteomic and physiological analyses of grain yield reduction in rice under abrupt drought–flood alternation stress
Authors: Xiong Qiang‐Qiang , Shen Tian‐Hua , Zhong Lei , Zhu Chang‐Lan , Peng Xiao‐Song , He Xiao‐Peng , Fu Jun‐Ru , Ouyang Lin‐Juan , Bian Jian‐Min , Hu Li‐Fang , Sun Xiao‐Tang , Xu Jie , Zhou Hui‐Ying , He Hao‐Hua , Chen Xiao‐Rong
Published: December 2018

Abrupt drought–flood alternation (T1) is a meteorological disaster that frequently occurs during summer in southern China and the Yangtze river basin, often causing a significant loss of rice production. In this study, the response mechanism of yield decline under abrupt drought–flood alternation stress at the panicle differentiation stage was analyzed by looking at the metabolome, proteome as well as yield and physiological and biochemical indexes. The results showed that drought and flood stress caused a decrease in the yield of rice at the panicle differentiation stage, and abrupt drought–flood alternation stress created a synergistic effect for the reduction of yield. The main reason for the decrease of yield per plant under abrupt drought–flood alternation was the decrease of seed setting rate. Compared with CK0 (no drought and no flood), the net photosynthetic rate and soluble sugar content of T1 decreased significantly and its hydrogen peroxidase, superoxide dismutase, peroxidase activity increased significantly. The identified differential metabolites and differentially expressed proteins indicated that photosynthesis metabolism, energy metabolism pathway and reactive oxygen species response have changed strongly under abrupt drought–flood alteration stress, which are factors that leads to the rice grain yield reduction.
Molecular phylogenetics and biogeography provide insights into the subgeneric classification of Wiedemannia Zetterstedt (Diptera: Empididae: Clinocerinae)
Authors: Ivković Marija , Wahlberg Emma , Previšić Ana
Published: December 2018

The subgenera of Wiedemannia are poorly defined and, as such, most recently described species are not assigned to a subgenus or have been assigned to a subgenus without explanation. In this study we perform a molecular phylogenetic analysis to elucidate relationships within the genus Wiedemannia. We sequenced two mitochondrial (cytochrome oxidase c subunit I and cytochrome β) and two nuclear (carbomoylphosphate synthase domain of rudimentary and elongation factor‐1α) gene fragments to reconstruct phylogenetic relationships among the subgenera Chamaedipsia, Eucelidia, Philolutra, Pseudowiedemannia, Roederella and Wiedemannia (s.s.) using both Bayesian inference and maximum likelihood approaches. The genus was found to be monophyletic, but most of the subgenera were not. We propose eliminating the present subgeneric division altogether. Molecular dating using a log‐normal clock model and calibration with fossil species indicated that Wiedemannia diversified about 48 Ma, while there was still land connectivity between Europe and Asia with North America. Wiedemannia has a near‐worldwide distribution apart from the Australasian and Neotropical regions and Antarctica, with greatest species richness in the western Palaearctic, especially the Mediterranean region. Molecular phylogenetics support more recent morphological studies. The subgenera of Wiedemannia are invalid and rejected. Biogeographical data suggest potential hotspots, and the current distribution is discussed.
Student‐led community placement in physiotherapy
Authors: O'Connor Anne , Liston Ellen , O'Donnell Marie
Published: December 2018

Background

Service provision and the education of health professionals has diversified with the shift in health care focus to primary care. Current evidence, particularly in physiotherapy education, has identified shortfalls in practical experience and education provided in health promotion. To address this, practice placements in non‐traditional settings have been recommended; however, limited evidence exists to guide this innovation. This study aimed to address this gap by exploring the challenges and facilitators of a community‐based, student‐led placement involving physiotherapy undergraduate students and community‐based groups.

Methods

A qualitative descriptive approach was employed. Students (n = 7) and the service users and community facilitators (n = 12) who had engaged in this placement model were invited to participate in focus groups and semi‐structured interviews. Interviews were recorded, transcribed and analysed using thematic analysis.

Results

Two themes were identified: collaborative learning and embracing change. The acquisition of professional skills, such as leadership, teamwork and adaptability, was perceived to be greater than on traditional placements. Students, service users and community facilitators experienced mutual learning benefits, but also identified challenges with the placement model. These insights informed opinion regarding the sustainability of the model.

Discussion

Student‐led community‐based placements appear to impact positively on the well‐being of community service users. Mutual benefits were acknowledged by all stakeholders. This evaluation highlighted issues related to sustainability, and the need for a balanced representation of student and service user needs. Areas for development were identified, providing an optimistic outlook for the feasibility of this model and its transferability to other health professions.

Health professional services have diversified, in both social and health contexts, with a shift in focus from the treatment of ill health to health promotion
Experimental Evolution of Escherichia coli K-12 in the Presence of Proton Motive Force (PMF) Uncoupler Carbonyl Cyanide
m
-Chlorophenylhydrazone Selects for Mutations Affecting PMF-Driven Drug Efflux Pumps
Authors: Griffith Jessie M. , Basting Preston J. , Bischof Katarina M. , Wrona Erintrude P. , Kunka Karina S. , Tancredi Anna C. , Moore Jeremy P. , Hyman Miriam R. L. , Slonczewski Joan L.
Published: December 2018

The genetic responses of bacteria to depletion of proton motive force (PMF), and their effects on drug resistance, are poorly understood. PMF drives export of many antibiotics, but the energy cost may decrease fitness when antibiotics are absent. Our evolution experiment reveals genetic mechanisms of adaptation to the PMF uncoupler CCCP, including selection for increased CCCP efflux but also against the expression of PMF-driven pumps for drugs not present. The results have implications for our understanding of the gut microbiome, which experiences high levels of organic acids that decrease PMF.
Characterization of FlgP, an Essential Protein for Flagellar Assembly in
Rhodobacter sphaeroides
Authors: Pérez-González Caleb , Domenzain Clelia , Poggio Sebastian , González-Halphen Diego , Dreyfus Georges , Camarena Laura
Published: December 2018

Flagellar based motility confers a selective advantage on bacteria by allowing migration to favorable environments or in pathogenic species to reach the optimal niche for colonization. The flagellar structure has been well established in
Salmonella
. However, other accessory components have been identified in other species. Many of these have been implied in adapting the flagellar function to enable faster rotation, or higher torque. FlgP has been proposed to be the main component of the basal disk located underlying the outer membrane in
Campylobacter jejuni
and
Vibrio fischeri
. Its role is still unclear, and its absence impacts motility differently in different species. The study of these new components will bring a better understanding of the evolution of this complex organelle.
A Recombinant Rabies Virus Expressing the Marburg Virus Glycoprotein Is Dependent upon Antibody-Mediated Cellular Cytotoxicity for Protection against Marburg Virus Disease in a Murine Model
Authors: Keshwara Rohan , Hagen Katie R. , Abreu-Mota Tiago , Papaneri Amy B. , Liu David , Wirblich Christoph , Johnson Reed F. , Schnell Matthias J.
Published: December 2018

Marburg virus (MARV) is a virus similar to Ebola virus and also causes a hemorrhagic disease which is highly lethal. In contrast to EBOV, only a few vaccines have been developed against MARV, and researchers do not understand what kind of immune responses are required to protect from MARV. Here we show that antibodies directed against MARV after application of our vaccine protect in an animal system but fail to neutralize the virus in a widely used virus neutralization assay against MARV. This newly discovered activity needs to be considered more when analyzing MARV vaccines or infections.
Möbius syndrome associated with obesity and precocious puberty
Authors: De Silva Samantha Roshani , Painter Sally L , Hildebrand Darius
Published: December 2018

Möbius syndrome is a neurological disorder involving underdevelopment of the sixth and seventh cranial nerves. Multiple associations have been described including dysfunction of other cranial nerves, limb abnormalities and hypogonadotrophic hypogonadism causing delayed puberty. We present the second reported case of Möbius syndrome associated with obesity and with precocious puberty. These features may be secondary to dysregulation of the hypothalamic–pituitary axis. We highlight the need to consider extraocular symptoms in these patients and for close liaison with physicians in their management.
Sebaceous lymphadenoma requiring superficial parotidectomy
Authors: Sun Luona , Zhu Roger Chen , Tong Jiankun , Shemen Larry
Published: December 2018

An 82-year-old woman presented with a painless, progressively enlarging right neck mass of 2 years’ duration. CT with contrast showed a 5.0 cm confluence of nodes just inferior to the right parotid gland. Fine-needle aspiration showed a lymphoproliferative disorder. Incisional biopsy showed sebaceous lymphadenoma. She subsequently underwent superficial right parotidectomy with neck dissection of level II-V (performed for enlarged lymph nodes causing significant pain). Facial nerve was preserved. She remained free of disease nearly 1 year postoperatively.
Hiding in plain sight: a brain lesion in a patient with a history of colon and breast cancer
Authors: Eze Dominic , Hollis Kathryn , Ahmed Mohamed H , Alner Victoria
Published: December 2018

We present a case of a 76-year-old woman who was admitted to our hospital with a low Glasgow Coma Scale score. She had a medical history of breast and colon cancer. The CT scan showed possible diagnosis of brain metastasis. However, the MRI scan showed this to be a completely different diagnosis.
An unusual presentation of multiple myeloma
Authors: Schembri Emma Louise , Mifsud Simon , Gauci Jonathan , Mizzi Adrian , Fsadni Peter
Published: December 2018

The authors report a case of a 58-year-old woman, ex-smoker, who was referred to the respiratory clinic with a presumed unresolving airspace shadowing in the right lung. Further evaluation of the shadowing with a CT thorax revealed rib lesions, a pancreatic lesion and multiple liver lesions, making the diagnosis of metastatic pancreatic carcinoma most likely. However, further blood investigations and imaging eventually revealed the cause for the shadowing to be multiple myeloma, since the unresolving shadowing was actually a rib lesion.
Treatment of advanced stage methotrexate-associated lymphoproliferative disorders (MTX-LPDs) with methotrexate discontinuation
Authors: Ross Yael , Kamran Mohammad
Published: December 2018

We present two cases of patient’s with long-standing autoimmune diseases being treated with immunosuppressants that developed aggressive lymphoproliferative disorders. Immunosuppressants have a well-known association with disorders. Sustained regression of these lymphoproliferative disorders occurred with simple discontinuation of these immunosuppressive agents.
Difficult case of a rare form of familial Alzheimer’s disease with PSEN1 P117L mutation
Authors: Rocha Ana Luísa , Costa Andreia , Garrett Maria Carolina , Meireles Joana
Published: December 2018

Less than 10% of Alzheimer’s disease (AD) cases are familial. Presenilin-1 (PSEN1) mutations are the most frequent aetiology and may be associated to atypical neurological manifestations. We report the case of a 27-year-old right-handed man, ensuing with mild cognitive impairment, motor discoordination and axial myoclonus after a parachute accident. At age 32 he was referred to our neurology clinic, presenting cognitive impairment, cerebellar syndrome, axial myoclonus and hypomimia, without other signs of parkinsonism. Because of absence of family history, he was worked up along the line of spinal ataxic disorders. Later, he developed pseudobulbar affect, cognitive deterioration, right upper limb paresis and spastic paraparesis. Subsequent investigation identified a PSEN1 P117L mutation and the diagnosis of autosomal dominant AD was made. This case illustrates the diagnostic challenge imposed by atypical presentation of de novo PSEN1 mutation, leading to unnecessary investigation. Genetic study might be essential for defining the diagnosis.
Treatment dilemma for survivors of rituximab-induced bowel perforation in the setting of post-transplant lymphoproliferative disorder
Authors: Sullivan Brianne J , Kim Grace J , Sara Gabriel
Published: December 2018

Post-transplant lymphoproliferative disorder (PTLD) is a recognised complication of solid and haematopoietic stem cell transplant. It consists of a heterogeneous group of lymphoid neoplasms that arises secondary to post-transplant immunosuppression. Although there is no definite standard of care for the optimal treatment for PTLD, rituximab, a monoclonal antibody, with and/or without chemotherapy (usually CHOP=cytoxan, doxorubicin, vincristine, prednisone) has become a routine part of the treatment of any CD20 (+) PTLD, with response rates similar to chemotherapy with decreased toxicity. A rare and often lethal, complication of rituximab therapy for PTLD is bowel perforation secondary to tumour lysis of lymphoma involving the intestine. A small number of cases of bowel perforation have been reported, with very few documented survivors. The risk for recurrent perforation in the setting of ongoing rituximab treatment is unknown. There is sparse data supporting how to best treat the survivors.
Severe hypocalcaemia following denosumab in a patient with cancer with vitamin D deficiency
Authors: Watthanasuntorn Kanramon , Abid Haisam , Gnanajothy Rosana
Published: December 2018

Denosumab is a monoclonal antibody that has been widely used for the prevention of skeletal-related events in patients with cancer with solid tumours and bone metastases, and acts by reducing the release of calcium from bones into the bloodstream. Severe hypocalcaemia is a rare and dangerous side effect of denosumab. We present a case of a patient with metastatic prostate cancer who developed severe hypocalcaemia after receiving a single dose of denosumab. Further laboratory analysis showed that the patient had a low vitamin D level, which contributed to the development of hypocalcaemia. He required an inpatient admission for repeated doses of intravenous calcium.
Late onset of dropped head syndrome following mantle radiation therapy for Hodgkin lymphoma
Authors: Di Stefano Vincenzo , Attanasi Carmine , Ferrante Camilla , Di Muzio Antonio
Published: December 2018

Dropped head syndrome (DHS) is a rare condition, characterised by weakness of the cervical paraspinal muscles with sagging of the head. It is usually seen in association with neurological disorders and rarely can follow radiotherapy. We report a case of a 54-year-old man survivor of Hodgkin lymphoma (HL), who developed DHS 28 years after radiotherapy. He was referred to our department due to progressive weakness and atrophy of cervical paraspinal and shoulder girdle musculature. Physical and neurophysiological examination, electromyography and MRI confirmed the diagnosis of DHS. In the following years, there was no progression of symptoms.
Renal sarcoidosis: a rare case
Authors: Menezes Maria , Patarata Eunice
Published: December 2018

Sarcoidosis is a multisystemic granulomatous disease with rare renal involvement. We describe a case of a 45-year-old female patient admitted to the hospital with severe acute kidney injury and uveitis. After clinical investigation, sarcoidosis with renal, hepatic and ocular involvement was diagnosed. Renal biopsy revealed acute granulomatous interstitial nephritis and treatment with systemic corticosteroids was started with marked improvement in renal function.
Polyarticular arthropathy and encephalopathy in a 70-year-old woman
Authors: Lewis Cameron Scott , Skiba Rohen , Gabbay Eli
Published: December 2018

A 70-year-old woman with a background of portopulmonary hypertension, managed with sildenafil and oral diuretics, and cirrhosis, presented with acute on chronic haemorrhoidal bleeding, iron deficiency anaemia and worsening right heart failure. She presented in a normal conscious and cognitive state. Management involved intravenous diuresis with frusemide and blood transfusion. She quickly begun to develop fever, severe polyarticular arthropathy and progressive encephalopathy. Analgesia was started and antibiotics administered for potential septic sources. Extensive investigations, including full septic screen and neurological imaging, revealed no explainable aetiology for her precipitous decline. She continued to have febrile episodes, worsening polyarticular arthropathy and progressive encephalopathy eventually becoming unresponsive. Given the severe polyarticular arthropathy knee aspiration was performed. Urate crystals were identified and intravenous hydrocortisone and colchicine were started. Within 2 days she achieved full resolution of her systemic, musculoskeletal and neurological symptoms. We propose this as a rare case of gout-induced encephalopathy.
Curious case of fever of unknown origin
Authors: Bhatt Manasvini , Soneja Manish , Tripathi Madhavi , Biswas Ashutosh
Published: December 2018

A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive forMycobacterium tuberculosiswith sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.
Rare occurrence of a huge traumatic extradural haematoma in a patient with an ipsilateral sylvian arachnoid cyst
Authors: Alhillo Haider Tawfeeq , Sadik Hatem Azet , Gheni Teeba N , Hoz Samer S
Published: December 2018

A man, a teenage victim of an assault to the head, presented to the emergency department, in Baghdad, with a Glasgow Coma Score of 4/15 (E1 M2 V1) and total right-sided paralysis. CT of the brain revealed a large-left sided frontotemporoparietal extradural haematoma with the presence of an ipsilateral sylvian arachnoid cyst deep to the haematoma. Urgent surgical evacuation of the haematoma was performed, leaving the arachnoid cyst intact. The patient improved and gained full consciousness within 4 days.

Three years after the initial trauma, the patient has remained well. This case required a thorough discussion of the surgical options, in particular whether to intervene with the associated cyst, and whether any intervention with the cyst should be performed in the same or future operations. This dilemma forms the basis of the discussion in the following report.
Youth with type 2 diabetes have hepatic, peripheral, and adipose insulin resistance
Authors: Cree-Green Melanie , Wiromrat Pattara , Stuppy Jacob J. , Thurston Jessica , Bergman Bryan C. , Baumgartner Amy D. , Bacon Samantha , Scherzinger Ann , Pyle Laura , Nadeau Kristen J.
Published: December 2018

Adolescents with type 2 diabetes (T2D) have severe insulin resistance (IR) secondary to obesity, genetics, and puberty, and IR predicts metabolic comorbidities. Adults with T2D have multitissue IR, which has guided therapeutic developments, but this is not established in youth. We sought to assess adipose, hepatic, and peripheral insulin sensitivity in adolescents with and without T2D. Twenty-seven youth with T2D [age: 15.6 ± 0.4 yr; female: 78%; body mass index (BMI) percentile: 96.1 (52.6, 95.9), late puberty; hemoglobin A1c (HbA1c) 7.3% (6.2, 10.1)] and 21 controls of similar BMI, pubertal stage, and habitual activity were enrolled. Insulin action was measured with a four-phase hyperinsulinemic-euglycemic clamp (basal, 10, 16, and 80 mU·m−2·min−1 for studying adipose, hepatic, and peripheral IR, respectively) with glucose and glycerol isotope tracers. Total fat mass, fat-free mass, liver fat fraction, and visceral fat were measured with dual-energy x-ray absorptiometry (DXA) and MRI, respectively. Free fatty acids (FFAs), lipid profile, and inflammatory markers were also measured. Adolescents with T2D had higher lipolysis ( P = 0.012), endogenous glucose production ( P < 0.0001), and lower glucose clearance ( P = 0.002) during hyperinsulinemia than controls. In T2D, peripheral IR positively correlated to FFA ( P < 0.001), inflammatory markers, visceral ( P = 0.004) and hepatic fat ( P = 0.007); hepatic IR correlated with central obesity ( P = 0.004) and adipose IR ( P = 0.003). Youth with T2D have profound multitissue IR compared with BMI-equivalent youth without T2D. The development of multitissue interactions appears crucial to the pathogenesis of T2D. Therapeutic targets on multitissue IR may be of benefit, deserving of further research.
Depression and Its Help Seeking Behaviors: A Systematic Review and Meta-Analysis of Community Survey in Ethiopia
Authors: Bifftu Berhanu Boru , Takele Wubet Worku , Guracho Yonas Deressa , Yehualashet Fekadu Ambaw
Published: December 2018

Background. Depression is one of the most common mental illnesses affecting around 322 million individual in the world. Although the prevalence of depression is high and its treatment is effective, little is known about its pooled prevalence and help seeking behaviors in the community settings of Ethiopia. Thus, this study aimed to determine the pooled prevalence of depression and its help seeking behaviors in Ethiopia. Methods. A systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar was performed. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool adapted for cross-sectional studies. Heterogeneity test and evidence of publication bias were assessed. Moreover, sensitivity test was also performed. Pooled prevalence of depression and its help seeking behavior were calculated using random effects model. Results. A total 13 studies for depression, 4 studies for help seeking intention, and 5 studies for help seeking behaviour were included in this review. The pooled prevalence of depression and help seeking intention and behaviour was found to be 20.5% (95% CI; 16.5% -24.4%), 42% (95% CI; 23%-60%), and 38% (95% CI; 23%-52%), respectively. There is no significant heterogeneity for depression (I2 = 0%, p =0.620), help seeking intention (I2 = 0%, p =0.996), and behaviour (I2 = 0%, p =0.896). There is no publication bias for depression egger’s test (p =0.689). Conclusion. More than one in every five individuals were experiencing depression. Less than one-third of individuals with depression seek help from modern treatment. Authors suggest community based mental health screening and treatment.
Verifying the Placement of Nasogastric Tubes at an Emergency Center: Comparison of Ultrasound with Chest Radiograph
Authors: Yıldırım Çağdaş , Coşkun Selçuk , Gökhan Şervan , Pamukçu Günaydın Gül , Özhasenekler Ayhan , Özkula Uğur
Published: December 2018

The objective of this study was to verify the nasogastric tube position with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture and auscultation and to compare the effectiveness of these methods with chest radiography. This is a single-center, prospective, single-blind study. Patients who were admitted to our emergency department and had an indication of nasogastric tube placement were included. Nasogastric tube localization was verified with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture, auscultation, and direct radiography that was accepted as the ‘gold standard technique’. A total of 49 patients (27 Male, 22 Female) with a mean age of 58.3±22.7 years were included. Sensitivity of neck ultrasound was 91.5%, and positive predictive value was 100%. As for the subxiphoid ultrasound sensitivity was 78.72%. When neck ultrasound + subxiphoid ultrasound and giving water-air mixture were combined sensitivity reached 95.74%. Sensitivity of neck ultrasound + subxiphoid ultrasound + air-water mixture + auscultation was 97.87% and positive predictive value was 100%. In the light of our results, neck and subxiphoid ultrasound seem to be an alternative method for verifying nasogastric tube localization. Combination of the air-water mixture and auscultation with ultrasound improves the sensitivity.
Metabolomics of Pregnancy Complications: Emerging Application of Maternal Hair
Authors: Delplancke Thibaut D. J. , Wu Yue , Han Ting-Li , Joncer Lingga R. , Qi Hongbo , Tong Chao , Baker Philip N.
Published: December 2018

In recent years, the study of metabolomics has begun to receive increasing international attention, especially as it pertains to medical research. This is due in part to the potential for discovery of new biomarkers in the metabolome and to a new understanding of the “exposome”, which refers to the endogenous and exogenous compounds that reflect external exposures. Consequently, metabolomics research into pregnancy-related issues has increased. Biomarkers discovered through metabolomics may shed some light on the etiology of certain pregnancy-related complications and their adverse effects on future maternal health and infant development and improve current clinical management. The discoveries and methods used in these studies will be compiled and summarized within the following paper. A further focus of this paper is the use of hair as a biological sample, which is gaining increasing attention across diverse fields due to its noninvasive sampling method and the metabolome stability. Its significance in exposome studies will be considered in this review, as well as the potential to associate exposures with adverse pregnancy outcomes. Currently, hair has been used in only two metabolomics studies relating to fetal growth restriction (FGR) and gestational diabetes mellitus (GDM).
Quantitative Evaluation of the Relationship between T-Wave-Based Features and Serum Potassium Level in Real-World Clinical Practice
Authors: Yoon Dukyong , Lim Hong Seok , Jeong Jong Cheol , Kim Tae Young , Choi Jung-gu , Jang Jong-Hwan , Jeong Eugene , Park Chan Min
Published: December 2018

Background. Proper management of hyperkalemia that leads to fatal cardiac arrhythmia has become more important because of the increased prevalence of hyperkalemia-prone diseases. Although T-wave changes in hyperkalemia are well known, their usefulness is debatable. We evaluated how well T-wave-based features of electrocardiograms (ECGs) are correlated with estimated serum potassium levels using ECG data from real-world clinical practice.Methods. We collected ECGs from a local ECG repository (MUSE™) from 1994 to 2017 and extracted the ECG waveforms. Of about 1 million reports, 124,238 were conducted within 5 minutes before or after blood collection for serum potassium estimation. We randomly selected 500 ECGs and two evaluators measured the amplitude (T-amp) and right slope of the T-wave (T-right slope) on five lead waveforms (V3, V4, V5, V6, and II). Linear correlations of T-amp, T-right slope, and their normalized feature (T-norm) with serum potassium levels were evaluated using Pearson correlation coefficient analysis.Results. Pearson correlation coefficients for T-wave-based features with serum potassium between the two evaluators were 0.99 for T-amp and 0.97 for T-right slope. The coefficient for the association between T-amp, T-right slope, and T-norm, and serum potassium ranged from -0.22 to 0.02. In the normal ECG subgroup (normal ECG or otherwise normal ECG), there was no correlation between T-wave-based features and serum potassium level.Conclusions. T-wave-based features were not correlated with serum potassium level, and their use in real clinical practice is currently limited.