bluuebunny/crossref_metadata_2025 huggingface dataset:
Alpha‐melanocyte stimulating hormone increases the activity of melanocortin‐3 receptor‐expressing neurons in the ventral tegmental area
Authors: West Katherine Stuhrman , Lu Chunxia , Olson David P. , Roseberry Aaron G.
Published: May 2019

Key points

Alpha‐melanocyte stimulating hormone (α‐MSH) is an anorexigenic peptide. Injection of the α‐MSH analog MTII into the ventral tegmental area (VTA) decreases food and sucrose intake and food reward.

Melanocortin‐3 receptors (MC3R) are highly expressed in the VTA, suggesting that the effects of intra‐VTA α‐MSH may be mediated by α‐MSH changing the activity of MC3R‐expressing VTA neurons.

α‐MSH increased the firing rate of MC3R VTA neurons in acute brain slices from mice, although it did not affect the firing rate of non‐MC3R VTA neurons.

The α‐MSH induced increase in MC3R neuron firing rate is probably activity‐dependent, and was independent of fast synaptic transmission and intracellular Ca2+ levels.

These results help us to better understand how α‐MSH acts in the VTA to affect feeding and other dopamine‐dependent behaviours.

The mesocorticolimbic dopamine system, the brain's reward system, regulates multiple behaviours, including food intake and food reward. There is substantial evidence that the melanocortin system of the hypothalamus, an important neural circuit controlling feeding and body weight, interacts with the mesocorticolimbic dopamine system to affect feeding, food reward and body weight. For example, melanocortin‐3 receptors (MC3Rs) are expressed in the ventral tegmental area (VTA) and our laboratory previously showed that intra‐VTA injection of the MC3R agonist, MTII, decreases home‐cage food intake and operant responding for sucrose pellets. However, the cellular mechanisms underlying the effects of intra‐VTA alpha‐melanocyte stimulating hormone (α‐MSH) on feeding and food reward are unknown. To determine how α‐MSH acts in the VTA to affect feeding, we performed electrophysiological recordings in acute brain slices from mice expressing enhanced yellow fluorescent protein in MC3R neurons to test how α‐MSH affects the activity of VTA MC3R neurons. α‐MSH significantly increased the firing rate of VTA MC3R neurons without altering the activity of non‐MC3R expressing VTA neurons. In addition, the α‐MSH‐induced increase in MC3R neuron activity was independent of fast synaptic transmission and intracellular Ca2+ levels. Finally, we show that the effect of α‐MSH on MC3R neuron firing rate is probably activity‐dependent. Overall, these studies provide an important advancement in the understanding of how α‐MSH acts in the VTA to affect feeding and food reward.
Rear-Impact Neck Whiplash: Role of Head Inertial Properties and Spine Morphological Variations on Segmental Rotations
Authors: John Jobin D. , Saravana Kumar Gurunathan , Yoganandan Narayan
Published: May 2019

Whiplash injuries continue to be a concern in low-speed rear impact. This study was designed to investigate the role of variations in spine morphology and head inertia properties on cervical spine segmental rotation in rear-impact whiplash loading. Vertebral morphology is rarely considered as an input parameter in spine finite element (FE) models. A methodology toward considering morphological variations as input parameters and identifying the influential variations is presented in this paper. A cervical spine FE model, with its morphology parametrized using mesh morphing, was used to study the influence of disk height, anteroposterior vertebral depth, and segmental size, as well as variations in head mass, moment of inertia, and center of mass locations. The influence of these variations on the characteristic S-curve formation in whiplash response was evaluated using the peak C2–C3 flexion marking the maximum S-curve formation and time taken for the formation of maximum S-curve. The peak C2–C3 flexion in the S-curve formation was most influenced by disk height and vertebral depth, followed by anteroposterior head center of mass location. The time to maximum S-curve was most influenced by the anteroposterior location of head center of mass. The influence of gender-dependent variations, such as the vertebral depth, suggests that they contribute to the greater segmental rotations observed in females resulting in different S-curve formation from men. These results suggest that both spine morphology and head inertia properties should be considered to describe rear-impact responses.
Head and Neck Response of an Active Human Body Model and Finite Element Anthropometric Test Device During a Linear Impactor Helmet Test
Authors: Bruneau David A. , Cronin Duane S.
Published: May 2019

It has been proposed that neck muscle activation may play a role in head response resulting from impacts in American Football. The importance of neck stiffness and active musculature in the standard linear impactor helmet test was assessed using a detailed head and neck finite element (FE) model from a current human body model (HBM) compared to a validated hybrid III head and neck FE model. The models were assessed for bare-head and helmeted impacts at three speeds (5.5, 7.4, and 9.3 m/s) and three impact orientations. The HBM head and neck was assessed without muscle activation and with a high level of muscle activation representing a braced condition. The HBM and hybrid III had an average cross-correlation rating of 0.89 for acceleration in the primary impact direction, indicating excellent correspondence regardless of muscle activation. Differences were identified in the axial head acceleration, attributed to axial neck stiffness (correlation rating of 0.45), but these differences did not have a large effect on the overall head response using existing head response metrics (head injury criteria, brain injury criteria, and head impact power). Although responses that develop over longer durations following the impact differed slightly, such as the moment at the base of the neck, this occurred later in time, and therefore, did not considerably affect the short-term head kinematics in the primary impact direction. Though muscle activation did not play a strong role in the head response for the test configurations considered, muscle activation may play a role in longer duration events.
Indirect Traumatic Optic Neuropathy Induced by Primary Blast: A Fluid–Structure Interaction Study
Authors: Tong Junfei , Kedar Sachin , Ghate Deepta , Gu Linxia
Published: May 2019

Current knowledge of traumatic ocular injury is still limited as most studies have focused on the ocular injuries that happened at the anterior part of the eye, whereas the damage to the optic nerve known as traumatic optic neuropathy (TON) is poorly understood. The goal of this study is to understand the mechanism of the TON following the primary blast through a fluid–structure interaction model. An axisymmetric three-dimensional (3D) eye model with detailed orbital components was developed to capture the dynamics of the eye under the blast wave. Our numerical results demonstrated a transient pressure elevation in both vitreous and cerebrospinal fluid (CSF). A high strain rate over 100 s−1 was observed throughout the optic nerve during the blast with the most vulnerable part located at the intracanalicular region. The optic nerve deforming at such a high strain rate may account for the axonal damage and vision loss in patients subjected to the primary blast. The results from this work would enhance the understanding of indirect TON and provide guidance in the design of protective eyewear against such injury.
Hidden Chaotic Attractors and Synchronization for a New Fractional-Order Chaotic System
Authors: Wang Zuoxun , Liu Jiaxun , Zhang Fangfang , Leng Sen
Published: May 2019

Although a large number of hidden chaotic attractors have been studied in recent years, most studies only refer to integer-order chaotic systems and neglect the relationships among chaotic attractors. In this paper, we first extend LE1 of sprott from integer-order chaotic systems to fractional-order chaotic systems, and we add two constant controllers which could produce a novel fractional-order chaotic system with hidden chaotic attractors. Second, we discuss its complicated dynamic characteristics with the help of projection pictures and bifurcation diagrams. The new fractional-order chaotic system can exhibit self-excited attractor and three different types of hidden attractors. Moreover, based on fractional-order finite time stability theory, we design finite time synchronization scheme of this new system. And combination synchronization of three fractional-order chaotic systems with hidden chaotic attractors is also derived. Finally, numerical simulations demonstrate the effectiveness of the proposed synchronization methods.
Comparing Slicing Technologies for Digital Light Processing Printing
Authors: Kwok Tsz-Ho
Published: May 2019

In additive manufacturing (AM), slicing is a crucial step in process planning to convert a computer-aided design (CAD) model to a machine-specific format. Digital light processing (DLP) printing is an important AM process that has a good surface finish, high accuracy, and fabrication speed and is widely applied in many dental and engineering industries. However, as DLP uses images for fabrication different from other toolpath-based processes, its process planning is understudied. Therefore, the main goal of this paper is to study and compare the slicing technologies for DLP printing. Three slicing technologies are compared: contour, voxelization, and ray-tracing.
Theoretical and Experimental Investigation of Thermal Dynamics of Steinhart–Hart Negative Temperature Coefficient Thermistors
Authors: Fatoorehchi Hooman , Alidadi Mahdi , Rach Randolph , Shojaeian Abolfazl
Published: May 2019

The temperature-dependent dynamics of a negative temperature coefficient (NTC) thermistor conducting variable electric current is modeled using the differential approach. The thermistor is assumed to follow the Steinhart–Hart resistance-temperature equation. The developed mathematical model consists of a nonlinear differential-algebraic equations system, and it was analyzed by the Adomian decomposition method (ADM) and its time-marching version known as the multistage Adomian decomposition method (MADM) as well as the Dormand–Prince (DP) numerical method. Five sets of experiments were conducted on five different NTC thermistors and the laboratory measurements were compared with the model predictions. It is demonstrated that the proposed model, when combined with the MADM, can accurately simulate the thermal behavior of the NTC thermistors. The MADM reproduces the experimental temperature dynamics of the five NTC thermistors with an average absolute relative error of about 2.601% while the corresponding errors for the DP method and the classic ADM are 8.122% and 51.255%, respectively. Also, it is shown that the MADM is highly efficient in terms of computational efficiency and it is approximately 6.5 times faster than the classic DP method, when tuned appropriately.
Evolving a Psycho-Physical Distance Metric for Generative Design Exploration of Diverse Shapes
Authors: Khan Shahroz , Gunpinar Erkan , Moriguchi Masaki , Suzuki Hiromasa
Published: May 2019

In this paper, a generative design approach is proposed that involves the users’ psychological aspect in the design space exploration stage to create distinct design alternatives. Users’ perceptual judgment about designs is extracted as a psycho-physical distance metric, which is then integrated into the design exploration step to generate design alternatives for the parametric computer-aided design (CAD) shapes. To do this, a CAD model is first parametrized by defining geometric parameters and determining ranges of these parameters. Initial design alternatives for the CAD model are generated using Euclidean distance-based sampling teaching–learning-based optimization (S-TLBO), which is recently proposed and can sample N space-filling design alternatives in the design space. Similar designs are then clustered, and a user study is conducted to capture the subjects’ perceptual response for the dissimilarities between the cluster pairs. In addition, a furthest-point-sorting technique is introduced to equalize the number of designs in the clusters, which are being compared by the subjects in the user study. Afterward, nonlinear regression analyses are carried out to construct a mathematical correlation between the subjects’ perceptual response and geometric parameters in the form of a psycho-physical distance metric. Finally, a psycho-physical distance metric obtained is utilized to explore distinct design alternatives for the CAD model. Another user study is designed to compare the diversification between the designs when the Euclidean and the suggested psycho-physical distance metrics are utilized. According to the user study, designs generated with the latter metric are more distinct.
Design of Conformal Porous Structures for the Cooling System of an Injection Mold Fabricated by Additive Manufacturing Process
Authors: Tang Yunlong , Gao Zhengyang , Zhao Yaoyao Fiona
Published: May 2019

The cooling system of plastic injection mold plays a critical role during the injection molding process. It not only affects part quality but also its cycle time. Traditionally, due to the limitations of conventional drilling methods, the cooling system of the injection mold usually consists of simple paralleled straight channels. It seriously limits the mobility of cooling fluid, which leads to the low cooling efficiency for the parts with complex free-form surfaces. In this research, an innovative design method for the cooling system of an injection mold is proposed by using conformal porous structures. The size and shape of each cell in the conformal porous structure are varied according to the shape of an injection molded part. Design cases are provided at the end of this paper to further illustrate the efficiency of the proposed method. Compared with those existing design methods for the uniform porous structures, the proposed method can further reduce the nonuniformity of the mold surface temperature distribution and decrease the pressure drop of the cooling system.
Influence of Material Parameters and Thermal Parameters on Sealing Performance of Reactor Pressure Vessel Under Heat Focusing Effect
Authors: Tian Jingyi , Feng Huihua , Yang Ye , Liang Junming , Kuang Yuxiao , Zhang Huiyong
Published: May 2019

In this paper, an effective numerical model is established by combining the fluid–structure coupling and thermomechanical coupling methods to solve complex sealing problems of a reactor pressure vessel (RPV) test simulator under heat focusing effect. Some key factors are considered in the structure and thermal analysis, such as contact nonlinearity, high temperature elastic–plastic, and high temperature compression–resilience performance. The simulation results agree well with the data of test. An analysis is performed to study the effects of material and thermal parameters on sealing performance. The stress and deformation mechanism of bolt flange and gasket connection system is clarified.
Modeling and Mechanical Analysis of Snake Robots on Cylinders
Authors: Tang Chaoquan , Li Peng , Zhou Gongbo , Meng Deyuan , Shu Xin , Guo Shuai , Li Zhixiong
Published: May 2019

The narrow and redundant body of the snake robot makes it suitable for the inspection of complex bar structures, such as truss or tree structures. One of the key issues affecting the efficient motion of snake robots in complex bar structures is the development of mechanical models of snake robots on cylinders. In other words, the relationship between the payload and structural and performance parameters of the snake robot is still difficult to clarify. In this paper, the problem is approached with the Newton–Euler equations and the convex optimal method. Firstly, from the kinematic point of view, the optimal attitude of the snake robot wrapped around the cylinder is found. Next, the snake robot is modeled on the cylinder and transformed into a convex optimization problem. Then, the relationship between the payload of the snake robot on the cylinder and the geometric and attitude parameters of the body of snake robots is analyzed. Finally, the discussion for the optimal winding attitude and some advices for the design of the snake robot are proposed. This study is helpful toward the optimal design of snake robots, including geometry parameters and motor determination.
A Novel Wire-Driven Variable-Stiffness Joint Based on a Permanent Magnetic Mechanism
Authors: Zhang Ming , Fang Lijin , Sun Feng , Oka Koichi
Published: May 2019

The variable-stiffness joint (VSJ) plays an important role in creating compliant and powerful motions. This paper presents a novel wire-driven VSJ based on a permanent magnetic mechanism (PMM). The proposed joint regulates the joint stiffness with lower energy consumption through a wide range via the permanent magnetic mechanism. This effect possibly depends on the novel nonlinear combination of a permanent magnet-spring and wire-driven system that achieves the same stiffness with lower wire tension. A trapezoidal layout of the joint is proposed. Because of the relationship among the stiffness, the position of the joint and the stiffness of the PMM, the stiffness model is also been established. Based on this model, the decoupling controller is built to independently control the position and stiffness of the joint. Experiments show that the VSJPMM achieves position and stiffness independently and also reduces energy and power required to regulate the stiffness compared with the traditional approach. In addition, the proposed mechanism displays a powerful motion and short stiffness adjustment time.
Design, Modeling, and Motion Analysis of a Novel Fluid Actuated Spherical Rolling Robot
Authors: Tafrishi Seyed Amir , Svinin Mikhail , Esmaeilzadeh Esmaeil , Yamamoto Motoji
Published: May 2019

This paper studies a novel fluid actuated system for a spherical mobile robot. The robot’s mechanism consists of two essential parts: circular pipes to lead spherical moving masses (cores) and an internal driving unit to propel the cores. The spherical shell of the robot is rolled by displacing the cores in the pipes filled with fluid. First, we describe the structure of the robot and derive its nonlinear dynamics using the D’Alembert principle. Next, we model the internal driving unit that actuates the core inside the pipe. The simulated driving unit is studied with respect to three important parameters—the input motor torque, the actuator size, and the fluid properties. The overall model of the robot is then used for analyzing motion patterns in the forward direction. Analytical studies show that the modeled robot can be implemented under the given design specifications.
Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States
Authors: Karlsson Maria , Stanton Richard A. , Ansari Uzma , McAllister Gillian , Chan Monica Y. , Sula Erisa , Grass Julian E. , Duffy Nadezhda , Anacker Melissa L. , Witwer Medora L. , Rasheed J. Kamile , Elkins Christopher A. , Halpin Alison Laufer
Published: May 2019

We report on a carbapenemase-producing hypervirulent
Klebsiella pneumoniae
(CP-hvKP) isolate collected from a U.S. patient at an outpatient clinic.
New Insights into the Cyp51 Contribution to Azole Resistance in
Aspergillus
Section
Nigri
Authors: Pérez-Cantero Alba , López-Fernández Loida , Guarro Josep , Capilla Javier
Published: May 2019

Invasive aspergillosis (IA) is a severe condition mainly caused by
Aspergillus fumigatus
, although other species of the genus, such as section
Nigri
members, can also be involved. Voriconazole (VRC) is the recommended treatment for IA; however, the prevalence of azole-resistant
Aspergillus
isolates has alarmingly increased in recent years, and the underlying resistance mechanisms in non-
fumigatus
species remain unclear.
A Novel Cre Recombinase-Mediated
In Vivo
Minicircle DNA (CRIM) Vaccine Provides Partial Protection against Newcastle Disease Virus
Authors: Jiang Yanlong , Gao Xing , Xu Ke , Wang Jianzhong , Huang Haibin , Shi Chunwei , Yang Wentao , Kang Yuanhuan , Curtiss Roy , Yang Guilian , Wang Chunfeng
Published: May 2019

Minicircle DNA (mcDNA) has been considered an attractive alternative to DNA vaccines; however, the relatively high cost and complicated process of purifying mcDNA dramatically restricts the application of mcDNA in the veterinary field. We designed a novel
in vivo
mcDNA platform in which the complete plasmid could spontaneously transform into mcDNA
in vivo
. In combination with the regulated-delayed-lysis
Salmonella
strain, the newly designed mcDNA vaccine provides us with an elegant platform for veterinary vaccine development.
A TaqMan Probe-Based Real-Time PCR Assay for the Rapid Identification of the Emerging Multidrug-Resistant Pathogen Candida auris on the BD Max System
Authors: Lima Amorce , Widen Raymond , Vestal Grant , Uy Dominic , Silbert Suzane
Published: May 2019

Candida auris
is an emerging multidrug-resistant fungal pathogen that has been associated with nosocomial bloodstream and deep wound infections causing a high mortality rate mainly in intensive care unit (ICU) patients. Laboratories currently rely on phenotypic testing using commercial automated systems for identification of yeasts; however, this technique has often led to misidentification of
C. auris
to other closely related species.
Morphological Plasticity in a Sulfur-Oxidizing Marine Bacterium from the SUP05 Clade Enhances Dark Carbon Fixation
Authors: Shah Vega , Zhao Xiaowei , Lundeen Rachel A. , Ingalls Anitra E. , Nicastro Daniela , Morris Robert M.
Published: May 2019

Identifying shifts in microbial metabolism across redox gradients will improve efforts to model marine oxygen minimum zone (OMZ) ecosystems. Here, we show that aerobic morphology and metabolism increase cell size, sulfur storage capacity, and carbon fixation rates in “
Ca
. Thioglobus autotrophicus,” a chemosynthetic bacterium from the SUP05 clade that crosses oxic-anoxic boundaries.
Nonmuscle Myosin Heavy Chain IIA Recognizes Sialic Acids on Sialylated RNA Viruses To Suppress Proinflammatory Responses via the DAP12-Syk Pathway
Authors: Liu Yingqi , Li Rui , Chen Xin-xin , Zhi Yubao , Deng Ruiguang , Zhou En-min , Qiao Songlin , Zhang Gaiping
Published: May 2019

NMHC-IIA, a subunit of nonmuscle myosin IIA (NM-IIA), takes part in diverse physiological processes, including cell movement, cell shape maintenance, and signal transduction. Recently, NMHC-IIA has been demonstrated to be a receptor or factor contributing to viral infections. Here, we identified that NMHC-IIA recognizes sialic acids on sialylated RNA viruses, vesicular stomatitis virus (VSV) and porcine reproductive and respiratory syndrome virus (PRRSV). Upon recognition, NMHC-IIA associates with the transmembrane region of DAP12 to recruit Syk. Activation of the DAP12-Syk pathway impairs the host antiviral proinflammatory cytokine production and signaling cascades. More importantly, sialic acid mimics and sialylated RNA viruses enable the antagonism of LPS-triggered proinflammatory responses through engaging the NMHC-IIA–DAP12-Syk pathway. These results actually support that NMHC-IIA is involved in negative modulation of the host innate immune system, which provides a molecular basis for prevention and control of the sialylated RNA viruses and treatment of inflammatory diseases.
Enterococcus faecalis
Encodes an Atypical Auxiliary Acyl Carrier Protein Required for Efficient Regulation of Fatty Acid Synthesis by Exogenous Fatty Acids
Authors: Zhu Lei , Zou Qi , Cao Xinyun , Cronan John E.
Published: May 2019

AcpB homologs are encoded by many, but not all, lactic acid bacteria (
Lactobacillales
), including many members of the human microbiome. The mechanisms regulating fatty acid synthesis by exogenous fatty acids play a key role in resistance of these bacteria to those antimicrobials targeted at fatty acid synthesis enzymes. Defective regulation can increase resistance to such inhibitors and also reduce pathogenesis.
Alzheimer’s Disease Microbiome Is Associated with Dysregulation of the Anti-Inflammatory P-Glycoprotein Pathway
Authors: Haran John P. , Bhattarai Shakti K. , Foley Sage E. , Dutta Protiva , Ward Doyle V. , Bucci Vanni , McCormick Beth A.
Published: May 2019

Studies of the intestinal microbiome and AD have demonstrated associations with microbiome composition at the genus level among matched cohorts. We move this body of literature forward by more deeply investigating microbiome composition via metagenomics and by comparing AD patients against those without dementia and with other dementia types. We also exploit machine learning approaches that combine both metagenomic and clinical data. Finally, our functional studies using stool samples from elders demonstrate how the c microbiome of AD elders can affect intestinal health via dysregulation of the P-glycoprotein pathway. P-glycoprotein dysregulation contributes directly to inflammatory disorders of the intestine. Since AD has been long thought to be linked to chronic bacterial infections as a possible etiology, our findings therefore fill a gap in knowledge in the field of AD research by identifying a nexus between the microbiome, loss of intestinal homeostasis, and inflammation that may underlie this neurodegenerative disorder.
Influenza “Trains” the Host for Enhanced Susceptibility to Secondary Bacterial Infection
Authors: Shirey Kari Ann , Perkins Darren J. , Lai Wendy , Zhang Wei , Fernando Lurds R. , Gusovsky Fabian , Blanco Jorge C. G. , Vogel Stefanie N.
Published: May 2019

Enhanced susceptibility to 2° bacterial infections following infection with influenza virus is a global health concern that accounts for many hospitalizations and deaths, particularly during pandemics. The complexity of the impaired host immune response during 2° bacterial infection has been widely studied. Both type I IFN and neutrophil dysfunction through decreased chemokine production have been implicated as mechanisms underlying enhanced susceptibility to 2° bacterial infections. Our findings support the conclusion that selective suppression of CXCL1/CXCL2 represents an IFN-β-mediated “training” of the macrophage transcriptional response to TLR2 agonists and that blocking of TLR4 therapeutically with Eritoran after influenza virus infection reverses this suppression by blunting influenza-induced IFN-β.
Bovine Genome-Microbiome Interactions: Metagenomic Frontier for the Selection of Efficient Productivity in Cattle Systems
Authors: Myer Phillip R.
Published: May 2019

The mutualistic, commensal, and parasitic microorganisms that reside in the rumen and lower gastrointestinal tract of cattle and other ruminants exert enormous influence over animal physiology and performance. Because these microbial communities are critical for host nutrient utilization and contribute to the metabolic capacity of the rumen, past research has aimed to define host-microbe symbioses in cattle by examining the rumen and lower gut microbiomes with respect to production phenotypes, such as feed efficiency.
Visual loss in pregnancy
Authors: Bachmeier Caroline Annette Erika , Snell Cameron , Morton Adam
Published: May 2019

Visual loss in pregnancy may be caused by a variety of reasons including pituitary adenomas. Prolactinomas (PRLs) are the most common hormone-secreting tumours in pregnant women. As most PRLs present with menstrual abnormalities, infertility or galactorrhoea, they are most commonly diagnosed before pregnancy. We present the case of a 30-year-old primigravida who presented at 36+5weeks gestation with headaches and left-sided visual loss. MRI of the pituitary gland confirmed a 10×11 mm left suprasellar mass. Results of her anterior pituitary function were unremarkable for her gestational age. Postpartum, she underwent an endoscopic endonasal resection of the pituitary tumour. The histology was consistent with a PRL. Literature review reveals only one possible case of a new diagnosis of a PRL during pregnancy. It highlights the importance to consider a wide range of differential diagnoses when assessing visual loss in pregnancy.
Sparganosis: an under-recognised zoonosis in Australia?
Authors: Tran Quoc (Ryan) , Tran My Co , Mehanna Daniel
Published: May 2019

Sparganosis is a rare zoonotic parasitosis that is sporadically reported worldwide. In Australia, the causative tapeworms are considered endemic in wildlife animals, however, there have been only five reported human infections. We present three additional cases of sparganosis, involving two Australian born gentlemen who have never travelled overseas and a woman who emigrated from Ethiopia. The first man presented with two unusual subcutaneous lumps that migrated along the anterior abdominal wall connected by a tunnel. The second man presented with two separate lumps, one on the thigh and the other on the left upper abdomen over a 4-week interval. The woman presented with 6 weeks of intermittent fevers, night sweats, abdominal pain and passing intestinal worms. This series of patients suggests that sparganosis is under-recognised in Australia and serves as a reminder for clinicians to the varied presentations that can be characteristic of this lesser known zoonosis.
Cone Beam CT study of a case of eosinophilic granuloma of the mandible in a young patient
Authors: Izzetti Rossana , De Marco Emanuela , Caramella Davide
Published: May 2019

Eosinophilic granuloma (EG) is a rare bony disease deriving from abnormal proliferation of histiocytes, and is the most common form of presentation of Langerhans cell histiocytosis. EG predominantly affects the axial skeleton. However, when localised in the head and neck district, mandibular lesions account for the majority of cases. Mandibular lesions can mimic other pathological conditions, making biopsy fundamental for differential diagnosis. Treatment depends on the severity of the disease, ranging from pharmacological treatment to surgical approach. However, EG is also reported to possibly undergo spontaneous resolution. In this case report, we describe a rare case of EG with particularly aggressive behaviour in a young patient. Initially, local pharmacological treatment with intralesional administration of corticosteroids lead to worsening of the symptoms, increase in lesion’s dimensions, and disruption of the cortical bone. A more invasive therapeutic approach involving radical surgery was then performed, with consequent resolution of the disease.
Primary non-Hodgkin’s lymphoma of the vagina (PNHLV): a gynaecologist’s enigma!
Authors: Bhagat Nanak , Kalkur Pallavi , Kalkur Sanjaya
Published: May 2019

Primary lymphoma of the female genital tract is very rare, particularly those presenting primarily in the vagina are even rarer. We report a case of a 60-year-old woman who presented with generalised abdominal pain, vaginal discharge and a thickening of the posterior vaginal wall. Prompt radiological investigations and biopsy led to early diagnosis and appropriate treatment. Complete metabolic remission was obtained with three cycles of chemotherapy and radiotherapy. This case highlights the need for increasing the awareness about lymphomas presenting as vaginal lesion(s) and for clinicians to keep an open mind when working up such patients.
Hispanic representation in diabetes cardiovascular outcomes trials
Authors: Kelley A. Taylor , Mizokami-Stout Kara , O'Brien Matthew J. , Bowen Michael E. , Sussman Jeremy
Published: May 2019

Objective

To examine Hispanic/Latino representation in diabetes cardiovascular outcomes trials for novel antidiabetic drugs.

Research design and methods

We compared Hispanic/Latino representation, age, gender and body mass index in diabetes cardiovascular outcomes trials published from January 2008 to October 2018 to Hispanic adults with diabetes in the National Health Examination and Nutrition Survey over the same time period.

Results

Hispanics/Latinos comprised 18.5 % of trial subjects, which was similar to the proportion of US adults with diabetes who identify as Hispanic. Trial subjects were significantly younger, more likely to be female, and more obese than US Hispanics/Latinos. At least 10 different Latin American countries and territories were represented across the 10 trials.

Conclusions

US Hispanics/Latinos differ from subjects in diabetes cardiovascular outcomes trials, which may limit generalizability of trial results.
Impact of introducing a faecal immunochemical test (FIT) for haemoglobin into primary care on the outcome of patients with new bowel symptoms: a prospective cohort study
Authors: Mowat Craig , Digby Jayne , Strachan Judith A , McCann Rebecca , Hall Christopher , Heather Duncan , Carey Francis , Fraser Callum G , Steele Robert J C
Published: May 2019

Objective

To determine whether a faecal immunochemical test (FIT) for faecal haemoglobin concentration (f-Hb) can be safely implemented in primary care as a rule-out test for significant bowel disease (SBD) (colorectal cancer (CRC), higher risk adenoma (HRA) and inflammatory bowel disease (IBD)) when used as an adjunct to the clinical assessment of new bowel symptoms.

Design

Single-centre prospective cohort study of all patients who attended primary care and submitted a FIT in the first calendar year of the service beginning December 2015. f-Hb was estimated using HM-JACKarc (Kyowa Medex) with a clinical cut-off of ≥10 µg Hb/g faeces. Incident cases of CRC were verified via anonymised record linkage to the Scottish Cancer Registry.

Results

5422 patients submitted 5660 FIT specimens, of which 5372 were analysed (positivity: 21.9%). 2848 patients were referred immediately to secondary care and three with f-Hb <10 µg/g presented acutely within days with obstructing CRC. 1447 completed colonoscopy in whom overall prevalence of SBD was 20.5% (95 CRC (6.6%), 133 HRA (9.2%) and 68 IBD (4.7%)); 6.6% in patients with f-Hb <10 µg/g vs 32.3% in patients with f-Hb ≥10 µg/g. One CRC was detected at CT colonoscopy. 2521 patients were not immediately referred (95.3% had f-Hb <10 µg/g) of which four (0.2%) later developed CRC. Record linkage identified no additional CRC cases within a follow-up period of 23–35 months.

Conclusion

In primary care, measurement of f-Hb, in conjunction with clinical assessment, can safely and objectively determine a patient’s risk of SBD.
Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review
Authors: Li-zhen Liao , Yun Xu , Xiao-Dong Zhuang , Shu-bin Hong , Zi-lian Wang , Adrian Sandra Dobs , Bin Liu
Published: May 2019

Objective

Guidelines for screening and diagnosis of gestational diabetes mellitus (GDM) have been updated in the past several years, and various inconsistencies exist across these guidelines. Moreover, the quality of these updated guidelines has not been clarified. We thus conducted this systematic review to evaluate the relationship between the quality and detailed recommendations of these guidelines.

Data sources

The Guidelines International Network Library, the National Institute for Health and Clinical Excellence (NICE) database, the Medline database, the Embase and the National Guidelines Clearinghouse were searched for guidelines containing recommendations on screening and diagnosis strategies for GDM between 2009 and November 2018.

Methods

Guidelines included a target group of women with GDM, and contained recommendations for screening and diagnostic strategies for GDM were included in the present systematic review. Reviewers summarised recommendations on screening and diagnosis strategies from each guideline and rated the quality of guidelines by using the Appraisal of Guidelines Research and Evaluation (AGREE) criteria.

Results

A total of 459 citations were collected by the preliminary literature selection, and 16 guidelines that met the inclusion criteria were assessed. The inconsistencies of the guidelines mainly focus on the screening process (one step vs two step) and criteria of oral glucose tolerance test (OGTT) (International Association of Diabetes and Pregnancy Study Groups [IADPSG] vs CarpenterandCoustan). Guidelines with higher AGREE scores usually recommend a one-step OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks, and the majority of these guidelines likely to select evidence by Grading of Recommendations Assessment, Development and Evaluation criteria.

Conclusions

The guidelines of WHO-2013, NICE-2015, American Diabetes Association-2018, Endocrine Society-2013, Society of Obstetricians and Gynaecologists of Canada-2016, International Federation of Gynecology and Obstetrics-2015, American College of Obstetricians and Gynecologists-2018, United States Preventive Services Task Force-2014 and IADPSG-2015 are strongly recommended in the present evaluation, according to the AGREE II criteria. Guidelines with higher quality tend to recommend a one-step 75 g OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks.
Risk of bias assessment of randomised controlled trials referenced in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care: a cross-sectional review
Authors: Cho Yongil , Kim Changsun , Kang Bossng
Published: May 2019

Objectives

To identify the risk of bias of randomised controlled trials (RCTs) referenced in the 2015 American Heart Association (AHA) guidelines update for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).

Design

A cross-sectional review.

Setting

All RCTs cited as references in the 2015 AHA guidelines update for CPR and ECC were extracted. After excluding non-human trials, studies that analysed existing RCTs, and RCTs published in a letter format, two reviewers assessed the risk of bias among RCTs included in this study.

Outcome measures

The Cochrane Collaboration’s tool for assessing the risk of bias in six domains (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data and selective reporting) was used.

Results

Two hundred seventy-three RCTs were selected for the analyses. Of these RCTs, 78.8% had a high risk of bias for blinding of participants and personnel, mostly (87.7%) non-drug trials. In drug trials, the proportion of trials with a low risk of bias for blinding of participants and personnel was 73.0%. The proportion of RCTs with an unclear risk of bias were higher for random sequence generation (38.5%) and allocation concealment (34.1%) than in other domains. Unclear risk of bias proportions was 65.4% for random sequence generation and 57.7% for allocation concealment before the introduction of Consolidated Standards of Reporting Trials (CONSORT) but decreased to 31.3% and 32.2% after the 2010 CONSORT update, respectively.

Conclusions

The proportion of RCTs with an unclear risk of bias was still high for random sequence generation and allocation concealment in the 2015 AHA guidelines for CPR and ECC. The risk of bias should be considered when interpreting and applying the CPR guidelines. Authors should plan and report their research using CONSORT guidelines and the Cochrane Collaboration’s tool to reduce the risk of bias.
Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies
Authors: Ayoub-Charette Sabrina , Liu Qi , Khan Tauseef A , Au-Yeung Fei , Blanco Mejia Sonia , de Souza Russell J , Wolever Thomas MS , Leiter Lawrence A , Kendall Cyril , Sievenpiper John L
Published: May 2019

Objective

Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear.

Design

To assess the relation of important food sources of fructose-containing sugars with incident gout and hyperuricaemia, we conducted a systematic review and meta-analysis of prospective cohort studies.

Methods

We searched MEDLINE, Embase and the Cochrane Library (through 13 September 2017). We included prospective cohort studies that investigated the relationship between food sources of sugar and incident gout or hyperuricaemia. Two independent reviewers extracted relevant data and assessed the risk of bias. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method with random effects model and expressed as RR with 95% confidence intervals (CIs). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

Results

We identified three studies (1 54 289 participants, 1761 cases of gout), comparing the highest with the lowest level of exposure for SSBs, fruit juices and fruits. No reports were found reporting incident hyperuricaemia. Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty).

Conclusion

There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates.

Trial registration number

NCT02702375; Results.
Association between parity and persistent weight gain at age 40–60 years: a longitudinal prospective cohort study
Authors: Zoet Gerbrand Albertus , Paauw Nina D , Groenhof Katrien , Franx Arie , Gansevoort Ron T , Groen Henk , Van Rijn Bas , Lely Titia
Published: May 2019

Objectives

Physiological metabolic adaptations occur in the pregnant woman. These may persist postpartum and thereby contribute to an unfavourable cardiovascular disease (CVD) risk profile in parous women. The aim of the current study is to assess time-dependent changes of cardiometabolic health in parous women compared with nulliparous women.

Design and setting

We studied data of 2459 women who participated in the Prevention of Renal and Vascular End-stage Disease study, a population-based prospective longitudinal cohort for assessment of CVD and renal disease in the general population.

Participants

We selected women ≥40 years at the first visit, who reported no new pregnancies during the four follow-up visits. All women were categorised in parity groups, and stratified for age.

Outcome measures

We compared body mass index (BMI), high-density lipoprotein (HDL) cholesterol, blood pressure as continuous measurements and as clinical relevant CVD risk factors among parity groups over the course of 6 years using generalised estimating equation models adjusted for age.

Results

The BMI was significantly higher in women para 2 or more in all age categories: per child, the BMI was 0.6 kg/m2higher. corresponding with 1.5–2.0 kg weight gain per child. HDL cholesterol was significantly lower in women para 2 or more aged 40–49 and 50–59 years: per child, the HDL cholesterol was up to 0.09 mmol/L lower. Blood pressure did not differ among parity groups in any of the age categories.

Conclusions

Higher parity is associated with higher BMI, lower HDL cholesterol and a higher prevalence of cardiovascular risk factors, which is constant over time. These findings warrant for prospective research assessing determinants of cardiometabolic health at earlier age to understand the role of pregnancy in the development of CVD in women.
Characteristics and factors associated with post-exposure prophylaxis (PEP) treatment of dog and cat bites among left-behind children: a cross-sectional study in two cities of China
Authors: Yan Shuzhen , Chen Ying , Ye Wanbao , Chen Fuxiang , Li Liping
Published: May 2019

Objective

Animal injury is a significant cause of morbidity and mortality worldwide. Dog bites account for tens of millions of injuries annually and the highest risk is among children. However, children may not receive postexposure prophylaxis (PEP) treatment timely and appropriately after rabies exposure. This study aimed to investigate the characteristics and factors associated with PEP treatment of dog and cat bites among left-behind children.

Design

A cross-sectional study using questionnaire was conducted in primary and high schools.

Setting

Shenzhen and Shantou cities, Guangdong Province, China.

Participants

A total of 9380 participants were included and 2236 of them were with a history of dog and cat bites.

Results

1188 (53.1%) boys and 1048 (46.9%) girls suffered from animal bites. Bitten in holidays was less likely to receive PEP treatment (OR 0.512, 95% CI 0.377 to 0.695) than those bitten in school days. Bitten while being with family (OR 1.418, 95% CI 1.040 to 1.934) and bitten at roadside (OR 1.842, 95% CI 1.297 to 2.171), bitten by unvaccinated animals (OR 1.745, 95% CI 1.246 to 2.443) tended to receive PEP treatment. Compared with unbroken skin, bleeding (OR 1.789, 95% CI 1.165 to 2.745) and laceration (OR 3.834, 95% CI 2.310 to 6.366) were showed as treatment prompting factors.

Conclusions

Bitten in holidays was found as a risk factor of receiving PEP treatment of animal bites. Certain measures should be taken to raise left-behind children’s awareness of receiving PEP treatment timely and appropriately after dog and cat bites.
Comparing the variants of takotsubo syndrome: an observational study of the ECG and structural changes from a New Zealand tertiary hospital
Authors: Watson George M , Chan Christina W , Belluscio Laura , Doudney Kit , Lacey Cameron J , Kennedy Martin A , Bridgman Paul
Published: May 2019

Objectives

In takotsubo syndrome, QTc prolongation is a measure of risk of potentially fatal arrhythmia. It is not known how this risk, or derangement of other markers, differs across the echo variants of takotsubo syndrome. Therefore, we sought to explore whether apical takotsubo syndrome differs from the variants of the syndrome in more ways than just regional wall motion pattern. As the region of affected myocardium is usually larger, we hypothesised that patients with the classic apical ballooning form of takotsubo syndrome would have more severe derangement of their markers.

Design

Observational study of patients gathered from a prospective database (2010–2018) and by retrospective review (2006–2009).

Setting

The sole tertiary hospital from a New Zealand region in which case clusters of takotsubo syndrome were precipitated by large earthquakes in 2010, 2011 and 2016.

Participants

A total of 222 patients who met a modified version of the Mayo criteria for takotsubo syndrome were included. All patients had digitally archived echocardiograms that were over-read by a second echocardiologist blinded to the clinical report.

Primary outcome measures

Ejection fraction, peak troponin and QTc interval.

Results

Patients with the apical form were older (p=0.011), had a lower initial left ventricular ejection fraction (35% vs 44%, p<0.0001) and a higher peak high-sensitivity troponin I (hsTnI) (p=0.01) than those with variant forms. There was no difference in the electrical abnormalities between the variants (QTc interval, heart rate, PR interval, QRS duration or T-wave axis). There was also no correlation between any of peak hsTnI, peak QTc and ejection fraction. QTc interval increased on day 2 and peaked on day 3 before falling steeply (p<0.0001).

Conclusions

The variants of takotsubo syndrome differ in more ways than just their echo pattern but do not differ in their electrical abnormalities. There is a dissociation between the structural and electrical abnormalities. QTc peaks on day 3 and then falls steeply.