bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress Adaptation
Authors: Brown Alistair J. P. , Cowen Leah E. , di Pietro Antonio , Quinn Janet
Published: July 2017

Fungal species display an extraordinarily diverse range of lifestyles. Nevertheless, the survival of each species depends on its ability to sense and respond to changes in its natural environment. Environmental changes such as fluctuations in temperature, water balance or pH, or exposure to chemical insults such as reactive oxygen and nitrogen species exert stresses that perturb cellular homeostasis and cause molecular damage to the fungal cell. Consequently, fungi have evolved mechanisms to repair this damage, detoxify chemical insults, and restore cellular homeostasis. Most stresses are fundamental in nature, and consequently, there has been significant evolutionary conservation in the nature of the resultant responses across the fungal kingdom and beyond. For example, heat shock generally induces the synthesis of chaperones that promote protein refolding, antioxidants are generally synthesized in response to an oxidative stress, and osmolyte levels are generally increased following a hyperosmotic shock. In this article we summarize the current understanding of these and other stress responses as well as the signaling pathways that regulate them in the fungi. Model yeasts such as
Saccharomyces cerevisiae
are compared with filamentous fungi, as well as with pathogens of plants and humans. We also discuss current challenges associated with defining the dynamics of stress responses and with the elaboration of fungal stress adaptation under conditions that reflect natural environments in which fungal cells may be exposed to different types of stresses, either sequentially or simultaneously.
Skin Fungi from Colonization to Infection
Authors: de Hoog Sybren , Monod Michel , Dawson Tom , Boekhout Teun , Mayser Peter , Gräser Yvonne
Published: July 2017

Humans are exceptional among vertebrates in that their living tissue is directly exposed to the outside world. In the absence of protective scales, feathers, or fur, the skin has to be highly effective in defending the organism against the gamut of opportunistic fungi surrounding us. Most (sub)cutaneous infections enter the body by implantation through the skin barrier. On intact skin, two types of fungal expansion are noted: (A) colonization by commensals, i.e., growth enabled by conditions prevailing on the skin surface without degradation of tissue, and (B) infection by superficial pathogens that assimilate epidermal keratin and interact with the cellular immune system. In a response-damage framework, all fungi are potentially able to cause disease, as a balance between their natural predilection and the immune status of the host. For this reason, we will not attribute a fixed ecological term to each species, but rather describe them as growing in a commensal state (A) or in a pathogenic state (B).
Breaking Transmission with Vaccines: The Case of Tuberculosis
Authors: Gonzalo-Asensio Jesus , Aguilo Nacho , Marinova Dessislava , Martin Carlos
Published: July 2017

Members of the
Mycobacterium tuberculosis
complex (MTBC) have evolved causing tuberculosis (TB) in different mammalian hosts. MTBC ecotypes have adapted to diverse animal species, with
M. bovis
being the most common cause of TB in livestock. Cattle-to-human transmission of
M. bovis
through ingestion of raw milk was common before introduction of the pasteurization process. TB in humans is mainly caused by
M. tuberculosis
. This bacterium is considered a genetically clonal pathogen that has coevolved with humans due to its ability to manipulate and subvert the immune response. TB is a major public health problem due to airborne person-to-person transmission of
M. tuberculosis
. The essential yet unanswered question on the natural history of TB is when
M. tuberculosis
decides to establish latent infection in the host (resambling the lysogenic cycle of lambda phage) or to cause pulmonary disease (comparable to the lytic cycle of lambda phage). In this latter case,
M. tuberculosis
kills the host with the aim of achieving transmission to new hosts. Combating the TB epidemic requires stopping transmission.
M. bovis
BCG, the present vaccine against TB, is derived from
M. bovis
and only protects against disseminated forms of TB. Thus, a priority in TB research is development of new effective vaccines to prevent pulmonary disease. Attenuated vaccines based on
M. tuberculosis
as MTBVAC are potential candidates that could contribute to break the TB transmission cycle.
Bio-Plex immunoassay measuring the quantity of lysosomalN-acetylgalactosamine-6-sulfatase protein in dried blood spots for the screening of mucopolysaccharidosis IVA in newborn: a pilot study
Authors: Chuang Chih-Kuang , Lin Hsiang-Yu , Wang Tuan-Jen , Huang Sung-Fa , Lin Shuan-Pei
Published: July 2017

Objective

Mucopolysaccharidosis (MPS) IVA (Morquio syndrome A) is an autosomal-recessive lysosomal storage disorder caused by the deficiency ofN-acetylgalactosamine-6-sulfatase (GALNS) resulting in excessive lysosomal storage of keratan sulfate. Treatments for MPS IVA have recently become available with optimal outcomes associated with early diagnosis and treatment which can be achieved by newborn screening.

Design

Newborn screening programme for MPS IVA pilot study.

Setting

MacKay Memorial Hospital (MMH), Taipei and another three branch hospitals in Taiwan.

Participants

A total of 7415 newborns were born in four branch hospitals of MMH and had joined the MPS IVA newborn screening programme. Written informed consents were obtained from parents prior to the screening process (12MMHIS188 approved by MacKay Memorial Hospital Institutional Review Board).

Outcome measures

An alternative newborn screening method for MPS IVA has been performed. Screening involved measuring the quantity of GALNS in dried blood spot (DBS) from newborn infants using the Bio-Plex immunoassay. The amount of fluorescence sorting detected by yttrium aluminium garnet laser was proportional to the quantity of GALNS protein.

Results

Of the 7415 neonates analysed, eight infants whose GALNS levels were below the cut-off value of 8.30 µg/L had been recalled for a second DBS collection. The reference values were 8.30–27.43 µg/L. In patients with confirmed MPS IVA (n=11), the GALNS quantities were far below 5% of the normal population.

Conclusion

The Bio-Plex immunoassay is a validated method used for measuring GALNS protein in DBS and has the potential to be adopted for MPS IVA newborn screening study design.
Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation
Authors: Sheard Laura , Marsh Claire , O’Hara Jane , Armitage Gerry , Wright John , Lawton Rebecca
Published: July 2017

Objectives

A patient safety intervention was tested in a 33-ward randomised controlled trial. No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards.

Design

Large qualitative process evaluation of the implementation of a patient safety intervention.

Setting and participants

National Health Service staff based on 17 acute hospital wards located at five hospital sites in the North of England.

Data

We concentrate on three sources here: (1) analysis of taped discussion between ward staff during action planning meetings; (2) facilitators’ field notes and (3) follow-up telephone interviews with staff focusing on whether action plans had been achieved. The analysis involved the use of pen portraits and adaptive theory.

Findings

First, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff.

Conclusions

A dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components.
Primary care workforce and continuous medical education in China: lessons to learn from a nationwide cross-sectional survey
Authors: Wong William C W , Zhu ShanZhu , Ong Jason J , Peng MingHui , Lam Cindy L K , Kidd Michael R , Roland Martin , Jiang SunFang
Published: July 2017

Objectives

This study aimed to examine the education and training background of Chinese community health centres (CHCs) staff, continuous medical education (CME) and factors affecting participation in CME.

Design

Cross-sectional survey.

Setting

Community health centres(CHCs).

Participants

All doctors and nurses working in selected CHCs (excluding those solely practising traditional Chinese Medicine).

Main outcome measures

CME recorded by CHCs and self-reported CME participation.

Methods

A stratified random sample of CHCs based on geographical distribution and 2:1 urban–suburban ratio was selected covering three major regions of China. Two questionnaires, one for lead clinicians and another for frontline health professionals, were administered between September–December 2015, covering the demographics of clinic staff, staff training and CME activities.

Results

149 lead clinicians (response rate 79%) and 1734 doctors and 1846 nurses completed the survey (response rate 86%). Of the doctors, 54.5% had a bachelor degree and only 47% were registered as general practitioners (GPs). Among the doctors, 10.5% carried senior titles. Few nurses (4.6%) had training in primary care. Those who have reported participating in CME were 91.6% doctors and 89.2% nurses. CME participation in doctors was more commonly reported by older doctors, females, those who were registered as a GP and those with intermediate or senior job titles. CME participation in nurses was more common among those with a bachelor degree or intermediate/senior job titles or those with longer working experience in the CHC.

Conclusion

Only half of doctors have bachelor degrees or are registered as GPs as their prime registration in the primary care workforce in China. The vast majority of CHC staff participated in CME but there is room for improvement in how CME is organised.
Does a one-day workshop improve clinical faculty’s comfort and behaviour in practising and teaching evidence-based medicine? A Canadian mixed methods study
Authors: Allen David , Abourbih Jacques , Maar Marion , Boesch Lisa , Goertzen James , Cervin Catherine
Published: July 2017

Objective

The purpose of this study was to determine the impact of a 1-day evidence-based medicine (EBM) workshop on physician attitudes and behaviours around teaching and practicing EBM.

Design

A mixed methods study using a before/after cohort.

Setting

A medical school delivering continuing professional development to 1250 clinical faculty over a large geographic area in Canada.

Participants

105 physician clinical faculty members.

Intervention

A 1-day workshop presented at 11 different sites over an 18-month period focusing on EBM skills for teaching and clinical practice.

Outcome measures

(1) A quantitative survey administered immediately before and after the workshop, and 3–6 months later, to assess the hypothesis that comfort with teaching and practising EBM can be improved.

(2) A qualitative survey of the expectations for, and impact of the workshop on, participant behaviours and attitudes using a combination of pre, post and 3 to 6-month follow-up questionnaires, and telephone interviews completed 10–14 months after the workshop.

Results

Physician comfort with their EBM clinical skills improved on average by 0.93 points on a 5-point Likert scale, and comfort with EBM teaching skills by 0.97 points (p values 0.001). Most of this improvement was sustained 3–6 months later. Three to fourteen months after the workshop, half of responding participants reported that they were using the Population Intervention Comparator Outcome (PICO) methodology of question framing for teaching, clinical practice or both.

Conclusions

Comfort in teaching and practicing EBM can be improved by a 1-day workshop, with most of this improvement sustained 3–6 months later. PICO question framing can be learnt at a 1-day workshop, and is associated with a self-reported change in clinical and teaching practice 3–14 months later. This represents both level 2 (attitudes) and level 3 (behaviours) change using the Kirkpatrick model of evaluation.
Does recruitment source moderate treatment effectiveness? A subgroup analysis from the EVIDENT study, a randomised controlled trial of an internet intervention for depressive symptoms
Authors: Klein Jan Philipp , Gamon Carla , Späth Christina , Berger Thomas , Meyer Björn , Hohagen Fritz , Hautzinger Martin , Lutz Wolfgang , Vettorazzi Eik , Moritz Steffen , Schröder Johanna
Published: July 2017

Objective

This study aims to examine whether the effects of internet interventions for depression generalise to participants recruited in clinical settings.

Design

This study uses subgroup analysis of the results of a randomised, controlled, single-blind trial.

Setting

The study takes place in five diagnostic centres in Germany.

Participants

A total of 1013 people with mild to moderate depressive symptoms were recruited from clinical sources as well as internet forums, statutory insurance companies and other sources.

Interventions

This study uses either care-as-usual alone (control) or a 12-week internet intervention (Deprexis) plus usual care (intervention).

Main outcome measures

The primary outcome measure was self-rated depression severity (Patient Health Questionnaire-9) at 3 months and 6 months. Further measures ranged from demographic and clinical parameters to a measure of attitudes towards internet interventions (Attitudes towards Psychological Online Interventions Questionnaire).

Results

The recruitment source was only associated with very few of the examined demographic and clinical characteristics. Compared with participants recruited from clinical sources, participants recruited through insurance companies were more likely to be employed. Clinically recruited participants were as severely affected as those from other recruitment sources but more sceptical of internet interventions. The effectiveness of the intervention was not differentially associated with recruitment source (treatment by recruitment source interaction=0.28, p=0.84).

Conclusion

Our results support the hypothesis that the intervention we studied is effective across different recruitment sources including clinical settings.

Trial registration number

ClinicalTrials.govNCT01636752.
Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
Authors: Nishijo Muneko , Nakagawa Hideaki , Suwazono Yasushi , Nogawa Kazuhiro , Kido Teruhiko
Published: July 2017

Objective

To clarify the causes of deaths among patients with Itai-itai disease and severe cadmium (Cd) poisoning.

Design

Nested case–control analysis of a population-based cohort study.

Setting

Database of patients with Itai-itai disease and residents of Cd-polluted areas, maintained by the Ministry of Environment, Japan.

Participants

Subjects included 142 women with Itai-itai disease, 111 women with Cd-induced renal tubular dysfunction and 253 controls matched for sex, age and occupation. All subjects participated in a health impact survey between 1979 and 1984 and were followed until 30 November 2005.

Main outcomes and measures

Adjusted HRs with 95% CIs for cause of death in women with Itai-itai disease and screened female cases with tubular dysfunction were compared with matched pair controls, using Cox’s proportional hazard model. Vital statistics data were used to determine cause of death. Direct causes of death from autopsy records were used in 29 patients who died from Cd poisoning.

Results

The most common cause of death among patients with Itai-itai disease was pneumonia, with a significantly increased adjusted HR of 4.54 (95% CI 2.65 to 7.76). Renal diseases were the most common cause of death in renal tubular dysfunction cases, with an increased HR of 12.0 (95% CI 3.92 to 36.8). The adjusted HR for renal diseases was also significantly increased in patients with Itai-itai disease (19.49 (95% CI 6.43 to 59.09)), with a greater impact on mortality of patients with Itai-itai disease than screened cases. The HR for gastrointestinal (GI) diseases was significantly increased (13.79 (95% CI 3.87 to 49.10)) in patients, especially in the first 10 years (37.1 (4.81 to 286.0)).

Conclusions

Among patients with Itai-itai disease, pneumonia and GI diseases contributed to increased mortality risk. Renal disease is also a significant mortality risk in patients with Itai-itai disease and women with renal tubular dysfunction.
Assessing the medium-term impact of a home-visiting programme on child maltreatment in England: protocol for a routine data linkage study
Authors: Lugg-Widger Fiona V , Cannings-John Rebecca , Channon Sue , Fitzsimmons Deborah , Hood Kerenza , Jones Kerina H , Kemp Alison , Kenkre Joyce , Longo Mirella , McEwan Kirsten , Moody Gwenllian , Owen-Jones Eleri , Sanders Julia , Segrott Jeremy , Robling Michael
Published: July 2017

Introduction

Child maltreatment involves acts of omission (neglect) or commission (abuse) often by caregivers that results in potential or actual harm to a child. The Building Blocks trial (ISRCTN23019866) assessed the short-term impact of an intensive programme of antenatal and postnatal visiting by specially trained nurses to support young pregnant women in England. The Building Blocks: 2–6 Study will assess the medium-term impacts of the programme for mothers and children (n=1562), through the linkage of routinely collected data to the trial data, with a particular emphasis on the programme’s impact on preventing child maltreatment.

Methods and analysis

We have developed a bespoke model of data linkage whereby outcome data for the trial cohort will be retrieved by linked anonymous data abstraction from NHS Digital, Office for National Statistics and the Department for Education’s National Pupil Database. Participants will be given reasonable opportunity to opt out of this study prior to data transfer. The information centres will match participants to the information held in their databases using standard identifiers and send extracts to a third-party safe haven. The study will have 80% power to detect a 4% difference (4%vs8%) for the binary primary outcome of child in need status (from birth to key stage 1) at a two-sided 5% alpha level by following up 602 children in each trial arm. Analysis will be by intention to treat using logistic multilevel modelling. A cost-and-consequences analysis will extend the time frame of the economic analysis from the original trial.

Ethics and dissemination

The study protocol has been approved by the National Health Service Wales Research Ethics Committee and the Health Research Authority’s Confidentiality Advisory Group. Methods of innovative study design and findings will be disseminated through peer-reviewed journals and conferences; results will be of interest to clinical and policy stakeholders in the UK.

Trial registration number

ISRCTN23019866.
Sociodemographic differences in women’s experience of early labour care: a mixed methods study
Authors: Henderson Jane , Redshaw Maggie
Published: July 2017

Objectives

To explore women’s experiences of early labour care focusing on sociodemographic differences, and to examine the effect of antenatal education, using mixed methods.

Setting

England, 2014.

Participants

Women who completed postal questionnaires about their experience of maternity care, including questions about antenatal education, early labour and sociodemographic factors, included space for free-text comments.

Outcome measures

Worries about labour, contact with midwives in early labour and subsequent care.

Methods

This study was based on secondary analysis of a national maternity survey carried out in England in 2014. Quantitative data were analysed using descriptive statistics and binary logistic regression; qualitative data were analysed using a thematic content analytic approach.

Results

Completed questionnaires were received from 4578 women (47% response rate). There were significant differences by sociodemographic factors, particularly ethnicity, in women’s worries about early labour. Compared with white women, women from black or minority ethnic groups had an adjusted OR of 1.93 (95% CI 1.56 to 2.39) of feeling worried about not knowing when labour would start. Among women who contacted a midwife at the start of labour, 84% perceived their advice as appropriate, more in older and multiparous women. Overall, 64% of women were asked to come to the hospital at this time, more in multiparous women (adjusted OR 1.63, 95% CI 1.35 to 1.96). Those who did not have access to antenatal education experienced greater worry about early labour. Five themes emerged from the qualitative analysis: ‘Differentiating between early and active labour’, ‘Staff attitudes’, ‘Not being allowed…’, ‘Previous labours’ and ‘Perceived consequences for women’.

Conclusion

These findings reinforce the importance of providing reassurance to women in early labour, taking care that women do not feel neglected or dismissed. In particular, primiparous and ethnic minority women reported greater worry about early labour and require additional reassurance.
Evaluating the predictive strength of the LACE index in identifying patients at high risk of hospital readmission following an inpatient episode: a retrospective cohort study
Authors: Damery Sarah , Combes Gill
Published: July 2017

Objective

To assess how well the LACE index and its constituent elements predict 30-day hospital readmission, and to determine whether other combinations of clinical or sociodemographic variables may enhance prognostic capability.

Design

Retrospective cohort study with split sample design for model validation.

Setting

One large hospital Trust in the West Midlands.

Participants

All alive-discharge adult inpatient episodes between 1 January 2013 and 31 December 2014.

Data sources

Anonymised data for each inpatient episode were obtained from the hospital information system. These included age at index admission, gender, ethnicity, admission/discharge date, length of stay, treatment specialty, admission type and source, discharge destination, comorbidities, number of accident and emergency (A&E) visits in the 6 months before the index admission and whether a patient was readmitted within 30 days of index discharge.

Outcome measures

Clinical and patient characteristics of readmission versus non-readmission episodes, proportion of readmission episodes at each LACE score, regression modelling of variables associated with readmission to assess the effectiveness of LACE and other variable combinations to predict 30-day readmission.

Results

The training cohort included data on 91 922 patient episodes. Increasing LACE score and each of its individual components were independent predictors of readmission (area under the receiver operating characteristic curve (AUC) 0.773; 95% CI 0.768 to 0.779 for LACE; AUC 0.806; 95% CI 0.801 to 0.812 for the four LACE components). A LACE score of 11 was most effective at distinguishing between higher and lower risk patients. However, only 25% of readmission episodes occurred in the higher scoring group. A model combining A&E visits and hospital episodes per patient in the previous year was more effective at predicting readmission (AUC 0.815; 95% CI 0.810 to 0.819).

Conclusions

Although LACE shows good discriminatory power in statistical terms, it may have little added value over and above clinical judgement in predicting a patient’s risk of hospital readmission.
Managing an intentional overdose in a hospice
Authors: Dinnen Toby , Armstrong Hannah , Perkins Paul
Published: July 2017

This case report describes a patient admitted unconscious to a hospice following an intentional overdose of oxycodone. She had previously declined conventional medical treatment for cancer and had made an advance decision stating that she wished to avoid hospital admission and refusing life-prolonging treatment. This case illustrates the practical and ethical challenges of managing an intentional overdose in a palliative care setting.
The limitations of using randomised controlled trials as a basis for developing treatment guidelines
Authors: Mulder Roger , Singh Ajeet B , Hamilton Amber , Das Pritha , Outhred Tim , Morris Grace , Bassett Darryl , Baune Bernhard T , Berk Michael , Boyce Philip , Lyndon Bill , Parker Gordon , Malhi Gin S
Published: July 2017

Randomised controlled trials (RCTs) are considered the ‘gold standard’ by which novel psychotropic medications and psychological interventions are evaluated and consequently adopted into widespread clinical practice. However, there are some limitations to using RCTs as the basis for developing treatment guidelines. While RCTs allow researchers to determine whether a given medication or intervention is effective in a specific patient sample, for practicing clinicians it is more important to know whether it will work for their particular patient in their particular setting. This information cannot be garnered from an RCT. These inherent limitations are exacerbated by biases in design, recruitment, sample populations and data analysis that are inevitable in real-world studies. While trial registration and CONSORT have been implemented to correct and improve these issues, it is worrying that many trials fail to achieve such standards and yet their findings are used to inform clinical decision making. This perspective piece questions the assumptions of RCTs and highlights the widespread distortion of findings that currently undermine the credibility of this powerful design. It is recommended that the clinical guidelines include advice as to what should be considered good and relevant evidence and that external bodies continue to monitor RCTs to ensure that the outcomes published indeed reflect reality.
Accuracy and precision of venous pressure measurements of endovascular microcatheters in the setting of dural venous sinus stenosis
Authors: Avery Michael B , Sambrano Sheryl , Khader Eliyas Javed , Eesa Muneer , Mitha Alim P
Published: July 2017

Introduction

Dural venous sinus stenosis (DVSS) may lead to increased intracranial pressure, sometimes requiring a stent if a high pressure gradient exists. Many neuroendovascular physicians use microcatheters to measure gradients, yet there are no studies comparing the accuracies and precisions of modern day microcatheters. We examined pressure recordings from five commonly used microcatheters in an experimental DVSS model.

Methods

Using a programmable pump, dynamic flow was established in a closed circuit mimicking the venous sinus waveform. Microcatheters with 150 cm effective lengths were connected proximally to pressure transducers. Mean recording pressures were compared with a high fidelity microcatheter (HFM) in several configurations including no stenosis, proximal to a focal stenosis, and distal to a focal stenosis in opposing orientations.

Results

All microcatheters recorded lower pressures than the HFM. Three of the five microcatheters successfully met intracranial pressure monitoring device standards in all conditions, while one did not meet standards in any configuration. The performance of the final microcatheter was variable, with inaccuracies occurring in unrestricted flow. All microcatheters demonstrated relatively high precision, but with variable accuracies. The larger diameter microcatheters displayed the least damping and therefore the greatest accuracies. Of the three smaller microcatheters, dimensions did not predict performance, suggesting that microcatheter construction may also play a role in pressure accuracy.

Conclusion

The use of microcatheters to record dural venous sinus pressures must be done with an understanding of the inherent limitations and inaccuracies, especially if clinical decisions are made from the results.
Use of a next-generation multi-durometer long guide sheath for triaxial access in flow diversion: experience in 95 consecutive cases
Authors: Lin Li-Mei , Bender Matthew T , Colby Geoffrey P , Beaty Narlin B , Jiang Bowen , Campos Jessica K , Huang Judy , Tamargo Rafael J , Coon Alexander L
Published: July 2017

Background

Intracranial access techniques in modern neurointerventions have shifted towards more robust access platforms. The long guide sheath is one of the building blocks of triaxial systems used in intracranial embolizations. Here we present our experience with the AXS Infinity LS long sheath in the triaxial platform for the implantation of the Pipeline embolization device (PED).

Methods

We retrospectively identified patients who underwent PED Flex treatment with the AXS Infinity LS at a single institution. Procedural data collected included parent artery tortuosity, patient demographics, vasodilator use, aneurysm characteristics, equipment utilized, and catheter-related complications.

Results

A total of 95 cases were completed using the AXS Infinity LS for the triaxial platform foundation in PED Flex treatment of cerebral aneurysms. Mean patient age was 56.2±12.2 years (range 21–86). Average aneurysm size was 6.9±6.2 mm (range 1–38). There were 89 anterior circulation cases (94%) and 6 posterior circulation cases (6%). Significant cervical ICA tortuosity was present in 11/89 (12%) and moderate to severe cavernous ICA tortuosity was present in 29/89 (33%). Mean fluoroscopy time was 40.0±19.8 min. In 14/95 cases (15%), vasospasm prophylaxis or treatment with intra-arterial verapamil infusion was performed. Catheter access-related complications included asymptomatic iatrogenic dissection in one case (1%) from the distal intracranial catheter and groin hematoma in one case (1%). No parent vessel wall abnormalities were visualized in the region of the Infinity long sheath on final control angiography in all 95 cases.

Conclusion

The AXS Infinity LS is the newest long guide sheath available for modern neurointerventional procedures. We have shown its utility in augmenting the triaxial access platform in PED Flex cases by providing enhanced distal tip trackability with added support in the aortic arch and proximal great vessels.
Role of P-glycoprotein on CD69+CD4+cells in the pathogenesis of proliferative lupus nephritis and non-responsiveness to immunosuppressive therapy
Authors: Tsujimura Shizuyo , Adachi Tomoko , Saito Kazuyoshi , Tanaka Yoshiya
Published: July 2017

Introduction

P-glycoprotein (P-gp) expression on activated lymphocytes in systemic lupus erythematosus (SLE) plays a role in active efflux of intracellular drugs, resulting in drug resistance. The role of P-gp-expressing lymphocytes in the pathogenesis of SLE remains unclear. The aim of this study was to determine the importance of P-gp+CD4+cells in organ manifestations in refractory SLE.

Methods

The proportion of P-gp+CD4+cells was determined by flow cytometry in peripheral blood of patients with SLE (n=116) and healthy adults (n=10). Renal biopsy specimens were examined by immunohistochemistry for P-gp expression.

Results

CD69 is a marker of CD4 cell activation. The proportion of both P-gp-expressing CD4+cells and CD69-expressing CD4+cells in peripheral blood was higher in SLE than control. The proportion of P-gp+CD69+CD4+cells correlated with Systemic Lupus Erythematosus Disease Activity Index and was higher in poor responders to corticosteroids. Furthermore, the proportion of P-gp+CD69+CD4+cells was significantly higher in proliferative lupus nephritis (LN) with poor response to corticosteroids. The efficacy of immunosuppressive therapy depended on the regulation of the proportion of P-gp+CD69+CD4+cells. Marked accumulation of P-gp+CD4+cells in renal interstitial tissue and high proportion of peripheral P-gp+CD69+CD4+cells were noted in patients with proliferative LN.

Conclusions

The results showed high proportion of P-gp+CD69+CD4+cells in peripheral blood and their accumulation in renal tissue in patients with proliferative LN refractory to CS therapy, suggesting that P-gp expression on activated CD4+T cells is a potentially useful marker for refractoriness to treatment and a novel target for treatment.
Dipeptidyl Peptidase‐4 Regulates Hematopoietic Stem Cell Activation in Response to Chronic Stress
Authors: Zhu Enbo , Hu Lina , Wu Hongxian , Piao Limei , Zhao Guangxian , Inoue Aiko , Kim Weon , Yu Chenglin , Xu Wenhu , Bando Yasuko K. , Li Xiang , Lei Yanna , Hao Chang‐Ning , Takeshita Kyosuke , Kim Woo‐Shik , Okumura Kenji , Murohara Toyoaki , Kuzuya Masafumi , Cheng Xian Wu
Published: July 2017

Background

DPP4 (Dipeptidyl peptidase‐4)‐GLP‐1 (glucagon‐like peptide‐1) and its receptor (
GLP
‐1R) axis has been involved in several intracellular signaling pathways. The Adrβ3 (β3‐adrenergic receptor)/
CXCL
12 (C‐X‐C motif chemokine 12) signal was required for the hematopoiesis. We investigated the novel molecular requirements between
DPP
4‐
GLP
‐1/
GLP
‐1 and Adrβ3/CXCL12 signals in bone marrow (
BM
) hematopoietic stem cell (
HSC
) activation in response to chronic stress.

Methods and Results

Male 8‐week‐old mice were subjected to 4‐week intermittent restrain stress and orally treated with vehicle or the
DPP
4 inhibitor anagliptin (30 mg/kg per day). Control mice were left undisturbed. The stress increased the blood and brain
DPP
4 levels, the plasma epinephrine and norepinephrine levels, and the
BM
niche cell Adrβ3 expression, and it decreased the plasma
GLP
‐1 levels and the brain
GLP
‐1R and
BM CXCL
12 expressions. These changes were reversed by
DPP
4 inhibition. The stress activated
BM
sca‐1
high
c‐Kit
high
CD
48
low
CD
150
high
HSC
proliferation, giving rise to high levels of blood leukocytes and monocytes. The stress‐activated
HSC
proliferation was reversed by
DPP
4 depletion and by
GLP
‐1R activation. Finally, the selective pharmacological blocking of Adrβ3 mitigated
HSC
activation, accompanied by an improvement of
CXCL
12 gene expression in
BM
niche cells in response to chronic stress.

Conclusions

These findings suggest that
DPP
4 can regulate chronic stress‐induced
BM HSC
activation and inflammatory cell production via an Adrβ3/
CXCL
12‐dependent mechanism that is mediated by the
GLP
‐1/
GLP
‐1R axis, suggesting that the
DPP
4 inhibition or the
GLP
‐1R stimulation may have applications for treating inflammatory diseases.
Regulating Natural Resource Funds: Alaska Heritage Trust Fund, Alberta Permanent Fund, and Government Pension Fund of Norway
Authors: Onifade Temitope Tunbi
Published: July 2017

The paper is a comparative regulatory analysis of the Alaska Heritage Trust Fund, the Alberta Permanent Fund, and the Government Pension Fund of Norway, as developed country natural resource fund (nrf) models. Its objective is to examine how nrfs are regulated. To achieve this objective, it explores and compares the socio-political contexts and regulatory features of the three nrfs, drawing lessons along the way. Given the dearth of publications on the domestic as opposed to the transnational regulation of nrfs, it carries out an original review of primary and secondary policy sources, both legal and non-legal documents, along with a synthesis of representative bodies of literature. It finds that nrfs are mainly regulated by laws and institutional support, which constitute four key regulatory features: legal frameworks and objectives, ownership regimes, structure and functionality, and governance and operation. The conclusion is that how nrfs are regulated, based on these features, determines their outcomes.
The Role of Support in Psychoanalysis
Authors: De Jonghe F. , Rijnierse P. , Janssen R.
Published: July 2017

A two-factor theory of clinical psychoanalysis is proposed. In accordance with the predominant position of the structural-adaptational (“classical”) approach in psychoanalytic theory, the power of interpretation and insight in clinical psychoanalysis has received ample attention in psychoanalytic literature. There seems, however, to be a growing awareness among analysts that not all the facts of an analytic treatment can be accounted for by this approach alone. A second factor is increasingly recognized: the power of adequate support provided by the analyst and resulting in a specific experience by the analysand. In the application of the developmental (“postclassical”) approach of psychoanalytic theory, the importance of this support-experience factor in the treatment of ordinary neurosis by means of ordinary psychoanalysis is emphasized. The relative neglect of this aspect of clinical psychoanalysis may be indicative of the present-day dilemma of how to translate advances in theoretical knowledge of mental development into the therapeutic praxis of psychoanalysis. There may, however, be another important reason. Support and experience are phenomena often occurring on the nonverbal level. In contrast to interpretation and insight, they are usually not voiced, let alone distinctly and loudly expressed. They are the silent power of psychoanalysis.
Analysis of the Transference Neurosis in a Child with Transsexual Symptoms
Authors: Loeb Loretta R.
Published: July 2017

This paper touches on two issues that have been disputed by child analysts: the genesis of the transsexual symptom complex, and the question of transference neurosis in child analysis. My observation, as reported previously (Loeb and Shane, 1980) and shown in the present case, is that the transsexual symptom complex can develop out of intrapsychic conflict and can be resolved in a fully developed transference neurosis. In the analysis of a four-and-a-half-year-old boy with transsexual symptoms, I was abstinent—not benevolent or supportive—and both positive and negative transference feelings developed into a full-blown transference neurosis. Then, as I interpreted its elements, we worked through his conflicts, which manifested themselves as acting out of his identification with his aggressive, seductive, and castrating grandmother. As he came to understand his conflicts, the boy's transsexual symptoms vanished.
Trinity - The consummated covenant: Theses on the doctrine of the trinitarian God
Authors: Schoonenberg P.J.A.M.
Published: July 2017

In 1971 Herder and Herder of New York published my book The Christ,1 which under the heading 'God and man, or God in man?' contains a study of Jesus Christ as God and man. This study implies a doctrine of the Trinity, although one more intimated than articulated. In Dietrich Wiederkehr's grandiose 'Design for a systematic Christology,'2 this doctrine of the Trinity was implicitly contested. It also occasioned Jean Galot to speak of a Christology 'en dessous de l'arianisme' (beneath Arianism).3 Recently, in a report in Herder Korrespondenz,4 this conception of the Trinity was judged less consequent than that of Karl Rahner, although I think I am carrying on Rahner's trinitarian thinking.

Although I am preparing a longer work on the Trinity, it seems opportune to present my views provisionally in thesis form, so that a judgment can be formed about them. I am grateful to the editors of SR for providing this opportunity. The text was first published in German in the Swiss periodical Orientierung, 31 May 1973. It was translated by Dr Robert C. Ware and afterwards modified by me.
Reinforcement of Nickel with some High-Strength Filaments
Authors: Ahmad Iqbal , Greco V.P. , Barranco J.M.
Published: July 2017

Composites of nickel containing 35 volume percent tungsten filaments and 11 volume percent alpha-Al 2O3 whiskers have been fabricated by the electroforming technique. Their (.2%) yield and ultimate tensile strengths after annealing (650° in H2 for 1/2 hour) have been found to be a linear function of the volume percent of the filament. The feasibility of producing nickel com posite reinforced with boron and E-glass filaments and SiC whiskers by this technique has also been demonstrated.
Mechanical Properties of Fiber Reinforced Composites
Authors: Chen C.H. , Shun Cheng
Published: July 2017

Theoretical expressions are obtained by means of classical theory of elasticity for determining the composite elastic con stants for fiber reinforced plastics in terms of the elastic moduli and the geometric parameters of the constituents. Infinite series are used for the solution of the differential equations and a com bination of least square method and Fourier method is employed. Although the investigation is made for hexagonal array, the principles are also valid for other fiber arrangements. Numerical examples have been worked out for hexagonal array and compared with an existing analysis.
Axial Loading of a Unidirectional Composite
Authors: Bloom Joseph M. , Wilson Howard B.
Published: July 2017

The behavior of a unidirectional fiber-reinforced composite subjected to axial loading is investigated. The elastic analysis of a composite containing a hexagonal array of perfectly bonded circular filaments is formulated to simulate the axial loading of a unidirectional composite. A modified plane strain theory is adopted so that the existing methodology of Muskhelishvili can be utilized. The resulting power series solution along with a point matching technique yields a system of simultaneous equations. Once these equations are solved, the interface, matrix, and filament stresses are found. Graphical presentation of these stresses is made. The conclusions arrived at are that the maximum in-plane stresses are small relative to the applied axial stress and occur at the fiber- matrix interface. These stresses are directly related to the dif ference of the Poisson's ratios of the fiber and matrix. Lastly, the assumption of axial symmetry is valid when considering a unidi rectional composite under axial loading.
Effect of Elastic Constants on Stress In A Composite Under Plane Deformation
Authors: Dundurs J.
Published: July 2017

When a composite body consisting of two isotropic and elastic phases is subjected to prescribed surface tractions, generally the stress field depends on three parameters involving the elastic con stants. If the composite is in a state of plane deformation, and there are no net forces on internal boundaries, however, the stress depends on only two combinations of elastic constants. Convenient constants for the composite material are proposed.
The Effect of Mechanical Prestrain on the Creep Response of Arall® 4 Laminates
Authors: Willlams Todd O. , Pindera Marek-Jerzy
Published: July 2017

The paper addresses the effect of mechanical prestrain on the creep response of Arall 4 laminates at 121°C. Arall 4 is a recently developed hybrid composite belonging to the Arall family of laminates composed of symmetrically laminated alternating layers of aramid/epoxy and aluminum. This particular variant has been developed for applications involving elevated temperatures up to 150°C. It is experimentally demonstrated that the substantial extent of creep at stress levels below the proportional limit observed in Arall 4 laminates at 121°C can be significantly reduced by mechanical prestraining. Mechanical prestraining alters the residual stresses in the aramid/epoxy and aluminum layers of Arall 4 which, in turn, leads to the reduction in creep strain. An analytical model is developed which simulates the prestraining process and the creep response of the hybrid composite. The demonstrated predictive capability of the model provides the analyst/designer/manufacturer with a rational tool for optimizing the creep response of Arall 4 for the given application.
The Informal Patient in England and Wales
Authors: Andoh Benjamin
Published: July 2017

The informal status of a patient is a very important topic because the vast majority of mental patients in hospital are informal. The origins of the status are traced to the Royal Commissions of 1924–6 and 1954–7 which recommended voluntary admissions and informal admissions, respectively. It is pointed out, inter alia, that it is only generally true to say the informal patient has consented to admission and cannot be treated without his or her consent because exceptionally he or she can be given such treatment, e.g. on the grounds of necessity, as held by the House of Lords in R v Bournewood Community and Mental Health Trust (1998) and that today there are two types of informal patients: those who can, and do, consent to admission, and those who cannot consent to admission, but do not show willingness to leave hospital.

It is argued that there is only a power under the Mental Health Act 1983 to admit patients informally. Finally, the informal patient's consent to admission, consent to treatment, other rights, leaving hospital, and how his or her position can be improved are looked at.
A Case of Serial Homicide by Injection of Succinylcholine
Authors: Maeda H , Fujita M Q , Zhu B-L , Ishidam K , Oritani S , Tsuchihashi H , Nishikawa M , Izumi M , Matsumoto F
Published: July 2017

The abstract of this paper was presented at the 14th Meeting of the International Association of Forensic Sciences, Tokyo in 1996.

We report a bizarre criminal case of suspected serial homicide by injection of a muscle relaxant (succinylcholine). Five victims were found buried in a rural area. In two victims showing moderate decomposition (about three months after death), intense pulmonary oedema with pleural effusion was observed. Evidence of a puncture site was found in one of the victims. Succinylcholine could not be detected in the victims, but was identified in a syringe found near the corpses. The 40-mg ampule dose of succinylcholine administered intramuscularly to the victims, possibly causing prolonged apnea, was considered to be at least around the minimum lethal dose, although the combined effect of the sedation with hypnotics also used was not negligible.
A Fatal Air Rifle Pellet Wound of the Brain
Authors: James W. R. L.
Published: July 2017

Unless an air rifle is declared to be specially dangerous an owner does not require a firearms certificate under the Firearms Act, 1937, though a licence under the Gun Licence Act, 1870, is needed. The case described here shows that an ordinary air rifle can cause a fatal accident and suggests the stricter enforcement of the licensing provision.
“Salicyluria”…the Ingestion of Salicylamide
Authors: Stevens H. M.
Published: July 2017

Salicylamide, after ingestion, could be extracted as such by ether from acidified urine. Salicyluric acid was not produced as a metabolite of this compound. Some diagnostic chemical characteristics of salicylamide are described.
Overdose of Parstelin (Tranylcypromine)
Authors: Griffiths G. J.
Published: July 2017

A case of overdose of Parstelin is described. The post-mortem findings, the forensic laboratory report, the discussion of the case, and the treatment in such a case of overdose are considered.

In the correspondence column of the British Medical Journal, MacCaig and Edmondson (1969) describe a case of a fit young man of 25 years who took 25 tablets of Parstelin and died 36 hours later. A similar case is described here.
Menstruation and Behaviour in a Special Hospital
Authors: Hands Joyce , Herbert Virginia , Tennent Gavin
Published: July 2017

This paper reports the findings of a retrospective study of the records of twenty-three women patients resident in one of the English special hospitals. The temporal relationship between disturbed behaviour and the menstrual cycle was studied for each patient over a period of at least six months. The results, although they confirm the findings of previous studies in institutionalized groups of women, suggest that it may be a particular group of women only who exhibit disturbed behaviour and there may exist other sub-groups whose behaviour also follows a cyclical pattern.