bluuebunny/crossref_metadata_2025 huggingface dataset:
Black spruce (Picea mariana) colonization of subarctic snowpatches in response to warmer climate
Authors: Truchon‐Savard Alexandre , Jean Mélanie , Payette Serge
Published: December 2018

Snowpatches are disjunct arctic ecosystems scattered across the subarctic, particularly on wind‐protected lee slopes, where a thick snow cover accumulates during the winter. These snow‐rich treeless ecosystems are affected by delayed snowmelt, causing shorter growing seasons. Snow‐tolerant plants occupy the centre of subarctic snowpatches, whereas black spruce trees grow at the margins. Snowpatches have shown sporadic expansion and shrinkage phases from tree establishment and mortality linked to climatic trends. Field surveys in the subarctic of eastern Canada are showing an afforestation process occurring in snowpatches. The origin and nature of this afforestation were investigated based on the hypothesis that tree colonization and growth were closely associated with recent changes in climate.

Snowpatches were categorized into three types based on border trees: forested, semi‐forested and tundra‐like. In eight randomly selected snowpatches of each type, snowpatch borders and areas covered by deciduous shrubs or trees were mapped and chionophilous plants and frost‐associated soil disturbances were recorded. Radial (tree‐ring) and vertical growth were measured on stems to evaluate the impact of climate and local factors on snowpatch black spruce populations.

Two waves of spruce colonization occurred in all forested and semi‐forested snowpatches in the 1960s and in the 1980s to present. Spruce establishment was more frequent and abundant in recent years, near the forest margins and on moss and barren seedbeds. Expanding shrub (dwarf birch) cover inhibited spruce seedling establishment. Tree establishment and growth were positively correlated with growing season temperature and negatively correlated with annual maximum snow depth. More recently established spruce seedlings exhibited faster vertical growth than those established in the 20th century.

Synthesis. Due to warmer conditions and earlier snowmelt in eastern Canada, black spruce trees and dwarf birch shrubs are racing through subarctic snowpatches. This afforestation could change biodiversity in the subarctic and affect watershed dynamics through a change in snowmelt pattern. Subarctic snowpatches are climate‐sensitive ecosystems of the forest–tundra landscape, forming ideal biotopes for snow‐tolerant, arctic–alpine species. Further tree encroachment in snowpatches in this century is potentially a threat to plant diversity, especially chionophilous species that have no corridors to migrate towards arctic ecosystems.
Soil nutrients and dispersal limitation shape compositional variation in secondary tropical forests across multiple scales
Authors: van Breugel Michiel , Craven Dylan , Lai Hao Ran , Baillon Mario , Turner Benjamin L. , Hall Jefferson S.
Published: December 2018

Soil resource partitioning and dispersal limitation have been shown to shape the tree community structure of mature tropical forests, but are poorly studied in the context of forest succession. We examined the relative contributions of both ecological processes to the variation in the species composition of young tropical secondary forests at different spatial scales, and if the relative importance of these two ecological processes changed during succession. At the species level, we examined if the association between species abundances and soil fertility differed between early and late successional species and/or changed over the course of succession.

We used vegetation and soil data from 47 secondary forest sites with two plots each in a tropical agricultural landscape. A distance‐based redundancy analysis and variation partitioning were employed to examine the relative importance of spatial distance (proxy for dispersal limitation) and heterogeneity in soil nutrients (proxy for soil nutrient partitioning) at the landscape scale, and a linear regression to test their effects at the local scale. We examined interspecific variation in species’ responses to successional age and soil nutrients with a joint species distribution model.

Dispersal limitation and soil niche partitioning drove considerable variation in the composition of plant communities at local and landscape scales. The relative contribution of these two ecological processes changed with scale (local vs. landscape) and topography (lower slope vs. upper slope plots). At the species level, significant abundance–soil fertility associations were mostly positive. Most species became less responsive to soil nutrients over the first few decades of tropical forest succession, probably because light became the main limiting resource in older forests.

Synthesis. Our key finding is that spatial heterogeneity in soil resources and spatial distance jointly drive compositional variation within and across early successional forests. Our results highlight that a network of forest fragments enhances the resilience of ecological processes and the potential of secondary forests to restore and preserve biodiversity in human‐modified landscapes. To advance our understanding of ecological succession, we need to move beyond single‐factor and local‐scale studies and examine the effects of multiple variables on succession at different spatial scales.
Metacaspase involvement in programmed cell death of the marine cyanobacterium Trichodesmium
Authors: Spungin Dina , Bidle Kay D. , Berman‐Frank Ilana
Published: December 2018

Metacaspases are cysteine specific proteases implicated in cell‐signalling, stress acclimation and programmed cell death (PCD) pathways in plants, fungi, protozoa, bacteria and algae. We investigated metacaspase‐like gene expression and biochemical activity in the bloom‐forming, N2‐fixing, marine cyanobacterium Trichodesmium, which undergoes PCD under low iron and high‐light stress. We examined these patterns with respect to in‐silico analyses of protein domain architectures that revealed a diverse array of regulatory domains within Trichodesmium metacaspases‐like (TeMC) proteins. Experimental manipulations of laboratory cultures and oceanic surface blooms of Trichodesmium from the South Pacific Ocean triggered PCD under Fe‐limitation and high light along with enhanced TeMC activity and upregulated expression of diverse TeMC representatives containing different regulatory domains. Furthermore, TeMC activity was significantly and positively correlated with caspase‐like activity, which has been routinely observed to increase with PCD induction in Trichodesmium. Although both TeMC and caspase‐like activities were stimulated upon PCD induction, inhibitor treatments of these proteolytic activities provided further evidence of largely distinct substrate specificities, even though some inhibitory crossover was observed. Our findings are the first results linking metacaspase expression and activity in PCD induced mortality in Trichodesmium. Yet, the role/s and specific activities of these different proteins remain to be elucidated.
Body Transportation after Homicides: Offender and Offense Characteristics
Authors: Lee Seo Jin , Park Jisun
Published: December 2018

Body transportation is defined as moving the body of the victim from the scene of a homicide to another location. We analyzed data on 513 South Korean homicide cases with convictions to compare 104 homicides involving the transportation of victims’ bodies with 409 homicides that did not. Offenders who transported their victims’ bodies were significantly younger and more likely to be related to the victims and were less likely to use sharp instruments and more likely to use blunt instruments or strangle the victims than offenders who did not. Victims of homicide involving body transportation were more likely to suffer injuries to the neck and head and less likely to suffer injuries to the torso. Finally, offenders who transported victims’ bodies were more likely to have planned the offense and destroyed evidence. The present findings have practical implications for police investigations.
First spike latency of ON/OFF neurons in the optic tectum of pigeons
Authors: WANG Songwei , WANG Mengke , WANG Zhizhong , SHI Li
Published: December 2018

Some shallow and middle optic tectum (OT) neurons have stable, asymmetric full‐screen ON and OFF stimulus response properties, which makes them candidates for delay encoding. In this paper, we investigated the delay encoding mechanism for the neuronal clusters in the OT region of pigeons and determined the mechanism of delay coding in the OT region. By analyzing the responses of the neuron cluster under full‐screen switch‐on and switch‐off stimulation, we found that the delay coding was widespread in the OT region where the ON/OFF stimulation time difference was 4–6 ms. Information theory analysis under grating stimulation and experiments based on single‐neuron character reconstruction of neurons showed that OT neuron clusters use the first spike latency (FSL) for the rapid transfer of spatial structure information. Furthermore, 4 models were used to predict the first spike latency of these OT neurons. The best simulation results were obtained using an architecture where the ON and OFF paths of multiple retinal ganglion cells (RGCs) were integrated and summed, respectively.
From a sequential pattern, temporal adjustments emerge in hummingbird traplining
Authors: TELLO‐RAMOS Maria C. , HURLY Andrew T. , HEALY Susan D.
Published: December 2018

Animals that feed from resources that are constant in space and that refill may benefit from repeating the order in which they visit locations. This is a behavior known as traplining, a spatial phenomenon. Hummingbirds, like other central‐place foragers, use short traplines when moving between several rewarding sites. Here we investigated whether traplining hummingbirds also use relevant temporal information when choosing which flowers to visit. Wild rufous hummingbirds that were allowed to visit 3 artificial flower patches in which flowers were refilled 20 min after they had been depleted repeated the order in which they visited the 3 patches. Although they tended to visit the first 2 patches sooner than 20 min, they visited the third patch at approximately 20‐min intervals. The time between visits to the patches increased across the experiment, suggesting that the birds learned to wait longer before visiting a patch. The birds appeared to couple the sequential pattern of a trapline with temporal regularity, to some degree. This suggests that there is a temporal component to the repeated spatial movements flown by foraging wild hummingbirds.
Male Burmese pythons follow female scent trails and show sex‐specific behaviors
Authors: RICHARD Shannon A. , TILLMAN Eric A. , HUMPHREY John S. , AVERY Michael L. , PARKER M. Rockwell
Published: December 2018

Animals communicate with potential mates using species‐specific signals, and pheromones are powerful sexual signals that modify conspecific behavior to facilitate mate location. Among the vertebrates, snakes are especially adept in mate searching via chemical trailing, which is particularly relevant given that many snake species are invasive outside their native ranges. Chemical signals used in mate choice are, thus, potentially valuable tools for management of invasive snake species. The Burmese python (Python bivittatus) is an invasive snake in the Florida Everglades where it is negatively impacting native fauna. In this study, we sought to: (i) determine if males can follow conspecific chemical trails in a Y‐maze; and (ii) describe the mate searching behaviors exhibited by males while trailing. All males consistently followed a single female scent trail in the maze, but when only a male scent trail was present they did not discriminate between the male and blank arms. Rate of tongue‐flicking, a proxy for chemosensory sampling, was also marginally higher when males were following female versus male scent trails. However, when both female and male scent trails were simultaneously present in the Y‐maze, males did not show a preference for the female arm, although the tongue‐flick rate was higher in the female‐only trial compared to female versus male. Analyses of multiple male behaviors individually and using an ethogram revealed that behaviors were more frequent and complex in the female‐only trials compared to male‐only trials. Additional behavioral trials are needed to determine if an effective pheromonal approach to Burmese python management is possible.
More to Lose: The Attributes of Involuntary Bankruptcy
Authors: O'Brien Lucinda , Anderson Malcolm , Ramsay Ian , Ali Paul
Published: December 2018

While the majority of those who declare bankruptcy do so voluntarily, a significant proportion are forced into bankruptcy as a result of legal action. This paper interrogates data obtained from the Australian Financial Security Authority to explore the attributes of debtors who go bankrupt involuntarily. Based on this analysis, the authors hypothesise that people who go bankrupt involuntarily are those who have more to lose by going bankrupt – such as a family home, a business venture or a managerial or professional occupation – meaning that they are more likely to resist bankruptcy until they are forced into it by their creditors.
Proton beam therapy is a safe and feasible treatment for patients with second primary lung cancer after lung resection
Authors: Ono Takashi , Nakamura Tatsuya , Azami Yusuke , Suzuki Motohisa , Wada Hitoshi , Kikuchi Yasuhiro , Murakami Masao , Nemoto Kenji
Published: December 2018

Background

The purpose of the present study was to retrospectively evaluate the safety and efficacy of proton beam therapy (PBT) in patients with second primary lung cancer after lung resection.

Methods

Patients who were diagnosed with second primary lung cancer after lung resection and underwent PBT between January 2009 and February 2015 were retrospectively recruited. Toxicities were evaluated using Common Terminology Criteria for Adverse Events version 4.0.

Results

Nineteen patients were eligible for inclusion in this study. All of the patients completed the treatment. The median age was 75 (range: 63–82) years, and the median follow‐up time of living patients was 60 months. The median dose of PBT was 76.8 Gy relative biological effectiveness (range: 66.0–80.0 Gy). The three‐year overall survival rate was 63.2% and the three‐year local control rate was 84.2%. No grade 4 or 5 toxicities were observed after PBT.

Conclusions

Our results suggest that PBT is a safe and feasible treatment for second primary lung cancer compared to surgery or X‐ray radiotherapy. PBT may become a treatment choice for patients with second primary lung cancer after lung resection.
Inulin Ameliorates Alcoholic Liver Disease via Suppressing LPS‐TLR4‐Mψ Axis and Modulating Gut Microbiota in Mice
Authors: Yang Xiaoli , He Fang , Zhang Yanting , Xue Jing , Li Ke , Zhang Xiaoxia , Zhu Lili , Wang Zhen , Wang Hao , Yang Shaoqi
Published: December 2018

Background

Alcoholic liver disease (ALD) represents a chronic liver disorder caused by alcohol abuse. Numerous studies have demonstrated that gut microbiota dysbiosis plays a critical role in ALD pathogenesis. Application of prebiotic, probiotic, and dietary supplementation to the modulation of gut microbiota contributes to a novel approach to the management of ALD. Inulin, a natural prebiotic found in plants, can restore gut dysbiosis in ALD. However, the exact mechanism of dietary inulin in ALD remains largely unknown.

Methods

Sixty female C57BL/6J mice were randomly divided into 4 groups: pair‐fed (PF) group (PF/CON); alcohol‐fed (AF) group (AF/CON); PF with inulin (INU) group (PF/INU); and AF with INU group (AF/INU). All mice were fed with isocaloric modified Lieber‐DeCarli liquid diets with or without alcohol.

Results

After 6 weeks of feeding, mice were euthanized and associated indications were investigated. The results showed that chronic ethanol (EtOH) intake led to the loss of body weights, abnormal levels of transaminases, and inflammatory indicators (lipopolysaccharide [LPS], interleukin [IL]‐6, IL‐10, tumor necrosis factor‐α, IL‐17A), while inulin administration ameliorated these effects. To further understand the underlying mechanism, we investigated macrophages (Mψs) and gut microbiota in diverse groups. The number of Mψs was reduced after dietary inulin treatment in chronic EtOH exposure. Hepatic Toll‐like receptor 4 (TLR4+) Mψs in AF/INU group were lower than AF/CON group. 16S rRNA sequencing and analysis of gut microbiota indicated the reduction of Allobaculum, Lactobacillus, and Lactococcus, as well as the increase of Parasutterella in AF group compared with PF control. Increased Allobaculum, Lactobacillus, and Lactococcus but reduced Parasutterella in AF/INU group were confirmed that dietary inulin rectified gut dysbiosis to attenuate ALD.

Conclusions

Dietary inulin ameliorates ALD via suppressing LPS‐TLR4‐Mψ axis and modulating gut microbiota in mice, thus potentially provides theoretical foundation for inulin intervention in the prevention and treatment of ALD.
Strategising in the midst of management controls: a case study on the relationship between management controls and promises on strategies
Authors: Tekathen Matthäus , Bui Binh , Wang Zhichao (Alex)
Published: December 2018

By understanding strategies as promises, this study investigates how management controls are implicated in organisations’ strategising practice under continuous changes of external forces. Based on a historical case study of a New Zealand electricity firm, the study shows how multiple management controls facilitate a strategising practice that focuses on repromising new futures for the firm by enabling senior managers, board members and operational staff to memorise, forget and forgive promises made. The study suggests that organisations seeking to move from one promised future to another use management controls to help develop, solidify and bridge promises.
Oxytocin inhibits methamphetamine‐associated learning and memory alterations by regulating DNA methylation at the Synaptophysin promoter
Authors: Fan Xin‐Yu , Yang Jing‐Yu , Dong Ying‐Xu , Hou Ying , Liu Shuai , Wu Chun‐Fu
Published: December 2018

Methamphetamine (METH) causes memory changes, but the underlying mechanisms are poorly understood. Epigenetic mechanisms, including DNA methylation, can potentially cause synaptic changes in the brain. Oxytocin (OT) plays a central role in learning and memory, but little is known of the impact of OT on METH‐associated memory changes. Here, we explored the role of OT in METH‐induced epigenetic alterations that underlie spatial and cognitive memory changes. METH (2.0 mg/kg, i.p.) was administered to male C57BL/6 mice once every other day for 8 days. OT (2.5 μg, i.c.v.) or aCSF was given prior to METH. Spatial and cognitive memory were assessed. In Hip and PFC, synaptic structures and proteins were examined, levels of DNA methyltransferases (DNMTs) and methyl CpG binding protein 2 (MECP2) were determined, and the DNA methylation status at the Synaptophysin (Syn) promoter was assessed. METH enhanced spatial memory, decreased synapse length, downregulated DNMT1, DNMT3A, DNMT3B, and MECP2, and induced DNA hypomethylation at the Syn promoter in Hip. In contrast, METH reduced cognitive memory, increased synapse thickness, upregulated DNMT1, DNMT3A, and MECP2, and induced DNA hypermethylation at the Syn promoter in PFC. OT pretreatment specifically ameliorated METH‐induced learning and memory alterations, normalized synapse structures, and regulated DNMTs and MECP2 to reverse the DNA methylation status changes at the Syn promoter in Hip and PFC. DNA methylation is an important gene regulatory mechanism underlying METH‐induced learning and memory alterations. OT can potentially be used to specifically manipulate METH‐related memory changes.
Perinatal free‐choice of a high‐calorie low‐protein diet affects leptin signaling through IRS1 and AMPK dephosphorylation in the hypothalami of female rat offspring in adulthood
Authors: Rivera Patricia , Ramírez‐López María T. , Vargas Antonio , Decara Juan , Vázquez Mariam , Arco Rocío , Gómez de Heras Raquel , Argente Jesús , Rodríguez de Fonseca Fernando , Chowen Julie A. , Suárez Juan
Published: December 2018

Aim

We aimed to investigate whether a dysregulated maternal diet during gestation and lactation induces long‐lasting changes in the hypothalamic control of feeding behavior in the offspring and whether this effect is sex specific.

Methods

The study included an analysis of appetite‐regulating metabolic hormones and hypothalamic signaling in male and female offspring in adulthood after exposure to a free‐choice high‐calorie palatable low‐protein (P) diet or standard chow (C) during (pre)gestation/lactation (maternal) and/or postweaning (offspring).

Results

Maternal exposure to the P diet resulted in decreased protein intake and body weight gain in dams and decreased body weight gain in offspring during lactation. The maternal P diet (PC) specifically increased feed efficacy and decreased body weight and cholesterol levels in the female offspring in adulthood, but no changes in adiposity or leptin levels were found. In contrast, P diet exposure after weaning (CP and PP) increased caloric intake, adiposity and circulating levels of leptin in the male and female offspring in adulthood. The hypothalami of the female offspring exposed to the maternal P diet (PC and PP) expressed high levels of the phospho‐leptin receptor and low levels of SOCS3, phospho‐IRS1 and phospho‐AMPK, regardless of the postweaning diet. The hypothalami of the female rats in the PC group also showed increased levels of STAT3 and the orexigenic neuropeptide Agrp.

Conclusions

Maternal exposure to a free‐choice high‐calorie low‐protein diet induces a long‐term feed efficacy associated with changes in leptin signaling through IRS‐1 and AMPK dephosphorylation in the hypothalami of female offspring in adulthood.
Comparison of the effect of beclometasone/formoterol in asthma patients after methacholine‐induced bronchoconstriction: A noninferiority study using metered dose vs. dry powder inhaler
Authors: Singh Dave , van den Berg Frans , Leaker Brian , Corradi Massimo , Jabbal Sunny , Collarini Sara , Mongelli Valentina , Santoro Luigi , Piccinno Annalisa , Biondaro Sonia , Lipworth Brian
Published: December 2018

Aims

To demonstrate the noninferiority of extrafine beclomethasone/formoterol fumarate (BDP/FF) dry powder inhaler (DPI) vs. extrafine BDP/FF pressurized metered dose inhaler (pMDI; Foster® 100/6 μg NEXThaler and pMDI, respectively) in the onset of reliever effect after methacholine induced bronchospasm in asthmatic patients, evaluated in terms of forced expiratory volume in 1 s (FEV1) at 5 min postdose. The DPI provides an alternative device option for patients who cannot use a pMDI properly during an acute asthma attack.

Methods

Sixty‐five patients received one inhalation of BDP/FF DPI, BDP/FF pMDI or placebo after methacholine challenge, according to a double‐blind, double‐dummy, cross‐over design. Lung function and Borg dyspnoea score were assessed up to 30 min postdose.

Results

FEV1 adjusted mean difference between BDP/FF DPI and BDP/FF pMDI at 5 min postdose was 2 ml (95% confidence interval: –0.060; 0.065). A similar result was observed at the other time points. Median time to 85% recovery in FEV1 was 8 min for BDP/FF DPI, 7.5 min for BDP/FF pMDI and 28 min for placebo (P = 0.554 DPI vs. pMDI). The Borg score improved after treatment with both BDP/FF DPI and pMDI and the effect was greater than after placebo. Median time to reach 50% recovery was 4.2 min for BDP/FF DPI, 4.0 min for BDP/FF pMDI and 10.0 min for placebo (P = 0.609 DPI vs. pMDI).

Conclusions

Extrafine Foster® NEXThaler, a flow‐independent DPI, is comparable to extrafine Foster® pMDI when administered as reliever therapy after methacholine challenge, thus supporting the maintenance and reliever therapy approach also with Foster® NEXThaler.
Revisiting five decades of educational technology research: A content and authorship analysis of the British Journal of Educational Technology
Authors: Bond Melissa , Zawacki‐Richter Olaf , Nichols Mark
Published: December 2018

Reflecting on 50 years of educational technology research, a content and authorship analysis was conducted of 1777 research article titles and abstracts, published in the British Journal of Educational Technology (BJET) from 1970 to Issue 3, 2018. A text‐mining tool (Leximancer) was used to identify key concepts and themes emerging throughout each of the five decades, which were then compared to those found in a previous analysis of Computers & Education, as well as the most cited BJET publications in each decade. The framework of West and Rich (2012) was then used to provide guidance on BJET’s rigour, impact and prestige. Common themes in BJET throughout the past 50 years have included the evolution of teaching and learning in distance education, the emergence of instructional design, misunderstanding between practitioners and learning designers, issues of pre and in‐service teacher education and technology uptake by educators and students, including the confidence to do so, the technology skills of educators and students, as well as a lack of institutional support to provide space and time for training and integration to occur. The authorship analysis revealed an encouraging increase in international identity over time, with 60% of articles in BJET published by an author outside of the UK over the past 50 years, and 79% in the past decade. Despite this, contributions from South America, the Middle East and Africa are vastly underrepresented, and authors from these regions need further support from the field. Suggested future research areas include finding alternative models of educator professional development, further exploration of the role of theory and policy, as well as the rise of co‐authorship and collaborative research.
Shwachman‐Diamond syndrome with clonal interstitial deletion of the long arm of chromosome 20 in bone marrow: haematological features, prognosis and genomic instability
Authors: Valli Roberto , Minelli Antonella , Galbiati Marta , D'Amico Giovanna , Frattini Annalisa , Montalbano Giuseppe , Khan Abdul W. , Porta Giovanni , Millefanti Giorgia , Olivieri Carla , Cipolli Marco , Cesaro Simone , Pasquali Francesco , Danesino Cesare , Cazzaniga Gianni , Maserati Emanuela
Published: December 2018

In Shwachman‐Diamond syndrome (SDS), deletion of the long arm of chromosome 20, del(20)(q), often acquired in bone marrow (BM), may imply a lower risk of developing myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML), due to the loss of the EIF6 gene. The genes L3MBTL1 and SGK2, also on chromosome 20, are in a cluster of imprinted genes, and their loss implies dysregulation of BM function. We report here the results of array comparative genomic hybridization (a‐CGH) performed on BM DNA of six patients which confirmed the consistent loss of EIF6 gene. Interestingly, array single nucleotide polymorphisms (SNPs) showed copy neutral loss of heterozygosity for EIF6 region in cases without del(20)(q). No preferential parental origin of the deleted chromosome 20 was detected by microsatellite analysis in six SDS patients. Our patients showed a very mild haematological condition, and none evolved into BM aplasia or MDS/AML. We extend the benign prognostic significance of del(20)(q) and loss of EIF6 to the haematological features of these patients, consistently characterized by mild hypoplastic BM, no or mild neutropenia, anaemia and thrombocytopenia. Some odd results obtained in microsatellite and SNP‐array analysis demonstrate a peculiar genomic instability, in an attempt to improve BM function through the acquisition of the del(20)(q).
Argon plasma coagulation is an effective treatment for chronic radiation proctitis in gynaecological malignancy: an observational study
Authors: Sultania S. , Sarkar R. , Das K. , Dhali G. K.
Published: December 2018

Aim

Chronic radiation proctitis (CRP) develops in 5–15% of patients after pelvic radiation therapy, with rectal bleeding being the main symptom. Reports suggest that argon plasma coagulation (APC) can be an effective therapy for CRP following radiotherapy for prostate cancer, but there is less information about how useful it is after radiotherapy for gynaecological malignancy. The aim of this work therefore was to study the efficacy of APC for CRP after radiotherapy for gynaecological malignancy.

Method

This was a prospective study of consecutive patients with CRP following radiotherapy for gynaecological malignancy at IPGME&R, SDLD, Kolkata, India; symptoms included rectal bleeding grade (RBG) ≥ 2. APC was performed at monthly intervals to a maximum of four treatment sessions. Severity of disease at baseline was graded (endoscopically) by the total colonoscopic severity score (TCSS) and treatment response was assessed by reduction in RBG from ≥ 2 to ≤ 1 measured at > 6 months after cessation of APC.

Results

Seventy patients [90% with cervical cancer, 10% with endometrial cancer; mean age 51.93 ± 9.15 years; median RBG 3 (range 2–4)] received APC. Seven patients died due to underlying malignancy and seven patients were lost to follow‐up. Fifty‐six (85.7%) patients responded to therapy after a median of 2 (range 1–4) treatment sessions. Multivariate analysis demonstrated that a lower haemoglobin at the start of treatment predicted failure of therapy (P < 0.05).

Conclusion

APC is an effective management option for CRP in female patients with gynaecological malignancy. However, the more anaemic the patient the less likely it is to be successful.
Histological findings and pathologic diagnosis of spiradenocarcinoma: A case series and review of the literature
Authors: Huang Amy , Vyas Nikki S. , Mercer Stephen E. , Phelps Robert G.
Published: December 2018

Background

Atypical spiradenoma and spiradenocarcinoma present a diagnostic challenge. We aim to assess the significance of certain histologic features, which may facilitate diagnosis of these tumors.

Methods

A natural language search for cases of “atypical spiradenoma” and “spiradenocarcinoma” diagnosed between 2009 and 2018 was performed. Original slides were retrieved and a subset of cases (n = 5) were stained for Ki‐67, p53, carcinoembryonic antigen (CEA), and S100. All cases (n = 7) were assessed for overall architecture, atypical mitotic figures, abnormal cytology, necrosis, ductal proliferation, dilated vessels, and loss of dual cell population.

Results

All our cases showed an abrupt transition from benign to malignant morphology, nuclear atypia, atypical mitotic figures, and a monomorphic loss of the dual cell population (7/7; 100%). The majority also had dilated vessels (6/7; 85.7%), and ductal dilation or proliferation (5/7; 71.4%). Fewer cases showed tumor encapsulation (3/7; 43%), massive necrosis (3/7; 43%), and focal cellular necrosis (1/7; 14%). All cases showed a relatively increased Ki‐67 proliferation index at the transitional interface (5/5; 100%). Almost all cases stained positively for p53 (4/5; 80%). Malignant areas of tumor or at the transitional interface showed more intense S100 staining (3/5; 60%). All cases were negative for CEA.

Conclusion

Histologic features that strongly favor atypical spiradenoma or spiradenocarcinoma include abrupt transition to malignant foci, atypical mitotic figures, and monomorphic loss of the dual cell population. Ki‐67, p53, and S100 may help delineate areas of atypical or malignant transformation in spiradenomas.
Endoscopic papillary large balloon dilation without sphincterotomy for users of antithrombotic agents: A multicenter retrospective study
Authors: Hakuta Ryunosuke , Kogure Hirofumi , Nakai Yousuke , Hamada Tsuyoshi , Noguchi Kensaku , Saito Kei , Saito Tomotaka , Takahara Naminatsu , Mizuno Suguru , Yagioka Hiroshi , Ito Yukiko , Tada Minoru , Isayama Hiroyuki , Koike Kazuhiko
Published: December 2018

Background and Aim

With an aging population, an increasing number of individuals on antithrombotic agents are diagnosed with large bile duct stones. Studies have shown the effectiveness of endoscopic papillary large balloon dilation (EPLBD) for removal of large bile duct stones. EPLBD without endoscopic sphincterotomy (EST) may reduce the risk of procedure‐related bleeding, but the safety of this procedure for users of antithrombotic agents remains unclear.

Methods

In this multicenter retrospective study, we included patients who underwent EPLBD without EST for bile duct stones between March 2008 and December 2017. We compared adverse events and other clinical outcomes between users and non‐users of antithrombotic agents (antiplatelet agents and anticoagulants).

Results

We analyzed a total of 144 patients (47 users and 97 non‐users of antithrombotic agents). Among the users, the agents were continued in 13% and were replaced with heparin in 62% during the periprocedural period. We did not observe clinically significant bleeding and thrombotic events irrespective of the use of antithrombotic agents. Overall rate of early adverse events did not differ between users and non‐users (6.4% and 7.2%, P = 0.99). Procedural outcomes did not differ between the groups (necessity for lithotripsy, 28% vs. 29%; and complete stone removal in a single session, 72% vs. 71%, for users and non‐users, respectively).

Conclusions

Endoscopic papillary large balloon dilation without EST may be done without a substantial increase in procedure‐related bleeding for users of antithrombotic agents. A larger study is required to refine the management strategy for those agents during the periprocedural period.
Early executive functioning in a global context: Developmental continuity and family protective factors
Authors: Obradović Jelena , Finch Jenna E. , Portilla Ximena A. , Rasheed Muneera A. , Tirado‐Strayer Nicole , Yousafzai Aisha K.
Published: December 2018

This study extends the methodological and theoretical understanding of executive functions (EFs) in preschoolers from low‐ and middle‐income countries (LMIC). First, the authors describe a rigorous process of adapting and evaluating six EF tasks to produce a culturally and developmentally appropriate measure of emerging EFs in a large sample of at‐risk children in rural Pakistan. Next, the authors identify critical developmental and family factors that relate to preschoolers’ EFs over the first 4 years of life. Direct assessment of children's general cognitive skills at age two showed developmental continuity with EFs at age four, and these early cognitive skills mediated the effect of an antecedent parenting intervention on EFs as well as associations of targeted individual and family factors with EFs. Furthermore, directly assessed maternal cognitive capacities and observed maternal scaffolding uniquely predicted EFs in preschoolers. This study is also the first to demonstrate a significant overlap between direct assessments of IQ and EFs in young children from LMIC. Children's general intelligence mediated the associations of EFs with antecedent physical growth and cognitive skills as well as concurrent family factors (maternal verbal intelligence, maternal scaffolding, and home stimulation). After controlling for shared variance between preschoolers’ general intelligence and EFs, three factors emerged as unique predictors of EFs: exposure to an early parenting intervention, physical growth status at age two, and number of older siblings. The findings have important implications for the design of interventions that aim to improve EFs in young children in LMIC. A video abstract of this article can be viewed at https://vimeo.com/316329544/5abde94cd7
Identifying the right outcomes to measure for children with medical complexity
Authors: Brosco Jeffrey P
Published: December 2018

This commentary is on the original article by Fayed et al. on pages 1093–1100 of this issue.
Are newer insulin analogues better for people with Type 1 diabetes?
Authors: Misra S. , Mathieu C.
Published: December 2018

Achieving optimal blood glucose control in Type 1 diabetes is a delicate balance between ensuring tight glycaemic control and achieving this without the expense of hypoglycaemia and weight gain, two major factors impacting quality of life. This is a real challenge for people with Type 1 diabetes and underpins many of the struggles they face in self‐managing on a day‐to‐day basis. The main goals of insulin delivery are to try to simulate the physiology of β‐cell insulin secretion as closely as possible and to overcome the challenges of peripheral insulin administration by achieving rapidity of onset with mealtime insulins and stability of the glucose‐lowering effects of long‐acting insulins. Since the early days of human insulin use, there have been many developments in insulin formulations that aim to achieve these goals as much as possible, thus contributing to better glycaemic control whilst minimizing hypoglycaemia. In the present review we discuss the currently available insulin analogues and the challenges of achieving glucose control using current analogues in those on multiple daily injections, and appraise the evidence base for newer‐generation insulin analogues, such as insulin degludec, glargine U300, faster‐acting insulin aspart and BioChaperone lispro. We also highlight new insulins in development and unmet needs in people with Type 1 diabetes.
A Two‐sided Matching Model of Monitored Finance
Authors: Antón Arturo , Dam Kaniṣka
Published: December 2018

We analyse an incentive contracting model of partnership formation between heterogeneous investors and entrepreneurs. Partnerships are subject to double‐sided moral hazard problems in entrepreneurial action and monitoring by investors. Greater monitoring ability implies stronger incentives to monitor. On the other hand, low‐collateral borrowers have lower inside equity participation. Hence the incentive problem is best mitigated by assigning low‐collateralized entrepreneurs to high‐ability investors following a negative assortative matching pattern. Moreover, negative assortative matching implies that the equilibrium loan rate is in general non‐monotonic in borrower collateral. Finally, our model sheds light on how changes in the inequality of collateral distribution affect the cost of external borrowing.
Echocardiographic features of interventricular septal dissection in patients with Behçet's disease
Authors: Yu Shaomei , Han Jiancheng , Gao Shuang , Ruan Yanping , Gu Xiaoyan , Sun Lin , He Yihua
Published: December 2018

Involvement of the heart in Behçet's disease (BD) is rare. We retrospectively analyzed these three patients with interventricular septal (IVS) dissection in BD and discussed the echocardiographic manifestations of IVS dissections. In our patients, the echocardiographic characteristics of IVS dissection were echo‐free space in the IVS basal segment or basal to middle segment, dilatation in the diastole and contraction in systole, and abnormal turbulent blood flow in the heart.
Aortopulmonary window in tetralogy of Fallot with absent conal septum
Authors: Aurigemma David , Dixon Chandler , Tucker Suzanne , Davis Christopher , Silverman Norman
Published: December 2018

Background

Aortopulmonary window is a rare conotruncal defect that is often associated with other congenital heart defects. We present a patient with a previously unreported combination of aortopulmonary window with tetralogy of Fallot with an absent conal septum.

Case Presentation

A term, 2.4 kg newborn male infant presented at a community hospital with cyanosis unresponsive to supplemental oxygen. Transthoracic echocardiography demonstrated a conotruncal defect with a large conoventricular ventricular septal defect and an over‐riding, dysplastic aortic valve. The main pulmonary artery (MPA) appeared to arise from left facing sinus of the aortic valve, with confluent yet hypoplastic right and left branch pulmonary arteries. There was no evidence of prograde flow into the MPA in systole, though there did appear to be retrograde flow in diastole from the patent ductus. The patient underwent multiple advanced imaging studies, and the diagnosis was not fully elucidated. Postmortem examination demonstrated morphology consistent with Tetralogy of Fallot with the absence of the conal septum. There were two distinct semilunar valves in fibrous continuity with an aortopulmonary window immediately cephalad to the valve.

Discussion

The rare combination of defects and the patient's size made the anatomic diagnosis by conventional imaging challenging. However, retrospective review of imaging studies did demonstrate anatomic features seen by direct examination of the specimen.
Beech leaf disease: An emerging forest epidemic
Authors: Ewing Carrie J. , Hausman Constance E. , Pogacnik John , Slot Jason , Bonello Pierluigi
Published: December 2018

Beech leaf disease (BLD) is a currently undiagnosed and seemingly lethal disease that was discovered in 2012 on American beech trees (Fagus grandifolia) in north‐east Ohio in the United States. Since its discovery, BLD has spread rapidly and can now be found in forests in 10 counties in Ohio, eight counties in Pennsylvania and five counties in Ontario, Canada. The initial symptoms of the disease appear as a dark green, interveinal banding pattern on the lower canopy foliage. These initial symptoms typically occur in the shrub or sampling layer of a beech stand. The later symptoms result in solidly darkened leaves that are shrunken and crinkled. The symptoms appear to progress through the buds as the affected buds are eventually aborted and no new leaves are produced. We fear this disease has the potential to drastically alter the Eastern deciduous forests of the United States on its own and through potential compounding disease effects. In addition, BLD poses a threat to global forests as symptoms of the disease were detected on European (F. sylvatica) and Oriental (F. orientalis) beech species in nurseries in north‐eastern Ohio. Due to its rapid spread and variability in environmental conditions where it has been detected, it seems unlikely that BLD is an abiotic disorder. Thus, intense efforts are underway to determine the causal agent of BLD. Relevant stakeholders are advised to be alert for BLD symptoms in beech forests in the Northern Hemisphere, and substantial resources should be invested in understanding this emerging forest disease.
Investigating the prevalence of dissociative disorders and severe dissociative symptoms in first episode psychosis
Authors: Sun Pamela , Alvarez‐Jimenez Mario , Lawrence Katherine , Simpson Katrina , Peach Natalie , Bendall Sarah
Published: December 2018

Aim

Increasing evidence suggests that childhood trauma and dissociation are associated with psychotic symptoms and disorders. Significant rates of dissociative disorders and clinical levels of dissociative symptoms are found in chronic schizophrenia. To date, no studies have examined the prevalence of these in a first episode psychosis (FEP) group. This study aimed to investigate the prevalence of dissociative disorders and symptoms in a FEP sample as well as the prevalence of severe dissociative symptoms in those with or without experiences of childhood trauma.

Methods

Sixty‐six young people with FEP completed a research interview which included the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) Axis I Disorders, Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM‐IV Dissociative Disorders‐Revised.

Results

Dissociative symptoms at clinical levels were found in 36.4% of the sample. Furthermore, 13.6% of the sample met diagnostic criteria for a lifetime dissociative disorder. Significant differences in the frequency of clinical dissociative symptoms between those with or without childhood trauma were also found.

Conclusions

Dissociative symptoms should be routinely assessed for in early intervention settings, especially in cases where childhood trauma is disclosed or suspected. Where present, dissociative symptoms should also be incorporated into subsequent case formulation and treatment planning.
Spatial impact of microglial distribution on dynamics of dendritic spines
Authors: Iida Tadatsune , Tanaka Shinji , Okabe Shigeo
Published: December 2018

Microglia regulate synapse stability and remodeling through multiple molecular pathways. Regulated spatial distribution of microglia within nervous tissues may affect synapse dynamics. Here, we focused on the spatial relationship between microglia and spine synapses in the mouse neocortex and found that the distance between microglial cell bodies (MCBs) and spines is a critical parameter in spine stability. The region close to MCBs contains microglial processes with higher density and with more spine contacts. This region also shows more extensive exploration of tissue space by microglial processes. To test if the relative positions between MCBs and spines are important for spine stability, we simultaneously imaged spines and microglia in vivo and found negative correlation between spine–MCB distance and spine stability. Optical clearing methods enabled us to record the positions of all microglia in a large cortical volume and indicated their mutually exclusive distribution with similar density across cortical layers. This spatial arrangement of microglia is responsible for the repeated appearance of domains close to MCBs along dendritic arborization. The microglial position was largely independent of other cellular components. These results suggest that the spatial arrangement of microglia is critical for generating repetitive domains of synaptic instability along dendrites, which operates independently of other glial components.
Oral anticoagulation and left atrial appendage closure: a new strategy for recurrent cardioembolic stroke
Authors: Masjuan J. , Salido L. , DeFelipe A. , Hernández‐Antolín R. , Fernández‐Golfín C. , Cruz‐Culebras A. , Matute C. , Vera R. , Pérez‐Torre P. , Zamorano J. L.
Published: December 2018

Background and purpose

There are no recommendations regarding how to treat cardioembolic recurrent strokes when patients are well anticoagulated. We evaluated the safety and efficacy of combining oral anticoagulation (OAC) with percutaneous left atrial appendage closure (LAAC) in patients with well‐anticoagulated atrial fibrillation (AF) with recurrent strokes.

Methods

In an explorative, prospective, observational study, LAAC was performed in patients with AF with at least two ischaemic strokes in the previous year, despite good anticoagulation using the Amplatzer Cardiac Plug (St Jude Medical, St Paul, MN, USA) or Amulet Abbot device (Abbot Vascular, Santa Clara, CA, USA). We recorded age, type of AF, CHA2DS2‐VASC and HAS‐BLED scores, types of OAC and risk factors. After closure, treatment with aspirin (100 mg/day) was continued for 3 months in combination with indefinite OAC. Clinical status, recurrent embolisms and bleeding complications were recorded during follow‐up.

Results

A total of 19 patients were included (mean age, 72.1 ± 9.6 years; mean CHA2DS2‐VASC score, 5.3 ± 1.48; mean number of previous strokes, 2.78 ± 1.15). Thirteen had spontaneous echocardiographic contrast and all had dilatation of the left atrium. Eighteen patients had a multilobulated left atrial appendage, 17 with ‘chicken‐wing’ morphology and one patient had a left atrial appendage thrombus. There were no complications during the procedure. Only one patient had a transient ischaemic attack and no major bleeding occurred during a mean follow‐up of 17.4 ± 11.5 months.

Conclusion

Combination therapy with indefinite OAC plus LAAC in patients with AF with recurrent strokes despite good anticoagulation should be considered in order to prevent a new stroke.