bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies
Authors: Barber Thomas M , Hanson Petra , Weickert Martin O , Franks Stephen
Published: September 2019

Polycystic ovary syndrome (PCOS) is a common female condition typified by reproductive, hyperandrogenic, and metabolic features. Polycystic ovary syndrome is a genetic condition, exacerbated by obesity. There is a close link between obesity and PCOS based on epidemiological data, and more recently corroborated through genetic studies. There are many mechanisms mediating the effects of weight-gain and obesity on the development of PCOS. The metabolic effects of insulin resistance and steroidogenic and reproductive effects of hyperinsulinaemia are important mechanisms. Adipokine production by subcutaneous and visceral fat appears to play a part in metabolic function. However, given the complexity of PCOS pathogenesis, it is important also to consider possible effects of PCOS on further weight-gain, or at least on hampering attempts at weight-loss and maintenance through lifestyle changes. Possible mediators of these effects include changes in energy expenditure, mental ill health, or physical inactivity. In this brief review, we discuss the main mechanisms that underlie the association between obesity and PCOS, from divergent perspectives of weight-gain contributing to development of PCOS and vice versa. We also consider novel management options for women with obesity and PCOS.
To Get Back on Track: A Qualitative Study on Childless Women’s Expectations on Future Fertility Before Undergoing Bariatric Surgery
Authors: Nilsson-Condori Emma , Järvholm Stina , Thurin-Kjellberg Ann , Sidlovskaja Ilona , Hedenbro Jan L , Friberg Britt
Published: September 2019

Background:

In Sweden, 4700 women seek bariatric surgery annually, many of those being nulliparous. Anovulation is common among obese women, but bariatric surgery is not considered a treatment for infertility. The aim of this study was to explore the motives of women in fertile age for seeking bariatric surgery and their expectations on future fertility.

Materials and methods:

A qualitative study with semi-structured interviews with childless women ( n = 12) aged 20 to 35 years. Interviews were conducted 1 to 3 weeks prior to surgery, transcribed verbatim, and analyzed with thematic analysis.

Results:

“To get back on track” was identified as a master theme with 3 underlying subthemes, with the following headings: “A better me,” “A fertile me,” and “A pregnant me.” The participants were hoping that weight-loss would make them feel more content with themselves, break isolation, and make it easier to find a partner. The participants considered fertility to improve after bariatric surgery, mainly based on stories from other patients of bariatric surgery. Having a child was expressed to be of great importance to them.

Conclusions:

Even though obese young women do not seek bariatric surgery for fertility reasons alone, there is a general perception of enhanced fertility after surgery, which is regarded as positive and important.
On a Walking Tour to No Man’s Land: Brokering and Shifting Narratives of Violence in Trench Town, Jamaica
Authors: Osbourne Alana
Published: September 2019

Tourists who visit Trench Town are drawn in by the neighborhood’s rich musical heritage. They want to see the birthplace of reggae and witness the circumstances depicted in many famous Jamaican songs. Knowingly venturing into marginalized territory, into the “ghetto,” travelers expect to encounter spectacular forms of violence. Yet what the walking tour of Trench Town reveals is an experience of another kind, an excursion that exposes poverty as structural violence, and that points to the historical and political struggles that are constitutive of the area’s social fabric. In this article, drawing on an ethnographic vignette of a walking tour that starts in Bob Marley’s rehearsal grounds and ends by an empty plot locally known as “No Man’s Land,” I focus on the entanglements of violence and tourism and present the discrepancy that exists between touristic desires and the reality of the tourism commodity. This analysis reveals how residents of Trench Town simultaneously choose to address and disregard different (un)spectacular forms of violence during the tourism encounter and I argue that in so doing, local tour guides productively leverage violence to denounce and grapple with structural and historical brutalities.
Donald Trump and Trumpism: Leadership, ideology and narrative of the business executive turned politician
Authors: Mollan Simon , Geesin Beverly
Published: September 2019

In this article, Donald Trump and the emerging ideology of ‘Trumpism’ are interpreted by drawing on perspectives from management and organization studies and related fields. The article begins by exploring key themes that emerge from a critical interpretation of Trump’s business career. Beginning as a real estate entrepreneur in the 1970s and 1980s, Trump experienced a period of mixed fortune in the 1990s, before eventually becoming a popular celebrity via the reality TV show The Apprentice. This portrayed Trump as a decisive and successful business leader. Trump’s approach to business leadership is critiqued. Emphasis is placed on seeking opportunity in economic decline, a zero-sum or negative-sum approach to profit-making and economic value, often benefitting at the expense of counter-parties. The article then explores how this approach to business was combined with previously marginal right-wing conservative ideas to project Trump as both critic and solution to bleak and troubling perceptions of American politics, economy and society. In turn this has led to a radical conservative agenda in office.
The physical health costs of positive adaptation to childhood adversity
Authors: Rudd Kristen L , Doan Stacey N , Yates Tuppett M
Published: September 2019

Theories of allostatic load suggest that recurrent adaptive adjustments in contexts of adversity may have a negative impact on physical well-being. To test this hypothesis, this study evaluated 6-year-old children’s ego-resilience and physical abuse experiences on behavior problems and physical illness at the age of 8 years. A significant interaction between ego-resilience and physical abuse exposure indicated that, although ego-resilience buffered physically abused children from internalizing problems, it also predicted more physical illness in that group. Findings contribute to the growing body of evidence suggesting that efforts to mobilize an adaptive response in contexts of adversity may exact a cost on physical well-being.
Creating and Evaluating a General Psychology Custom Textbook: A Goal-Oriented Approach
Authors: Davis Teresa L , Fromuth Mary Ellen
Published: September 2019

This paper describes a model for the articulation and assessment of goals in the development and use of a general psychology custom textbook. A description of custom textbooks is presented, and the specific textbook that our Psychology Department has developed is discussed. Two studies present data on student and faculty perceptions of the effectiveness of the textbook. Study 1 involved faculty members who used the custom textbook, and Study 2 included students who were enrolled in General Psychology. For both studies, perceived benefits and drawbacks of the custom textbook were surveyed, as well as the helpfulness of its various components. Results revealed higher satisfaction with the custom textbook as compared to a traditional text, as well as consistency between faculty and students in the perceived helpfulness of different components of the text. Results also indicated that the original goals of the project were met. The benefits and drawbacks of using a custom text and the importance of having clear goals before beginning a customization project were discussed.
Therapeutic Effect of a Traditional Chinese Medicine on the Treatment of Painful Leg Ulcer
Authors: Lu Xuya , Xu Qiang , Li Pinchuan , Zhang Zhaohui
Published: September 2019

This study aimed to investigate the therapeutic effect of a traditional Chinese medicine on the treatment of painful leg ulcer. Twelve cases of painful leg ulcer were recruited and their characteristics (etiology, size, Visual Analog Scale score, and duration) were recorded. Then, an herbal medicine–oriented treatment protocol combining Zhi Tong Sheng Ji powder (ZTSJ) and SJXP (Sheng Ji Xiang Pi plaster) was applied to these patients. The results suggested that this therapeutic protocol contributed to pain relief and promoted wound healing simultaneously. Specifically, 2 days after applying ZTSJ on wounds, the intensity of pain reduced substantially, and the difference between pre- and post-treatment Visual Analog Scale scores (46 mm vs 23 mm, P < .001) was statistically significant. Epithelialization varied according to ulcer depth. If the wound was deep to the fascia, islands of epithelia did not form within wounds, but rather formed at the edge of wounds, generating island of epithelial cells (IECs) or newly formed epithelial tissue. If the wound was superficial and the dermis remained, scattered IECs appeared within ulcers and merged eventually. Furthermore, as wound pain decreased, IECs appeared, expanded, and merged, or epithelial proliferation and migration occurred in wound margin, eventually healing wounds. No infection spread, topical rashes, itching, or other allergies occurred in these 12 cases, and the time for recovery ranged from 16 to 163 days. ZTSJ is effective for the treatment of painful leg ulcers, but the specific mechanism is not clear.
Fostering Ethical, Legal, and Social Implications Research in Tribal Communities: The Center for the Ethics of Indigenous Genomic Research
Authors: Hiratsuka Vanessa Y. , Beans Julie A. , Reedy Justin , Yracheta Joseph M. , Peercy Michael T. , Saunkeah Bobby , Woodbury R. Brian , O’Leary Marcia , Spicer Paul G.
Published: September 2019

Genomic research raises unique ethical concerns among Alaska Native and American Indian (AN/AI) people and their communities. The Center for the Ethics of Indigenous Genomic Research (CEIGR) was created to foster research that takes these concerns into account while considering the sovereign status of AN/AI tribal nations. Relationships developed within CEIGR have allowed for effective, collaborative research among individuals who come from diverse cultures, political and historical backgrounds, and academic disciplines, and who work for organizations with varying resources, capacities, and expectations. The CEIGR framework may inform other groups seeking to conduct social science research related to genomic research with tribal people and their communities.
‘Cautiously optimistic’: Older parent-carers of adults with intellectual disabilities – Responses to the Care Act 2014
Authors: Gant Valerie , Bates Claire
Published: September 2019

This article discusses potential opportunities for best practice in the United Kingdom that may be brought about by the Care Act (2014). Carers in the United Kingdom were given new rights within this legislation with a focus on needs led assessment. The underpinning philosophy of the Care Act is to streamline the previous legislation and offers a framework for carers and people in receipt of care, to enable a more personalized approach to care and support. Offering a discussion of likely opportunities brought about by provisions of the Care Act, this article draws on a small study involving older parent/carers of sons or daughters with intellectual disabilities. Exploring the extent to which such parents of adults with intellectual disabilities were aware of the details of this legislation and the potential impact it may have on their lives highlighted other significant areas, some of which are discussed below. Semi-structured interviews were conducted with five parents over the age of 60 of sons or daughters with intellectual disabilities in North West England. The study adds to the body of knowledge and understanding about parents of adults with intellectual disabilities and explores and provides a deeper understanding of parents’ experiences of the implementation of this specific piece of legislation and their perception of the relevance of it to themselves. Findings include some awareness of the legislation and some feelings of optimism about its likely implications, although participants appeared less clear about the specificities and the impact of these upon them and/or their sons or daughters. Findings from the semi-structured interviews also showed parent’s articulation of the extent of reciprocal care manifest between them and their son or daughter with an intellectual disability, as well as an awareness of the fragility of their own emotional well-being.
Evaluating the clinical and cost-effectiveness of permissive hypotension in critically ill patients aged 65 years or over with vasodilatory hypotension: Protocol for the 65 randomised clinical trial
Authors: Richards-Belle Alvin , Mouncey Paul R , Grieve Richard D , Harrison David A , Sadique M Zia , Henry Doreen , Whitman Chris , Camsooksai Julie , Gordon Anthony C , Young J Duncan , Rowan Kathryn M , Lamontagne François
Published: September 2019

Vasodilatory shock is common in critically ill patients and vasopressors are a mainstay of therapy. A meta-analysis suggested that use of a higher, as opposed to a lower, mean arterial pressure target to guide titration of vasopressor therapy, could be associated with a higher risk of death in older critically ill patients. The 65 trial is a pragmatic, multi-centre, parallel-group, open-label, randomised clinical trial of permissive hypotension (a mean arterial pressure target of 60–65 mmHg during vasopressor therapy) versus usual care in critically ill patients aged 65 years or over with vasodilatory hypotension. The trial is conducted in 2600 patients from 65 United Kingdom adult, general critical care units. The primary outcome is all-cause mortality at 90 days. An economic evaluation is embedded. The 65 trial received favourable ethical opinion from the South Central – Oxford C Research Ethics Committee and approval from the Health Research Authority. The results will be presented at national and international conferences and published in peer-reviewed medical journals.

Trial registration: ISRCTN10580502
Practical perspective of cricket ball swing
Authors: Scobie James A , Shelley William P , Jackson Richard W , Hughes Simon P , Lock Gary D
Published: September 2019

A cricket ball has an encircling, stitched seam proud from the leather, separating the surface into two distinct hemispheres. When angled, this seam is exploited by the skilful bowler to create an asymmetry in the viscous boundary layer and the ball will swing. In this article, the fluid dynamics of both conventional swing and reverse swing are explained and demonstrated. Using balls worn under match conditions and insight from a professional cricketer, factors affecting swing were tested experimentally in a wind tunnel. The surface condition of the ball was demonstrated to have a substantial effect on the amount of swing: conventional swing was most obvious for a new, polished cricket ball and the swing reduced as the ball accumulated wear as would happen as the match progresses; reverse swing was seen at high bowling speeds with a worn ball. Humidity in isolation was shown to have no significant effect on swing, dispelling a long-standing myth in the cricketing community. A grid was used to simulate atmospheric convective micro-turbulence above a cricket pitch on a hot day without cloud cover; strong evidence suggested that turbulence inhibits the fragile conditions necessary for laminar flow and prevents swing.
Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience
Authors: Steinhoff Bernhard J. , Staack Anke M.
Published: September 2019

Until the early 1990s, a limited number of antiepileptic drugs (AEDs) were available. Since then, a large variety of new AEDs have been developed and introduced, several of them offering new modes of action. One of these new AED families is described and reviewed in this article. Levetiracetam (LEV) and brivaracetam (BRV) are pyrrolidone derivate compounds binding at the presynaptic SV2A receptor site and are thus representative of AEDs with a unique mode of action. LEV was extensively investigated in randomized controlled trials and has a very promising efficacy both in focal and generalized epilepsies. Its pharmacokinetic profile is favorable and LEV does not undergo clinically relevant interactions. Adverse reactions comprise mainly asthenia, somnolence, and behavioral symptoms. It has now been established as a first-line antiepileptic drug. BRV has been recently introduced as an adjunct antiepileptic drug in focal epilepsy with a similarly promising pharmacokinetic profile and possibly increased tolerability concerning psychiatric adverse events. This review summarizes the essential preclinical and clinical data of LEV and BRV that is currently available and includes the experiences at a large tertiary referral epilepsy center.
Is, ought and being careful what you wish for
Authors: Whiteside Heather
Published: September 2019

This brief commentary on Henry Wai-chung Yeung’s “Rethinking Mechanism and Process in the Geographical Analysis of Uneven Development” makes three points. First, the commentary supports the article’s assertions that ‘analytical rigor’ is compromised when process and mechanism are conflated, that causal mechanisms are under- theorized in much economic geography, and that a latent realist ontology often lurks beneath interpretive and process-based approaches. Second, it explores the inherent hurdles that a revival of critical realism presents for efforts of engaged pluralism given geography’s contending perspectives on ontology and epistemology and multiple social and substantive theories. Third, the commentary concludes with a hopeful yet cautionary tale of what multidisciplinary engagement on causal mechanisms might entail given the ‘rigor mortis’ mainstream orthodoxy elsewhere in the social sciences.
DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation
Authors: Mahmood Soran , Johannesson Liza , Testa Giuliano , de Prisco Gregory
Published: September 2019

Objective:

Uterus transplantation is rapidly becoming a viable clinical option for women with uterine-factor infertility and a desire for parenthood. Radiological imaging plays a central role in selecting the optimal living donors for uterus transplantation and serves to exclude any pathology and evaluate the uterine vasculature. The latter is the most important variable in the ultimate technical success of the uterus transplant. In this first report of imaging in the setting of uterus transplantation, we report our experience with living-donor selection, and the evolution of the imaging techniques that ultimately allowed a significant improvement in donor selection and transplant outcome. We also suggest a framework for preoperative imaging in uterus transplantation.

Methods:

Between 2016 and 2018, 27 potential living donors were evaluated by imaging prior to uterine donation for uterus transplantation. Predonation imaging included a screening chest radiograph, dual-phase computed tomography (CT) angiograms of the abdomen and pelvis in the arterial and venous phases and pelvic sonography with Doppler. Seventeen potential donors additionally underwent multiphasic pelvic MR angiograms. The imaging performed was meant to display features of the vascular anatomy relevant for uterus transplantation.

Results:

Out of the 27 potential live donors who were evaluated by imaging, 9 eventually donated their uterus for transplantation. The most frequent reason for exclusion was suboptimal quality of the vessels (33%), including small uterine arteries, the presence of atherosclerosis or small size/poor quality of the uterine or utero-ovarian veins, or both. The next most common reason was voluntary patient withdrawal or failure to complete the evaluation process (28%). Three potential donors (16.6%) were rejected for uterine factors, fibroids, and/or adenomyosis. Other reasons for donor rejection included ABO incompatibility and unfavorable psychological evaluation.

Conclusion:

Diagnostic imaging plays a crucial role in selecting appropriate potential donors, screening prospective recipients, planning the graft procedure, and following up on any graft or nongraft-related complications in both the donor and recipient after the transplantation procedure is performed. Contrast-enhanced CT and MR angiographies have complementary roles, especially when evaluating the donor for adequacy of the arterial and venous supply to the uterine graft and the experience gained from our series indicates that the inclusion of both modalities contributed directly to successful uterus transplant graft survival by selecting patients with favorable arterial and venous vasculature.
Physical activity pattern in early pregnancy and gestational diabetes mellitus risk among low-income women: A prospective cross-sectional study
Authors: do Nascimento Graciliano Ramos , Borges Maria do Carmo , Figueiroa José Natal , Alves Lucas Victor , Alves João Guilherme
Published: September 2019

Objective:

Gestational diabetes mellitus is increasing worldwide, mainly in developing countries, and physical activity has not been studied in gestational diabetes mellitus prevention among low-income population. This prospective cross-sectional study assessed the gestational diabetes mellitus risk related to physical activity in early pregnancy among low-income women.

Methods:

A prospective cross-sectional study with 544 low-income pregnant women was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira, Brazil. Gestational diabetes mellitus was diagnosed using the International Association of Diabetes and Pregnancy Study Groups criteria. Physical activity was assessed during early pregnancy using the Pregnancy Physical Activity Questionnaire and categorized as sedentary, light, moderate, or vigorous intensity.

Results:

Gestational diabetes mellitus occurred in 95 of 544 women (17.4%). Body mass index was higher in the gestational diabetes mellitus group. Nearly half of all pregnant women studied were physically inactive, and none of them were classified as vigorous physical active. Sedentary physical activity pattern was associated with a higher odds of gestational diabetes mellitus (odds ratio = 1.8, 95% confidence interval = 1.1–2.9), which did not change after adjusting for several covariates (odds ratio = 1.9, 95% confidence interval = 1.2–3.1).

Conclusion:

Physical inactivity in early pregnancy is associated with a higher risk of gestational diabetes mellitus among low-income women.
Three Optimized Methods for In Situ Quantification of Progenitor Cell Proliferation in Embryonic Kidneys Using BrdU, EdU, and PCNA
Authors: O’Hara Rosalie E. , Arsenault Michel G. , Esparza Gonzalez Blanca P. , Patriquen Ashley , Hartwig Sunny
Published: September 2019

Background:

Nephron progenitor cells derived from the metanephric mesenchyme undergo a complex balance of self-renewal and differentiation throughout kidney development to give rise to the mature nephron. Cell proliferation is an important index of progenitor population dynamics. However, accurate and reproducible in situ quantification of cell proliferation within progenitor populations can be technically difficult to achieve due to the complexity and harsh tissue treatment required of certain protocols.

Objective:

To optimize and compare the performance of the 3 most accurate S phase–specific labeling methods used for in situ detection and quantification of nephron progenitor and ureteric bud cell proliferation in the developing kidney, namely, 5-bromo-2’-deoxyuridine (BrdU), 5-ethynyl-2’-deoxyuridine (EdU), and proliferating cell nuclear antigen (PCNA).

Methods:

Protocols for BrdU, EdU, and PCNA were optimized for fluorescence labeling on paraformaldehyde-fixed, paraffin-embedded mouse kidney tissue sections, with co-labeling of nephron progenitor cells and ureteric bud with Six2 and E-cadherin antibodies, respectively. Image processing and analysis, including quantification of proliferating cells, were carried out using free ImageJ software.

Results:

All 3 methods detect similar ratios of nephron progenitor and ureteric bud proliferating cells. The BrdU staining protocol is the lengthiest and most complex protocol to perform, requires tissue denaturation, and is most subject to interexperimental signal variability. In contrast, bound PCNA and EdU protocols are relatively more straightforward, consistently yield clear results, and far more easily lend themselves to co-staining; however, the bound PCNA protocol requires substantive additional postexperimental analysis to distinguish the punctate nuclear PCNA staining pattern characteristic of proliferating cells.

Conclusions:

All 3 markers exhibit distinct advantages and disadvantages in quantifying cell proliferation in kidney progenitor populations, with EdU and PCNA protocols being favored due to greater technical ease and reproducibility of results associated with these methods.
Rescue Cardiac Surgeries After Pediatric Catheter-Based Interventions: A Ten-Year Retrospective Study
Authors: Menaissy Yasser , Alkady Hesham , El-Saiedi Sonia
Published: September 2019

Background:

Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention.

Methods:

Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results.

Results:

There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during balloon valvuloplasty. Median age was 4 years (range, 2 months to 12 years). All rescue surgeries were done via median sternotomy. The mean time interval between the decision to remove the device surgically and the actual surgical procedure was 75 ± 14 minutes. There were no reported cases of postoperative complications or mortality among the patients who underwent surgery.

Conclusion:

Our single-center experience confirms that early rescue cardiac surgery to correct adverse events after pediatric transcatheter interventions is safe and effective. Surgical strategies should be tailored according to the situation in each case.
Ross Procedure: How to Do It and How to Teach It
Authors: Herrmann Jeremy L. , Stram Amanda R. , Brown John W.
Published: September 2019

Prosthesis choice for aortic valve replacement (AVR) in children is frequently compromised by unavailability of prostheses in very small sizes, the lack of prosthetic valve growth, and risks associated with long-term anticoagulation. The Ross procedure with pulmonary valve autograft offers several advantages for pediatric and adult patients. We describe our current Ross AVR technique including replacement of the ascending aorta with a prosthetic graft. The procedure shown in the video involves an adult-sized male with a bicuspid aortic valve, mixed aortic stenosis and insufficiency, and a dilated ascending aorta.
A Novel Case of Marfan Syndrome in an Infant With Hypoplastic Left Heart Syndrome
Authors: Karunanandaa Aravinth , Plant Kari Crawford , Herlong James René , Monteleone Berrin , Kirshbom Paul M. , Schwartz Matthew C.
Published: September 2019

This report describes a case of hypoplastic left heart syndrome (HLHS) and Marfan syndrome presenting in conjunction, and highlights how a connective tissue disorder may alter medical and surgical management of newborns with HLHS.
Pulmonary Allograft Versus Medtronic Freestyle Valve in Surgical Pulmonary Valve Replacement for Adults Following Correction of Tetralogy of Fallot or Its Variants
Authors: Wijayarathne Pasangi Madhuka , Skillington Peter , Menahem Samuel , Thuraisingam Amalan , Larobina Marco , Grigg Leeanne
Published: September 2019

Background:

Following corrective surgery in infancy/childhood for tetralogy of Fallot (TOF) or its variants, patients may eventually require pulmonary valve replacement (PVR). Debate remains over which valve is best. We compared outcomes of the Medtronic Freestyle valve with that of the pulmonary allograft valve following PVR.

Methods:

A retrospective study was undertaken from a single surgical practice of adult patients undergoing elective PVR between April 1993 and March 2017. The choice of valve was at the surgeon’s discretion. There was a trend toward the almost exclusive use of the more readily available Medtronic Freestyle valve since 2008.

Results:

One hundred fifty consecutive patients undergoing 152 elective PVRs were reviewed. Their mean age was 33.8 years. Ninety-four patients had a Medtronic Freestyle valve, while 58 had a pulmonary allograft valve. There were no operative or 30-day mortality. The freedom from reintervention at 5 and 10 years was 98% and 98% for the pulmonary allograft and 99% and 89% for the Medtronic Freestyle. There was no significant difference in the rate of reintervention, though this was colored by higher pulmonary gradients across the Medtronic Freestyle despite its shorter follow-up.

Conclusions:

Pulmonary valve replacement following previous surgical repair of TOF or its variants was found to be safe with no significant differences in mortality or reintervention between either valve. Although the Medtronic Freestyle valve had a greater tendency toward pulmonary stenosis, additional follow-up is needed to further document its long-term outcomes.
Norwood Procedure With Left Ventricle Exclusion in Complex Single Ventricle Patients: A Novel Technique
Authors: Riggs Kyle W. , Kavoosi Tazheh A. , Kroslowitz Benjamin , Zafar Farhan , Heydarian Haleh C. , Morales David L. S.
Published: September 2019

Background:

Hypoplastic left heart disease and its variants complicated by severe semilunar and atrioventricular valve insufficiency are associated with a high mortality risk in utero and postnatally. Through the description of three cases, this report outlines the evolution of a successful strategy of morphological left ventricle isolation (ie, “left-sided Starnes”) in caring for this rare cohort of patients with hypoplastic left heart syndrome (HLHS).

Methods:

This study includes three patients: two patients prenatally diagnosed and one transferred from an outside hospital. All patients presented with complex univentricular heart disease with a nonfunctional left ventricle and severe left-sided atrioventricular and/or semilunar valve insufficiency.

Results:

Two patients were delivered with an operating room on standby due to the possibility of emergent surgery being necessary; however, all patients were able to be medically stabilized after birth. Patient 1 underwent successful left ventricle exclusion with a fenestrated polytetrafluoroethylene (PTFE) patch, despite severe mitral valve regurgitation. Patient 2 reinforced the efficacy of PTFE patch occlusion in addition to having aortic valve closure with a small washing jet. Patient 3’s clinical course was successfully predicted based on the previous patients and outlined for the family prenatally. All patients are currently growing well at home, awaiting Fontan with marked improvement in cardiac function.

Conclusion:

This rare cohort of patients with HLHS having severe left-sided atrioventricular and/or semilunar valve insufficiency appear to survive to birth and can be medically stabilized prior to semiurgent intervention. The Norwood procedure with left ventricle exclusion appears to be a successful strategy for these unique patients.
Bentall’s Procedure for Annuloaortic Ectasia and Severe Aortic Regurgitation in a Patient With Repaired Tetralogy of Fallot and Aortic Valvular Reconstruction
Authors: Chowdhury Ujjwal Kumar , George Niwin , Gudala Vasubabu , Gupta Anish , Avneesh Sheil , Sankhyan Lakshmi Kumari , Malik Vishwas , Kumar Pramod
Published: September 2019

A 21-year-old female patient with repaired tetralogy of Fallot and aortic valvular reconstruction with aneurysmal aortic root and severe aortic regurgitation underwent aortic root replacement. Intrinsic aortopathy in tetralogy of Fallot and its surgical importance are highlighted.
Acute Myelogenous Leukemia With Trisomy 8 and Concomitant Acquired Factor VII Deficiency
Authors: Moosavi Leila , Bowen Jonathan , Coleman Jeffrey , Heidari Arash , Cobos Everardo
Published: September 2019

Acquired isolated factor VII deficiency is a rare bleeding disorder and has been reported in 31 cases. This is in contrast to congenital factor VII deficiency, which while also infrequent is the most common rare congenital bleeding disorder. Acquired isolated factor VII deficiency has been described primarily in patients with solid malignancies, sepsis, and in the presence of anti-factor VII autoantibodies. We report a case of acute myelogenous leukemia with an associated trisomy 8 cytogenetic abnormality presenting with factor VII deficiency. The factor VII deficiency cleared after induction chemotherapy and with the disappearance of the cytogenetic and molecular abnormalities. We discuss a possible link between trisomy 8 and vitamin K metabolism, which might result in acquired factor VII deficiency in acute myelogenous leukemia.
Immunoadsorption enables successful rAAV5-mediated repeated hepatic gene delivery in nonhuman primates
Authors: Salas David , Kwikkers Karin L. , Zabaleta Nerea , Bazo Andrea , Petry Harald , van Deventer Sander J. , Aseguinolaza Gloria Gonzalez , Ferreira Valerie
Published: September 2019

Adeno-associated virus (AAV)–based liver gene therapy has been shown to be clinically successful. However, the presence of circulating neutralizing antibodies (NABs) against AAV vector capsids remains a major challenge as it may prevent successful transduction of the target cells. Therefore, there is a need to develop strategies that would enable AAV-mediated gene delivery to patients with preexisting anti-AAV NABs. In the current study, the feasibility of using an immunoadsorption (IA) procedure for repeated, liver-targeted gene delivery in nonhuman primates was explored. The animals were administered IV with recombinant AAV5 (rAAV5) carrying the reporter gene human secreted embryonic alkaline phosphatase (hSEAP). Seven weeks after the first rAAV treatment, all of the animals were readministered with rAAV5 carrying the therapeutic hemophilia B gene human factor IX (hFIX). Half of the animals administered with rAAV5-hSEAP underwent IA prior to the second rAAV5 exposure. The transduction efficacies of rAAV5-hSEAP and rAAV5-hFIX were assessed by measuring the levels of hSEAP and hFIX proteins. Although no hFIX was detected after rAAV5-hFIX readministration without prior IA, all animals submitted to IA showed therapeutic levels of hFIX expression, and a threshold of anti-AAV5 NAB levels compatible with successful readministration was demonstrated. In summary, our data demonstrate that the use of a clinically applicable IA procedure enables successful readministration of an rAAV5-based gene transfer in a clinically relevant animal model. Finally, the analysis of anti-AAV NAB levels in human subjects submitted to IA confirmed the safety and efficacy of the procedure to reduce anti-AAV NABs. Furthermore, clinical translation was assessed using an immunoglobulin G assay as surrogate.
Atomic-Scale Characterization of Slip Deformation and Nanometric Machinability of Single-Crystal 6H-SiC
Authors: Meng Binbin , Yuan Dandan , Xu Shaolin
Published: September 2019

As an important third-generation semiconductor material, the micro-deformation and removal mechanism of 6H-SiC at the atomic scale are vital for obtaining ultra-smooth and damage-free surface with atomic steps. Due to the difficulties in directly observing the surface/subsurface of nanomachining region by current experimental means, molecular dynamics method is used to study the atomic-scale details in nanomachining process, such as dislocation slip motion, phase transition, and material separation mechanism. The influence of crystallography-induced anisotropy on the slip deformation and nanometric machinability of 6H-SiC is emphatically investigated. This study contributes significantly to the understanding of micro-deformation and nanomachining process of 6H-SiC.
Predicting links between tumor samples and genes using 2-Layered graph based diffusion approach
Authors: Timilsina Mohan , Yang Haixuan , Sahay Ratnesh , Rebholz-Schuhmann Dietrich
Published: September 2019

Background

Determining the association between tumor sample and the gene is demanding because it requires a high cost for conducting genetic experiments. Thus, the discovered association between tumor sample and gene further requires clinical verification and validation. This entire mechanism is time-consuming and expensive. Due to this issue, predicting the association between tumor samples and genes remain a challenge in biomedicine.

Results

Here we present, a computational model based on a heat diffusion algorithm which can predict the association between tumor samples and genes. We proposed a 2-layered graph. In the first layer, we constructed a graph of tumor samples and genes where these two types of nodes are connected by “hasGene” relationship. In the second layer, the gene nodes are connected by “interaction” relationship. We applied the heat diffusion algorithms in nine different variants of genetic interaction networks extracted from STRING and BioGRID database. The heat diffusion algorithm predicted the links between tumor samples and genes with mean AUC-ROC score of 0.84. This score is obtained by using weighted genetic interactions of fusion or co-occurrence channels from the STRING database. For the unweighted genetic interaction from the BioGRID database, the algorithms predict the links with an AUC-ROC score of 0.74.

Conclusions

We demonstrate that the gene-gene interaction scores could improve the predictive power of the heat diffusion model to predict the links between tumor samples and genes. We showed the efficient runtime of the heat diffusion algorithm in various genetic interaction network. We statistically validated our prediction quality of the links between tumor samples and genes.
A novel R2R3-MYB from grape hyacinth, MaMybA, which is different from MaAN2, confers intense and magenta anthocyanin pigmentation in tobacco
Authors: Chen Kaili , Du Lingjuan , Liu Hongli , Liu Yali
Published: September 2019

Background

The primary pigments in flowers are anthocyanins, the biosynthesis of which is mainly regulated by R2R3-MYBs. Muscari armeniacum is an ornamental garden plant with deep cobalt blue flowers containing delphinidin-based anthocyanins. An anthocyanin-related R2R3-MYB MaAN2 has previously been identified in M. armeniacum flowers; here, we also characterized a novel R2R3-MYB MaMybA, to determine its function and highlight similarities and differences between MaMybA and MaAN2.

Results

In this study, a novel anthocyanin-related R2R3-MYB gene was isolated from M. armeniacum flowers and functionally identified. A sequence alignment showed that MaMybA contained motifs typically conserved with MaAN2 and its orthologs. However, the shared identity of the entire amino acid sequence between MaMybA and MaAN2 was 43.5%. Phylogenetic analysis showed that they were both clustered into the AN2 subgroup of the R2R3-MYB family, but not in the same branch. We also identified a IIIf bHLH protein, MabHLH1, in M. armeniacum flowers. A bimolecular fluorescence complementation assay showed that MabHLH1 interacted with MaMybA or MaAN2 in vivo; a dual luciferase assay indicated that MaMybA alone or in interaction with MabHLH1 could regulate the expression of MaDFR and AtDFR, but MaAN2 required MabHLH1 to do so. When overexpressing MaMybA in Nicotiana tabacum ‘NC89’, the leaves, petals, anthers, and calyx of transgenic tobacco showed intense and magenta anthocyanin pigments, whereas those of OE-MaAN2 plants had lighter pigmentation. However, the ovary wall and seed skin of OE-MaMybA tobacco were barely pigmented, while those of OE-MaAN2 tobacco were reddish-purple. Moreover, overexpressing MaMybA in tobacco obviously improved anthocyanin pigmentation, compared to the OE-MaAN2 and control plants, by largely upregulating anthocyanin biosynthetic and endogenous bHLH genes. Notably, the increased transcription of NtF3′5′H in OE-MaMybA tobacco might lead to additional accumulation of delphinidin 3-rutinoside, which was barely detected in OE-MaAN2 and control plants. We concluded that the high concentration of anthocyanin and the newly produced Dp3R caused the darker color of OE-MaMybA compared to OE-MaAN2 tobacco.

Conclusion

The newly identified R2R3-MYB transcription factor MaMybA functions in anthocyanin biosynthesis, but has some differences from MaAN2; MaMybA could also be useful in modifying flower color in ornamental plants.
Microbiological and clinical characteristics of Streptococcus gallolyticus subsp. pasteurianus infection in China
Authors: Li Yi , Chen Xingchun , Zhang Zhijun , Wang Lijun , Wang Junrui , Zeng Ji , Yang Junwen , Lu Binghuai
Published: September 2019

Background

Infections by Streptococcus gallolyticus subsp. pasteurianus (SGSP) is often underestimated. Herein, the epidemiological features and resistant characteristics of SGSP in mainland China are characterized to enable a better understanding of its role in clinical infections.

Methods

In the present work, 45 SGSP isolates were collected from the samples of bloodstream, urine, aseptic body fluid, and fetal membrane/placenta from patients in 8 tertiary general hospitals of 6 cities/provinces in China from 2011 to 2017. The identification of all isolates was performed using traditional biochemical methods, 16S rRNA and gyrB sequencing, followed by the characterization of their antibiotic resistance profiling and involved genes.

Results

Among 34 non-pregnancy-related patients, 4 (4/34,11.8%) patients had gastrointestinal cancer, 10 (10/34, 29.4%) patients had diabetes, and one patient had infective endocarditis. Moreover, 11 cases of pregnant women were associated with intrauterine infection (9/11, 81.2%) and urinary tract infection (1/11, 9.1%), respectively. Except one, all other SGSP isolates were correctly identified by the BD Phoenix automated system. We found that all SGSP isolates were phenotypically susceptible to penicillin, ampicillin, cefotaxime, meropenem, and vancomycin. Forty strains (40/45, 88.9%) were both erythromycin and clindamycin-resistant, belonging to the cMLSB phenotype, and the majority of them carried erm(B) gene (39/40, 97.5%). Although the cMLSB/erm(B) constituted the most frequently identified phenotype/genotype combination (25/40, 62.5%) among all erythromycin-resistant cMLSB isolates, erm(B)/erm(A), erm(B)/mef(A/E), and erm(B)/erm(T) was detected in 7, 4, and 3 isolates, respectively. Furthermore, 43 strains (43/45, 95.6%) were tetracycline-resistant, and out of these, 39 strains (39/45, 86.7%) carried tet(L), 27(27/45, 60.0%) strains carried tet(O), and 7 (7/45, 15.6%) strains carried tet(M), alone or combined, respectively. All erythromycin-resistant isolates were also resistant to tetracycline.

Conclusions

It is important to study and draw attention on SGSP, an underreported opportunistic pathogen targeting immunodeficient populations, notably elderly subjects, pregnant women and neonates.
“If there are no female nurses to attend to me, I will just go and deliver at home”: a qualitative study in Garissa, Kenya
Authors: N’Gbichi Coralie , Ziraba Abdhalah Kasiira , Wambui David Wainaina , Bakibinga Pauline , Kisiangani Isaac , Njoroge Pauline , Noor Rumana , Njoroge Ngugi , Salah Raha Abdi , Mohamed Elmi
Published: September 2019

Background

The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community.

Methods

The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes.

Results

Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted.

Conclusion

To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.