bluuebunny/crossref_metadata_2025 huggingface dataset:
Slow cooling versus episodic fluid injections: Deciphering the Caledonian orogeny in Vestvågøy, Lofoten islands, Norway
Authors: Fournier Herbert W. , Lee James K. W. , Camacho Alfredo
Published: March 2019

The determination of the thermal (temperature–time) histories of high‐P metamorphic terranes has been commonly based on the concepts of slow cooling and closure temperatures. In this paper, we find that this approach cannot reconcile a geochronological data set obtained from the amphibolite‐facies allochthonous Leknes Group of the Lofoten islands, Norway, which reveals an extremely complex thermal history. Using detailed results from several different geochronometers such as 40Ar/39Ar, Rb–Sr and U–Pb, we show that a model invoking multiple, short‐lived thermal pulses related to hot‐fluid infiltration channelized by shear zones can reconcile this complicated data set. This model suggests that hot fluids infiltrated throughout basement shear zones and affected the overlying cold allochthon, partially resetting U/Pb rutile and titanite ages, crystallizing new zircon and produced identical 40Ar/39Ar and Rb/Sr ages in muscovite, biotite and amphibole in various rocks throughout the region. This paper shows the enormous potential of coupling laser Ar‐spot data with thermal modelling to identify and constrain the duration of short‐lived events. An optimal P–T–t history has been derived by modelling the age data from a previously dated large muscovite crystal (Hames & Andresen, 1996, Geology, 24:1005) and using Zr‐in‐rutile thermometry which is consistent with all geochronological data and geological constraints from the basement zones and allochthon cover. This tectonothermal model history suggests that there have been three episodic hot‐fluid and 40Ar‐free infiltration events, resulting in the total resetting of Ar ages during the Scandian (425 Ma) for 1 Ma at 650°C and two reheating events at 415 Ma for 400 ka at 650°C and at 365 Ma for 50 ka at 600°C, which are modelled as thermal spikes above an ambient temperature of 300°C. Independent confirmation of these parameters was provided by Pb‐diffusion modelling in rutile and titanite. The model suggests that the amphibolite facies rocks of the Leknes Group probably remained cold before being exhumed for at least 60 Ma (425–365 Ma) and successfully explains the presence of different minerals that crystallized or were totally/partially reset in the allochthon and in the basement. The migration of hot fluids for short periods of times within conduits extending through the basement and allochthon rock units is likely associated with episodic seismic activity during the Caledonian orogeny.
Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation
Authors: Kwon Hye‐Mee , Moon Young‐Jin , Jung Kyeo‐Woon , Park Yong‐Seok , Jun In‐Gu , Kim Seon‐Ok , Song Jun‐Gol , Hwang Gyu‐Sam
Published: March 2019

Background & Aims

Early allograft dysfunction (EAD) is predictive of poor graft and patient survival following living donor liver transplantation (LDLT). Considering the impact of the inflammatory response on graft injury extent following LDLT, we investigated the association between neutrophil‐to‐lymphocyte ratio (NLR) and EAD, 1‐year graft failure, and mortality following LDLT, and compared it to C‐reactive protein (CRP), procalcitonin, platelet‐to‐lymphocyte ratio and the Glasgow prognostic score.

Methods

A total of 1960 consecutive adult LDLT recipients (1531/429 as development/validation cohort) were retrospectively evaluated. Cut‐offs were derived using the area under the receiver operating characteristic curve (AUROC), and multivariable regression and Cox proportional hazard analyses were performed.

Results

The risk of EAD increased proportionally with increasing NLR, and the NLR AUROC was 0.73, similar to CRP and procalcitonin and higher than the rest. NLR ≥ 2.85 (best cut‐off) showed a significantly higher EAD occurrence (20.5% vs 5.8%, P < 0.001), higher 1‐year graft failure (8.2% vs 4.9%, log‐rank P = 0.009) and higher 1‐year mortality (7% vs 4.5%, log‐rank P = 0.039). NLR ≥ 2.85 was an independent predictor of EAD (odds ratio, 1.89 [1.26‐2.84], P = 0.002) after multivariable adjustment, whereas CRP and procalcitonin were not. Increasing NLR was independently associated with higher 1‐year graft failure and mortality (both P < 0.001). Consistent results in the validation cohort strengthened the prognostic value of NLR.

Conclusions

Preoperative NLR ≥ 2.85 predicted higher risk of EAD, 1‐year graft failure and 1‐year mortality following LDLT, and NLR was superior to other parameters, suggesting that preoperative NLR may be a practical index for predicting graft function following LDLT.
Lower intakes of protein, carbohydrate, and energy are associated with increased global DNA methylation in 2‐ to 3‐year‐old urban slum children in Bangladesh
Authors: Iqbal Mohd S. , Rahman Sabuktagin , Haque Md Ahshanul , Bhuyan Mohammad Junayed , Faruque Abu Syed Golam , Ahmed Tahmeed
Published: March 2019

Stunting in children is a global public health concern. We investigated how global DNA methylation relates to food intakes, dietary diversity, and development of stunting among 324 children aged 24–36 months in a slum community in Dhaka, Bangladesh. Stunted children (height‐for‐age z score ˂−2; n = 162) and their age‐ and sex‐matched nonstunted counterparts (height‐for‐age z score ˃−1; n = 162) were selected by active community surveillance. We studied global DNA methylation, measured as 5‐mC% content in whole blood. Dietary intake, anthropometric measurement, and sociodemographic information were obtained. In the multiple linear regression model, increased global DNA methylation level in children was significantly associated with consumption of lower amount of energy, coef: .034 (95% CI [.014, .053]); P = .001, protein, coef: .038 (95% CI [.019, .057]); P = .000, carbohydrate, coef: .027 (95% CI [.008, .047]); P = .006, zinc, coef: .020 (95% CI [.001, .039]); P = .043, total dietary intakes, coef: .020 (95% CI [.001, .039]); P = .043, and intake from plant sources, coef: .028 (95% CI [.009, .047]); P = .005, after adjusting for other covariates. Moreover, higher fruits and vegetables consumption was significantly associated with lower 5‐mC% level, coef: −.022 (95% CI [−.041, −.002]); P = .028. Our findings suggest a significant association between low dietary intakes and increased global DNA methylation. We also found increased global DNA methylation in stunted children. To establish the relationship among the macronutrient intakes, global DNA methylation, and stunting, future prospective studies are warranted in resource‐poor settings.
Tandem‐running and scouting behaviour are characterized by up‐regulation of learning and memory formation genes within the ant brain
Authors: Alleman Austin , Stoldt Marah , Feldmeyer Barbara , Foitzik Susanne
Published: March 2019

Tandem‐running is a recruitment behaviour in ants that has been described as a form of teaching, where spatial information possessed by a leader is conveyed to following nestmates. Within Temnothorax ants, tandem‐running is used within a variety of contexts, from foraging and nest relocation to—in the case of slavemaking species—slave raiding. Here, we elucidate the transcriptomic basis of scouting, tandem‐leading and tandem‐following behaviours across two species with divergent lifestyles: the slavemaking Temnothorax americanus and its primary, nonparasitic host T. longispinosus. Analysis of gene expression data from brains revealed that only a small number of unique differentially expressed genes are responsible for scouting and tandem‐running. Comparison of orthologous genes between T. americanus and T. longispinosus suggests that tandem‐running is characterized by species‐specific patterns of gene usage. However, within both species, tandem‐leaders showed gene expression patterns median to those of scouts and tandem‐followers, which was expected, as leaders can be recruited from either of the other two behavioural states. Most importantly, a number of differentially expressed behavioural genes were found, with functions relating to learning and memory formation in other social and nonsocial insects. This includes a number of up‐regulated receptor genes such as a glutamate and dopamine receptor, as well as serine/threonine‐protein phosphatases and kinases. Learning and memory genes were specifically up‐regulated within scouts and tandem‐followers, not only reinforcing previous behavioural studies into how Temnothorax navigate novel environments and share information, but also providing insight into the molecular underpinnings of teaching and learning within social insects.
Nitrate acts at the Arabidopsis thaliana shoot apical meristem to regulate flowering time
Authors: Olas Justyna Jadwiga , Van Dingenen Judith , Abel Christin , Działo Magdalena Anna , Feil Regina , Krapp Anne , Schlereth Armin , Wahl Vanessa
Published: March 2019

Optimal timing of flowering, a major determinant for crop productivity, is controlled by environmental and endogenous cues. Nutrients are known to modify flowering time; however, our understanding of how nutrients interact with the known pathways, especially at the shoot apical meristem (SAM), is still incomplete. Given the negative side‐effects of nitrogen fertilization, it is essential to understand its mode of action for sustainable crop production.

We investigated how a moderate restriction by nitrate is integrated into the flowering network at the SAM, to which plants can adapt without stress symptoms.

This condition delays flowering by decreasing expression of SUPRESSOR OF OVEREXPRESSION OF CONSTANS 1 (SOC1) at the SAM. Measurements of nitrate and the responses of nitrate‐responsive genes suggest that nitrate functions as a signal at the SAM. The transcription factors NIN‐LIKE PROTEIN 7 (NLP7) and NLP6, which act as master regulators of nitrate signaling by binding to nitrate‐responsive elements (NREs), are expressed at the SAM and flowering is delayed in single and double mutants. Two upstream regulators of SOC1 (SQUAMOSA PROMOTER BINDING PROTEIN‐LIKE3 (SPL3) and SPL5) contain functional NREs in their promoters.

Our results point at a tissue‐specific, nitrate‐mediated flowering time control in Arabidopsis thaliana.
Tetranins: new putative spider mite elicitors of host plant defense
Authors: Iida Junya , Desaki Yoshitake , Hata Kumiko , Uemura Takuya , Yasuno Ayano , Islam Monirul , Maffei Massimo E. , Ozawa Rika , Nakajima Tadaaki , Galis Ivan , Arimura Gen‐ichiro
Published: March 2019

The two‐spotted spider mite (Tetranychus urticae) is a plant‐sucking arthropod herbivore that feeds on a wide array of cultivated plants. In contrast to the well‐characterized classical chewing herbivore salivary elicitors that promote plant defense responses, little is known about sucking herbivores’ elicitors. To characterize the sucking herbivore elicitors, we explored putative salivary gland proteins of spider mites by using an Agrobacterium‐mediated transient expression system or protein infiltration in damaged bean leaves.

Two candidate elicitors (designated as tetranin1 (Tet1) and tetranin2 (Tet2)) triggered early leaf responses (cytosolic calcium influx and membrane depolarization) and increased the transcript abundances of defense genes in the leaves, eventually resulting in reduced survivability of T. urticae on the host leaves as well as induction of indirect plant defenses by attracting predatory mites. Tet1 and/or Tet2 also induced jasmonate, salicylate and abscisic acid biosynthesis.

Notably, Tet2‐induced signaling cascades were also activated via the generation of reactive oxygen species.

The signaling cascades of these two structurally dissimilar elicitors are mostly overlapping but partially distinct and thus they would coordinate the direct and indirect defense responses in host plants under spider mite attack in both shared and distinct manners.
Japanese clinical practice guidelines for sacrococcygeal teratoma, 2017
Authors: Fumino Shigehisa , Tajiri Tatsuro , Usui Noriaki , Tamura Masanori , Sago Haruhiko , Ono Shigeru , Nosaka Shunsuke , Yoneda Akihiro , Souzaki Ryota , Higashi Mayumi , Sakai Kohei , Takahashi Ken , Sugiura Takahiro , Taguchi Tomoaki
Published: March 2019

Background

Sacrococcygeal teratoma (SCT) is the most common extragonadal germ cell tumor in neonates and infants. Although most cases of infantile SCT are benign tumors by nature, some develop into extremely large lesions, leading to massive bleeding, high‐output heart failure, disseminated intravascular coagulation, and even fatal outcomes during the neonatal period. In addition, some patients may present with tumor recurrence, malignant transformation, long‐term sequelae (including bladder and bowel dysfunction) and lower leg palsy during the long‐term follow up. SCT, however, is very rare, and there are few opportunities to encounter this disease, therefore general physicians without expert credentials currently lack information relevant to clinical practice. For this reason, the research project committee has compiled guidelines concerning SCT.

Methods

The purpose of these guidelines was to share information concerning the treatment and follow up of infantile SCT. The guidelines were developed using the methodologies in the Medical Information Network Distribution System. A comprehensive search of the English‐ and Japanese‐language articles in PubMed and Ichu‐Shi Web identified only case reports or case series, and the recommendations were developed through a process of informal consensus.

Results

The clinical questions addressed the risk factors, the efficacy of cesarean section, the initial devascularization of tumor feeding vessels, interventional radiology, recommended clinical studies for follow up and possible long‐term complications.

Conclusions

These are the first guidelines for SCT to be established in Japan, and they may have huge clinical value and significance in terms of developing therapeutic strategies and follow up, potentially contributing to the improvement of the prognosis and quality of life of SCT patients.
Epithelial cell adhesion molecule (EpCAM) from pleural fluid cell lysates is a highly accurate diagnostic biomarker of adenocarcinomatous effusions
Authors: Porcel José M. , Esquerda Aureli , Bielsa Silvia , Novell Anna , Sorolla Maria Alba , Gatius Sonia , Zamora Carlos , Vidal Silvia , Salud Antonieta
Published: March 2019

Background and objective

The discovery of highly accurate pleural fluid (PF) biomarkers of malignancy remains elusive. We assessed the operating characteristics of the PF epithelial cell adhesion molecule (EpCAM), claudin 4 (CL4) and human epididymis protein 4 (HE4) as potential markers of epithelial malignancies.

Methods

The three markers were quantified by immunoassays in the supernatants (s) and cell lysates (cl) of 175 PF samples. The cut‐off values with 100% specificity were selected for malignant–benign discrimination. An immunocytochemical staining index score for each marker was also evaluated on PF cell blocks. The resulting best biomarker was further validated in two independent populations of 73 and 48 patients with pleural effusions (PE).

Results

An EpCAM(cl) >98 pg/g total lysate protein yielded 75% sensitivity, 100% specificity, negative likelihood ratio of 0.25 and area under the curve of 0.94 for labelling adenocarcinomatous effusions. Sensitivity reached 88% if EpCAM(cl) was combined with EpCAM immunostaining. One‐third or more of the malignant effusions exhibiting a false‐negative cytological fluid examination were correctly classified by EpCAM(cl) concentrations. Immunoassays for CL4 and HE4 were diagnostically useless.

Conclusion

EpCAM(cl) is a new biomarker of adenocarcinomatous PE with meaningful discriminating properties.
Exercise and cognitive function in patients with end‐stage kidney disease
Authors: Chu Nadia M. , McAdams‐DeMarco Mara A.
Published: March 2019

In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end‐stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long‐term adverse consequences, including dementia and death. Home‐based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short‐term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long‐term follow‐up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long‐term health outcomes, including dementia prevention and better survival, are yet to be determined.
Comprehensive phenotyping reveals interactions and functions of Arabidopsis thaliana TCP genes in yield determination
Authors: van Es Sam W. , van der Auweraert Elwin B. , Silveira Sylvia R. , Angenent Gerco C. , van Dijk Aalt D.J. , Immink Richard G.H.
Published: March 2019

Members of the Arabidopsis thaliana TCP transcription factor (TF) family affect plant growth and development. We systematically quantified the effect of mutagenizing single or multiple TCP TFs and how altered vegetative growth or branching influences final seed yield. We monitored rosette growth over time and branching patterns and seed yield characteristics at the end of the lifecycle. Subsequently, an approach was developed to disentangle vegetative growth and to determine possible effects on seed yield. Analysis of growth parameters showed all investigated tcp mutants to be affected in certain growth aspects compared with wild‐type plants, highlighting the importance of TCP TFs in plant development. Furthermore, we found evidence that all class II TCPs are involved in axillary branch outgrowth, either as inhibitors (BRANCHED‐like genes) or enhancers (JAW‐ and TCP5‐like genes). Comprehensive phenotyping of plants mutant for single or multiple TCP TFs reveals that the proposed opposite functions of class I and class II TCPs in plant growth needs revision and shows complex interactions between closely related TCP genes instead of full genetic redundancy. In various instances, the alterations in vegetative growth or in branching patterns result into negative trade‐off effects on seed yield that were missed in previous studies, showing the importance of comprehensive and quantitative phenotyping.
(Non‐)donor demographics, donation willingness, and the donor career
Authors: Piersma Tjeerd W. , Merz Eva‐Maria
Published: March 2019

KEY IDEAS

Donation willingness is generally high but registering with donor centers lags behind.

We need to understand why and when during the life course which groups of individuals are motivated to donate.

With this knowledge, we can design targeted recruitment and retention strategies and improve evidence‐based donor management.
“Going global” and FDI inflows in China: “One Belt & One Road” initiative as a quasi‐natural experiment
Authors: Luo Changyuan , Chai Qingyuan , Chen Huiyao
Published: March 2019

This paper investigates the impact of “One Belt & One Road” as an exogenous policy shock on the utilisation of foreign capital in China in the short term. Based on provincial panel data for the years 2003–15, the empirical study is conducted with difference‐in‐differences design. The first difference is whether a province is an OBOR province, and the second is whether “One Belt & One Road” initiative has been proposed. The empirical results suggest the utilisation of foreign capital in OBOR provinces has decreased significantly compared to non‐OBOR provinces after the initiative has been proposed. The study has further shown that the OBOR construction not only means factor movements and projects but also stands for policy shock. Its impact on utilisation of foreign capital cannot be simply captured by the commonly quantifiable “going global” indicators, namely outward direct investment, overseas contracted projects or overseas labour services. The negative impact of the initiative on foreign capital utilisation is strongly reflected in the OBOR provinces with low levels of economic development, heavy fiscal burdens and high proportions of state‐owned economy. In the short term, the negative impact of the initiative on foreign capital utilisation may be due to its role in resource competition and signal delivering. The former means that the OBOR initiative may induce resource competition between “going global” and “bringing in,” and the latter suggests that this initiative is likely to be regarded as a “signal” by foreign investors that “going global,” not “bringing in,” has become the priority of the government.
Unusual first presentation of a metabolic disorder
Authors: Strauss Claire Emma , Hann Gayle
Published: March 2019

An 8-month-old boy presented to hospital with a fever, irritability and ‘back arching’. On examination, he demonstrated profound opisthotonic posturing and had tonsillitis. He had a full septic screen and was treated with broad spectrum antibiotics. Blood tests showed a transaminitis, raised alpha fetoprotein and deranged clotting. The clotting abnormalities and raised alpha fetoprotein persisted post discharge and an abdominal ultrasound showed steatosis, splenomegaly and bilateral increased renal cortical reflectivity. A full metabolic screen revealed type 1 tyrosinaemia. The opisthotonic posturing, a major part of this child’s presentation, has not been reported as a presenting feature of tyrosinaemia. It was part of a ‘neurological crisis’ caused by tyrosinaemia and exacerbated by the intercurrent infection. These are known to occur in tyrosinaemia but not commonly as the first presentation. This represents an unusual presentation of a metabolic condition which, without intervention, can lead to severe hepatic, renal and neurodevelopmental complications.
Vacuum phenomenon in the shoulder of a child
Authors: Ray Partha , King Ian CC , Thomas Philip Stephen William
Published: March 2019

A 10-year-old boy struck a car bonnet following which his left shoulder got pinned under the wheel. No life-threatening injuries were identified. However, the patient sustained extensive abrasions to the back and the left shoulder, a closed deformity of the left clavicle and a swollen, but stable right knee. The patient was neurovascularly intact globally and all joints had a full range of motion. Plain radiographs suggested a possible greenstick fracture of the left clavicle, but also free gas within the left glenohumeral joint. Concern was raised of an unidentified open injury to the joint. CT was supportive of the finding of gas within the left glenohumeral joint, but ruled out the possible greenstick fracture as a spurious finding. There were no other injuries. The gas was within the left glenohumeral joint and was consistent with vacuum phenomenon. The injury was treated expectantly and the child made a full recovery.
Sticky Business: a syndrome of mucoid bacterial spread
Authors: Pillsbury McKinsey M , Geha Rabih M , Edson Randall S
Published: March 2019

A 70-year-old man presented with acute wrist pain concerning for septic arthritis. Shortly thereafter, he developed acute monocular vision loss and was diagnosed with endogenous endophthalmitis. Subsequent imaging revealed numerous visceral abscesses and a mycotic abdominal aortic aneurysm. Cultures, in conjunction with the clinical syndrome, were strongly suggestive of hypervirulentKlebsiella pneumoniaesyndrome (hvKP). hvKP syndrome may present with multiple sites of infection or subsequent metastatic spread may develop; the liver, lungs, central nervous system and eye are most commonly involved. Prompt source control and intravenous antibiotic therapy leads to a cure in the majority of patients. This case highlights the risk factors, presentation, management and prognosis of this disease as well as its increasing incidence in North America and Europe.
Unusual presentation of extramedullary haematopoiesis in a young boy
Authors: Darole Pramod , Sundar Uma , Kuchekar Nilesh , Karre Ajay
Published: March 2019

Acute transverse myelopathy in a young person may be due to infection, postinfective or inflammatory demyelination, or vascular causes. Rarely, a completely reversible cause of acute transverse myelopathy may be seen, as described here in our case of transverse myelopathy due to extramedullary haematopoiesis (EMH). An 18-year-old man who had a history of a lone blood transfusion at age of 7 years presented with paraplegia. MRI showed multiple epidural space masses of EMH compressing the spinal cord. He was detected to have thalassaemia intermedia and was treated with blood transfusions, steroids and radiotherapy to the involved paraspinal areas. He recovered fully over 15 days and remained symptom free at 6 months.
Multisystemic sarcoidosis—important lessons learnt from one of the great imitators
Authors: Santosa Anindita , Wong Chin Fong , Koh Li Wearn
Published: March 2019

We report a case of a woman who was admitted with a suspicion of metastatic malignancy of unknown primary origin. A few months prior to her admission, she presented to a rheumatologist with acute anterior uveitis, psoriasiform rashes and polyarthritis. A diagnosis of psoriatic arthropathy was made and she was treated accordingly. Soon after she presented with persistent back and right upper quadrant abdominal pain for which she had a CT scan done with evidence of hilar lymphadenopathy, liver hypodensities and lytic-sclerotic bone lesions. She was referred to our hospital for further investigations and management. After re-exploring her clinical presentation and further investigations (including a liver biopsy), a diagnosis of multisystemic sarcoidosis with ocular, reticuloendothelial, hepatic and skeletal involvement was made. The patient was started on systemic glucocorticoids and second line immunosuppressants and demonstrated significant clinical improvement with resolution of her liver granulomata on imaging and improvement in her back pain. The case illustrates the importance of a thorough clinical assessment, review of investigations and an open mind in the evaluation of a patient.
Calcium pyrophosphate dihydrate crystal deposition disease and MRSA septic arthritis of the atlantoaxial joint in a patient with Tourette syndrome
Authors: Northrup Edward Nicholas , Pflederer Benjamin Robert
Published: March 2019

A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. He exhibited cervical spinal and paraspinal tenderness with very limited range of motion. Erythrocyte sedimentation rate and C reactive protein were elevated, and blood cultures grew methicillin-resistantStaphylococcus aureus(MRSA). Lumbar puncture was unremarkable. CT and MRI of the neck showed calcification of the longus colli, fluid and capsular distention of C1–C2 joints, enhancement of the joint capsule and retropharyngeal oedema suggestive of septic arthritis. Fluid was aspirated from C1 to C2 joint by interventional radiology and showed calcium pyrophosphate crystals and heavy MRSA colonisation, consistent with both pseudogout and septic arthritis of the cervical vertebrae. The patient was started on a 6-week course of daptomycin and showed gradual improvements in neck pain and mobility.
Platinum sensitive carcinoma of ovary relapsed as pericardial effusion with cardiac tamponade
Authors: Dracham Chinna Babu , Gupta Shipra , Das Chandan Krushna , Elangovan Arun
Published: March 2019

Epithelial ovarian cancers typically spread by intraperitoneal exfoliation and retroperitoneal lymph nodal involvement along the ovarian vascular supply. Pericardial involvement in ovarian malignancies is very rare with only few cases reported in the literature. Malignancy is the most common cause for pericardial effusion in the western world. In this case report, we present a 58-year-old woman treated for high-grade serous carcinoma of the ovary in 2010, relapsed with pericardial effusion and cardiac tamponade in 2017. Imaging studies revealed gross pericardial effusion. Two-dimensional echocardiogram showed massive pericardial effusion, with cardiac tamponade, New York Heart Association—IV. Pericardiocentesis and pigtail drain was placed under echo guidance. Immunocytochemistry has confirmed the tumour cells to be of the ovarian origin. The patient underwent surgical pericardial window via thoracotomy, followed by paclitaxel and carboplatin-based chemotherapy and olaparib maintenance.
Chylous ascites in disseminated Kaposi sarcoma: an unusual manifestation as immune reconstitution inflammatory syndrome
Authors: Cipriano Patrícia , Nabais Inês , Melo Nuno , Alves Ana Rafaela
Published: March 2019

A 29-year-old man with diarrhoea, fever, abdominal pain and multiple purple papular lesions, neither pruriginous nor painful, was diagnosed with HIV-1 infection and disseminated Kaposi sarcoma (KS) with gastrointestinal involvement. He was started on highly active antiretroviral therapy immediately, as well as doxorubicin. Three weeks later, the patient developed bilateral moderate pleural effusion and large-volume ascites compatible with chylothorax and chylous ascites. An immune reconstitution inflammatory syndrome (IRIS) reaction was assumed. KS flare was associated with lymphatic obstruction and infiltration of thoracic duct by the tumour itself with leakage of chylous into pleural and peritoneal cavities. KS is the most common tumour in HIV patients and the existence of related effusions is not uncommon. KS-related chylothorax is an unusual manifestation of KS; there are only four cases described in the literature of chylous ascites related to KS–HIV. Overall survival is improving in KS but explosive and debilitating IRIS reactions can explain cases with poor prognosis.
Two rare case reports of ingestion of ammonium hydroxide and novel study of gastrointestinal toxicity
Authors: Perananthan Varan , Wijerathna Thilini , Nagaratnam Amitesh , Gawarammana Indika , Dawson Andrew , Buckley Nicholas
Published: March 2019

Objective

We report the only two adult cases of NH4OH ingestion described in literature at the Peradeniya Teaching Hospital in Sri Lanka. Both cases showed clinical evidence of gastrointestinal toxicity and using intestinal fatty acid binding protein (IFABP), a novel biomarker, we attempted to quantify the extent of enterocyte damage. Procalcitonin was also measured as a maker of bacterial sepsis to ascertain whether there was a link between enterocyte damage and infection secondary to bacterial translocation.

Cases

A 45-year-old, previously well man was brought in by family with a reduced level of consciousness after ingestion of an unknown quantity of industrial NH4OH (29% solution) with suicidal intent. Peak IFABP and procalcitonin levels were 1274 pg/mL and 2.0 ng/mL, respectively, 7.7 hours following presumed ingestion. A 23-year-old, previously well woman presented 24 hours after consuming 100 mL of NH4OH (5.4% solution) used as a cleaning product. She presented with ongoing vomiting and oropharyngeal pain. Her peak IFABP and procalcitonin levels were 865 pg/mL and 5.8 ng/mL, respectively, 27.2 hours following ingestion.

Conclusion

We report the only two adult cases of NH4OH ingestion and describe severe gastrointestinal damage both clinically and biochemically. IFABP, currently only a marker used in research settings, was elevated in both cases but only marginally below that of levels seen in mesenteric ischaemia (levels greater than 1300 pg/mL). The use of a marker for enterocyte damage especially in ingestion of caustic solutions can allow clinicians to monitor progress, predict complications and evaluate the need for further invasive procedures.
PACMAN trial protocol, Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac major surgery: a randomised, multicentre, double-blind, superiority study
Authors: Asehnoune Karim , Futier Emmanuel , Feuillet Fanny , Roquilly Antoine
Published: March 2019

Introduction

Postoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival after surgery. An excessive postoperative inflammatory response participates to the development of postoperative infection and mortality. The aim of the Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac surgery (PACMAN) study is to assess the effectiveness of perioperative administration of corticosteroid to reduce postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.

Methods and analysis

The PACMAN is a multicentre, randomised, controlled, double-blind, superiority, two-arm trial of 1222 high-risk patients aged 50 years or older undergoing major non-cardiac surgery at 32 acute care hospital in France. Patients are randomly assigned to dexamethasone (0.2 mg/kg at the end of the surgical procedure and at day +1, n=611) or to placebo (n=611). The primary outcome is a composite of predefined 14-day major pulmonary complications and mortality. Secondary outcomes are surgical complications, infections, organ failures, critical care-free days, length of hospital stay and all-cause mortality at 28 days.

Ethics and dissemination

The PACMAN trial protocol has been approved by the ethics committee of Sud Mediterranée V, and will be carried out according to the Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The PACMAN trial is a randomised controlled trial powered to investigate whether perioperative administration of corticosteroids in patients undergoing non-cardiac major surgery reduces postoperative complications. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.

Trial registration number

NCT03218553; Pre-results.
Effects of ischaemic postconditioning on outcomes of patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention: a meta-analysis
Authors: Xing Zhenhua , Tang Liang , Huang Jiabing , Peng Xiaofan , Hu Xinqun
Published: March 2019

Objective

The aim of this meta-analysis was to evaluate the effects of ischaemic postconditioning (IPC) therapy on hard clinical endpoints in ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PPCI).

Design

Systematic review and meta-analysis to evaluate the effects of IPC on the outcomes of patients with STEMI.

Data sources

PubMed, Embase and the Cochrane Library were systematically searched for relevant articles published prior to May 1, 2018.

Eligibility criteria for selecting studies

Randomised trials comparing conventional PPCI to PPCI combined with IPC in STEMI patients were included. The primary endpoint was heart failure. Secondary endpoints were all-cause mortality and major adverse cardiac events (MACE), including cardiac death, heart failure and MI. The Cochrane Reviewer’s Handbook 4.2 was used to assess the risk of bias.

Data extraction and synthesis

Relevant data were extracted by two independent investigators. We derived pooled risk ratios (RRs) with random effects models. Sensitivity and subgroup analyses were performed.

Results

Ten studies that had enrolled 3137 patients were included. PPCI combined with IPC failed to reduce heart failure (RR: 0.88, 95% CI: 0.61 to 1.26, p=0.47; absolute risk: 3.64% in the IPC group and 4.11% in the PPCI only group), all-cause mortality (RR: 0.94, 95% CI: 0.69 to 1.27, p=0.68; absolute risk: 5.07% in the IPC group and 5.27% in the PPCI onlygroup), MACE (RR: 1.05, 95% CI: 0.83 to 1.32, p=0.69; absolute risk: 9.37% in the IPC group and 8.93% in the PPCI only group), cardiac death (RR: 1.28, 95% CI: 0.85 to 1.93, p=0.24; absolute risk: 4.28% in the IPC group and 3.25% in the PPCI only group) and MI (RR: 1.08, 95% CI: 0.38 to 3.12, p=0.88; absolute risk: 3.61% in the IPC group and 3.44% in the PPCI only group).

Conclusions

IPC combined with PPCI does not reduce heart failure, MACE and all-cause mortality compared with traditional PPCI in patients with STEMI.

Trial registration number

CRD42017063959
Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan
Authors: Tang Chao-Hsiun , Chen Hsi-Hsien , Wu Ming-Ju , Hsu Bang-Gee , Tsai Jer-Chia , Kuo Chi-Cheng , Lin Shih-Pi , Chen Tso-Hsiao , Sue Yuh-Mou
Published: March 2019

Objectives

The total medical (economic) costs of haemodialysis (HD) and peritoneal dialysis (PD), including direct medical costs, out-of-pocket (OOP) costs and productivity losses, have become an important issue. This study aims to compare the direct non-medical costs and indirect medical costs of both modalities in Taiwan.

Design and setting

This multicentre study included cross-sectional interviews of patients over 20 years old and articulate, who had been continuously receiving long-term HD or PD for more than 3 months between April 2015 and March 2016. Mann-Whitney U test, Wilcoxon rank-sum test and 1000 bootstrap procedures with replacement were used for analysis.

Outcome measures

Differences in OOP costs and productivity losses.

Results

There were 308 HD and 246 PD patients available for analysis. HD patients had significantly higher monthly OOP costs than PD patients after bootstrap procedures (NTD 5912 vs NTD 5225, p<0.001; NTD, new Taiwan dollars; 1 US dollar=30 NTD). Compared with PD patients, HD patients had higher monthly productivity losses after bootstrap procedures (NTD 14 150 vs NTD 11 611, p<0.001), resulting from more time spent seeking outpatient care (HD, 70.4 hours vs PD, 4.4 hours, p<0.001) and time spent by family caregivers for outpatient care (HD, 66.1 hours vs PD, 6.1 hours, p<0.001). The total costs per patient–month of HD and PD modalities, including OOP costs and productivity losses, were NTD 20 062 and NTD 16 836, respectively.

Conclusions

The HD modality has higher OOP costs and productivity losses than the PD modality in Taiwan.
Identifying cardiac surgery operations in hospital episode statistics administrative database, with an OPCS-based classification of procedures, validated against clinical data
Authors: Bortolussi Giacomo , McNulty David , Waheed Hina , Mawhinney Jamie A , Freemantle Nick , Pagano Domenico
Published: March 2019

Objectives

Administrative databases with dedicated coding systems in healthcare systems where providers are funded based on services recorded have been shown to be useful for clinical research, although their reliability is still questioned. We devised a custom classification of procedures and algorithms based on OPCS, enabling us to identify open heart surgeries from the English administrative database, Hospital Episode Statistics, with the objective of comparing the incidence of cardiac procedures in administrative and clinical databases.

Design

A comparative study of the incidence of cardiac procedures in administrative and clinical databases.

Setting

Data from all National Health Service Trusts in England, performing cardiac surgery.

Participants

Patients classified as having cardiac surgery across England between 2004 and 2015, using a combination of procedure codes, age >18 and consultant specialty, where the classification was validated against internal and external benchmarks.

Results

We identified a total of 296 426 cardiac surgery procedures, of which majority of the procedures were coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral repair and aortic surgery. The matching at local level was 100% for CABG and transplant, >90% for aortic valve and major aortic procedures and >80% for mitral. At national level, results were similar for CABG (IQR 98.6%–104%), AVR (IQR 105%–118%) and mitral valve replacement (IQR 86.2%–111%).

Conclusions

We set up a process which can identify cardiac surgeries in England from administrative data. This will lead to the development of a risk model to predict early and late postoperative mortality, useful for risk stratification, risk prediction, benchmarking and real-time monitoring. Once appropriately adjusted, the system can be applied to other specialties, proving especially useful in those areas where clinical databases are not fully established.
Not engaged in education, employment or training (NEET) in an Arctic sociocultural context: the NAAHS cohort study
Authors: Bania Elisabeth Valmyr , Eckhoff Christian , Kvernmo Siv
Published: March 2019

Objectives

The purpose of the study is to explore the prevalence and predictors of not engaged in education, employment or training (NEET) status in a multicultural young adult population in Northern Norway.

Design and setting

The longitudinal design link a self-reported survey (2003–2005) with an objective registry linkage follow-up 8–10 years later.

Participants

Of all 5877 tenth graders (aged 15–16 years) in Northern Norway, 83% of the total age cohort from all 87 municipalities participated in the baseline survey. The follow-up studies consisted of 3987 consent giving adolescents (68%), were 365 (9.2%) reported indigenous Sami ethnicity.

Outcome measures

Youth NEET at the age of 23–25 years.

Methods

Explanatory variables were sociodemographic factors (gender, ethnicity, residency, parental education), mental health problems and musculoskeletal pain in adolescence. Outcome variable characterised as NEET-status was defined by no educational engagement, long-term recipient of sickness benefit, medical and non-medical benefit receipt or long-term unemployment.

Results

NEET-status in young adulthood was significantly higher among females (20.9%) than among males (16.2%). Ethnic differences occurred as being NEET among Sami males was significantly higher than among non-Sami males, 23.0% and 15.2% respectively. Minority Sami females experienced NEET-status to a lower degree (16.6%) than non-Sami females (20.8%). Among females adolescent peer problems (adjusted OR=1.09) and hyperactivity problems (adjusted OR=1.10) were associated with later NEET-status. Peer problems (adjusted OR=1.23), conduct problems (adjusted OR=1.17) and musculoskeletal problems (adjusted OR=1.15) in male adolescents were associated with later NEET-status, whereas emotional problems among males predicted significantly less later NEET- status (adjusted OR=0.88).

We found lower parental education to be significantly associated with being NEET-later in young adults (females: adjusted OR=2.11, males: adjusted OR=3.22).

Conclusions

To address the disengagement of education and work, particular emphasis must be placed on supporting young people struggling with mental and physical health problems.
Qualitative evaluation of a complex intervention to implement health promotion activities according to healthcare attendees and health professionals: EIRA study (phase II)
Authors: Pons-Vigués Mariona , Berenguera Anna , Coma-Auli Núria , March Sebastià , Pombo Haizea , Masluk Barbara , Pulido-Fuentes Montserrat , Rodriguez Carmela , Bellón Juan A , Pujol-Ribera Enriqueta
Published: March 2019

Objective

To evaluate the implementation and development of a complex intervention on health promotion and changes in health-promoting behaviours in primary healthcare according to healthcare attendees and health professionals.

Design

Descriptive qualitative evaluation research conducted with 94 informants. Data collection techniques consisted of 14 semistructured individual interviews, 9 discussion groups, 1 triangular group and 6 documents. Three analysts carried out a thematic content analysis with the support of Atlas.ti software. This evaluation was modelled on Proctor and colleagues’ concept of outcomes for implementation research.

Setting

7 primary care centres from seven Spanish regions: Andalusia, Aragon, Balearic Islands, Basque Country, Castilla-La Mancha, Castilla-Leon and Catalonia.

Participants

The study population were healthcare attendees (theoretical sampling) and health professionals (opportunistic sampling) who had participated in the exploratory trial of the EIRA intervention (2015).

Results

Healthcare attendees and professionals had a positive perception of the study. Healthcare attendees even reported that they would recommend participation to family and friends. Health professionals became aware of the significance of the motivational interview, especially for health promotion, and emphasised social prescribing of physical activity. They also put forward recommendations to improve recruitment, screening and retention of participants. Healthcare attendees modified behaviours and health professionals modified working practices. To achieve sustainability, health professionals believe that it is crucial to adapt agendas and involve all the staff.

Conclusions

The discourses of all stakeholders on the intervention must be taken into consideration for the successful, setting-specific implementation of adequate, acceptable, equitable and sustainable strategies aimed at health promotion and well-being.
Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation
Authors: Chung Daniel , Hadzi-Pavlovic Dusan , Wang Maggie , Swaraj Sascha , Olfson Mark , Large Matthew
Published: March 2019

Objective

To assess the magnitude of suicide rates in the first week and first month postdischarge following psychiatric hospitalisation.

Design

Meta-analysis of relevant English-language, peer-reviewed papers published in MEDLINE, PsycINFO or Embase between 01 January 1945 and 31 March 2017 and supplemented by hand searching and personal communication. A generalised linear effects model was fitted to the number of suicides, with a Poisson distribution, log link and log of person years as an offset. A random effects model was used to calculate the overall pooled rates and within subgroups in sensitivity analyses.

Outcome measures

Suicides per 100 000 person years in the first week and the first month after discharge from psychiatric hospitalisation.

Results

Thirty-four included papers comprised 29 studies that reported suicides in the first month postdischarge (3551 suicides during 222 546 patient years) and 24 studies that reported suicides in the first week postdischarge (1928 suicides during 60 880 patient years). The pooled estimate of the suicide rate in the first month postdischarge suicide was 2060 per 100 000 person years (95% CI=1300 to 3280, I2=90). The pooled estimate of the suicide rate in the first week postdischarge suicide was 2950 suicides per 100 000 person years (95% CI=1740 to 5000, I2=88). Eight studies that were included after personal communication had lower pooled rates of suicide than studies included after data extraction and there was evidence of publication bias towards papers reporting a higher rate of postdischarge suicide.

Conclusion

Acknowledging the presence of marked heterogeneity between studies and the likelihood of bias towards publication of studies reporting a higher postdischarge suicide rate, the first week and first month postdischarge following psychiatric hospitalisation are periods of extraordinary suicide risk. Short-term follow-up of discharged patients should be augmented with greater focus on safe transition from hospital to community care.

PROSPERO registration number

PROSPERO registration CRD42016038169