bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterizing differences in the collagen fiber organization of skin wounds using quantitative polarized light imaging
Authors: Woessner Alan E. , McGee James D. , Jones Jake D. , Quinn Kyle P.
Published: August 2019

Collagen fiber organization requires characterization in many biomedical applications, but it is difficult to objectively quantify in standard histology tissue sections. Quantitative polarized light imaging is a low‐cost technique that allows for rapid measurement of collagen fiber orientation and thickness. In this study, we utilize a quantitative polarized light imaging system to characterize fiber orientation and thickness from wound sections. Full thickness skin wound sections that were previously stained with hematoxylin and eosin were used to assess collagen fiber content and organization at different points during the wound healing process. Overall, wounds exhibited a measurable increase in collagen fiber thickness and a nonlinear change in fiber reorganization within the wound. Our study demonstrates that quantitative polarized light imaging is an inexpensive alternative or supplement to standard histology protocols, requiring no additional stains or dyes, and yields repeatable quantitative assessments of collagen organization.
Occupational swine exposure and Hepatitis E virus, Leptospira, Ascaris suum seropositivity and MRSA colonization in Austrian veterinarians, 2017–2018—A cross‐sectional study
Authors: Taus Karin , Schmoll Friedrich , El‐Khatib Ziad , Auer Herbert , Holzmann Heidemarie , Aberle Stephan , Pekard‐Amenitsch Shiva , Monschein Stefanie , Sattler Tatjana , Steinparzer Romana , Allerberger Franz , Schmid Daniela
Published: August 2019

We investigated the prevalence of Hepatitis E Virus (HEV), Leptospira and Ascaris suum (A. suum) seropositivity, and of nasal methicillin‐resistant Staphylococcus aureus (MRSA) colonization among Austrian practising veterinarians, and assessed the association with occupational swine livestock exposure. The 261 participants completed a questionnaire on demographics, intensity of occupational swine livestock contact and glove use during handling animals and their secretions. Participants' blood samples were tested for HEV, Leptospira and A. suum seropositivity and nasal swabs cultured for MRSA. We compared swine veterinarians (defined as >3 swine livestock visits/week) to non‐swine veterinarians (≤3 swine livestock visits/week) with regard to the outcomes through calculating prevalence ratio (PR) and 95% confidence interval (CI). Furthermore, the relationship between occupational swine livestock contact and the study outcomes was examined by age (</≥55 years) and glove usage. The prevalence of nasal MRSA colonization was 13.4% (95% CI: 9.3–17.6), of HEV seropositivity 20.8% (95% CI: 15.8–25.7) and A. suum seropositivity 44% (95% CI: 37.7–50.2). The highest anti‐leptospiral antibodies titres were 1:200 (L. hebdomadis) and 1:100 (L. autumnalis, L. caicola) found in three non‐swine veterinarians. Compared to non‐swine veterinarians, swine veterinarians were 1.9 (95% CI: 1.0–3.4) and 1.5 (95%CI: 1.0–2.3) times more likely HEV seropositive and A. suum seropositive, respectively, and 4.8 (95%CI: 2.5; 9.3) times more likely nasally colonized with MRSA. Among glove‐using veterinarians, occupational swine contact was no longer a determinant for HEV seropositivity (PR 1.6; 95% CI: 0.8–2.9). Similar was found for A. suum seropositivity, which was no longer associated with occupational swine livestock contact in the subgroup of glove using, ≥55‐year‐old veterinarians (PR: 1.07; 95% CI: 0.4–3.3). Our findings indicate that >3 occupational swine livestock visits per week is associated with HEV and A. suum seropositivity and nasal MRSA colonization and that glove use may play a putative preventive role in acquiring HEV and A. suum. Further analytical epidemiological studies have to prove the causality of these associations.
Review Article: Atomic layer deposition of doped ZnO films
Authors: Gao Zhengning , Banerjee Parag
Published: August 2019

This article reviews the process-structure-property relationship in doped ZnO thin films via atomic layer deposition (ALD). ALD is an important manufacturing-scalable, layer-by-layer, thin film deposition process that precisely controls dopant type and concentration at the nanoscale. ZnO is an important technological material, which can be doped to modulate structure and composition to tailor a wide variety of optical and electronic properties. ALD doped ZnO is viewed as a transparent conducting oxide for application in solar cells, flexible transparent electronics, and light-emitting diodes. To date, there are 22 elements that have been reported as dopants in ZnO via ALD. This article studies the underlying trends across dopants and establishes generalized relationships for (1) the role of ALD process parameters, (2) the impact of these parameters on the structure of the ZnO matrix, and (3) the impact of dopants on the optical and electrical properties. The article ends with a brief discussion on the limitations of the ALD-based doping scheme, knowledge gaps in the compositional maps, and a perspective on the future of ALD doped ZnO films.
Surface states in bulk single crystal of topological semimetal Co
3
Sn
2
S
2
toward water oxidation
Authors: Li Guowei , Xu Qiunan , Shi Wujun , Fu Chenguang , Jiao Lin , Kamminga Machteld E. , Yu Mingquan , Tüysüz Harun , Kumar Nitesh , Süß Vicky , Saha Rana , Srivastava Abhay K. , Wirth Steffen , Auffermann Gudrun , Gooth Johannes , Parkin Stuart , Sun Yan , Liu Enke , Felser Claudia
Published: August 2019

Co
3
Sn
2
S
2
hosts Co atom–derived surface states at the Kagome lattice, favoring the electron transfer process in oxygen evolution.
Long-range, selective, on-demand suspension interactions: Combining and triggering soluto-inertial beacons
Authors: Banerjee Anirudha , Squires Todd M.
Published: August 2019

Versatile and tunable soluto-inertial interactions can collect, separate, and direct colloids over millimeter distances.
In Vitro
Activity of Minocycline against U.S. Isolates of Acinetobacter baumannii-Acinetobacter calcoaceticus Species Complex, Stenotrophomonas maltophilia, and Burkholderia cepacia Complex: Results from the SENTRY Antimicrobial Surveillance Program, 2014 to 2018
Authors: Flamm Robert K. , Shortridge Dee , Castanheira Mariana , Sader Helio S. , Pfaller Michael A.
Published: August 2019

We evaluated the activity of minocycline and comparator agents against a large number of
Stenotrophomonas maltophilia
(
n
 = 1,289),
Acinetobacter baumannii
-
Acinetobacter calcoaceticus
species complex (
n
 = 1,081), and
Burkholderia cepacia
complex (
n
 = 101) isolates collected from 2014 to 2018 from 87 U.S. medical centers spanning all 9 census divisions.
Influence of Sustained Low-Efficiency Dialysis Treatment on Isavuconazole Plasma Levels in Critically Ill Patients
Authors: Lahmer Tobias , Batres Baires Gonzalo , Heilmaier Markus , Schmid Roland M. , Sörgel Fritz , Kinzig Martina , Huber Wolfgang , Mayr Ulrich , Rasch Sebastian
Published: August 2019

Isavuconazole plasma concentrations were measured before and after sustained low-efficiency dialysis (SLED) treatment in 22 critically ill adult patients with probable invasive aspergillosis and underlying hematological malignancies. Isavuconazole levels were significantly lower after SLED treatment (5.73 versus 3.36 μg/ml;
P
< 0.001). However, even after SLED treatment, isavuconazole concentrations exceeded the
in vivo
MICs for several relevant
Aspergillus
species.
Membrane Lipid Composition of the Moderately Thermophilic Ammonia-Oxidizing Archaeon “
Candidatus
Nitrosotenuis uzonensis” at Different Growth Temperatures
Authors: Bale Nicole J. , Palatinszky Marton , Rijpstra W. Irene C. , Herbold Craig W. , Wagner Michael , Sinninghe Damsté Jaap S.
Published: August 2019

For
Thaumarchaeota
, the ratio of their glycerol dialkyl glycerol tetraether (GDGT) lipids depends on growth temperature, a premise that forms the basis of the widely applied TEX
86
paleotemperature proxy. A thorough understanding of which GDGTs are produced by which
Thaumarchaeota
and what the effect of temperature is on their GDGT composition is essential for constraining the TEX
86
proxy. “
Ca
. Nitrosotenuis uzonensis” is a moderately thermophilic thaumarchaeote enriched from a thermal spring, setting it apart in its environmental niche from the other marine mesophilic members of its order. Indeed, we found that the GDGT composition of “
Ca
. Nitrosotenuis uzonensis” cultures was distinct from those of other members of its order and was more similar to those of other thermophilic, terrestrial
Thaumarchaeota
. This suggests that while phylogeny has a strong influence on GDGT distribution, the environmental niche that a thaumarchaeote inhabits also shapes its GDGT composition.
High-Level Abundances ofMethanobacterialesandSyntrophobacteralesMay Help To Prevent Corrosion of Metal Sheet Piles
Authors: in ‘t Zandt Michiel H. , Kip Nardy , Frank Jeroen , Jansen Stefan , van Veen Johannes A. , Jetten Mike S. M. , Welte Cornelia U.
Published: August 2019

Iron sheet piles are widely used to reinforce dikes and river banks. Damage due to iron corrosion poses a significant safety risk and has significant economic impact. Different groups of microorganisms are known to either stimulate or inhibit the corrosion process. Recently, natural corrosion-protective deposit layers were found on sheet piles. Analyses of the microbial composition indicated a potential role for methane-producing archaea. However, the full metabolic potential of the microbial communities within these protective layers has not been determined. The significance of this work lies in the reconstruction of the microbial food web of natural corrosion-protective layers isolated from noncorroding metal sheet piles. With this work, we provide insights into the microbiological mechanisms that potentially promote corrosion protection in freshwater ecosystems. Our findings could support the development of screening protocols to assess the integrity of iron sheet piles to decide whether replacement is required.
Viability Quantitative PCR Utilizing Propidium Monoazide, Spheroplast Formation, and Campylobacter coli as a Bacterial Model
Authors: Lazou Thomai P. , Iossifidou Eleni G. , Gelasakis Athanasios I. , Chaintoutis Serafeim C. , Dovas Chrysostomos I.
Published: August 2019

There is need for rapid and accurate methods to detect viable bacterial cells of foodborne pathogens. Conventional culture-based methods are time-consuming and unable to detect bacteria in a viable-but-nonculturable state. The high sensitivity and specificity of the quantitative PCR (qPCR) are negated by its inability to differentiate the DNAs from viable and dead cells. The combination of propidium monoazide (PMA), a DNA-intercalating dye, with qPCR assays is promising for detection of viable cells. Despite encouraging results, these assays still encounter various challenges, such as false-positive signals by dead cells and the lack of an internal control identifying these signals per sample. The significance of our research lies in enhancing the selective entrance of PMA into deadCampylobacter colicells via spheroplasting and in developing an internal sample process control, thus delivering reliable results in pure cultures and meat samples, approaches that can be applicable to other Gram-negative pathogens.
Metabolism of the Gram-Positive Bacterial Pathogen
Listeria monocytogenes
Authors: Sauer John-Demian , Herskovits Anat A. , O’Riordan Mary X.D.
Published: August 2019

Bacterial metabolism represents the biochemical space that bacteria can manipulate to produce energy, reducing equivalents and building blocks for replication. Gram-positive pathogens, such as
Listeria monocytogenes
, show remarkable flexibility, which allows for exploitation of diverse biological niches from the soil to the intracytosolic space. Although the human host represents a potentially rich source for nutrient acquisition, competition for nutrients with the host and hostile host defenses can constrain bacterial metabolism by various mechanisms, including nutrient sequestration. Here, we review metabolism in the model Gram-positive bacterium,
L. monocytogenes
, and highlight pathways that enable the replication, survival, and virulence of this bacterial pathogen.
Late Cretaceous topographic doming caused by initial upwelling of Deccan magmas: Stratigraphic and sedimentological evidence
Authors: Li Juan , Hu Xiumian , Garzanti Eduardo , Banerjee Santanu , BouDagher-Fadel Marcelle
Published: August 2019

This study focused on uppermost Cretaceous sedimentary rocks deposited in the Himalayan region and around the core of peninsular India just before the eruption of the Deccan Traps. Detailed stratigraphic and sedimentological analysis of Late Cretaceous successions in the Himalayan Range together with literature data from the Kirthar fold-and-thrust belt and central to southeastern India document a marked shallowing-upward depositional trend that took place in the Campanian–Maastrichtian before the Deccan magmatic outburst around the Cretaceous-Tertiary boundary. Topographic uplift of the Indian peninsula began in Campanian time and is held responsible for thick sediment accumulation associated with shorter periods of nondeposition in peripheral areas (Himalayan Range, Kirthar fold belt, and Krishna-Godavari Basin) than in the central part of the Deccan Province. Surface uplift preceding Deccan volcanism took place at warm-humid equatorial latitudes, which may have led to an acceleration of silicate weathering, lowered atmospheric pCO2, and climate cooling starting in the Campanian–Maastrichtian. The radial centrifugal fluvial drainage in India that is still observed today was established at that time.
Magmatically folded and faulted schlieren zones formed by magma avalanching in the Sonora Pass Intrusive Suite, Sierra Nevada, California
Authors: Alasino P.H. , Ardill K. , Stanback J. , Paterson S.R. , Galindo C. , Leopold M.
Published: August 2019

The southwestern margin of the Late Cretaceous Sonora Pass Intrusive Suite, northern Sierra Nevada, California (USA), preserves a densely populated zone of magmatic structures that record dynamic magmatic layer formation and deformation (faulting and folding) within a solidifying upper-crustal magma mush. This zone consists largely of coupled melanocratic (or schlieren) and leucocratic bands hosted within the 95.6 ± 1.5 Ma Kinney Lakes granodiorite (Leopold, 2016), with orientations approximately parallel to the intrusive margin and with inward younging directions. Schlieren consist of a high modal abundance of medium-grained ferromagnesian minerals (hornblende + biotite), zircon, sphene, apatite, opaque minerals, and minor plagioclase and interstitial quartz. Leucocratic bands are dominated by coarse-grained feldspar + quartz with minor ferromagnesian and accessory minerals. Whole-rock geochemical and Sr and Nd isotopic data indicate that the schlieren are derived from the Kinney Lakes granodiorite by effective mechanical separation of mafic minerals and accessory phases.

We interpret that the schlieren zone at the margin of the Kinney Lakes granodiorite formed by large-scale collapse of crystal mush by “magma avalanching,” facilitated by gravity, local convection, and possibly by host-rock stoping at the margin. This process eroded a significant portion of the solidifying margin of the chamber and resulted in the formation of magmatically deformed layered structures, which experienced further mingling, re-intrusion, magmatic erosion, and recycling processes. We envisage that magma avalanching of magma mushes in plutons can be achieved by any unstable process (e.g., tectonic, fluid-assisted, stoping, or gravity-driven) in large, long-lived magma-mush chambers.
Nature of the crust in the northern Gulf of California and Salton Trough
Authors: van Wijk Jolante W. , Heyman Samuel P. , Axen Gary J. , Persaud Patricia
Published: August 2019

In the southern Gulf of California, the generation of new oceanic crust has resulted in linear magnetic anomalies and seafloor bathymetry that are characteristic of active seafloor-spreading systems. In the northern Gulf of California and the onshore (southeastern California, USA) Salton Trough region, a thick sedimentary package overlies the crystalline crust, masking its nature, and linear magnetic anomalies are absent. We use potential-field data and a geotherm analysis to constrain the composition of the crust (oceanic or continental) and develop a conceptual model for rifting. Gravity anomalies in the northern Gulf of California and Salton Trough are best fit with crustal densities that correspond to continental crust, and the fit is not as good if densities representative of mafic rocks, i.e., oceanic crust or mafic underplating, are assumed. Because extensive mafic underplated bodies would produce gravity anomalies that are not in agreement with observed gravity data, we propose, following earlier work, that the anomalies might be due to serpentinized peridotite bodies such as found at magma-poor rifted margins. The density and seismic velocities of such serpentinized peridotite bodies are in agreement with observed gravity and seismic velocities. Our conceptual model for the Salton Trough and northern Gulf of California shows that net crustal thinning here is limited because new crust is formed rapidly from sediment deposition. As a result, continental breakup may be delayed.
Delphi method to identify expert opinion to support children’s cancer referral guidelines
Authors: Murray Matthew J , Ruffle Amy , Lowis Stephen , Howell Lisa , Shanmugavadivel Dhurgshaarna , Dommett Rachel , Gamble Ashley , Shenton Geoff , Nicholson James
Published: August 2019

Background

The National Institute for Health and Care Excellence (NICE) guidance for referral of children with suspected cancer was first published in 2005 and updated in 2015. The updated version relied on sparse primary care evidence and published without input from key stakeholders, for example, acute general paediatricians and paediatric haematologists/oncologists. This led to a document that fell short as a practical guide for referring physicians managing children with potentially life-threatening conditions. Following discussions between the Children’s Cancer and Leukaemia Group (CCLG, the UK multidisciplinary professional body for healthcare professionals caring for children with cancer) and NICE, it was agreed that a practical supplement should be produced for the 2015 guidance. A prerequisite was evidence gathering from tertiary care to balance the existing primary care evidence, and a Delphi consensus method was therefore convened.

Methods

A CCLG NICE Guidance Committee formulated 25 draft statements for review. The CCLG emailed its paediatric haematologist/oncologist membership (n=179) and 88 responded (49%). To achieve consensus, statements required ≥70% agreement from ≥60% of actual respondents, from the denominator (n=88).

Results

Fifteen of 25 original statements were accepted at the first round of voting. Three of 25 statements where >50% did not support were rejected outright. One statement could not be revised without replicating a previously accepted statement. The six remaining statements were revised and a second round of voting undertaken; all six revised statements were accepted. Overall, 21 of 25 statements (84%) met consensus criteria.

Conclusions

This expert opinion should help streamline suspected cancer referral in children and help optimise subsequent outcomes.
Hyponatraemia presenting as reversible cerebellar ataxia in Addison’s disease
Authors: Arul Judah Nijas , Rajkumar Mani , Suja Lakshmanan
Published: August 2019

Addison’s disease is a common endocrinopathy often diagnosed in patients presenting with hyponatraemia. Cerebellar ataxia as a presentation of hyponatraemia is extremely rare. A 42-year-old man presented with vomiting, fever, ataxic gait and scanning type of dysarthria. Clinical examination revealed signs suggestive of isolated cerebellar involvement. Patient was found to have severe hyponatraemia and serum cortisol was found to be extremely low while MRI brain was found to be normal. Corticosteroid therapy was initiated and cerebellar ataxia was resolved following normalisation of sodium levels.
A relapse of POEMS syndrome presenting as acute kidney injury
Authors: Rees David Owen , Thomas David Hywel , Parry-Jones Nilima , Roberts Gareth
Published: August 2019

Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes (POEMS) syndrome is a rare disease, and only in a minority of cases, causes an impairment of kidney function. Here, we describe a case of a 55-year-old man with a history of POEMS syndrome who presented with acute kidney injury following a routine blood test. On further investigation, a relapse in POEMS syndrome was diagnosed, uniquely isolated to renal involvement.
Takayasu’s arteritis: a unique ophthalmic presentation with CRAO and BRVO
Authors: Gupta Vinita , Luthra Saurabh , Shrinkhal N , Sinha Sony
Published: August 2019

A unique case of sequential occurrence of central retinal artery occlusion (CRAO) and superotemporal branch retinal vein occlusion (ST-BRVO) in a patient of Takayasu’s arteritis is described. An 18-year-old man was diagnosed as left eye CRAO on his initial presentation and was subjected to a complete cardiovascular evaluation revealing findings diagnostic of Takayasu’s arteritis. Patient was however lost to follow-up and presented 16 months later with ST-BRVO in the right eye. Multidisciplinary intervention and an appropriate ocular intervention led to complete recovery of vision in the right eye that was maintained until his last ophthalmic evaluation (2.5 years after the initial presentation). Though uncommon, small retinal vessel involvement can occur in Takayasu’s arteritis as the inaugural feature. Hence, CRAO or branch retinal vein occlusion in a young patient, especially a male, mandates a thorough systemic evaluation and a high index of suspicion of Takayasu’s arteritis to prevent vision threatening complications.
An unusual case of neonatal seizures as manifestation of asymptomatic maternal hypoparathyroidism
Authors: LK Pragathi , Kannan P Raja , Shanbhag Manas
Published: August 2019

Neonatal hypoparathyroidism is one of the rare causes of hypocalcaemia. Several cases of neonatal hypoparathyroidism secondary to maternal hyperparathyroidism have been reported. In this case report, we have a term neonate with normal birth history who presented with late onset hypocalcemic seizures. After excluding polyendocrinopathies and related syndromes, hypocalcaemia seizures were secondary to maternal asymptomatic hypoparathyroidism. Since this is one variety of unusual case of maternal and fetal hypoparathyroidism, further testing was mandatory to confirm familial origin. This focuses on the need for every clinician to test maternal metabolic status in case of neonatal manifestations.
Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum
Authors: Bousema Jelle E , van de Luijtgaarden Koen M , Wilhelmus Suzanne , Poelman Marijn M
Published: August 2019

Acute abdominal pain is a common symptom in young women. We describe a patient with acute illness and severe lower abdominal pain. Laboratory tests were normal except for mildly deranged inflammatory markers. No abnormalities were reported on abdominal ultrasonography and MRI, whereas diagnostic laparoscopy revealed a tumour located dorsally from the uterus. We resected the tumour and pathology results showed a well-differentiated papillary mesothelioma of the peritoneum (WDPMP). Microscopy showed evidence of acute ischaemia in the resected lesion, which was likely the cause of the acute abdominal pain. WDPMP is a rare disease that arises from the serous membranes which does not seem to have a relation to asbestos exposure. Generally, WDPMP has a mild clinical course and good long-term prognosis.
Endovascular treatment of asymptomatic free-floating thrombus in the carotid artery bifurcation: a direct aspiration first-pass technique under double balloon protection
Authors: Yamaoka Ayumu , Miyata Kei , Iihoshi Satoshi , Mikuni Nobuhiro
Published: August 2019

Free-floating thrombus (FFT) in the carotid artery has been reported as a rare cause of acute ischaemic stroke. There are various treatment strategies, but higher risk of distal embolism may limit their applicability. A 77-year-old woman noticed right upper arm weakness. A CT angiogram revealed that a large floating thrombus had strayed across the carotid bifurcation, while another thrombus was present in the right axillary artery. As for the carotid FFT, in spite of anticoagulation therapy, the number of asymptomatic microthrombuses gradually increased on diffusion-weighted MRI. We performed endovascular therapy utilising two temporary occlusion balloon catheters and performed direct aspiration with a reperfusion catheter. The procedure was uneventful. We successfully performed a new endovascular technique for FFT in the carotid bifurcation. Our method is effective, minimally invasive and safe.
Myopericarditis as a presentation of eosinophilic granulomatosus with polyangiitis (EGPA)
Authors: Dey Mrinalini , Nair Jagdish , Sankaranarayanan Rajiv , Kanagala Prathap
Published: August 2019

A 60-year-old woman was admitted to the hospital with worsening dyspnoea, cough and chest pain. This was on a background of weight loss, decreased appetite, mononeuritis multiplex, chronic eosinophilia and a single episode of a non-blanching rash. Investigations demonstrated a raised troponin and ischaemic changes on ECG, and she was therefore initially treated for a presumed myocardial infarction. However, her symptoms failed to improve with treatment for the acute coronary syndrome. A coronary angiogram revealed no significant flow-limiting disease, and further investigations yielded confirmation of raised eosinophils and a positive perinuclear antineutrophil cytoplasmic antibody test. An echocardiogram demonstrated a pericardial effusion, and subsequent cardiac magnetic resonance features were compatible with myopericarditis. In light of these findings, the patient was diagnosed with eosinophilic granulomatous with polyangiitis and commenced on high-dose intravenous methylprednisolone and cyclophosphamide. She made an excellent recovery and remains in remission on azathioprine and a tapering dose of corticosteroids.
Morphea masquerading as cellulitis
Authors: Sethu Claire , Wong Kai Yuen , Slade-Sharman Diana
Published: August 2019

A case of morphea postbreast reconstruction is presented. It is a rare condition that can be easily mistaken for other inflammatory conditions or infection.
Observation of nine previously reported and 10 non-reported SLC4A11 mutations among 20 Iranian CHED probands and identification of an MPDZ mutation as possible cause of CHED and FECD in one family
Authors: Moazzeni Hamidreza , Javadi Mohammad Ali , Asgari Danial , Khani Marzieh , Emami Mohammad , Moghadam Abolfazl , Panahi-Bazaz Mahmoud-Reza , Hosseini Tehrani Mehdi , Karimian Farid , Hosseini Bagher , Nekuie Moghadam Tayebeh , Hassanpour Hossein , Akbari Mohammad Taghi , Elahi Elahe
Published: August 2019

Background/aims

SLC4A11 is the only known causative gene of congenital hereditary endothelial dystrophy (CHED). Mutation screenings have shown that most but not all patients with CHED harbour mutations in SLC4A11, suggesting that other CHED-causing genes may exist. We aimed to screen SLC4A11 in Iranian patients to learn the mutation spectrum of this gene among Iranians and to gain further knowledge on potential contribution of other genes to CHED aetiology.

Methods

SLC4A11 was screened in 21 Iranian patients with CHED by sequencing. Previously unreported variations were checked in at least 200 controls, and segregation analysis within families and bioinformatics predictions on effects of variations were performed. Exome sequencing was done for the single patient without an SLC4A11 mutation and for her parents.

Results

Nine previously reported and 10 unreported SLC4A11 mutations were observed among 20 patients; a mutation was not found in one patient. A mutation in MPDZ was identified as the only candidate cause of CHED in this patient. Her mother who carried the same mutation was diagnosed with Fuchs endothelial corneal dystrophy (FECD).

Conclusion

SLC4A11 mutations are the usual cause of CHED in Iranians. The 10 novel mutations observed contribute significantly to the approximately 85 mutations reported since discovery of the role of the gene in CHED pathogenesis more than 10 years ago. MPDZ mutations may be a cause of CHED and even FECD in a minority of patients. Proposed functions of MPDZ with respect to tight junctions and maintenance of the corneal endothelial barrier are in accordance with a role in corneal endothelial pathobiology.
Foveal microvasculature, refractive errors, optical biometry and their correlations in school-aged children with retinopathy of prematurity after intravitreal antivascular endothelial growth factors or laser photocoagulation
Authors: Chen Yen-Chih , Chen San-Ni
Published: August 2019

Aims

To compare the differences and to assess the correlations regarding to foveal microvasculature, refractive errors and optical biometry in children with history of type 1 retinopathy of prematurity (ROP) treated with either laser photocoagulation or intravitreal injection of antivascular endothelial growth factors (anti-VEGF).

Methods

This is a retrospective and comparative case series. Measurements of fovea microvasculature included the retinal thickness and subfoveal choroid thickness, the size of fovea avascular zone (FAZ), the fovea, parafovea and perifoveal vessel density (VD). Measurements of refractive errors and optical biometry included spherical equivalent, astigmatism, cornea curvature, anterior chamber depth (ACD), lens thickness and axial length (AXL).

Results

A total 47 eyes in 25 children were studied (22 laser-treated eyes from 12 children and 25 anti-VEGF treated eyes from 13 children). Laser-treated eyes had significantly smaller FAZ (p=0.004), higher fovea VD, lower parafoveal VD (p=0.02 and 0.01 in superficial capillary plexus; p=0.05 and 0.01 in deep capillary plexus), thicker inner retinal thickness (p=0.002). Laser-treated eyes had significantly higher degree of myopia (p=0.01). Regarding to optical biometry, laser-treated eyes had significant steeper cornea curvature, shallower ACD and thicker lens (p=0.01, 0.01 and 0.02, respectively) but no differences in AXL was noted (p=0.58). Significant correlations presented between inner retina thickness and FAZ to anterior segment variables.

Conclusion

In school-aged children with history of type 1 ROP, despite similar visual acuity outcome, those who underwent anti-VEGF injection had favourable developmental outcomes compared with laser photocoagulation. Significant correlations exist between fovea microvasculature and optical biometric components.
Modulation of cortical and subcortical brain areas at low and high exercise intensities
Authors: Fontes Eduardo Bodnariuc , Bortolotti Henrique , Grandjean da Costa Kell , Machado de Campos Brunno , Castanho Gabriela K , Hohl Rodrigo , Noakes Timothy , Min Li Li
Published: August 2019

Introduction

The brain plays a key role in the perceptual regulation of exercise, yet neuroimaging techniques have only demonstrated superficial brain areas responses during exercise, and little is known about the modulation of the deeper brain areas at different intensities.

Objectives/methods

Using a specially designed functional MRI (fMRI) cycling ergometer, we have determined the sequence in which the cortical and subcortical brain regions are modulated at low and high ratings perceived exertion (RPE) during an incremental exercise protocol.

Results

Additional to the activation of the classical motor control regions (motor, somatosensory, premotor and supplementary motor cortices and cerebellum), we found the activation of the regions associated with autonomic regulation (ie, insular cortex) (ie, positive blood-oxygen-level-dependent (BOLD) signal) during exercise. Also, we showed reduced activation (negative BOLD signal) of cognitive-related areas (prefrontal cortex), an effect that increased during exercise at a higher perceived intensity (RPE 13–17 on Borg Scale). The motor cortex remained active throughout the exercise protocol whereas the cerebellum was activated only at low intensity (RPE 6–12), not at high intensity (RPE 13–17).

Conclusions

These findings describe the sequence in which different brain areas become activated or deactivated during exercise of increasing intensity, including subcortical areas measured with fMRI analysis.
Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda
Authors: Palagyi Anna , Dodd Rebecca , Jan Stephen , Nambiar Devaki , Joshi Rohina , Tian Maoyi , Abimbola Seye , Peiris David
Published: August 2019

Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strategies for reorganising PHC delivery, determine where relevant evidence gaps exist and prioritise these for future study. This paper describes an approach for doing this using the best available evidence combined with consultation to establish evidence priorities. We first reviewed PHC organisational interventions in Asia-Pacific LMICs and ascertained evidence gaps. The largest gaps related to interventions to promote access to essential medicines, patient management tools, effective health promotion strategies and service planning and accountability. Evidence from Pacific Island countries was particularly scant. We then engaged an expert panel of 22 PHC stakeholders from seven Asia-Pacific LMICs in a Delphi exercise to identify priority questions for future research. Research priorities were: (1) identifying effective PHC service delivery models for chronic diseases; (2) devising sustainable models of disease integration; (3) optimising task shifting; (4) understanding barriers to care continuity; (5) projecting future PHC needs; and (6) designing appropriate PHC service packages. Notably, stakeholder-determined priorities reflected large, context-dependent system issues, while evidence gaps centred on discrete interventions. Future research on the organisation of PHC services in Asia-Pacific LMICs should incorporate codesign principles to engage researchers and national PHC system stakeholders, and innovative methods that build on existing evidence and account for system complexity.
Quality, safety and performance management in primary health care: from scoping review to research priority setting and implementation plan in the Eastern Mediterranean Region
Authors: Fadlallah Racha , Bou-Karroum Lama , El-Jardali Fadi , Hishi Lama , Al-Akkawi Alaa , Tsolakian Ibrahim George , Hemadi Nour , Hamadeh Randa S. , AbuAlRub Raeda , Hamadeh Randah R. , Arfa Chokri
Published: August 2019

Introduction

Strong primary health care (PHC) leads to better health outcomes, improves health equity and accelerates progress towards universal health coverage (UHC). The Astana Declaration on PHC emphasised the importance of quality care to achieve UHC. A comprehensive understanding of the quality paradigm of PHC is critical, yet it remains elusive in countries of the Eastern Mediterranean Region (EMR). This study used a multistep approach to generate a policy-relevant research agenda for strengthening quality, safety and performance management in PHC in the EMR.

Methods

A multistep approach was adopted, encompassing the following steps: scoping review and generation of evidence and gap maps, validation and ranking exercises, and development of an approach for research implementation. We followed Joanna Briggs Institute guidelines for conducting scoping reviews and a method review of the literature to build the evidence and gap maps. For the validation and ranking exercises, we purposively sampled 55 high-level policy-makers and stakeholders from selected EMR countries. We used explicit multicriteria for ranking the research questions emerging from the gap maps. The approach for research implementation was adapted from the literature and subsequently tailored to address the top ranked research question.

Results

The evidence and gap maps revealed limited production of research evidence in the area of quality, safety and performance management in PHC by country and by topic. The priority setting exercises generated a ranked list of 34 policy-relevant research questions addressing quality, safety and performance management in PHC in the EMR. The proposed research implementation plan involves collaborative knowledge generation with policy-makers along with knowledge translation and impact assessment.

Conclusion

Study findings can help inform and direct future plans to generate, disseminate and use research evidence to enhance quality, safety and performance management in PHC in EMR and beyond. Study methodology can help bridge the gap between research and policy-making.
What factors hinder ethnic minority women in rural China from getting antenatal care? A retrospective data analysis
Authors: Liu Bo , Shi Duorui , Wang Wei , Nan Lei , Yin Bibo , Wei Chongyi , Emu Aga , Zhou Haiqun , Wazha Wuha , Zhu Jianming , Wang Shumei , Ma Wei
Published: August 2019

Background

Mother-to-child transmission (MTCT) is one of the main transmission routes of HIV, and the probability of MTCT can be dramatically reduced with comprehensive interventions. In southwest and western regions in China, the level of development in rural areas is relatively backwards and retains some original features, which also increases the difficulty of controlling infectious diseases. The Liangshan Prefecture started the prevention of MTCT programme in 2009. However, the implementation of the programme is not ideal, and the coverage of HIV testing is still low. Many Yi (local major ethnicity) women did not take antenatal care (ANC) and just gave birth to their babies at home for a variety of reasons.

Methods

Women with pregnancy history in the last 5 years were recruited from two townships based on cluster sampling. Face-to-face interviews were conducted to collect data. Descriptive analysis was performed to describe demographic characteristics, history of pregnancy and ANC uptake, knowledge of and attitudes towards ANC. Multivariable analysis was used to identify factors associated with uptake of ANC.

Results

Among 538 women who completed the questionnaires, 77.9% knew that ANC was necessary during and after pregnancy. However, only 24.2% actually accessed ANC. Almost all women (94.6%) expressed their willingness to receive ANC for pregnancy but barriers towards actual uptake of ANC existed including shyness, lack of independence and unavoidable cost. Multivariate analysis showed that no experience of living outside of Zhaojue for more than 6 months, higher number of births, not knowing the necessity of ANC during pregnancy and not knowing the government’s promotion policies for ANC were associated with lack of ANC uptake.

Conclusion

Although ethnic minority women in rural Liangshan expressed strong intention to use ANC, actual uptake of ANC was low. Knowledge of ANC and HIV prevention for MTCT should be improved among this population, and efforts should be made to help them overcome barriers to accessing ANC.
Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial
Authors: Schlapbach Luregn J , Horton Stephen Brian , Long Debbie Amanda , Beca John , Erickson Simon , Festa Marino , d’Udekem Yves , Alphonso Nelson , Winlaw David , Johnson Kerry , Delzoppo Carmel , van Loon Kim , Gannon B , Fooken Jonas , Blumenthal Antje , Young Paul , Jones Mark , Butt Warwick , Schibler Andreas
Published: August 2019

Introduction

Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol.

Methods and analysis

The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery.

Ethics and dissemination

The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal.

Trial registration number

ACTRN12617000821392
Effects of ketamine treatment on suicidal ideation: a qualitative study of patients’ accounts following treatment for depression in a UK ketamine clinic
Authors: Lascelles Karen , Marzano Lisa , Brand Fiona , Trueman Hayley , McShane Rupert , Hawton Keith
Published: August 2019

Objective

It is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients’ perspectives on such effects. Studying these can contribute to greater understanding of the mechanisms underlying impact of ketamine treatment on SI. The aim of this study was to investigate patients’ reports of the impact of treatment on their SI, the duration of effects and possible mechanisms.

Design and setting

This qualitative study consisted of semi-structured interviews with patients who had received ketamine treatment for depression. Interview data were analysed thematically.

Participants

Fourteen patients (8 females, 6 males, aged 24–64 years) who had received treatment with ketamine for treatment-resistant depression, and had SI at the initiation of treatment. Two participants also had a diagnosis of bipolar type 1 and two of emotionally unstable personality disorder. Eight had a history of self-harm.

Results

SI reduced following ketamine treatment in 12 out of 14 participants for periods of a few hours following a single treatment to up to three years with ongoing treatment. Reduction of SI was variable in terms of extent and duration, and re-emergence of suicidal thoughts often occurred when treatment ceased. Participants’ accounts indicated that reduced SI was associated with improved mood and reduced anxiety, as were clarity of thought, focus and concentration, and ability to function. Participants reported experiencing some or all of these effects in various orders of occurrence.

Conclusion

Generally, ketamine treatment was experienced as effective in reducing SI, although duration of effects varied considerably. Patients’ perspectives indicated similarities in the mechanisms of reduction in SI, but some differences in their manifestation, particularly in relation to chronology. Experiences of this cohort suggest that reduced anxiety and improvement in ability to think and function were important mechanisms alongside, or in some cases independently of, improvement in mood. Further studies of patients’ experiences are required to gain enhanced understanding of the variability of effects of ketamine on SI and functionality.
Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol
Authors: Webb Elizabeth , Neeman Teresa , Gaida Jamie , Bowden Francis J , Mumford Virginia , Bissett Bernie
Published: August 2019

Introduction

Cellulitis represents a significant burden to patients’ quality of life (QOL) and cost to the healthcare system, especially due to its recurrent nature. Chronic oedema is a strong risk factor for both an initial episode of cellulitis and cellulitis recurrence. Expert consensus advises compression therapy to prevent cellulitis recurrence in individuals with chronic oedema, however, there is little supporting evidence. This research aims to determine if the management of chronic oedema using compression therapy effectively delays the recurrence of lower limb cellulitis.

Methods and analysis

A randomised controlled trial with cross-over will be used to assess the impact of compression therapy on clinical outcomes (time to next episode of cellulitis, rate of cellulitis-related hospital presentations, QOL and leg volume). Using concealed allocation, 162 participants will be randomised into the intervention (compression) or control (no compression) group. Randomisation will be stratified by prophylactic antibiotic use. Participants will be followed up at 6 monthly intervals for up to 3 years or until 45 episodes of cellulitis occur across the cohort. Following an episode of recurrent cellulitis, control group participants will cross-over to the intervention group. Survival analysis will be undertaken to assess the primary outcome measure of time to cellulitis recurrence. The hypotheses are that compression therapy to control lower limb chronic oedema will delay recurrent lower limb cellulitis, reduce the rate of associated hospitalisations, minimise affected limb volume and improve the QOL of this population.

Ethics and dissemination

Ethics approval has been obtained from the ethics committees of all relevant institutions. Results will be disseminated through relevant peer-reviewed journal articles and conference presentations.

Trial registration number

ACTRN12617000412336; Pre-results. The ICTOC trial is currently in progress. Participant recruitment started in May 2017 and is expected to continue until December 2019.