bluuebunny/crossref_metadata_2025 huggingface dataset:
STAFF PERCEPTIONS OF THE IMPACT OF OVERNIGHT RESIDENT PED CONSULTANTS ON PATIENT CARE AND TRAINING
Authors: Doubal Kim , Hore Carolyn , Ross James
Published: August 2014

Objectives & Background

EM and Paediatrics are specialties at the forefront of the move towards 24/7 consultant delivered care. This shift has been partly driven in EM by trauma pathways, as well as aiming to provide better patient care, and to support training.

Chelsea and Westminster Paediatric ED sees around 34,000 children a year. It is not a major trauma centre. In May 2013, 6 consultant paediatricians were appointed to be resident in PED at night. This study evaluates the PED team's perceptions of the impact of this change on the quality of clinical care, training and job satisfaction, and of trainee's views of undertaking a similar role in the future.

Methods

An online questionnaire was sent to all nursing staff and junior doctors (ST1-ST8) working in PED, in May 2014. Questions were answered on a 5 point Likert scale, with scope for free text responses, and role specific questions for both nursing and medical staff.

Results

26/35 (75%) of staff responded (42% medical/58% nursing staff). 72% of respondents preferred working with resident consultants.

Clinical Care

100% of trainees and 80% of nurses felt the quality of care was improved at night. 90% felt it improved the management of a resuscitation, and 100% felt it was easier to discuss safeguarding concerns.

Training & Supervision

Trainees felt it improved their supervision in practical procedures (70%), increased their opportunity to complete WBPAs (80%), and increased the number of learning opportunities (70%). Registrars were concerned that opportunities for leadership and management experience were reduced.

Nursing staff

87% believed decision making was faster, 73% felt children spent less time in the department and 80% felt waiting times were reduced.

Perceptions

Only 30% of trainees would like to work as a resident consultant in the future. 90% believed that resident on call working should be time limited.

Conclusion

PED staff at C&W have welcomed the move to 24/7 consultant delivered care. The core aims – to improve the efficiency and proficiency of patient care, and to better utilise out of hours working as a training opportunity – are being achieved. Concerns remain about disempowerment of senior trainees and the perceived impact of night shifts in a consultant role on work-life balance. To sustain this model, trainees must be convinced of the benefits of becoming a resident consultant upon their own career.
WHAT'S COMING THROUGH THE FRONT DOOR? PAEDIATRIC AND ADOLESCENT GYNAECOLOGY IN THE EMERGENCY DEPARTMENT
Authors: Westwood Kirsty , Irani Shirin
Published: August 2014

Objectives & Background

Paediatric gynaecology can provide challenging and varied consultations in the emergency department setting. Although the first international journal and society were established in the late 1980's, no specific UK guidelines have been published for the care of children and teenagers in this specialty. Moreover, limited published data is available regarding the types of cases presenting at the “front door”. This study aimed to investigate the scope of paediatric and adolescent gynaecological problems presenting to the emergency department of a UK children's hospital.

Methods

A retrospective review of all gynaecological emergency department presentations at Birmingham Children's Hospital from 1stDecember 2012 to 30thNovember 2013.

Results

The casualty cards for seventy patients were reviewed individually with ages ranging from 4 days to 15 years old. A spectrum of 16 different diagnoses was found, with the majority relating to vulvovaginitis (46%) and menstrual disorders (20%). The most common presenting complaints were equally divided between vaginal bleeding (21%) and vaginal pain (21%). Patients were mainly treated medically (40%), whereas nearly a third received advice (30%) and a quarter did not receive any treatment (26%). Over 95% of cases were discharged home from the emergency department; the majority of those (63%) needing further follow-up.

Conclusion

The study demonstrates the wide variety of paediatric gynaecology cases that present to the emergency department, nearly two thirds of which require ongoing care. This exhibits a need for both national guidance and appropriate training for front line medical staff covering the common gynaecological problems found in children.
THE TRANSITION TO EXPERT: A QUALITATIVE STUDY EXPLORING CLINICAL DECISION MAKING FOR CHILDREN UNDER FIVE ATTENDING THE EMERGENCY DEPARTMENT WITH MINOR RESPIRATORY CONDITIONS
Authors: Bowen Leah , Purdy Sarah , Lyttle Mark D , Heawood Alison
Published: August 2014

Objectives & Background

Unplanned paediatric admissions are increasing for young children and infants experiencing respiratory illnesses. Many admissions are short-stay events, typically lasting less than 48 hrs. The short duration of these admissions could indicate that minor conditions are responsible for many of these events, and could consequently be targets for management by primary care teams.

The purpose of this exploratory qualitative research is to understand more about admissions in young children attending the emergency department of a Children's hospital in the UK, with the aim of collaboratively identifying interventions to reduce admissions for minor respiratory conditions. The findings presented here will focus on the theme of clinical decision making by staff in this setting.

Methods

Semi-structured interview discussions were conducted with 15 emergency clinical staff with varying levels of experience in paediatrics and/or emergency medicine.

Participants considered two clinical cases where they had been responsible for the care of a child presenting to the department with a minor respiratory complaint. These reflective cases facilitated discussion around the decision making process and treatment approach taken during the clinical situation.

Interviews were audio-recorded and transcribed verbatim. Themes from the data were extracted and collated using thematic analysis.

Results

There were clear differences in the approach to decision making taken by experienced clinicians and their junior colleagues. Clinicians with less experience relied heavily on guidelines, admission criteria, clinical theory and second opinions from seniors in order to achieve safe clinical decisions. The ‘informal' learning process was significant among junior staff, where tacit knowledge, clinical intuition and risk tolerance were developed.

In direct contrast, senior clinicians used a high level of intuition, tacit knowledge and clinical experience to effectively manage risk to achieve a clinical decision.

Conclusion

This research will interest educators and trainers operating in emergency paediatric settings. The emergence of 'informal learning', its acquisition and role in clinical decision making has implications in the development of training programmes for clinicians working in emergency paediatrics.
THE MEDICAL BOOMERANG—WILL IT COME BACK?
Authors: McDermott Cian , Sheridan Michael , Moore Katie
Published: August 2014

Objectives & Background

To explore the increasing numbers of Emergency Medicine registrars that obtained their primary medical degree from United Kingdom (UK) or Irish universities, who work in Emergency Departments (ED) throughout Australia and New Zealand.

Table 1

Trends in Australasian Emergency Medicine registrar numbers 2008–2013 (courtesy of ACEM Policy & Research Department)

YearTotal registrarsTotal IMGsUK/Ire IMGs% UK/Ire of total IMGs% UK/Ire of total registrars2008142078728536.220.12009165495832934.319.920101952113741336.321.220111973114443738.222.120122078118548140.623.120132258125256645.225.1

Methods

The VERS-2013 (Victoria Emergency Registrar Study) was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013.1As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working in Australasian EDs.

Results

UK and Irish Emergency Medicine registrars make up the largest proportion of IMGs in working in Australasian EDs. These figures have increased from 36.2% in 2008 to 45.2% in 2013 (table 1). In 2013 alone, the largest year-on-year increase occurred, of UK and Irish ED IMG registrars, migrating to work in Australia and New Zealand. Current data shows that over 25% of all ED registrars working in Australasian EDs, studied for their primary medical degree in a university either in Ireland or the UK (table 1).

Conclusion

Many IMGs (in particular from UK and Ireland) leave their country of origin to work overseas in Australia and New Zealand. Highly trained, skilled independent practitioners have, in the past, returned to the UK to work at consultant level. However, evidence from ACEM (table 1) and the VERS-20131 study show clearly that these doctors are now migrating to Australia for the long-term, leaving EDs the length and breath of the British Isles bereft of talented senior EM decision-making personnel. Meanwhile in Australia, continued IMG influx is at odds with a stated Health Workforce Australia taskforce aim to achieve self-sufficiency by 2025.2 The challenge is set for the College of Emergency Medicine, in conjunction with the UK and Irish governments, to enhance the attractiveness of Emergency Medicine as a credible and sustainable career option.
HIP 7: USING A BUNDLE OF CARE TO STREAMLINE THE MANAGEMENT OF PATIENTS WITH A FRACTURED NECK OF FEMUR
Authors: Kerr Jacques , Bishop Mary , Meikle Alastair , Lakie Kirk , Davidson Jane
Published: August 2014

Objectives & Background

SIGN guideline 111 makes recommendations on the optimal management of patients with a hip fracture.1It is clear from the use of care bundles in other conditions, eg sepsis, that these perform very well in time-critical settings and ensure that all necessary actions for person-centred care are achieved timeously. Given the success of our Emergency Department (ED) compliance with the Sepsis 6 bundle (100%–unpublished data) the principal author (JK) rationalised that a bundle applied to the SIGN hip fracture recommendations would ensure that all actions were achieved in a timely manner.

Methods

We used an improvement methodology strategy to devise a bundle of care for patients with a fractured neck of femur. This work culminated in a list of 7 actions that could be captured in an acronym devised by the principal author as an aide-memoir (see table 1). The principal author ran training sessions on the bundle with all ED medical and nursing staff and data were captured over a four-month period (October 2013–February 2014) to examine compliance and to compare with data from the same period in the previous year. All actions in the bundle had to be achieved within the hour.

Table 1

FEMORAL-Hip 7 Bundle of Care

F - Fasttrack to ED Procedure RoomE - Establish IV access & take bloodsM - Medical assessment, including SIRS chart & ECGO - Opiates & fascia iliaca blockR - Radiology – fasttrack for pelvis and hip X raysA - Abbreviated Mental Test ScoreL - Liaise with Orthopaedic Ward for admission

Results

Analysis of data from the study period showed a significant improvement in compliance with

a) intravenous fluid therapy administration: 37% pre- and 91.4% post-bundle;

b) opiates and regional nerve block administration: 35% pre- and 75% post-bundle;

c) documentation of SIRS score: 40% pre- and 91% post-bundle, and

d) inspection of pressure areas: 5% pre- and 100% post-bundle.

Conclusion

Although fractures of the neck of femur do not necessarily result in the physiological derangement associated with sepsis, it is evident that the use of a bundle of care will ensure that hip fracture patients are managed in a timely, person-centred and safe fashion as recommended in SIGN 111. Future work will concentrate on improving compliance with all seven actions within one hour of patient attendance.
RESTRICTIVE VERSUS LIBERAL BLOOD TRANSFUSION FOR ACUTE UPPER GASTROINTESTINAL BLEEDING (TRIGGER): PRAGMATIC, CLUSTER RANDOMISED, FEASIBILITY TRIAL
Authors: Gray A , Jairath V , Kahan B , Dore C , Palmer K , Travis S , Logan R , Walsh T , Murphy M
Published: August 2014

Objectives & Background

Transfusion thresholds for upper gastrointestinal bleeding (UGIB) are controversial. Observational studies suggest associations between liberal red blood cell (RBC) transfusion and adverse outcome. A recent trial reported increased mortality following liberal transfusion. We delivered a cluster randomised trial to evaluate the feasibility and safety of implementing a restrictive (transfusion when haemoglobin (Hb) <8 g dL) vs liberal (transfusion when Hb <10 g/dL) RBC transfusion policy for UGIB.

Methods

Hospitals were randomised to a policy which was implemented through a multi-faceted educational intervention. Patients were recruited in Emergency Departments and acute admission units. All adult patients were eligible to participate, regardless of co-morbidity; the only exclusion criterion was exsanguinating haemorrhage. Feasibility and exploratory clinical outcomes were recorded up to day 28.

Results

936 patients were enrolled in six hospitals. Rockall and Blatchford risk scores were identical between policies. Protocol adherence was 96% in the restrictive policyvs83% in the liberal policy (difference 14%, 95% CI 7 to 21%). In patients with Hb <120 g/L, Hb at discharge was lower for the restrictive policy (difference −0.7; 95% CI −1.4 to 0.0; p=0.05). For the restrictive policy fewer patients received RBCs (difference −13%, 95% CI −35 to 11%) with on average 0.8 (−1.9 to 0.3) fewer RBC units transfused. Clinical outcomes were better in the restrictive policy: 28-day further bleeding, 5% restrictivevs9% liberal (difference −3.7%, 95% CI -12.2 to 4.8%); 28-day mortality, 5% restrictivevs7% liberal (difference −1.3%, 95% CI −8.0 to 5.5%).; serious adverse events, 18% restrictivevs22% liberal (difference −4.9%, 95% CI −22.6 to 12.8%). In the subgroup with IHD, there was a large observed difference for mortality (12% restrictive arm (n=6) vs. 3% liberal arm (n=2); interaction P=0.11).

Conclusion

Adherence to both policies was high, resulting in a reduction in RBC transfusion and separation in the degree of anaemia and RBC exposure. There was a trend towards improved safety in the restrictive policy. We have demonstrated that a large-scale cluster randomised trial is feasible and is now warranted to determine the effectiveness of implementing restrictive RBC transfusion for all patients with AUGIB.
PRE-HOSPITAL CONTINUOUS POSITIVE AIREWAY PRESSURE (CPAP) FOR ACUTE RESPIRATORY FAILURE: AN ECONOMIC ANALYSIS
Authors: Goodacre Steve , Thokala Praveen
Published: August 2014

Objectives & Background

We aimed to determine the cost-effectiveness of pre-hospital CPAP compared with standard care for adults presenting to the emergency services with acute respiratory failure.

Methods

An economic model was developed to explore the costs and health outcomes when pre-hospital CPAP provided by paramedics and standard care (in-hospital non-invasive ventilation (NIV)) were applied to a hypothetical cohort with acute respiratory failure. The model assigned each patient a probability of intubation or death depending upon their characteristics and whether they had pre-hospital CPAP or standard care. The patients that survived accrued lifetime quality-adjusted life year (QALYs) and health care costs according to their age and sex. Costs were accrued through costs of intervention and hospital treatment costs, which depended on patient outcomes.

Results

Pre-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio (ICER) of £20,514/QALY and a 49.5% probability of being cost-effective at the £20,000/QALY threshold. The probability of pre-hospital CPAP being cost-effective at the £20,000/QALY threshold depended on the incidence of eligible patients, and varied from 35.4% when a low estimate of incidence was used to 91.3% with a high estimate. If a typical ambulance service treated 175 appropriate patients per year it could save around 11 lives while incurring £241,250 additional costs, whereas if a typical ambulance service treated 2000 appropriate patients per year it could save 124 lives while incurring £876,480 additional costs. Variation in the incidence of eligible patients also had a marked impact on the expected value of sample information for a future randomised trial.

Conclusion

The cost-effectiveness of pre-hospital CPAP is uncertain and current evidence is insufficient to support widespread implementation. The immediate research priority is to estimate the incidence of patients eligible for pre-hospital CPAP. This appears to be the key determinant of the cost-effectiveness of a future trial and of pre-hospital CPAP itself.

Model structure
Evidence for genetic incompatibilities associated with post-zygotic reproductive isolation in the human fungal pathogenCryptococcus neoformans
Authors: Vogan Aaron A. , Xu Jianping
Published: August 2014

Hybridization is a potent mechanism for generating unique strains with broad host ranges and increased virulence in fungal pathogens. In the opportunistic basidiomycete pathogen Cryptococcus neoformans, intervarietal hybrids are commonly found infecting patients. The two parental varieties C. neoformans var. grubii and C. neoformans var. neoformans mate readily under laboratory conditions, but the hybrid basidiospores have germination rates about four times lower than those from intravarietal crosses. Here, we used microdissection to collect basidiospores from a hybrid cross and analysed the genotypes of germinated basidiospores to identify potentially antagonistic allelic combinations between loci that impact basidiospore germination. Our analyses showed clear evidence for Bateson–Dobzhansky–Muller (BDM) incompatibility affecting basidiospore viability. Antagonistic combinations of alleles from both two loci and three loci were found. Interestingly, most of the hybrid progeny showed segregation distortion in favour of the alleles from var. neoformans, consistent with large-scale epistatic interactions among loci affecting basidiospore viability. Our study presents the first evidence of BDM incompatibility between nuclear genes affecting post-zygotic reproductive isolation in this model basidiomycete yeast.
OBJECTIVE EVALUATION OF ELBOW FLEXION STRENGTH AND FATIGABILITY AFTER NERVE TRANSFER IN ADULT TRAUMATIC UPPER BRACHIAL PLEXUS INJURIES
Authors: Maricq Céline , Jeunehomme Martine , Mouraux Dominique , Rémy Pascal , Brassinne Eric , Bahm Jörg , Schuind Frédéric
Published: August 2014

Nerve transfers Oberlin-type are currently used in upper brachial plexus lesions to recover elbow flexion. Is the regained active motion sufficient to resume heavy manual activities? Five adult patients (mean age 37 years) operated of a nerve transfer to recover elbow flexion (transfer of a motor fascicle of the ulnar nerve to the motor branch of the biceps; in three patients, additional transfer from the median to the motor nerve of the brachialis) were clinically and isokinetically evaluated, after a mean follow-up of 47 months. The median Constant-Murley score was 22/100, the DASH 56/100 and the MEPI 60/100. For isokinetic tests the most significant finding was a severe deficit of elbow strength, of about 80%. No patient was able to maintain an isometric contraction during sufficient time to evaluate fatigability. This preliminary study suggests that major functional impairments persist despite early recovery of elbow flexion. These results should be confirmed in a study on a larger group of patients.
MODIFIED BRUNELLI PULL-OUT SUTURE TECHNIQUE IN ZONE II FLEXOR TENDON RUPTURE: A FRESH HUMAN CADAVER STUDY
Authors: Başar Hakan , Tetik Cihangir
Published: August 2014

Purpose: The aim of our study is to develop a suture technique that has sufficient strength of active mobilization.

Methods: Thirty two fingers of six fresh human cadavers were divided into two groups. Flexor digitorum profundus (FDP) tendons in the study group were repaired by modified Brunelli suture technique and modified Kessler suture technique, while those in the control group were repaired by Modified Kessler suture technique. Flexion and extension movements were performed with 10 N of load, increasing 1 N at a time to the tendons in both groups. Rupture and significant gap formation was evaluated up to 20 N of load. In the study, to evaluate the resistance to active motion, 1000 times flexion and extension motion cycle was performed with a load of 20 N. The succeeding repaired tendons was also tested with flexion and extension movements increasing the load 1 N at a time.

Results: In the study group, failure and significant gap formation on the repair zone were not observed after 20 N of load and 1000 times cyclic flexion and extension movements for resisting to active motion. The rupture and significant gap formation was observed on a average load of 98.43 ± 0.47 N. In the Modified Kessler suture technique, on the eight tendons before reaching the 20 N of load for resisting to active motion, and the remaining eight tendons, during the 20 N loaded motion cycle essential for active motion, rupture and significant gap formation was observed. The failure and significant gap formation was observed on a average load of 18.37 ± 1.89 N. It is measured that by accompanying Modified Brunelli suture to the Modified Kessler suture technique, the resistance was increased up to 5–6 times.

Discussion: By the Modified Brunelli suture technique, active motion can be started to the finger without a dorsal block sling immediately after the surgery.

Clinical Relavans: By the modified technique, the rehabilitation difficulty and joint stiffness will be minimized.
TREATMENT OF HOOK OF THE HAMATE FRACTURES IN ADULTS USING LOW-INTENSITY PULSED ULTRASOUND
Authors: Tomaru Michiyo , Osada Denju , Fujita Satoshi , Tamai Kazuya
Published: August 2014

Two delayed unions and one nonunion of hook of the hamate fractures in adults aged 31-, 40-, and 41-years-old were treated with low-intensity pulsed ultrasound (LIPUS). Ultrasound treatment was started at three, four, and six months after injury and ultrasound exposure at the hook of the hamate in the hypothenar eminence was carried out for four to five months. During the management period, there was no immobilisation with a cast or brace and limited strain with only routine daily activities allowed. In all cases, bony union was confirmed on carpal tunnel radiographs or computed tomography at the final follow-up time of eight and 36 months after injuries.
Exogenous lactate supply affects lactate kinetics of rainbow trout, not swimming performance
Authors: Omlin Teye , Langevin Karolanne , Weber Jean-Michel
Published: August 2014

Intense swimming causes circulatory lactate accumulation in rainbow trout because lactate disposal ( Rd) is not stimulated as strongly as lactate appearance ( Ra). This mismatch suggests that maximal Rdis limited by tissue capacity to metabolize lactate. This study uses exogenous lactate to investigate what constrains maximal Rdand minimal Ra. Our goals were to determine how exogenous lactate affects: 1) Raand Rdof lactate under baseline conditions or during graded swimming, and 2) exercise performance (critical swimming speed, Ucrit) and energetics (cost of transport, COT). Results show that exogenous lactate allows swimming trout to boost maximal Rdlactate by 40% and reach impressive rates of 56 μmol·kg−1·min−1. This shows that the metabolic capacity of tissues for lactate disposal is not responsible for setting the highest Rdnormally observed after intense swimming. Baseline endogenous Ra(resting in normoxic water) is not significantly reduced by exogenous lactate supply. Therefore, trout have an obligatory need to produce lactate, either as a fuel for oxidative tissues and/or from organs relying on glycolysis. Exogenous lactate does not affect Ucritor COT, probably because it acts as a substitute for glucose and lipids rather than extra fuel. We conclude that the observed 40% increase in Rdlactate is made possible by accelerating lactate entry into oxidative tissues via monocarboxylate transporters (MCTs). This observation together with the weak expression of MCTs and the phenomenon of white muscle lactate retention show that lactate metabolism of rainbow trout is significantly constrained by transmembrane transport.
Oxidative stress-induced alterations in PPAR-γ and associated mitochondrial destabilization contribute to kidney cell apoptosis
Authors: Small David M. , Morais Christudas , Coombes Jeff S. , Bennett Nigel C. , Johnson David W. , Gobe Glenda C.
Published: August 2014

The mechanism(s) underlying renoprotection by peroxisome proliferator-activated receptor (PPAR)-γ agonists in diabetic and nondiabetic kidney disease are not well understood. Mitochondrial dysfunction and oxidative stress contribute to kidney disease. PPAR-γ upregulates proteins required for mitochondrial biogenesis. Our aim was to determine whether PPAR-γ has a role in protecting the kidney proximal tubular epithelium (PTE) against mitochondrial destabilisation and oxidative stress. HK-2 PTE cells were subjected to oxidative stress (0.2–1.0 mM H2O2) for 2 and 18 h and compared with untreated cells for apoptosis, mitosis (morphology/biomarkers), cell viability (MTT), superoxide (dihydroethidium), mitochondrial function (MitoTracker red and JC-1), ATP (luminescence), and mitochondrial ultrastructure. PPAR-γ, phospho-PPAR-γ, PPAR-γ coactivator (PGC)-1α, Parkin (Park2), p62, and light chain (LC)3β were investigated using Western blots. PPAR-γ was modulated using the agonists rosiglitazone, pioglitazone, and troglitazone. Mitochondrial destabilization increased with H2O2 concentration, ATP decreased (2 and 18 h; P < 0.05), Mitotracker red and JC-1 fluorescence indicated loss of mitochondrial membrane potential, and superoxide increased (18 h, P < 0.05). Electron microscopy indicated sparse mitochondria, with disrupted cristae. Mitophagy was evident at 2 h (Park2 and LC3β increased; p62 decreased). Impaired mitophagy was indicated by p62 accumulation at 18 h ( P < 0.05). PPAR-γ expression decreased, phospho-PPAR-γ increased, and PGC-1α decreased (2 h), indicating aberrant PPAR-γ activation and reduced mitochondrial biogenesis. Cell viability decreased (2 and 18 h, P < 0.05). PPAR-γ agonists promoted further apoptosis. In summary, oxidative stress promoted mitochondrial destabilisation in kidney PTE, in association with increased PPAR-γ phosphorylation. PPAR-γ agonists failed to protect PTE. Despite positive effects in other tissues, PPAR-γ activation appears to be detrimental to kidney PTE health when oxidative stress induces damage.
Collecting duct-specific knockout of renin attenuates angiotensin II-induced hypertension
Authors: Ramkumar Nirupama , Stuart Deborah , Rees Sara , Hoek Alfred Van , Sigmund Curt D. , Kohan Donald E.
Published: August 2014

The physiological and pathophysiological significance of collecting duct (CD)-derived renin, particularly as it relates to blood pressure (BP) regulation, is unknown. To address this question, we generated CD-specific renin knockout (KO) mice and examined BP and renal salt and water excretion. Mice containing loxP-flanked exon 1 of the renin gene were crossed with mice transgenic for aquaporin-2-Cre recombinase to achieve CD-specific renin KO. Compared with controls, CD renin KO mice had 70% lower medullary renin mRNA and 90% lower renin mRNA in microdissected cortical CD. Urinary renin levels were significantly lower in KO mice (45% of control levels) while plasma renin concentration was significantly higher in KO mice (63% higher than controls) during normal-Na intake. While no observable differences were noted in BP between the two groups with varying Na intake, infusion of angiotensin II at 400 ng·kg−1·min−1 resulted in an attenuated hypertensive response in the KO mice (mean arterial pressure 111 ± 4 mmHg in KO vs. 128 ± 3 mmHg in controls). Urinary renin excretion and epithelial Na+ channel (ENaC) remained significantly lower in the KO mice following ANG II infusion compared with controls. Furthermore, membrane-associated ENaC protein levels were significantly lower in KO mice following ANG II infusion. These findings suggest that CD renin modulates BP in ANG II-infused hypertension and these effects are associated with changes in ENaC expression.
Radial-tangential anisotropy of crowding in the early visual areas
Authors: Kwon MiYoung , Bao Pinglei , Millin Rachel , Tjan Bosco S.
Published: August 2014

Crowding, the inability to recognize an individual object in clutter (Bouma H. Nature 226: 177–178, 1970), is considered a major impediment to object recognition in peripheral vision. Despite its significance, the cortical loci of crowding are not well understood. In particular, the role of the primary visual cortex (V1) remains unclear. Here we utilize a diagnostic feature of crowding to identify the earliest cortical locus of crowding. Controlling for other factors, radially arranged flankers induce more crowding than tangentially arranged ones (Toet A, Levi DM. Vision Res 32: 1349–1357, 1992). We used functional magnetic resonance imaging (fMRI) to measure the change in mean blood oxygenation level-dependent (BOLD) response due to the addition of a middle letter between a pair of radially or tangentially arranged flankers. Consistent with the previous finding that crowding is associated with a reduced BOLD response [Millin R, Arman AC, Chung ST, Tjan BS. Cereb Cortex (July 5, 2013). doi:10.1093/cercor/bht159], we found that the BOLD signal evoked by the middle letter depended on the arrangement of the flankers: less BOLD response was associated with adding the middle letter between radially arranged flankers compared with adding it between tangentially arranged flankers. This anisotropy in BOLD response was present as early as V1 and remained significant in downstream areas. The effect was observed while subjects' attention was diverted away from the testing stimuli. Contrast detection threshold for the middle letter was unaffected by flanker arrangement, ruling out surround suppression of contrast response as a major factor in the observed BOLD anisotropy. Our findings support the view that V1 contributes to crowding.
The irregular firing properties of thalamic head direction cells mediate turn-specific modulation of the directional tuning curve
Authors: Tsanov Marian , Chah Ehsan , Noor Muhammad S. , Egan Catriona , Reilly Richard B. , Aggleton John P. , Erichsen Jonathan T. , Vann Seralynne D. , O'Mara Shane M.
Published: August 2014

Head direction cells encode an animal's heading in the horizontal plane. However, it is not clear why the directionality of a cell's mean firing rate differs for clockwise, compared with counterclockwise, head turns (this difference is known as the “separation angle”) in anterior thalamus. Here we investigated in freely behaving rats whether intrinsic neuronal firing properties are linked to this phenomenon. We found a positive correlation between the separation angle and the spiking variability of thalamic head direction cells. To test whether this link is driven by hyperpolarization-inducing currents, we investigated the effect of thalamic reticular inhibition during high-voltage spindles on directional spiking. While the selective directional firing of thalamic neurons was preserved, we found no evidence for entrainment of thalamic head direction cells by high-voltage spindle oscillations. We then examined the role of depolarization-inducing currents in the formation of separation angle. Using a single-compartment Hodgkin-Huxley model, we show that modeled neurons fire with higher frequencies during the ascending phase of sinusoidal current injection (mimicking the head direction tuning curve) when simulated with higher high-threshold calcium channel conductance. These findings demonstrate that the turn-specific encoding of directional signal strongly depends on the ability of thalamic neurons to fire irregularly in response to sinusoidal excitatory activation. Another crucial factor for inducing phase lead to sinusoidal current injection was the presence of spike-frequency adaptation current in the modeled neurons. Our data support a model in which intrinsic biophysical properties of thalamic neurons mediate the physiological encoding of directional information.
Consensus Tracking for Multiagent Systems with Nonlinear Dynamics
Authors: Dong Runsha
Published: August 2014

This paper concerns the problem of consensus tracking for multiagent systems with a dynamical leader. In particular, it proposes the corresponding explicit control laws for multiple first-order nonlinear systems, second-order nonlinear systems, and quite general nonlinear systems based on the leader-follower and the tree shaped network topologies. Several numerical simulations are given to verify the theoretical results.
Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis
Authors: Saber Aly , Hokkam Emad N.
Published: August 2014

Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies.Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction.Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient’s satisfaction.Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient’s satisfaction was92.66±6.8in group A compared with75.34±12.85in group B.Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.
Surgical Cryoablation of Drug Resistant Ventricular Tachycardia and Aneurysmectomy of Postinfarction Left Ventricular Aneurysm
Authors: Pojar Marek , Harrer Jan , Omran Nedal , Vobornik Martin
Published: August 2014

Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function. Ventricular tachycardia is a common and a negative prognostic factor in patients with endocardial scarring following myocardial infarction and aneurysm formation. The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago. The patient was admitted to the hospital with sustained ventricular tachycardia despite maximal pharmacotherapy and also underwent unsuccessful percutaneous radiofrequency ablation in the right ventricle. Transthoracic echocardiography revealed left ventricle dysfunction with ejection fraction of 25%, aneurysm of the apex of the left ventricle with thrombus formation inside the aneurysm. Surgical therapy consisted of the cryoablation applied at the transitional zone of the scar and viable tissue and the resection of the aneurysm. The patient remained free of any ventricular tachycardia four months later.
Low-Salt Intake during Mating or Gestation in Rats Is Associated with Low Birth and Survival Rates of Babies
Authors: Chou Ranna , Hara Anna , Du DongDong , Shimizu Namiko , Sakuyama Hiroe , Uehara Yoshio
Published: August 2014

We investigated the influence of maternal salt restriction during mating or gestation on birth rate and offspring growth in Dahl salt-sensitive rats (DS). DS were divided into 5 groups: DS fed a low-salt (0.3% NaCl, w/w) (DS-low) or high-salt (4% NaCl, w/w) diet (DS-high) during mating and DS-high or DS-low during gestation, and DS fed regular chow (0.75% NaCl, w/w) (DS-regular) throughout mating and gestation. During the unspecified periods, the rats were given regular chow. DS-low during mating delivered fewer infants than high-salt mothers (P<0.05). The birth rate on regular chow was 87%. Six out of 11 DS-low rats during pregnancy produced pups while the rats fed a high-salt diet all delivered pups (P<0.025). The pup survival rate was 67% for high-salt mothers during mating and 54% for mothers on a low-salt diet. The pup survival rate was 95% for mothers on a high-salt diet during pregnancy and 64% for mothers on a low-salt diet (P<0.0001). Seven out of 8 DS-regular rats during mating delivered 59 neonates. However, 66% of the neonates survived. A low-salt diet during mating or pregnancy lowers birth rate and the neonates from low-salt mothers during pregnancy were more likely to die than those from high-salt mothers.
CSF Biomarkers of Alzheimer’s Disease: Impact on Disease Concept, Diagnosis, and Clinical Trial Design
Authors: Fagan Anne M.
Published: August 2014

Data from clinicopathologic and biomarker studies have converged to support the view of Alzheimer’s disease (AD) as a continuum, with pathology developing decades prior to the onset of cognitive symptoms which culminate as dementia at the end stage of the disease. This concept is impacting disease nomenclature, diagnostic criteria, prognostic potential, and clinical trial design. Revisions to diagnostic criteria to incorporate biomarker results have recently been proposed in order to increase the confidence of AD as the underlying etiology of a clinical impairment and to permit a diagnosis of AD across the disease continuum, eventually perhaps in the asymptomatic period. Individuals in this preclinical stage are receiving intense focus as a targeted population for secondary prevention trials aimed at identifying disease-modifying therapies that have the best chance of preserving normal cognitive function. The goal is to bring validated biomarkers to clinical practice for the purpose of disease diagnosis, prognosis, and evaluation of therapeutic efficacy once disease-modifying treatments become available. Realization of this goal requires worldwide biomarker standardization efforts, consensus among researchers and clinicians regarding the clinical utility of assessing biomarkers in patient care settings, and eventually the endorsement and adoption of such procedures and practices into global health care systems.
Successful Antiviral Triple Therapy in a Longstanding Refractory Hepatitis C Virus Infection with an Acute Kidney Injury
Authors: Callau Monje David , Braun Niko , Latus Joerg , Amann Kerstin , Alscher Mark Dominik , Kimmel Martin
Published: August 2014

Introduction.The HCV infection is a common disease with many chronically infected patients worldwide. So far, the standard therapy of a chronic HCV infection consisted of interferon as single therapy or in combination with ribavirin. After approval of the two protease inhibitors, boceprevir and telaprevir, the standard therapy for patients with genotype 1 changed. In patients with acute kidney injury (AKI) these therapies are not approved and have so far not been evaluated in studies.Case Report.In April 2012, a 58-year-old female was admitted due to a cryoglobulin-positive chronic HCV infection which had been treated with interferon and ribavirin. Currently, the patient was admitted because of severe complications with an acute kidney injury. We treated our patient successfully with a boceprevir based triple therapy.Conclusion.Limited data suggests that a therapy with ribavirin in patients with AKI seems to be safe under close monitoring. Our patient was treated successfully with a protease inhibitor based triple therapy. Nevertheless, it is necessary to plan an interventional study to evaluate the exact risk-benefit profile of triple therapy regimens in patients with AKI and hepatitis C.
Tension Pneumocephalus Related to Radiotherapy for Nasopharyngeal Carcinoma
Authors: Jimenez-Jimenez Esther , Martí Sebastià Sabater , Villas M. Victoria
Published: August 2014

Introduction.Tension pneumocephalus (TP) is a very rare complication related to radiotherapy for nasopharyngeal carcinoma (NPC).Case Presentation.A 46-year-old man was admitted to the hospital with an altered mental status and aqueous rhinorrhea for several hours of evolution. The computed tomography (CT) scan showed TP, a defect in the skull base and nasocranial fistula. The patient was receiving a second course of radiotherapy for local relapse. With medical treatment the patient recovered neurological status but died two days later.Discussion.In our knowledge, only 4 cases with similar characteristics have been reported in the literature. This is the first case report of TP during radiotherapy. TP was an abrupt and rapid process with neurological impairment for hours of evolution without suspicious osteoradionecrosis (OR) in previous scan images. The defect in the skull base could be due to a rapid disappearance of the tumor. The appearance of aqueous rhinorrhea and neurological symptoms must be viewed as signs of alarm.
A Metabolic Study on Colon Cancer Using1H Nuclear Magnetic Resonance Spectroscopy
Authors: Zamani Zahra , Arjmand Mohammad , Vahabi Farideh , Eshaq Hosseini Seyed Mahmood , Fazeli Sadegh Mohammad , Iravani Ayda , Bayat Parastoo , Oghalayee Akbar , Mehrabanfar Mahshid , Haj Hosseini Reza , Tashakorpour Mohammad , Tafazzoli Mohsen , Sadeghi Sedigheh
Published: August 2014

Background. Colorectal carcinoma is the third cause of cancer deaths in the world. For diagnosis, invasive methods like colonoscopy and sigmoidoscopy are used, and noninvasive screening tests are not very accurate. We decided to study the potential of1HNMR spectroscopy with metabolomics and chemometrics as a preliminary noninvasive test. We obtained a distinguishing pattern of metabolites and metabolic pathways between colon cancer patient and normal.Methods. Sera were obtained from confirmed colon cancer patients and the same number of healthy controls. Samples were sent for1HNMR spectroscopy and analysis was carried out Chenomex and MATLAB software. Metabolites were identified using Human Metabolic Data Base (HDMB) and the main metabolic cycles were identified using Metaboanalyst software.Results. 15 metabolites were identified such as pyridoxine, orotidine, and taurocholic acid. Main metabolic cycles involved were the bile acid biosynthesis, vitamin B6 metabolism, methane metabolism, and glutathione metabolism.Discussion. The main detected metabolic cycles were also reported earlier in different cancers. Our observations corroborated earlier studies that suggest the importance of lowering serum LCA/DCA and increasing vitamin B6 intake to help prevent colon cancer. This work can be looked upon as a preliminary step in using1HNMR analysis as a screening test before invasive procedures.
Atypical Presentation of PKDL due toLeishmania infantumin an HIV-Infected Patient with Relapsing Visceral Leishmaniasis
Authors: Celesia Benedetto Maurizio , Cacopardo Bruno , Massimino Daniela , Gussio Maria , Tosto Salvatore , Nunnari Giuseppe , Pinzone Marilia Rita
Published: August 2014

We describe the case of an Italian patient with HIV infection who developed an atypical rash resembling post-kala-azar dermal leishmaniasis (PKDL) when receiving liposomal Amphotericin B (L-AMB) for secondary prophylaxis of visceral leishmaniasis (VL). At the time of PKDL appearance, the patient was virologically suppressed but had failed to restore an adequate CD4+ T-cell count. Histology of skin lesions revealed the presence of a granulomatous infiltrate, with lymphocytes, plasma cells, and macrophages, most of which containedLeishmaniaamastigotes. Restriction fragment length polymorphism-polymerase chain reaction was positive forLeishmania infantum. Paradoxically, cutaneous lesions markedly improved when a new relapse of VL occurred. The patient received meglumine antimoniate, with a rapid clinical response and complete disappearance of cutaneous rash. Unfortunately, the patient had several relapses of VL over the following years, though the interval between them has become wider after restarting maintenance therapy with L-AMB 4 mg/kg/day once a month. Even if rare, PKDL due toLeishmania infantummay occur in Western countries and represents a diagnostic and therapeutic challenge for physicians. The therapeutic management of both PKDL and VL in HIV infection is challenging, because relapses are frequent and evidence is often limited to small case series and case reports.
Effect of Tillage Practices on Soil Properties and Crop Productivity in Wheat-Mungbean-Rice Cropping System under Subtropical Climatic Conditions
Authors: Alam Md. Khairul , Islam Md. Monirul , Salahin Nazmus , Hasanuzzaman Mirza
Published: August 2014

This study was conducted to know cropping cycles required to improve OM status in soil and to investigate the effects of medium-term tillage practices on soil properties and crop yields in Grey Terrace soil of Bangladesh under wheat-mungbean-T.amancropping system. Four different tillage practices, namely, zero tillage (ZT), minimum tillage (MT), conventional tillage (CT), and deep tillage (DT), were studied in a randomized complete block (RCB) design with four replications. Tillage practices showed positive effects on soil properties and crop yields. After four cropping cycles, the highest OM accumulation, the maximum root mass density (0–15 cm soil depth), and the improved physical and chemical properties were recorded in the conservational tillage practices. Bulk and particle densities were decreased due to tillage practices, having the highest reduction of these properties and the highest increase of porosity and field capacity in zero tillage. The highest total N, P, K, and S in their available forms were recorded in zero tillage. All tillage practices showed similar yield after four years of cropping cycles. Therefore, we conclude that zero tillage with 20% residue retention was found to be suitable for soil health and achieving optimum yield under the cropping system in Grey Terrace soil (Aeric Albaquept).
Alpine Cold Vegetation Response to Climate Change in the Western Nyainqentanglha Range in 1972–2009
Authors: Wang Xu , Sun Ziyong , Zhou Ai-Guo
Published: August 2014

The Tibetan Plateau is regarded as one of the most climatic-sensitive regions all over the world. Long-term remote sensing data enable us to monitor spatial-temporal change in this area. The vegetation changes of the western Nyainqentanglha region were detected by using RS and GIS techniques. And the vegetation coverage was derived by the NDVI-SMA (spectral mixture analysis) methods. An incensement of vegetation was observed in the mountain areas during 1972–2009 with a mean vegetation coverage of 24.87%, 35.89%, and 42.88% in 30/09/1972, 14/09/1991, and 30/08/2009, respectively. The vegetation fraction increased by 18% in the period of 1972–2009. The bin with the elevation between 4400 and 5200 m had the highest vegetation coverage. This may be the result of the mountain effect. Alpine vegetation had a trend to increase and expand to higher altitudes with the climate change in the past 40 years. The variation appears to be associated with an increase in mean temperature of 0.05°C per year and an increase in precipitation of 1.83 mm per year in the growing season of the past four decades. The results provide further evidence of alpine ecosystem change due to climate change in the central Tibetan Plateau.
Acute Pancreatitis as the Initial Presentation of Systematic Lupus Erythematosus
Authors: Jia Yi , Ortiz Arleen , Mccallum Richard , Salameh Hasan , Serrato Pedro
Published: August 2014

Systematic lupus erythematosus (SLE) is a multisystem disease, including the gastrointestinal system in about half of SLE patients. As a rare complication of SLE, acute pancreatitis presents as generalized flare-ups in most cases of patients previously diagnosed with SLE. Here we report a rare case of acute pancreatitis as the initial presentation with later diagnosis of SLE.