bluuebunny/crossref_metadata_2025 huggingface dataset:
BolA Is a Transcriptional Switch That Turns Off Motility and Turns On Biofilm Development
Authors: Dressaire Clémentine , Moreira Ricardo Neves , Barahona Susana , Alves de Matos António Pedro , Arraiano Cecília Maria
Published: February 2015

Bacteria are extremely versatile organisms that rapidly adapt to changing environments. When bacterial cells switch from planktonic growth to biofilm, flagellum formation is turned off and the production of fimbriae and extracellular polysaccharides is switched on. BolA is present in most Gram-negative bacteria, and homologues can be found from proteobacteria to eukaryotes. Here, we show that BolA is a new bacterial transcription factor that modulates the switch from a planktonic to a sessile lifestyle. It negatively modulates flagellar biosynthesis and swimming capacity in
Escherichia coli
. Furthermore, BolA overexpression favors biofilm formation, involving the production of fimbria-like adhesins and curli. Our results also demonstrate that BolA is a protein with high affinity to DNA and is able to regulate many genes on a genome-wide scale. Moreover, we show that the most significant targets of this protein involve a complex network of genes encoding proteins related to biofilm development. Herein, we propose that BolA is a motile/adhesive transcriptional switch, specifically involved in the transition between the planktonic and the attachment stage of biofilm formation.

IMPORTANCE
Escherichia coli
cells possess several mechanisms to cope with stresses. BolA has been described as a protein important for survival in late stages of bacterial growth and under harsh environmental conditions. BolA-like proteins are widely conserved from prokaryotes to eukaryotes. Although their exact function is not fully established at the molecular level, they seem to be involved in cell proliferation or cell cycle regulation. Here, we unraveled the role of BolA in biofilm development and bacterial motility. Our work suggests that BolA actively contributes to the decision of bacteria to arrest flagellar production and initiate the attachment to form structured communities, such as biofilms. The molecular studies of different lifestyles coupled with the comprehension of the BolA functions may be an important step for future perspectives, with health care and biotechnology applications.
Complication characteristics between young-onset type 2 versus type 1 diabetes in a UK population
Authors: Song Soon H
Published: February 2015

Background

In the UK, the care of young people with diabetes has focused predominantly on type 1 diabetes (T1D). However, young-onset T2D has become increasingly prevalent. At present, it is unclear which type of diabetes represents the more adverse phenotype to develop complications. This study aims to determine the complication burden and its predictive factors in young-onset T2D compared with T1D.

Methods

A cross-sectional study using a hospital diabetes register to identify patients with young-onset T2D and T1D. Young-onset T2D was defined as age of diagnosis below 40 years. The T1D cohort with a similar age of diagnosis was used as a comparator. Data from the last clinic visit was used for analysis. Clinical characteristics and diabetes complications were evaluated at diabetes durations <10, 10–20, and >20 years. Predictive factors for diabetes complications (age, sex, glycated hemoglobin, creatinine, diabetes duration, hypertension, dyslipidemia, and body mass index >25) were determined by logistic regression analysis.

Results

Data were collected on 1287 patients, of which 760 and 527 had T1D and T2D, respectively. In all diabetes durations, the T2D cohort had an older age of onset (p<0.0005) with a higher prevalence of obesity, hypertension, and dyslipidemia (all p<0.0005) while glycemic control was similar in both groups. Cardiovascular disease (p<0.005) and neuropathy (p<0.05) were more prevalent in the young-onset T2D cohort in all diabetes durations. There was no difference in retinopathy. Cardiovascular disease was predominantly due to ischemic heart disease. Stroke and peripheral vascular disease became significantly higher in T2D after 20 years duration. After controlling for traditional risk factors, young-onset T2D was an independent predictor for cardiovascular disease (p<0.005) and neuropathy (p<0.05) but not for retinopathy.

Conclusions

Young-onset T2D is a more aggressive phenotype than T1D to develop diabetes complications, particularly for ischemic heart disease and neuropathy.
Improving outcomes in patients with coexisting multimorbid conditions—the development and evaluation of the combined diabetes and renal control trial (C-DIRECT): study protocol
Authors: Griva Konstadina , Mooppil Nandakumar , Khoo Eric , Lee Vanessa Yin Woan , Kang Augustine Wee Cheng , Newman Stanton P
Published: February 2015

Introduction

Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD). Patients with diabetes on dialysis have worse clinical outcomes and increased psychological burden. The need to manage the combined treatment demands for both conditions is particularly challenging yet there is paucity of data of the barriers preventing optimal management to combined therapy for diabetes and kidney failure. The study aims to explore needs of patients and develop an intervention to enable people with diabetes and ESRD to better manage both their conditions.

Methods and analysis

A two-phase study comprising a mixed method observational study (phase I) and a feasibility trial (phase II). Phase I will seek to document outcomes and needs of the population (patients with DM-ESRD) and seek input on preferred delivery/implementation for the programme. Data will be collected with in-depth interviews with patients, caregivers and healthcare providers (N=50), and from a questionnaire-based survey (N=170). Phase 2 will build on these data to design and test the feasibility of a practical, low-intensity, clinic-integrated intervention using a self-management paradigm. The intervention will primarily seek to support behavioural change so as to improve adherence and clinical outcomes for DM as well as for ESRD. For the feasibility trial, we will be evaluating acceptability, retention and completion rates of the programme.

Ethics and dissemination

The study protocol has been approved by the local ethics committee and written informed consent is required from every participant. Findings will be disseminated through journals, conferences and will be used to create a fully manualised intervention (materials) and training course for facilitators.
A randomised controlled study of the long-term effects of exercise training on mortality in elderly people: study protocol for the Generation 100 study
Authors: Stensvold Dorthe , Viken Hallgeir , Rognmo Øivind , Skogvoll Eirik , Steinshamn Sigurd , Vatten Lars J , Coombes Jeff S , Anderssen Sigmund A , Magnussen Jon , Ingebrigtsen Jan Erik , Fiatarone Singh Maria A , Langhammer Arnulf , Støylen Asbjørn , Helbostad Jorunn L , Wisløff Ulrik
Published: February 2015

Introduction

Epidemiological studies suggest that exercise has a tremendous preventative effect on morbidity and premature death, but these findings need to be confirmed by randomised trials. Generation 100 is a randomised, controlled study where the primary aim is to evaluate the effects of 5 years of exercise training on mortality in an elderly population.

Methods and analysis

All men and women born in the years 1936–1942 (n=6966), who were residents of Trondheim, Norway, were invited to participate. Between August 2012 and June 2013, a total of 1567 individuals (790 women) were included and randomised to either 5 years of two weekly sessions of high-intensity training (10 min warm-up followed by 4×4 min intervals at ∼90% of peak heart rate) or, moderate-intensity training (50 min of continuous work at ∼70% of peak heart rate), or to a control group that followed physical activity advice according to national recommendations. Clinical examinations, physical tests and questionnaires will be administered to all participants at baseline, and after 1, 3 and 5 years. Participants will also be followed up by linking to health registries until year 2035.

Ethics and dissemination

The study has been conducted according to the SPIRIT statement. All participants signed a written consent form, and the study has been approved by the Regional Committee for Medical Research Ethics, Norway. Projects such as this are warranted in the literature, and we expect that data from this study will result in numerous papers published in world-leading clinical journals; we will also present the results at international and national conferences.

Trial registration number

Clinical trial govNCT01666340.
The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale
Authors: Duff Putu , Shoveller Jean , Dobrer Sabina , Ogilvie Gina , Montaner Julio , Chettiar Jill , Shannon Kate
Published: February 2015

Background

This study aims to report on a newly developedSafer Indoor Work Environmental Scalethat characterises the social, policy and physical features of indoor venues and social cohesion; and using this scale, longitudinally evaluate the association between these features on sex workers’ (SWs’) condom use for pregnancy prevention.

Methods

Drawing on a prospective open cohort of female SWs working in indoor venues, a newly developedSafer Indoor Work Environment Scalewas used to build six multivariable models with generalised estimating equations (GEE), to determine the independent effects of social, policy and physical venue-based features and social cohesion on condom use.

Results

Of 588 indoor SWs, 63.6% used condoms for pregnancy prevention in the last month. In multivariable GEE analysis, the following venue-based features were significantly correlated with barrier contraceptive use for pregnancy prevention: managerial practices and venue safety policies (adjusted OR (AOR)=1.09; 95% CI 1.01 to 1.17), access to sexual and reproductive health services/supplies (AOR=1.10; 95% CI 1.00 to 1.20), access to drug harm reduction (AOR=1.13; 95% CI 1.01 to 1.28) and social cohesion among workers (AOR=1.05; 95% CI 1.03 to 1.07). Access to security features was marginally associated with condom use (AOR=1.13; 95% CI 0.99 to 1.29).

Conclusions

The findings of the current study highlight how work environment and social cohesion among SWs are related to improved condom use. Given global calls for the decriminalisation of sex work, and potential legislative reforms in Canada, this study points to the critical need for new institutional arrangements (eg, legal and regulatory frameworks; labour standards) to support safer sex workplaces.
Socioeconomic status is positively associated with measures of adiposity and insulin resistance, but inversely associated with dyslipidaemia in Colombian children
Authors: Buitrago-Lopez Adriana , van den Hooven Edith H , Rueda-Clausen Christian F , Serrano Norma , Ruiz Alvaro J , Pereira Mark A , Mueller Noel T
Published: February 2015

Background

Low socioeconomic status (SES) has been associated with higher risk of cardiometabolic diseases in developed societies, but investigation of SES and cardiometabolic risk in children in less economically developed populations is sparse. We aimed to examine associations among SES and cardiometabolic risk factors in Colombian children.

Methods

We used data from a population-based study of 1282 children aged 6–10 years from Bucaramanga, Colombia. SES was classified according to household wealth, living conditions and access to public utilities. Anthropometric and biochemical parameters were measured at a clinic visit. Cardiometabolic risk factors were analysed continuously using linear regression and as binary outcomes—according to established paediatric cut points—using logistic regression to calculate OR and 95% CIs.

Results

Mean age of the children was 8.4 (SD 1.4) and 51.1% of the sample were boys. Odds of overweight/obesity, abdominal obesity and insulin resistance were greater among higher SES. Compared with the lowest SES stratum, children in the highest SES had higher odds of overweight/obesity (OR=3.25, 95% CI 1.89 to 5.57), abdominal obesity (OR=2.74, 95% CI 1.41 to 5.31) and insulin resistance (OR=2.60, 95% CI 1.81 to 3.71). In contrast, children in the highest SES had lower odds of hypertriglyceridaemia (triglycerides ≥90th centile; OR=0.28, 95% CI 0.14 to 0.54) and low (≤10th centile) high-density lipoprotein (HDL) cholesterol (OR=0.35, 95% CI 0.15 to 0.78).

Conclusions

In Colombian children, SES is directly associated with obesity and insulin resistance, but inversely associated with dyslipidaemia (hypertriglyceridaemia and low HDL cholesterol). Our findings highlight the need to analyse cardiometabolic risk factors separately in children and to carefully consider a population's level of economic development when studying their social determinants of cardiometabolic disease.
Socioeconomic marginalisation in the structural production of vulnerability to violence among people who use illicit drugs
Authors: Richardson Lindsey A , Long Cathy , DeBeck Kora , Nguyen Paul , Milloy M-J S , Wood Evan , Kerr Thomas H
Published: February 2015

Objective

Many people who use illicit drugs (PWUD) face challenges to their financial stability. Resulting activities that PWUD undertake to generate income may increase their vulnerability to violence. We therefore examined the relationship between income generation and exposure to violence across a wide range of income generating activities among HIV-positive and HIV-negative PWUD living in Vancouver, Canada.

Methods

Data were derived from cohorts of HIV-seropositive and HIV-seronegative PWUD (n=1876) between December 2005 and November 2012. We estimated the relationship between different types of income generation and suffering physical or sexual violence using bivariate and multivariate generalised estimating equations, as well as the characteristics of violent interactions.

Results

Exposure to violence was reported among 977 (52%) study participants over the study period. In multivariate models controlling for sociodemographic characteristics, mental health status, and drug use patterns, violence was independently and positively associated with participation in street-based income generation activities (ie, recycling, squeegeeing and panhandling; adjusted OR (AOR)=1.39, 95% CI 1.23 to 1.57), sex work (AOR=1.23, 95% CI 1.00 to 1.50), drug dealing (AOR=1.63, 95% CI 1.44 to 1.84), and theft and other acquisitive criminal activity (AOR=1.51, 95% CI 1.27 to 1.80). Engagement in regular, self-employment or temporary employment was not associated with being exposed to violence. Strangers were the most common perpetrators of violence (46.7%) and beatings the most common type of exposure (70.8%).

Conclusions

These results suggest that economic activities expose individuals to contexts associated with social and structural vulnerability to violence. The creation of safe economic opportunities which can minimise vulnerability to violence among PWUD is therefore urgently required.
Republished: Reversible changes in diffusion- and perfusion-based imaging in cerebral venous sinus thrombosis
Authors: Lin Ning , Wong Andrew K , Lipinski Lindsay J , Mokin Maxim , Siddiqui Adnan H
Published: February 2015

Diffusion- and perfusion-based imaging studies are regularly used in patients with ischemic stroke. Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and is primarily treated by systemic anticoagulation. Endovascular intervention can be considered in cases of failed medical therapy, yet the prognostic value of diffusion- and perfusion-based imaging for CVST has not been clearly established. We present a patient with CVST whose abnormal findings on MRI and CT perfusion images were largely reversed after endovascular treatment.
A systematic review of ICD complications in randomised controlled trials versus registries: is our ‘real-world’ data an underestimation?
Authors: Ezzat Vivienne A , Lee Victor , Ahsan Syed , Chow Anthony W , Segal Oliver , Rowland Edward , Lowe Martin D , Lambiase Pier D
Published: February 2015

Implantable cardioverter defibrillator (ICD) implantation carries a significant risk of complications, however published estimates appear inconsistent. We aimed to present a contemporary systematic review using meta-analysis methods of ICD complications in randomised controlled trials (RCTs) and compare it to recent data from the largest international ICD registry, the US National Cardiovascular Data Registry (NCDR).

PubMed was searched for any RCTs involving ICD implantation published 1999–2013; 18 were identified for analysis including 6433 patients, mean follow-up 3 months–5.6 years. Exclusion criteria were studies of children, hypertrophic cardiomyopathy, congenital heart disease, resynchronisation therapy and generator changes.

Total pooled complication rate from the RCTs (excluding inappropriate shocks) was 9.1%, including displacement 3.1%, pneumothorax 1.1% and haematoma 1.2%. Infection rate was 1.5%.There were no predictors of complications but longer follow-up showed a trend to higher complication rates (p=0.07). In contrast, data from the NCDR ICD, reporting on 356 515 implants (2006–2010) showed a statistically significant threefold lower total major complication rate of 3.08% with lead displacement 1.02%, haematoma 0.86% and pneumothorax 0.44%.

The overall ICD complication rate in our meta-analysis is 9.1% over 16 months. The ICD complication reported in the NCDR ICD registry is significantly lower despite a similar population. This may reflect under-reporting of complications in registries. Reporting of ICD complications in RCTs and registries is very variable and there is a need to standardise classification of complications internationally.
Recurrent thrombo-embolic episodes: the association of cholangiocarcinoma with antiphospholipid syndrome
Authors: Samadian S , Estcourt L
Published: February 2015

Antiphospholipid syndrome is a disorder of recurrent vascular thrombosis, pregnancy loss and thrombocytopenia associated with persistently elevated levels of antiphospholipid antibodies. It was first described in a group of patients with systemic lupus erythematosus but has since been associated with a wide range of conditions, including other autoimmune disorders and malignancy. It can also occur in isolation, the so-called primary antiphospholipid syndrome. We describe an elderly woman with the antiphospholipid syndrome thought to be associated with a cholangiocarcinoma.
Osmosis, osmometry, and osmoregulation
Authors: Lord R C C
Published: February 2015

The maintenance of adequate body fluid volume and the correct distribution of this fluid between the body compartments is a critical part of homeostasis. The process of osmosis plays an important role in movement of fluid within the body and the use of osmometry is an important part of the management of many patients. In addition to the application of osmometry to the measurement of body fluids, most commonly plasma and urine, osmotic action plays a part in some therapeutic actions of drugs and its strength needs to be quantified in fluids administered to patients. Unfortunately confusion often exists in the various terms that are used in the field of osmometry. This review aims to explain the different terms used, the laboratory methodology involved in osmometry, and the clinical application and interpretation of the results obtained.
Delays by patients in seeking treatment for acute chest pain: implications for achieving earlier thrombolysis
Authors: Mumford Andrew D , Warr Kim V , Owen Sandra J , Fraser Alan G
Published: February 2015

A study was set up to identify why patients delay seeking medical assistance after myocardial infarction. The study was performed in 100 consecutive patients with suspected acute myocardial infarction admitted to either the University Hospital of Wales, Cardiff, UK, or the Royal Jubilee Hospital, Victoria, British Columbia, Canada (50 patients from each centre). The main outcome measure was the delay from the onset of symptoms to admission to hospital. The mean total delay before admission was 385 minutes (SEM 45). The mean delay incurred by the patient in seeking assistance was 172 minutes (SEM 27), representing 45% of the total. Delay was longer in patients with crescendo angina and shorter in those later confirmed to have myocardial infarction. Patients with prior ischaemic heart disease (74% of patients) presented later than those with no such history. No other demographic or clinical factors predicted early or late presentation.

Delays in seeking medical assistance after the onset of severe chest pain contribute significantly to total delays in patients' hospital admission and thrombolysis. The unexpected observation that patients with known ischaemic heart disease delay longer before seeking help in spite of their frequent contact with doctors, suggests that opportunities for educating patients are being wasted. Major efforts are needed to understand and modify behaviour of patients with chest pain to further reduce delays in treatment.
Lack of response to octreotide in Cushing's syndrome due to metastatic adrenocortical carcinoma
Authors: Chan N N , Isaacs A J
Published: February 2015

Functional metastatic adrenocortical carcinoma is an uncommon cause of Cushing's syndrome, which rarely responds to conventional treatment. A patient presenting with Cushing's syndrome secondary to adrenocortical carcinoma underwent surgical resection. Post-operatively, she developed metastatic disease resistant to conventional chemotherapy. Octreotide, a somatostatin analogue which is effective in the treatment of several types of neuroendocrine tumour, was tried to ameliorate her secretory symptoms, but without any therapeutic effect.
Lemierre's syndrome (necrobacillosis)
Authors: Golpe Rafael , Marín Belén , Alonso Miguel
Published: February 2015

Lemierre's syndrome or postanginal septicaemia (necrobacillosis) is caused by an acute oropharyngeal infection with secondary septic thrombophlebitis of the internal jugular vein and frequent metastatic infections. Fusobacterium necrophorum is the most common pathogen isolated from the patients. The interval between the oropharyngeal infection and the onset of the septicaemia is usually short. The most common sites of septic embolisms are the lungs and joints, and other locations can be affected. A high degree of clinical suspicion is needed to diagnose the syndrome. Computed tomography of the neck with contrast is the most useful study to detect internal jugular vein thrombosis. Treatment includes intravenous antibiotic therapy and drainage of septic foci. The role of anticoagulation is controversial. Ligation or excision of the internal jugular vein may be needed in some cases.
Transient ischaemic attacks related to carotid stenosis precipitated by straining, bending, and sneezing
Authors: Harrison M J G
Published: February 2015

Three patients are described in whom one or more carotid territory transient ischaemic attacks (TIAs) were preceded by sneezing, straining, or bending over. It is argued that the mechanism involved dislodgment of embolic material from the site of carotid atheroma. This mechanism should be considered as an alternative to paradoxical embolism when TIAs are precipitated by such physiological manoeuvres. Furthermore, TIAs should be added to the list of medical hazards associated with such events.
Non-organic visual loss
Authors: Beatty S
Published: February 2015

Visual complaints without a physical basis are not uncommon presentations to the general physician, the neurologist, or the ophthalmologist. These alleged visual disturbances may be psychogenic or feigned. The diagnosis is made when all possible contributory pathology of the visual system is excluded, and reassurance remains the cornerstone of management.
Can the use of low-dose dopamine for treatment of acute renal failure be justified?
Authors: Burton Christopher J , Tomson Charles R V
Published: February 2015

The use of dopamine for the prevention and treatment of acute renal failure is widespread. Its use is based on physiology suggesting selective renal vasodilation when it is infused at low dose. This article reviews the available data on the clinical use of dopamine. When used to prevent acute renal failure in high-risk treatments there is no evidence of benefit of dopamine but, given the low incidence of significant renal failure, the studies are underpowered. In treatment of acute renal failure, the quality of the data is poor. Only in one small randomised trial of moderate acute renal failure in patients with malaria was a clinically significant benefit of dopamine shown. The rest of the data, in the form of case series, showed either no benefit of dopamine or small benefits of little clinical significance. Again, these studies are of insufficient power for conclusions to be drawn as to the overall benefits and risks. We conclude that benefits of dopamine use cannot be ruled out by currently available data but its use cannot be advised until trials examining clincally important endpoints in large numbers of patients have been performed.
Diagnostic approach to patients with suspected pulmonary embolism: a report from the real world
Authors: Saro G , Campo J F , Hernández M J , Anta M , Olmos J M , González-Macías J , Riancho J A
Published: February 2015

This study was carried out to examine the diagnostic approach to patients with suspected pulmonary embolism (PE) in a university hospital. A retrospective case record review of 251 patients with suspected pulmonary embolism was carried out according to a standard protocol, which looked at the utilisation of imaging techniques and compared clinical diagnoses with a standardised diagnosis established according to current recommendations. Isotopic lung scan was the most commonly used technique (73%), followed by leg vein sonography (36%) and contrast venography (31%). Lung arteriography was done in only 7% of patients. Among the 205 patients with a clinical diagnosis of PE, 115 (56%) would be diagnosed as having PE according to the standard criteria, 84 (41%) would be unclassified, and six (3%) would not be regarded as having PE. Among patients who were diagnosed as having PE and received anticoagulant therapy, 32% did not have the diagnosis confirmed by an imaging technique. Most of these had a non-diagnostic lung scan which, despite evidence to the contrary, seemed to be interpreted as confirmation of PE. We conclude that clinicians do not seem to follow current recommendations when approaching patients with suspected PE. In particular, there is an over-reliance on lung scans, and the significance of non-diagnostic scans was often misinterpreted. Arteriography was underused. These results emphasise the need to take measures to implement practice guidelines and to explore the usefulness of newer non-invasive techniques.
Hypoxaemia — think of the liver! Every internist should be aware of the hepatopulmonary syndrome
Authors: Mokhashi Mahesh S
Published: February 2015

Hepatopulmonary syndrome is characterised by arterial hypoxaemia, liver disease, and intrapulmonary vascular dilatation. A case is reported in which severe hypoxaemia, detected by chance, led to the diagnosis of liver disease and hepatopulmonary syndrome.
Massive pleural effusions in cryptococcal meningitis
Authors: Wong C M M , Lim K H , Liam C K
Published: February 2015

Cryptococcal infection uncommonly presents with pulmonary manifestations and even more rarely so as massive bilateral effusions. Pleural involvement is usually associated with underlying pulmonary parenchymal lesions and is unusual while on antifungal therapy. We report a patient with cryptococcal meningitis who, while on intravenous 5-flucytosine and amphotericin B, developed life-threatening bilateral massive pleural effusions with evidence of spontaneous resolution, consistent with prior hypothesis of antigenic stimulation as the cause of pleural involvement.
A large pelvic arteriovenous malformation in an adult patient with cystic fibrosis
Authors: Ledson M J , Wahbi Z , Harris P , Walshaw M J
Published: February 2015

We present a prepubertal male cystic fibrosis patient with high circulating oestrogen levels (as a consequence of severe cystic-fibrosis-related hepatobiliary disease) who subsequently developed a large pelvic arteriovenous malformation. This has not previously been described in patients with cystic fibrosis, despite the association between high oestrogen levels and arteriovenous malformations. The aetiology and treatment options of arteriovenous malformations are discussed.
Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes
Authors: Leong King Sun , Wallymahmed Maureen , Wilding John , MacFarlane Ian
Published: February 2015

In a clinic population of 509 type 1 diabetic patients aged 16–45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and Addison's disease was present in four patients (0.8%, one male). In all patients, type 1 diabetes preceded the diagnosis of the other autoimmune disorder. The clinical presentation of hypothyroidism was usually insidious with few symptoms, although an increased frequency of hypoglycaemic symptoms and/or raised serum cholesterol levels often prompted thyroid function testing. In contrast, the patients with thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg), palpable goitres, increasing insulin requirements, and low cholesterol levels. Six patients did not achieve remission or had recurrent thyrotoxicosis after oral antithyroid treatment and required131I or thyroid surgery. A family history of autoimmune disease was present in 25% of patients with thyroid disorders (seven thyrotoxic and one hypothyroid) and in three of the four patients with Addison's disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and Addison's disease should be carried out if there is clinical suspicion and/or unexplained changes in diabetic metabolic control or serum cholesterol. Careful follow-up of patients with a family history of these conditions is recommended.
A regional survey of chest drains: evidence-based practice?
Authors: Tang Augustine , Hooper Timothy , Hasan Ragheb
Published: February 2015

Although the use of chest drains is common in medicine, there appear to be wide variations in practice. A survey was therefore conducted to establish the current status of chest drain management in the Northwest region. A questionnaire targeted consultants practising in the specialties of chest medicine, general surgery, accident & emergency and cardiothoracic surgery. The questionnaire consisted of five sections encompassing aspects of the insertion, day-to-day care and removal of chest drains. With an overall response rate of 75.3% (110/146), important variations in every major aspect of the practice of chest drains were found between the specialties and to a large extent within each specialty. We have made a number of recommendations which aim to encourage good practice and reduce unnecessary complications, including the adoption of standardised protocols for inserting and managing chest drains.
Reversible cerebellar involvement in the idiopathic hypereosinophilic syndrome
Authors: Díaz Fernando , Collazos Julio
Published: February 2015

We report a patient with cerebellar manifestations due to the idiopathic hypereosinophilic syndrome, in whom magnetic resonance imaging (MRI) showed hyperintense lesions in both cerebellar hemispheres. Following steroids and hydroxyurea administration, the lesions on MRI disappeared, suggesting that the pathogenetic mechanism was reversible and did not cause significant structural damage. To our knowledge, the resolution of the abnormal MRI findings have not been reported to date in the idiopathic hypereosinophilic syndrome.
Extramedullary myeloid cell tumour: presentation as anterior chest wall mass during AML relapse
Authors: Wadhwa Jyoti , Gujral S , Kumar Lalit , Mohanti B K , Kochupillai Vinod
Published: February 2015

Acute myeloid leukaemia is an uncommon but an important cause of soft tissue swellings. Such extrameningeal, extramedullary leukaemic infiltrates are called extramedullary myeloid cell tumours. Despite their large size they may respond well to chemotherapy and local radiotherapy, as is demonstrated in this case.
Atherosclerotic renal artery stenosis: from diagnosis to treatment
Authors: Carmichael Paul , Carmichael Amtul R
Published: February 2015

Renovascular hypertension represents a form of correctable hypertension and preventable renal failure. Such patients need to be identified early so that specific therapy can be instigated. Patient identification requires a high index of suspicion in patients with certain clinical features. Subsequent non-invasive imaging may result in angiography which is required for diagnostic purposes and for planning intervention. Correctable therapy takes one of two forms, namely percutaneous transluminal renal angioplasty, with or without stenting, or surgical revascularisation, together with modification of underlying risk factors.
Medical restrictions to driving: the awareness of patients and doctors
Authors: Kelly Rosemary , Warke Timothy , Steele Ian
Published: February 2015

The study was set up to investigate the awareness of elderly patients and medical doctors of medical restrictions to driving. Separate questionnaires were completed by patients and doctors. All were interviewed face-to-face, without prior warning and their immediate answers were recorded. In total, 150 elderly patients from the acute elderly care wards, rehabilitation wards and day hospital, and 50 doctors (including all grades from consultant to junior house officer) were interviewed. The main outcome measures were numbers of patients currently driving and previously driving; patients' awareness of how their medical condition affected their ability to drive; doctors' spontaneous knowledge of medical conditions which restrict driving, current licensing policy, and restrictions for five specific medical conditions (epilepsy, myocardial infarction, stroke, 5-cm abdominal aortic aneurysm, and diabetes). Only 21 patients were current drivers, and six of these should not have been driving. While 103 perceived themselves eligible to drive, 46 had medical restrictions to driving. Seventeen of the 47 patients who perceived themselves not eligible to drive possibly did not have restrictions to driving. Doctors' knowledge of the current licensing policy and action to be taken if a patient was not eligible to drive was very poor. Knowledge of medical restrictions to driving was scanty, with few doctors giving the correct driving restrictions for the five specific conditions. We recommend that education of doctors regarding medical restrictions to driving should begin at an undergraduate level and be continued throughout their postgraduate career.
Extrinsic cerebral venous sinus obstruction resulting in intracranial hypertension
Authors: Goldsmith P , Burn D J , Coulthard A , Jenkins A
Published: February 2015

We report the case of a 70-year-old man reporting with headache and visual disturbances who was being treated for prostate cancer. Investigations showed him to have intracranial hypertension caused by venous sinus obstruction. Patients with metastatic disease and raised intracranial pressure in the absence of focal signs should be considered as possible cases of venous outflow obstruction.
Progressive supranuclear palsy (Steele-Richardson-Olszewski disease)
Authors: Morris Huw R , Wood Nicholas W , Lees Andrew J
Published: February 2015

Progressive supranuclear palsy is a neurodegenerative disease which affects the brainstem and basal ganglia. Patients present with disturbance of balance, a disorder of downward gaze and L-DOPA-unresponsive parkinsonism and usually develop progressive dysphagia and dysarthria leading to death from the complications of immobility and aspiration. Treatment remains largely supportive but, potentially, treatments based on cholinergic therapy may be useful. As in Alzheimer's disease, the neuronal degeneration is associated with the deposition of hyperphosphorylated tau protein as neurofibrillary tangles but there are important distinctions between the two diseases. Evidence from familial fronto-temporal dementia with parkinsonism linked to chromosome 17 suggests that tau protein deposition is a primary pathogenic event in some neurodegenerative diseases. The understanding of the mechanism of tau deposition in progressive supranuclear palsy is likely to be of importance in unravelling its aetiology.
Sudden unexpected death in epilepsy
Authors: Lhatoo S D , Langan Y , Sander J W A S
Published: February 2015

The majority of persons with epilepsy develop lasting remission from seizures, although mortality is significantly greater than that of the age-matched general population. Of the deaths that are thought to be directly related to seizures, sudden unexpected death in epilepsy is probably the commonest category; more so than status epilepticus or seizure-related accidents. Annual incidence rates vary from 1 in 200 patients with chronic epilepsy to about 1 in 1000 in more population-based studies. Young adults with severe, intractable epilepsy appear to be the most frequently affected group and may have even higher incidence rates. Other risk factors may also be important. An area of great research interest, several pathogenetic mechanisms have been postulated, centering mainly around cardiac rhythm and central hypoventilation. Given the frequent devastation caused by sudden unexpected death in epilepsy, the importance of seizure control is emphasised.
Challenges in changing to non-chlorofluorocarbon inhalers in the treatment of asthma
Authors: Walley T , Bundred P , Rannard A , Bogg J
Published: February 2015

The chlorofluorocarbon (CFC)-based metered dose inhaler, which has been the mainstay of the management of obstructive lung diseases, will soon be phased out world wide and replaced by CFC-free devices. Patients will have to be changed to the devices in a co-ordinated manner to avoid any risk to their health and safety. The different shapes and aerosol delivery characteristics of the new inhalers, as well as their distinctive taste, could add to the levels of poor drug use already experienced in asthma. From previous change scenarios in disease management, the potential for unstable asthma control is a real possibility with all the attendant costs. By using the time available before CFC-based inhalers are withdrawn, there is an opportunity to enhance asthma management during this period of change.
The Seamen's Hospital Society: a progenitor of the tropical institutions
Authors: Cook G C
Published: February 2015

1999 marks the centenary of the two major British Schools of Tropical Medicine, founded in London and Liverpool, respectively. The origin(s) of the former clearly lies in the Seamen's Hospital Society, which dates from 1821. It seems likely that the foundation of this school (with Government support) also acted as a catalyst for the school at Liverpool, which in fact opened its doors a few months before that in London.
Association between birth conditions and glucose and cortisol profiles of periparturient dairy cows and neonatal calves
Authors: Vannucchi C. I. , Rodrigues J. A. , Silva L. C. G. , Lúcio C. F. , Veiga G. A. L. , Furtado P. V. , Oliveira C. A. , Nichi M.
Published: February 2015

Parturition in cattle is a stressful event for both the dam and the offspring. Stress and pain can alter the energy profile of calves and calving cows, producing a metabolic imbalance at birth. This study aimed to assess the effects of dystocia and oxytocin and calcium infusion on metabolic homeostasis in dairy cows and calves. Thirty Holstein cows and their calves were divided into three groups: an eutocia group (n=10), in which no calving assistance was needed; a dystocia group, which required mild‐to‐severe obstetric assistance (n=10); and a uterine inertia group, which was treated with oxytocin and calcium (n=10). To assess serum cortisol and blood glucose levels, blood samples were collected during the peripartum period from cows and during the first hour since birth from calves. All groups were hyperglycaemic following parturition. Infusion of oxytocin and calcium resulted in lower maternal glucose concentrations and lower levels of stress than in cows in the dystocia group. Birth condition was significantly associated with blood glucose and cortisol concentrations in calves. Glucose concentration was lower in calves born with oxytocin and calcium infusion than those born with fetal extraction. In conclusion, assisted calving with fetal extraction causes important metabolic changes for the dam and calf. Conversely, the practice of oxytocin and calcium infusion for hypotonic cows has no harmful effects on metabolic balance and can be safely employed as a medical treatment.
Synergistic effect of co-reactant promotes one-step oxidation of cyclohexane into adipic acid catalyzed by manganese porphyrins
Authors: Li Hui , She Yuanbin , Fu Haiyan , Cao Meijuan , Wang Jing , Wang Tao
Published: February 2015

The synergistic effect of cyclohexane and cyclohexanone promoted synthesis of adipic acid catalyzed by [MnIIIT(p-Cl)PP]Cl with cyclohexane and cyclohexanone as co-reactants. The results showed that the conversions of cyclohexane and cyclohexanone were significantly enhanced because of the cyclohexanone synergistic effect, and the higher selectivity to adipic acid was obtained with dioxygen as an oxidant. The studies indicated that the co-oxidation of cyclohexane and cyclohexanone was influenced by the initial molar ratio of cyclohexanone and cyclohexane, catalyst structure, catalyst concentrations, and reaction conditions. The preliminary mechanism of the co-oxidation reaction of cyclohexane and cyclohexanone using [MnIIIT(p-Cl)PP]Cl as the catalyst was proposed.
Dust acoustic shock waves in arbitrarily charged dusty plasma with low and high temperature non-thermal ions
Authors: Dev Apul N. , Sarma Jnanjyoti , Deka Manoj K.
Published: February 2015

Using the well-known reductive perturbation technique, the three-dimensional (3D) Burgers equation and modified 3D Burgers equation have been derived for a plasma system comprising of non-thermal ions, Maxwellian electrons, and negatively charged fluctuating dust particles. The salient features of nonlinear propagation of shock waves in such plasmas have been investigated in detail. The different temperature non-thermal ions and Maxwellian electrons are found to play an important role in the shock waves solution. The analytical solution of the 3D Burgers equation and modified 3D Burgers equation ratifying the propagation of dust acoustic shock waves are derived using the well-known tanh method. On increasing the population of non-thermal ions, an enhancement in the amplitude of shock waves is seen for negatively charged dust particles. A striking dependence of amplitude and width of shock waves on the ratio of ion temperatures and densities are also reported. Finally we introduced a new stretching coordinate and perturbation for the nth-order nonlinear 3D Burgers equation and its solution by the use of the tanh method. We found that, due to higher nonlinearity, the amplitude of shock waves decreases while width remains constant for all plasma parameters considered in the present investigation. The features accounted here could be relevant in the case of different space and astrophysical plasmas and laboratory dusty plasma for negatively charged dust fluctuation.
Consistency of matter models with asymptotically safe quantum gravity
Authors: Donà Pietro , Eichhorn Astrid , Percacci Roberto
Published: February 2015

We discuss the compatibility of quantum gravity with dynamical matter degrees of freedom. Specifically, we present bounds we obtained in Donà et al. (Phys. Rev. D, 89, 084035 (2014) doi:10.1103/PhysRevD.89.084035 ) on the allowed number and type of matter fields within asymptotically safe quantum gravity. As a novel result, we show bounds on the allowed number of spin-3/2 (Rarita–Schwinger) fields (e.g., the gravitino). These bounds, obtained within truncated renormalization group flows, indicate the compatibility of asymptotic safety with the matter fields of the standard model. Further, they suggest that extensions of the matter content of the standard model are severely restricted in asymptotic safety. This means that searches for new particles at colliders could provide experimental tests for this particular approach to quantum gravity.
Fluctuation complexity of agent-based financial time series model by stochastic Potts system
Authors: Hong Weijia , Wang Jun
Published: February 2015

Financial market is a complex evolved dynamic system with high volatilities and noises, and the modeling and analyzing of financial time series are regarded as the rather challenging tasks in financial research. In this work, by applying the Potts dynamic system, a random agent-based financial time series model is developed in an attempt to uncover the empirical laws in finance, where the Potts model is introduced to imitate the trading interactions among the investing agents. Based on the computer simulation in conjunction with the statistical analysis and the nonlinear analysis, we present numerical research to investigate the fluctuation behaviors of the proposed time series model. Furthermore, in order to get a robust conclusion, we consider the daily returns of Shanghai Composite Index and Shenzhen Component Index, and the comparison analysis of return behaviors between the simulation data and the actual data is exhibited.
Reconfigurable Hardware for Machine Learning Applications
Authors: Vranjković Vuk S. , Struharik Rastislav J. R. , Novak Ladislav A.
Published: February 2015

This paper proposes universal coarse-grained reconfigurable computing architecture for hardware implementation of decision trees (DTs), artificial neural networks (ANNs), and support vector machines (SVMs), suitable for both field programmable gate arrays (FPGA) and application specific integrated circuits (ASICs) implementation. Using this universal architecture, two versions of DTs (functional DT and axis-parallel DT), two versions of SVMs (with polynomial and radial kernel) and two versions of ANNs (multi layer perceptron ANN and radial basis ANN) machine learning classifiers, have been implemented in FPGA. Experimental results, based on 18 benchmark datasets of standard UCI machine learning repository database, show that FPGA implementation provides significant improvement (1–2 orders of magnitude) in the average instance classification time, in comparison with software implementations based on R project.
A Reduced Uncertainty-Based Hybrid Evolutionary Algorithm for Solving Dynamic Shortest-Path Routing Problem
Authors: Kusetogullari Huseyin , Sharif Md. Haidar , Leeson Mark S. , Celik Turgay
Published: February 2015

The need of effective packet transmission to deliver advanced performance in wireless networks creates the need to find shortest network paths efficiently and quickly. This paper addresses a reduced uncertainty-based hybrid evolutionary algorithm (RUBHEA) to solve dynamic shortest path routing problem (DSPRP) effectively and rapidly. Genetic algorithm (GA) and particle swarm optimization (PSO) are integrated as a hybrid algorithm to find the best solution within the search space of dynamically changing networks. Both GA and PSO share context of individuals to reduce uncertainty in RUBHEA. Various regions of search space are explored and learned by RUBHEA. By employing a modified priority encoding method, each individual in both GA and PSO are represented as a potential solution for DSPRP. A complete statistical analysis has been performed to compare the performance of RUBHEA with various state-of-the-art algorithms. It shows that RUBHEA is considerably superior (reducing the failure rate by up to 50%) to similar approaches with increasing number of nodes encountered in the networks.