bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematics of Leptosphaeria Species Found on the Rosaceae
Authors: Huhndorf Sabine M. 
Published: May 2020

The present research reassesses the taxonomic position of species of Leptosphaeria described from plants in the family Rosaceae. In doing so, this wori< emphasizes a concept of Leptosphaeria based on its type species. Because discrete groups of morphologically similar species were found on related hosts (Nixlulosphaeria on Compositae, Phaeosphaeria on Gramineae and Entodesmiitm on Leguminosae), a goal of the study was to determine whether a distinct group of related species could be found on Rosaceous hosts. Also, approaching the taxonomy of this large, complex genus on the basis of host family is a convenient way of dividing the large numbers of Leptosphaeria species into smaller, workable groups.
Fifty-five species described from Rosaceous hosts have been included in Leptosphaeria (see appendix). Efforts were made to locate and obtain type material for all of the described species. The names of herbaria providing material are abbreviated in this dissertation according to Index Herbariorum (Holmgren et al. 1990). Whenpossible, type specimens were studied, supplemented by other collections, and the species were redescribed and illustrated from the type material. Unfortunately, type material could not be located for all of the species; in such cases, descriptions were based on other material only when the resulting concept of the species was obviously in accordance with the original description. From this work, it became apparent that no discrete group of related species is specialized on the Rosaceae. Thespecies studied were determined to represent a mixture of Loculoascomycetes and Hymenoascomycetes, and non-Leptosphaeria species were reassigned to more appropriate genera.
Status, trends, and population demographics of selected sportfish species in the La Grange Reach of the Illinois River
Authors: Solomon Levi Eric , Pendleton Richard M , Maxson Kristopher A , Gibson-Reinemer Daniel K , Anderson Cory A , Anderson Rebekah L , Lampo Eli G , Lamer James T , Casper Andrew F 
Published: May 2020

Abstract
Sportfish species, specifically Yellow Bass Morone mississippiensis, White Bass Morone chrysops, Largemouth Bass Micropterus salmoides, Bluegill Lepomis macrochirus, Black Crappie Pomoxis nigromaculatus, and White Crappie P. annularis, often drive economically valuable fisheries in large river systems, including the Upper Mississippi River System (UMRS). Within the Illinois River, part of the UMRS, these species are routinely sampled by an ongoing long-term fisheries monitoring program. Through this program, we investigated long-term trends (1993-2017) in catch rates and relative weights and quantified demographic rates from 2012-2016. We found all six species, with the exception of Yellow Bass, to have declining catch rates with this decline being most stark in larger, older fishes. Population demographics for Yellow Bass, White Bass, Bluegill, and Black Crappie suggest populations are dominated by younger individuals, with only Black Crappie regularly living to age 3 and older, which may be driving population declines. There are many environmental stressors acting on the Illinois River that could be contributing to the lack of older and larger fishes, including, but not limited to, navigation efforts, altered hydrology, pollution, sedimentation, lack of overwintering habitat, and introduction of invasive species. Results of this study demonstrate that additional research to understand mechanisms driving reduced abundance and stunted age structure are needed to identify effective management actions that would benefit populations of recreationally valuable sportfish species.
Budaya Sunda pada Novel Perempuan Bernama Arjuna Karya Remy Sylado: Suatu Kajian Antropologi Sastra
Authors: Lestari Chintya Bayu , Zuriyati Zuriyati , Nuruddin Nuruddin 
Published: May 2020

Penelitian ini bertujuan untuk mengungkapkan budaya Sunda pada novel Perempuan Bernama Arjuna karya Remy Sylado. Jenis penelitian ini ialah penelitian kualitatif dengan menggunakan metode analisis isi. Sumber data penelitian ini yakni novel Perempuan Bernama Arjuna karya Remy Sylado. Adapun data penelitian ini berupa kutipan kata, kalimat, wacana, atau paragraf yang menunjukan unsur budaya Sunda. Model analisis data menggunakan analisis data Philip Mayring. Hasil penelitian menunjukan bahwa bentuk budaya Sunda pada novel Perempuan Bernama Arjuna karya Remy Sylado dikemas melalui unsur-unsur kebudayaan. Unsur budaya tersebut mencakup (1) sistem pengetahuan sejarah dan kesenian Sunda. (2) Seni tembang. (3) Seni musik. (4) Organisasi sosial berkenaan dengan perkawinan adat Sunda. (5) Bahasa yang diungkapkan mengenai bahasa tulisan.
Minding The Gap: Severe Anion Gap Metabolic Acidosis Associated With 5-Oxoproline Secondary To Chronic Acetaminophen Use
Authors: Frankfurter Claudia , Venus Kevin , Frost David 
Published: May 2020

AbstractAn 89-year-old man with multiple comorbidities presented to the emergency department with diffuse abdominal pain and dyspnea. He was found to have a severe anion-gap metabolic acidosis with the normal osmolar gap. An initial panel of investigations for common causes of anion-gap metabolic acidosis was unremarkable. Further history revealed long-term daily acetaminophen use. A presumptive diagnosis of 5-oxoprolinemia secondary to chronic acetaminophen use was made. Despite supportive care, the patient did not survive. There is emerging literature on elevated anion gap metabolic acidosis induced by the accumulation of 5-oxoproline, an intermediate organic acid in the gamma-glutamyl cycle. A quantitative profile of urinary organic acids to measure 5-oxoproline is valuable in confirming the diagnosis. Treatment is largely supportive, consisting of cessation of acetaminophen, alkali therapy, and N-acetylcysteine. Clinicians should consider 5-oxoprolemia in patients who present with an otherwise unexplained anion gap metabolic acidosis and a history of chronic acetaminophen use.
RESUMEUn homme de 89 ans souffrant de comorbidités multiples s’est présenté à l’urgence avec douleur abdominale diffuse et dyspnée. On a découvert qu’il souffrait d’une acidose métabolique grave à anions nuls avec un écart osmolaire normal. Un premier groupe d’études sur les causes courantes d’acidose métabolique à intervalle anionique n’a pas été remarquable. D’autres antécédents ont révélé une utilisation quotidienne à long terme de l’acétaminophène. Un diagnostic présumé de 5-oxoprolinémie secondaire à l’utilisation chronique d’acétaminophène a été posé. Malgré des soins de soutien, le patient n’a pas survécu. Il existe une littérature émergente sur l’acidose métabolique à intervalle anionique élevé induite par l’accumulation de 5-oxoproline, un acide organique intermédiaire dans le cycle gamma-glutamyle. Un profil quantitatif d’acides organiques urinaires pour mesurer la 5-oxoproline est utile pour confirmer le diagnostic. Le traitement est largement favorable, consistant en l’arrêt de l’acétaminophène, un traitement alcalin et de la N-acétylcystéine. Les cliniciens devraient envisager l’administration de 5-oxoprolemia chez les patients qui présentent une acidose métabolique par gap anionique autrement inexpliquée et des antécédents d’utilisation chronique d’acétaminophène.
Point-Counterpoint: Perioperative Cardiac Biomarkers
Authors: Ruzycki Shannon Marie , Prystajecky Michael 
Published: May 2020

In the following review article, we present arguments for and against the use of postoperative troponin surveillance and preoperative natriuretic peptide testing. This article covers the evidence that informed the CCS 2016 perioperative guidelines and research published since then. This review is based on the debate held at the Canadian Society of Internal Medicine/American College of Physicians Rocky Mountain Chapter Annual Meeting (CSIM/ACP RM) held in October 2018 in Banff, Alberta.

Resume
Dans l'article de synthèse qui suit, nous présentons des arguments pour et contre l'utilisation de la surveillance postopératoire de la troponine et des tests préopératoires de peptides natriurétiques. Cet article porte sur les données probantes qui ont éclairé les lignes directrices périopératoires de la SCC 2016 et les recherches publiées depuis lors. Cet examen est fondé sur le débat qui a eu lieu à l'assemblée annuelle de la section des Rocheuses de la Société canadienne de médecine interne et de l'American College of Physicians (CSIM/ACP RM) tenue en octobre 2018 à Banff, en Alberta.
Rhabdomyolysis as a Side Effect of the Drug Interaction Between Atorvastatin and Sacubitril/Valsartan
Authors: Chan Ka Hong (Casey) , Pournazari Payam , Champagne Patick 
Published: May 2020

Sacubitril/valsartan is an increasingly used medication in patients with severe left ventricular dysfunction. Here, we present an 83-year-old male with an ejection fraction of 18% who presented with rhabdomyolysis shortly after initiation of this medication in the setting of being on atorvastatin safely for many years previously. Interestingly, prior pharmacological studies have demonstrated an interaction between sacubitril and atorvastatin via the OATP pathway. In particular, sacubitril has been shown to inhibit OATP1B1 and 1B3, the rate-limiting step for the elimination of atorvastatin, which can result in the drug’s accumulation. This phenomenon was determined to be the most likely etiology behind the patient’s rhabdomyolysis in this case. Once the medications were discontinued, the rhabdomyolysis resolved. If both a statin and sacubitril/ valsartan need to be co-administered, starting the statin at a low dose with careful monitoring of symptoms, CK, electrolytes, and creatinine during gradual titration should be considered.
Le sacubitril/valsartan est un médicament de plus en plus utilisé chez les patients souffrant de dysfonctionnement grave du ventricule gauche. Nous présentons ici un homme de 83 ans avec une fraction d’éjection de 18 % qui a présenté une rhabdomyolyse peu après le début de ce médicament dans le cadre d’un traitement à l’atorvastatine sans risque pendant plusieurs années auparavant. Il est intéressant de noter que des études pharmacologiques antérieures ont démontré une interaction entre le sacubitril et l’atorvastatine par la voie de l’OATP. En particulier, il a été démontré que le sacubitril inhibe l’OATP1B1 et 1B3, l’étape limitant la vitesse d’élimination de l’atorvastatine, ce qui peut entraîner l’accumulation du médicament. Ce phénomène a été déterminé comme étant l’étiologie la plus probable derrière la rhabdomyolyse du patient dans ce cas. Une fois les médicaments arrêtés, la rhabdomyolyse s’est résorbée. Si une statine et le sacubitril/valsartan doivent être co-administrés, il faut envisager de commencer la statine à faible dose en surveillant attentivement les symptômes, la CK, les électrolytes et la créatinine pendant le titrage progressif.
The Core Internal Medicine Training: Evolving beyond the Clinical Teaching Unit
Authors: Panju Mohamed , Whitehead Lori , Martin Leslie 
Published: May 2020

AbstractOver the past 50 years, the CTU has remained a core part of training for residents within internal medicine training programs. At the same time, the needs of society have changed significantly over the years, and current training needs to reflect this change. This is not a novel idea, but one that we feel requires greater attention to adequately address the needs of academic teaching hospitals across the country.
ResumeAu cours des 50 dernières années, la CTU est restée un élément essentiel de la formation des résidents dans le cadre des programmes de formation en médecine interne. Dans le même temps, les besoins de la société ont considérablement évolué au fil des ans, et la formation actuelle doit refléter ce changement. Il ne s’agit pas d’une idée nouvelle, mais d’une idée qui, selon nous, nécessite une plus grande attention afin de répondre adéquatement aux besoins des hôpitaux universitaires d’enseignement à travers le pays.
Sugar and Stones
Authors: Elhadi M , D’Costa J , De Vogel C , Devarajan R , Otite U 
Published: May 2020

Introduction Urolithiasis is a common urological problem in the United Kingdom. 6% of the adult population were diag-nosed with diabetes in England in 2013. Researchers suggest the association of diabetes with stone forma-tion, recurrence, and morbidity. This study aimed to compare the prevalence of risk factors like metabolic syndrome, urinary tract infections, age, gender and ethnicity among diabetics versus non-diabetics and to determine how diabetes affects the biochemical and surgical outcomes of urolithiasis. Methods There were182 patients treated surgically for urolithiasis between January 2010 and December 2012 were retrospectively analyzed. Information was cross-referenced with electronic notes to produce biochemical and surgical data. Results A total of 31 (17%) patients had type 2 diabetes. The mean age of diabetics was significantly higher than non-diabetics by nearly 12 years (p-value < 0.001). Hypertension, hyperlipidaemia, obesity and UTIs were more prevalent among diabetics (p-value < 0.001, < 0.001, 0.01, 0.009 respectively). Diabetics had signifi-cantly bigger mean stones size (p-value=0.008) and are at higher risk of stone recurrence at 1 year (p-value =0.04) than non-diabetics. Stone recurrence was not significant at 3 and 5 years between the two groups. Diabetics significantly had higher urinary oxalate, and nearly statistically significant lower phosphate levels (p-value=0.007, 0.076 respectively). Conclusions Diabetics were significantly older and associated with metabolic syndrome. UTIs were more prevalent among diabetics which put them at risk of postoperative complications. Diabetics are at higher risk of stone recurrence at 1 year compare to non-diabetics. Biochemical urinary findings are important as they can guide the management of recurrent stone formers.
The Burden on a Urologist of Percutaneous Nephrostomies and Antegrade Ureteric Stents: Should Trainee Urologists Learn to Perform these Procedures?
Authors: Donati-Bourne J Jack , Nour Shahd Seifeldin , Siddiqui Zain , Viney RP Richard P. 
Published: May 2020

Background and Objective Renal obstruction is a common urological emergency potentially requiring urgent decompression by percutaneous nephrostomy (PCN) or antegrade ureteric stent (AUrS), procedures performed by interventional radiologists, or retrograde stenting in theatre by a urologist. The study aimed to assess the burden of PCN / AUrS on the overall workload of a urology department and evaluate impact of procedural delays in terms of bed-occupancy and cost. The findings serve to explore whether formal PCN / AUrS training would be desirable for UK trainees in urology. Material and Methods Prospective study of all patients admitted under urology at Queen Elizabeth Hospital Birmingham (QEHB) between 20thOctober - 18thNovember 2018. Electronic records to retrieve data pertaining to admission, treatment provided, length of in-patient stay and delay awaiting PCN / AUrS. Results n=148 patients identified. n=22 (14.8% of total) primary admission reason and/or main treatment provided related to PCN / AUrS. 601 urology in-patient days occupied for all causes, 166 (27.6%) related to PCN / AUrS and 66 (10.9%) awaiting PCN / AUrS (delays cost �11,361 / month). Conclusion PCN / AUrS constituted a noteworthy proportion of all admissions and in-patient bed days in QEHB urology. Clinically non-urgent patients experienced notable cumulative delays whilst awaiting PCN / AUrS which adversely impacted bed occupancy. A suitably trained urologist competent at PCN / AUrS may positively address these issues. The findings merit consideration of a call for UK urology trainees to be trained in PCN / AUrS as part of CCT requirements.
Trends in Renal Stone Clearance after Ureteroscopy: A Review
Authors: Subramonian Subiksha , Gopalakrishnan Somasundari , Smith Yuko 
Published: May 2020

Background and Objectives Stone clearance rate in ureteroscopy has varied over the years. This study aims to review the stone clear-ance rate over the last 25 years and assess the change over time. We have analyzed the reasons for the peaks and troughs in stone clearance rate to see if it correlates with any factors such as the introduction of new technology like the holmium laser, flexible ureteroscopy, access sheaths, and digital ureteroscopy. Material and Methods We performed a PubMed search (August 2019) for papers including the terms “lithiasis”, “stone clear-ance”, “calculi”, “kidney stone”, “ureteric stone”, “ureteroscopy”, “holmium laser”, “retrorenal surgery” in their title and published between the years 1994 and 2019. The stone size, stone clearance rate and mode of imaging to determine clearance rates were recorded. For data analysis, only prospective studies with a minimum of 50 patients and ureteroscopy arm of prospective randomized controlled trials were included. Results We reviewed 16 papers with a total of 1,689 patients with renal stones. Average stone clearance was 80% and the median stone size was 11.0mm. Stone clearance was determined by either: Computed tomography (CT) scan (8 studies), x-ray alone (3 studies), x-ray and ultrasound (3 studies) or not mentioned (2 studies). CT scan yielded lower stone clearance rates than x-ray due to the increased detail shown on CT. For studies that used absolute clearance with no residual stones, average clearance was 52%, and this stone clearance rate increased as the cut-off size used to determine the stone-free rate was increased. Conclusion This study highlights that stone clearance rate after ureteroscopy varies significantly amongst different pa-pers because of the stone size used to define ‘stone-free rate’ and the method of imaging used to determine stone clearance. The study also shows that stone clearance rates have not improved significantly over time, despite the introduction of advances in technology.
Day Case Mini Percutaneous Nephrolithotomy (PCN): First UK Experience
Authors: Auer A , Abdelqader B , Glassey A , Rowbotham C , Ismail M 
Published: May 2020

Background and Objective To investigate the safety, efficacy, and feasibility of performing mini PCN (MIP-M Karl Storz) as a day case procedure. We report our experience and outcomes from our case series which to our knowledge is the first reported in the UK. Material and Methods Ten patients appropriate for mini PCN and day-case surgery were selected prospectively. All 10 patients underwent a mini PCN procedure in a prone position. Access was achieved by the operating surgeon under fluoroscopic guidance in 9 cases and by a consultant uroradiologist under ultrasound guidance in 1 patient with a ureterosigmoidostomy using a Kellet needle and the MIP-M system (Karl Storz, Germany). Stones were fragmented with a 550um laser fibre and retrieved by both the Vortex effect and a grasper. Drainage was achieved with a 6 Fr antegrade stent in 9 cases and a 10 Fr nephrostomy tube in one patient. Stone related outcomes, duration of surgery, length of stay and complications were recorded. Results All cases were completed as planned. The mean operating time was 93 minutes. A day case rate of 80% was achieved. Two patients were admitted overnight for social reasons; one lived on a nearby island and was not ready for discharge in time to catch the last ferry and another no longer had a responsible adult at home to monitor him overnight. All patients were deemed radiologically stone free. No readmissions, transfusion, infections or other complications were recorded at 90 days postoperatively. Conclusion We have shown that day-case mini PCN is a feasible and safe procedure in selected patients. A larger number of cases are needed to establish our patient selection criteria and corroborate our early outcomes.
Metabolic Stone Screening – Can Education Improve Adherence to National Guidelines?
Authors: Ravindraanandan Manoj , Jayawardena Panduka 
Published: May 2020

Nephrolithiasis is a common urological disease affecting approximately 13% of the global population. Identifying a preventable cause during follow-up for stone formation is a necessary factor in reducing recurrence. The majority of kidney stones are comprised of calcium, with oxalate and phosphate compounds account-ing for approximately 80% of stone formers. Serum analysis can be used to identify the levels of calcium in the blood, excluding metabolic causes for stones. Current NICE guidelines recommend performing a metabolic screen during an acute admission. Adherence to these guidelines from clinicians can be poor. We aim to see whether education can improve serum metabolic requests from clinicians in the UK. Method A case-control study was performed in a single rural district general hospital in the UK. Patients who pre-sented with renal colic were analyzed retrospectively for four months, looking at serum metabolic screen requests. Two months of education was then delivered to acute departments, with a further prospective study performed following this for six months. Outcomes were then compared between both groups to see if there was an improvement in serum requests following the delivery of local education. Results A total of 124 patients were included in our study. 50 patients were analyzed in cohort A over a 4-month period. Complete serum analysis was performed on 22% (n=11) of patients. Incomplete serum analysis was performed on 58% (n-29) of patients with uric acid being missed on all of them. 10 patients had no metabolic serum analysis performed at all, with 1 patient having a previous history of stones. A total of 74 patients were analyzed in cohort B over a 6-month period. This was following the 2 months of departmental education given by urologists. Complete serum analysis was performed on 24% (n=18) of patients. Incomplete serum analysis was performed on 55% (n=41) of patients with uric acid being missed from all of them. The remaining 21% of patients (n=15) had no metabolic serum screen performed at all. There was no significant difference seen between both cohorts after comparing metabolic serum requests before and after department education for 2 months (p=0.7287). Conclusion Improving adherence to clinical guidelines for metabolic screening has proved difficult with departmental teaching alone, with very little improvement achieved. Nevertheless, formal face-to-face education is ad-vocated to reinforce knowledge in junior doctors managing renal stones.
Female Urinary Retention: Observations from a Retrospective Case Note Review
Authors: Khela Aman , Olateju Ayooluwa , Gunendran Thiruendran , Montague Richard J 
Published: May 2020

Background and Objective There are no current guidelines to manage female retention patients. We aimed to see if a standardized approach could be used to manage these patients. Methods Between October 2014 and September 2016, all female patients with urinary retention admitted under a urology consultant were reviewed. Results A total of 46 females had a single episode of urinary retention whilst 19 females had recurrent episodes. The commonest cause for a single episode of retention was attributed to anesthesia (general/spinal) (n=9), constipation (n=9) and medication use (n=4). Most of these women (95%) voided on the first attempt fol-lowing catheter removal. In the absence of any neurological symptoms, pelvic ultrasound was the only investigation that revealed any underlying pathology in female retention patients. A pelvic mass was identi-fied in 3 (4.5%) patients. Conclusion Females with an isolated episode of retention, with an obvious precipitating cause identified during full history and examination, could proceed directly to a nurse-led trial of catheter removal without the need for any further urology review. Others should undergo a pelvic ultrasound and review by a urologist. In our opinion, females with recurrent unexplained episodes of urinary retention should be referred for a trial of sacral neuromodulation if considered appropriate.