bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical emergencies in rural North Queensland: Doctors perceptions of the training needs
Authors: Pandit Tarsh , Sabesan Sabe , Ray Robin A. 
Published: November 2018

AbstractObjectiveThis study aimed to explore doctors’ perceptions of the training needs of rural doctors in the context of managing emergencies in rural North Queensland.DesignUsing a qualitative approach, 20 semistructured interviews were conducted via telephone, video conference and in‐person. Using an interview guide, areas such as preparedness of junior doctors for rural practice, areas for further training and confidence with managing emergencies were discussed. Interviews were analysed using the principles of grounded theory. Participant recruitment continued until data saturation was achieved.SettingMultiple health facilities across three hospital and health services in North Queensland.Participants(i) Doctors with current or recent work in rural North Queensland; (ii) doctors involved with rural medical training; and (iii) emergency medicine specialists working in a tertiary referral centre.Main outcome measurePerspectives of doctors on the training needs of rural doctors in North Queensland.ResultsRural doctors were found to be as prepared as they could be to take up rural practice; however, they still had training needs. Region‐specific emergencies, access to regular in‐house simulations and non‐medical challenges, including understanding local team dynamics and taking on a team leader role, were seen as key training needs. Senior doctors indicated that further formal and informal on‐the‐job training were required for provisional fellows with limited experience in the emergency department.ConclusionCertain training needs of rural doctors still remain unmet. Further access to in‐house simulations and tele‐training could be useful strategies to meet these training needs to further support rural doctors.
Neural signatures of the risk for bipolar disorder: A meta‐analysis of structural and functional neuroimaging studies
Authors: Cattarinussi Giulia , Di Giorgio Annabella , Wolf Robert Christian , Balestrieri Matteo , Sambataro Fabio 
Published: November 2018

ObjectiveWidespread functional and structural alterations in the brain have been extensively reported in unaffected relatives (RELs) of patients with bipolar disorder (BD) who are at genetic risk for BD. A sufficiently powered meta‐analysis of structural (sMRI) and functional magnetic resonance imaging (fMRI) alterations in RELs is still lacking.MethodsFunctional and structural magnetic resonance imaging studies investigating RELs and healthy controls (HCs) published by July 2017 were included in the meta‐analyses. Study procedures were conducted in accordance with the Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Random‐effects coordinate‐based meta‐analyses were performed across all the studies per imaging modality using Seed‐based d Mapping (SDM). For fMRI studies, meta‐analyses were calculated for each task type. For sMRI studies, regional volumetric changes‐analyses were estimated using R. Finally, multimodal meta‐analyses of structural and functional abnormalities were performed.ResultsSixty‐nine imaging studies (2195 RELs and 3169 HCs) were included in the meta‐analyses. RELs showed hyperactivation in the fronto‐striatal regions as well as parietal hypoactivation during cognition. Also, activation was increased in the amygdala during emotional processing and in the orbitofrontal cortex during reward, respectively. Frontal and superior temporal cortex were hypertrophic in RELs. The right inferior frontal gyrus (rIFG) showed both increased activation during cognitive tasks and greater volume in RELs.ConclusionsOur findings demonstrate that increased brain volume and activation are present in RELs and may represent intermediate phenotypes for the disorder. Furthermore, some neural changes including increased rIFG volume may be associated with the resilience to BD.
Venous thromboembolism in multiple myeloma – choice of prophylaxis, role of direct oral anticoagulants and special considerations
Authors: Swan Dawn , Rocci Alberto , Bradbury Charlotte , Thachil Jecko 
Published: November 2018

SummaryMultiple myeloma is associated with a significant risk of venous thromboembolism (VTE), causing substantial levels of morbidity and mortality. The thrombogenicity of myeloma is multifactorial, with disease‐ and treatment‐related factors playing important roles. Immunomodulatory drugs (IMiDs) and high‐dose dexamethasone, in particular, are known to enhance the thrombotic potential of myeloma. For this reason, assessment of the VTE risk has long been advocated prior to treatment initiation in patients with myeloma requiring IMiD‐based regimens. However, despite routine use of thromboprophylaxis, these patients can still develop VTE and its sequelae. The optimum choice and dose of thromboprophylactic drug is not entirely clear, and with this, there is growing interest regarding use of the direct oral anticoagulants in this setting. In this review we discuss the pathogenesis of thrombosis in multiple myeloma, its relation to some of the commonly used chemotherapeutic regimens, current risk stratification and the evidence supporting the different anticoagulants used as thromboprophylaxis. We propose an amended risk stratification, and consider management of challenging patients, including those with renal impairment and recurrent thrombosis.
CLARITY reveals a more protracted temporal course of axon swelling and disconnection than previously described following traumatic brain injury
Authors: Weber Maura T. , Arena John D. , Xiao Rui , Wolf John A. , Johnson Victoria E. 
Published: November 2018

AbstractDiffuse axonal injury (DAI) is an important consequence of traumatic brain injury (TBI). At the moment of trauma, axons rarely disconnect, but undergo cytoskeletal disruption and transport interruption leading to protein accumulation within swellings. The amyloid precursor protein (APP) accumulates rapidly and the standard histological evaluation of axonal pathology relies upon its detection. APP+ swellings first appear as varicosities along intact axons, which can ultimately undergo secondary disconnection to leave a terminal “axon bulb” at the disconnected, proximal end. However, sites of disconnection are difficult to determine with certainty using standard, thin tissue sections, thus limiting the comprehensive evaluation of axon degeneration. The tissue‐clearing technique, CLARITY, permits three‐dimensional visualization of axons that would otherwise be out of plane in standard tissue sections. Here, we examined the morphology and connection status of APP+ swellings using CLARITY at 6 h, 24 h, 1 week and 1 month following the controlled cortical impact (CCI) model of TBI in mice. Remarkably, many APP+ swellings that appeared as terminal bulbs when viewed in standard 8‐µm‐thick regions of tissue were instead revealed to be varicose swellings along intact axons when three dimensions were fully visible. Moreover, the percentage of these potentially viable axon swellings differed with survival from injury and may represent the delayed onset of distinct mechanisms of degeneration. Even at 1‐month post‐CCI, ~10% of apparently terminal bulbs were revealed as connected by CLARITY and are thus potentially salvageable. Intriguingly, the diameter of swellings decreased with survival, including varicosities along intact axons, and may reflect reversal of, or reduced, axonal transport interruption in the chronic setting. These data indicate that APP immunohistochemistry on standard thickness tissue sections overestimates axon disconnection, particularly acutely post‐injury. Evaluating cleared tissue demonstrates a surprisingly delayed process of axon disconnection and thus longer window of therapeutic opportunity than previously appreciated. Intriguingly, a subset of axon swellings may also be capable of recovery.
Oligodendroglial α‐synucleinopathy‐driven neuroinflammation in multiple system atrophy
Authors: Hoffmann Alana , Ettle Benjamin , Battis Kristina , Reiprich Simone , Schlachetzki Johannes C. M. , Masliah Eliezer , Wegner Michael , Kuhlmann Tanja , Riemenschneider Markus J. , Winkler Jürgen 
Published: November 2018

AbstractNeuroinflammation and oligodendroglial cytoplasmic α‐synuclein (α‐syn) inclusions (GCIs) are important neuropathological characteristics of multiple system atrophy (MSA). GCIs are known to interfere with oligodendroglial maturation and consequently result in myelin loss. The neuroinflammatory phenotype in the context of MSA, however, remains poorly understood. Here, we demonstrate MSA‐associated neuroinflammation being restricted to myeloid cells and tightly linked to oligodendroglial α‐syncleinopathy. In human putaminal post‐mortem tissue of MSA patients, neuroinflammation was observed in white matter regions only. This locally restricted neuroinflammation coincided with elevated numbers of α‐syn inclusions, while gray matter with less α‐synucleinopathy remained unaffected. In order to analyze the temporal pattern of neuroinflammation, a transgenic mouse model overexpressing human α‐syn under the control of an oligodendrocyte‐specific myelin basic protein (MBP) promoter (MBP29‐hα‐syn mice) was assessed in a pre‐symptomatic and symptomatic disease stage. Strikingly, we detected an increased neuroinflammation in regions with a high α‐syn load, the corpus callosum and the striatum, of MBP29‐hα‐syn mice, already at a pre‐symptomatic stage. Furthermore, this inflammatory response was restricted to myeloid cells being highly proliferative and showing an activated, phagocytic phenotype. In contrast, severe astrogliosis was observed only in gray matter regions of MSA patients as well as MBP29‐hα‐syn mice. To further characterize the influence of oligodendrocytes on initiation of the myeloid immune response, we performed RNA sequencing analysis of α‐syn overexpressing primary oligodendrocytes. A distinct gene expression profile including upregulation of cytokines important for myeloid cell attraction and proliferation was detected in α‐syn overexpressing oligodendrocytes. Additionally, microdissected tissue of MBP29‐hα‐syn mice exhibited a similar cellular gene expression profile in white matter regions even pre‐symptomatically. Collectively, these results imply an early crosstalk between neuroinflammation and oligodendrocytes containing α‐syn inclusions leading to an immune response locally restricted to white matter regions in MSA.
Ileal pouch revision vs excision: short‐term (30‐day) outcomes from the National Surgical Quality Improvement Program
Authors: Holubar S. D. , Neary P. , Aiello A. , Shawki S. , Delaney C. P. , Steele S. R. , Hull T. , Stocchi L. 
Published: November 2018

AbstractAimIleal pouch–anal anastomosis (IPAA) failure occurs in approximately 5%–10% of patients. We aimed to compare short‐term (30‐day) postoperative outcomes associated with pouch revision and pouch excision using a large international database. Our null hypothesis was that there is no statistically significant difference in overall postoperative complications between patients selected for pouch revision vs pouch excision.MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program Participant User File from 2005 to 2016 we identified patients who underwent either IPAA revision via the combined abdominoperineal approach [Current Procedural Terminology (CPT) 46712] or IPAA excision (CPT 45136). Differences in baseline characteristics and short‐term outcomes between groups were assessed with univariate and matched analyses.ResultsWe identified 593 reoperative IPAA procedures: revision group 78 (13%) and excision group 515 (86%). The groups had similar age and body mass index (kg/m2), but the revision group had more women (65.4% vs 51.8%, P = 0.02) and fewer were on chronic steroids (3.9% vs 17.9%, P = 0.0008) relative to the excision group. Revision IPAA patients were more likely to have received a preoperative transfusion (5.1% vs 0.97%, P = 0.02). Revision and excision were associated with similar postoperative length of stay (9.3 vs 8.6 days, 0.44), mortality (nil vs 0.58%, respectively; P = 0.99) and short‐term morbidity (34.6% vs 40.2%, respectively; P = 0.88) at 30 days.ConclusionsPouch revision and excision have comparable short‐term postoperative outcomes, but pouch excision appears to be more commonly utilized. Increased awareness of the indications for pouch revision or referral to specialized centres may improve pouch revision rates.
Endoscopic ultrasound‐guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: A prospective multicenter study
Authors: Itonaga Masahiro , Kitano Masayuki , Hatamaru Keiichi , Tamura Takashi , Nuta Junya , Kawaji Yuki , Takenaka Mamoru , Minaga Kosuke , Kudo Masatoshi , Ogura Takeshi , Higuchi Kazuhide , Chiba Yasutaka 
Published: November 2018

Background and AimWhen endoscopic retrograde cholangiopancreatography (ERCP) fails in patients with malignant distal biliary obstruction, endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) is an alternative. It has high technical and clinical success rates, but also has high adverse event rates. This prospective cohort study was aimed to evaluate the clinical efficacy and safety of EUS‐CDS with our newly developed partially covered self‐expandable metal stent with a thin delivery system.MethodsPatients consisted of all consecutive patients in three tertiary referral centers with unresectable malignant distal obstruction in whom ERCP failed and in whom EUS‐CDS with the thin delivery system was selected as the second‐line approach. Rates of clinical success, technical success, technical success in cases not requiring fistulous tract dilation, adverse events, and stent dysfunction were determined.ResultsIn the 20 patients, technical and clinical success rates were 95.0% (19/20) and 100% (19/19), respectively. In 31.6% (6/19), the delivery system was successfully inserted into the bile duct without requiring a fistulous‐tract dilatation device. These patients had significantly shorter procedure times than patients requiring fistulous‐tract dilatation (12.7 ± 3.1 vs 23.2 ± 2.1 min; P < 0.01). One patient (5.0%) who required fistulous dilation had an adverse event, which was managed conservatively. There were no procedure‐related deaths. During follow up, four patients (21.1%) developed stent dysfunction. Reintervention was successful in all cases.ConclusionsThe EUS‐CDS approach had 95% technical and 100% clinical success rates, with adverse events reported in 5% of cases. EUS‐CDS may become safer if efforts are made to avoid the dilation step (UMIN 000023938).
Cryptic temporal changes in stock composition explain the decline of a flounder (Platichthys spp.) assemblage
Authors: Momigliano Paolo , Jokinen Henri , Calboli Federico , Aro Eero , Merilä Juha 
Published: November 2018

AbstractUnobserved diversity, such as undetected genetic structure or the presence of cryptic species, is of concern for the conservation and management of global biodiversity in the face of threatening anthropogenic processes. For instance, unobserved diversity can lead to overestimation of maximum sustainable yields and therefore to overharvesting of the more vulnerable stock components within unrecognized mixed‐stock fisheries. We used DNA from archival (otolith) samples to reconstruct the temporal (1976–2011) genetic makeup of two mixed‐stock flounder fisheries in the Åland Sea (AS) and the Gulf of Finland (GoF). Both fisheries have hitherto been managed as a single stock of European flounders (Platichthys flesus), but were recently revealed to target two closely related species: the pelagic‐spawning P. flesus and the newly described, demersal‐spawning P. solemdali. While the AS and GoF fisheries were assumed to consist exclusively of P. solemdali, P. flesus dominated the GoF flounder assemblage (87% of total) in 1983, had disappeared (0%) by 1993, and remained in low proportions (10%–11%) thereafter. In the AS, P. solemdali dominated throughout the sampling period (>70%), and P. flesus remained in very low proportions after 1983. The disappearance of P. flesus from the GoF coincides in time with a dramatic (~60%) decline in commercial landings and worsening environmental conditions in P. flesus’ northernmost spawning ground, the Eastern Gotland Basin, in the preceding 4–6 years. These results are compatible with the hypothesis that P. flesus in the GoF is a sink population relying on larval subsidies from southern spawning grounds and the cause of their disappearance is a cessation of larval supply. Our results highlight the importance of uncovering unobserved genetic diversity and studying spatiotemporal changes in the relative contribution of different stock components, as well as the underlying environmental causes, to manage marine resources in the age of rapid anthropogenic change.
Transcriptional control of natural killer cell differentiation
Authors: Brillantes Marc , Beaulieu Aimee M. 
Published: November 2018

SummaryNatural killer (NK) cells are highly specialized cytotoxic lymphocytes that provide protection against pathogens and malignant cells. They develop from common lymphoid progenitors via a multi‐stage lineage commitment and differentiation process that gives rise to mature NK cells with potent cytotoxic functionality. Although generally considered cells of the innate immune system, recent studies have demonstrated that NK cells have the capacity to mount immune responses with features of adaptive immunity, including robust antigen‐specific clonal‐like expansion and the generation of long‐lived memory cells that mediate enhanced recall responses. Here, we discuss specific transcription factors that have been shown to commonly and uniquely regulate NK cell development and effector and memory responses in experimental mouse models.
Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza
Authors: Li Zhihao , He Liya , Li Shuhua , He Waner , Zha Caihui , Ou Wanxing , Hou Qiaozhen , Wang Weiying , Sun Xin , Liang Huiying 
Published: November 2018

ObjectiveThis study evaluated the diagnostic value of measuring the levels of procalcitonin (PCT) and C‐reactive protein (CRP) to differentiate children co‐infected with H1N1 influenza and bacteria from children infected with H1N1 influenza alone.MethodsConsecutive patients (children aged < 5 years) with laboratory‐confirmed H1N1 influenza who were hospitalized or received outpatient care from a tertiary‐care hospital in Canton, China, between January 1, 2012, and September 1, 2017, were included in the present study. Laboratory results, including serum PCT and CRP levels, white blood cell (WBC) counts, and bacterial cultures, were analyzed. The predictive value of the combination of biomarkers versus any of the biomarkers alone for diagnosing bacterial co‐infections was evaluated using logistic regression analyses.ResultsSignificantly higher PCT (1.46 vs 0.21 ng/mL, P < 0.001) and CRP (19.20 vs 5.10 mg/dL, P < 0.001) levels were detected in the bacterial co‐infection group than in the H1N1 infection‐alone group. Using PCT or CRP levels alone, the areas under the curves (AUCs) for predicting bacterial co‐infections were 0.801 (95% CI, 0.772‐0.855) and 0.762 (95% CI, 0.722‐0.803), respectively. Using a combination of PCT and CRP, the logistic regression‐based model, Logit(P) = −1.912 + 0.546 PCT + 0.087 CRP, showed significantly greater accuracy (AUC: 0.893, 95% CI: 0.842‐0.934) than did the other three biomarkers.ConclusionsThe combination of PCT and CRP levels could provide a useful method of distinguishing bacterial co‐infections from an H1N1 influenza infection alone in children during the early disease phase. After further validation, the flexible model derived here could assist clinicians in decision‐making processes.
Conductivity of iron‐doped strontium titanate in the quenched and degraded states
Authors: Long Daniel M. , Cai Biya , Baker Jonathon N. , Bowes Preston C. , Bayer Thorsten J.M. , Wang Jian‐Jun , Wang Rui , Chen Long‐Qing , Randall Clive A. , Irving Douglas L. , Dickey Elizabeth C. 
Published: November 2018

AbstractThe electrical behavior of iron‐doped strontium titanate (Fe:SrTiO3) single crystals equilibrated at 900°C and quenched below 400°C at various oxygen partial pressures () was investigated via impedance spectroscopy and compared to defect chemistry models. Fe:SrTiO3 annealed and quenched between 1.2 × 10−14 and 2.0 × 10−4 Pa exhibits a conduction activation energy (EA) around 0.6 eV, consistent with ionic conduction of oxygen vacancies. However, sudden changes in EA are found to either side of this range; a transition from 0.6 to 1 eV is found in more oxidizing conditions, while a sudden transition to 1.1 and then 0.23 eV is found in reducing These transitions, not described by the widely used canonical model, are consistent with predictions of transitions from ionic to electronic conductivity, based on first principles point defect chemistry simulations. These models demonstrate that activation energies in mixed conductors may not correlate to specific conduction mechanisms, but are determined by the cumulative response of all operative conduction processes and are very sensitive to impurities. A comparison to electrically degraded Fe:SrTiO3 provides insight into the origins of the conductivity activation energies observed in those samples.
Structural and physical characteristics of Au2O3‐doped sodium antimonate glasses – Part II electrical characteristics
Authors: Ashok Jujjavarapu , Kostrzewa Marek , Ingram Adam , Nalluri Purnachand , Venkatramaiah Nutalapati , Srinivasa Reddy Maddireddy , Ravi Kumar Vandana , Veeraiah Nalluri 
Published: November 2018

AbstractIn continuation of our earlier investigations on structural and physical characteristics of Au2O3‐doped sodium antimonate glass‐ceramics (Part‐1), in this part we have investigated the influence of gold ions on electrical characteristics of the Na2O–Sb2O3: Au2O3 glass‐ceramics. The study contains the results of quantitate investigations on dielectric properties, impedance spectra and A.C. conductivity in larger ranges of continuous frequencies (4 Hz‐8 MHz) and temperatures (300‐630 K). The variations exhibited by dielectric parameters with temperature and also with frequency were discussed in terms of various polarization mechanisms. The observed dielectric relaxation effects were analyzed using pseudo Cole‐Cole plot method and the analysis indicated spreading of relaxation times for dipoles. A.c. conductivity and also d.c. conductivity were found to decrease (to three orders of magnitude) with increase in Au2O3 concentration upto 0.1 mol%. The decrement is ascribed to the increasing concentration of Sb5+ ions that were predicted to participate in the glass network forming with SbO4 units. Even though, both ionic and polaronic contributions are possible for conduction in the studied material, quantitative analysis of these results indicated that the polaronic conduction (due to intervalence transfer between Sb3+ ↔ Sb5+ and Au0 ↔ Au3+) is prevalent. The results have also suggested that there is a gradual decrement in the ionic component with increase in Au2O3 concentration. Variation in σac in the low‐temperature region could satisfactorily be explained using quantum mechanical tunneling (QMT) model. Analysis of the results of d.c. conductivity indicated that the small polaron hoping (SPH) model is valid, especially in a high‐temperature region while the low temperature part of d.c. conductivity is analyzed based on variable range hopping (VRH) model. Overall, the increase in Au2O3 dopant concentration in the studied glass‐ceramics caused a decrement in the magnitude of the conductivity or increase in the insulating strength of the material.