bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring
Authors: Jan Matevž , Žižek David , Geršak Živa Miriam , Geršak Borut 
Published: May 2018

AbstractIntroductionWhile catheter ablation (CA) is an established treatment for symptomatic paroxysmal atrial fibrillation (AF), convergent epicardial and endocardial ablation procedure (CVP) has been primarily used to treat persistent AF. The aim of this single‐center, prospective, randomized study was to compare treatment efficacy of CA and CVP in paroxysmal AF patients by monitoring AF, atrial tachycardia (AT), and atrial flutter (AFL) recurrence with Implantable Loop Recorder (ILR).Methods and resultsFifty patients (74% male) with history of paroxysmal AF were randomized between CA and CVP. Outcomes were determined by ILRs; every episode of AF/AT/AFL lasting 6 minutes or more was defined as a recurrence. AF burden (AFB) and required AF reinterventions (cardioversions and repeat ablations) were quantified after a 3‐month blanking period.Total procedural (266 ± 44 vs. 242 ± 39 minutes) and ablation duration (52 ± 10 vs. 48 ± 12 minutes) was similar in both groups. Recurrence of AF/AT/AFL was more likely in the CA group compared to the CVP group (OR 3.78 (95% CI (1.17, 12.19), P = 0.048)). During the follow‐up period (mean 30.5 ± 6.9 months), higher AF burden and more reinterventions for recurrent AF were recorded in the CA group. There were more periprocedural complications in the CVP group (12.5%) compared to the CA group (0%).ConclusionTreatment of paroxysmal AF with CVP showed less arrhythmia recurrence compared to CA. In addition, patients after CVP had fewer reinterventions and lower AF burden, but more periprocedural complications.
Incidence of pericardial effusion after left atrial appendage closure: The impact of underlying heart rhythm—Data from the EWOLUTION study
Authors: Schmidt Boris , Betts Timothy R. , Sievert Horst , Bergmann Martin W. , Kische Stephan , Pokushalov Evgeny , Schmitz Thomas , Meincke Felix , Mazzone Patrizio , Stein Kenneth M. , Ince Hüseyin , Boersma Lucas V. A. 
Published: May 2018

AbstractIntroductionPericardial effusion/tamponade (PE/PT) is a rare but serious complication following left atrial appendage closure (LAAC). It may be speculated that LAA contraction during sinus rhythm (SR) exerts mechanical force on the device that eventually leads to PE. We sought to determine the incidence and predictors of PE following LAAC using Watchman with special emphasis on the underlying heart rhythm during implant.Methods and resultsFrom 47 centers in 13 European countries 1,020 patients underwent LAAC and data on baseline rhythm were available from 1,010 patients (mean age 73 ± 9 years, 60% male, median CHA2DS2‐VASc = 4). Data were collected via electronic case report forms. A Cox proportional hazard model was calculated adjusting for multiple variables: age, gender, number of recaptures, and device oversizing. During implant, 41% and 59% of patients were in SR and atrial fibrillation (AF), respectively. PE/PT rate was significantly lower in patients implanted during AF at day 30 postimplant (n = 1; 0.2% vs. n = 6; 1.5%; P = 0.02). No PE requiring intervention occurred in the AF group compared to 5 events (1.2%) in the SR group (P = 0.01). While univariate analysis identified SR and gender as predictors for PE/tamponade, multivariate analysis only showed a statistical trend for both variables.ConclusionThe overall incidence of PE/PT was very low after LAAC using Watchman. Although SR was not identified as an independent predictor of PE/PT, all events requiring intervention occurred in patients with SR. It may be advisable to perform an extended echocardiographic follow‐up in that patient population.
Cerebral Hemodynamic Response During Concealment of Information About a Mock Crime: Application of a General Linear Model With an Adaptive Hemodynamic Response Function
Authors: Niioka Kiyomitsu , Uga Minako , Nagata Taihei , Tokuda Tatsuya , Dan Ippeita , Ochi Keita 
Published: May 2018

AbstractWe investigated cerebral hemodynamic response during concealment of information about a mock crime using functional near‐infrared spectroscopy (fNIRS). Participants either committed a mock crime or not and then were presented with a randomized series of crime‐relevant questions and crime‐irrelevant questions in a standard concealment task. Participants in the guilty group concealed crime‐relevant information about the mock crime but those in the innocent group did not. Recorded fNIRS timeline data sets were analyzed within the framework of a general linear model approach with an adaptive hemodynamic response function. In this analysis, we affirmed that an adaptive temporal parameter in hemodynamic response function during the concealment task differs from a conventionally used temporal parameter. Group analysis showed that the guilty group elicited greater hemodynamic response during the concealment task than did the innocent group. These results suggest that both the frontal cluster, including frontopolar and orbitofrontal areas, and the temporal cluster are involved in concealment. We also identified a potential application for fNIRS to detect concealment in criminal investigations.
Modelling Changes in the Cognitive Processing of Grammar in Implicit and Explicit Learning Conditions: Insights From an Eye‐Tracking Study
Authors: Indrarathne Bimali , Ratajczak Michael , Kormos Judit 
Published: May 2018

AbstractThis study used eye‐tracking to examine changes in how second language (L2) learners process target grammatical exemplars in written L2 input in implicit and explicit instructional conditions and how these changes relate to learning gains. In three separate sessions, 77 L2 learners of English read a story containing seven examples of a grammatical construction. The results of a growth curve analysis indicated significant main effects for the instructional condition and test sessions on total fixation duration and a significant interaction between these two variables. There was minimal attentional processing and no improvement in processing efficiency of the target construction in the unenhanced condition. Learners’ attentional processing in the textually enhanced conditions decreased and, by the end of the experiment, they engaged in establishing and fine tuning form–meaning links. In the two explicit instructional conditions, participants’ attention decreased over time and form–meaning representations of the target structure were strengthened.Open PracticesThis article has been awarded an Open Materials badge. All materials are publicly accessible via the IRIS Repository at https://www.iris-database.org. Learn more about the Open Practices badges from the Center for Open Science: https://osf.io/tvyxz/wiki.
Advanced maxillofacial imaging for temporomandibular disorder in special needs patients
Authors: Chompunud Na Ayudhya Chalatip , Granquist Eric J. , Mupparapu Mel , Sollecito Thomas P. , Stoopler Eric T. 
Published: May 2018

ABSTRACTTemporomandibular disorder (TMD) is prevalent in special needs patients. Clinical examination of the temporomandibular joint (TMJ) complex and imaging in this patient population can be challenging due to patient disposition and cooperation. We report a case of a 29‐year‐old male with neurologic and behavioral special needs who required advanced maxillofacial imaging for a suspected TMD under general anesthesia, which has not been reported previously. This article intends to serve as a resource for health care providers who may encounter similar clinical situations.
Mucopolysaccharidosis VI and effects on growth of the apical bases: a case report
Authors: Ferreira dos Reis Moema , Pinheiro Lucas Rodrigues , Pinheiro Maria das Graças Rodrigues , de Almeida Haroldo Amorim , Feio Patrícia do Socorro Queiroz , de Almeida Sâmia Cordovil , de Souza Isabel Cristina Neves , Giugliani Roberto , Schwartz Ida Vanessa Doederlein , Cavaleiro Rosely Maria dos Santos , Pinheiro João de Jesus Viana , da Silva Luiz Carlos Santana 
Published: May 2018

ABSTRACTObjectiveMucopolysaccharidosis (MPS) VI is a rare disorder caused by an autosomal recessive mutation in the short arm of chromosome 5 (5q12‐13) leading to an N‐acetylgalactosamine‐sulfatase lysosomal enzyme deficiency and numerous systemic clinical changes. The oral and maxillofacial complex may exhibit tooth eruption anomalies, macroglossia, gingival hypertrophy, mouth breathing, increased lower facial height, open bite, retrognathia, and progressive TMJ arthrosis. This report describes craniofacial growth changes in two MPS VI patients, sisters and daughters of outbred parents, who were longitudinally monitored from 11 to 15 years of age.Study DesignSkull lateral teleradiography and cephalometric tracings were performed. The measurements were assessed in the anteroposterior and vertical directions based on protocols by McNamara and Usp/Unicamp and compared to the normal reported ranges.ResultsA similar skeletal class III malocclusion was observed in both patients. The jaw was retruded, the anterior skull base decreased, and the mandibular body was normal or larger than normal. The vertical growth direction differed between the patients; one was hyperdivergent, while the other was hypodivergent.ConclusionsBy understanding the craniofacial growth changes in MPS VI patients, new treatment options may be developed for affected patients.
Brucella Peptide Cross-Reactive Major Histocompatibility Complex Class I Presentation Activates SIINFEKL-Specific T Cell Receptor-Expressing T Cells
Authors: Harms Jerome S. , Khan Mike , Hall Cherisse , Splitter Gary A. , Homan E. Jane , Bremel Robert D. , Smith Judith A. 
Published: May 2018

ABSTRACTBrucellaspp. are intracellular pathogenic bacteria remarkable in their ability to escape immune surveillance and therefore inflict a state of chronic disease within the host. To enable further immune response studies,Brucellawas engineered to express the well-characterized chicken ovalbumin (OVA). Surprisingly, we found that CD8 T cells bearing T cell receptors (TCR) nominally specific for the OVA peptide SIINFEKL (OT-1) reacted to parentalBrucella-infected targets as well as OVA-expressingBrucellavariants in cytotoxicity assays. Furthermore, splenocytes fromBrucella-immunized mice produced gamma interferon (IFN-γ) and exhibited cytotoxicity in response to SIINFEKL-pulsed target cells.To determine if the SIINFEKL-reactive OT-1 TCR could be cross-reacting toBrucellapeptides, we searched theBrucellaproteome using an algorithm to generate a list of near-neighbor nonamer peptides that would bind to H2Kb. Selecting fiveBrucellapeptide candidates, along with controls, we verified that several of these peptides mimicked SIINFEKL, resulting in T cell activation through the “SIINFEKL-specific” TCR. Activation was dependent on peptide concentration as well as sequence. Our results underscore the complexity and ubiquity of cross-reactivity in T cell recognition. This cross-reactivity may enable microbes such asBrucellato escape immune surveillance by presenting peptides similar to those of the host and may also lead to the activation of autoreactive T cells.
Malleilactone Is a Burkholderia pseudomallei Virulence Factor Regulated by Antibiotics and Quorum Sensing
Authors: Klaus Jennifer R. , Deay Jacqueline , Neuenswander Benjamin , Hursh Wyatt , Gao Zhe , Bouddhara Tiffany , Williams Todd D. , Douglas Justin , Monize Kyle , Martins Patricia , Majerczyk Charlotte , Seyedsayamdost Mohammad R. , Peterson Blake R. , Rivera Mario , Chandler Josephine R. 
Published: May 2018

ABSTRACT

Burkholderia pseudomallei
, the causative agent of melioidosis, encodes almost a dozen predicted polyketide (PK) biosynthetic gene clusters. Many of these are regulated by LuxR-I-type acyl-homoserine (AHL) quorum-sensing systems. One of the PK gene clusters, the
mal
gene cluster, is conserved in the close relative
Burkholderia thailandensis
. The
B. thailandensis mal
genes code for the cytotoxin malleilactone and are regulated by a genetically linked LuxR-type transcription factor, MalR. Although AHLs typically interact with LuxR-type proteins to modulate gene transcription, the
B. thailandensis
MalR does not appear to be an AHL receptor. Here, we characterize the
mal
genes and MalR in
B. pseudomallei
. We use chemical analyses to demonstrate that the
B. pseudomallei mal
genes code for malleilactone. Our results show that MalR and the
mal
genes contribute to the ability of
B. pseudomallei
to kill
Caenorhabditis elegans
. In
B. thailandensis
, antibiotics like trimethoprim can activate MalR by driving transcription of the
mal
genes, and we demonstrate that some of the same antibiotics induce expression of
B. pseudomallei malR
. We also demonstrate that
B. pseudomallei
MalR does not respond directly to AHLs. Our results suggest that MalR is indirectly repressed by AHLs, possibly through a repressor, ScmR. We further show that malleilactone is a
B. pseudomallei
virulence factor and provide the foundation for understanding how malleilactone contributes to the pathology of melioidosis infections.

IMPORTANCE
Many bacterially produced polyketides are cytotoxic to mammalian cells and are potentially important contributors to pathogenesis during infection. We are interested in the polyketide gene clusters present in
Burkholderia pseudomallei
, which causes the often-fatal human disease melioidosis. Using knowledge gained by studies in the close relative
Burkholderia thailandensis
, we show that one of the
B. pseudomallei
polyketide biosynthetic clusters produces a cytotoxic polyketide, malleilactone. Malleilactone contributes to
B. pseudomallei
virulence in a
Caenorhabditis elegans
infection model and is regulated by an orphan LuxR family quorum-sensing transcription factor, MalR. Our studies demonstrate that malleilactone biosynthesis or MalR could be new targets for developing therapeutics to treat melioidosis.
Evaluation of a Turbidimetric β-
d
-Glucan Test for Detection of Pneumocystis jirovecii Pneumonia
Authors: Dichtl Karl , Seybold Ulrich , Wagener Johannes 
Published: May 2018

ABSTRACT

Currently, diagnosis of
Pneumocystis jirovecii
pneumonia (PJP) relies on analysis of lower respiratory specimens, either by microscopy or quantitative real-time PCR (qPCR). Thus, bronchoscopy is required, which is associated with increased risk of respiratory failure. We assessed the value of noninvasive serologic β-
d
-glucan (BDG) testing for laboratory diagnosis of PJP using a newly available turbidimetric assay. We identified 73 cases of PJP with positive qPCR results from lower respiratory specimens for
Pneumocystis
and serology samples dating from 1 week before to 4 weeks after qPCR. In addition, 25 sera from controls with suspected PJP but specimens negative for
Pneumocystis
by qPCR were identified. Sera were tested with a turbidimetric BDG assay (Fujifilm Wako Chemicals Europe GmbH, Neuss, Germany), using an 11-pg/ml cutoff. Sensitivity and specificity were calculated based on qPCR test results as a reference. The turbidimetric BDG assay identified 63/73 patients with positive or slightly positive qPCR tests for an overall sensitivity of 86%; after exclusion of cases with only slightly positive qPCR results, sensitivity was 91%. No correlation between serum BDG levels and respiratory specimen DNA levels was found. Serologic BDG testing was negative in 25/25 controls with negative qPCR for a specificity of 100% using the predefined cutoff. In 22/25 samples (88%), no BDG was detected. Serologic BDG testing using the turbidimetric assay showed high sensitivity and specificity compared to qPCR of lower respiratory specimens for the diagnosis of PJP. Both turnover time and test performance will allow clinicians to delay or in some cases forego bronchoscopy.
Sexual risk behaviour, sexual victimisation, substance use and other factors related to depression in men who have sex with men in Wenzhou, China: a cross-sectional study
Authors: Pan Xiaohong , Li Runhua , Ma Qiaoqin , Wang Hui , Jiang Tingting , He Lin , Zeng Shidian , Wang Dayong , Ye Zhenmiao , Zhu Haishen , Zhao Dongshe , Xia Shichang 
Published: May 2018

ObjectivesMen who have sex with men (MSM) are a marginalised population at high risk for a variety of mental health problems that may mutually facilitate HIV transmission. We assessed factors associated with depressive symptoms among MSM, which can provide some guidance for future mental health interventions with the MSM population for prevention of HIV infection and transmission.MethodsA cross-sectional study was conducted in Wenzhou city, China using respondent-driven sampling (RDS) between December 2013 and June 2014. A face-to-face questionnaire survey was employed to collect information about mental and psychosocial health conditions and sexual behaviour characteristics among MSM. Bivariate and multivariable logistic regression analyses were used to identify factors associated with major depressive symptoms.ResultsOf the 454 participants in the study, prevalence of major depressive symptoms was 34.6%. During the past 6 months, 85% had anal sex with men, and rate of consistent condom use during anal intercourse was 45.1%. Of the respondents, 16.1% reported suicidal ideation, 62.6% had a history of smoking and 41.4% had a history of drinking alcohol, of which 46.3% reported that they were once drunk. Drug use was reported in 3.7% of the sample. Adult sexual violence from same-sex partners was 7.9%, and 5.1% reported childhood sexual abuse. ARDS-weighted multivariable analysis showed that major depressive symptoms among MSM were associated with inconsistent condom use during anal sex with men, multiple oral male sexual partners, suicidal ideation, adult sexual violence from male partners and being once drunk in the past year.ConclusionWe found high levels of depressive symptoms, unprotected sex and suicidal ideation among MSM. Comprehensive intervention strategies that combine psychological, behavioural and social aspects are needed to address the mental health issues of MSM, with special attention given to suicidality and high-risk behaviours in mental health and HIV prevention interventions.
Association between high-fasting insulin levels and metabolic syndrome in non-diabetic middle-aged and elderly populations: a community-based study in Taiwan
Authors: Chen Yun-Hung , Lee Yu-Chien , Tsao Yu-Chung , Lu Mei-Chun , Chuang Hai-Hua , Yeh Wei-Chung , Tzeng I-Shiang , Chen Jau-Yuan 
Published: May 2018

ObjectivesWe aimed to determine the association between fasting insulin (FI) levels and metabolic syndrome (MetS) in non-diabetic middle-aged and elderly adults in a community in Taiwan.DesignCross-sectional observational study.SettingCommunity-based investigation in Guishan township of northern Taiwan.ParticipantsOur study included adults aged 50 years and above during community health examinations between January and October 2014. People with diabetes mellitus were excluded. A total of 321 people were enrolled.Outcome measuresWe divided participants according to tertiles of FI as low, medium and high levels. Pearson correlation was assessed between insulin level and each of the diagnostic components of metabolic syndrome (MetS-DCs) with adjustment of age. The prevalence of MetS-DCs based on tertiles of FI were studied and analysed by Cochran–Armitage trend test. The risk for prevalence of MetS in the middle and high insulin group as compared with the low insulin group were assessed by multivariate logistic regression with adjustments for age, gender, smoking, body mass index (BMI), hypertension and hyperlipidaemia. Youden Index was performed for the optimised cut-off value.ResultsOur results showed positive correlation of FI level with systolic blood pressure, waist circumference, fasting plasma glucose and triglyceride levels, while negative correlation was shown with high-density lipoprotein (P<0.001). The prevalence of each MetS-DCs increased as a trend while FI levels increased (P<0.001). OR (95% CI) of MetS was 5.04 (2.15 to 11.81) for high insulin groups compared with the low insulin group after adjusting confounders (P<0.001). Area under receiver operating characteristic curve (ROC) curve (AUC) was 0.78, and cut-off value 7.35 μU/mL for FI was obtained (sensitivity: 0.69; specificity: 0.77).ConclusionsMiddle-aged and elderly non-diabetic people with increased FI are associated with a higher prevalence of MetS in the community in Taiwan. Furthermore, FI is an independent risk factor of MetS in this study population.
‘Treading water but drowning slowly’: what are GPs’ experiences of living and working with mental illness and distress in England? A qualitative study
Authors: Riley Ruth , Spiers Johanna , Chew-Graham Carolyn A , Taylor Anna K , Thornton Gail A , Buszewicz Marta 
Published: May 2018

ObjectivesThis paper provides an in-depth account of general practitioners’ (GPs) experiences of living and working with mental illness and distress, as part of a wider study reporting the barriers and facilitators to help-seeking for mental illness and burn-out, and sources of stress/distress for GP participants.DesignQualitative study using in-depth interviews with 47 GP participants. The interviews were audio recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.SettingEngland.ParticipantsA purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face to face or over the telephone.ResultsThe findings report GP participants’ in-depth experiences of distress and mental illness with many recollecting their distressing experiences and significant psychological and physical symptoms relating to chronic stress, anxiety, depression and/or burn-out, and a quarter articulating thoughts of suicide. Many talked about their shame, humiliation and embarrassment at their perceived inability to cope with the stresses of their job and/or their symptoms of mental illness.ConclusionsThese findings paint a concerning picture of the situation affecting primary care doctors, with participants’ accounts suggesting there is a considerable degree of mental ill health and reduced well-being among GPs. The solutions are complex and lie in prevention and provision. There needs to be greater recognition of the components and cumulative effect of occupational stressors for doctors, such as the increasing workload and the clinical and emotional demands of the job, as well as the need for a culture shift within medicine to more supportive and compassionate work environments.
Slipped disc and dyspnoea in a French bulldog
Authors: McLellan Laura 
Published: May 2018

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐ dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Slipped disc and dyspnoea in a French bulldog’, was submitted and is discussed by Laura McLellan. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.The series is being coordinated by Dr Steven McCulloch, acting director of the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.