bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role for
cis
-Acting RNA Sequences in the Temperature-Dependent Expression of the Multiadhesive Lig Proteins in Leptospira interrogans
Authors: Matsunaga James , Schlax Paula J. , Haake David A. 
Published: September 2013

ABSTRACT

The spirochete
Leptospira interrogans
causes a systemic infection that provokes a febrile illness. The putative lipoproteins LigA and LigB promote adhesion of
Leptospira
to host proteins, interfere with coagulation, and capture complement regulators. In this study, we demonstrate that the expression level of the LigA and LigB proteins was substantially higher when
L. interrogans
proliferated at 37°C instead of the standard culture temperature of 30°C. The RNA comprising the 175-nucleotide 5′ untranslated region (UTR) and first six
lig
codons, whose sequence is identical in
ligA
and
ligB
, is predicted to fold into two distinct stem-loop structures separated by a single-stranded region. The ribosome-binding site is partially sequestered in double-stranded RNA within the second structure. Toeprint analysis revealed that
in vitro
formation of a 30S-tRNA
fMet
-mRNA ternary complex was inhibited unless a 5′ deletion mutation disrupted the second stem-loop structure. To determine whether the
lig
sequence could mediate temperature-regulated gene expression
in vivo
, the 5′ UTR and the first six codons were inserted between the
Escherichia coli
l
-arabinose promoter and
bgaB
(β-galactosidase from
Bacillus stearothermophilus
) to create a translational fusion. The
lig
fragment successfully conferred thermoregulation upon the β-galactosidase reporter in
E. coli
. The second stem-loop structure was sufficient to confer thermoregulation on the reporter, while sequences further upstream in the 5′ UTR slightly diminished expression at each temperature tested. Finally, the expression level of β-galactosidase was significantly higher when point mutations predicted to disrupt base pairs in the second structure were introduced into the stem. Compensatory mutations that maintained base pairing of the stem without restoring the wild-type sequence reinstated the inhibitory effect of the 5′ UTR on expression. These results indicate that
ligA
and
ligB
expression is limited by double-stranded RNA that occludes the ribosome-binding site. At elevated temperatures, the ribosome-binding site is exposed to promote translation initiation.
Finely Tuned Regulation of the Aromatic Amine Degradation Pathway in Escherichia coli
Authors: Zeng Ji , Spiro Stephen 
Published: September 2013

ABSTRACT

FeaR is an AraC family regulator that activates transcription of the
tynA
and
feaB
genes in
Escherichia coli
. TynA is a periplasmic topaquinone- and copper-containing amine oxidase, and FeaB is a cytosolic NAD-linked aldehyde dehydrogenase. Phenylethylamine, tyramine, and dopamine are oxidized by TynA to the corresponding aldehydes, releasing one equivalent of H
2
O
2
and NH
3
. The aldehydes can be oxidized to carboxylic acids by FeaB, and (in the case of phenylacetate) can be further degraded to enter central metabolism. Thus, phenylethylamine can be used as a carbon and nitrogen source, while tyramine and dopamine can be used only as sources of nitrogen. Using genetic, biochemical and computational approaches, we show that the FeaR binding site is a TGNCA-N
8
-AAA motif that occurs in 2 copies in the
tynA
and
feaB
promoters. We show that the coactivator for FeaR is the product rather than the substrate of the TynA reaction. The
feaR
gene is upregulated by carbon or nitrogen limitation, which we propose reflects regulation of
feaR
by the cyclic AMP receptor protein (CRP) and the nitrogen assimilation control protein (NAC), respectively. In carbon-limited cells grown in the presence of a TynA substrate,
tynA
and
feaB
are induced, whereas in nitrogen-limited cells, only the
tynA
promoter is induced. We propose that
tynA
and
feaB
expression is finely tuned to provide the FeaB activity that is required for carbon source utilization and the TynA activity required for nitrogen and carbon source utilization.
Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment
Authors: Wand Benedict Martin , Abbaszadeh Sam , Smith Anne Julia , Catley Mark Jon , Moseley G Lorimer 
Published: September 2013

BackgroundHigh-quality clinical evidence suggests that although acupuncture appears superior to usual care in the management of chronic low back pain, there is little meaningful difference between true and sham acupuncture. This suggests that the benefits of acupuncture are mediated by the placebo response. An alternative explanation is that sham acupuncture is an active treatment and shares a mechanism of action with traditionally applied acupuncture. One plausible candidate for this mechanism is improvement in self-perception mediated through the sensory discrimination-like qualities of acupuncture. We aimed to compare the effects of acupuncture with a sensory discrimination training component to acupuncture without.Methods25 people with chronic low back pain were enroled in a randomised cross-over experiment. We compared the effect of acupuncture delivered when sensory discrimination is optimised to acupuncture delivered when it is not, on movement-related back pain immediately after each intervention.ResultsWe found that the average pain intensity after participants had received acupuncture with sensory discrimination training (2.8±2.5) was less than when they received acupuncture without sensory discrimination training (3.6±2.0). This difference was statistically significant (after adjustment; mean difference=−0.8, 95% CI −1.4 to −0.3; p=0.011).ConclusionsOur findings are consistent with the idea that acupuncture may offer specific benefit that is not dependent on precisely where the needles are inserted so much as that the patient attends to where they are inserted. If so, the location of the needles might be better focused on the painful area and the need for penetration of the skin may be mitigated.
Respiratory dysrhythmia in dementia with Lewy bodies: a cross-sectional study
Authors: Hibi Shinichiro , Yamaguchi Yasuhiro , Umeda-Kameyama Yumi , Iijima Katsuya , Takahashi Miwako , Momose Toshimitsu , Akishita Masahiro , Ouchi Yasuyoshi 
Published: September 2013

ObjectivesDementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease (AD). DLB is characterised by intracytoplasmic inclusions called Lewy bodies that are often seen in the brainstem. Because modulation of the respiratory rhythm is one of the most important functions of the brainstem, patients with DLB may exhibit dysrhythmic breathing. This hypothesis has not yet been systematically studied. Therefore, we evaluated the association between DLB and dysrhythmic breathing.DesignIn this cross-sectional study consecutive inpatients who were admitted for the evaluation of progressive cognitive impairment were enrolled. We assessed breathing irregularity using polysomnographic recordings on bed rest with closed eyes, without reference to the clinical differentiation among DLB, AD and having no dementia.SettingSingle centre in Japan.Participants14 patients with DLB , 21 with AD and 12 without dementia were enrolled in this study.Primary outcome measuresThe coefficient of variation (CV) of the breath-to-breath time was calculated. We also examined the amplitude spectrum A(f) obtained using the fast Fourier transform and Shannon entropy S of A(f) in patients with DLB compared with patients with AD and patients without dementia.ResultsThe values of CV and entropy S were significantly higher in patients with DLB than in patients with AD and patients without dementia. No significant differences were observed between patients with AD and patients without dementia.ConclusionsPatients with DLB exhibit dysrhythmic breathing compared with patients with AD and patients without dementia. Dysrhythmic breathing is a new clinical feature of DLB and the spectral analysis of breathing patterns can be clinically useful for the diagnostic differentiation of DLB from AD.
ASSOCIATION OF DEMENTIA WITH DELAYED ED ANALGESIA IN PATIENTS OVER 70 WITH ACUTE MUSCULOSKELETAL INJURY
Authors: Markey G , Rabbani W , Kelly P 
Published: September 2013

Objectives & BackgroundPatients with dementia and traumatic injury require prompt and adequate pain relief. However we hypothesised that they may be at risk of under-treatment with analgesia in the emergency setting.MethodsWe identified patients over 70 who attended our ED with acute musculoskeletal injuries and were either referred to the Orthopaedics/Trauma surgeons on call or the fracture clinic. Using clinical records and discharge diagnosis coding, 61 injured patients with dementia were identified. 84 injured patients over 70 without dementia were also studied. Their ED prescription records were examined and whether analgesia was given or not, together with the time interval from arrival to administration of first analgesic was noted. Kaplan-Meier curves were constructed from the time-interval data. Significance testing was by the log rank test.Results62% of the patients with dementia had acute fractures. 77% of controls had acute fractures. The remaining patients (21% overall) had soft tissue injuries or joint dislocations. 50% of injured patients with dementia received analgesia in the ED phase of their care, compared with 56% of controls. There was a trend to delayed administration of analgesia to patients with dementia compared to controls (p=0.074, log rank). (Figure 1 for Kaplan-Meier curves).ConclusionOur findings suggest that injured patients with dementia are less likely to receive timely analgesia in the ED than patients without dementia. Further work is needed to identify the reasons behind this inequity and intervene accordingly.Abstract 022 Figure 1Kaplan-Meier plot of time interval from ED arrival to first analgesic; patients with dementia (upper curve) vs. controls (lower curve); p=0.074.
THE ACCURACY OF ALTERNATIVE TRIAGE RULES FOR IDENTIFICATION OF SIGNIFICANT TRAUMATIC BRAIN INJURY: A DIAGNOSTIC COHORT STUDY
Authors: Fuller G W , Woodford M , Lawrence T , Coats T , Lecky F 
Published: September 2013

Objectives & BackgroundTraumatic brain injury (TBI) is a leading cause of death and disability in young adults. Reorganisation of trauma services with direct triage of suspected head injury patients to trauma centres may improve outcomes following TBI. This study aimed to determine the sensitivity of principal English triage tools for identifying significant TBI.MethodsWe performed a diagnostic cohort study using data prospectively collated from the Trauma Audit and Research Network database between 2005–2011. Adult head injury patients were retrospectively classified according to London Ambulance Service (LAS) and Head Injury Transportation Straight to Neurosurgery study (HITS-NS) triage criteria. Sensitivity and specificity were then calculated against a reference standard of significant TBI, comprising head region abbreviated injury score (AIS) ≥3 or neurosurgical operation. To investigate the determinants of triage rule sensitivity patient characteristics were compared between true positive and false negative groups using descriptive statistics and hypothesis testing. Additional analyses were conducted to explore the robustness of results to selection bias and examine the sensitivity of pre-hospital Glasgow Coma Score (GCS) for detecting significant TBI.Results6,559 patients were included in complete case analyses. The LAS and HITS-NS triage tools demonstrated sensitivities of 44.5% (95% CI 43.2–45.9) and 32.6% (95% CI 31.4–33.9) respectively for identifying significant TBI patients. These results were not materially changed following multiple imputation of missing data under a missing at random assumption. False negative significant TBI cases were relatively older, more likely to be female, more frequently secondary to low-level falls, and were less likely to have very severe AIS 5 or 6 head injuries, p<0.01. Pre-hospital GCS did not appear to be a sensitive discriminator for identifying significant TBI, with 44.9% of patients classified as having significant TBI presenting with a PH GCS of ≥13.Conclusionconsiderable proportion of significant head injury patients may not to be triaged directly to trauma centres. Investment is therefore necessary to improve the accuracy of existing triage rules and maintain expertise in TBI diagnosis and management in non-specialist emergency departments.
A STUDY TO ASSESS WHETHER THE CLINICAL BACKGROUND OF A PAEDIATRIC TRAUMA TEAM LEADER AFFECTS THEIR CHOICE OF IMAGING MODALITY IN COMPARABLE TRAUMA PATIENTS
Authors: Thorpe E , Mcleod K A , Vaidya M 
Published: September 2013

Objectives & BackgroundPaediatric trauma team leaders (TTL) may be trained in different clinical sub specialties. The purpose of this study was to compare TTL trained in adult and paediatric emergency medicine in ordering pan CT scans in a similar category of trauma patient. Radiation doses received are often extremely high and carry with them a significantly increased risk for the child of developing cancer in the future.MethodsA retrospective review of the case notes of 455 consecutive paediatric trauma patients aged 15 and younger between January 2010 and December 2012 at a London based tertiary paediatric trauma centre. 116 patients were identified whose mechanism of injury was pedestrian versus car (>10 MPH). The training background of the trauma team leader (TTL) in each case was identified and imaging recorded. The ISS (Injury Severity Scores) and the clinical yield of each pan scan were analysed.Results116 patients were identified whose mechanism of injury was pedestrian versus car (>10 MPH). 67 of these patients (58%) had a consultant TTL trained in adult emergency medicine (EM). 49 of the patients (42%) had a consultant TTL trained in paediatric emergency Medicine (PEM). Of the traumas lead by EM TTLs, 14 (21%) had an ISS >16 (polytrauma) and 26 (39%) had ISS <5. A total of 36 (54%) cases received a pan CT scan.15 patients (42%) required clinical intervention including admission to ICU for observation. The remaining patients (58%) were either managed for injuries identified on plain films or did not require medical management for their injuries. Of the traumas lead by PEM TTLs, 14 (28%) had an ISS >16 (polytrauma) and 17 (34%) had ISS <5. A total of 24 (49%) cases received a pan CT scan. 15 patients (62%) required clinical intervention including admission to ICU for observation. The remaining patients (38%) were either managed for injuries identified on plain films or did not require medical management for their injuries.ConclusionTrauma team leaders from paediatric and adult emergency background have a similar propensity to order CT pan scans in trauma. Regardless of who the TTL was, the overall yield of the CT pan scans was only 50%, so the need for weighing up the risks/benefits is imperative in this group.
DOES ANAPHYLAXIS MASQUERADE AS ASTHMA IN CHILDREN?
Authors: Sargant N , Lajeunesse M , Benger J 
Published: September 2013

Objectives & BackgroundAnaphylaxis is under-reported in emergency settings and the potential for diagnostic confusion with acute asthma has been reported, especially in children who experience predominantly respiratory symptoms. However, no previous study has directly investigated the probability of unrecognised anaphylaxis in either adults or children presenting with acute asthma.MethodsA retrospective case note analysis of children admitted with acute asthma to Bristol's Paediatric Intensive Care Unit (PICU) was conducted. Cases were identified from the PICU admission database and children with other pre-existing respiratory disease were excluded. A total of 73 cases remained eligible for inclusion and were subjected to analysis using the Brighton Collaboration Case Definition (BCCD) for anaphylaxis. Cases with evidence of anaphylaxis were assigned a level of diagnostic probability from 1 (high) to 3 (low) based upon the BCCD.ResultsThe case notes of 84 children admitted to Bristol Royal Hospital for Children's PICU were obtained. 11 cases met exclusion criteria leaving 73 eligible for inclusion in the study. Clinical features consistent with a diagnosis of anaphylaxis were discovered in a total of 13 cases (17.8%). A single case (1.4%) met the criteria for level 1 (high probability) and the remaining 12 cases (16.4%) met criteria for level 2 (intermediate) probability. Following careful clinical review of each case meeting the BCCD, it became clear that anaphylaxis was probable in 3 cases (4.1%). The clinical features exhibited in the other 10 cases could each be more reasonably explained by the original diagnosis of acute asthma and/or concurrent infection.ConclusionThe results support the conclusion that some cases of anaphylaxis are unidentified and managed as acute asthma in children. The local frequency was estimated at 4.1% of children admitted to PICU but larger prospective multi-centre studies are required to better define the true prevalence nationally.
PERIORBITAL CELLULITIS: AMBULATORY CARE THAT IS SAFE AND COST EFFECTIVE
Authors: Yule E J , Fryer J , Ross J 
Published: September 2013

Objectives & BackgroundIncreasing ambulatory care is a goal of the College of Emergency Medicine. It reduces burden on inpatient wards, and is well received by patients and parents. Ambulatory care of children with periorbital cellulitis is not universally accepted, and warrants evaluation.MethodsWe reviewed all patients less than 16 years old diagnosed with periorbital cellulitis in a paediatric emergency department (PED) between April 2009 and April 2013. We identified the treatment received, length of stay in those admitted and number of visits to the ED in those ambulated. We compared each year since 2009 (when ambulation was written into local guidelines) looking at treatment given and patient outcomes. We calculated an estimated cost of care for each case using local tariffs.Results353 cases were identified. 63 (17.8%) were admitted from first assessment. 194 (54.9%) received ambulatory intravenous antibiotics, of those 5 (1.4%) were subsequently admitted. No children who received ambulatory care developed a significant complication e.g. orbital cellulitis. Comparison of the first and last 12 months demonstrated a falling admission rate from 32.9% to 10.3% (p<0.05). During the same period ambulatory intravenous antibiotic use rose from 32.9% to 67.9% (p<0.05). There was a reduction in initial treatment with oral antibiotics (31.2% to 21.8% p>0.05). This is a less significant trend but has important implications considering the morbidity and patient/parent acceptability of cannulation. We estimate an average saving of £2,420 per patient ambulated.ConclusionAmbulatory care of periorbital cellulitis is safe and cost effective, with very low rate of complication. We postulate that the availability of ambulatory intravenous antibiotics may be affecting clinical decision making, resulting in more children with mild periorbital cellulitis receiving intravenous rather than oral antibiotics. We suggest there is a role for developing a periorbital cellulitis scoring system to assess severity and guide treatment.Abstract 031 Figure 1Periorbital Cellulitis.Abstract 032 Figure 1Street Doctors.
USING EXISTING PAEDIATRIC PRE-HOSPITAL TRAUMA TRIAGE TOOLS TO IDENTIFY CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY–AN ANALYSIS OF NATIONAL TRAUMA REGISTRY DATA
Authors: Lyttle M D , Ardolino A , Berry K , Bouamra O , Cheung R , Lawrence T , Lecky F , Maconochie I K 
Published: September 2013

Objectives & BackgroundSevere traumatic brain injury (TBI) in childhood causes long term neurodisability and death, though early neurosurgical intervention may improve outcome. Primary transfer to a neurosurgical centre reduces the time from initial Emergency Department arrival to performance of time critical procedures. Paediatric trauma and neurosurgery services in England have recently undergone reconfiguration. To assist pre-hospital clinicians in determining the most suitable destination for an injured child a number of trauma triage tools have been developed. We aimed to assess the performance of these tools in identifying children with severe TBI.MethodsEight paediatric pre-hospital trauma triage tools were identified via survey and literature review. Retrospective clinical registry data for children <16 years were obtained from the Trauma Audit and Research Network during 2007–2012. Severe TBI was defined as Abbreviated Injury Score ≥3 in the head region as less severe injuries are unlikely to require neurosurgery. Performance of the tools in identifying severe TBI was assessed, with clinically acceptable cut-offs for under and over-triage assigned at the level of ≤5% and ≤50% respectively.Results338 (30%) of 1118 patients had severe TBI. None of the tools demonstrated an acceptable under-triage rate (range 7–68%). Two had acceptable over-triage rates of 90% and 82%, though these displayed the highest rates of under-triage. The remaining tools had over-triage rates of 56–83%.ConclusionNone of the existing paediatric pre-hospital trauma triage tools perform adequately in identifying severe TBI. Given the incidence of severe TBI in this population, and the benefits of appropriate disposition, any such tools subsequently derived should pay particular attention to their performance in regard to severe TBI with particular focus on optimising under triage rates.
ISOLATED VOMITING–A POOR INDICATION FOR CT SCAN IN HEAD INJURY?
Authors: Fryer J , Pusapati S , Abrahamson E 
Published: September 2013

Objectives & BackgroundMinor head injuries account for a significant number of paediatric presentations to the Emergency Department. In 2007 NICE produced national guidelines to improve and standardise practice across the UK. One indication for CT head scanning is vomiting ≥3 times, even in the absence of any other risk factors. In this study we reviewed CT outcomes with specific focus on children with isolated vomiting.MethodsAll CT Heads performed by Chelsea and Westminster Hospital Paediatric ED for minor head injury in patients under 16 years of age between July 2007 and May 2013 were reviewed. We identified those in whom the sole indication for CT head was vomiting ≥3 times post head injury.Results8096 children attended our department with head injury during the study period. Of these 516 (6.4%) underwent CT of the head. In 104 patients (20.2%) the indication for the CT was isolated vomiting, as the sole indication. Of this group, only one child had an abnormal CT (a minor finding requiring no intervention). The remaining 412 patients in the study had other NICE indications for a CT (sometimes multiple). Of these 67 (16.3%) had an abnormal scan.ConclusionThis study looks at practice in our unit over a 6 year period, starting 6 months after the 2007 NICE guidelines were introduced. This clearly shows that a large percentage of CTs are being performed on children following minor head injury on the basis of vomiting alone (20.2%). The yield of this is however extremely low with only 0.96% of the patients scanned having an abnormality. There are other clinical decision making algorithms in use internationally which do not have isolated vomiting as an indicator. We believe the current NICE guideline is exposing children‘s' heads to unnecessary ionising radiation.