bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial Use and Stewardship Programs Among Dialysis Centers
Authors: D'Agata Erika M.C. 
Published: April 2013

AbstractAntimicrobial exposure contributes to the emergence and spread of multidrug‐resistant organisms. As rates of colonization and infection with these organisms are among the highest in the population of chronic hemodialysis patients and antimicrobial exposure among this patient population is extensive, it is imperative to prescribe antimicrobials judiciously. Thirty to forty percent of chronic hemodialysis patients receive at least one dose of antimicrobials in outpatient centers over a one‐year period. Up to 30% of these antimicrobials are prescribed inappropriately, as per national guidelines. The predominant reasons include (i) failure to de‐escalate to a more narrow‐spectrum antimicrobial, (ii) criteria for infection, especially skin and soft tissue infections, are not met, and (iii) indications and duration for surgical prophylaxis for minor vascular‐access‐related procedures do not follow recommended guidelines. Vancomycin, third‐ or fourth‐generation cephalosporins and cefazolin are the most common antimicrobials or antimicrobial classes prescribed inappropriately. Antimicrobial stewardship programs reduce both inappropriate antimicrobial exposure and associated costs. Effective strategies include (i) education, (ii) guidelines and clinical pathways, (iii) antimicrobial order forms, (iv) de‐escalation therapy, and (v) prospective audit and feedback. Dialysis centers need to identify a team of individuals that will lead the antimicrobial stewardship program. Administrative and financial support for this team is essential. After implementation of the program, regular monitoring for compliance with strategies, and identifying factors that are preventing compliance are necessary. The efficacy of the program should also be evaluated at regular intervals through process and outcome measures.
Iranian ultrapotassic volcanism at ~11 Ma signifies the initiation of post‐collisional magmatism in the Arabia–Eurasia collision zone
Authors: Pang Kwan‐Nang , Chung Sun‐Lin , Zarrinkoub Mohammad Hossein , Lin Yu‐Chin , Lee Hao‐Yang , Lo Ching‐Hua , Khatib Mohammad Mahdi 
Published: April 2013

AbstractUltrapotassic rocks are a common, but volumetrically minor, hallmark of post‐collisional magmatism along the Alpine–Himalayan orogenic belt. Here, we document the occurrence of ultrapotassic volcanic rocks from the Eslamy peninsula, NW Iran in the Arabia–Eurasia collision zone. Our results indicate that magma genesis involved melting of phlogopite‐ and apatite‐bearing peridotites in the sub‐continental lithospheric mantle at ~11 Ma. These peridotites likely formed by metasomatism involving components derived from subducted sediments during Neotethyan subduction. The ~11 Ma ultrapotassic volcanism was preceded by a magmatic gap of ~11 Ma after the cessation of arc magmatism in NW Iran and Armenia, thus likely representing the initiation of post‐collisional magmatism. The age coincides with the onset of collision‐related magmatic activity and topographic uplift in the Caucasus–Iran–Anatolia region, and also with other regional geological events including the closure of the eastern Tethys gateway, the end of Arabian underthrusting and the start of escape tectonics in Anatolia.
Cytosolic monoterpene biosynthesis is supported by plastid‐generated geranyl diphosphate substrate in transgenic tomato fruits
Authors: Gutensohn Michael , Orlova Irina , Nguyen Thuong T. H. , Davidovich‐Rikanati Rachel , Ferruzzi Mario G. , Sitrit Yaron , Lewinsohn Efraim , Pichersky Eran , Dudareva Natalia 
Published: April 2013

SummaryGeranyl diphosphate (GPP), the precursor of most monoterpenes, is synthesized in plastids from dimethylallyl diphosphate and isopentenyl diphosphate by GPP synthases (GPPSs). In heterodimeric GPPSs, a non‐catalytic small subunit (GPPS‐SSU) interacts with a catalytic large subunit, such as geranylgeranyl diphosphate synthase, and determines its product specificity. Here, snapdragon (Antirrhinum majus) GPPS‐SSU was over‐expressed in tomato fruits under the control of the fruit ripening‐specific polygalacturonase promoter to divert the metabolic flux from carotenoid formation towards GPP and monoterpene biosynthesis. Transgenic tomato fruits produced monoterpenes, including geraniol, geranial, neral, citronellol and citronellal, while exhibiting reduced carotenoid content. Co‐expression of the Ocimum basilicum geraniol synthase (GES) gene with snapdragon GPPS‐SSU led to a more than threefold increase in monoterpene formation in tomato fruits relative to the parental GES line, indicating that the produced GPP can be used by plastidic monoterpene synthases. Co‐expression of snapdragon GPPS‐SSU with the O. basilicum α–zingiberene synthase (ZIS) gene encoding a cytosolic terpene synthase that has been shown to possess both sesqui‐ and monoterpene synthase activities resulted in increased levels of ZIS‐derived monoterpene products compared to fruits expressing ZIS alone. These results suggest that re‐direction of the metabolic flux towards GPP in plastids also increases the cytosolic pool of GPP available for monoterpene synthesis in this compartment via GPP export from plastids.
Targeted transcriptomic and metabolic profiling reveals temporal bottlenecks in the maize carotenoid pathway that may be addressed by multigene engineering
Authors: Farré Gemma , Maiam Rivera Sol , Alves Rui , Vilaprinyo Ester , Sorribas Albert , Canela Ramon , Naqvi Shaista , Sandmann Gerhard , Capell Teresa , Zhu Changfu , Christou Paul 
Published: April 2013

SummaryCarotenoids are a diverse group of tetraterpenoid pigments found in plants, fungi, bacteria and some animals. They play vital roles in plants and provide important health benefits to mammals, including humans. We previously reported the creation of a diverse population of transgenic maize plants expressing various carotenogenic gene combinations and exhibiting distinct metabolic phenotypes. Here we performed an in‐depth targeted mRNA and metabolomic analysis of the pathway to characterize the specific impact of five carotenogenic transgenes and their interactions with 12 endogenous genes in four transgenic lines representing distinct genotypes and phenotypes. We reconstructed the temporal profile of the carotenoid pathway during endosperm development at the mRNA and metabolic levels (for total and individual carotenoids), and investigated the impact of transgene expression on the endogenous pathway. These studies enabled us to investigate the extent of any interactions between the introduced transgenic and native partial carotenoid pathways during maize endosperm development. Importantly, we developed a theoretical model that explains these interactions, and our results suggest genetic intervention points that may allow the maize endosperm carotenoid pathway to be engineered in a more effective and predictable manner.
Proliferative, lymphocytic, infundibular mural folliculitis and dermatitis with prominent follicular apoptosis and parakeratotic casts in four Labrador retrievers: preliminary description and response to therapy
Authors: Hargis Ann M. , Myers Sherry , Gortel Kinga , Duclos David , Randolph‐Habecker Julie 
Published: April 2013

ObjectivesTo describe the clinical, histopathological and immunohistochemical lesions and the response to therapy of a novel skin disease in four dogs, and to compare the lesions with those of other similar conditions.MethodsClinical lesions, the histopathological findings in skin biopsy samples, immunohistochemistry for CD3 and cleaved caspase‐3 and the response to therapy were evaluated.ResultsClinical lesions included multifocal, coalescing, verrucous, crusted papules and plaques with erythematous borders and comedones or follicular casts. Lesions were in haired skin; they occurred at the edges of paw pads and claw beds in one dog. Histopathological lesions included ortho‐ and more prominent parakeratotic hyperkeratosis involving follicular infundibular epithelium, with cast formation and a papillary epidermal surface. Lymphocytic exocytosis affected all strata of follicular infundibular epithelium and epidermis. Variable numbers of acidophilic shrunken keratinocytes, often bordered by lymphocytes (satellitosis), occupied the more superficial strata of the follicular infundibular epithelium and epidermis. Immunohistochemistry revealed numerous CD3+ T lymphocytes and fewer cleaved caspase‐3‐positive apoptotic keratinocytes in the infundibular hair follicle epithelium and epidermis, with numerous CD3+ T lymphocytes and cleaved caspase‐3‐positive cells in the dermis. Two dogs responded completely to therapy with ciclosporin and remained lesion free off therapy; one dog responded to therapy with prednisone, azathioprine and ciclosporin, but relapsed; and one dog was not treated.Conclusions and clinical importanceThe cause of the lesions is unknown; the presence of intraepithelial CD3+ lymphocytes and cleaved caspase‐3‐positive apoptotic keratinocytes and the positive response to immunosuppressive therapy suggest an immune response directed towards unidentified antigens expressed on the surface of keratinocytes.
Leaflet repair and valve sparing (inclusion technique) aortic root repair: reference to the latest principles
Authors: Tucker Adam , Parissis Harry 
Published: April 2013

Up to 150 words summarising the case presentation and outcome (this will be freely available online). A Marfan case with dilated aortic root and prolapsed leaflets underwent aortic repair. The non-coronary leaflet-measured effective height was 7 mm (prolapsing) and was lifted up to 10 mm with a centrally placed plicating sutures. The right coronary leaflet had a geometric height of 17 mm (restricted) and was enlarged up to 21 mm with an autologous pericardial patch. The enlarged root was repaired with an inclusion technique. The final result showed a competent valve. This report outlines the feasibility of aortic repair provided one adheres to the principles of aortic valve repair.
Dissociation between Goal-directed and Discrete Response Localization in a Patient with Bilateral Cortical Blindness
Authors: Buetti Simona , Tamietto Marco , Hervais-Adelman Alexis , Kerzel Dirk , de Gelder Beatrice , Pegna Alan J. 
Published: April 2013

Abstract
We investigated localization performance of simple targets in patient TN, who suffered bilateral damage of his primary visual cortex and shows complete cortical blindness. Using a two-alternative forced-choice paradigm, TN was asked to guess the position of left–right targets with goal-directed and discrete manual responses. The results indicate a clear dissociation between goal-directed and discrete responses. TN pointed toward the correct target location in approximately 75% of the trials but was at chance level with discrete responses. This indicates that the residual ability to localize an unseen stimulus depends critically on the possibility to translate a visual signal into a goal-directed motor output at least in certain forms of blindsight.
Representation of Contextually Related Multiple Objects in the Human Ventral Visual Pathway
Authors: Song Yiying , Luo Yu L. L. , Li Xueting , Xu Miao , Liu Jia 
Published: April 2013

Abstract
Real-world scenes usually contain a set of cluttered and yet contextually related objects. Here we used fMRI to investigate where and how contextually related multiple objects were represented in the human ventral visual pathway. Specifically, we measured the responses in face-selective and body-selective regions along the ventral pathway when faces and bodies were presented either simultaneously or in isolation. We found that, in the posterior regions, the response for the face and body pair was the weighted average response for faces and bodies presented in isolation. In contrast, the anterior regions encoded the face and body pair in a mutually facilitative fashion, with the response for the pair significantly higher than that for its constituent objects. Furthermore, in the right fusiform face area, the face and body pair was represented as one inseparable object, possibly to reduce perceptual load and increase representation efficiency. Therefore, our study suggests that the visual system uses a hierarchical representation scheme to process multiple objects in natural scenes: the average mechanism in posterior regions helps retaining information of individual objects in clutter, whereas the nonaverage mechanism in the anterior regions uses the contextual information to optimize the representation for multiple objects.
Decreased levels of serum omentin-1 in patients with obstructive sleep apnoea syndrome
Authors: Wang Qiuyan , Feng Xuewei , Zhou Chuming , Li Peng , Kang Jian 
Published: April 2013

Background Inflammation is involved in the mechanism of obstructive sleep apnoea syndrome (OSAS). Omentin, a newly discovered adipokine, is implicated to play an anti-inflammatory role. This study aims to determine whether serum levels of omentin-1 are associated with the presence and severity of OSAS. Methods This study consisted of 192 patients with OSAS and 144 healthy subjects. Serum levels of omentin-1 were measured using enzyme-linked immunosorbent assay. Results Serum omentin-1 levels were significantly decreased in OSAS patients compared with healthy controls. Multivariable logistic regression analysis revealed that serum omentin-1 levels were inversely associated with the presence of OSAS (odds ratio 0.520, 95% confidence interval 0.433 to 0.623; P < 0.001). Severe OSAS patients had significantly lower serum omentin-1 levels compared with mild and moderate OSAS patients. Spearman correlation analysis showed that serum omentin-1 levels were correlated with the severity of OSAS. Simple linear regression analysis showed that the serum levels of omentin-1 were negatively correlated with waist circumference, body mass index, systolic blood pressure, homeostasis model assessment of insulin resistance (HOMA-IR), C-reactive protein (CRP), and apnoea-hypopnoea index in patients with OSAS. Furthermore, only HOMA-IR and CRP remained inversely associated with serum omentin-1 after multiple stepwise regression analysis. Conclusion Decreased serum omentin-1 levels could be considered as an independent predictive marker of the presence and severity of OSAS.
A multicentre study comparing two methods for serum free light chain analysis
Authors: Lock RJ , Saleem R , Roberts EG , Wallage MJ , Pesce TJ , Rowbottom A , Cooper SJ , McEvoy ED , Taylor JL , Basu S 
Published: April 2013

Background Serum free light chain analysis is now well established in the investigation of monoclonal gammopathies. In the UK there has, until recently, been a single supplier of kits for such analysis. Recently, a second method using monoclonal antisera was introduced. We have compared the performance of these two kits in four routine laboratories. Method Samples submitted for routine analysis (327 samples, 258 [79%] from patients with B-cell lymphoproliferative disease) for serum free light chains were tested by both technologies (Freelite, Binding Site and N Latex FLC, Siemens), according to the manufacturers’ instructions. Results Qualitative data were available by both methods on 313 samples for serum free kappa chains and 324 samples for lambda free light chains. We found poor correspondence of 81% for kappa and 74% for lambda. Five percent of samples were significantly discordant in these assays. Conclusions These assays perform very differently in clinical practice. They cannot be used interchangeably, especially if monitoring patient responses to therapy.
Best practice guidelines on clinical management of acute attacks of porphyria and their complications
Authors: Stein Penelope , Badminton Mike , Barth Julian , Rees David , Stewart M Felicity 
Published: April 2013

The British and Irish Porphyria Network guidelines describe best practice in the clinical assessment, investigation and management of acute porphyria attacks and their complications, including severe attacks with neuropathy. Acute attacks of porphyria may occur in acute intermittent porphyria (AIP), variegate porphyria (VP) and hereditary coproporphyria (HCP). Aminolaevulinic acid dehydratase deficiency porphyria (ADP) is a very rare autosomal recessive porphyria; only six cases substantiated by mutation analysis have yet been described in the literature. Urinary porphobilinogen (PBG) is always raised in an acute attack due to AIP, VP or HCP and this analysis is essential to confirm the diagnosis. A positive result in a qualitative or semi-quantitative screening test must be followed by PBG quantitation at the earliest opportunity. However in a severely ill patient, treatment should not be delayed. Removal of precipitating factors, effective analgesia and control of symptoms with safe medication, attention to nutrition and fluid balance are essential. The indications for use of intravenous haem arginate are set out, together with advice on its administration. A small proportion of acute porphyria patients develop recurrent attacks and management options that may be considered include gonadotrophin-releasing hormone analogues, ‘prophylactic’ regular haem arginate infusion or ultimately, liver transplantation.
Artifactually elevated serum bicarbonate results caused by elevated serum lactate dehydrogenase concentrations
Authors: Saleem Mohamed , Dimeski Goce , Bourne Les , Coates Penelope 
Published: April 2013

Background An accurate estimation of serum bicarbonate concentration (HCO[Formula: see text]) is essential to the diagnosis and treatment of acid-base disorders and electrolyte disturbances. We noted significant discrepancies between HCO[Formula: see text] concentration measured by the Olympus AU2700 analyser and total serum carbon dioxide (TCO2) concentration derived from a Radiometer blood gas analyser on several patient samples. This was reported to the manufacturer which led to a recall of certain reagent lot numbers. We hypothesised the mechanism for this interference to be elevated levels of lactate dehyrogenase (LD). Methods We investigated the effect of increasing LD concentration on HCO[Formula: see text] with the reagent lot that was recalled and compared this with a subsequent reagent lot that was known to be unaffected on an Olympus AU2700. Results The experimental data confirmed a positive interference in the Olympus AU2700 HCO[Formula: see text] assay using older reagent lot numbers. The false positive HCO[Formula: see text] interference was significant (>10% change) when the LD concentration exceeded 845 U/L. Conclusions Very high levels of LD concentrations were the cause of interference in the Olympus AU2700 HCO[Formula: see text] enzymatic assay. Laboratorians should be aware that very high levels of LD may be a potential interference in some enzymatic HCO[Formula: see text] assays.
Difficult airway communication between anaesthetists and general practitioners
Authors: Wilkes M , Beattie C , Gardner C , McNarry AF 
Published: April 2013

Background and aims Advance warning of patients who are difficult to intubate may prevent an airway catastrophe but relies on effective communication between specialties. Anaesthetists aim to inform general practitioners whenever a difficult airway is encountered and expect general practitioners to include this information in subsequent referrals. We investigated how anaesthetists communicated with general practitioners, their knowledge of the Read Code (used by general practitioner computer systems) for difficult tracheal intubation, and how likely general practitioners were to pass the information on. Methods and results We surveyed 631 consultant anaesthetists and 217 general practitioners. We found only 125 (20%) anaesthetists consistently wrote difficult airway letters to general practitioners. Only 20 (3%) knew the Read Code for difficult intubation (SP2y3), although 454 (72%) thought it to be useful. Most general practitioners (212, 98%) thought airway information to be important, but only half receiving a difficult airway communication forwarded it on. General practitioners recommended including the Read Code SP2y3 and labelling it ‘high priority’, ensuring that ‘Difficult Tracheal Intubation’ would be listed in the Emergency Care Summary generated for hospital referrals. Conclusion Communication between anaesthetists and general practitioners is currently poor, but could be improved by simplifying difficult airway letters and including the SP2y3 code and a statement of priority.
Patient outcomes using revised guidance NHS Continuing Care Eligibility Criteria, Scotland (CEL 2008)
Authors: Martin BJ , Valiyaparambath N , Gray J 
Published: April 2013

Aim To determine the efficacy of selection of patients for NHS (Scotland) continuing care using revised guidance eligibility criteria, CEL (2008). Methods On September 2009, a census was conducted of 632 patients, distributed over 10 hospital sites in NHS Lanarkshire Older People's Directorate, to identify those patients who had future care needs assessed using revised NHSS CEL (2008) eligibility criteria during the previous 3 months. These patients were then assigned to one of four categories: (1) eligible for NHS continuing care; (2) likely destination care home; (3) likely discharge home with complex care package; and (4) outcome uncertain. ‘Frailty’ was recorded in a sub-group of patients using Rockwood’s frailty index. The index records frailty on a scale 0–1, a higher score indicating greater frailty. Outcomes were recorded at 2-monthly intervals for 1 year. Patients undergoing acute assessment and/or specialist rehabilitation, those admitted before 1 April 2009 and already accepted for NHS continuing care and those with a planned discharge date were excluded. Results Two hundred and eleven patients were identified as meeting the criteria for allocation to one of the four categories. Mortality at 1 year was as follows: NHS continuing care 40/45 (89%), likely Care Home destination 39/81 (48%), likely home discharge 22/61 (35%), outcome uncertain 13/24 (54%). Mean frailty scores were: NHS continuing care 0.4, likely care home 0.34, likely discharge home 0.29; p=0.0002 (ANOVA). Re-admission rates were high, 60% once and 40% twice or more, in patients discharged from hospital. Conclusion The revised guidance on Eligibility for NHS Continuing Care in Scotland, CEL (2008), is useful in identifying the frailest patients with complex needs and limited survival. However, hospital re-admission rates and mortality are high in all patients considered for eligibility to NHS continuing care in whom the guidance is applied.
Variation in practice: an analysis of Scottish Surgical Profiles ENT data
Authors: Yeo JCL , Ah-See KW , MacKenzie K 
Published: April 2013

Background Variation in otolaryngology intervention rates is reported in the Scottish Surgical Profiles Project. Tonsillectomy is one of the selected key indicator procedures. The variation in practice was discussed nationally at the Scottish Otolaryngology Society summer meetings in 2009 and 2010. NHS Grampian had a significantly higher tonsillectomy rate compared with other Scottish NHS boards. Aims To determine the accuracy of NHS Grampian data reported by the Information Service Division (ISD) and to record the appropriateness of listing of patients for tonsillectomy with reference to the Scottish Intercollegiate Guidelines Network (SIGN). Methods Retrospective review of case notes and surgical records of patients who had undergone tonsillectomy between March 2007 and March 2008 in NHS Grampian. Results Between March 2007 and March 2008, 509 tonsillectomy cases were performed in NHS Grampian. This corresponded to the data received from ISD. 87% of tonsillectomies performed were compliant with SIGN guidelines. Conclusion The Scottish otolaryngology clinicians have found the reporting of the intervention rates stimulating and challenging. Discussion of the surgical profile project regularly at national specialty meetings resulted in a preliminary detailed targeted audit of those who were persistent outliers for tonsillectomy. This refuted the presumed reasons for this variation, namely inaccurate figures from ISD and inappropriate listings by clinicians.