Sortases are enzymes mostly found in Gram-positive bacteria which cleave proteins site-specifically. This feature makes them a promising tool in molecular biology and biotechnology. In this study, using bacter...
https://ift.tt/2tGFTMY
Σάββατο 30 Ιουνίου 2018
Engineering E. coli cell surface in order to develop a one-step purification method for recombinant proteins
Long-term nitrate removal through methane-dependent denitrification microorganisms in sequencing batch reactors fed with only nitrate and methane
Denitrifying anaerobic methane oxidation (damo) bioprocesses can remove nitrate using methane as the electron donor, which gains great concern due to the current stringent discharge standard of nitrogen in was...
https://ift.tt/2KBzBor
A peculiar reaction curve with dual spikes in absorbance during a total bilirubin assay in spite of accurate results induced by high M-protein concentration
Authors: Bora, Kaustubh / Chutia, Happy
https://ift.tt/2IFvd5T
Norbert Tietz, 13th November 1926–23rd May 2018
Authors: Plebani, Mario / Lippi, Giuseppe
https://ift.tt/2KfFxr4
Harmonization of microbiology processes and standards: work in progress
Authors: Samuel, Linoj P.
https://ift.tt/2tz2Alv
History of disruptions in laboratory medicine: what have we learned from predictions?
Authors: Kricka, Larry J.
https://ift.tt/2I9i70E
An overview of EFLM harmonization activities in Europe
Authors: Kilpatrick, Eric S. / Sandberg, Sverre
https://ift.tt/2M4FR8v
Innovative approaches in diabetes diagnosis and monitoring: less invasive, less expensive… but less, equally or more efficient?
Authors: Jaisson, Stéphane / Gillery, Philippe
https://ift.tt/2taTuef
Procalcitonin-guided antibiotic therapy: an expert consensus
Authors: Bartoletti, Michele / Antonelli, Massimo / Bruno Blasi, Francesco Arturo / Casagranda, Ivo / Chieregato, Arturo / Fumagalli, Roberto / Girardis, Massimo / Pieralli, Filippo / Plebani, Mario / Rossolini, Gian Maria / Sartelli, Massimo / Viaggi, Bruno / Viale, Pierluigi / Viscoli, Claudio / Pea, Federico
https://ift.tt/2xKI4n8
Serum ischemia-modified albumin concentration may reflect long-term hypoxia in chronic respiratory disease: a pilot study
Authors: Kimura, Satoshi / Yamaguchi, Hayato / Shikama, Yusuke / Tateno, Hidetsugu / Kawaguchi, Masaya / Kotani, Kazuhiko / Menini, Teresita / Gugliucci, Alejandro
https://ift.tt/2M1TPIV
Model construction of Niemann-Pick type C disease in zebrafish
Authors: Lin, Yusheng / Cai, Xiaolian / Wang, Guiping / Ouyang, Gang / Cao, Hong
https://ift.tt/2I59hkt
Selective BH3-mimetics targeting BCL-2, BCL-XL or MCL-1 induce severe mitochondrial perturbations
Authors: Henz, Kristina / Al-Zebeeby, Aoula / Basoglu, Marion / Fulda, Simone / Cohen, Gerald M. / Varadarajan, Shankar / Vogler, Meike
https://ift.tt/2tTECRY
BNIP3 contributes to the glutamine-driven aggressive behavior of melanoma cells
Authors: Vara-Perez, Monica / Maes, Hannelore / Van Dingenen, Sarah / Agostinis, Patrizia
https://ift.tt/2lMworm
New clues into the self-assembly of Vmh2, a basidiomycota class I hydrophobin
Authors: Pennacchio, Anna / Cicatiello, Paola / Notomista, Eugenio / Giardina, Paola / Piscitelli, Alessandra
https://ift.tt/2tdbaqE
Sphingolipids in inflammatory hypoxia
Authors: Glaser, Ulrike G. / Fandrey, Joachim
https://ift.tt/2JQrlEP
Profiling system for skin kallikrein proteolysis applied in gene-deficient mouse models
Authors: Horn, Martin / Zbodakova, Olga / Kasparek, Petr / Srp, Jaroslav / Haneckova, Radka / Hradilek, Martin / Mares, Michael / Sedlacek, Radislav
https://ift.tt/2I26Oas
Insulin-like signaling within and beyond metazoans
Authors: Vitali, Valerio / Horn, Florian / Catania, Francesco
https://ift.tt/2M72TeZ
Upregulation of Twist is involved in Gli1 induced migration and invasion of hepatocarcinoma cells
Authors: Li, Juan / He, Yuting / Cao, Yuan / Yu, Yan / Chen, Xiaolong / Gao, Xiaojuan / Hu, Qiuyue
https://ift.tt/2I3JvND
Novel splice variants of the human kallikrein-related peptidases 11 (KLK11) and 12 (KLK12), unraveled by next-generation sequencing technology
Authors: Adamopoulos, Panagiotis G. / Kontos, Christos K. / Scorilas, Andreas
https://ift.tt/2I4YLJY
Twitch or swim: towards the understanding of prokaryotic motion based on the type IV pilus blueprint
Authors: Daum, Bertram / Gold, Vicki
https://ift.tt/2JOW0kO
Regulation of LRRK2: insights from structural and biochemical analysis
Authors: Gilsbach, Bernd K. / Eckert, Marita / Gloeckner, Christian Johannes
https://ift.tt/2JPIMEv
Jaw tremor: a manifestation of vascular parkinsonism? - a case report
Vascular Parkinsonism (VP) is a heterogeneous group of conditions that manifest clinically in parkinsonian features, but are presumably of vascular cause. It is usually bilateral, non-tremulous, and frequently as...
https://ift.tt/2KxS70J
The function of sphingomyelinases in mycobacterial infections
Journal Name: Biological Chemistry
Issue: Ahead of print
https://ift.tt/2KjY2uh
Rapid, Safe, and Simple Manual Bedside Nucleic Acid Extraction for the Detection of Virus in Whole Blood Samples
Here, we present a protocol for the rapid virus nucleic acid extraction from the virus-inactivated whole blood. The extraction is performed directly in the blood collection tubes and requires no equipment or electricity. The method is not dependent on laboratory facilities and can be used anywhere (e.g., in field hospitals).
https://ift.tt/2ICNEs0
Construction and Operation of a Light-driven Gold Nanorod Rotary Motor System
Plasmonic gold nanorods can be trapped in liquids and rotated at kHz frequencies using circularly-polarized optical tweezers. Introducing tools for Brownian dynamics analysis and light scatteringspectroscopy leads to a powerful system for research and application in numerous fields of science.
https://ift.tt/2IFkQiw
Assessment of Kidney Function in Mouse Models of Glomerular Disease
This protocol describes a full kidney work-up that should be carried out in mouse models of glomerular disease. The methods allow for detailed functional, structural, and mechanistic analysis of glomerular function, which can be applied to all mouse models of glomerular disease.
https://ift.tt/2KiouV8
Multi-color Localization Microscopy of Single Membrane Proteins in Organelles of Live Mammalian Cells
https://ift.tt/2yTI0lH
Fabricating Reactive Surfaces with Brush-like and Crosslinked Films of Azlactone-Functionalized Block Co-Polymers
https://ift.tt/2tJiiv9
Concurrent EEG and Functional MRI Recording and Integration Analysis for Dynamic Cortical Activity Imaging
https://ift.tt/2IEFIGw
Responsiveness of the PROMIS, NDI and ODI Instruments in Patients with Spinal Disorders
Publication date: Available online 30 June 2018
Source:The Spine Journal
Author(s): Man Hung, Charles L. Saltzman, Maren W. Voss, Jerry Bounsanga, Richard Kendall, Ryan Spiker, Brandon Lawrence, Darrel Brodke
Background ContextThe Patient-Reported Outcomes Information System (PROMIS) instruments are an important advancement in the use of PROs, but need to be evaluated with longitudinal data to determine whether they are responsive to change in specific clinical populations.PurposeThe purpose of this study was to assess the responsiveness of the PROMIS Physical Function (PF), PROMIS Pain Interference (PI), Neck Disability Index (NDI) and the Oswestry Disability Index (ODI).Study Design/SettingThis study entailed prospective data collection from consecutive patients aged 18 and older, visiting a university-based orthopaedic spine clinic between October 2013 and January 2017.Patient SampleThe 763 participants in the sample had a mean age of 58 (SD=15) years and the sample was 50.2% male and 92.8% Caucasian.Outcome MeasuresThe PROMIS PF and PROMIS PI Computerized Adaptive Tests along with either the NDI or ODI instruments were administered on tablet computers prior to clinic visits. Global rating of change questions relating to pain and function levels were also administered.MethodsBaseline scores were compared to follow-up scores at four different time-points from 3-months to 6-months and beyond. Patient demographics, mean scores, paired-sample t-tests, Standardized Response Mean (SRM), and Effect Size (ES) were analyzed to determine instrument responsiveness. This project was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number U01AR067138 and the authors have no conflicts of interest to disclose.ResultsThe PROMIS instruments were strongly correlated with each other as well as with the NDI and ODI. Responsiveness was significant on all four instruments at every time-point assessed (paired sample t-tests ranged from p<0.001 to p=0.049). SRM's were large and over 0.94 for every instrument at every time-point. Cohen's d ES were large and over 0.96 for all at all time-points, except for the NDI which had ES ranging from 0.74 to 0.83. This study showed large effect sizes and responsiveness of the PROMIS PF, PROMIS PI, NDI and ODI in a population of orthopaedic patients with spine pathologies.ConclusionThis study demonstrates strong responsiveness of the PROMIS PF and PROMIS PI in a spine clinic population.
https://ift.tt/2KkV4Ww
Jingshu Keli attenuates cervical spinal nerve ligation-induced allodynia in rats through inhibition of spinal microglia and Stat3 activation
Publication date: Available online 30 June 2018
Source:The Spine Journal
Author(s): Nianye Zheng, Xiaodong Liu, Ri Zhang, Idy Ho, Shihui Chen, Jiankun Xu, Hao Yao, Jiali Wang, Jiang Yue, Xinluan Wang, Ling Qin
Background ContextCervical radicular pain resulting from mechanical compression of a spinal nerve secondary to spinal degenerative alternations negatively impacts patients' quality of life. Jingshu Keli (JSKL), a traditional Chinese medicine formula with multiple active compounds, has been prescribed for pain management in patients with cervical radiculopathy for decades. Two major components of JSKL, ferulic acid and cinnamaldehyde, were identified to have anti-inflammation effect via inhibiting activation of Stat3.PurposeTo investigate the efficacy of JSKL by investigating its mechanism in attenuating cervical radiculopathy-induced mechanical allodynia via modulation activation of spinal microglia and phosphorylation of signal transducer and activator of transcription 3 (Stat3).Study DesignAn in vivo animal experiment.MethodsCervical radiculopathy of rats was established by C7 spinal nerve ligation (SNL) with 6-0 silk suture. The effect of post-operational daily gavage of JSKL on mechanical allodynia of rats was tested on day 3, 7, and 14 after surgery. Furthermore, spinal glial cells activation and phosphorylation of Stat3 (p-Stat3) were tested with immunofluorescence imaging and Western blot.ResultJSKL significantly inhibited SNL-induced allodynia as well as microglia activation in the spinal cord on day 7 and 14 after surgery. Moreover, expression of p-Stat3 was decreased in rats with SNL and JSKL treatment in comparison with rats with SNL and vehicle treatment.ConclusionsJSKL attenuated SNL-induced mechanical allodynia in rats. This analgesic effect might be explained by the suppression of activations of spinal microglia as well as p-Stat3. Our study provides experimental evidence for JSKL as an alternative approach to manage refractory pain in patients with cervical radiculopathy.
https://ift.tt/2ID0lDe
Radiation Injury, Burns and Illness: A Review of Best Practices. Your approach should include identifying sources, determining exposure and managing resources.
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Radiation Injury, Burns and Illness: A Review of Best Practices. Your approach should include identifying sources, determining exposure and managing resources.
EMS World. 2016 Oct;45(10):52-59
Authors: Kearns RD, Sugarman S, Cairns CB, Holmes Th JH, Cairns BA, Rich PB
PMID: 29953758 [PubMed]
https://ift.tt/2MzMqzZ
When 'Just Ask' Doesn't Work. Consider the when and why along with the what.
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When 'Just Ask' Doesn't Work. Consider the when and why along with the what.
EMS World. 2017 Apr;46(4):58
Authors: Loscar T
PMID: 29953773 [PubMed - in process]
https://ift.tt/2KyAP6Z
Understanding the Gas Exchange Process. The body's use of oxygen and creation of carbon dioxide requires a highly efficient absorption/elimination and transport system.
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Understanding the Gas Exchange Process. The body's use of oxygen and creation of carbon dioxide requires a highly efficient absorption/elimination and transport system.
EMS World. 2017 Apr;46(4):50-56
Authors: Gilpin R
PMID: 29953772 [PubMed - in process]
https://ift.tt/2MAOg3L
Virginia Brings Standards to Remounts. State law outlining requirements for ground ambulances doesn't exempt them, leaders say.
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Virginia Brings Standards to Remounts. State law outlining requirements for ground ambulances doesn't exempt them, leaders say.
EMS World. 2017 Apr;46(4):45
Authors: Gates H
PMID: 29953771 [PubMed - in process]
https://ift.tt/2KDFCnX
Kansas Agency to Field a Low-Top Ambulane. Butler County EMS is bringing a European design to the U.S.
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Kansas Agency to Field a Low-Top Ambulane. Butler County EMS is bringing a European design to the U.S.
EMS World. 2017 Apr;46(4):46-48
Authors: Sagarra SE
PMID: 29953770 [PubMed - in process]
https://ift.tt/2MDd0bM
EMS WORLD ROUNDTABLE: Ambulane Safety and Innovation. What's new and what's concerning to experts in EMS transportation?
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EMS WORLD ROUNDTABLE: Ambulane Safety and Innovation. What's new and what's concerning to experts in EMS transportation?
EMS World. 2017 Apr;46(4):41-44
Authors: Erich J
PMID: 29953769 [PubMed - in process]
https://ift.tt/2KANoi4
How a Novel Disease Threat Brought EMS and Public Health Together. In Washington, Ebola efforts helped players and systems improve cooperation and collaboration.
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How a Novel Disease Threat Brought EMS and Public Health Together. In Washington, Ebola efforts helped players and systems improve cooperation and collaboration.
EMS World. 2017 Apr;46(4):34-40
Authors: Mund E
PMID: 29953768 [PubMed - in process]
https://ift.tt/2MypFg4
How Care Collaboration Is Improving Patient Outcomes. In South Florida, paramedics serve as the "eyes, ears and hands" of vulnerable patients' physicians.
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How Care Collaboration Is Improving Patient Outcomes. In South Florida, paramedics serve as the "eyes, ears and hands" of vulnerable patients' physicians.
EMS World. 2017 Apr;46(4):26-33
Authors: Antevy P
PMID: 29953767 [PubMed - in process]
https://ift.tt/2KjtjO6
The Worst-Case Bariatrik Patient. When a homebound, germ-phobic patient needed care, a system found itself unprepared.
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The Worst-Case Bariatrik Patient. When a homebound, germ-phobic patient needed care, a system found itself unprepared.
EMS World. 2017 Apr;46(4):24-25
Authors: Page D, Krost W
PMID: 29953766 [PubMed - in process]
https://ift.tt/2MAUYqn
Patient Handoffs. Are EMS providers including all key information when they turn patient care over?
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Patient Handoffs. Are EMS providers including all key information when they turn patient care over?
EMS World. 2017 Apr;46(4):22-23
Authors: Fernandez AR
PMID: 29953765 [PubMed - in process]
https://ift.tt/2Kjtjh4
For Getting Better, Every Metric Matters. EMS is a rich source of data that can help you improve your organization's efficiency.
| Related Articles |
For Getting Better, Every Metric Matters. EMS is a rich source of data that can help you improve your organization's efficiency.
EMS World. 2017 Apr;46(4):14-21
Authors: Lawrence R
PMID: 29953764 [PubMed - in process]
https://ift.tt/2MzwGgp
Pony Up. Years later, the lessons of a mentor still prove their value.
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Pony Up. Years later, the lessons of a mentor still prove their value.
EMS World. 2016 Oct;45(10):90
Authors: Loscar T
PMID: 29953763 [PubMed]
https://ift.tt/2Ky07Cg
An Introduction to K9 Tactical Emergency Casualty Care. New initiative blends evidence-based medicine and user experience for high-threat veterinary trauma care recommendations.
| Related Articles |
An Introduction to K9 Tactical Emergency Casualty Care. New initiative blends evidence-based medicine and user experience for high-threat veterinary trauma care recommendations.
EMS World. 2016 Oct;45(10):84-87
Authors: Palmer L
PMID: 29953762 [PubMed]
https://ift.tt/2MxqzcD
BODY ARMOR INJURIES: What You Heed to Know. Know the capabilities and limitations of armor, and the mechanisms of injury you may encounter.
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BODY ARMOR INJURIES: What You Heed to Know. Know the capabilities and limitations of armor, and the mechanisms of injury you may encounter.
EMS World. 2016 Oct;45(10):81-83
Authors: Kolb JJ
PMID: 29953761 [PubMed]
https://ift.tt/2KDFC7r
READY FOR THE HEAT: Training Inside the Hot Zone.
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READY FOR THE HEAT: Training Inside the Hot Zone.
EMS World. 2016 Oct;45(10):76-80
Authors: Serino P
PMID: 29953760 [PubMed]
https://ift.tt/2MDFbY3
Strategies for Longevity in EMS. A dozen ways to ensure a long and rewarding EMS career.
| Related Articles |
Strategies for Longevity in EMS. A dozen ways to ensure a long and rewarding EMS career.
EMS World. 2016 Oct;45(10):72-75
Authors: Dick T
PMID: 29953759 [PubMed]
https://ift.tt/2KmUA2f
Medical Control: Colleagues in Patient Care. Its mission should be not only consultative but collaborative.
| Related Articles |
Medical Control: Colleagues in Patient Care. Its mission should be not only consultative but collaborative.
EMS World. 2016 Oct;45(10):45-51
Authors: Rubin M
PMID: 29953757 [PubMed]
https://ift.tt/2Kjtfhk
It Takes a Team of Teams to Transform Healthare. Northwell Health's integrated EMS revolution.
| Related Articles |
It Takes a Team of Teams to Transform Healthare. Northwell Health's integrated EMS revolution.
EMS World. 2016 Oct;45(10):36-43
Authors: Washko JD
PMID: 29953756 [PubMed]
https://ift.tt/2MzuKo8
FIGHTING THE OPIOID CRISIS FROM THE FRONT LINE. How EMS can share data and partner with public health to help combat the overdose epidemic.
| Related Articles |
FIGHTING THE OPIOID CRISIS FROM THE FRONT LINE. How EMS can share data and partner with public health to help combat the overdose epidemic.
EMS World. 2016 Oct;45(10):25-34
Authors: Kinsman JM, Elder JM, Kanter JM
PMID: 29953755 [PubMed]
https://ift.tt/2KmUyr9
You May Be Causing Low Morale! Here's what you can do to keep your people happier.
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You May Be Causing Low Morale! Here's what you can do to keep your people happier.
EMS World. 2016 Oct;45(10):22
Authors: Ludwig G
PMID: 29953754 [PubMed]
https://ift.tt/2MBg6ge
The unexpected diversity of microbial communities associated with black corals revealed by high-throughput Illumina sequencing
Abstract
The microbes associated with black corals remain poorly studied. The present study is the first attempt to investigate microbial community structure in the black corals Antipathes ceylonensis and A. dichotoma from the South China Sea by using high-throughput Illumina sequencing. A total of 52 bacterial and 3 archaeal phyla were recovered in this study, suggesting the black corals harboured highly diverse microbial communities. Among the 55 microbial phyla, Proteobacteria, Firmicutes, Bacteroidetes, Chloroflexi, Acidobacteria and Actinobacteria dominated in the two black corals from the South China Sea. Although most of the microbial phyla recovered from the two black corals have been reported in previous studies on coral-associated microbes, eight bacterial phyla including Synergistetes, Thermi, AncK6, GNO2, NKB19, NC10, WWE1 and GAL15, and the archaeal phylum Parvarchaeota are reported for the first time from corals in this study, which expands our knowledge about the diversity of coral-associated microbes. The comparison of microbial communities in the different black coral species indicated that A. ceylonensis harboured few abundant bacterial genera such as Citrobacter and Pseudomonas, whereas a high diversity of rare bacterial genera (<1% abundance), such as Winogradskyella and Rubricoccus, was detected only in A. dichotoma. These results suggested that the microbial community in black corals exhibited species-specific variation.https://ift.tt/2IFfcwS
Transport and metabolic engineering of the cell factory Corynebacterium glutamicum
Abstract
Corynebacterium glutamicum has a long and successful history in the biotechnological production of the amino acids l-glutamate and l-lysine. In the recent years, C. glutamicum has been engineered for the production of a broad catalog of value-added compounds including organic acids, vitamins, terpenoids and proteins. Moreover, this bacterium has been engineered to realize a flexible carbon source concept enabling product formation from various second generation feedstocks without competing uses in human and animal nutrition. In this review, we highlight transport engineering to improve product export and substrate uptake or to avoid loss of intermediates by excretion as well as the application of new metabolic engineering concepts for C. glutamicum strain development including the use of designed synthetic E. coli-C. glutamicum consortia. As examples, pathway extension of l-lysine and l-glutamate biosynthesis to produce derived value-added chemicals is described. The described examples of C. glutamicum strain engineering reflect strategies to cope with the increasing complexity of biotechnological processes that are required for successful applications in the bioeconomy.https://ift.tt/2Kw5cuV
Educating in antimicrobial resistance awareness: adaptation of the Small World Initiative program to service-learning
Abstract
The Small World Initiative (SWI) is a consolidated and successful education program rooted in the USA that tackles the antibiotic crisis by a crowdsourcing strategy. Based on active learning, it challenges young students to discover novel bioactive-producing microorganisms form environmental soil samples. Besides its pedagogical efficiency to impart Microbiology contents in academic curricula, SWI promotes vocations on research and development in Experimental Sciences and, at the same time, disseminates the antibiotic awareness guidelines of the World Health Organization (WHO). We have adapted the SWI program to the Spanish academic environment by a pioneering hierarchic strategy based on service-learning that involves two education levels (higher education and high school) with different degrees of responsibility. Along the academic year, 23 SWI teams each consisting of 3–7 undergraduate students led by one faculty member have coordinated off-campus programs in 22 local high schools, involving 597 secondary/high school students as researchers. Post-survey-based evaluation of the program reveals a satisfactory achievement of goals: acquiring scientific abilities and general or personal competencies by university students, as well as promoting academic decisions to inspire vocations for science- and technology-oriented degrees in younger students, and successfully communicating scientific culture in antimicrobial resistance to a young stratum of society.https://ift.tt/2IEhNHj
Insights into the phylogeny of false-branching heterocytous cyanobacteria with the description of Scytonema pachmarhiense sp. nov. isolated from Pachmarhi Biosphere Reserve, India
Abstract
A false branching cyanobacterium (strain 10A1_PS) was isolated from a freshwater body of the Pachmarhi Biosphere Reserve, India and was characterized using the polyphasic approach. The detailed morphological examination indicated that the strain belonged to the complex genus Scytonema as it exhibited typical false branching character whose frequency increased with age of the culture. As the family Scytonemataceae and the genus Scytonema has been shown to be polyphyletic in many studies, we provide deep insights into the phylogenetic complexities within the family Scytonemataceae based on 16S rRNA gene phylogeny along with complete morphological, molecular and phylogenetic characterization of the strain. The 16S rRNA gene phylogenetic tree inferred by Bayesian Inference, Neighbor-Joining and Maximum Parsimony methods showed that the strain clustered within the Scytonema sensu stricto clade. The phylogenetic distance and the positioning of the strain clearly indicated it to be different from other Scytonema species. Further analysis using rbcL phylogeny, folded secondary structures of the 16S-23S ITS, p-distance and percentage pairwise similarity matrix clearly distinguished the strain 10A1_PS from the other closely related species. In accordance with the International Code of Nomenclature of Algae, Fungi and Plants we propose the name of the new species to be Scytonema pachmarhiense.https://ift.tt/2KtXh1d
The influence of sigma factors and ribosomal recognition elements on heterologous expression of cyanobacterial gene clusters in Escherichia coli
Abstract
Cyanobacterial natural products offer new possibilities for drugs and lead compounds but many factors can inhibit the production of sufficient yields for pharmaceutical processes. While Escherichia coli and Streptomyces sp. have been used as heterologous expression hosts to produce cyanobacterial natural products, they have not met with resounding success largely due to their inability to recognize cyanobacterial promoter regions. Recent work has shown that the filamentous freshwater cyanobacterium Anabaena sp. strain PCC 7120 recognizes various cyanobacterial promoter regions and can produce lyngbyatoxin A from the native promoter. Introduction of Anabaena sigma factors into E. coli might allow the native transcriptional machinery to recognize cyanobacterial promoters. Here, all 12 Anabaena sigma factors were expressed in E. coli and subsets were found to initiate transcription from several cyanobacterial promoters based on transcriptional fusions to the chloramphenicol acetyltransferase (CAT) reporter. Expression of individual Anabaena sigma factors in E. coli did not result in lyngbyatoxin A production from its native cyanobacterial gene cluster, possibly hindered by deficiencies in recognition of cyanobacterial ribosomal binding sites by native E. coli translational machinery. This represents an important step toward engineering E. coli into a general heterologous expression host for cyanobacterial biosynthetic gene cluster expression.https://ift.tt/2ICwzhZ
Effect of spatial origin and hydrocarbon composition on bacterial consortia community structure and hydrocarbon biodegradation rates
Abstract
Oil reserves in deep-sea sediments are currently subject to intense exploration, with associated risks of oil spills. Previous research suggests that microbial communities from deep-sea sediment (>1000 m) can degrade hydrocarbons, but have a lower degradation ability than shallow (<200 m) communities, probably due to in situ temperature. This study aimed to assess the effect of marine origin on microbial hydrocarbon (HC) degradation potential while separating the influence of temperature, and to characterise associated HC-degrading bacterial communities. Microbial communities from 135 and 1000 m deep sediments were selectively enriched on crude oil at in situ temperatures and both consortia were subsequently incubated for 42 days at 20°C with two HC mixtures: diesel fuel or model oil. Significant HC biodegradation occurred rapidly in the presence of both consortia, especially of low molecular weight HCs and was concomitant with microbial community changes. Further, oil degradation was higher with the shallow consortium than with the deep one. Dominant HC-degrading bacteria differed based on both spatial origin of the consortia and supplemented HC-types. This study provides evidence for influence of sediment spatial origin and hydrocarbon composition on the selection and activity of marine HC-degrading bacterial communities and is relevant for future bioremediation developments.https://ift.tt/2NaOHTq
Antibiotic resistant bacteria and resistance genes in the bottom sediment of a small stream and the potential impact of remobilization
Abstract
River sediments are regarded as hot spots of bacterial density and activity. Moreover, high bacterial densities and biofilm formation are known to promote horizontal gene transfer, the latter playing a vital role in the spread of antimicrobial resistance. It can thus be hypothesized that sediments act as a reservoir of antibiotic resistant bacteria (ARB) and resistance genes (ARGs), particularly in rivers receiving microbes and drug residues from treated sewage. We analyzed the phenotypic susceptibility of 782 Escherichia coli isolates against 24 antimicrobials and we measured the relative abundances of five ARGs in water and sediment extracts of a small stream. We did not find evidence for a general increase in the proportion of resistant E. coli isolated from sediments as compared to those found in stream water. For most antimicrobials, the likelihood of detecting a resistant isolate was similar in water and sediment or it was even lower in the latter compartment. The mean relative abundance of ARGs was moderately increased in sediment-borne samples. Generally, absolute abundances of resistant cells and resistance genes in the sediment exceeded the pelagic level owing to higher bacterial densities. The river bottom thus represents a reservoir of ARB and ARGs which can be mobilized by resuspension.https://ift.tt/2ICtP4b
Microbial distribution and turnover in Antarctic microbial mats highlight the relevance of heterotrophic bacteria in low-nutrient environments
Abstract
Maritime Antarctica has shown the highest increase in temperature in the Southern Hemisphere. Under this scenario, biogeochemical cycles may be altered, resulting in rapid environmental change for Antarctic biota. Microbes, that drive biogeochemical cycles often form biofilms or microbial mats in continental meltwater environments. Limnetic microbial mats from the Fildes Peninsula were studied using high-throughput 16S rRNA gene sequencing. Mat samples were collected from fifteen meltwater stream sites, comprising a natural gradient from ultraoligotrophic glacier flows to meltwater streams exposed to anthropogenic activities. Our analyses show microbial structure differences between mats are explained by environmental NH4+, NO3−, DIN, soluble reactive silicon and conductivity. Microbial mats living under ultraoligotrophic meltwater conditions did not exhibit a dominance of cyanobacterial photoautotrophs, as it has been documented for other Antarctic limnetic microbial mats. Instead, ultraoligotrophic mat communities were characterized by the presence of microbes recognized as heterotrophs and photoheterotrophs. This suggests that microbial capabilities for recycling may be a key factor to dwell in ultra-low nutrient conditions. Our analyses show that phylotype level assemblages exhibit coupled distribution patterns in environmental oligotrophic inland waters. The evaluation of these microbes suggests the relevance of reproductive and structural strategies to pioneer these psychrophilic ultraoligotrophic environments.https://ift.tt/2NdoJyT
Missing from the debate? A qualitative study exploring the role of communities within interventions to address female genital mutilation in Europe
Introduction
Public attention on female genital mutilation (FGM) in diaspora communities is increasing in Europe, as health and social welfare implications become better understood. This study explored the role of potentially affected communities within interventions to address FGM in Europe, examining current practices, promising interventions and remaining gaps.
MethodsA qualitative study design incorporated 18 individual key informant interviews and five semistructured group interviews with policy-makers, service providers and community representatives. Data were analysed thematically, guided by the Scottish Government '4Ps' framework for addressing violence against women and girls, that is, prevention, protection, provision of services and participation.
ResultsParticipants emphasised both the importance of community participation and the lack of consistent engagement by policy-makers and practitioners. All indicated that communities had a key role, though most interventions focused on awareness-raising rather than community empowerment, behaviour change or influence on the design, delivery and/or evaluation of interventions.
ConclusionsDespite clear consensus around the need to engage, support and empower potentially affected communities and several examples of meaningful community participation in addressing FGM (eg, REPLACE, REPLACE 2, Ketenaapak, Tackling FGM Initiative), the role of communities remains inconsistent and further engagement efforts are necessary.
https://ift.tt/2IBQPAc
Accuracy and utility of using administrative healthcare databases to identify people with epilepsy: a protocol for a systematic review and meta-analysis
Introduction
In an increasingly digital age for healthcare around the world, administrative data have become rich and accessible tools for potentially identifying and monitoring population trends in diseases including epilepsy. However, it remains unclear (1) how accurate administrative data are at identifying epilepsy within a population and (2) the optimal algorithms needed for administrative data to correctly identify people with epilepsy within a population. To address this knowledge gap, we will conduct a novel systematic review of all identified studies validating administrative healthcare data in epilepsy identification. We provide here a protocol that will outline the methods and analyses planned for the systematic review.
Methods and analysisThe systematic review described in this protocol will be conducted to follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and Embase will be searched for studies validating administrative data in epilepsy published from 1975 to current (01 June 2018). Included studies will validate the International Classification of Disease (ICD), Ninth Revision (ICD-9) onwards (ie, ICD-9 code 345 and ICD-10 codes G40–G41) as well as other non-ICD disease classification systems used, such as Read Codes in the UK. The primary outcome will be providing pooled estimates of accuracy for identifying epilepsy within the administrative databases validated using sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curves. Heterogeneity will be assessed using the I2 statistic and descriptive analyses used where this is present. The secondary outcome will be the optimal administrative data algorithms for correctly identifying epilepsy. These will be identified using multivariable logistic regression models. 95% confidence intervals will be quoted throughout. We will make an assessment of risk of bias, quality of evidence, and completeness of reporting for included studies.
Ethics and disseminationEthical approval is not required as primary data will not be collected. Results will be disseminated in peer-reviewed journals, conference presentations and in press releases.
PROSPERO registrationCRD42017081212.
https://ift.tt/2tIdWV1
How do care home staff understand, manage and respond to agitation in people with dementia? A qualitative study
Objectives
Little is known about how care home staff understand and respond to distress in residents living with dementia labelled as agitation. The aim of this study was to describe how care home staff understand and respond to agitation and the factors that determine how it is managed.
DesignWe conducted a qualitative thematic analysis.
SettingWe recruited staff from six care homes in South East England including residential and nursing homes of differing sizes run by both the private and charity sector and located in urban and rural areas.
ParticipantsWe interviewed 25 care home staff using purposive sampling to include staff of either sex, differing age, ethnicity, nationality and with different roles and experience.
ResultsWe identified four overarching themes: (1) behaviours expressing unmet need; (2) staff emotional responses to agitation; (3) understanding the individual helps and (4) constraints on staff responses. Staff struggled with the paradox of trying to connect with the personhood of residents while seeing the person as separate to and, therefore, not responsible for their behaviours. Staff often felt powerless, frightened and overwhelmed, and their responses were constrained by care home structures, processes and a culture of fear and scrutiny.
ConclusionsResponding to agitation expressed by residents was not a linear process and staff faced tensions and dilemmas in deciding how to respond, especially when initial strategies were unsuccessful or when attempts to respond to residents' needs were inhibited by structural and procedural constraints in the care home. Future trials of psychosocial interventions should support staff to identify and respond to residents' unmet needs and include how staff can look after themselves.
https://ift.tt/2KyMAaq
POFA trial study protocol: a multicentre, double-blind, randomised, controlled clinical trial comparing opioid-free versus opioid anaesthesia on postoperative opioid-related adverse events after major or intermediate non-cardiac surgery
Introduction
Reducing opioid consumption during and after surgery has been recommended for more than 10 years. Opioid-free anaesthesia (OFA) is a multimodal anaesthesia associating hypnotics, NMDA antagonists, local anaesthetics, anti-inflammatory drugs and α-2 agonists. Proofs of the effect of OFA on reducing opioid-related adverse effects after major or intermediate non-cardiac surgery are still scarce. We hypothesised that the reduced opioid consumption allowed by OFA compared with standard of care will be associated with a reduction of postoperative opioid-related adverse events.
Methods/analysisThe POFA trial is a prospective, randomised, parallel, single-blind, multicentre study of 400 patients undergoing elective intermediate or major non-cardiac surgery. Patients will be randomly allocated to receive either a standard anaesthesia protocol or an OFA. The primary outcome measure is the occurrence of a severe postoperative opioid-related adverse event within the first 48 hours after extubation defined as: postoperative hypoxaemia or postoperative ileus or postoperative cognitive dysfunction. In addition, each component of the primary outcome measure will be analysed separately. Data will be analysed on the intention-to-treat principle and a per-protocol basis.
Ethics and disseminationThe POFA trial has been approved by an independent ethics committee for all study centres. Participant recruitment begins in November 2017. Results will be published in international peer-reviewed medical journals.
Trial registration numberNCT03316339; Pre-results.
https://ift.tt/2tIdOVx
SMARTphone and social media-based Cardiac Rehabilitation and Secondary Prevention (SMART-CR/SP) for patients with coronary heart disease in China: a randomised controlled trial protocol
Introduction
The burden of cardiovascular disease (CVD) is rapidly increasing in developing countries, however access to cardiac rehabilitation and secondary prevention (CR/SP) in these countries is limited. Alternative delivery models that are low-cost and easy to access are urgently needed to address this service gap. The objective of this study is to investigate whether a smartphone and social media-based (WeChat) home CR/SP programme can facilitate risk factor monitoring and modification to improve disease self-management and health outcomes in patients with coronary heart disease (CHD), after percutaneous coronary intervention (PCI) therapy.
Methods and analysisWe propose a single-blind, randomised controlled trial of 300 patients post-PCI with follow-up over 12 months. The intervention group will receive a smartphone-based and WeChat-based CR/SP programme providing education and support for risk factor monitoring and modification. SMART-CR/SP incorporates core components of modern CR/SP: physical activity tracking with interactive feedback and goal setting; education modules addressing CHD understanding and self-management; remote blood pressure monitoring and strategies to improve medication adherence. Furthermore, a dedicated data portal and a CR/SP coach will facilitate individualised supervision and counselling. The control group will receive usual care but no formal CR/SP programme. The primary outcome is change in exercise capacity measured by 6 minute walk test distance. Secondary outcomes include knowledge and awareness of CHD, risk factor status, medication adherence, psychological well-being and quality of life, major cardiovascular events, re-hospitalisations and all-cause mortality. To assess the feasibility and patients' acceptance of the intervention, a process evaluation will be performed at the conclusion of the study.
Ethics and disseminationEthics approval was granted by both the Human Research Ethics Committee of Fudan University Zhongshan Hospital (HREC B2016-058) and Curtin University Human Research Ethics Office (HRE2016-0120). Results will be disseminated via peer-reviewed publications and presentations at conferences.
Clinical trial registration numberChiCTR-INR-16009598; Pre-results.
https://ift.tt/2IDjQLV
Long-term sickness absence of 32 chronic conditions: a Danish register-based longitudinal study with up to 17 years of follow-up
Objectives
Sickness absence has been used as a central indicator of work disability, but has mainly been examined in single diseases, with limited follow-up time. This study identified the risk of long-term sickness absence (LTSA) of 32 chronic disease groups in the first year after diagnosis and the subsequent years.
SettingWe identified chronic disease groups prevalent in the work force (26 physical and 6 mental conditions) requiring all levels of care (primary, secondary, tertiary), by national registers of diagnoses from all hospital visits and prescribed medicine in Denmark from 1994 to 2011.
ParticipantsA general population sample within the working age range (18–59 years) was drawn by Statistics Denmark. Participants not working before and during the follow-up period were excluded. A total of 102 746 participants were included.
Primary and secondary outcome measuresHRs of transitions from work to LTSA of each of the chronic conditions were estimated in Cox proportional hazards models for repeated events—distinguishing between risk within the first (<1 year) and subsequent years of diagnosis (≥1 year) and an HR ratio (HRR): HR ≥1 year divided by HR <1 year.
ResultsAlmost all the conditions were associated with significantly increased risks of LTSA over time. The risks were generally more increased in men than in women. Three main patterns of LTSA were identified across diseases: strong decreases of LTSA from the first to subsequent years (eg, stroke in men <1 year: HR=7.55, 95% CI 6.45 to 8.85; ≥1 year HR=1.43, 95% CI 1.20 to 1.74; HRR=0.23). Moderate or small decreases in LTSA (HRR between 0.46 and 0.76). No changes (HRR between 0.92 and 0.95) or increases in elevated risks of LTSA over time (HRR between 1.02 and 1.16).
ConclusionsThe 32 chronic diseases were associated with three different risk patterns of LTSA over time. These patterns implicate different strategies for managing work disability over time.
https://ift.tt/2tF8Cli
Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study
Introduction
Knowledge about allocation of doctors into postgraduate training programmes is essential in terms of workforce planning, transparency and equity issues. However, this is a rarely examined topic. To address this gap in the literature, the current study examines the relationships between applicants' sociodemographic characteristics and outcomes on the UK Foundation Training selection process.
MethodsA longitudinal, cohort study of trainees who applied for the first stage of UK postgraduate medical training in 2013–2014. We used UK Medical Education Database (UKMED) to access linked data from different sources, including medical school admissions, assessments and postgraduate training. Multivariable ordinal regression analyses were used to predict the odds of applicants being allocated to their preferred foundation schools.
ResultsApplicants allocated to their first-choice foundation school scored on average a quarter of an SD above the average of all applicants in the sample. After adjusting for Foundation Training application score, no statistically significant effects were observed for gender, socioeconomic status (as determined by income support) or whether applicants entered medical school as graduates or not. Ethnicity and place of medical qualification were strong predictors of allocation to preferred foundation school. Applicants who graduated from medical schools in Wales, Scotland and Northern Ireland were 1.17 times, 3.33 times and 12.64 times (respectively), the odds of applicants who graduated from a medical school in England to be allocated to a foundation school of their choice.
ConclusionsThe data provide supportive evidence for the fairness of the allocation process but highlight some interesting findings relating to 'push-pull' factors in medical careers decision-making. These findings should be considered when designing postgraduate training policy.
https://ift.tt/2Kz3pBZ
Quality of life among individuals with rugby-related spinal cord injuries in South Africa: a descriptive cross-sectional study
Objectives
Rugby-related spinal cord injuries (SCIs) are rare but life altering and traumatic events. Little is known about the long-term consequences and outcomes of players who have sustained these injuries. This study investigated current quality of life (QoL) and factors associated with QoL, among individuals with rugby-related SCI in South Africa, by using the International Classification of Functioning, Disability and Health (ICF) framework.
DesignDescriptive cross-sectional study.
SettingRugby-related SCI population of South Africa, as captured in the BokSmart/Chris Burger Petro Jackson Players' Fund database.
ParticipantsNinety (n=90) of the 102 eligible players on the database agreed to participate in the study.
Main outcome measureThe relationship between QoL, as measured with the WHO Quality of Life questionnaire (WHOQOL-BREF) and specific independent variables (demographic information, level of independence and participation in various activities and life roles) was investigated. Variables that were significantly associated with QoL in bivariate analyses were included in multiple linear regression analyses.
ResultsThe mean score and SD of the WHOQOL-BREF was 15.1±2.3 arbitrary units. Participation (an ICF framework construct) and income were significantly associated with overall QoL (p<0.001). Participation was the only variable significantly associated with all QoL subdomains (p<0.001). Additionally, number of health concerns, type of healthcare (public vs private) and level of education were significantly associated with various QoL domains (p<0.001).
ConclusionsOn average, these individuals with rugby-related SCI presented with higher QoL scores than other comparable SCI studies. However, lower levels of participation and income, certain levels of education, increased health concerns and use of public healthcare were associated with lower levels of QoL. Sporting bodies have a responsibility to optimise player welfare, by acting on the modifiable factors associated with QoL.
https://ift.tt/2tEoyEA
Prevalence of dyslipidaemia and awareness of blood cholesterol levels among community-living people: results from the Longevity check-up 7+ (Lookup 7+) cross-sectional survey
Objective
The aim of the present study was to investigate the prevalence of abnormal cholesterol levels and to explore awareness of cholesterol values in an unselected sample of community-living adults.
DesignCross-sectional survey.
SettingExhibitions, malls and health promotion campaigns across Italy.
Participants3535 community dwellers aged 18–98 years were enrolled between September 2016 and June 2017. Analyses were conducted in 3040 participants, after excluding 495 enrolees on cholesterol-lowering medications.
Main outcome measuresTotal blood cholesterol levels and awareness of cholesterol values.
ResultsAbnormal blood cholesterol values were found in 1961 (64.5%) of participants with no differences between genders (p=0.06). Among those who believed they had normal cholesterol levels, only 48% had values below 200 mg/dL. More than 40% had cholesterol values between 200 and 240 mg/dL, and around 10% had values >240 mg/dL. More than one-third of participants had not measured cholesterol in the last year. Among them, only 36% had normal cholesterol levels.
ConclusionsAbnormal blood cholesterol is highly prevalent in our sample of Italian community dwellers, with less than half of participants being aware of their cholesterol levels.
https://ift.tt/2KB6Tns
Development and feasibility of a guided and tailored internet-based cognitive-behavioural intervention for kidney donors and kidney donor candidates
Objectives
Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. A subgroup of the kidney donor population experiences adjustment problems during or after the donation procedure (eg, anxiety or fatigue). There is a need for evidence-based interventions that decrease donation-related difficulties before or after donation. In the current study, a guided and tailored internet-based cognitive-behavioural therapy (ICBT) intervention for donors and donor candidates was developed and the feasibility and perceived effectiveness were evaluated.
DesignPilot study including qualitative and quantitative research methods for intervention development and evaluation.
SettingLiving kidney donor population of two Dutch transplantation centres.
ParticipantsDonors and healthcare professionals participated in focus group interviews conducted to identify intervention themes and to map attitudes towards internet-based interventions. In a pilot feasibility study, 99 donors and donor candidates participated, of whom 38 completed the screening. Eight donors or donor candidates with a risk profile (ie, impaired mental health-related quality of life (HRQoL)) received and evaluated the intervention.
InterventionsA guided and tailored ICBT intervention for donors and donor candidates was developed. Donation-related treatment modules, assignments and psychoeducation were integrated within an existing disease-generic ICBT intervention.
Outcome measuresHRQoL, anxiety and depression were assessed before and after the ICBT intervention. Additional questionnaires were included to identify specific problem areas of donor functioning to tailor the ICBT intervention to the donor's needs.
ResultsDifferent intervention themes were derived from the focus group interviews (eg, physical limitations, and donation-specific emotional and social-relational problems). Participants were satisfied about the intervention content (7.7±0.8 on a 0–10 scale) and the therapeutic relationship (4.4±0.6 on a 1–5 scale), and indicated an improvement on domains of their treatment goals (3.2±0.7 on a 1–4 scale).
ConclusionThis study showed positive evaluations concerning both feasibility and perceived effectiveness of the tailored ICBT intervention in kidney donors and donor candidates, in line with previous studies using comparable ICBT treatment protocols in other populations. Future research should examine the possibilities of integrating the intervention into psychosocial care for kidney donors.
https://ift.tt/2NaKQ8M
Development of a toolkit to enhance care processes for people with a long-term neurological condition: a qualitative descriptive study
Objective
To (A) explore perspectives of people with a long-term neurological condition, and of their family, clinicians and other stakeholders on three key processes: two-way communication, self-management and coordination of long-term care; and (B) use these data to develop a 'Living Well Toolkit', a structural support aiming to enhance the quality of these care processes.
DesignThis qualitative descriptive study drew on the principles of participatory research. Data from interviews and focus groups with participants (n=25) recruited from five hospital, rehabilitation and community settings in New Zealand were analysed using conventional content analysis. Consultation with a knowledge-user group (n=4) and an implementation champion group (n=4) provided additional operational knowledge important to toolkit development and its integration into clinical practice.
ResultsFour main, and one overarching, themes were constructed: (1) tailoring care:referring to getting to know the person and their individual circumstances; (2) involving others: representing the importance of negotiating the involvement of others in the person's long-term management process; (3) exchanging knowledge: referring to acknowledging patient expertise; and (4) enabling: highlighting the importance of empowering relationships and processes. The overarching theme was: assume nothing. These themes informed the development of a toolkit comprising of two parts: one to support the person with the long-term neurological condition, and one targeted at clinicians to guide interaction and support their engagement with patients.
ConclusionPerspectives of healthcare users, clinicians and other stakeholders were fundamental to the development of the Living Well Toolkit. The findings were used to frame toolkit specifications and highlighted potential operational issues that could prove key to its success. Further research to evaluate its use is now underway.
https://ift.tt/2Kz3cPd
Conflict of interest among Italian medical oncologists: a national survey
Objectives
To assess Italian medical oncologists' opinion on the implications of conflict of interest (COI) on medical education, care and research, and to evaluate their direct financial relationships.
DesignNational cross-sectional survey conducted between March and April 2017 among Italian oncologists.
SettingOnline survey sponsored by the Italian College of Medical Oncology Chiefs through its website.
ParticipantsItalian oncologists who filled out an anonymous questionnaire including 19 items and individual and working characteristics.
Main outcome measureThe proportion of medical oncologists perceiving COI as an outstanding issue and those receiving direct payments from industry.
ResultsThere were 321 respondents, representing 13% of Italian tenured medical oncologists. Overall, 62% declared direct payments from the pharmaceutical industry in the last 3 years. Sixty-eight per cent felt the majority of Italian oncologists have a COI with industry, but 59% suppose this is not greater than that of other specialties. Eighty-two per cent consider that most oncology education is supported by industry. More than 75% believe that current allocation of industry budget on marketing and promotion rather than research and development is unfair, but 75% consider it appropriate to receive travel and lodging hospitality from industry. A median net profit margin of 5000 per patient enrolled in an industry trial was considered appropriate for the employee institution. Sixty per cent agree to receive a personal fee for patients enrolled in industry trials, but 79% state this should be reported in the informed consent. Over 90% believe that scientific societies should publish a financial report of industry support. Finally, 79% disagree to being a coauthor of an article written by a medical writer when no substantial scientific contribution is made.
ConclusionsAmong Italian oncologists COI is perceived as an important issue influencing costs, education, care and science. A more rigorous policy on COI should be implemented.
https://ift.tt/2tF8B0I
Facilitators and barriers to the effective implementation of the individual maternal near-miss case reviews in low/middle-income countries: a systematic review of qualitative studies
Background
The maternal near-miss cases review (NMCR), a type of clinical audit, proved to be effective in improving quality of care and decreasing maternal mortality in low/middle-income countries (LMICs). However, challenges in its implementation have been described.
ObjectivesSynthesising the evidence on facilitators and barriers to the effective implementation of NMCR in LMICs.
DesignSystematic review of qualitative studies.
Data sourcesMEDLINE, LILACS, Global Health Library, SCI-EXPANDED, SSCI, Cochrane library and Embase were searched in December 2017.
Eligibility criteria for selecting studiesQualitative studies exploring facilitators and/or barriers of implementing NMCR in LMIC were included.
Data extraction and synthesisTwo independent reviewers extracted data, performed thematic analysis and assessed risk of bias.
ResultsOut of 25 361 papers retrieved, 9 studies from Benin, Brazil, Burkina Faso, Cote D'Ivoire, Ghana, Malawi, Morocco, Tanzania, Uganda could be included in the review. The most frequently reported barriers to NMCR implementation were the following: absence of national guidelines and local protocols; insufficient training on how to perform the audit; lack of leadership, coordination, monitoring and supervision; lack of resources and work overload; fear of blame and punishment; poor knowledge of evidenced-based medicine; hierarchical differences among staff and poor understating of the benefits of the NMCR. Major facilitators to NMCR implementation included: good leadership and coordination; training of all key staff; a good cultural environment; clear staff's perception on the benefits of conducting audit; patient empowerment and the availability of external support.
ConclusionsIn planning the NMCR implementation in LMICs, policy-makers should consider actions to prevent and mitigate common challenges to successful NMCR implementation. Future studies should aim at documenting facilitators and barriers to NMCR outside the African Region.
https://ift.tt/2KwjsRa
What can make things better for parents when babies need abdominal surgery in their first year of life? A qualitative interview study in the UK
Objectives
To understand the experiences of parents of infants who required surgery early in life. To identify messages and training needs for the extended clinical teams caring for these families—including paediatric surgeons, neonatologists, nurses, obstetricians, midwives and sonographers.
SettingUK-wide interview study, including England, Wales and Scotland.
ParticipantsIn-depth interviews were conducted with 44 parents who had a baby who underwent early abdominal surgery. Conditions included those diagnosed antenatally (eg, exomphalos, gastroschisis, congenital diaphragmatic hernia) or those which were detected postnatally (eg, Hirschsprung's disease, necrotising enterocolitis). Interviews were video and audio recorded and analysed using a modified grounded-theory approach.
ResultsWhile some parents reported experiencing excellent communication and felt they were listened to and involved by the care team, this was not always the case. Dealing with large, complex medical and surgical teams could result in conflicting messages, uncertainty and distress. Parents wanted information but also described being overwhelmed and wanting to distance themselves to maintain hope. Information and support from other parents in hospital and online groups were highly valued. Of particular concern was support when going home and caring for their baby after discharge; an open access policy for readmission offered a helpful safety net.
ConclusionsListening to the experience of parents provides rich data to enhance clinical understandings on how to improve information and communication with parents, and ameliorate the deep and lasting distress and anxiety that some parents feel when their infants face early surgery. We suggest that the writings of Bourdieu could have resonance in interpreting the experiences of parents as they enter the world of highly technical neonatal medicine and surgery and the knowledge of the professionals who work in these environments.
https://ift.tt/2tHsEvz
Development of a research platform for children with arthrogryposis multiplex congenita: study protocol for a pilot registry
Introduction
Arthrogryposis multiplex congenita (AMC) describes a heterogeneous group of conditions with multiple congenital contractures. These conditions may be attributed to genetic or other factors inducing decreased fetal movements, including maternal and paternal factors. Discovering the underlying genetic pathways has important repercussions for prevention, gene therapy and genetic counselling. The current literature mainly consists of small-scale, single-site studies, limiting comparability and pooling of findings across individual studies. A pilot registry for children presenting with AMC is proposed to provide the framework for a large-scale AMC registry. This registry will provide the platform to support high-quality studies to inform the distribution, clinical practice and genetics contributing to this group of conditions.
Methods and analysisThe registry will be piloted on 40 families of children from birth to 21 years of age presenting with AMC. Data will be collected on the child (demographic and newborn variables), mother and father (demographic, lifestyle habits and medical history). To promote standardised data collection, a manual of operations will be developed. Descriptive statistics will be used to summarise relevant data, regression analyses will be used to explore associations to generate hypotheses regarding factors contributing to AMC. Qualitative analysis will also be used to better describe the various phenotypes.
Ethics and disseminationEthics approval was obtained at the participating sites. The pilot registry will provide the platform for multisite AMC registry that will generate multiple research avenues to enhance current care and establish new therapies. Following this pilot study, the participant selection criteria will be refined and datasets will be expanded to include rehabilitation and surgical interventions, and genetic sequencing. The best timing for the questionnaire administration and frequency of follow-up prior to the implementation of a multisite AMC registry will be determined.
https://ift.tt/2KySoRa
Using electronic health records to quantify and stratify the severity of type 2 diabetes in primary care in England: rationale and cohort study design
Introduction
The increasing prevalence of type 2 diabetes mellitus (T2DM) presents a significant burden on affected individuals and healthcare systems internationally. There is, however, no agreed validated measure to infer diabetes severity from electronic health records (EHRs). We aim to quantify T2DM severity and validate it using clinical adverse outcomes.
Methods and analysisPrimary care data from the Clinical Practice Research Datalink, linked hospitalisation and mortality records between April 2007 and March 2017 for patients with T2DM in England will be used to develop a clinical algorithm to grade T2DM severity. The EHR-based algorithm will incorporate main risk factors (severity domains) for adverse outcomes to stratify T2DM cohorts by baseline and longitudinal severity scores. Provisionally, T2DM severity domains, identified through a systematic review and expert opinion, are: diabetes duration, glycated haemoglobin, microvascular complications, comorbidities and coprescribed treatments. Severity scores will be developed by two approaches: (1) calculating a count score of severity domains; (2) through hierarchical stratification of complications. Regression models estimates will be used to calculate domains weights. Survival analyses for the association between weighted severity scores and future outcomes—cardiovascular events, hospitalisation (diabetes-related, cardiovascular) and mortality (diabetes-related, cardiovascular, all-cause mortality)—will be performed as statistical validation. The proposed EHR-based approach will quantify the T2DM severity for primary care performance management and inform the methodology for measuring severity of other primary care-managed chronic conditions. We anticipate that the developed algorithm will be a practical tool for practitioners, aid clinical management decision-making, inform stratified medicine, support future clinical trials and contribute to more effective service planning and policy-making.
Ethics and disseminationThe study protocol was approved by the Independent Scientific Advisory Committee. Some data were presented at the National Institute for Health Research School for Primary Care Research Showcase, September 2017, Oxford, UK and the Diabetes UK Professional Conference March 2018, London, UK. The study findings will be disseminated in relevant academic conferences and peer-reviewed journals.
https://ift.tt/2NaKGyc
Death within 1 year among emergency medical admissions to Scottish hospitals: incident cohort study
Background
It is increasingly recognised that large numbers of hospital inpatients have entered the last year of their lives.
AimTo establish the likelihood of death within 12 months of admission to hospital; to examine the influence on survival of a cancer diagnosis made within the previous 5 years; to assess whether previous emergency admissions influenced mortality; and to compare mortality with that of the wider Scottish population.
DesignIncident cohort study.
Setting22 hospitals in Scotland.
ParticipantsThis study used routinely collected data from 10 477 inpatients admitted as an emergency to medicine in 22 Scottish hospitals between 18 and 31 March 2015. These data were linked to national death records and the Scottish Cancer Registry.
Primary outcome measures1 year cohort mortality compared with that of the general Scottish population. Patient factors correlating with higher risk of mortality were identified using Cox regression.
ResultsThere were 2346 (22.4%) deaths in the year following the census admission. Six hundred and ten patients died during that admission (5.8% of all admissions and 26% of all deaths) while 1736 died after the census admission (74% of all deaths). Malignant neoplasms (33.8%), circulatory diseases (22.5%) and respiratory disease (17.9%) accounted for almost three-quarters of all deaths. Mortality rose steeply with age and was five times higher at 1 year for patients aged 85 years and over compared with those who were under 60 years of age (41.9%vs7.9%) (p<0.001). Patients with cancer had a higher mortality rate than patients without a cancer diagnosis (55.6%vs16.6%) (p<0.001). Mortality was higher among patients with one or more emergency medical admissions in the previous year (30.1% v 15.1%) (p<0.001). Age/sex-standardised mortality was 110.4 (95% CI 104.4 to 116.5) for the cohort and 11.7 (95% CI 11.6 to 11.8) for the Scottish population, a 9.4-fold increase in risk.
ConclusionThese data may help identify groups of patients admitted to hospital as medical emergencies who are at greatest risk of dying not only during admission but also in the following 12 months.
https://ift.tt/2KySkRq
Mindful Self-Care and Resiliency (MSCR): protocol for a pilot trial of a brief mindfulness intervention to promote occupational resilience in rural general practitioners
Introduction
The Mindful Self-Care and Resiliency (MSCR) programme is a brief psychosocial intervention designed to promote resilience among various occupational groups. The intervention is based on the principles of mindfulness and also incorporates an educational self-care component. The current paper presents the protocol for a pilot study that will evaluate the effectiveness of this programme among general practitioners working in rural Queensland, Australia.
Methods and analysisWe will measure the impact of the MSCR programme on levels of employee resilience (Connor-Davidson Resilience Scale; State-Trait Assessment of Resilience STARS), compassion satisfaction and compassion fatigue (Professional Quality of Life Scale), self-compassion (Self-Compassion Scale) and mood (Positive and Negative Affect Scale). We will also assess the impact of the programme on job satisfaction (The Abridged Job in General Scale), absenteeism/presenteeism (The WHO Health and Work Performance Questionnaire) and general well-being (WHO Five Well-being Index). Repeated measures analysis of variance will be used to analyse the impact of the intervention on the outcome measures taken at pre, post, 1-month, 3-month and 6-month follow-ups. We will conduct individual interviews with participants to gather data on the feasibility and acceptability of the programme. Finally, we will conduct an initial cost-effectiveness analysis of the programme.
Ethics and disseminationApproval for this study was obtained from the Curtin University Human Research ethics committee and the study has been registered with the Australian Clinical Trials Registry. Results will be published and presented at national and international congresses.
Trial registration numberACTRN12617001479392p; Pre-results.
https://ift.tt/2tFYxV5
Physiotherapy and Anterior Resection Syndrome (PARiS) trial: feasibility study protocol
Introduction
Rectal cancer affects more than 600 patients per year in Wales, with a 5-year survival rate of around 60%. A recent report demonstrated that 19% of patients with bowel cancer had difficulty controlling their bowels after surgery, and these patients were twice as likely to report lower quality of life than those who had control. Nearly all patients will experience bowel dysfunction initially following surgery and up to 25% will experience severe bowel dysfunction on a long-term basis. The aim of this study is to test the feasibility of introducing a simple intervention in an attempt to improve bowel function following surgery for rectal cancer. We propose the introduction of an educational session from specialist nurses and physiotherapists prior to surgery and a subsequent physiotherapy programme for 3 months to teach patients how to strengthen their pelvic floor.
Methods and analysisAll patients with rectal cancer planned to receive an anterior resection will be approached for the study. The study will take place in three centres over 12 months, and we expect to recruit 40 patients. The primary outcome measure is the proportion of eligible patients approached who consent to and attend the educational session. The secondary outcomes include patient compliance to the pelvic floor rehabilitation programme (assessed by patient paper or electronic diary), the acceptability of the intervention to the patient (assessed using qualitative interviews) and preoperative and postoperative pelvic floor tone (assessed using the Oxford Grading System and the International Continence Society Grading System), patient bowel function and patient quality of life (assessed using validated questionnaires).
Ethics and disseminationEthics approval was granted. This feasibility study is in progress. If patients find the intervention acceptable, the next stage would be a trial comparing outcomes after anterior resection in those who have and do not have physiotherapy.
Trial registration numberISRCTN77383505; Pre-results.
https://ift.tt/2KwOvMt
Can inspiratory muscle training improve weaning outcomes in difficult to wean patients? A protocol for a randomised controlled trial (IMweanT study)
Introduction
Respiratory muscle dysfunction has been associated with failure to wean from mechanical ventilation. It has therefore been hypothesised that these patients might benefit from inspiratory muscle training (IMT). Evidence, however, is thus far limited to data from small, single-centre studies with heterogeneity in inclusion criteria, training modalities and outcomes. The aim of this study is to evaluate the effects of a novel IMT method on weaning outcomes in selected patients with weaning difficulties.
MethodsThis study is designed as a double-blind, parallel-group, randomised controlled superiority trial with 1:1 allocation ratio. Patients with weaning difficulties will be randomly allocated into either an IMT group (intervention) or a sham-IMT group (control). Ninetypatients (45 in each group) will be needed to detect a 28% difference in the proportion of weaning success between groups (estimated difference in primary outcome based on previous studies) with a risk for type I error (α) of 5% and statistical power (1-β) of 80%. Patients will perform four sets of 6–10 breaths daily against an external load using a tapered flow resistive loading device (POWERbreathe KH2, HaB International, UK). Training intensity in the intervention group will be adjusted to the highest tolerable load. The control group will train against a low resistance that will not be modified during the training period. Training will becontinued until patients are successfully weaned or for a maximum duration of 28 days. Pulmonary and respiratory muscle function, weaning duration, duration of mechanical ventilation, ventilator-free days and length of stay in the intensive care unit will be evaluated as secondary outcomes. X2 tests and analysis of covariance with adjustments for baseline values of respective outcomesas covariates will be used to compare results after the intervention period between groups.
Ethics and disseminationEthics approval was obtained from the local ethical committee (Ethische Commissie Onderzoek UZ/KU Leuven protocol ID: S60516). Results from this randomised controlled trial will be presented at scientific meetings as abstracts for poster or oral presentations and published in peerreviewed journals.
Trial statusEnrolment into the study have started in August 2017. Data collection and data analysis are expected to be completed in September 2021.
Trial registration numberhttps://ift.tt/2Nb1R2I
Monthly News Roundup - June 2018
First Cannabis-Based Drug Epidiolex Approved for Childhood Seizures In June, the U.S. Food and Drug Administration (FDA) approved GW Pharmaceuticals' Epidiolex (cannabidiol) [CBD], an oral solution for patients two years and older to treat...
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Geographic variation in molecular subtype for gastric adenocarcinoma
The presence of distinct molecular subgroups of gastric cancer (GC) has been recently highlighted in Gut.1 2 However, there has been little focus on the geographic distribution of molecular subgroups. Differences in GC molecular subtypes were assessed using data from The Cancer Genome Atlas (TCGA). Razvan et al established four clinically relevant molecular subtypes, which are MSS (microsatellite stable)/TP53–, MSS/TP53+, MSI (microsatellite instability) and MSS/EMT (epithelial–mesenchymal transition), further delineating GC.3 The clinical significance has been evaluated in a recent study using the TCGA proposed comprehensive molecular classification of patients with GC into four subtypes: Epstein-Barr virus (EBV), chromosomal instability (CIN), MSI and genomically stable (GS). Sohn et al reported that CIN and MSI subtypes had better overall survival than GS, but worse than EBV subtypes.4 Identification of molecular subtypes of GC may offer improved ways to monitor the progression, and predict prognosis5 and distinct therapeutic features.
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The Hsp70 inhibitor 2-phenylethynesulfonamide inhibits replication and carcinogenicity of Epstein–Barr virus by inhibiting the molecular chaperone function of Hsp70
The Hsp70 inhibitor 2-phenylethynesulfonamide inhibits replication and carcinogenicity of Epstein–Barr virus by inhibiting the molecular chaperone function of Hsp70
The Hsp70 inhibitor 2-phenylethynesulfonamide inhibits replication and carcinogenicity of Epstein–Barr virus by inhibiting the molecular chaperone function of Hsp70, Published online: 29 June 2018; doi:10.1038/s41419-018-0779-3
The Hsp70 inhibitor 2-phenylethynesulfonamide inhibits replication and carcinogenicity of Epstein–Barr virus by inhibiting the molecular chaperone function of Hsp70https://ift.tt/2KAVi7U
Παρασκευή 29 Ιουνίου 2018
Ayurveda metallic-mineral 'Bhasma-associated severe liver injury
Ayurveda Bhasma is a metallic-mineral preparation homogenised with herbal juices or decoctions and modified with heat treatment to apparently detoxify the heavy metals. It is widely recommended for the treatment of many disease conditions by practitioners of complementary and alternative medicine in the absence of good quality clinical trial evidence on its safety and efficacy. Heavy metal-induced liver injury is widely reported in the literature, and heavy metal adulteration of non-Bhasma-related Ayurveda and herbal products has been well described. We report a patient who developed severe liver injury requiring listing for liver transplantation for improved survival, after consumption of Bhasma for dyspepsia. This case describes the first documented case and toxicology analysis of Ayurveda Bhasma associated with severe drug-induced liver injury. Physicians must be alert regarding patient's use of supposedly safe Ayurveda Bhasma that may promote acute severe liver injury in the absence of other known aetiologies.
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Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinsons disease
Continuous duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established treatment to control motor fluctuations in Parkinson's disease. Duodenal infusion allows a steady absorption of the drug in the small bowel, reducing plasmatic fluctuations of levodopa. Some complications may occur during the treatment, often related to intrajejunal percutaneous endoscopic gastrostomy (PEG-J). We report a case of duodenal ulcer associated with a phytobezoar involving the end of jejunal probe, in a patient who underwent PEG-J for LCIG infusion. In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. This case is interesting because of the extension of the ulcerative lesion due to PEG-J dislocation and because of the subtle symptoms associated with it.
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Just another case of bacterial meningitis... or... is it?
Non-traumatic cerebrospinal fluid (CSF) rhinorrhoea is a rare condition. We describe a case of a 62-year-old woman with pneumococcal bacterial meningitis who later was found to have CSF rhinorrhoea secondary to an eroding skull base tumour, which was proven to be pituitary macroadenoma on biopsy. She recovered well from meningitis without any neurological sequelae and underwent trans-sphenoidal surgery for tumour removal as well as dural repair.
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Ectopic insulinomas in the pelvis secondary to rectum neuroendocrine tumour
We describe a middle-aged woman with recurrent hypoglycaemia, who confirmed with rectum G1 neuroendocrine tumour (NET) 6 years ago. Biochemical assay showed high concentration of serum insulin and C-peptide associated with hypoglycaemia. Because of recurrent hypoglycaemia in June 2015, she underwent a resection of the tail of the pancreas. However, hypoglycaemia attack happened more frequently and severely. 68Ga-DOTA-NOC positron emission tomography/CT revealed five foci in the pelvis with intense uptake. Immediately after excision of the pelvic lesions, insulin and C-peptide decreased to normal levels promptly, and therefore, serum glucose increased significantly. Hypoglycaemia was disappeared, and insulin and C-peptide were normal at 2 years follow-up after surgery. Immunohistochemistry validated the primary rectum NET and pelvic tumours expressed with higher insulin, somatostatin receptor and glucagon-like peptide-1. This is the first reported ectopic pelvic insulinomas secondary to rectum NET, which may originate both from neuroendocrine cells in the rectum and pelvic tissues.
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Pineal gland apoplexy mimicking as migraine-like headache
Description
A 24-year-old female patient presented with acute-onset, vertex headache associated with photophobia, nausea and vomiting. Initially, the headache was mild (pain scale 4/10), but over the next 4–5 hours, the severity of the headache increased to pain scale of 8/10. She had a history of similar headaches of lesser intensity in the past. There was also a strong family history of migraine. Her mother and younger sister used to get similar headaches and got relieved with antimigraine medications. Exact details of her medication history were unavailable since the progression of severity of her headache was gradual. This was unlike thunderclap headache and, in high likelihood, another episode of migraine.
Her vitals were stable. Neurological examination, including funduscopy, was grossly normal
On radiological evaluation, the MRI brain showed T1-weighted hyperintense pineal gland, as seen on the axial view suggestive of intrapineal gland apoplexy (figure 1). The fluid–fluid interface is depicted by the horizontal...
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Unusual cause of elbow pain in a baseball pitcher
An adolescent, right hand-dominant, baseball pitcher presented to sports medicine clinic with posterolateral right elbow pain over 4 months. He rated his pain as 8/10 with pitching, especially at the late cocking phase of throwing. Prior to consult, he had rested 3 months from pitching, progressing to strengthening exercises, with no pain relief. On physical examination, he had 120° of active external rotation, 80° of active internal rotation, mild tenderness to palpation over the capitellum and normal elbow radiography. Magnetic resonance arthrogram of the right elbow revealed subtle, posterolateral joint capsular tear and adjacent synovial hypertrophy. The patient was diagnosed with elbow synovial fold syndrome that was causing impingement at the radiocapitellar joint and was referred to an orthopaedic surgeon. Arthroscopy revealed redundant tissue; scar formation at the radiocapitellar joint was debrided. The patient participated in physical therapy for 2 months and was able to start throwing 3 months later.
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Double tongue signs in a case of submandibular space infection
Description
Double tongue signs are a unique physical finding which involve an elevation of floor of the oropharynx caused by a bilateral infection of the submandibular space (a well-known example is Ludwig's angina) (figure 1A).1 2 In this case, an 80-year-old woman with a 10-year history of diabetes mellitus was referred to our emergency department. She presented with swelling from the submandibular region to the neck surface, with a 3-day history of continuous fever, weakness and fatigue. Physical examination revealed neck oedema with erythema and tenderness (figure 1B), without lymphadenopathy. The floor of the oropharynx was clearly swollen and elevated, such that it appeared to be a double tongue; this was erythematous and tender. Enhanced CT of the neck was performed, which revealed bilateral fluid retention with swollen surrounding soft tissues in the submandibular space (figure 2). We...
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Early-stage right temporal lobe variant of frontotemporal dementia: 3 years of follow-up observations
The right temporal lobe variant of frontotemporal dementia (FTD) is an uncommon progressive neurodegenerative disorder. We present the case of a 77-year-old right-handed man who presented with altered behaviour and problems with interpersonal relationships. He had no decline in cognitive function but brain perfusion single-photon emission CT demonstrated distinct hypoperfusion in the right temporal pole. At 2-year follow-up, he could not recognise his wife's relatives; and at 3-year follow-up, he had semantic aphasia. Decreased brain perfusion extended from the right temporal lobe into the contralateral temporal and both frontal lobes. These findings suggest that the right temporal lobe variant of FTD should be considered in elderly patients with altered behaviour and problems with interpersonal relationships, even if dementia is not suspected. The right anterior temporal lobe may play a key role in the onset of the early symptoms of this disease.
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Pseudo-Wellens syndrome secondary to concurrent cannabis and phencyclidine intoxication
Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels. Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain. He was eventually diagnosed with pseudo-Wellens' syndrome. This paper illustrates that physicians should be vigilant for Wellens' syndrome mimicked by acute phencyclidine and cannabis intoxication. Additionally, we present a review of various aetiologies of pseudo-Wellens' syndrome, especially in patients with substance abuse.
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Suction-induced retinopathy: optical coherence tomography correlations
We report a clinical case of a teenager whose eyes were exposed to highly negative suction pressures for brief seconds. The patient presented with a bilateral cystoid macular oedema associated with a thickening of outer nuclear layer evidenced by optical coherence tomography. The patient's constellation of findings is most easily explained by the abrupt expansion and traction of a cohesive vitreous base onto the retinal layers.
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Inflammatory myofibroblastic tumour: a rare cause of central airway obstruction
Description
A 70-year-old woman with no comorbidities presented with cough, wheezing, exertional dyspnoea and a sensation of throat fullness. She never smoked and was recently diagnosed with asthma based on a normal chest radiograph and pulmonary function testing but failed to improve with bronchodilators and steroids. Her initial chest radiograph was unremarkable, and spirometry suggested a fixed intrathoracic obstruction. CT of the chest obtained after 2 months showed an irregular density in the trachea, 1.4x1.7 cm (figure 1). Flexible bronchoscopy showed a polypoid mass 2–3 cm above the carina adherent to the right wall of the trachea (figure 2). Rigid bronchoscopy with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser photoresection was performed. Given the vascular nature of the tumour, removal was complicated by significant bleeding, which required endobronchial epinephrine and laser coagulation. The patient recovered without further complications. Immunohistochemical staining on the excised tumour was positive for vimentin...
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Second look at Streptococcus sanguinis and the colon
Although the link between Streptococcus bovis bacteraemia and colon cancer is well established, bacteraemia from other viridans group streptococci that commonly colonise colonic mucosa may also herald occult malignancy. We present a case of Streptococcus sanguinis bacteraemia in an elderly man with new anaemia that led to the detection and removal of a high-grade colon neoplasm. This case contributes to a growing body of literature contending that unexplained streptococcal bacteraemia merits a thorough workup that may include relatively invasive procedures such as endoscopy. Diagnostic colonoscopy provides an opportunity to prevent invasive malignancy that may outweigh bleeding and perforation risks in elderly patients.
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Atypical presentation of type B aortic dissection mimicking appendicitis managed medically
This is a case of a 53-year-old male patient with a history of hypertension who developed sudden onset of right lower quadrant pain. On arrival, chest X-ray showed prominent aortic arch without cardiomegaly. CT of the abdomen/pelvis showed aortic dissection in descending aorta without rupture. CT of the chest displayed sparing of ascending and aortic arch. Ultrasound Doppler of the kidney displayed mild renal artery stenosis. Differential diagnosis was acute appendicitis, acute ureteric and severe gastroenteritis. The patient was started on oral blood pressure (BP) medicine to titrate off intravenous nicardipine and esmolol drip. After 10 days, he was switched to oral BP medicine. His leg pain was resolved with normal palpable pulse. One week later, his kidney function worsened. Thus, Lasix and minoxidil were stopped. The patient had no chest/abdominal pain and was tolerating the medicine well during his 2-week follow-up. Acute aortic dissection can be a fatal clinical emergency. Timing is critical during diagnosis and management of patients.
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EBV colitis with ulcerative colitis: a double whammy
We report this case of a 21-year-old immunocompetent man presenting with ulcerative colitis and superimposed Epstein-Barr virus (EBV) colitis. He presented for the first time with symptoms of blood-mixed diarrhoea and raised inflammatory markers. His endoscopic and histological appearances were found to be due to ulcerative colitis for which he was started on standard therapy with intravenous steroids. In spite of this, he continued to be symptomatic and his inflammatory markers continued to rise. A virology screen done showed evidence of previous EBV infection, and in view of poor response to immunosuppression, a superimposed infection was suspected. EBV DNA PCR done on colonic biopsies was found to be positive and the patient was started on intravenous ganciclovir to which he responded well. This case highlights the importance of considering a superimposed infection in patients with poor initial response to steroid therapy in inflammatory bowel disease.
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Adult-onset epileptic aphasia
Aphasia is a language disorder characterised by loss of ability to produce or comprehend written or spoken language. In majority of the cases, it is due to stroke. Aphasia may also present as an ictal or postictal state of temporal or frontal lobe seizures. Nevertheless, its isolated occurrence in individuals without a clear-cut history of seizures raises diagnostic difficulties with important therapeutic implications.
A case of epileptic aphasia is reported in which the diagnosis was confirmed by electroencephalogram with a dramatic therapeutic response to an antiepileptic drug.
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Reversible cardiac dysfunction in long-standing hypertension may be global variant of stress cardiomyopathy
An adult man with long-standing poorly controlled cardiac risk factors presented with acute decompensated heart failure (ADHF). Echocardiogram, cardiac MRI and catheterisation suggested idiopathic dilated cardiomyopathy, severe systolic dysfunction, ejection fraction 25% with global left ventricular (LV) dilation and apical thrombus. He responded well to diuretics and gradual uptitration of lisinopril and carvedilol. Follow-up echocardiogram in 2 months demonstrated complete recovery of systolic function, normalisation of LV size and shape with severe LV hypertrophy. This presentation is potentially a global variant of stress cardiomyopathy with recovery of LV function, highlighting the importance of appropriate imaging, catheterisation and clinical monitoring in patients with ADHF.
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Anomalous aortic origin of a coronary artery with an intraseptal course: novel techniques in haemodynamic assessment
Description
A 7-year-old boy presented to the emergency room after an episode of syncope while at home. Although, it was non-exertional, it lasted 2 min and was preceded by angina-like chest pain. Vitals, physical examination, chest radiograph and ECG were normal. Subsequent cardiology evaluation led to an echocardiogram that showed anomalous origin of the left main coronary artery from the opposite sinus of Valsalva with adjacent ostia which was confirmed on CT angiography. In addition, it showed a long 2.5–3 cm deep intraseptal course of the left anterior descending (LAD) and short intraseptal course of the left circumflex (LCX) artery. Stress nuclear perfusion scan and Holter monitoring were negative, but stress cardiac MRI showed an inducible perfusion defect along the anterior interventricular septal wall most prominent at the mid-ventricular and basilar levels. Coronary angiography (figure 1 and video 1) and intravascular ultrasound demonstrated significant systolic compression of the intraseptal segment...
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Biots breathing associated with acute bacterial meningitis in a child
Description
A 19-month-old boy presented to the emergency room of our hospital with fever and drowsiness following asymmetric focal seizure. On examination the patient was somnolent, had signs of meningeal irritation and intermittent nystagmus. Laboratory examination revealed increased C-reactive protein (200 mg/L), procalcitonin (25.9 ng/mL) and hyponatraemia (132 mEq/L). The initial CT of the brain was normal. Given presumed meningoencephalitis, intravenous dexamethasone, vancomycin, ceftriaxone and acyclovir treatment was started, and the child was admitted to the paediatric intensive care unit. Several hours after the admission, irregular, jerky respirations appeared, consistent with Biot's breathing (figure 1). The patient developed hypertension (129/90 mm Hg) and relative bradycardia (90 bpm). Due to these signs, consistent with increased intracranial pressure, lumbar puncture was deferred and the child received mannitol with notable improvement in his condition. On hospital day 2, lumbar puncture revealed turbid fluid with an opening pressure of 5 cmH2O, white blood cells...
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Subfoveal congenital hypertrophy of retinal pigment epithelium
Description
A 25-year-old man presented with slight blurring of vision in the right eye (RE), noted 3 years ago. There was no positive systemic history. His best corrected visual acuity was 6/9 in RE and 6/6 in the left eye (LE) at presentation. Anterior segment evaluation was unremarkable in both eyes with normal pupil light reflexes. Fundus evaluation revealed a flat circular lesion beneath the fovea, and was measured to be one-third of the size of the optic nerve head. It was a densely pigmented lesion, black in colour, with a surrounding depigmented whitish halo (figure 1). The LE was within normal range on clinical examination. Spectral domain optical coherence tomography (SD-OCT) of RE revealed the lesion to be irregular but flat with hyper-reflectivity at the level of the retinal pigment epithelium (RPE). Discontinuity of the ellipsoid zone was noted to be overlying some parts of the lesion. These findings were also accompanied...
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A case of massive haemoptysis
Description
A 77-year-old female never-smoker presented with massive haemoptysis. Admission plain chest radiograph was normal.
She was haemodynamically stable on presentation but the following morning she had a further large-volume haemoptysis (>500 mL), resulting in respiratory arrest. Following resuscitation, haemoglobin fell from 94 to 66 g/dL. CT angiogram was performed (figure 1).
Figure 1
Sagittal CT angiogram, performed once the patient was stabilised.
She had previously been investigated for small volume haemoptysis and left upper lobe mass-like consolidation, which had fully resolved following a course of antibiotics. Recent bronchoscopy was normal, with no pathological organisms. There was no evidence of malignancy or connective tissue disease, and there was no additional past medical history. CT imaging had been reviewed at a thoracic oncology multi-disciplinary meeting and the previous episode was attributed to non-specific infection.
QuestionWhat is the diagnosis (see figure 1)?
(A) Pulmonary artery...
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Childhood Craniopharyngioma: A 22-Year Challenging Follow-Up in a Single Center
Horm Metab Res
DOI: 10.1055/a-0641-5956
Craniopharyngioma is a sellar/suprasellar benign tumor whose aggressiveness may imply in endocrine disturbances (hypothalamic obesity and hormone deficiencies). Fifty-seven patients were evaluated according to clinical characteristics, hypothalamic involvement, type of treatment, anthropometric variables, adiposity indexes (body mass index Z score category at diagnosis and post-treatment, total body fat, visceral adipose tissue, and metabolic syndrome components) and analyzed through multiple regression and logistic models. Patients were stratified according to growth hormone deficiency and recombinant human growth hormone use. Mean ages at diagnosis and at study evaluation were 9.6 and 16.6 years old, respectively. A set of 43/57 (75.4%) patients presented with important hypothalamic involvement, 24/57 (42.1%) received surgical treatment and cranial radiotherapy, and 8/57 (14%) interferon-α exclusively. Fifty-five patients (96.5%) were considered growth hormone deficient, and 26/57 (45.6%) grew despite no recombinant human growth hormone replacement therapy. At diagnosis, 12/57 (21%) patients were obese, and 33/57 (57.9%) at study evaluation, and after 3.2 years (median) post first therapy. There was no influence of height Z score on body mass index Z score. Body mass index Z score at diagnosis positively influenced body mass index Z score, total body fat, waist circumference and the presence of the metabolic syndrome post-treatment. Replacement of recombinant human growth hormone decreased total body fat and visceral adipose tissue. Craniopharyngioma patients worsened body mass index Z score category 3.2 years (median) after first treatment. Body mass index Z score increased due to real weight gain, without height decrease. Replacement of recombinant human growth hormone had beneficial effect on adiposity.
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© Georg Thieme Verlag KG Stuttgart · New York
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Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
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heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
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