Intramolecular Cyclizations of Cyclopropenes with Indole

Chem. Commun., 2016, Accepted Manuscript
DOI: 10.1039/C6CC02226J, Communication

Min Shi, Peng-Long Zhu, Xiang-Ying Tang
Novel intramolecular cycloisomerizations of nitrogen-tethered cyclopropenes with indole in the presence of Bronsted acid have been developed. The reaction proceeded through the same pathway but stopped at different stage according...
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Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department

Publication date: Available online 6 May 2016
Source:American Journal of Infection Control
Author(s): P.R.H. Arntz, J. Hopman, M. Nillesen, E. Yalcin, C.P. Bleeker-Rovers, A. Voss, M. Edwards, A. Wei
BackgroundHand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a multimodal improvement strategy on hand hygiene compliance in the ED.MethodsOur study was a prospective before-and-after study to determine the effect of a multimodal improvement strategy on the compliance of HH in the ED according to the My 5 Moments of Hand Hygiene defined by the World Health Organization. Interventions such as education, reminders, and regular feedback on HH performance and role models were planned during the 3 intervention weeks.ResultsIn total, 57 ED nurses and ED physicians were observed in this study, and approximately 1,000 opportunities for handrubs were evaluated during the 3 intervention periods. HH compliance increased significantly from baseline from 18% (74/407) to 41% (77/190) after the first intervention and stabilized to 50% (99/200) and 46% (96/210) after the second and third interventions, respectively.ConclusionsImplementing a multimodal HH improvement program significantly improved the HH compliance of ED personnel.



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Use of a provincial surveillance system to characterize postoperative surgical site infections after primary hip and knee arthroplasty in Alberta, Canada

Publication date: Available online 6 May 2016
Source:American Journal of Infection Control
Author(s): Elissa Rennert-May, Kathryn Bush, David Vickers, Stephanie Smith
BackgroundKnee and hip replacements are an effective intervention for improving quality of life. Rates of these surgeries in North America are growing, coinciding with increasing obesity and an aging population.MethodsAlberta Health Services' infection prevention and control program collects data prospectively on surgical site infections (SSIs) after primary total hip and knee arthroplasty completed in Alberta, Canada. We reviewed all SSIs within 180 days of surgical procedures between March 1, 2012, and June 30, 2014.ResultsThere were 312 SSI cases reviewed. Rates of SSI (per 100 procedures) were 1.77 and 1.26 for hip and knee arthroplasties, respectively. Seventy-nine percent of infections occurred within 30 days postoperatively. Stratified by time to infection, larger proportions of knee SSIs occurred after 30 days versus hip SSI. Colonization with methicillin-resistant Staphylococcus aureus (MRSA) was associated with subsequent infection (odds ratio, 40; 95% confidence interval, 10.2-154.2). We have identified important characteristics that may be helpful for determining optimal prevention strategies.ConclusionsIntensive postoperative follow-up within 30 days of knee arthroplasty may help to identify SSI early, allowing for prompt treatment and avoiding the need for invasive therapy, such as surgery for hardware revision. Decolonization techniques may decrease subsequent MRSA SSI in colonized patients.



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The survival and inactivation of enteric viruses on soft surfaces: A systematic review of the literature

Publication date: Available online 6 May 2016
Source:American Journal of Infection Control
Author(s): Thomas Yeargin, David Buckley, Angela Fraser, Xiuping Jiang
BackgroundWorldwide, enteric viruses are the main cause of acute gastroenteritis. In humans, these viruses spread via person-to-person contact, food, water, and/or the environment. Their survival and inactivation on hard surfaces have been extensively studied; however, nonlaunderable soft surfaces, such as upholstery and carpet, have received little attention. The aim of this systematic review was to determine factors that influence the survival and inactivation of enteric viruses on nonlaunderable soft surfaces.MethodsEBSCO and Web of Science were searched for experimental studies published between 1965 and 2015 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods. Titles and abstracts were screened using 3 eligibility criteria. The quality of all study methods was also assessed.ResultsOur search yielded 12 articles. Viruses survived between 0 hours and 140 days depending on surface and environment conditions. Virus survival was influenced by temperature, relative humidity, organic content, and deposition method. A variety of chemistries were tested across studies and were shown to have a varied effect on enteric viruses. Chlorine, glutaraldehyde, vaporous ozone, and hydrogen peroxide were the most efficacious against enteric viruses (> 3-log reduction).ConclusionsEnvironmental factors, such as temperature and relative humidity, can influence survival of enteric viruses on nonlaunderable soft surfaces. The efficacy of liquid and vaporous chemistries are associated with surface and virus type.



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Reduction in total patient isolation days with a change in influenza testing methodology

Publication date: Available online 5 May 2016
Source:American Journal of Infection Control
Author(s): M.P. Muller, S. Junaid, L.M. Matukas
BackgroundBoth hospital admissions and patient isolation increase during influenza season. Influenza testing methodologies that reduce turnaround time (TAT) could reduce time in isolation.MethodsWe assessed the impact of a new influenza test on TAT and isolation days. TAT and daily mean isolation days were compared at a single hospital over 2 influenza seasons. An automated real-time reverse-transcription polymerase chain reaction assay (rRT-PCR) with random access replaced a conventional rRT-PCR assay for the second influenza season. Automation and random access allowed continuous testing, rather than once daily testing 3-5 d/wk.ResultsConfirmed influenza cases (57 vs 68) and total patient days (66,308 vs. 66,366) were similar for the 2012-2013 and 2013-2014 influenza seasons. TAT fell from 35 to 3.6 hours. Daily mean isolation days (32.9 vs 27.7, P < .01) fell, as did days in contact precautions (25.0 vs 19.8, P < .01) and droplet precautions (6.0 vs 3.5, P < .01). Although daily mean droplet precaution days for confirmed influenza rose slightly (0.86 vs 1.1, P = .16), droplet precaution days for suspected influenza fell 85% (2.7 vs 0.41, P < .001).ConclusionsInfluenza testing technology that reduced TAT from days to hours resulted in a 42% reduction in droplet precaution days and reduced overall isolation days during influenza season.



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Understanding socioeconomic inequalities in cervical screening

Douglas, E; (2016) Understanding socioeconomic inequalities in cervical screening. Doctoral thesis, UCL (University College London). Green open access

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Data as Infrastructure for Smart Cities

Dos Santos Romualdo Suzuki, LC; (2016) Data as Infrastructure for Smart Cities. Doctoral thesis, UCL (University College London).

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An Investigation into the Determinants of Diffusion of Renewable Energy

Delaportas, K; (2016) An Investigation into the Determinants of Diffusion of Renewable Energy. Doctoral thesis, UCL (University College London). Green open access

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Probing bb production with the ATLAS detector at the LHC

Davison, PR; (2016) Probing bb production with the ATLAS detector at the LHC. Doctoral thesis, UCL (University College London). Green open access

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The autism and schizophrenia associated genes CYFIP1 and Ahi1 in synaptic signalling and neuronal development

Davenport, EC; (2016) The autism and schizophrenia associated genes CYFIP1 and Ahi1 in synaptic signalling and neuronal development. Doctoral thesis, UCL (University College London).

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Deciphering mechanisms of tetraploid tolerance

Crockford, AJ; (2016) Deciphering mechanisms of tetraploid tolerance. Doctoral thesis, UCL (University College London). Green open access

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Automatic integration of letters and speech-sounds in typical reading development and dyslexia

Clayton, FJ; (2016) Automatic integration of letters and speech-sounds in typical reading development and dyslexia. Doctoral thesis, UCL (University College London).

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Comparative Outcomes of Resident vs Attending Performed Surgery: A Systematic Review and Meta-Analysis

D'Souza, N; Hashimoto, DA; Gurusamy, K; Aggarwal, R; (2016) Comparative Outcomes of Resident vs Attending Performed Surgery: A Systematic Review and Meta-Analysis. Journal of Surgical Education , 73 (3) pp. 391-399. 10.1016/j.jsurg.2016.01.002 .

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Where art thou pituitary?

A middle-aged woman presented with premature menopause and recurrent episodes of vomiting with hyponatraemia. Since primary causes of hormone deficiencies were the only studies initially evaluated, there was a delayed diagnosis. Pituitary tropic hormones (serum thyroid stimulating hormone/follicle stimulating hormone/luteinising hormone), inappropriately low for low-level of target hormones (free thyroxin/oestradiol), led to detailed evaluation of trophic hormone deficiencies by pituitary stimulation. The pituitary stimulation by insulin challenge test confirmed secondary (pituitary) hypofunction. Pituitary imaging revealed an uncommon cause of hypopituitarism, which is discussed in this case report.

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Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome

A 91-year-old presented with a rare cause of cardiac arrest. He was initially admitted with severe back pain following vomiting and diagnosed with probable aspiration pneumonia. On day 3 of admission, he was discovered in cardiac arrest and cardiopulmonary resuscitation was started. On intubation, a left-sided pneumothorax and subcutaneous emphysema were noted. Needle decompression showed gastric fluid leaking from the cannula. The patient regained a cardiac output, and a subsequent CT scan confirmed a large pneumomediastinum with air tracking to the neck and chest, and bilateral pneumothoraces. A diagnosis of Boerhaave's syndrome was made. The patient was transferred to the intensive care unit but did not survive. This case demonstrates the importance of looking for and treating the rarer reversible causes of cardiac arrest, and of maintaining a high index of suspicion for Boerhaave's syndrome. Despite its rarity, Boerhaave's syndrome is often misdiagnosed on initial presentation, leading to delayed treatment and poor outcomes.

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Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use

Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

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'Crazy-paving pattern: an exceptional presentation of cryptogenic organising pneumonia associated with chronic obstructive pulmonary disease

Organising pneumonia (OP) is a distinct but uncommon entity with characteristic clinicoradiological features and histological findings. When the aetiology of OP remains unknown, it is termed as cryptogenic OP (COP). COP is seen in the majority of patients with OP and usually observed in non/former smokers. A 54-year-old man, a smoker, presented with breathlessness, cough and mucoid sputum. Imaging demonstrated unilateral 'Crazy-paving' pattern in the left upper lobe and left-sided effusion. In addition, paraseptal emphysema and left lower lobe bullae along with very severe obstructive ventilatory defect and impaired diffusion suggested chronic obstructive pulmonary disease (COPD). Transbronchial biopsy was suggestive of OP. In the absence of a definite aetiology, a diagnosis of COP associated with COPD was established. COP presenting as a unilateral 'Crazy-paving' pattern is yet to be documented. To the best of our knowledge, this is the first detailed description of COP presenting as unilateral 'Crazy-paving' pattern associated with COPD.

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Residual mucin and response after neoadjuvant chemotherapy (NAC) in breast cancer

Neoadjuvant chemotherapy (NAC) is the standard of care for patients with breast cancer with inoperable disease or smaller tumours who might benefit from a conservative surgery after downstaging of their disease. Nevertheless, evidence shows that preoperative and postoperative chemotherapy are equivalent in terms of long-term survival. Response and histological changes after NAC have been widely studied in invasive ductal carcinoma not otherwise specified, but there is a paucity of characterisation of patterns of response to chemotherapy in less frequent histological types. We report extensive residual mucin deposits after chemotherapy in a woman with locally advanced breast cancer and a prominent mucinous component at diagnosis. Interestingly, residual mucin was co-located with the initial tumour, in the breast as well as in the axillary lymph nodes. The distribution of mucin may be a valuable marker of the extent of mucinous carcinomas prior to NAC.

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To leave no stone unturned: cholelithiasis and subsequent gallstone ileus

Description

A 68-year-old man was admitted after a sudden collapse and a 5-day history of severe vomiting. On admission, he was hypotensive with a blood pressure of 70/60 mm Hg and had to be fluid resuscitated with 3 L of intravenous fluids via a femoral venous catheter. A nasogastric tube was inserted and 1600 mLs of brown vomitus aspirated. Venous blood gas showed a lactate of 5 mmol/L. The patient was in acute renal failure with urea of 30 mmol/L and creatinine of 224 μmol/L. On surgical review, he was not thought to be clinically obstructed and an abdominal radiograph showed some sentinel loops but otherwise did not reveal any obvious bowel dilation (figure 1). The patient had had a CT scan a month earlier when he had been staged for newly diagnosed prostate cancer; the scan had visualised a calcified circular opacity with a laminated appearance consistent with a gallstone in the...

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Gestational trophoblastic disease in a Greenlandic Inuit: diagnosis and treatment in a remote area

We report on a 21-year-old pregnant Greenlandic Inuit woman, who presented at a small local hospital in Northern Greenland. The patient suffered from lower abdominal pain, irregular bleeding and vomiting. urine-human chorionic gonadotropin (U-hCG) was positive. Ultrasonography showed the typical 'snow-storm' images of a mole pregnancy. Owing to the fact that local physicians were able to perform an ultrasound, proper diagnosis could be established, and the patient was transferred to the regional hospital, located nearly 1200 km away. At the regional hospital, uterine evacuation was performed under general anaesthesia. Blood analysis showed that serum hCG returned to undetectable levels, and the patient recovered uneventfully. Our case shows that ultrasonography is a valuable diagnostic tool also in remote areas. In Greenland, geographical distances are large and weather conditions can be extreme, and in this report, we discuss how healthcare can be optimised in remote areas.

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Unusual case of hereditary multiple exostoses presenting with compressive myelopathy

A 15-year-old boy presented with progressive weakness of both lower limbs. He had classical clinical features suggestive of multiple hereditary exostoses (MHE). Imaging studies of the spine revealed osteochondromas at D7, D11 and L5 vertebrae. The tumour at D11 was encroaching into the spinal canal and causing cord compression. The patient underwent osteochondroma excision and posterior spinal stabilisation, following which there was complete neurological recovery by 3 months.

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Doppler ultrasound findings in a patient with primary infertility and triorchidism

Polyorchidism, presence of more than two testes in a scrotum, is a rare clinical entity. To date, about 200 cases have been reported in the literature. We report a case of triorchidism in a patient presenting with a 7-year history of primary infertility. Clinical examination revealed two completely separate testes with two separate epididymides and single vas suggesting a complete division of the genital ridge and partial duplication of the vas deferens. In our patient, the clinical picture together with ultrasound findings were characteristic enough to exclude other diagnoses, allowing conservative management. We also present the Doppler ultrasound findings of this rare condition, which may be helpful for comparison in patients with triorchidism who present with testicular torsion.

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Unusual complications of placental chorioangioma: consumption coagulopathy and hypertension in a preterm newborn

We report a case of a preterm neonate born to a mother with giant placental chorioangioma. The baby had microangiopathic haemolytic anaemia, thrombocytopenia and cardiac failure at birth. In addition, she had a disseminated intravascular coagulation-like picture and had bleeding from multiple sites, which was treated with transfusion of multiple blood products. She also developed transient hypertension and required antihypertensive drugs for 3 weeks. The baby was successfully managed and discharged home, though with signs of neurosensory impairment.

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Temperature dependence of acoustic harmonics generated by nonlinear ultrasound wave propagation in water at various frequencies

Ultrasound-based thermometry requires a temperature-sensitive acoustic parameter that can be used to estimate the temperature by tracking changes in that parameter during heating. The objective of this study is to investigate the temperature dependence of acoustic harmonicsgenerated by nonlinearultrasoundwave propagation in water at various pulse transmit frequencies from 1 to 20 MHz. Simulations were conducted using an expanded form of the Khokhlov–Zabolotskaya–Kuznetsov nonlinear acoustic wave propagation model in which temperature dependence of the medium parameters was included. Measurements were performed using single-element transducers at two different transmit frequencies of 3.3 and 13 MHz which are within the range of frequencies simulated. The acoustic pressure signals were measured by a calibrated needle hydrophone along the axes of the transducers. The water temperature was uniformly increased from 26 °C to 46 °C in increments of 5 °C. The results show that the temperature dependence of the harmonic generation is different at various frequencies which is due to the interplay between the mechanisms of absorption, nonlinearity, and focusing gain. At the transmit frequencies of 1 and 3.3 MHz, the harmonic amplitudes decrease with increasing the temperature, while the opposite temperature dependence is observed at 13 and 20 MHz.

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Asymptotic limits of some models for sound propagation in porous media and the assignment of the pore characteristic lengths

Modeling of sound propagation in porous media requires the knowledge of several intrinsic material parameters, some of which are difficult or impossible to measure directly, particularly in the case of a porous medium which is composed of pores with a wide range of scales and random interconnections. Four particular parameters which are rarely measured non-acoustically, but used extensively in a number of acoustical models, are the viscous and thermal characteristic lengths, thermal permeability, and Pride parameter. The main purpose of this work is to show how these parameters relate to the pore size distribution which is a routine characteristicmeasured non-acoustically. This is achieved through the analysis of the asymptotic behavior of four analytical models which have been developed previously to predict the dynamic density and/or compressibility of the equivalent fluid in a porous medium. In this work the models proposed by Johnson, Koplik, and Dashn [J. Fluid Mech. 176, 379–402 (1987)], Champoux and Allard [J. Appl. Phys. 70(4), 1975–1979 (1991)], Pride, Morgan, and Gangi [Phys. Rev. B 47, 4964–4978 (1993)], and Horoshenkov, Attenborough, and Chandler-Wilde [J. Acoust. Soc. Am. 104, 1198–1209 (1998)] are compared. The findings are then used to compare the behavior of the complex dynamic density and compressibility of the fluid in a material pore with uniform and variable cross-sections.

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Histopathologic and mutational analysis of a case of blue nevus-like melanoma

Abstract

Blue nevi are a heterogeneous group of dermal melanocytic proliferations that share a common clinical appearance but remain controversial in their histopathologic and biologic distinction. While common blue nevi and cellular blue nevi are well-defined entities that are classified without significant controversy, the distinction between atypical cellular blue nevi and blue nevus-like melanoma remains diagnostically challenging. We report a case of a 46-year-old female with recurrent blue nevus-like melanoma of the scalp with liver metastases; mutational analysis demonstrated GNA11 Q209L and BAP1 Q393 mutations. To our knowledge, this is the first case of blue nevus-like melanoma with GNA11 and BAP1 mutations. These particular mutations and the predilection for liver metastases in our patient's case underscore a fundamental biological relationship between blue nevi and uveal melanoma and suggest the two entities may prove amenable to similar diagnostic and prognostic testing and targeted therapies.

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Nuclear Factor XIIIa Staining (Clone AC-1A1 Mouse Monoclonal) is a Sensitive and Specific Marker to Discriminate Sebaceous Proliferations from Other Cutaneous Clear Cell Neoplasms

Abstract

Sebaceous carcinoma is a rare but serious malignancy that may be difficult to diagnose when poorly differentiated. Other epithelial tumors with clear cell change may mimic sebaceous carcinoma. Few useful or specific immunohistochemical markers for sebaceous differentiation are available. Nuclear staining with factor XIIIa (clone AC-1A1) was recently found to be a highly sensitive marker of sebaceous differentiation. We evaluated nuclear factor XIIIa (AC-1A1) staining in sebaceous neoplasms versus other cutaneous clear cell tumors. We stained 27 sebaceous proliferations: sebaceous hyperplasia (7), sebaceous adenoma (8), sebaceoma (5), sebaceous carcinoma (7). We also stained 67 tumors with clear cell change: basal cell carcinoma (8), squamous cell carcinoma (8), hidradenoma (7), desmoplastic trichilemmoma (2), trichilemmoma (10), trichilemmal carcinoma (3), clear cell acanthoma (9), atypical fibroxanthoma (1), syringoma (8), trichoepithelioma (1), metastatic renal cell carcinoma (2), and nevi with balloon cell change (8). Nuclear factor XIIIa (AC-1A1) staining was present in 100% of sebaceous proliferations; 96% displayed strong staining. Non-sebaceous clear cell tumors were negative or only weakly positive with factor XIIIa (AC-1A1) in 95.5%; only 4.5% showed strong staining. This suggests that strong nuclear factor XIIIa (AC-1A1) staining is a sensitive and specific marker of sebaceous neoplasms versus other clear cell tumors.

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PD-L1 expression in cutaneous squamous cell carcinoma correlates with risk of metastasis

Abstract

Background

Programmed cell death ligand 1 (PD-L1) expression in primary cutaneous squamous cell carcinoma has not been described.

Methods

We reviewed immunohistochemical stained sections of forty primary and five metastatic cutaneous squamous cell carcinomas using antibody to PD-L1 and classified the staining pattern according to the DAKO tumor proportion score method. We compared the staining results with microscopic staging parameters associated with risk of metastasis including tumor diameter, histologic grade, tumor thickness and perineural invasion.

Results

PD-L1 expression was present in 4 of 20 low risk tumors (20%), all of which showed low expression. PD-L1 expression was present in 14 of 20 high risk tumors (70%), 12 of which showed low expression and 2 of which showed high expression. 5 of 5 metastases (100%), with 3 showing low expression and 2 showing high expression.

Conclusions

This survey documents PD-L1 expression in cutaneous squamous cell carcinoma and shows a positive correlation between the degree PD-L1 expression and pathologic findings related to risk of metastasis including large diameter, higher histological grade and tumor thickness.

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Pathologic features of anogenital precancerous high grade squamous intraepithelial lesion (squamous cell carcinoma in situ)

Abstract

Background

Precancerous high grade squamous intraepithelial lesion (HSIL), the current consensus terminology for anogenital squamous cell carcinoma in situ, often presents with distinctive histopathologic findings that may be a function of anatomic site or associated human papillomavirus infection.

Methods

Fifty-six specimens of anogenital HSIL were compared with an equal number of specimens of squamous cell carcinoma in situ (SCCIS) from non-anogential sites in regard to the presence of parakeratosis, flag sign in the stratum corneum, compact stratum corneum, hypergranulosis, koilocytes, small blue cells, clonal populations of keratinocytes, pagetoid scatter of atypical keratinocytes, clear cell change, glassy red cytoplasm, pigmentation, nuclear/cytoplasmic(N/C) ratio >2/1, nuclear hyperchromasia, pleomorphic nuclei, mitotic figures, abnormal mitotic figures, dyskeratotic keratinocytes, involvement of skin appendages, acantholysis, and amyloid deposition.

Results

Hypergranulosis, koilocytes, small blue cells, pigmentation, nuclear hyperchromasia, dyskeratotic keratinocytes, and amyloid deposition were more frequently noted in anogenital HSIL. Parakeratosis, clear cell change, pleomorphic nuclei, skin appendages involvement and acantholysis were strongly associated with non-anogenital location. There was no significant difference in the incidence of the remaining features.

Conclusion

The strongest predicators of an anogenital location included hypergranulosis, koilocytes, small blue cells, and nuclear hyperchromasia. Pigmentation and amyloid deposition were also strongly associated with an anogenital location.

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Nuclear Factor XIIIa Staining (Clone AC-1A1 Mouse Monoclonal) is a Highly Sensitive Marker of Sebaceous Differentiation in Normal and Neoplastic Sebocytes

Abstract

Background

Sebaceous proliferations are common and may be confused with other cutaneous neoplasms. Few useful or specific immunohistochemical markers for sebaceous differentiation are available. We incidentally observed strong factor XIIIa (Ventana clone AC-1A1 on Ventana Benchmark Ultra stainer) nuclear staining in normal sebaceous glands and hypothesized that this might be a useful marker in sebaceous proliferations.

Methods

Immunohistochemistry for factor XIIIa (AC-1A1) was performed on 7 sebaceous hyperplasias, 8 sebaceous adenomas, 5 sebaceomas, 7 sebaceous carcinomas.

Results

Strong nuclear factor XIIIa (AC-1A1) staining was present in 100% of normal sebaceous glands, 100% of sebaceous hyperplasia, adenoma, and carcinoma, and 80% of sebaceoma. Moderately or poorly differentiated squamous cell carcinomas (n = 26) were also stained for factor XIIIa (AC-1A1); two showed focal strong staining (8%), but the remainder showed only weak or negative staining (92%). In contrast, factor XIIIa clones from Abcam (EP3372) and Vector Laboratories (E980.1) were negative in sebocyte nuclei.

Conclusions

We report the novel finding of consistent nuclear factor XIIIa (AC-1A1) staining in normal, hyperplastic, and neoplastic sebocytes. Factor XIIIa (AC-1A1) is a highly sensitive marker of sebaceous differentiation. It may have potential clinical utility as a specific marker to distinguish sebaceous carcinoma from poorly differentiated squamous cell carcinoma.

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Multimodal quantitative MRI assessment of cortical damage in relapsing-remitting multiple sclerosis

Purpose

To investigate magnetization transfer ratio (MTR), T₁ relaxation time, and proton density (PD) as indicators of gray matter damage in relapsing-remitting multiple sclerosis (RRMS), reflecting different aspects of microstructural damage and as imaging correlates of clinical disability. We aimed to determine which of these parameters may optimally quantify cortical damage, and serve as an imaging surrogate of clinical disability. In this study, cortical values of MTR, a surrogate for demyelination in MS, of PD, reflecting replacement of neural tissue by water, and of T₁, indicating a complex array of microstructural changes, were assessed in a group of RRMS patients in comparison to healthy controls (HC).

Materials and Methods

22 RRMS patients with varying disease duration (4.0 ± 6.54 years) and 10 HC received quantitative 3T magnetic resonance imaging (MRI) with MTR, T₁, and PD mapping. We tested for differences in cortical measurements between patients and HC. Additionally, correlation with disability as quantified by the Expanded Disability Status Scale was investigated.

Results

Cortical parameter values were significantly altered in the RRMS group, with increased values of T₁ (P = 0.008) and PD (P = 0.028) and reduced values of MTR (P = 0.043). Only cortical T₁ was correlated with clinical disability measurements (P = 0.001, r = 0.65). Receiver operating characteristic analysis demonstrated the best discriminatory power for T₁ (area under the curve 0.79, PD: 0.75, MTR 0.73).

Conclusion

Out of the parameters studied, cortical T₁ is best suited to detect cortical damage as an imaging surrogate of clinical disability in RRMS. J. Magn. Reson. Imaging 2016.

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Quantifying learning-dependent changes in the brain: Single-trial multivoxel pattern analysis requires slow event-related fMRI

Abstract

Single-trial analysis is particularly useful for assessing cognitive processes that are intrinsically dynamic, such as learning. Studying these processes with fMRI is problematic, as the low signal-to-noise ratio of fMRI requires the averaging over multiple trials, obscuring trial-by-trial changes in neural activation. The superior sensitivity of multivoxel pattern analysis over univariate analyses has opened up new possibilities for single-trial analysis, but this may require different fMRI designs. Here, we measured fMRI and pupil dilation responses during discriminant aversive conditioning, to assess associative learning in a trial-by-trial manner. The impact of design choices was examined by varying trial spacing and trial order in a series of five experiments (total n = 66), while keeping stimulus duration constant (4.5 s). Our outcome measure was the change in similarity between neural response patterns related to two consecutive presentations of the same stimulus (within-stimulus) and between patterns related to pairs of different stimuli (between-stimulus) that shared a specific outcome (electric stimulation vs. no consequence). This trial-by-trial similarity analysis revealed clear single-trial learning curves in conditions with intermediate (8.1–12.6 s) and long (16.5–18.4 s) intervals, with effects being strongest in designs with long intervals and counterbalanced stimulus presentation. No learning curves were observed in designs with shorter intervals (1.6–6.1 s), indicating that rapid event-related designs—at present, the most common designs in fMRI research—are not suited for single-trial pattern analysis. These findings emphasize the importance of deciding on the type of analysis prior to data collection.

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Single-centre experience of primary cutaneous Merkel cell carcinoma of the head and neck between 1996 and 2014

Publication date: Available online 5 May 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Muneer Patel, Carrie Newlands, Stephen Whitaker
We retrospectively reviewed the management at our centre of 25 patients with Merkel cell carcinoma (MCC) of the head and neck. We obtained details of the operation, including wide local excision, sentinel lymph node biopsy (SNB), neck dissection, postoperative radiotherapy, and clinical outcomes, from patients' records. All patients were white, 11 were men and 14 women, mean age at presentation 81 years (range 67-90). At the time of diagnosis, 18 patients had stage I disease, and 7 stage II disease. Twenty had wide local excision and radiotherapy, and 5 had wide local excision alone. Wide local excision and radiotherapy are successful treatments. In patients with no sign of metastases, SNB at the time of excision is a well-researched option and should be considered the gold standard of care.



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Simple method of securing an airway while accessing a bleeding tracheostomy site when nasal or oral endotracheal intubation is not feasible

Publication date: Available online 6 May 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Alexander M. Bobinskas, Anastasios N. Kanatas, Matthew B. Law, Gillon Fabbroni




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Severity of nocturnal hypoxia and daytime hypercapnia predict CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

Publication date: Available online 6 May 2016
Source:Sleep Medicine
Author(s): Zuzana Kuklisova, Ruzena Tkacova, Pavol Joppa, Emiel Wouters, Manuel Sastry
BackgroundObstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are independent risk factors for cardiovascular diseases. In patients with OSA and concurrent COPD, continuous positive airway pressure (CPAP) therapy improves survival. Nevertheless, a significant proportion of such patients do not tolerate CPAP. The aim of the present study was to analyze early predictors of CPAP failure in patients with OSA and concurrent COPD, and to evaluate the effects of bilevel positive airway pressure (BiPAP) in this high-risk group of patients.MethodsA post hoc analysis from the database of 2100 patients diagnosed with OSA between 2012 and 2014 identified 84 subjects as having concomitant COPD and meeting inclusion criteria. Demographic data, pulmonary function tests, OSA parameters, blood gases, response to CPAP and BiPAP titration, and 2 months of therapy were collected. A multivariate model was generated to find determinants of CPAP failure.ResultsPrimary CPAP failure was found in 23% of patients who were more obese (p=0.018), had worse lung function, lower PO2 (p=0.023) and higher PCO2 while awake (p<0.001), and more sleep time with an SpO2 <90% (CT90%) (p<0.001) compared to those who responded to CPAP. In multivariate analysis, PCO2 while awake (odds ratio (OR) 29.5, confidence interval (CI) 2.22-391, p=0.010) and CT90% (OR 1.06, CI 1.01-1.11, p=0.017)independently predicted CPAP failure after adjustments for covariates. The BiPAP therapy was well tolerated and effectively alleviated hypercapnia in all patients with primary CPAP failure.ConclusionsDaytime hypercapnia and nocturnal hypoxia are independent predictors of early CPAP failure in patients with the OSA-COPD overlap syndrome.



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Guided wave reconstruction in complex geometries with a dictionary learning framework

Guided waves are an attractive tool for structural health monitoring (SHM) due to their ability to interrogate large areas of a structure. Yet, guided waves are characterized by multi-modal and frequency dispersive behavior and quickly grow in complexity with the structure. For example, guided wave reflections from plate edges, fasteners, or joints will lead to complex, difficult to analyze data. Most SHM algorithms try to remove or ignore these reflections. Yet, knowledge about the reflections and their acoustic behavior can significantly improve detection and localization algorithms. Hence, accurate knowledge about guided waves reflections is of a significant interest in SHM. In this paper, we reconstruct and predict guided wave measurements from geometric environments with reflections. We leverage dictionary learning and sparse recovery algorithms to achieve this goal. Dictionary learning is used to learn the building blocks of guided waves from simulation data. Sparse recovery algorithms are used to create predictive models of wave propagation based on experimental data. From simulation results, we show that our framework can successfully predict wave propagation, including reflections, across an aluminum plate with an accuracy of more than 95% from just 20 measurements. We demonstrate similar results with experimental data.

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Aircraft carrier noise measurements of a high-performance fighter jet

The on-deck measurement of F-35C noise levels occurred during the DT-II sea trials aboard the USS Dwight D. Eisenhower in October 2015. The existence of aircraft carrier flight deck fighter noise data is extremely rare, with this data set being only the second of its kind in terms of its scope. Custom acoustic recording instrumentation was designed to obtain quality broadband noise measurements of high-amplitude signals, protected from extraneous noise due to high wind speeds, and shielded from intense electromagnetic interference from the multiple on-board radar systems. The data collected allow for the estimation of noise exposures at all pertinent flight deck locations where crewmembers are positioned. [Work supported by USAFRL through ORISE and F-35 JPO.]

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How reproducible are psychoacoustic listening tests on spatial impression in auditoria?

In three psychoacoustic experiments, it was shown that changes in frequency (pitch) and level (loudness) of stimuli lead to significant differences in the perception of apparent source width (ASW). Due to partially identical test conditions in two of the experiments, it is possible to analyze the collected data in regard to stability of ASW perception over repeated testing sessions and to study inter-individual differences. This analysis shows that intra-individual effects of stimulus loudness and pitch are consistent across participants, whereas the absolute level of ASW perception varies between individuals and between experimental sessions. Using this data, possible influences such as listener training effect over repetition of test sessions are discussed. The presented results provide insights into possible improvements of investigating ASW in future studies.

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Restoring sensitivity to interaural timing differences in bilateral cochlear implant listeners using multi-electrode stimulation

Identification and discrimination of soundsources in complex auditory environments is facilitated for normal-hearing listeners from access to interaural time differences(ITDs). For patients fitted with bilateral cochlear implants (BiCI), binaural sensitivity is harder to achieve due to several factors, including asynchronous interaural processing. BiCI listeners have shown good ITD sensitivity with low rates of electrical stimulation; however, low-rate delivery of ITD cues is unrealistic for the high-rate pulsatile stimulation required to achieve good speech understanding. One solution is to present a mix of high- and low-rate stimulation on different electrodes, preserving both speech recognition and sound localization ability. In the present study, a binaural benefit was observed in a mixed-rate strategy under direct electrical stimulation: ITD sensitivity was measured in a two-alternative forced-choice discrimination task, using seven multi-electrode conditions. We hypothesized that by introducing low-rate ITDs at a few electrodes alongside high-rate ITDs at remaining electrodes provides sufficient ITD cues for sound localization. The present data suggests the binaural system of BiCI listeners can extract pertinent cues to achieve ITD sensitivity even when high-rate ITD information is presented at the majority of the cochlear locations. This lends to a possibility in implementation of ITD cues to current processing strategies.

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Bioacoustic absorption spectroscopy: An acoustical oceanography method for the study of marine ecosystems

Recent experiments have demonstrated the potential of the BioacousticAbsorption Spectroscopy (BAS) method for measuringnumber densities vs. fish length and species when combined with concurrent trawling data, and studying vertical migrations and schooling behavior of fish at mesoscale dimensions.. Measurements of transmission loss between moving or stationary broadband source(s) and vertical array(s) of hydrophones separated by several (up to ~10) km permits inference of absorption coefficients versus frequency and depth, and association of absorption lines with the resonance frequencies of fish swim bladders. BAS is environmentally friendly, as it can be implemented with source levels avoidance. The most significant results of BAS experiments will be reviewed, and possible approaches for use of the BAS method for routine scientific study and fisheries surveys of marine ecosystems will be considered.

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Interaction of pitch and phonation in Louma Oeshi

Louma Oeshi is an Akoid (Tibeto-Burman) language of Laos for which acoustic characteristics are undocumented with the exception of preliminary work by the present authors. This study focuses on the phonetic properties associated with Oeshi's three tones (high, mid, and low) and two registers (Tense, Lax), which fully intersect to yield a six-way suprasegmental contrast. Eight speakers were recorded in Phongsali Province, Lao PDR. Each spoke a 100 token word list, for which 30 tokens were repeated in a carrier sentence placing the token between high and mid-toned lax words. Decile measures of F0 and an array of measures reflecting phonation types (H1-H2, H1-A1, H1-A3, HNR, and SHR) were performed in Voicesauce (Shue et al. 2011) to capture dynamic values over the syllable duration. Our findings show a reliable three-way F0 contrast between tones and a single interaction with register such that High Tense words consistently fall (tones are otherwise level). Acoustic correlates of the Tense~Lax distinction are less clear. The picture that emerges is one where Tense register has variable phonetic manifestations — preglottalization of onsets, vocalic creaky voice, or a glottal stop coda — and the seemingly inconsistent acoustic results reflect these variable articulatory timing strategies.

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Yeast flocculation using acoustic agglomeration

A major cause of haziness in beer is due to yeast suspended in the liquid. The most common methods used to flocculate the yeast and have it settle out of the liquid solution are to use various chemicals, cold temperatures, and/or extended time. This research considers using acoustic agglomeration to cause the yeast to flocculate as a means to clarify beer. Acoustic agglomeration uses high intensity acoustic standing waves to clump fine particles together in order for them to become large enough to settle out of the fluid. In this work, an ultrasonic acoustic transducer will be implemented to achieve standing waves in the beer. In theory, these standing waves will cause the yeast particles to clump together and settle. The results from this approach will be compared to the traditional methods of yeast flocculation. This approach may lead to an increase in efficiency in clarifying beer without the use of undesirable chemicals. The preliminary work considered here is a proof of concept and will use visual inspection as a means of clarity comparison. Future work will use more in-depth laboratory analysis as a means of comparison of clarity.

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Underwater sound directionality of commercial ships

The underwater sound radiated by commercial ships is an unintended by-product of their operation and one of the most significant contributors to man-made noise at low frequencies in the ocean. To estimate the directionality of underwater sound radiated by current commercial ships, a seafloor array of five high-frequency acoustic recording packages (HARPs) deployed to 1 km depth with a maximum horizontal aperture of 1 km was used. As a ship of opportunity passed over the HARP array, the directions from the ship to each HARP along with the corresponding source levels were estimated for each ship location. Ships were tracked via satellites (Automatic Identification System—AIS) and acoustically by a frequency domain beamformer that was implemented for one of the HARPs configured with a volumetric hydrophone array (2 m maximum aperture). The directionality estimates of contemporary commercial ships exhibit significant stern-bow asymmetries among other quantitative characteristics that will be discussed.

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Maternal 47,XX,i(X)(q10) as a cause of false positive sex chromosome aneuploidy in noninvasive prenatal screening

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Noninvasive prenatal testing (NIPT) in twin pregnancies with treatment of assisted reproductive techniques (ART) in a single center

Abstract

Objective

To report the performance of noninvasive prenatal testing (NIPT) in twin pregnancies after the treatment of assisted reproductive technology (ART).

Method

In two years period, 565 pregnant women with ART twin pregnancies were prospectively tested by NIPT for screening for trisomy 21 (T21), 18 (T18) and 13 (T13) by sequencing cell-free DNA in maternal plasma. Positive NIPT results were confirmed by karyotyping, while negative results were interviewed after delivery. Pregnant decision based on NIPT and confirmation results was discussed during post-test counseling.

Results

In total of 565 cases, NIPT had a failure rate of 0.9% (5/565). Four cases of T21 were identified by NIPT and confirmed by karyotyping, resulting in 100% (95%CI 39.8%-100%) positive predictive value (PPV). Among 556 cases with NIPT negative results, 506 cases (91.0%) were confirmed by follow-up of postnatal phenotypes, while 33 cases (5.9%) had adverse pregnant outcomes with unconfirmed reasons due to the lack of cytogenetic samples. The remaining 17 cases (3.1%) refused follow-up. No false negative result was reported.

Conclusion

With apparently high PPV and low false positive rate, NIPT has the potential to be used as a good alternative approach of conventional prenatal screening at the first trimester in ART twin pregnancy. This article is protected by copyright. All rights reserved.

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Tg ERK7 is involved in the intracellular proliferation of Toxoplasma gondii

Abstract

Toxoplasma gondii uses a unique mechanism to fulfill its asexual life cycles by which the parasite can infect all the warm-blooded animals including humans. Mitogen-activated protein kinase (MAPK) or extracellular signal-regulated kinase (ERK) pathway widely existed in eukaryotic cells mediates the conversion of environmental stimuli to intracellular events such as proliferation and differentiation. Their counterparts have been identified in Apicomplexan parasites such as ERK7 in T. gondii. To confirm whether the unique mechanism of T. gondii is relevant to MAPK/ERK member, we created a mutant (ΔTgERK7) in GT1 tachyzoites using double homologous recombination method. Our results of virulence evaluation showed 100 % survival of all the ΔTgERK7-infected mice until 35 days post-challenge compared to no survival in wild-type GT1-infected group (10.6 ± 0.34 days). Furthermore, lower parasite loads were detected in the peritoneal fluid of ΔTgERK7-infected mice (P < 0.05). To ensure whether or not ERK7 gene knockout leads to the growth deficiency of T. gondii, the intracellular proliferation of ΔTgERK7 was also examined in vitro. Our data indicated that the proliferation of ΔTgERK7 parasites was significantly prolonged in comparison with wild-type GT1 tachyzoites (P < 0.05). Therefore, we concluded that TgERK7 is important for the intracellular proliferation of T. gondii, which further emphasized that MAPK/ERK derived from T. gondii participates in the regulation of the asexual life cycles to ensure the survival and reinfections of this parasite.

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Acute toxoplasmosis in pigs in Brazil caused by Toxoplasma gondii genotype Chinese 1

Abstract

This study reports the clinicopathological, immunohistochemical, and molecular findings from two cases of systemic toxoplasmosis in pigs showing apathy and dyspnea. In the post-mortem examination, severe diffuse necrotizing bronchointerstitial pneumonia with numerous intralesional tachyzoites of Toxoplasma gondii was observed. The lungs had not collapsed but were diffusely reddened, and the parenchyma showed friable whitish subpleural nodules with multifocal to coalescent distribution and diameters of 0.5–1.0 cm. The histopathological findings comprised mononuclear inflammation and multifocal areas of necrosis in alveolar septa (cases 1 and 2). In addition, esophagitis and ulcerations in the mucosa of the stomach and the small and large intestines were observed (case 1). Immunohistochemical analysis using anti-T. gondii antibodies on lung tissue in both cases revealed strong immunolabeling of free tachyzoites and tachyzoites in the cytoplasm of histiocytes and in cysts. Nested PCR targeting a 155-bp fragment of the B1 gene of T. gondii was positive for the DNA extracted from lung fragments from the two pigs. Genotyping of the samples by means of PCR-RFLP (10 markers) and by means of microsatellites (15 of them) revealed that these animals were infected with T. gondii that was molecularly characterized as the non-archetypal genotype Chinese 1. This presents worldwide circulation, but it had not previously been described in Brazil. The microsatellite analysis showed that the animals were infected with the same T. gondii isolate circulating in the environment.

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Molecular and biochemical characterization of Eimeria tenella hexokinase

Abstract

Hexokinase (HK) is one of the key enzymes in the glycolytic pathway that catalyzes the phosphorylation of glucose. In the present study, we cloned the HK gene from the coccidian Eimeria tenella (EtHK), expressed EtHK as a His-tagged fusion protein, and characterized its primary biochemical features. Mutagenesis confirmed that residues S159, N216, and D217 are essential or important to the EtHK catalytic activity. EtHK exhibited high affinity for d-glucose (Km = 0.67 to 0.79 mM), but was also able to utilize 2-deoxy-d-glucose (Km = 5.66 mM), d-fructose (Km = 13.76 mM), and d-mannose (Km = 25.41 mM). We also observed that quercetin and mangiferin could inhibit the EtHK enzyme activity (IC₅₀ values = 6.52 and 85.82 μM, respectively). Among the two inhibitors, mangiferin also inhibited the growth of E. tenella in vitro (MIC₅₀ = 0.12 μM). These observations suggest that EtHK may be explored as potential drug target, and mangiferin and its analogs may be explored for developing anti-coccidial therapeutics.

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Genetic diversity and population genetics of large lungworms ( Dictyocaulus , Nematoda) in wild deer in Hungary

Abstract

Dictyocaulus nematode worms live as parasites in the lower airways of ungulates and can cause significant disease in both wild and farmed hosts. This study represents the first population genetic analysis of large lungworms in wildlife. Specifically, we quantify genetic variation in Dictyocaulus lungworms from wild deer (red deer, fallow deer and roe deer) in Hungary, based on mitochondrial cytochrome c oxidase subunit 1 (cox1) sequence data, using population genetic and phylogenetic analyses. The studied Dictyocaulus taxa display considerable genetic diversity. At least one cryptic species and a new parasite–host relationship are revealed by our molecular study. Population genetic analyses for Dictyocaulus eckerti revealed high gene flow amongst weakly structured spatial populations that utilise the three host deer species considered here. Our results suggest that D. eckerti is a widespread generalist parasite in ungulates, with a diverse genetic backround and high evolutionary potential. In contrast, evidence of cryptic genetic structure at regional geographic scales was observed for Dictyocaulus capreolus, which infects just one host species, suggesting it is a specialist within the studied area. D. capreolus displayed lower genetic diversity overall, with only moderate gene flow compared to the closely related D. eckerti. We suggest that the differing vagility and dispersal behaviour of hosts are important contributing factors to the population structure of lungworms, and possibly other nematode parasites with single-host life cycles. Our findings are of relevance for the management of lungworms in deer farms and wild deer populations.

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