Ιατρικά Άρθρα

Δευτέρα 8 Μαΐου 2017

Neurological outcomes following suicidal hanging: A prospective study of 101 patients

Mohammed Turab Jawaid, S Deepak Amalnath, D. K. S. Subrahmanyam

Annals of Indian Academy of Neurology 2017 20(2):106-108

Context: Survivors of suicidal hanging can have variable neurological outcomes – from complete recovery to irreversible brain damage. Literature on the neurological outcomes in these patients is confined to retrospective studies and case series. Hence, this prospective study was carried out. Aims: The aim is to study the neurological outcomes in suicidal hanging. Settings and Design: This was a prospective observational study carried out from July 2014 to July 2016. Subjects and Methods: Consecutive patients admitted to the emergency and medicine wards were included in the study. Details of the clinical and radiological findings, course in hospital and at 1 month postdischarge were analyzed. Statistical Analysis Used: Statistical analysis was performed using IBM SPSS advanced statistics 20.0 (SPSS Inc., Chicago, USA). Univariate analysis was performed using Chi-square test for significance and Odd's ratio was calculated. Results: Of the 101 patients, 6 died and 4 had residual neuro deficits. Cervical spine injury was seen in 3 patients. Interestingly, 39 patients could not remember the act of hanging (retrograde amnesia). Hypotension, pulmonary edema, Glasgow coma scale (GCS) score <8 at admission, need for mechanical ventilation, and cerebral edema on plain computed tomography were more in those with amnesia as compared to those with normal memory and these findings were statistically significant. Conclusions: Majority of patients recovered without any sequelae. Routine imaging of cervical spine may not be warranted in all patients, even in those with poor GCS. Retrograde amnesia might be more common than previously believed and further studies are needed to analyze this peculiar feature.

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Direct mechanical thrombectomy with thromboaspiration in cerebral venous sinus thrombosis

Vikram Bohra, Romnesh deSouza, Vivek Karan, Vikram Huded

Annals of Indian Academy of Neurology 2017 20(2):160-161

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Unknown patients and neurology casualty services in an Indian metropolitan city: A decades experience

Achary Umesh, Guru S Gowda, Channaveerachari Naveen Kumar, Dwarakanath Srinivas, Bharath Rose Dawn, Ragasudha Botta, Ravi Yadav, Suresh Bada Math

Annals of Indian Academy of Neurology 2017 20(2):109-115

Objectives: A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of "unknown" patients. Materials and Methods: We did retrospective chart review of all "Unknown" patients from January 2002 to December 2011, who was admitted under Neurology Emergency Service at a Tertiary Care Neuropsychiatry Center in South Indian Metropolitan City. Clinical and sociodemographic characteristics and clinical outcome of the sample were analyzed. Results: A total of 151 unknown patients were admitted during the 10 years. Out of these, 134 (88.7%) were males with the mean age of 43.8 ± 14.8 years and 95 (63%) were aged >40 years. Among them, 147 (97.4%) were from the urban vicinity, 126 (83.6%) were brought by police and 75 (49.7%) were registered as medico-legal cases. Out of these, only 3 (2%) patients had normal sensorium, whereas 101 (66.9%) presented with loss of consciousness. Forty-one (27.2%) unknown patients had a seizure disorder, 37 (24.5%) had metabolic encephalopathy, 26 (17.2%) had a stroke, 9 (6%) had neuro-infection, and 17 (11.3%) had a head injury. Deranged liver functions were seen in 65 (43%), renal derangement in 37 (24.5%), dyselectrolytemia in 42 (27.8%), and abnormal brain imaging finding in 95 (62.9%) patients. Furthermore, there were 14 (9.3%) deaths. Conclusions: Our findings demonstrate seizures, metabolic causes, and neuro-infections were the primary reasons for admission of unknown patients to neuro-emergency service. This novel Indian study data show the common causes of admission of unknown patients in neurology. This pattern can be useful to guide the approach of healthcare providers in India.

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Molecular diagnosis of limb-girdle muscular dystrophy type 2A by next-generation sequencing

Clara Gómez-González, Maria Isabel Esteban-Rodríguez, Yolanda Ruano, Elena Vallespín, Pablo Lapunzina, Paloma Martínez, Samuel I Pascual, Jesús Molano, Carmen Prior

Annals of Indian Academy of Neurology 2017 20(2):164-165

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Study of refractory status epilepticus from a tertiary care center

Sahil Kohli, Suresh Babu Pasangulapati, Sangeetha Yoganathan, Gideon Lyngsyun Rynjah, AT Prabhakar, Sanjith Aaron, Mathew Alexander, Vivek Mathew

Annals of Indian Academy of Neurology 2017 20(2):116-121

Objectives: To determine the proportion of refractory status epilepticus (RSE) and super-RSE (SRSE) among patients with status epilepticus (SE) and to analyze RSE and non-RSE (NRSE) in terms of etiology and predictors for RSE. Materials and Methods: Patients were identified from discharge summaries database with keywords of SE and records of the portable electroencephalogram (EEG) machine from January 2011 to March 2016. Results: Two hundred and eighteen events were included in the study with 114 (52.3%) males, bimodal age preponderance age <5 years 30%, and second peak in age 15–65 years 52.8%, preexisting seizures were present in 34.4% (n = 75). Nearly 77.1% had NRSE (n = 168) and 22.9% had RSE (n = 50). This included 17 patients with SRSE (n = 17, 7.8% of all SE). Central nervous system (CNS) infection was a single largest etiological group in SE (69/218, 31.7%). In RSE, autoimmune encephalitis (17/50) and CNS infection (13/50) were the largest groups. De novo seizures (P = 0.007), low sensorium at admission (P = 0.001), low albumin at admission (P = 0.002), and first EEG being abnormal (P = 0.001) were risk factors on bivariate analysis. An unfavorable status epilepticus severity score (STESS) was predictive for RSE (P = 0.001). On multivariate analysis, de novo seizures (P = 0.009) and abnormal EEG at admission (P = 0.03) were predictive for RSE. Conclusions: Fifty patients had RSE (22.9%), of which 17 went on to become SRSE (7.8%). Unfavorable STESS score was predictive for RSE on bivariate analysis. On multivariate analysis, de novo seizures and abnormal initial EEG were predictors of RSE.

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Piloerection: A rare ictal phenomenon – Case report and review of literature

Samhita Panda, Chandrashekhar Agarwal, Ankkita Sharma

Annals of Indian Academy of Neurology 2017 20(2):169-172

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Maintenance of normoglycemia may improve outcome in acute ischemic stroke

Sruthi S Nair, PN Sylaja, Sapna Erat Sreedharan, Sankara Sarma

Annals of Indian Academy of Neurology 2017 20(2):122-126

Introduction: Several studies have shown that high admission glucose is associated with poor outcomes after stroke, but the impact of maintenance of normoglycemia on functional outcome during hospitalization for acute ischemic stroke is less well established. Aims: The aim of this study was to examine the independent association of postadmission glycemic status in the 1st week with 3-month functional outcome in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke admitted within 48 h of symptom onset with National Institutes of Health Stroke Scale (NIHSS) of ≥4 were selected from a prospectively maintained database by chart review. Demographic data, risk factors, NIHSS, and blood glucose values in the 1st week were collected. The primary outcome was Modified Rankin Scale (mRS) score at 3 months (good outcome-mRS ≤2). Results: Over 3 years, 342 patients were enrolled with 220 (64.32%) males. Mean age was 60.5 ± 13.4 years, and median admission score on NIHSS was 10 (interquartile range: 6–16). Blood glucose values persistently <140 mg/dl in the 1st week were associated with a good 3-month functional outcome in univariate analysis (P = 0.036). Hypoglycemic episodes occurred only in 11 (3.22%) patients. Conclusions: Blood glucose values persistently below 140 mg/dl in the 1st week after acute ischemic stroke were associated with a favorable outcome in our study. Future clinical trials are needed to confirm these findings.

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Turf wars in stroke medicine: Why should patients suffer

Shriram Varadharajan

Annals of Indian Academy of Neurology 2017 20(2):156-156

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Dorsal sural sensory nerve action potential: A study for reference values

Sweta Chetan Chaudhari, Khushnuma Anil Mansukhani, Alika Sharma, Lajita Balakrishnan, Aarthika Sreenivasan

Annals of Indian Academy of Neurology 2017 20(2):127-131

Background: Dorsal sural sensory nerve action potential (SNAP) could help diagnose early or subclinical peripheral neuropathy. Objectives: To establish reference data for dorsal sural SNAP amplitude, latency, and velocity in healthy participants. Materials and Methods: A prospective study was conducted in 45 nerves from healthy participants between 18 and 90 years and stratified into three age groups (a = 18–40 years, b = 41–60 years, and c≥60 years). StataCorp 12.2 statistical program was used for all statistical analyses. Mean-2 standard deviation was used to generate reference values for the lower limit of amplitude and velocity in each age group. ANOVA with Bonferroni correction was used for intergroup comparisons of amplitude and velocity. Regression analysis was used to compute an equation for the predicted amplitude with age, height, and weight as the covariates. Results: The lower limit for amplitude (uv) in Groups a, b, and c was 2.57, 1.97, and 1.01, respectively. The lower limit for velocity (m/s) was 33.6, 32, and 22.8, respectively. Statistical significance was noted between the amplitudes of participants in Groups b and c (P = 0.039) and a and c (P = 0.001). Similarly, velocity was significantly different between Groups b and c (P = 0.04) and a and c (P = 0.008). Age was the covariate with maximum effect on the dorsal sural amplitude. Gender and side-to-side comparison did not show statistical significance for amplitude and velocity measurements. Linear regression analysis of the transformed amplitude gave the predictive equation as (y) =3.338 + age (−0.0167) + height in meters (−0.209) + weight (0.001). Conclusion: This study provides reference data for dorsal sural SNAP in Indian population stratified by age.

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Paradigm shift in stroke prevention: Need of the hour

Pushpendra Nath Renjen

Annals of Indian Academy of Neurology 2017 20(2):158-159

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Teratogenic effects of carbamazepine in mice

Manna Jose, Harikrishnan Vijayakumar Sreelatha, Manjula Valiyamattathil James, Sabareeswaran Arumughan, Sanjeev Varghese Thomas

Annals of Indian Academy of Neurology 2017 20(2):132-137

Objectives: The aim of this study was to determine the teratogenic effects of carbamazepine (CBZ) in BALB/c mice. Materials and Methods: Mature female and male BALB/c mice (25–30 g) were used for all experiments. After standardization of administration and dose of CBZ, animals in the CBZ-treated groups (CBZ 450 mg/kg and 600 mg/kg) were fed on medicinal diet. The dams in the control group were mated on the same day as that of the CBZ-treated dams. After cesarean section (CS), fetal viability status and weights were recorded. Gross histopathological examination of fetuses was conducted to identify alterations in morphology and external or internal organs due to in utero exposure of CBZ. Results: Out of the nine female animals (three treated on CBZ 450 mg/kg, three treated on CBZ 600 mg/kg and three controls), seven were pregnant, and two (one each from the two CBZ-treated groups) were nonpregnant. All fetuses of the control group (n = 31) and CBZ 450 mg/kg treated group (n = 24) were live, but eight out of the twenty fetuses (40%) of CBZ 600 mg/kg treated group were dead at CS. The birth weight of the fetuses antenatally exposed to CBZ was drastically reduced (0.71 ± 0.06) when compared to control fetuses (1.67 ± 0.12) (P < 0.0001). All the fetuses of the CBZ-treated groups showed stunted physical development. Conclusion: Although oral administration of CBZ to mice is a convenient model to study the effect of CBZ to pregnancy, higher oral dose was associated with increased fetal loss. Some of the fetuses exposed to CBZ demonstrated structural abnormalities and low body weight.

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Successful revascularization of acute middle cerebral artery occlusion by intravenous thrombolysis while on apixaban

Vivek K Nambiar, TS Dhanya, Amrutha V Ajai

Annals of Indian Academy of Neurology 2017 20(2):161-162

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Clinical and imaging study of isolated and mixed rest and action tremor-essential tremor versus Parkinson's disease

Sandro Zambito Marsala, Michele Pistacchi, Manuela Gioulis, Franco Ferracci, Livio Capus

Annals of Indian Academy of Neurology 2017 20(2):138-141

Background: Some patients present an unusual association of both action tremor (AT) and rest tremor (RT) making the differential diagnosis between essential tremor (ET) and Parkinson's disease (PD) difficult. Aim: To investigate this particular clinical picture trying to focus on possible peculiar clinical inferences. Patients and Methods: Twenty-three patients with atypical tremor syndrome were selected for the study. They underwent neurological examination, neuroimaging study, and brain DaTSCAN single-photon emission computed tomography. Results: Twenty-three patients were evaluated; 17 presented mixed-tremor syndrome, while six patients showed only isolated AT or RT. DaTSCAN was pathological in 19 patients and normal in 3 patients. The emerging statistical data highlighted a positive correlation between disease duration and DaTSCAN abnormalities; Fisher's exact test showed a marked difference in evolution toward a dysfunction of dopaminergic pathways in patients with both AT and RT phenotype. Conclusion: The possible correlation between PD and ET has often been discussed without any clear findings. Are these patients suffering from ET prone to develop PD? Or are they the expression of a specific clinical phenotype? Our clinical survey has not led to absolute considerations; however, it seeks to highlight the clinical markers that might arouse the suspicion of extrapyramidal disease in patients with atypical tremor syndrome.

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Nuclear Receptor Function through Genomics: Lessons from the Glucocorticoid Receptor

Publication date: Available online 8 May 2017
Source:Trends in Endocrinology & Metabolism
Author(s): Daniel M. Cohen, David J. Steger
Unlocking the therapeutic potential of the glucocorticoid receptor (GR) has motivated a search for small molecules that selectively modulate its ability to activate or repress gene transcription. Recently, breakthrough studies in the field of genomics have reinvigorated debate over longstanding transcriptional models explaining how GR controls tissue-specific gene expression. Here, we highlight these genomic studies with the dual goals of advancing understanding of nuclear receptor-mediated transcription and stimulating thought on the development of anti-inflammatory and immunosuppressive ligands for GR that have reduced harmful effects on metabolism.

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Adulterant-Contaminant in MT-45 or Coingestion? – Reply from Authors

In a commentary to our publication entitled "Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45",[1] Yip and Deng [2] argue that the lack of opioid symptoms would indicate involvement of another drug class, possibly arsenic or 2,4-dinitrophenol (DNP). In this respect, it should be emphasized that the patients did not seek hospital care for acute opioid overdose symptoms but for unexpected, late adverse side effects involving the skin, hair, and eyes.

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The characteristics of salivary pepsin in patients with severe motor and intellectual disabilities

Publication date: Available online 8 May 2017
Source:Brain and Development
Author(s): Naoki Hashizume, Suguru Fukahori, Kimio Asagiri, Shinji Ishii, Nobuyuki Saikusa, Naruki Higashidate, Motomu Yoshida, Daisuke Masui, Saki Sakamoto, Yoshiaki Tanaka, Minoru Yagi, Yushiro Yamashita
PurposeThe aim of the present study was to determine the utility of measuring the salivary pepsin level (SPL) as an objective assessment of gastroesophageal reflux disease (GERD) in severe motor and intellectual disabilities (SMID) patients.Subjects and methodsThis prospective study included 26 SMID patients who underwent simultaneous 24-h multichannel intraluminal impedance pH measurement (pH/MII) and SPL evaluation. The enrolled patients were divided into GERD (+) or GERD (−) groups according to the pH/MII findings. The age, gender and pH/MII parameters were compared between the two groups. A correlation analysis was also conducted for the SPL following early-morning fasting and post-enteral feeding and the age, gender, presence of gastrostomy and tracheostomy and pH/MII parameters. The SPL was compared between the two sampling groups.ResultsFifteen patients were classified as GERD (+), and 11 patients were classified as GERD (−). The mean SPL following early-morning fasting and post-enteral feeding among all patients were 104.3 (median: 38, 25th and 75th percentile: 12, 361) ng/ml and 222.2 (median: 152:0, 500) ng/ml, respectively. Regarding positivity, 76.9% and 73.1% of SPL values in early-morning fasting and post-enteral feeding SMID patients, respectively, were positive (≧16ng/ml). The SPL following early-morning fasting demonstrated a weak but significant positive correlation with age. In contrast, we noted no correlation between the pH/MII parameters and the SPL for either the early-morning fasting or post-enteral feeding patients, and no significant difference in the SPL was observed between the GERD (+) and (−) patients.ConclusionsThe present study showed that a high proportion of SMID patients had a relatively high SPL, regardless of the presence of GERD. The SPL in SMID patients might be affected by several distinctive factors in addition to gastroesophageal reflux.

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Clipping and irrigation enhance grass biomass and nutrients: Implications for rangeland management

Publication date: May 2017
Source:Acta Oecologica, Volume 81
Author(s): Samuel Tuffa, Dana Hoag, Anna C. Treydte
Increasing frequency of drought and high herbivore pressure significantly affect individual grass functions in semiarid regions. Reseeding of degraded rangelands by native grass species has been recommended as a tool for restoration semiarid rangelands. However, how grass species used for reseeding respond to stressors has not been fully explored. We examined biomass allocation and nutrient contents of Cenchrus ciliaris and Chloris gayana in the semiarid Borana rangelands, Ethiopia. We tested clipped mature tufts of the same species for biomass allocation and nutritive values. Further, shifts in rainfall and herbivory were simulated by three irrigation and four clipping treatments, respectively, for newly established grasses in pot and field plot experiments. Aboveground biomass (AGB) significantly declined by up to 75% under increased clipping in mature tufts. In contrast, clipping significantly stimulated up to 152% higher AGB of newly established grasses. Lower irrigation reduced the AGB by 24 and 42% in C. ciliaris and in C. gayana, respectively. Clipping, further, significantly enhanced grass nutrients in grass tufts by up to 82 and 105% in C. ciliaris and C. gayana, respectively. Hence, management should focus on balancing this trade-off in mature grasses for nutritious rangeland production by clipping and storing for later supplemental feeding when grass nutrients drop. Further, young pastures should be moderately clipped/grazed for better establishment and biomass allocation. Additionally, our experiments established the first interactive effect of clipping and irrigation frequencies on the biomass allocation of native grasses in the semiarid Borana rangelands, Ethiopia. Knowledge of these interacting factors is deemed essential for policy makers to enhance productivity of degraded rangelands such as the Borana rangelands.

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Comparison of effectiveness of two commonly used two-handed mask ventilation techniques on unconscious apnoeic obese adults

<div class="boxTitle">Abstract</div>Background. Mask ventilation and tracheal intubation are basic techniques for airway management and mutually inclusive rescue measures to restore ventilation. The aim of this study was to compare the effectiveness of mask ventilation between two commonly used techniques of two-handed mask ventilation in obese unconscious apnoeic adults.Methods. Eighty-one obese adults received mask ventilation after induction using C-E clamp and modified V-E clamp techniques in a randomized crossover manner. Mechanical ventilation was provided using a pressure-control mode, at a rate of 10 bpm, with an inspiratory-to-expiratory time ratio of 1:2 and a pre-set plateau airway pressure of 20 cm H2O. The primary outcome was expired tidal volume.Results. The BMI for the subjects was 37 (sd 4.9) kg m−2. The failure rates for mask ventilation (tidal volume≤anatomical dead space) were 44% for the C-E technique and 0% for the V-E technique (P<0.001). Tidal volume was significantly lower for the C-E than the V-E technique [371 (sd 345) vs 720 (244) ml, P<0.001]. The peak airway pressures were 21 (sd 1.5) cm H2O for the C-E technique and 21 (1.3) cm H2O for the V-E technique.Conclusions. Mask ventilation using the modified V-E technique is more effective than with the C-E technique in unconscious obese apnoeic adults. Subjects who fail ventilation with the C-E technique can be ventilated effectively with the V-E technique.Clinical trial registration. NCT02580526.

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Association of intraoperative cerebral and muscular tissue oxygen saturation with postoperative complications and length of hospital stay after major spine surgery: an observational study

<div class="boxTitle">Abstract</div>Background. Compromised tissue oxygenation is one of the root causes of dysfunction of various organs and postoperative complications. Oxygenation of different tissue beds may follow different patterns of change during physiological derangement.Methods. Patients undergoing elective major posterior spine surgery participated in this prospective observational study. Cerebral tissue oxygen saturation (SctO2) was monitored on the upper forehead and muscular tissue oxygen saturation (SmtO2) on the lower leg. The associations of various oxygenation indices with postoperative composite complications and length of hospital stay (LOH) were investigated.Results. The number of composite complications per patient was 3 (2) while the LOH was 6 (3) days (n = 102). Multiple SmtO2 indices (maximum, minimum, mean, median, and area under curve (AUC)) were associated with composite complications (univariate analysis, P < 0.05). No SctO2 indices were associated with complications. Multiple SmtO2 indices (maximum, mean, median, and AUC) showed differences (P < 0.05) between patients with composite complications ≤3 and >3, respectively. SmtO2 standard deviation, AUC, and AUC weighted, and SctO2 standard deviation, were associated with LOH (univariate analysis, P < 0.05). Two SmtO2 indices (AUC and AUC weighted), showed differences (P < 0.05) between the patients with an LOH ≤6 and >6 days, respectively. SmtO2, but not SctO2, indices improved the adjusted R2 for composite complications (+54.0%, P = 0.0001) and LOH (+19.0%, P = 0.02) based on multiple linear models.Conclusions. Muscular tissue oxygenation has a stronger association with postoperative complications and length of hospital stay than cerebral tissue oxygenation after major spine surgery.

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National audits in the UK: fancy acronyms or real patient benefit?

'…give us the tools and we will finish the job.'Winston Churchill (1874–1965)

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Rainbow after the storm

Editor–A 71-year-old female presented with polymicrobial sepsis and mediastinitis following a dental procedure. After resuscitation with fluids and antibiotics, she required increasing doses of norepinephrine (up to 0.3 µg kg−1 min−1) prior to operative exploration. Point-of-care ultrasound revealed elevated cardiac filling pressures (dilated inferior vena cava without respiratory variation) and hyperdynamic cardiac function (ejection fraction >65%). Central venous pressure was 14 mmHg and central venous saturation was 70%. These findings, in addition to the requirement for high-dose intravenous vasopressors, confirmed a diagnosis of vasoplegia.<a href="#aex066-B1" class="reflinks">1</a> An intraoperative infusion pump failure of norepinephrine resulted in profound hypotension [blood pressure (BP) 30/20 mm Hg] as measured by an indwelling arterial line. Intravenous vasopressor boluses and 100 mg of methylene blue increased systolic arterial BP to >100 mm Hg for 15 min. Because methylene blue was effective, but only for a short duration, we administered intravenous hydroxocobalamin (1 g/h) to treat her vasoplegia.<a href="#aex066-B2" class="reflinks">2</a> Her acute oliguria (<10 ml h−1) was reversed and urine output increased to >500 ml h−1 during the final hours of surgery.

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Theory and context: putting the science into improvement

Quality Improvement has been around in healthcare for decades. However, the phrase "improvement science" is somewhat newer. In their Lancet Editorial in 2013, Marshall, Pronovost and Dixon-Woods proposed that Improvement Science was in Kuhn's <a href="#aew469-B1" class="reflinks">1</a> previously described "pre-paradigm phase of the emergence of a new discipline, one of the characteristics of which is the absence of an agreed definition."<a href="#aew469-B2" class="reflinks">2</a> Four yr on, the phrase "Improvement Science" is sometimes used interchangeably with quality improvement (QI). Are they the same thing? What is the point of drawing a distinction?

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Reduced hemidiaphragmatic paresis with extrafascial compared with conventional intrafascial tip placement for continuous interscalene brachial plexus block: a randomized, controlled, double-blind trial

<div class="boxTitle">Abstract</div>Background. The incidence of hemidiaphragmatic paresis with continuous interscalene brachial plexus block (CISB) can approach 100%. We tested the hypothesis that extrafascial placement of the catheter tip reduces the rate of hemidiaphragmatic paresis compared with intrafascial tip placement for CISB while providing effective analgesia.Methods. Seventy patients undergoing elective major shoulder surgery under general anaesthesia were randomized to receive an ultrasound-guided CISB plexus block for analgesia with the catheter tip placed either within (intrafascial group) or immediately outside (extrafascial group) the brachial plexus sheath midway between the levels of C5 and C6. Catheters were bolus dosed with ropivacaine 0.5% 20 ml before surgery, followed by an infusion of ropivacaine 0.2% at 4 ml h−1 for the first 2 days after surgery. The primary outcome was hemidiaphragmatic paresis measured by M-mode ultrasonography on postoperative day (POD) 1. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, and rest pain scores.Results. The incidence of hemidiaphragmatic paresis on POD 1 was significantly reduced in the extrafascial group {intrafascial, 41% [95% confidence interval (CI) 25–59%]; extrafascial, 15% (95% CI 5–32%); P=0.01}. We were unable to detect a difference between groups in any of the functional respiratory outcomes or in rest pain scores [numerical rating scale (1–10): intrafascial, 3 (95% CI 2–3); extrafascial, 3 (95% CI: 2–4); P=0.93] on POD 1.Conclusions. Placement of the catheter tip immediately outside of the brachial plexus sheath reduced the incidence of hemidiaphragmatic paresis on POD 1 associated with ultrasound-guided CISB while providing effective analgesia after major shoulder surgery. Our results do not support the routine placement of the catheter tip within the brachial plexus sheath for CISB.Clinical trial registration. NCT02433561.

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Taking two steps at a time does not necessarily bring you forward! Monitoring peripheral tissue perfusion with near-infrared spectroscopy

Evolution of tissue oxygenation monitoring by near-infrared spectroscopy (NIRS) is one of the most interesting recent developments in clinical monitoring.<a href="#aex032-B1" class="reflinks">1</a> Given the importance of organ tissue perfusion for outcomes from surgery and critical illness, the fact that this technology can be used to interrogate almost any body region of interest (that can be placed within the device's photon beam) has stimulated a tremendous amount of scientific work on the potential diagnostic utility of NIRS.

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Mayo Clinic Critical Care Case Review , R. Kashyap, J. C. O'Horo, J. C. Farmer.

Mayo Clinic Critical Care Case Review, KashyapR., O'HoroJ. C., FarmerJ. C.. Published by Oxford University Press. Pp. 288. ISBN-978-0-19-046481-3.

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What do people expect of general anaesthesia?

It is universally acknowledged that the public expect general anaesthesia to be an unconscious state.<a href="#aex040-B1" class="reflinks">1–4</a> While apparently self-evident, knowing whether different conscious states under anaesthesia are acceptable is important for clarification of the research agenda in anaesthesia, that is appropriately focused on patient-centred outcomes. Furthermore understanding patient expectations may be a key way to improve patient satisfaction with anaesthesia. The great success of anaesthesia is validated through low rates of explicit recall of intraoperative events, however it remains unclear whether the public think amnesia of intraoperative events is a sufficient endpoint for anaesthesia. It is unclear whether dreaming ("disconnected consciousness from the environment") or connected consciousness ("consciousness of external stimuli") are acceptable outcomes under general anaesthesia. These questions are made more pertinent by our recent report that 4.6% of patients undergoing intubation under general anaesthesia respond on the isolated forearm technique, implying they have connected consciousness,<a href="#aex040-B5" class="reflinks">5</a> with 1.9% reporting connected consciousness with pain. To provide some initial insight into public opinion on this, we conducted a survey posted on our website (<a href="http://ift.tt/2qhMQnw">http://ift.tt/2qSHFHI;), social media (Twitter, Reddit, and Facebook) and distributed electronically. We explored the public's views of states such as disconnected consciousness or dreaming during anaesthesia and intraoperative consciousness with and without amnesia.

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Assessing the pathogenicity of RYR1 variants in malignant hyperthermia

<div class="boxTitle">Abstract</div>Background. Missense variants in the ryanodine receptor 1 gene (RYR1) are associated with malignant hyperthermia but only a minority of these have met the criteria for use in predictive DNA diagnosis. We examined the utility of a simplified method of segregation analysis and a functional assay for determining the pathogenicity of recurrent RYR1 variants associated with malignant hyperthermia.Methods. We identified previously uncharacterised RYR1 variants found in four or more malignant hyperthermia families and conducted simplified segregation analyses. An efficient cloning and mutagenesis strategy was used to express ryanodine receptor protein containing one of six RYR1 variants in HEK293 cells. Caffeine-induced calcium release, measured using a fluorescent calcium indicator, was compared in cells expressing each variant to that in cells expressing wild type ryanodine receptor protein.Results. We identified 43 malignant hyperthermia families carrying one of the six RYR1 variants. There was segregation of genotype with the malignant hyperthermia susceptibility phenotype in families carrying the p.E3104K and p.D3986E variants, but the number of informative meioses limited the statistical significance of the associations. HEK293 functional assays demonstrated an increased sensitivity of RyR1 channels containing the p.R2336H, p.R2355W, p.E3104K, p.G3990V and p.V4849I compared with wild type, but cells expressing p.D3986E had a similar caffeine sensitivity to cells expressing wild type RyR1.Conclusions. Segregation analysis is of limited value in assessing pathogenicity of RYR1 variants in malignant hyperthermia. Functional analyses in HEK293 cells provided evidence to support the use of p.R2336H, p.R2355W, p.E3104K, p.G3990V and p.V4849I for diagnostic purposes but not p.D3986E.

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Lights! Oxygen! Action! Hollywood anaesthesia is coming to a theatre near you

By the time you are reading this editorial, 'La La Land', an Academy Awards contender movie about love, passion, and professional challenges of two Hollywood dreamers, will have nearly swept the Oscars. In the dream world of general anaesthesia, the top la la land award should undoubtedly be bestowed on Gustafsson and colleagues<a href="#aex077-B1" class="reflinks">1</a> for their publication in the April issue of British Journal of Anaesthesia.

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Individual patient data analysis of tidal volumes used in three large randomized control trials involving patients with acute respiratory distress syndrome

<div class="boxTitle">Abstract</div>Background. The acute respiratory distress syndrome (ARDS) is a condition with a high mortality and morbidity. Mechanical ventilation prevents immediate mortality but may further damage patients' lungs. Low tidal volume lung-protective strategies have been shown to increase survival by reducing this iatrogenic damage. Current guidelines recommend tidal volumes of 6–8 ml kg−1 of predicted body weight. We used data from three large randomized controlled trials of treatments for ARDS to determine compliance with these recommendations.Methods. We used the tidal volume recorded at randomization for all patients in the OSCAR, HARP-2, and BALTI-2 studies. In addition, we used the ventilation data for control arm patients in OSCAR and all patients in HARP-2 at days 1 and 7 after randomization.Results. The three trials enrolled 1660 patients, with tidal volume data available at least at one time point in 1412 patients. Compliance with the 6–8 ml kg−1 recommendation for tidal volume ranged from 20 to 39% of patients across all time points in all three trials.Conclusion. Poor compliance with the guidelines for tidal volume in patients with ARDS has been demonstrated before in case series, but not in clinical trials where the patient population is specifically selected against standard ARDS diagnostic criteria and the investigators were encouraged to use low tidal volumes. This study may indicate a need to improve implementation and compliance with protective lung ventilation.

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In this issue

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Can tongue thickness measured by ultrasonography predict difficult tracheal intubation?

<div class="boxTitle">Abstract</div>Background. Increased tongue thickness is likely to be associated with difficult airways. However, no methods to evaluate tongue thickness were available. Currently, tongue thickness can be measured by ultrasonography. The present study investigated the predictive value of tongue thickness to predict difficult tracheal intubation.Methods. Adult patients undergoing tracheal intubation and general anaesthesia were enrolled in the study. Tongue thickness was assessed using submental ultrasonography in the median sagittal plane before anaesthesia. Airway assessments were conducted. Ratios of tongue thickness to thyromental distance were calculated to investigate the potential predictive value of their combination. The primary outcome was difficult tracheal intubation. A multivariable logistic regression and receiver operating characteristic curve analysis were used.Results. In total, 2254 patients were analysed. One hundred and forty-two (6.3%) patients experienced difficult laryngoscopy, and 51 (2.3%) patients experienced difficult tracheal intubation. Increased tongue thickness (>6.1 cm) was an independent predictor for difficult tracheal intubation [sensitivity 0.75, 95% confidence interval (CI) 0.60–0.86; specificity 0.72, 95% CI 0.70–0.74]. An area under the curve of 0.78 (95% CI 0.77–0.80) for predicting difficult tracheal intubation was calculated. Increased ratios of tongue thickness to thyromental distance (>0.87) presented a considerable area under the curve (0.86, 95% CI 0.84–0.87), sensitivity (0.84, 95% CI 0.71–0.93), and specificity (0.79, 95% CI 0.77–0.81).Conclusions. Tongue thickness measured by ultrasonography and its ratio to thyromental distance present significant capacities to predict difficult tracheal intubation.Clinical trial registration. ChiCTR-RCS-14004539.

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Feasibility and efficiency of a preoperative anaemia walk-in clinic: secondary data from a prospective observational trial

Editor—Preoperative anaemia is independently associated with increased risk of morbidity and mortality.<a href="#aex024-B1" class="reflinks">1</a> Although haemoglobin (Hb) levels are always measured before major surgery, preoperative anaemia management is not implemented in most hospitals worldwide. Here we report the first steps and pilot clinical effects of implementing a preoperative anaemia clinic to diagnose and treat iron deficiency anaemia (IDA), which continues to be the top ranking cause worldwide,<a href="#aex024-B2" class="reflinks">2</a> to optimise preoperative anaemia and to reduce unnecessary red blood cell (RBC) utilization. This study is embedded in a previously published observational trial demonstrating the beneficial effects of implementing a patient blood management program.<a href="#aex024-B3" class="reflinks">3</a> A defined preoperative patient pathway including screening process, diagnostic algorithms and treatment protocol was developed.<a href="#aex024-B4" class="reflinks">4</a> The study protocol was approved by the ethics committee at the University Hospital Frankfurt. Primary endpoints were Hb increase and RBC transfusion rate. For the analysis of the dynamics of Hb levels over time, a complex non-parametric mixed effects model was used considering patients as random effects.<a href="#aex024-B5" class="reflinks">5</a> Data are provided as mean (sem) and median [interquartile range (IQR)]. P-values <0.005 were considered statistically significant.

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The role of microglia in the pathobiology of neuropathic pain development: what do we know?

<div class="boxTitle">Abstract</div>Neuropathic pain, a maladaptive and chronic condition that can develop after a lesion or disease affecting the somatosensory system, is characterized by allodynia, hyperalgesia and spontaneous pain, and comorbidities such as sleep deprivation, depression and anxiety. The activation of microglial cells in response to nerve injury has been implicated in the development of neuropathic pain. Mediators such as Neuregulin-1, matrix metalloproteinase (MMP)-2, MMP-9, The chemokine (C-C motif) ligand 2 (CCL2) and fractalkine are released after nerve injury and are involved in the activation of microglial cells. These activated cells in turn release factors that increase the excitation and decrease the inhibition of interneurons. Microglial cells release factors such as interleukin (IL)-6, IL-1β and tumour necrosis factor-α (TNF-α) that cause the painful symptoms. It is becoming increasingly apparent that an intricate network of cytokines and cellular signalling mechanisms underpin the complex relationship between microglia and various cell types including neurones, astrocytes, oligodendrocytes, mast cells and T-cells. Although the precise mechanism of action of microglial cells in producing neuropathic pain has not been completely elucidated, research into these different activating factors and cytokines is providing further insight into the role of microglial cells in the development and maintenance of neuropathic pain. Further studies also are required to elucidate how "pain" mediators act on neurones and how the interactions between these mediators, or between neurones and glia in the presence of these mediators occur, in order to develop effective therapies for the management of neuropathic pain.

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Determining the probability of a foreign body aspiration from history, symptoms and clinical findings in children

Editor—Life-threatening events with an acute airway obstruction require immediate intervention. Nevertheless, most cases of foreign body aspiration (FBA) result in expectoration or dislodgment into a main-stem bronchus, with subsequent normalization of breathing and non-specific respiratory symptoms occurring days or even weeks after the FBA, often not recognized by health care providers<a href="#aex023-B1" class="reflinks">1</a> or parents.<a href="#aex023-B2" class="reflinks">2</a> Bronchoscopy is a potentially harmful procedure requiring specialist expertise in small children.<a href="#aex023-B3" class="reflinks">3</a> Therefore, simple and reliable identifiers for the probability of actual FBA would be highly desirable.

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Hypoglycaemia after accidental ocular insulin injection

Editor—Typically, insulin is administered subcutaneously, intravenously, or intramuscularly. Alternate routes of insulin delivery, including oral, nasal, buccal, sublingual, ocular, rectal, and vaginal, have been described, but have resulted in unreliable effects.<a href="#aex065-B1" class="reflinks">1</a>

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Enhanced recovery after surgery for hip and knee arthroplasty: where is the evidence?

Editor—Recently, Soffin and YaDeau<a href="#aex058-B1" class="reflinks">1</a> published 'a review of the evidence' of enhanced recovery after surgery (ERAS) for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Although admittedly a narrative review, the review is not up to date, and at several points does not present 'the evidence'. For instance, a lot of space is used on fasting, carbohydrate loading, antimicrobial prophylaxis, and metabolic responses (all of which have no or limited effects on ERAS in these specific procedures). However, the review did not mention the more important recent research on the role of the inflammatory response for recovery<a href="#aex058-B2" class="reflinks">2</a> and its modification by high-dose steroids.<a href="#aex058-B3" class="reflinks">3</a><a href="#aex058-B4" class="reflinks">4</a> Also, the statement that epidural analgesia is to be recommended is against the evidence for many years.

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Comparison of bioreactance and echocardiographic non-invasive cardiac output monitoring and myocardial function assessment in primagravida women

<div class="boxTitle">Abstract</div>Background. Non-invasive cardiac output monitoring (NICOM) using bioreactance (BRT) in pregnancy is gaining interest but lacks validation. We compared simultaneous cardiac output (CO) measurements obtained using the NICOM® (BRT-CO) and echocardiography (echo-CO), and assessed the relationship between maternal characteristics and myocardial performance.Methods. Paired stroke volume (SV) and CO readings were obtained using NICOM® and echocardiography, in a group of healthy nulliparous women throughout a 15 min period. Agreement between NICOM® and echocardiography was assessed using Bland–Altman analysis and the intraclass correlation coefficient (ICC). Left ventricular (LV) function was assessed using systolic strain and tissue Doppler velocities (S′, E′, and A′ waves).Results. Thirty-five women with a median [interquartile range] age, weight, and gestation of 29 [26–34] yr, 71 [64–79] kg, and 28 [21–29] weeks, respectively, were enrolled. There was good agreement between NICOM®-measured and echocardiographically measured SV [mean bias 6 ml (limits of agreement −18 to 29); ICC 0.8 (95% confidence interval 0.6–0.9), P<0.001] and CO [mean bias 0.2 litres (limits of agreement −1.3–1.7); ICC 0.8 (95% confidence interval 0.7–0.9), P<0.001; mean percentage error ±26%; coefficient of error (precision)=3.4%]. The mean (sd) LV S′ was 9.7 (2.3) cm s−1. The mean (sd) LV strain was −18.6 (2.6)%. There was a negative relationship between BMI and LV diastolic function measured using the E′:A′ ratio (r = −0.51, P<0.01).Conclusions. Stroke volume and CO measurements obtained using NICOM® were comparable to those obtained using echocardiography, with acceptable limits of agreement. Increased maternal BMI negatively impacts LV diastolic function measured using tissue Doppler imaging.

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Issue Information

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Interactive effects of gallic/ferulic/caffeic acids and anthocyanins on pigment thermal stabilities

Publication date: June 2017
Source:Data in Brief, Volume 12
Author(s): Bing-Jun Qian, Jian-Hua Liu, Shu-Juan Zhao, Jian-Xiong Cai, Pu Jing
The data presented in this article are related to the research article entitled "The effects of gallic/ferulic/caffeic acids on colour intensification and anthocyanin stability" (Qian et al., 2017) [1]. This paper described preparation and isolation of anthocyanins from purple sweet potatoes (PSP) and the time-course of anthocyanin profiles treated with gallic, ferulic, or caffeic acids at 95°C. The color appearance of PSPanthocyanins alone, or with gallic, ferulic, or caffeic acids was described after the 15h of thermal treatment. The high resolution mass spectrographs of PSP anthocyanins were determined using UPLC-ESI-HRMS. The spatial interaction of peonidin 3-O-(2-O-β-D-glucopyranocyl-β-D-glucopyranoide)-5-O-β-D-glucopyranoside and gallic/ferulic/caffeic acids was illustrated by molecular dynamic simulation.

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Non-Melanoma Skin Cancers of the Fronto-Temporal Area Preferentially Localize in the Proximity of Arterial Blood Vessels

Background: Squamous cell carcinomas and basal cell carcinomas are both induced by chronic UV exposure. However, their predilection for specific areas of the face remains unexplained. Regional factors such as arterial blood flow may explain specific tumor localization. Objective: To determine whether in the fronto-temporal area of the face there is a preferential localization of non-melanoma skin cancer (NMSC) at sites of arterial blood vessels. Methods: Twenty-two patients with NMSC of the fronto-temporal area were selected for this study. The clinical tumor margins were demarked based on clinical examination. Arterial colocalization was determined using both sonography and histological analysis. Results: Echo-Doppler analysis revealed the colocalization of NMSC with an arterial branch in 59% of the patients. Histologically, colocalization between NMSC and artery was found in 68% of the patients. When combining echo-Doppler and histological results, colocalization of NMSC and arteries were found in 82% of the patients. Conclusion: In this study, we found an unexpectedly high colocalization of NMSC with arterial branches in the fronto-temporal area of the face. These results suggest that in addition to UV exposure, pulsatile arterial blood flow may represent an additional factor determining the precise facial localization of NMSC.
Dermatology

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Dermoscopy of Subungual Exostosis: A Retrospective Study of 10 Patients

Introduction: Subungual exostosis (SE), the most common nail tumor of young adults, is a benign bony proliferation of the distal phalanx occurring beneath the nail. Misdiagnosis or late diagnosis frequently occurs and no dermoscopy features of this tumor were previously outlined. Material and Methods: To describe the dermoscopic appearance of SE, 10 patients with radiologically and histologically confirmed SE were retrospectively retrieved from our tertiary referral centers. Data regarding age, gender, time to diagnosis, clinical presentation, dermoscopic features, involved nail and history of trauma were recorded for each patient. Results: In our patients, clinical findings were similar to previous reports. Among the dermoscopic features, vascular ectasia was the most common finding (70%), followed by hyperkeratosis (60%), onycholysis (40%), and ulceration (30%). Conclusion: Dermoscopy could be a useful technique aimed at creating diagnostic suspicion of this benign nail condition, although X-ray examination and histopathology are mandatory for the diagnosis.
Dermatology

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Towards rebuilding vaginal support utilizing an extracellular matrix bioscaffold

Publication date: Available online 6 May 2017
Source:Acta Biomaterialia
Author(s): Rui Liang, Katrina Knight, Deanna Easley, Stacy Palcsey, Steven Abramowitch, Pamela A. Moalli
As an alternative to polypropylene mesh, we explored an extracellular matrix (ECM) bioscaffold derived from urinary bladder matrix (MatriStem™) in the repair of vaginal prolapse. We aimed to restore disrupted vaginal support simulating application via transvaginal and transabdominal approaches in a macaque model focusing on the impact on vaginal structure, function, and the host immune response. In 16 macaques, after laparotomy, the uterosacral ligaments and paravaginal attachments to pelvic side wall were completely transected (IACUC# 13081928). 6ply MatriStem was cut into posterior and anterior templates with a portion covering the vagina and arms simulating uterosacral ligaments and paravaginal attachments, respectively. After surgically exposing the correct anatomical sites, in 8 animals, a vaginal incision was made on the anterior and posterior vagina and the respective scaffolds were passed into the vagina via these incisions (transvaginal insertion) prior to placement. The remaining 8 animals underwent the same surgery without vaginal incisions (transabdominal insertion). Three months post implantation, firm tissue bands extending from vagina to pelvic side wall appeared in both MatriStem groups. Experimental endpoints examining impact of MatriStem on the vagina demonstrated that vaginal biochemical and biomechanical parameters, smooth muscle thickness and contractility, and immune responses were similar in the MatriStem no incision group and sham-operated controls. In the MatriStem incision group, a 41% decrease in vaginal stiffness (P=0.042), a 22% decrease in collagen content (P=0.008) and a 25% increase in collagen subtypes III/I was observed vs. Sham. Active MMP2 was increased in both Matristem groups vs. Sham (both P=0.002). This study presents a novel application of ECM bioscaffolds as a first step towards the rebuilding of vaginal support.Statement of SignificancePelvic organ prolapse is a common condition related to failure of the supportive soft tissues of the vagina; particularly at the apex and mid-vagina. Few studies have investigated methods to regenerate these failed structures. The overall goal of the study was to determine the feasibility of utilizing a regenerative bioscaffold in prolapse applications to restore apical (level I) and lateral (level II) support to the vagina without negatively impacting vaginal structure and function. The significance of our findings is two fold: 1. Implantation of properly constructed extracellular matrix grafts promoted rebuilding of level I and level II support to the vagina and did not negatively impact the overall functional, morphological and biochemical properties of the vagina. 2. The presence of vaginal incisions in the transvaginal insertion of bioscaffolds may compromise vaginal structural integrity in the short term.

Graphical abstract

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Paroxysmal theta power reactivity is related to survival in anoxic vegetative state patients

Publication date: Available online 7 May 2017
Source:Clinical Neurophysiology
Author(s): Oded Meiron, Efraim Jaul

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2016 Articles of the Year, Reviewers of the Year, and Figure of the Year

We are delighted to announce the 10 best articles published in 2016. We believe that all papers published in the Journal meet the standard of excellence. However, the 10 papers selected this year represent, in the editors' opinions, the best in the field. The articles are listed below in the order of publication.

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Sexual Networks, Dyadic Characteristics, and HIV Acquisition and Transmission Behaviors Among Black Men Who Have Sex With Men in 6 US Cities

<div class="boxTitle">Abstract</div>The role of sexual networks in the epidemiology of human immunodeficiency virus (HIV) among black men who have sex with men (MSM) is poorly understood. Using data from 1,306 black MSM in the BROTHERS Study (2009–2010) in the United States, we examined the relationships between multiple sexual dyadic characteristics and serodiscordant/serostatus-unknown condomless sex (SDCS). HIV-infected participants had higher odds of SDCS when having sex at least weekly (odds ratio (OR) = 2.41, 95% confidence interval (CI): 1.37, 4.23) or monthly (OR = 1.94, 95% CI: 1.17, 3.24) versus once to a few times a year. HIV-uninfected participants had higher odds of SDCS with partners met offline at sex-focused venues (OR = 1.79, 95% CI: 1.15, 2.78) versus partners met online. In addition, having sex upon first meeting was associated with higher odds of SDCS (OR = 1.49, 95% CI: 1.21, 1.83) than was not having sex on first meeting, while living/continued communication with sexual partner(s) was associated with lower odds of SDCS (weekly: OR = 0.64, 95% CI: 0.47, 0.85; monthly: OR = 0.60, 95% CI: 0.44, 0.81; yearly: OR = 0.58, 95% CI: 0.39, 0.85) versus discontinued communication. Persons with primary/steady nonprimary partners versus commercial partners had lower odds of SDCS regardless of HIV serostatus. This suggests the need for culturally relevant HIV prevention efforts for black MSM that facilitate communication with sexual partners especially about risk reduction strategies, including preexposure prophylaxis.

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Does Choice of Influenza Vaccine Type Change Disease Burden and Cost-Effectiveness in the United States? An Agent-Based Modeling Study

<div class="boxTitle">Abstract</div>Offering a choice of influenza vaccine type may increase vaccine coverage and reduce disease burden, but it is more costly. This study calculated the public health impact and cost-effectiveness of 4 strategies: no choice, pediatric choice, adult choice, or choice for both age groups. Using agent-based modeling, individuals were simulated as they interacted with others, and influenza was tracked as it spread through a population in Washington, DC. Influenza vaccination coverage derived from data from the Centers for Disease Control and Prevention was increased by 6.5% (range, 3.25%–11.25%), reflecting changes due to vaccine choice. With moderate influenza infectivity, the number of cases averaged 1,117,285 for no choice, 1,083,126 for pediatric choice, 1,009,026 for adult choice, and 975,818 for choice for both age groups. Averted cases increased with increased coverage and were highest for the choice-for-both-age-groups strategy; adult choice also reduced cases in children. In cost-effectiveness analysis, choice for both age groups was dominant when choice increased vaccine coverage by ≥3.25%. Offering a choice of influenza vaccines, with reasonable resultant increases in coverage, decreased influenza cases by >100,000 with a favorable cost-effectiveness profile. Clinical trials testing the predictions made based on these simulation results and deliberation of policies and procedures to facilitate choice should be considered.

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The Use of a Binary Composite Endpoint and Sample Size Requirement: Influence of Endpoints Overlap

<div class="boxTitle">Abstract</div>Although composite endpoints (CE) are common in clinical trials, the impact of the relationship between the components of a binary CE on the sample size requirement (SSR) has not been addressed. We performed a computational study considering 2 treatments and a CE with 2 components: the relevant endpoint (RE) and the additional endpoint (AE). We assessed the strength of the components' interrelation by the degree of relative overlap between them, which was stratified into 5 groups. Within each stratum, SSR was computed for multiple scenarios by varying the events proportion and the effect of the therapy. A lower SSR using CE was defined as the best scenario for using the CE. In 25 of 66 scenarios the degree of relative overlap determined the benefit of using CE instead of the RE. Adding an AE with greater effect than the RE leads to lower SSR using the CE regardless of the AE proportion and the relative overlap. The influence of overlapping decreases when the effect on RE increases. Adding an AE with lower effect than the RE constitutes the most uncertain situation. In summary, the interrelationship between CE components, assessed by the relative overlap, can help to define the SSR in specific situations and it should be considered for SSR computation.

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Metabolic Mediators of the Association Between Adult Weight Gain and Colorectal Cancer: Data From the European Prospective Investigation into Cancer and Nutrition (EPIC) Cohort

<div class="boxTitle">Abstract</div>Evidence indicates that gaining weight in adult life is associated with an elevated risk of colorectal cancer; however, biological mechanisms that may explain this association remain unclear. We evaluated the mediation effect of 20 different biomarkers on the relationship between adult weight gain and colorectal cancer, using data from a prospective nested case-control study of 452 incident cases diagnosed between 1992 and 2003 and matched within risk sets to 452 controls within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The proportions of mediated effects (%) were estimated on the basis of differences in percent effect changes in conditional logistic regression models with and without additional adjustment for individual biomarkers. Greater adult weight gain (≥300 g/year vs. <300 g/year) was associated with a higher risk of colon cancer (multivariable-adjusted relative risk = 1.54, 95% confidence interval: 1.07, 2.24) but not rectal cancer (relative risk = 1.07, 95% confidence interval: 0.68, 1.66). This association was accounted for mostly by attained waist circumference (reduction of 61%) and by the biomarkers soluble leptin receptor (reduction of 43%) and glycated hemoglobin (reduction of 28%). These novel data suggest that the observed association between adult weight gain and colon cancer could be primarily explained by attained abdominal fatness and biomarkers of metabolic dysfunction.

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Food Environment and Weight Change: Does Residential Mobility Matter? The Diabetes Study of Northern California (DISTANCE)

<div class="boxTitle">Abstract</div>Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual association between change in food environment from 2006 to 2011 and change in BMI among adults with type 2 diabetes using clinical data from the Kaiser Permanente Diabetes Registry collected from 2007 to 2011. Healthy food environment was measured using the kernel density of healthful food venues. Fixed-effects models with a 1-year-lagged BMI were estimated. Separate models were fitted for persons who moved and those who did not. Sensitivity analysis using different lag times and kernel density bandwidths were tested to establish the consistency of findings. On average, patients lost 1 pound (0.45 kg) for each standard-deviation improvement in their food environment. This relationship held for persons who remained in the same location throughout the 5-year study period but not among persons who moved. Proximity to food venues that promote nutritious foods alone may not translate into clinically meaningful diet-related health changes. Community-level policies for improving the food environment need multifaceted strategies to invoke clinically meaningful change in BMI among adult patients with diabetes.

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Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995–2008

<div class="boxTitle">Abstract</div>Limitations of extant research on neighborhood disadvantage and health include general reliance on point-in-time neighborhood measures and sensitivity to residential self-selection. Using data from the US Census and the 1995–2008 National Longitudinal Study of Adolescent to Adult Health, we applied conventional methods and coarsened exact matching to assess how cardiometabolic health varies among those entering, exiting, or remaining in poor and nonpoor neighborhoods. Within the full sample (n = 11,767), we found significantly higher systolic and diastolic blood pressures among those who entered or consistently lived in poor neighborhoods relative to those who never lived in poor neighborhoods. Obesity was similarly more common among those who originated from poor neighborhoods than among those who originated from nonpoor neighborhoods. Having exited poor neighborhoods was associated with lower systolic blood pressure than was consistent residence in low-income communities. Among the matched sample (n = 9,727), results adjusted for confounders and residential self-selection revealed fewer significant contrasts. Compared with peers who had no neighborhood poverty exposure, those who consistently lived in poor neighborhoods had 46% and 52% higher odds of being obese or hypertensive, respectively. Those who exited neighborhood poverty had significantly higher diastolic blood pressures than those who had never lived in poor neighborhoods. These findings underscore the importance of past as well as current residential circumstances for cardiometabolic health.

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The Association Between Air Pollution and Onset of Depression Among Middle-Aged and Older Women

<div class="boxTitle">Abstract</div>Despite recently reported associations between air pollution and acute psychiatric outcomes, the association with depression onset has not, to our knowledge, been previously examined. We conducted a prospective cohort study among 41,844 women in the Nurses' Health Study, in the United States. The women had an average age of 66.6 (standard deviation, 7.6) years, were depression-free in 1996, and were followed through 2008. May–September ozone exposures were predicted by interpolating concentrations from the 5 nearest monitors. One-, 2-, and 5-year average concentrations of particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5) were predicted at each participant's residence using a spatiotemporal model. We defined depression as report of doctor's diagnosis or use of antidepressant medication. We estimated adjusted hazard ratios with time-varying Cox models. Hazard ratios for both pollutants were elevated (per 10-parts-per-billion increase in ozone, hazard ratio (HR) = 1.06; 95% confidence interval (CI): 1.00, 1.12; per 10-μg/m3 increase in 1-year PM2.5, HR = 1.08; 95% CI: 0.97, 1.20). Associations were stronger when only antidepressant use was used to define cases (for ozone, HR = 1.08; 95% CI: 1.02, 1.14; for PM2.5, HR = 1.12; 95% CI: 1.00, 1.25). To our knowledge, these results represent the first identification of a possible association between both long-term ozone and PM2.5 exposure and depression onset. Although the stronger association specifically with antidepressant use may reflect that this endpoint better captures the onset time and milder cases, our findings should be interpreted with caution.

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THE AUTHORS REPLY

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RE: “DETECTABLE RISKS IN STUDIES OF THE FETAL BENEFITS OF MATERNAL INFLUENZA VACCINATION”

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The Effect of Birth Weight on Academic Performance: Instrumental Variable Analysis

<div class="boxTitle">Abstract</div>Observationally, lower birth weight is usually associated with poorer academic performance; whether this association is causal or the result of confounding is unknown. To investigate this question, we obtained an effect estimate, which can have a causal interpretation under specific assumptions, of birth weight on educational attainment using instrumental variable analysis based on single nucleotide polymorphisms determining birth weight combined with results from the Social Science Genetic Association Consortium study of 126,559 Caucasians. We similarly obtained an estimate of the effect of birth weight on academic performance in 4,067 adolescents from Hong Kong's (Chinese) Children of 1997 birth cohort (1997–2016), using twin status as an instrumental variable. Birth weight was not associated with years of schooling (per 100-g increase in birth weight, −0.006 years, 95% confidence interval (CI): −0.02, 0.01) or college completion (odds ratio = 1.00, 95% CI: 0.96, 1.03). Birth weight was also unrelated to academic performance in adolescents (per 100-g increase in birth weight, −0.004 grade, 95% CI: −0.04, 0.04) using instrumental variable analysis, although conventional regression gave a small positive association (0.02 higher grade, 95% CI: 0.01, 0.03). Observed associations of birth weight with academic performance may not be causal, suggesting that interventions should focus on the contextual factors generating this correlation.

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Depressive Disorder Subtypes as Predictors of Incident Obesity in US Adults: Moderation by Race/Ethnicity

<div class="boxTitle">Abstract</div>We compared the relative importance of atypical major depressive disorder (MDD), nonatypical MDD, and dysthymic disorder in predicting 3-year obesity incidence and change in body mass index and determined whether race/ethnicity moderated these relationships. We examined data from 17,787 initially nonobese adults in the National Epidemiologic Survey on Alcohol and Related Conditions waves 1 (2001–2002) and 2 (2004–2005) who were representative of the US population. Lifetime subtypes of depressive disorders were determined using a structured interview, and obesity outcomes were computed from self-reported height and weight. Atypical MDD (odds ratio (OR) = 1.68, 95% confidence interval (CI): 1.43, 1.97; P < 0.001) and dysthymic disorder (OR = 1.66, 95% CI: 1.29, 2.12; P < 0.001) were stronger predictors of incident obesity than were nonatypical MDD (OR = 1.11, 95% CI: 1.01, 1.22; P = 0.027) and no history of depressive disorder. Atypical MDD (B = 0.41 (standard error, 0.15); P = 0.007) was a stronger predictor of increases in body mass index than were dysthymic disorder (B = −0.31 (standard error, 0.21); P = 0.142), nonatypical MDD (B = 0.007 (standard error, 0.06); P = 0.911), and no history of depressive disorder. Race/ethnicity was a moderator; atypical MDD was a stronger predictor of incident obesity in Hispanics/Latinos (OR = 1.97, 95% CI: 1.73, 2.24; P < 0.001) than in non-Hispanic whites (OR = 1.54, 95% CI: 1.25, 1.91; P < 0.001) and blacks (OR = 1.72, 95% CI: 1.31, 2.26; P < 0.001). US adults with atypical MDD are at particularly high risk of weight gain and obesity, and Hispanics/Latinos may be especially vulnerable to the obesogenic consequences of depressions.

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The “Dry-Run” Analysis: A Method for Evaluating Risk Scores for Confounding Control

<div class="boxTitle">Abstract</div>A propensity score (PS) model's ability to control confounding can be assessed by evaluating covariate balance across exposure groups after PS adjustment. The optimal strategy for evaluating a disease risk score (DRS) model's ability to control confounding is less clear. DRS models cannot be evaluated through balance checks within the full population, and they are usually assessed through prediction diagnostics and goodness-of-fit tests. A proposed alternative is the "dry-run" analysis, which divides the unexposed population into "pseudo-exposed" and "pseudo-unexposed" groups so that differences on observed covariates resemble differences between the actual exposed and unexposed populations. With no exposure effect separating the pseudo-exposed and pseudo-unexposed groups, a DRS model is evaluated by its ability to retrieve an unconfounded null estimate after adjustment in this pseudo-population. We used simulations and an empirical example to compare traditional DRS performance metrics with the dry-run validation. In simulations, the dry run often improved assessment of confounding control, compared with the C statistic and goodness-of-fit tests. In the empirical example, PS and DRS matching gave similar results and showed good performance in terms of covariate balance (PS matching) and controlling confounding in the dry-run analysis (DRS matching). The dry-run analysis may prove useful in evaluating confounding control through DRS models.

http://ift.tt/2pXEluR

Risk of Diabetes After Hysterectomy With or Without Oophorectomy in Postmenopausal Women

<div class="boxTitle">Abstract</div>The aim of this study was to determine the associations between hysterectomy, bilateral salpingo-oophorectomy (BSO), and incidence of diabetes in postmenopausal women participating in the Women's Health Initiative (WHI), a series of trials conducted in the United States, during the period 1993–1998. A total of 67,130 postmenopausal women aged 50–79 years were followed for a mean of 13.4 years. Among them, 7,430 cases of diabetes were diagnosed. Multivariable Cox proportional hazards models were used to assess the association between hysterectomy/oophorectomy status and diabetes incidence. Compared with women without hysterectomy, women with hysterectomy had a significantly higher risk of diabetes (hazard ratio = 1.13, 95% confidence interval: 1.06, 1.21). The increased risk of diabetes was similar for women with hysterectomy only and for women with hysterectomy with concomitant BSO. Compared with hysterectomy alone, hysterectomy with BSO was not associated with additional risk of diabetes after stratification by age at hysterectomy and hormone therapy status. In our large, prospective study, we observed that hysterectomy, regardless of oophorectomy status, was associated with increased risk of diabetes among postmenopausal women. However, our data did not support the hypothesis that early loss of ovarian estrogens is a risk factor for type 2 diabetes. The modest increased risk of diabetes associated with hysterectomy may be due to residual confounding, such as the reasons for hysterectomy.

http://ift.tt/2pVSLOk

The Relationship Between Objectively Measured Walking and Risk of Pedestrian–Motor Vehicle Collision

<div class="boxTitle">Abstract</div>Safe urban walking environments may improve health by encouraging physical activity, but the relationship between an individual's location and walking pattern and the risk of pedestrian–motor vehicle collision is unknown. We examined associations between individuals' walking bouts and walking risk, measured as mean exposure to the risk of pedestrian-vehicle collision. Walking bouts were ascertained through integrated accelerometry and global positioning system data and from individual travel-diary data obtained from adults in the Travel Assessment and Community Study (King County, Washington) in 2008–2009. Walking patterns were superimposed onto maps of the historical probabilities of pedestrian-vehicle collisions for intersections and midblock segments within Seattle, Washington. Mean risk of pedestrian-vehicle collision in specific walking locations was assessed according to walking exposure (duration, distance, and intensity) and participant demographic characteristics in linear mixed models. Participants typically walked in areas with low pedestrian collision risk when walking for recreation, walking at a faster pace, or taking longer-duration walks. Mean daily walking duration and distance were not associated with collision risk. Males walked in areas with higher collision risk compared with females, while vehicle owners, residents of single-family homes, and parents of young children walked in areas with lower collision risk. These findings may suggest that pedestrians moderate collision risk by using lower-risk routes.

http://ift.tt/2pXDSJ8

CAJAL CLUB KRIEG CORTICAL KUDOS FOR 2017

http://ift.tt/2pvHMus

Vocal Tract Images Reveal Neural Representations of Sensorimotor Transformation During Speech Imitation

<div class="boxTitle">Abstract</div>Imitating speech necessitates the transformation from sensory targets to vocal tract motor output, yet little is known about the representational basis of this process in the human brain. Here, we address this question by using real-time MR imaging (rtMRI) of the vocal tract and functional MRI (fMRI) of the brain in a speech imitation paradigm. Participants trained on imitating a native vowel and a similar nonnative vowel that required lip rounding. Later, participants imitated these vowels and an untrained vowel pair during separate fMRI and rtMRI runs. Univariate fMRI analyses revealed that regions including left inferior frontal gyrus were more active during sensorimotor transformation (ST) and production of nonnative vowels, compared with native vowels; further, ST for nonnative vowels activated somatomotor cortex bilaterally, compared with ST of native vowels. Using test representational similarity analysis (RSA) models constructed from participants' vocal tract images and from stimulus formant distances, we found that RSA searchlight analyses of fMRI data showed either type of model could be represented in somatomotor, temporal, cerebellar, and hippocampal neural activation patterns during ST. We thus provide the first evidence of widespread and robust cortical and subcortical neural representation of vocal tract and/or formant parameters, during prearticulatory ST.

http://ift.tt/2pqq1tJ

Effects of Antenatal Maternal Depressive Symptoms and Socio-Economic Status on Neonatal Brain Development are Modulated by Genetic Risk

<div class="boxTitle">Abstract</div>This study included 168 and 85 mother–infant dyads from Asian and United States of America cohorts to examine whether a genomic profile risk score for major depressive disorder (GPRSMDD) moderates the association between antenatal maternal depressive symptoms (or socio-economic status, SES) and fetal neurodevelopment, and to identify candidate biological processes underlying such association. Both cohorts showed a significant interaction between antenatal maternal depressive symptoms and infant GPRSMDD on the right amygdala volume. The Asian cohort also showed such interaction on the right hippocampal volume and shape, thickness of the orbitofrontal and ventromedial prefrontal cortex. Likewise, a significant interaction between SES and infant GPRSMDD was on the right amygdala and hippocampal volumes and shapes. After controlling for each other, the interaction effect of antenatal maternal depressive symptoms and GPRSMDD was mainly shown on the right amygdala, while the interaction effect of SES and GPRSMDD was mainly shown on the right hippocampus. Bioinformatic analyses suggested neurotransmitter/neurotrophic signaling, SNAp REceptor complex, and glutamate receptor activity as common biological processes underlying the influence of antenatal maternal depressive symptoms on fetal cortico-limbic development. These findings suggest gene–environment interdependence in the fetal development of brain regions implicated in cognitive–emotional function. Candidate biological mechanisms involve a range of brain region-specific signaling pathways that converge on common processes of synaptic development.

http://ift.tt/2pSS3Rw

Transient Cell-intrinsic Activity Regulates the Migration and Laminar Positioning of Cortical Projection Neurons

<div class="boxTitle">Abstract</div>Neocortical microcircuits are built during development and require the coordinated assembly of excitatory glutamatergic projection neurons (PNs) into functional networks. Neuronal migration is an essential step in this process. In addition to cell-intrinsic mechanisms, external cues including neurotransmitters regulate cortical neuron migration, suggesting that early activity could influence this process. Here, we aimed to investigate the role of cell-intrinsic activity in migrating PNs in vivo using a designer receptor exclusively activated by a designer drug (DREADD) chemogenetic approach. In utero electroporation was used to specifically express the human M3 muscarinic cholinergic Gq-coupled receptor (hM3Dq) in PNs and calcium activity, migratory dynamics, gene expression, and laminar positioning of PNs were assessed following embryonic DREADD activation. We found that transient embryonic DREADD activation induced premature branching and transcriptional changes in migrating PNs leading to a persistent laminar mispositioning of superficial layer PNs into deep cortical layers without affecting expression of layer-specific molecular identity markers. In addition, live imaging approaches indicated that embryonic DREADD activation increased calcium transients in migrating PNs and altered their migratory dynamics by increasing their pausing time. Taken together, these results support the idea that increased cell-intrinsic activity during migration acts as a stop signal for migrating cortical PNs.

http://ift.tt/2pqLrHc

Persistence of Amygdala–Hippocampal Connectivity and Multi-Voxel Correlation Structures During Awake Rest After Fear Learning Predicts Long-Term Expression of Fear

<div class="boxTitle">Abstract</div>After encoding, memories undergo a process of consolidation that determines long-term retention. For conditioned fear, animal models postulate that consolidation involves reactivations of neuronal assemblies supporting fear learning during postlearning "offline" periods. However, no human studies to date have investigated such processes, particularly in relation to long-term expression of fear. We tested 24 participants using functional MRI on 2 consecutive days in a fear conditioning paradigm involving 1 habituation block, 2 acquisition blocks, and 2 extinction blocks on day 1, and 2 re-extinction blocks on day 2. Conditioning blocks were preceded and followed by 4.5-min rest blocks. Strength of spontaneous recovery of fear on day 2 served as a measure of long-term expression of fear. Amygdala connectivity primarily with hippocampus increased progressively during postacquisition and postextinction rest on day 1. Intraregional multi-voxel correlation structures within amygdala and hippocampus sampled during a block of differential fear conditioning furthermore persisted after fear learning. Critically, both these main findings were stronger in participants who exhibited spontaneous recovery 24 h later. Our findings indicate that neural circuits activated during fear conditioning exhibit persistent postlearning activity that may be functionally relevant in promoting consolidation of the fear memory.

http://ift.tt/2pSMySY

Scholar : These new articles for Museum Management and Curatorship are available online

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New for Museum Management and Curatorship and online now on Taylor & Francis Online:

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'Virtual museums' as digital collection complexes. A museological perspective using the example of Hans-Gross-Kriminalmuseum (University of Graz)
Bernadette Biedermann
Pages: 1-17 | DOI: 10.1080/09647775.2017.1322916

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Scholar : These new articles for Journal of the Institute of Conservation are available online

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3D4Ever: why is it so hard to talk about the preservation of 3D data?
Dr. William Kilbride
Pages: 1-8 | DOI: 10.1080/19455224.2017.1317006This is the author accepted version which has not been proofed or edited

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Biocontrol activity of effusol from the extremophile plant, Juncus maritimus, against the wheat pathogen Zymoseptoria tritici

Abstract

Zymoseptoria tritici, responsible for Septoria tritici blotch, is the most important pathogen of wheat. The control of this parasite relies mainly on synthetic fungicides, but their use is increasingly controversial and searching for alternative management strategies is encouraged. In this context, the biocontrol potential of crude methanolic extracts of eight extremophile plant species from Tunisia, including three xerophytes and five halophytes, against Z. tritici was assessed. Only the extract of Juncus maritimus rhizomes showed significant in vitro antifungal activity. In extremophile plants, the production of secondary metabolites is often influenced by abiotic conditions. Thus, we collected several samples of J. maritimus rhizomes at different vegetative stages, at different periods, and from different substrates to compare their antifungal activities. Our results suggest that the plant environment, especially the substrate of the soil, should be taken into account to identify great sources of natural antifungal products. From the most active sample, a 9,10-dehydrophenanthrene derivative, effusol, absent from other J. maritimus rhizomes extracts, was purified. This product showed a strong antifungal activity against the pathogen, with a minimal inhibitory concentration of 19 μg mL⁻¹ and an half-maximal inhibitory concentration of 9.98 μg mL⁻¹. This phenanthrene derivative could be a promising biocontrol molecule against Z. tritici.

http://ift.tt/2qgR9zJ

Difference of performance in response to disease admissions between daily time air quality indices and those derived from average and entropy functions

Abstract

Daily time air quality indices, which can reflect air quality in 1 day, are suitable for identifying daily exposure during conditions of poor air quality. The aim of this study is to compare the main effectiveness of four daily time indices in representing variation in the number of disease admissions. These indices include pollution standard index (PSI), air quality index (AQI) and their respective indices derived from mean and entropy functions: MEPSI and MEAQI. The hourly concentrations of fine particulate matter less than 10 μm in diameter (PM₁₀), PM_2.5, O₃, CO, NO₂ and SO₂ from 1 January 2006 to 31 December 2010 were obtained from 14 air quality monitoring stations owned by the Environmental Protection Administration (EPA) in the Kaoping region, Taiwan.

Instead of circulatory system disease admissions, the indices were correlative with the number of respiratory disease admissions with correlative coefficients of 0.49 to 0.56 (P < 0.05). The daily time air quality indices derived from mean and entropy functions improved their performance of reactive range and air pollution identification. The reactive range of MEPSI and MEAQI was 1.4–3 times that of the original indices. The MEPSI and MEAQI increased identification from 40 to 180 in index scale and revealed one to two additional categories of public health effect information. In comparison with other indices, MEAQI is more effective for application to pollution events with multiple air pollutants.

http://ift.tt/2qRWyKq

The evaluation model of the enterprise energy efficiency based on DPSR

Abstract

The reasonable evaluation of the enterprise energy efficiency is an important work in order to reduce the energy consumption. In this paper, an effective energy efficiency evaluation index system is proposed based on DPSR (Driving forces-Pressure-State-Response) with the consideration of the actual situation of enterprises. This index system which covers multi-dimensional indexes of the enterprise energy efficiency can reveal the complete causal chain which includes the "driver forces" and "pressure" of the enterprise energy efficiency "state" caused by the internal and external environment, and the ultimate enterprise energy-saving "response" measures. Furthermore, the ANP (Analytic Network Process) and cloud model are used to calculate the weight of each index and evaluate the energy efficiency level. The analysis of BL Company verifies the feasibility of this index system and also provides an effective way to improve the energy efficiency at last.

http://ift.tt/2qgMyxs

Double genetically modified symbiotic system for improved Cu phytostabilization in legume roots

Abstract

Excess copper (Cu) in soils has deleterious effects on plant growth and can pose a risk to human health. In the last decade, legume-rhizobium symbioses became attractive biotechnological tools for metal phytostabilization. For this technique being useful, metal-tolerant symbionts are required, which can be generated through genetic manipulation.

In this work, a double symbiotic system was engineered for Cu phytostabilization: On the one hand, composite Medicago truncatula plants expressing the metallothionein gene mt4a from Arabidopsis thaliana in roots were obtained to improve plant Cu tolerance. On the other hand, a genetically modified Ensifer medicae strain, expressing copper resistance genes copAB from Pseudomonas fluorescens driven by a nodulation promoter, nifHp, was used for plant inoculation. Our results indicated that expression of mt4a in composite plants ameliorated plant growth and nodulation and enhanced Cu tolerance. Lower levels of ROS-scavenging enzymes and of thiobarbituric acid reactive substances (TBARS), such as malondialdehyde (a marker of lipid peroxidation), suggested reduced oxidative stress. Furthermore, inoculation with the genetically modified Ensifer further improved root Cu accumulation without altering metal loading to shoots, leading to diminished values of metal translocation from roots to shoots. The double modified partnership is proposed as a suitable tool for Cu rhizo-phytostabilization.

http://ift.tt/2qRVMNG

Biological control of broad-leaved dock infestation in wheat using plant antagonistic bacteria under field conditions

Abstract

Conventional weed management systems have produced many harmful effects on weed ecology, human health and environment. Biological control of invasive weeds may be helpful to minimize these harmful effects and economic losses incurred to crops by weeds. In our earlier studies, plant antagonistic bacteria were obtained after screening a large number of rhizobacteria for production of phytotoxic substances and effects on wheat and its associated weeds under laboratory conditions. In this study, five efficient strains inhibitory to broad-leaved dock and non-inhibitory to wheat were selected and applied to broad-leaved dock co-seeded with wheat both in pot trial and chronically infested field trial. Effects of plant antagonistic bacteria on the weed and infested wheat were studied at tillering, booting and harvesting stage of wheat. The applied strains significantly inhibited the germination and growth of the weed to variable extent. Similarly, variable recovery in losses of grain and straw yield of infested wheat from 11.6 to 68 and 13 to 72.6% was obtained in pot trial while from 17.3 to 62.9 and 22.4 to 71.3% was obtained in field trial, respectively. Effects of plant antagonistic bacteria were also evident from the improvement in physiology and nutrient contents of infested wheat. This study suggests the use of these plant antagonistic bacteria to biologically control infestation of broad-leaved dock in wheat under field conditions.

http://ift.tt/2qgCbth

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Δευτέρα 8 Μαΐου 2017

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