444 research outputs found

    A Rare Case of Cholecystitis Caused by Raoultella planticola

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    A 62-year-old female presented with right upper quadrant pain. Clinical examination and ultrasound scan were consistent with gallstones and acute cholecystitis. She received 3 days of intravenous Co-amoxiclav and was discharged with 5-days of oral antibiotics with arrangements to return for an elective cholecystectomy. This was performed 5 months later which revealed an inflamed gallbladder and a localised abscess secondary to gallbladder perforation. Fluid from the gallbladder was taken which cultured Raoultella planticola, a gram-negative, nonmotile environmental bacteria (Bagley et al. (1981)). This is the first report of biliary sepsis with a primary infection by R. planticola. This patient was treated with a 5-day course of oral Co-amoxiclav and made a full recovery

    Spatial fuzzy c-means thresholding for semiautomated calculation of percentage lung ventilated volume from hyperpolarized gas and (1) H MRI

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    Purpose To develop an image-processing pipeline for semiautomated (SA) and reproducible analysis of hyperpolarized gas lung ventilation and proton anatomical magnetic resonance imaging (MRI) scan pairs. To compare results from the software for total lung volume (TLV), ventilated volume (VV), and percentage lung ventilated volume (%VV) calculation to the current manual “basic” method and a K-means segmentation method. Materials and Methods Six patients were imaged with hyperpolarized 3He and same-breath lung 1H MRI at 1.5T and six other patients were scanned with hyperpolarized 129Xe and separate-breath 1H MRI. One expert observer and two users with experience in lung image segmentation carried out the image analysis. Spearman (R), Intraclass (ICC) correlations, Bland–Altman limits of agreement (LOA), and Dice Similarity Coefficients (DSC) between output lung volumes were calculated. Results When comparing values of %VV, agreement between observers improved using the SA method (mean; R = 0.984, ICC = 0.980, LOA = 7.5%) when compared to the basic method (mean; R = 0.863, ICC = 0.873, LOA = 14.2%) nonsignificantly (pR = 0.25, pICC = 0.25, and pLOA = 0.50 respectively). DSC of VV and TLV masks significantly improved (P < 0.01) using the SA method (mean; DSCVV = 0.973, DSCTLV = 0.980) when compared to the basic method (mean; DSCVV = 0.947, DSCTLV = 0.957). K-means systematically overestimated %VV when compared to both basic (mean overestimation = 5.0%) and SA methods (mean overestimation = 9.7%), and had poor agreement with the other methods (mean ICC; K-means vs. basic = 0.685, K-means vs. SA = 0.740). Conclusion A semiautomated image processing software was developed that improves interobserver agreement and correlation of lung ventilation volume percentage when compared to the currently used basic method and provides more consistent segmentations than the K-means method. Level of Evidence: 3 Technical Efficacy: Stage

    Surveying the Dynamic Radio Sky with the Long Wavelength Demonstrator Array

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    This paper presents a search for radio transients at a frequency of 73.8 MHz (4 m wavelength) using the all-sky imaging capabilities of the Long Wavelength Demonstrator Array (LWDA). The LWDA was a 16-dipole phased array telescope, located on the site of the Very Large Array in New Mexico. The field of view of the individual dipoles was essentially the entire sky, and the number of dipoles was sufficiently small that a simple software correlator could be used to make all-sky images. From 2006 October to 2007 February, we conducted an all-sky transient search program, acquiring a total of 106 hr of data; the time sampling varied, being 5 minutes at the start of the program and improving to 2 minutes by the end of the program. We were able to detect solar flares, and in a special-purpose mode, radio reflections from ionized meteor trails during the 2006 Leonid meteor shower. We detected no transients originating outside of the solar system above a flux density limit of 500 Jy, equivalent to a limit of no more than about 10^{-2} events/yr/deg^2, having a pulse energy density >~ 1.5 x 10^{-20} J/m^2/Hz at 73.8 MHz for pulse widths of about 300 s. This event rate is comparable to that determined from previous all-sky transient searches, but at a lower frequency than most previous all-sky searches. We believe that the LWDA illustrates how an all-sky imaging mode could be a useful operational model for low-frequency instruments such as the Low Frequency Array, the Long Wavelength Array station, the low-frequency component of the Square Kilometre Array, and potentially the Lunar Radio Array.Comment: 20 pages; accepted for publication in A

    Nitrous Oxide Dynamics in the Siberian Arctic Ocean and Vulnerability to Climate Change

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    Nitrous oxide (N2O) is a strong greenhouse gas and stratospheric ozone-depleting substance. Around 20% of global emissions stem from the ocean, but current estimates and future projections are uncertain due to poor spatial coverage over large areas and limited understanding of drivers of N2O dynamics. Here, we focus on the extensive and particularly data-lean Arctic Ocean shelves north of Siberia that experience rapid warming and increasing input of land-derived nitrogen with permafrost thaw. We combine water column N2O measurements from two expeditions with on-board incubation of intact sediment cores to assess N2O dynamics and the impact of land-derived nitrogen. Elevated nitrogen concentrations in water column and sediments were observed near large river mouths. Concentrations of N2O were only weakly correlated with dissolved nitrogen and turbidity, reflecting particulate matter from rivers and coastal erosion, and correlations varied between river plumes. Surface water N2O concentrations were on average close to equilibrium with the atmosphere, but varied widely (N2O saturation 38%–180%), indicating strong local N2O sources and sinks. Water column N2O profiles and low sediment-water N2O fluxes do not support strong sedimentary sources or sinks. We suggest that N2O dynamics in the region are influenced by water column N2O consumption under aerobic conditions or in anoxic microsites of particles, and possibly also by water column N2O production. Changes in biogeochemical and physical conditions will likely alter N2O dynamics in the Siberian Arctic Ocean over the coming decades, in addition to reduced N2O solubility in a warmer ocean.publishedVersio

    A Compensatory Mutation Provides Resistance to Disparate HIV Fusion Inhibitor Peptides and Enhances Membrane Fusion

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    Fusion inhibitors are a class of antiretroviral drugs used to prevent entry of HIV into host cells. Many of the fusion inhibitors being developed, including the drug enfuvirtide, are peptides designed to competitively inhibit the viral fusion protein gp41. With the emergence of drug resistance, there is an increased need for effective and unique alternatives within this class of antivirals. One such alternative is a class of cyclic, cationic, antimicrobial peptides known as θ-defensins, which are produced by many non-human primates and exhibit broad-spectrum antiviral and antibacterial activity. Currently, the θ-defensin analog RC-101 is being developed as a microbicide due to its specific antiviral activity, lack of toxicity to cells and tissues, and safety in animals. Understanding potential RC-101 resistance, and how resistance to other fusion inhibitors affects RC-101 susceptibility, is critical for future development. In previous studies, we identified a mutant, R5-tropic virus that had evolved partial resistance to RC-101 during in vitro selection. Here, we report that a secondary mutation in gp41 was found to restore replicative fitness, membrane fusion, and the rate of viral entry, which were compromised by an initial mutation providing partial RC-101 resistance. Interestingly, we show that RC-101 is effective against two enfuvirtide-resistant mutants, demonstrating the clinical importance of RC-101 as a unique fusion inhibitor. These findings both expand our understanding of HIV drug-resistance to diverse peptide fusion inhibitors and emphasize the significance of compensatory gp41 mutations. © 2013 Wood et al

    Optical Spectroscopy of Supernova 1993J During Its First 2500 Days

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    We present 42 low-resolution spectra of Supernova (SN) 1993J, our complete collection from the Lick and Keck Observatories, from day 3 after explosion to day 2454, as well as one Keck high-dispersion spectrum from day 383. SN 1993J began as an apparent SN II, albeit an unusual one. After a few weeks, a dramatic transition took place, as prominent helium lines emerged in the spectrum. SN 1993J had metamorphosed from a SN II to a SN IIb. Nebular spectra of SN 1993J closely resemble those of SNe Ib and Ic, but with a persistent H_alpha line. At very late times, the H_alpha emission line dominated the spectrum, but with an unusual, box-like profile. This is interpreted as an indication of circumstellar interaction.Comment: 19 pages plus 13 figures, AASTeX V5.0. One external table in AASTeX V4.0, in landscape format. Accepted for publication in A

    Folic acid to reduce neonatal mortality from neural tube disorders

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    Background Neural tube defects (NTDs) remain an important, preventable cause of mortality and morbidity. High-income countries have reported large reductions in NTDs associated with folic acid supplementation or fortification. The burden of NTDs in low-income countries and the effectiveness of folic acid fortification/supplementation are unclear

    Preconception care of women with diabetes: a review of current guideline recommendations

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    <p>Abstract</p> <p>Background</p> <p>The prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy.</p> <p>Methods</p> <p>Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted.</p> <p>Results</p> <p>All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy.</p> <p>Conclusions</p> <p>International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting.</p
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