New term in effective field theory at fixed topology

A random matrix model for lattice QCD which takes into account the positive definite nature of the Wilson term is introduced. The corresponding effective theory for fixed index of the Wilson Dirac operator is derived to next to leading order. It reveals a new term proportional to the topological index of the Wilson Dirac operator and the lattice spacing. The new term appears naturally in a fixed index spurion analysis. The spurion approach reveals that the term is the first in a new family of such terms and that equivalent terms are relevant for the effective theory of continuum QCD.Comment: 22 pages, 2 figures, version to appear in PR

Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers

Peptic ulcer predicts gastric cancer. It is controversial if peptic ulcers predict other gastrointestinal cancers, potentially related to Helicobacter pylori or shared lifestyle factors. We hypothesized that gastric and duodenal ulcers may have different impact on the risk of gastrointestinal cancers. In a nationwide cohort study using Danish medical databases 1994-2013, we quantified the risk of gastric and other gastrointestinal cancers among patients with duodenal ulcers (dominantly H. pylori-related) and gastric ulcers (dominantly lifestyle-related) compared with the general population. We started follow-up 1-year after ulcer diagnosis to avoid detection bias and calculated absolute risks of cancer and standardized incidence ratios (SIRs). We identified 54,565 patients with gastric ulcers and 38,576 patients with duodenal ulcers. Patient characteristics were similar in the two cohorts. The 1-5-year risk of any gastrointestinal cancer was slightly higher for gastric ulcers patients (2.1%) than for duodenal ulcers patients (2.0%), and SIRs were 1.38 (95% CI: 1.31-1.44) and 1.30 (95% CI: 1.23-1.37), respectively. The SIR of gastric cancer was higher among patients with gastric ulcer than duodenal ulcer (1.92 vs. 1.38), while the SIRs for other gastrointestinal cancers were similar (1.33 vs. 1.29). Compared with gastric ulcer patients, duodenal ulcer patients were at lower risk of smoking- and alcohol-related gastrointestinal cancers. The risk of nongastric gastrointestinal cancers is increased both for patients with gastric ulcers and with duodenal ulcers, but absolute risks are low. H. pylori may be less important for the development of nongastric gastrointestinal cancer than hypothesized

Discerning the role of polymicrobial biofilms in the ascent, prevalence, and extent of heteroresistance in clinical practice

Antimicrobial therapy is facing a worrisome and underappreciated challenge, the phenomenon of heteroresistance (HR). HR has been gradually documented in clinically relevant pathogens (e.g. Pseudomonas aeruginosa, Staphylococcus aureus, Burkholderia spp., Acinetobacter baumannii, Klebsiella pneumoniae, Candida spp.) towards several drugs and is believed to complicate the clinical picture of chronic infections. This type of infections are typically mediated by polymicrobial biofilms, wherein microorganisms inherently display a wide range of physiological states, distinct metabolic pathways, diverging refractory levels of stress responses, and a complex network of chemical signals exchange. This review aims to provide an overview on the relevance, prevalence, and implications of HR in clinical settings. Firstly, related terminologies (e.g. resistance, tolerance, persistence), sometimes misunderstood and overlapped, were clarified. Factors generating misleading HR definitions were also uncovered. Secondly, the recent HR incidences reported in clinically relevant pathogens towards different antimicrobials were annotated. The potential mechanisms underlying such occurrences were further elucidated. Finally, the link between HR and biofilms was discussed. The focus was to recognize the presence of heterogeneous levels of resistance within most biofilms, as well as the relevance of polymicrobial biofilms in chronic infectious diseases and their role in resistance spreading. These topics were subject of a critical appraisal, gaining insights into the ascending clinical implications of HR in antimicrobial resistance spreading, which could ultimately help designing effective therapeutic options.This work was supported by the Portuguese Foundation for Science Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2020 unit BioTecNorte operation [NORTE-01-0145-FEDER-000004] funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The authors also acknowledge COMPETE2020 FCT for the project POCI-01-0145-FEDER-029,841 and for the Scientific Employment Stimulus 2017 grant [CEECIND/01507/2017] (A. M. Sousa).info:eu-repo/semantics/publishedVersio

Short-term effects of implemented high intensity shoulder elevation during computer work

BACKGROUND: Work-site strength training sessions are shown effective to prevent and reduce neck-shoulder pain in computer workers, but difficult to integrate in normal working routines. A solution for avoiding neck-shoulder pain during computer work may be to implement high intensity voluntary contractions during the computer work. However, it is unknown how this may influence productivity, rate of perceived exertion (RPE) as well as activity and rest of neck-shoulder muscles during computer work. The aim of this study was to investigate short-term effects of a high intensity contraction on productivity, RPE and upper trapezius activity and rest during computer work and a subsequent pause from computer work. METHODS: 18 female computer workers performed 2 sessions of 15 min standardized computer mouse work preceded by 1 min pause with and without prior high intensity contraction of shoulder elevation. RPE was reported, productivity (drawings per min) measured, and bipolar surface electromyography (EMG) recorded from the dominant upper trapezius during pauses and sessions of computer work. Repeated measure ANOVA with Bonferroni corrected post-hoc tests was applied for the statistical analyses. RESULTS: The main findings were that a high intensity shoulder elevation did not modify RPE, productivity or EMG activity of the upper trapezius during the subsequent pause and computer work. However, the high intensity contraction reduced the relative rest time of the uppermost (clavicular) trapezius part during the subsequent pause from computer work (p < 0.04). CONCLUSION: Since a preceding high intensity shoulder elevation did not impose a negative impact on perceived effort, productivity or upper trapezius activity during computer work, implementation of high intensity contraction during computer work to prevent neck-shoulder pain may be possible without affecting the working routines. However, the unexpected reduction in clavicular trapezius rest during a pause with preceding high intensity contraction requires further investigation before high intensity shoulder elevations can be recommended as an integrated part of computer work

Tissue doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy

AbstractObjectivesWe sought to evaluate the long-term impact of cardiac resynchronization therapy (CRT) on left ventricular (LV) performance and remodeling using three-dimensional echocardiography and tissue Doppler imaging (TDI).BackgroundThree-dimensional echocardiography and TDI allow rapid and accurate evaluation of LV volumes and performance.MethodsTwenty-five consecutive patients with severe heart failure and bundle branch block who underwent biventricular pacemaker implantation were included. Before and after implantation of the pacemaker, three-dimensional echocardiography and TDI were performed. These examinations were repeated at outpatient visits every six months.ResultsFive patients (20%) died during one-year follow-up. In the remaining 20 patients, significant reductions in LV end-diastolic volume and LV end-systolic volume of 9.6 ± 14% and 16.5 ± 15%, respectively (p < 0.01), could be demonstrated during long-term follow-up. Accordingly, LV ejection fraction increased by 21.7 ± 18% (p < 0.01). According to a newly developed TDI technique—tissue tracking—all regional myocardial segments improved their longitudinal systolic shortening (p < 0.01). The extent of the LV base displaying delayed longitudinal contraction, as detected by TDI before pacemaker implantation, predicted long-term efficacy of CRT. The QRS duration failed to predict resynchronization efficacy.ConclusionsCardiac resynchronization significantly improved LV function and reversed LV remodeling during long-term follow-up. Patients likely to benefit from CRT can be identified by TDI before implantation of a biventricular pacemaker

Climate and site management as driving factors for the atmospheric greenhouse gas exchange of a restored wetland

The atmospheric greenhouse gas (GHG) budget of a restored wetland in western Denmark was established for the years 2009–2011 from eddy covariance measurements of carbon dioxide (CO&lt;sub&gt;2&lt;/sub&gt;) and methane (CH&lt;sub&gt;4&lt;/sub&gt;) fluxes. The water table in the wetland, which was restored in 2002, was unregulated, and the vegetation height was limited through occasional grazing by cattle and grass cutting. The annual net CO&lt;sub&gt;2&lt;/sub&gt; uptake varied between 195 and 983 g m&lt;sup&gt;−2&lt;/sup&gt; and the annual net CH&lt;sub&gt;4&lt;/sub&gt; release varied between 11 and 17 g m&lt;sup&gt;−2&lt;/sup&gt;. In all three years the wetland was a carbon sink and removed between 42 and 259 g C m&lt;sup&gt;−2&lt;/sup&gt; from the atmosphere. However, in terms of the full annual GHG budget (assuming that 1 g CH&lt;sub&gt;4&lt;/sub&gt; is equivalent to 25 g CO&lt;sub&gt;2&lt;/sub&gt; with respect to the greenhouse effect over a time horizon of 100 years) the wetland was a sink in 2009, a source in 2010 and neutral in 2011. Complementary observations of meteorological factors and management activities were used to explain the large inter-annual variations in the full atmospheric GHG budget of the wetland. The largest impact on the annual GHG fluxes, eventually defining their sign, came from site management through changes in grazing duration and animal stocking density. These changes accounted for half of the observed variability in the CO&lt;sub&gt;2&lt;/sub&gt; fluxes and about two thirds of the variability in CH&lt;sub&gt;4&lt;/sub&gt; fluxes. An unusually long period of snow cover in 2010 had the second largest effect on the annual CO&lt;sub&gt;2&lt;/sub&gt; flux, whose interannual variability was larger than that of the CH&lt;sub&gt;4&lt;/sub&gt; flux. Since integrated CO&lt;sub&gt;2&lt;/sub&gt; and CH&lt;sub&gt;4&lt;/sub&gt; flux data from restored wetlands are still very rare, it is concluded that more long-term flux measurements are needed to quantify the effects of ecosystem disturbance, in terms of management activities and exceptional weather patterns, on the atmospheric GHG budget more accurately

A rare Danish case of Yersinia pseudotuberculosis pyogenic liver abscess

Abstract Yersinia pseudotuberculosis is a rare Gram‐negative bacillus that cause enterocolitis and terminal ileitis. We report the first Danish case with Y. pseudotuberculosis multiple pyogenic liver abscess presenting with 6 weeks intermittently fever, fatigue, and weight loss. The patient was successfully treated with percutaneous drainage and intravenous piperacillin/tazobactam and oral ciprofloxacin