Observation of D^{+}→f_{0}(500)e^{+}ν_{e} and Improved Measurements of D→ρe^{+}ν_{e}

Using a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} recorded by the BESIII detector at a center-of-mass energy of 3.773 GeV, we present an analysis of the decays D^{0}→π^{-}π^{0}e^{+}ν_{e} and D^{+}→π^{-}π^{+}e^{+}ν_{e}. By performing a partial wave analysis, the π^{+}π^{-} S-wave contribution to D^{+}→π^{-}π^{+}e^{+}ν_{e} is observed to be (25.7±1.6±1.1)% with a statistical significance greater than 10σ, besides the dominant P-wave contribution. This is the first observation of the S-wave contribution. We measure the branching fractions B(D^{0}→ρ^{-}e^{+}ν_{e})=(1.445±0.058±0.039)×10^{-3}, B(D^{+}→ρ^{0}e^{+}ν_{e})=(1.860±0.070±0.061)×10^{-3}, and B(D^{+}→f_{0}(500)e^{+}ν_{e},f_{0}(500)→π^{+}π^{-})=(6.30±0.43±0.32)×10^{-4}. An upper limit of B(D^{+}→f_{0}(980)e^{+}ν_{e},f_{0}(980)→π^{+}π^{-})<2.8×10^{-5} is set at the 90% confidence level. We also obtain the hadronic form factor ratios of D→ρe^{+}ν_{e} at q^{2}=0 assuming the single-pole dominance parametrization: r_{V}={[V(0)]/[A_{1}(0)]}=1.695±0.083±0.051, r_{2}={[A_{2}(0)]/[A_{1}(0)]}=0.845±0.056±0.039.

Regional trade of medicinal plants has facilitated the retention of traditional knowledge: case study in Gilgit-Baltistan Pakistan

BACKGROUND

The ethnic groups in Gilgit-Baltistan have been utilizing local resources in their centuries-old traditional healing system. Most tribes within these ethnic groups still rely on traditional healing systems. We aim to understand the current status, uses, and abundance of medicinal plants, associated traditional knowledge, and trade.

MATERIALS AND METHODS

The study incorporated over 300 local community members (70% men and 30% women) in focused group discussions, semi-structured interviews, and homework assignments for 8th to 12th grade students to document traditional knowledge (TK) in six districts in Northeast Pakistan. We calculated various indices such as informant consensus factor, use value, relative frequency of citation, and CoKriging. These indices, along with repetitively used medicinal plants, were used to analyze differences in studied locations.

RESULTS

Most of the community members still rely on traditional medication in the study areas. However, we found the highest number of medicinal plants used in Skardu and Gilgit compared to other districts and these two districts also represent trade centers and a highly populated area regarding medicinal plants. Results indicate connection amongst the surveyed villages signifying mixing of knowledge from different sources, with certain areas more influenced by traditional Chinese medicine and others more by Ayurveda and Unani.

CONCLUSION

TK is mostly retained with elder community members; however, those directly linked with market value chain retain rich knowledge on traditional use of the medicinal plants from the region. Major trade centers in the region also coincide with a high density of medicinal plant occurrence, knowledge, and higher utilization. Therefore, with the increasing trade in medicinal plant in the region, there is potential for rejuvenation of this knowledge and of plant use in the region.

Study of the D^{0}→K^{-}μ^{+}ν_{μ} Dynamics and Test of Lepton Flavor Universality with D^{0}→K^{-}ℓ^{+}ν_{ℓ} Decays

Using e^{+}e^{-} annihilation data of 2.93  fb^{-1} collected at center-of-mass energy sqrt[s]=3.773  GeV with the BESIII detector, we measure the absolute branching fraction of D^{0}→K^{-}μ^{+}ν_{μ} with significantly improved precision: B_{D^{0}→K^{-}μ^{+}ν_{μ}}=(3.413±0.019_{stat}±0.035_{syst})%. Combining with our previous measurement of B_{D^{0}→K^{-}e^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{0}→K^{-}μ^{+}ν_{μ}}/B_{D^{0}→K^{-}e^{+}ν_{e}}=0.974±0.007_{stat}±0.012_{syst}, which agrees with the theoretical expectation of lepton flavor universality within the uncertainty. A study of the ratio of the two branching fractions in different four-momentum transfer regions is also performed, and no evidence for lepton flavor universality violation is found with current statistics. Taking inputs from global fit in the standard model and lattice quantum chromodynamics separately, we determine f_{+}^{K}(0)=0.7327±0.0039_{stat}±0.0030_{syst} and |V_{cs}|=0.955±0.005_{stat}±0.004_{syst}±0.024_{LQCD}.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Purple Urine Bag Syndrome in a Patient with an Ileal Conduit and Clostridium Difficile Infection

Purple urine bag syndrome is a potentially alarming phenomenon caused by bacterial metabolism of urinary tryptophan into indigo (blue) and indirubin (red) pigments. We report the case of a 46-year-old female with an ileal conduit who presented with a 2 week history of abdominal pain and purple discolouration of her urine. In addition, we review the literature on purple urine bag syndrome, and identify potential new risk factors and management considerations.

Measurement of the Absolute Branching Fraction of the Inclusive Semileptonic Λ_{c}^{+} Decay

Using a data sample of e^{+}e^{-} collisions corresponding to an integrated luminosity of 567  pb^{-1} collected at a center-of-mass energy of sqrt[s]=4.6  GeV with the BESIII detector, we measure the absolute branching fraction of the inclusive semileptonic Λ_{c}^{+} decay with a double-tag method. We obtain B(Λ_{c}^{+}→Xe^{+}ν_{e})=(3.95±0.34±0.09)%, where the first uncertainty is statistical and the second systematic. Using the known Λ_{c}^{+} lifetime and the charge-averaged semileptonic decay width of nonstrange charmed mesons (D^{0} and D^{+}), we obtain the ratio of the inclusive semileptonic decay widths Γ(Λ_{c}^{+}→Xe^{+}ν_{e})/Γ[over ¯](D→Xe^{+}ν_{e})=1.26±0.12.

Measurement of the Branching Fraction For the Semileptonic Decay D^{0(+)}→π^{-(0)}μ^{+}ν_{μ} and Test of Lepton Flavor Universality

Using a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} taken at a center-of-mass energy of 3.773 GeV with the BESIII detector operated at the BEPCII collider, we perform an analysis of the semileptonic decays D^{0(+)}→π^{-(0)}μ^{+}ν_{μ}. The branching fractions of D^{0}→π^{-}μ^{+}ν_{μ} and D^{+}→π^{0}μ^{+}ν_{μ} are measured to be (0.272±0.008_{stat}±0.006_{syst})% and (0.350±0.011_{stat}±0.010_{syst})%, respectively, where the former is of much improved precision compared to previous results and the latter is determined for the first time. Using these results along with previous BESIII measurements of D^{0(+)}→π^{-(0)}e^{+}ν_{e}, we calculate the branching fraction ratios to be R^{0}≡B_{D^{0}→π^{-}μ^{+}ν_{μ}}/B_{D^{0}→π^{-}e^{+}ν_{e}}=0.922±0.030_{stat}±0.022_{syst} and R^{+}≡B_{D^{+}→π^{0}μ^{+}ν_{μ}}/B_{D^{+}→π^{0}e^{+}ν_{e}}=0.964±0.037_{stat}±0.026_{syst}, which are compatible with the theoretical expectation of lepton flavor universality within 1.7σ and 0.5σ, respectively. We also examine the branching fraction ratios in different four-momentum transfer square regions, and find no significant deviations from the standard model predictions.

Observation of the Semileptonic Decay D^{0}→a_{0}(980)^{-}e^{+}ν_{e} and Evidence for D^{+}→a_{0}(980)^{0}e^{+}ν_{e}

Using an e^{+}e^{-} collision data sample of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV by the BESIII detector at BEPCII, we report the observation of D^{0}→a_{0}(980)^{-}e^{+}ν_{e} and evidence for D^{+}→a_{0}(980)^{0}e^{+}ν_{e} with significances of 6.4σ and 2.9σ, respectively. The absolute branching fractions are determined to be B(D^{0}→a_{0}(980)^{-}e^{+}ν_{e})×B(a_{0}(980)^{-}→ηπ^{-})=[1.33_{-0.29}^{+0.33}(stat)±0.09(syst)]×10^{-4} and B(D^{+}→a_{0}(980)^{0}e^{+}ν_{e})×B(a_{0}(980)^{0}→ηπ^{0})=[1.66_{-0.66}^{+0.81}(stat)±0.11(syst)]×10^{-4}. This is the first time the a_{0}(980) meson has been measured in a D^{0} semileptonic decay, which would open one more interesting page in the investigation of the nature of the puzzling a_{0}(980) states.

Measurement of the Absolute Branching Fraction of the Inclusive Decay Λ_{c}^{+}→Λ+X

Based on an e^{+}e^{-} collision data sample corresponding to an integrated luminosity of 567  pb^{-1} taken at the center-of-mass energy of sqrt[s]=4.6  GeV with the BESIII detector, we measure the absolute branching fraction of the inclusive decay Λ_{c}^{+}→Λ+X to be B(Λ_{c}^{+}→Λ+X)=(38.2_{-2.2}^{+2.8}±0.9)% using the double-tag method, where X refers to any possible final state particles. In addition, we search for direct CP violation in the charge asymmetry of this inclusive decay for the first time, and obtain A_{CP}≡[B(Λ_{c}^{+}→Λ+X)-B(Λ[over ¯]_{c}^{-}→Λ[over ¯]+X)]/[B(Λ_{c}^{+}→Λ+X)+B(Λ[over ¯]_{c}^{-}→Λ[over ¯]+X)]=(2.1_{-6.6}^{+7.0}±1.6)%, a statistically limited result with no evidence of CP violation.

Observation of a_{0}^{0}(980)-f_{0}(980) Mixing

We report the first observation of a_{0}^{0}(980)-f_{0}(980) mixing in the decays of J/ψ→ϕf_{0}(980)→ϕa_{0}^{0}(980)→ϕηπ^{0} and χ_{c1}→a_{0}^{0}(980)π^{0}→f_{0}(980)π^{0}→π^{+}π^{-}π^{0}, using data samples of 1.31×10^{9}  J/ψ events and 4.48×10^{8}  ψ(3686) events accumulated with the BESIII detector. The signals of f_{0}(980)→a_{0}^{0}(980) and a_{0}^{0}(980)→f_{0}(980) mixing are observed at levels of statistical significance of 7.4σ and 5.5σ, respectively. The corresponding branching fractions and mixing intensities are measured and the constraint regions on the coupling constants, g_{a_{0}K^{+}K^{-}} and g_{f_{0}K^{+}K^{-}}, are estimated. The results improve the understanding of the nature of a_{0}^{0}(980) and f_{0}(980).

Precision Measurement of the e^{+}e^{-}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} Cross Section Near Threshold

The cross section of the e^{+}e^{-}→Λ_{c}^{+}Λ[over ¯]_{c}^{-} process is measured with unprecedented precision using data collected with the BESIII detector at sqrt[s]=4574.5, 4580.0, 4590.0 and 4599.5 MeV. The nonzero cross section near the Λ_{c}^{+}Λ[over ¯]_{c}^{-} production threshold is cleared. At center-of-mass energies sqrt[s]=4574.5 and 4599.5 MeV, the higher statistics data enable us to measure the Λ_{c} polar angle distributions. From these, the Λ_{c} electric over magnetic form-factor ratios (|G_{E}/G_{M}|) are measured for the first time. They are found to be 1.14±0.14±0.07 and 1.23±0.05±0.03, respectively, where the first uncertainties are statistical and the second are systematic.

Atypical Presentation of Escherichia coli Monomicrobial Necrotizing Fasciitis in a Renal Transplant Patient: A Case Report

Skin and soft tissue infections (SSTIs) are one of most frequent infectious causes for referral to the emergency department and one of the most frequent infectious causes of hospital admissions. Escherichia coli, the most commonly occurring gram-negative pathogen involved in these infections, contributes to about 7% of all SSTIs cases where gram-positive organisms reign dominant. Patients are more susceptible to these gram-negative SSTIs if they are neutropenic, have hematologic malignancies, have undergone solid organ or hematopoietic transplantation, or have cirrhotic liver disease. Due to their immunocompromised state, the prognosis is very poor and not well understood. We report a case of an atypical presentation of an E coli monomicrobial necrotizing fasciitis in a renal transplant patient. Our findings support improved mortality with rapid aggressive interventions, such as amputation, in immunocompromised patients.

A large-scale study of a poultry trading network in Bangladesh: implications for control and surveillance of avian influenza viruses

BACKGROUND

Since its first report in 2007, avian influenza (AI) has been endemic in Bangladesh. While live poultry marketing is widespread throughout the country and known to influence AI dissemination and persistence, trading patterns have not been described. The aim of this study is to assess poultry trading practices and features of the poultry trading networks which could promote AI spread, and their potential implications for disease control and surveillance. Data on poultry trading practices was collected from 849 poultry traders during a cross-sectional survey in 138 live bird markets (LBMs) across 17 different districts of Bangladesh. The quantity and origins of traded poultry were assessed for each poultry type in surveyed LBMs. The network of contacts between farms and LBMs resulting from commercial movements of live poultry was constructed to assess its connectivity and to identify the key premises influencing it.

RESULTS

Poultry trading practices varied according to the size of the LBMs and to the type of poultry traded. Industrial broiler chickens, the most commonly traded poultry, were generally sold in LBMs close to their production areas, whereas ducks and backyard chickens were moved over longer distances, and their transport involved several intermediates. The poultry trading network composed of 445 nodes (73.2% were LBMs) was highly connected and disassortative. However, the removal of only 5.6% of the nodes (25 LBMs with the highest betweenness scores), reduced the network's connectedness, and the maximum size of output and input domains by more than 50%.

CONCLUSIONS

Poultry types need to be discriminated in order to understand the way in which poultry trading networks are shaped, and the level of risk of disease spread that these networks may promote. Knowledge of the network structure could be used to target control and surveillance interventions to a small number of LBMs.

Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis

BACKGROUND

The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.

METHODS

We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.

RESULTS

We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.

CONCLUSIONS

AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.

The variability in Oxford hip and knee scores in the preoperative period: is there an ideal time to score?

Background All NHS-funded providers are required to collect and report patient-reported outcome measures for hip and knee arthroplasty. Although there are established guidelines for timing such measures following arthroplasty, there are no specific time-points for collection in the preoperative period. The primary aim of this study was to identify whether there was a significant amount of variability in the Oxford hip and knee scores prior to surgical intervention when completed in the outpatient clinic at the time of listing for arthroplasty or when completed at the preoperative assessment clinic. Methods A prospective cohort study of patients listed for primary hip or knee arthroplasty was conducted. Patients were asked to fill in a preoperative Oxford score in the outpatient clinic at the time of listing. They were then invited to fill in the official outcome measures questionnaire at the preoperative assessment clinic. The postoperative Oxford score was then completed when the patient was seen again at their postoperative follow up in clinic. Results Of the total of 109 patients included in this study period, there were 18 (17%) who had a worse score of 4 or more points difference and 43 (39.4%) who had an improvement of 4 or more points difference when the scores were compared between time of listing at the outpatient and at the preoperative assessment clinic. There was a statistically significant difference (P = 0.0054) in the mean Oxford scores. Conclusions The results of our study suggest that there should be standardisation of timing for completing the preoperative patient-reported outcome measures.

Heterocyclic boronic acids display sialic acid selective binding in a hypoxic tumor relevant acidic environment

A group of heterocyclic boronic acids demonstrating unusually high affinity and selectivity for sialic acids are described, with strong interactions under the weakly acidic pH conditions associated with a hypoxic tumoral microenvironment.

Boronic acids are well known for their ability to reversibly interact with the diol groups found in sugars and glycoproteins. However, they are generally indiscriminate in their binding. Herein we describe the discovery of a group of heterocyclic boronic acids demonstrating unusually high affinity and selectivity for sialic acids (SAs or N-acetylneuraminic acid), which are sugar residues that are intimately linked with tumor growth and cancer progression. Remarkably, these interactions strengthen under the weakly acidic pH conditions associated with a hypoxic tumoral microenvironment. In vitro competitive binding assays uncovered a significantly higher ability of 5-boronopicolinic acid, one of the derivatives identified in this work as a strong SA-binder, to interact with cell surface SA in comparison to a gold-standard structure, 3-propionamidophenylboronic acid, which has proven to be an efficient SA-binder in numerous reports. This structure also proved to be suitable for further chemical conjugation with a well-preserved SA-binding capability. These findings suggest an attractive alternative to other ongoing boronic acid based chemistry techniques aiming to achieve tumor-specific chemotherapies and diagnoses.

A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures

Aims

The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.

Materials and Methods

A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database.

Results

A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation.

Conclusion

A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures. Cite this article: Bone Joint J 2017;99-B(4 Supple B):17–25.