Physicians Report Barriers to Deliver Best Practice Care for Asplenic Patients: A Cross-Sectional Survey

Background: Current management of asplenic patients is not in compliance with best practice standards, such as defined by the British Committee for Standards in Haematology. To improve quality of care, factors inhibiting best practice care delivery need to be identified first. With this study, we aimed to identify and quantify physicians' barriers to adhere to best practice management of asplenic patients in the Netherlands. Methods and Principal Findings: A cross-sectional survey, preceded by multiple focus group discussions, was performed among Dutch physicians responsible for prevention of infections in asplenic patients, including specialists ( of Internal medicine and Surgery) and general practitioners (GPs). Forty seven GPs and seventy three hospital specialists returned the questionnaire, yielding response rates of 47% and 36,5% respectively. Physicians reported several barriers to deliver best practice. For both GPs and specialists, the most frequently listed barriers were: poor patient knowledge (> 80% of hospital specialists and GPs) and lack of clarity about which physician is responsible for the management of asplenic patients (50% of Internists, 46% of Surgeons, 55% of GPs). Both GPs and hospital specialists expressed to experience a lack of mutual trust: specialists were uncertain whether the GP would follow their advice given on patient discharge (33-59%), whereas half of GPs was not convinced that specialists' discharge letters contained the correct recommendations. Almost all physicians (> 90%) indicated that availability of a national guideline would improve adherence to best practice, especially if accessible online. Conclusion: This study showed that, in accordance with reports on international performance, care delivery for asplenic patients in the Netherlands is suboptimal. We identified and quantified perceived barriers by physicians that prevent adherence to post-splenectomy guidelines for the first time. Better transmural collaboration and better informed patients are likely to improve the quality of care of the asplenic patient population. A national, online-available guideline is urgently require

Diversity, Phylogeny and Expression Patterns of Pou and Six Homeodomain Transcription Factors in Hydrozoan Jellyfish Craspedacusta sowerbyi

Formation of all metazoan bodies is controlled by a group of selector genes including homeobox genes, highly conserved across the entire animal kingdom. The homeobox genes from Pou and Six classes are key members of the regulation cascades determining development of sensory organs, nervous system, gonads and muscles. Besides using common bilaterian models, more attention has recently been targeted at the identification and characterization of these genes within the basal metazoan phyla. Cnidaria as a diploblastic sister group to bilateria with simple and yet specialized organs are suitable models for studies on the sensory organ origin and the associated role of homeobox genes. In this work, Pou and Six homeobox genes, together with a broad range of other sensory-specific transcription factors, were identified in the transcriptome of hydrozoan jellyfish Craspedacusta sowerbyi. Phylogenetic analyses of Pou and Six proteins revealed cnidarian-specific sequence motifs and contributed to the classification of individual factors. The majority of the Craspedacusta sowerbyi Pou and Six homeobox genes are predominantly expressed in statocysts, manubrium and nerve ring, the tissues with sensory and nervous activities. The described diversity and expression patterns of Pou and Six factors in hydrozoan jellyfish highlight their evolutionarily conserved functions. This study extends the knowledge of the cnidarian genome complexity and shows that the transcriptome of hydrozoan jellyfish is generally rich in homeodomain transcription factors employed in the regulation of sensory and nervous functions

Effect of structural changes in proteins derived from GATA4 nonsynonymous single nucleotide polymorphisms in congenital heart disease

Congenital heart disease is the most common type of birth defect. The single nucleotide polymorphism in GATA4 is associated with various congenital heart disease phenotypes. In the present study, we analysed the nonsynonymous single nucleotide polymorphism of GATA4, which are involved in congenital heart disease by predicting the changes in protein structures. Total of 49 nonsynonymous single nucleotide polymorphisms of GATA4 was screened from congenital heart disease patients of Mysore and also globally reported nonsynonymous single nucleotide polymorphisms. To understand the role of nonsynonymous single nucleotide polymorphisms, we mutated the sequence and translated into amino acids. Further the mutated protein secondary structure is predicted and tertiary structure is predicted using homology modeling. The quantitative evaluation of protein structure quality was verified with Volume Area Dihedral Angle Reporter server. Results revealed the secondary, tertiary structural changes along with changes in free energy of folding, volume and accessible surface area. Thus, the structural changes in the mutated proteins impaired the normal function of GATA4

Studies on the Luteolytic, Oestrogenic and Follicle-Stimulating Hormone like activity of Plant Rhaphidophora Pertusa (Roxb.)

The phytochemical, pharmacological and toxicological feature of plant Rhaphidophora pertusa (Roxb.) was done. Phytosteroids, flavonoids, tannins and glucosides were detected in the plant extracts. In cross-bred (Zebu X Holstein-Friesian or Jersey) dairy cows, subsequent to prostaglandin (PG) induced oestrus, to each group (n = 4), cloprostenol (PG control) 100$_{\mu}$ g i.m. on day 10, the rice gruel (vehicle) was fed on day 10 or the fresh stem (1 kg/animal/day) in rice gruel on day 9, or days 9 and 10, or days 9–11 of the oestrous cycle. Each group received subcutaneously either 5% gum acacia suspension or the plant ethyl acetate or methanol extract (1 g in gum acacia) on days 8 (to bannur ewes) or 10 (to dairy cows) of the oestrous cycle. In PG control cows or ewes, there was induction of oestrus in 48 h and a fall in serum progesterone concentration. The feeding of fresh stem in the rice gruel or the s.c. administration of the plant extract did not induce oestrus or significantly (P > 0.05) alter the serum progesterone, bilirubin, calcium, creatinine, phosphorus, magnesium and glucose concentrations or the total erythrocyte and leucocyte count, differential leucocyte count and haemoglobin concentration. The plant did not cause any toxicity in the cow or ewe. In immature rats, the aqueous or methanol (hot or cold) extract did not cause any follicle-stimulating hormone (FSH)-like activity. The methanol extract increased the uterine weight in ovariectomised rats. This suggested the presence of oestrogenic activity in the plant. In conclusion, the present study revealed the presence of oestrogenic activity in the plant and the absence of luteolytic or FSH-like or toxic activity

Structure of the central nervous system of a juvenile acoel, Symsagittifera roscoffensis

The neuroarchitecture of Acoela has been at the center of morphological debates. Some authors, using immunochemical tools, suggest that the nervous system in Acoela is organized as a commissural brain that bears little resemblance to the central, ganglionic type brain of other flatworms, and bilaterians in general. Others, who used histological staining on paraffin sections, conclude that it is a compact structure (an endonal brain; e.g., Raikova 2004; von Graff 1891; Delage Arch Zool Exp Gén 4:109-144, 1886). To address this question with modern tools, we have obtained images from serial transmission electron microscopic sections of the entire hatchling of Symsagittifera roscoffensis. In addition, we obtained data from wholemounts of hatchlings labeled with markers for serotonin and tyrosinated tubulin. Our data show that the central nervous system of a juvenile S. roscoffensis consists of an anterior compact brain, formed by a dense, bilobed mass of neuronal cell bodies surrounding a central neuropile. The neuropile flanks the median statocyst and contains several types of neurites, classified according to their types of synaptic vesicles. The neuropile issues three pairs of nerve cords that run at different dorso-ventral positions along the whole length of the body. Neuronal cell bodies flank the cords, and neuromuscular synapses are abundant. The TEM analysis also reveals different classes of peripheral sensory neurons and provides valuable information about the spatial relationships between neurites and other cell types within the brain and nerve cords. We conclude that the acoel S. roscoffensis has a central brain that is comparable in size and architecture to the brain of other (rhabditophoran) flatworms

Genomic introgression in laboratory evolved hybrid races, Cytorace 1 and Fissioncytorace-1 of Nasuta-albomicans

Nasuta-albomicans complex (NAC) of Drosophila is an artificial hybrid zone comprising of Drosophila nasuta nasuta, Drosophila nasuta albomicans and 16 Cytoraces, which are the evolutionary products of a long range hybridization experiment conducted in the laboratory environment. Occurrence of centric fission in the X3 chromosome of Cytorace 1 led to the derivation of Fissioncytorace-1. Molecular techniques have emerged as powerful and valuable tools for detection and exploitation of genetic polymorphism. In the present study, Cytorace 1 and Fissioncytorace-1 were subjected to Random Amplified Polymorphic DNA (RAPD) and Inter Simple Sequence Repeats (ISSR) analyses to determine the introgression of D. n. nasuta and D. n. albomicans genomes. It was found that Cytorace 1 and Fissioncytorace-1 exhibit similarities in RAPD and ISSR profiles although different combinations of genomic regions could have favoured Fissioncytorace-1, for better morphophenotypes and fitness, when compared to Cytorace 1, which has existed for over 15 years from the time of its evolution in the laboratory environment