bluuebunny/crossref_metadata_2025 huggingface dataset:
Families First? The Mobilization of Family Norms in Refugee Resettlement
Authors: Welfens Natalie , Bonjour Saskia
Published: November 2020

European resettlement programs prioritize the admission of refugee families. While this is seen as the “natural” thing to do, we argue that the mobilization of family norms is crucially political: in everyday bordering practices, interpretations of family norms are decisive for who is admitted to Europe. We study the selection of Syrian refugees in Turkey for humanitarian admission to Germany, which involves national governments, UNHCR, and NGOs. Fusing practice-theoretical approaches to humanitarianism and mobility governance on the one hand, with gender and sexuality scholarship on nationalism, empire, and migration on the other, we show how family norms configure discretionary power in transnational migration governance. First, family norms shape how power is exercised over refugees in vulnerability and assimilability assessments. Vulnerability assessments hinge on whether a family counts as protective and supportive, or deficient and threatening. Assimilability assessments scrutinize whether refugees do family “right”: in a way that will not disturb resettlement countries’ national (gender) order. Second, the mobilization of family norms reflects power disparities between actors. International and non-governmental actors strive to recognize plural family forms, but are disciplined into applying resettlement states’ more constraining family norms, thereby participating in the (re)production of the borders and boundaries of Europe.
Characterization of the novel OXA-213-like β-lactamase OXA-822 from Acinetobacter calcoaceticus
Authors: Tietgen Manuela , Leukert Laura , Sommer Julian , Kramer Jan S , Brunst Steffen , Wittig Ilka , Proschak Ewgenij , Göttig Stephan
Published: November 2020

Objectives

This study analysed the novel carbapenem-hydrolysing class D β-lactamase OXA-822 identified in the clinical Acinetobacter calcoaceticus isolate AC_2117.

Methods

WGS was employed for identification of β-lactamases. Micro-broth dilution was used for evaluation of antibiotic susceptibility of AC_2117 and transformants containing blaOXA-822. After heterologous purification of OXA-822, OXA-359 and OXA-213, enzyme kinetics were determined using spectrometry. The effect of OXA-822 upon meropenem treatment was analysed in the Galleria mellonella in vivo infection model.

Results

OXA-822 is a member of the intrinsic OXA-213-like family found in A. calcoaceticus and Acinetobacter pittii. Amino acid sequence similarity to the nearest related OXA-359 was 97%. Production of OXA-822, OXA-359 and OXA-213 in Acinetobacter baumannii ATCC® 19606T resulted in elevated MICs for carbapenems (up to 16-fold). Penicillinase activity of the purified OXA-822 revealed high KM values, in the millimolar range, combined with high turnover numbers. OXA-822 showed the highest affinity to carbapenems, but affinity to imipenem was ∼10-fold lower compared with other carbapenems. Molecular modelling revealed that imipenem does not interact with a negatively charged side chain of OXA-822, as doripenem does, leading to the lower affinity. Presence of OXA-822 decreased survival of infected Galleria mellonella larvae after treatment with meropenem. Only 52.7% ± 7.7% of the larvae survived after 24 h compared with 90.9% ± 3.7% survival in the control group.

Conclusions

The novel OXA-822 from a clinical A. calcoaceticus isolate displayed penicillinase and carbapenemase activity in vitro, elevated MICs in different species and decreased carbapenem susceptibility in A. baumannii in vivo.
The Potential of Systemic Control of Sand Flies Using Fipronil in the Novel Leishmania major (Kinetoplastida: Trypanosomatidae) Reservoirs Meriones tristrami (Rodentia: Muridea) and Meriones crassus (Rodentia: Muridea)
Authors: Tsurim Ido , Wasserberg Gideon , Ben Natan Gil , Abramsky Zvika
Published: November 2020

Leishmania major (Yakimoff & Schokhor, 1914), an important causative agent of Old World Cutaneous Leishmaniasis (CL), is transmitted by sand flies among a limited number of gerbilline reservoir-species. We can take advantage of this strong dependency to break the pathogen transmission cycle by using systemic insecticides that render the host toxic to the blood-feeding vector. We evaluated the potential of this approach with two novel reservoir species, incriminated for CL expansion in several sites in the Middle East. Specifically, we evaluated: 1) the residuality of the systemic insecticide fipronil in Meriones tristrami (Thomas, 1892) fed on fipronil-treated baits and 2) the treatments’ adulticide effect on sand flies that blood fed on treated and untreated M. tristrami and M. crassus (Sundevall, 1842). We fed M. tristrami with food pellets containing 0.1 g/kg fipronil and used gas chromatograph–mass spectrometery analysis and bioassays to examine its residual toxicity to blood-feeding female sand flies. In M. tristrami, fipronil was rapidly metabolized to fipronil sulfone, found in the blood, urine, and feces for ≥31 d after fipronil admission. The survival of sand flies that blood fed on fipronil-treated M. tristrami and M. crassus was significantly reduced for at least 15 and 9 d respectively, after fipronil admission. These results hold promise for the potential contribution of systemic control approaches to CL integrated management strategies against novel CL (due to L. major) outbreaks in Israel and elsewhere.
Systemic Control of Cutaneous Leishmaniasis Sand-Fly Vectors: Fipronil-Treated Rodent Bait Is Effective in Reducing Phlebotomus papatasi (Diptera: Psychodidae) Female Emergence Rate From Rodent Burrows
Authors: Tsurim Ido , Wasserberg Gideon , Ben Natan Gil , Abramsky Zvika
Published: November 2020

The strong dependency of some vectors on their host as a source of habitat can be viewed as a weak link in pathogen’s transmission cycles using the vertebrate host as a ‘Trojan horse’ to deliver insecticides directly to the vector-host point of contact (hereafter ‘systemic control’). This could, simultaneously, affect the survival of blood-feeding females and coprophagic larvae. Sand-flies, vectors of leishmaniasis worldwide, are often dependent on their bloodmeal host as a source of habitat and may therefore be good candidates for systemic control. In the present study, we field-tested this methodology by baiting Meriones crassus (Sundevall, 1842) (Rodentia:Muridea) with Fipronil-treated food pellets and evaluated its effect on reducing sand-fly emergence rate, in general, and of that of blood-fed females, in particular. We demonstrated 86% reduction in the abundance of female sand-flies that exit burrows of Fipronil-treated jirds, whereas male abundance was unaffected. Furthermore, whereas in control burrows 20% of the females were blood-fed, in treatment burrows no blood-fed females were detected. Sand-fly abundance outside the burrows was not affected by burrow treatment. This highlights the focal specificity of this method: affecting female sand-flies that feed on the reservoir host. This should result in the reduction of the pathogen transmission rate in the vicinity of the treated area by reducing the prevalence of leishmania-infected sand-fly females. These results hold promise for the potential of the systemic control approach in this system. Our next-step goal is to test this methodology at a large-scale cutaneous leishmaniasis control program.
Seasonal Impact of Heroin on Rabbit Carcass Decomposition and Insect Succession
Authors: Al-Qahtni Abdullah , Mashaly Ashraf , Haddadi Rania , Al-Khalifa Mohammed
Published: November 2020

This study investigates the succession of insects and the length of the decomposition of rabbit carcasses injected with heroin. In total, 24 rabbits (2–2.5 kg, Oryctolagus cuniculus domesticus L.) were used in the study. Twelve carcasses were exposed to insect activity in winter (January and February) and 12 in summer (July and August) in Riyadh, Saudi Arabia. Three replicate experiments were conducted in each season. For each experiment, three rabbits were injected with varying doses of heroin, and the fourth rabbit was used as a control, being injected only with saline solution. Insects belonging to the order Diptera, Coleoptera, and Hymenoptera were attracted to the carcasses. In both of the investigated seasons, heroin appeared to delay the decomposition process but did not have a significant impact on the number of insects. In general, the number of flies in both seasons was substantially higher than that of beetles and ants. During the summer, flies were more attracted to treated carcasses with a higher dose of heroin. Some flies such as Musca domestica L. (Diptera: Muscidae) and Chrysomya albiceps Wiedemann (Diptera: Calliphoridae) and some beetles such as Pimelia boyeri Solier (Coleoptera: Tenebrionidae) were represented on the carcasses by different developmental instars (larvae, pupae, and adults). Overall, heroin has not potential effects on the insect succession patterns of insect, however, influences the decomposition of rabbit carcasses. These findings are important while using insects in medicolegal investigation, since heroin is one of the common poisons used as an addictive agent.
Lemmatization in the collaborative editorial workflow of a medieval French text: The digital edition of the Histoire ancienne jusqu’à César
Authors: Morcos Hannah , Noël Geoffroy , Husar Marcus
Published: November 2020

This article demonstrates how lemmatization has been integrated into the workflow of the digital edition of the Histoire ancienne jusqu'à César, the earliest universal chronicle in French, involving specialists in the fields of medieval French literature, lexicography, and digital humanities. After presenting the dynamic and collaborative editorial workflow, we discuss how the project's lemmatizer, Lemming, has helped the team to improve the accuracy and quality of the edition and offered an opportunity to reflect on the language and lexis of the text. The results of lemmatization are integrated into the edition's faceted search page, which functions as a tool for linguistic research, a lexical support for readers, and an alternative to an index of names.
Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study
Authors: Ballegaard Christine , Skougaard Marie , Guldberg-Møller Jørgen , Nissen Christoffer V , Amris Kirstine , Jørgensen Tanja S , Dreyer Lene , Kristensen Lars E
Published: November 2020

Objectives

To explore the prognostic value of pre-specified comorbidities on treatment outcomes in PsA, and to compare baseline data with cutaneous psoriasis without arthritis and healthy controls (HC).

Methods

Patients initiating conventional synthetic/biological disease-modifying antirheumatic drugs were enrolled in this clinical observational cohort study, and data on comorbidities, and clinical and patient-reported outcomes were retrieved at baseline and after 4 months. Pearson’s chi-squared tests were performed to investigate the prognostic value of pre-specified comorbidities and achievement of ACR20, DAPSA50 and MDA. Mann–Whitney U tests were used to compare OMERACT PsA Core Outcome Set (COS) measures at baseline and follow-up for the pre-specified comorbidities.

Results

A total of 100 PsA patients were included at baseline. Statistically significantly fewer patients with obesity achieved DAPSA50 compared with patients without obesity (P =0.035), and fewer patients with hypertension (P =0.034) and Charlson Comorbidity Index (CCI) ≥1 (P =0.027), respectively, achieved MDA compared with patients without these comorbidities. Patients with obesity, hypertension, widespread pain, and CCI ≥1 had significantly worse COS measures at follow-up compared with patients without these comorbidities. At baseline, patients with PsA had higher disease burden compared with patients with cutaneous psoriasis and HC, including higher pain (P <0.001) and fatigue (P <0.001) scores, and more widespread pain (P =0.002).

Conclusion

Obesity, hypertension and CCI ≥1 were prognostic factors for poorer treatment outcome rates in PsA. Pain and fatigue were more frequently reported among patients with PsA compared with patients with cutaneous psoriasis and HC.

Trial registration

The Danish National Committee on Health Research Ethics: H-15009080; Data Protection Agency: 2012-58-0004; ClinicalTrials.gov: NCT02572700.
The Impact of Preoperative Depression on Patient Satisfaction With Spine Surgeons in the Outpatient Setting
Authors: Khan Hammad A. , Rabah Nicholas M. , Winkelman Robert D. , Levin Jay M. , Mroz Thomas E. , Steinmetz Michael P.
Published: November 2020

Study Design.

Retrospective review.

Objective.

The aim of this study was to examine the association between preoperative depression and patient satisfaction in the outpatient spine clinic after lumbar surgery.

Summary of Background Data.

The Clinician and Group Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is used to measure patient experience in the outpatient setting. CG-CAHPS scores may be used by health systems in physician incentive programs and quality improvement initiatives or by prospective patients when selecting spine surgeons. Although preoperative depression has been shown to predict poor patient-reported outcomes and less satisfaction with the inpatient experience following lumbar surgery, its impact on patient experience with spine surgeons in the outpatient setting remains unclear.

Methods.

Patients who underwent lumbar surgery and completed the CG-CAHPS survey at postoperative follow-up with their spine surgeon between 2009 and 2017 were included. Data were collected on patient demographics, Patient Health Questionnaire 9 (PHQ-9) scores, and Patient-Reported Outcome Measurement Information System Global Health Physical Health (PROMIS-GPH) subscores. Patients with preoperative PHQ-9 scores ≥10 (moderate-to-severe depression) were included in the depressed cohort. The association between preoperative depression and top-box satisfaction ratings on several dimensions of the CG-CAHPS survey was examined.

Results.

Of the 419 patients included in this study, 72 met criteria for preoperative depression. Depressed patients were less likely to provide top-box satisfaction ratings on CG-CAHPS metrics pertaining to physician communication and overall provider rating (OPR). Even after controlling for patient-level covariates, our multivariate analysis revealed that depressed patients had lower odds of reporting top-box OPR (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.06–0.63, P = 0.007), feeling that their spine surgeon provided understandable explanations (OR: 0.32, 95% CI: 0.11–0.91, P = 0.032), and feeling that their spine surgeon provided understandable responses to their questions or concerns (OR: 0.19, 95% CI: 0.06–0.63, P = 0.007).

Conclusion.

Preoperative depression is independently associated with lower OPR and satisfaction with spine surgeon communication in the outpatient setting after lumbar surgery.

Level of Evidence: 3
Directionality of Lumbosacral Fractional Curve Relative to C7 Plumb Line, A Novel Index Associated with Postoperative Coronal Imbalance in Patients with Degenerative Lumbar Scoliosis
Authors: Zhang Jiandang , Wang Zheng , Chi Pengfei , Chi Cheng
Published: November 2020

Study Design.

Retrospective case–control radiographic study.

Objective.

The aim of this study was to explore whether directionality of lumbosacral fractional curve relative to C7 plumb line (PL) affected postoperative coronal imbalance in patients with degenerative lumbar scoliosis (DLS).

Summary of Background Data.

The spatial relationship between lumbar main curve and C7 PL was reported to have impact on postoperative coronal imbalance in DLS. Although fractional curve played more important role than lumbar main curve in DLS, the spatial relationship between fractional curve and C7 PL and their impact on the postoperative coronal balance are still unknown.

Methods.

One hundred one DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included C7 migration, fractional curve, L4/L5 coronal tilt, major Cobb angle. Based on directionality of fractional curve (orientation of L4 coronal tilt was used to represent it) relative to C7 PL preoperatively, coronal patterns was separated into: consistency pattern, L4 coronally tilts toward C7 PL; opposition pattern, L4 coronally tilts opposite C7 PL; the distributions of these two patterns and Type A, B,C were analyzed. According to postoperative C7 migration, patients were divided into imbalanced group and balanced group.

Results.

Compared to balanced group, the imbalanced group had higher percentage of preoperative consistency pattern (80.6% vs. 33.8%, P < 0.001) and Type C (36.1% vs. 7.7%, P < 0.001); larger fractional curve or L4 coronal tilt pre- and postoperatively, larger L5 coronal tilt postoperatively. Logistic regression analysis showed predictors for postoperative coronal imbalance were consistency pattern (odds ratio [OR] 5.103, 95% confidence interval [CI]: 1.660–15.687, P = 0.004) and type C (OR 4.061; 95% CI: 1.056–15.618; P = 0.041).

Conclusion.

Directionality of fractional curve relative to C7 PL was associated with postoperative coronal imbalance in DLS patients. In addition to type C, consistency pattern might be an independent risk factor for postoperative coronal imbalance.

Level of Evidence: 3
Complication Rates After Elective Lumbar Fusion Procedures in Patients With Oral Preoperative Corticosteroid Use
Authors: Roberts Sidney , Formanek Blake , Wang Jeffrey C. , Buser Zorica
Published: November 2020

Level of Evidence: 3
Bone Formation During Correction of Vertebral Rounding Deformity in a Rat Model of Pediatric Spondylolisthesis
Authors: Manabe Hiroaki , Yamashita Kazuta , Higashino Kosaku , Morimoto Masatoshi , Sugiura Kosuke , Ishihama Yoshihiro , Tezuka Fumitake , Takata Yoichiro , Sakai Toshinori , Sairyo Koichi
Published: November 2020

Study Design.

A study using rat spondylolisthesis models.

Objective.

The aim of this study was to elucidate the mechanism for correction of vertebral rounding deformity.

Summary of Background Data.

Vertebral rounding deformity is the strongest risk factor for high-grade slippage associated with spondylolisthesis in adolescents. We previously reported that inadequate endochondral ossification of the anterior upper corner of the vertebral growth plate in response to mechanical stress could be the pathological mechanism of vertebral rounding deformity.

Methods.

We created a model of spondylolisthesis using 4-week-old rats. They were divided into a tail suspension group that underwent tail suspension to decrease mechanical stress starting at 2 weeks postoperatively and a ground control group with no intervention. Radiographs and microcomputed tomography scans were obtained once weekly for 6 weeks postoperatively. The lumbar spines were then harvested for histological analysis. Immunohistochemical studies detected types I, II, and X collagen in the growth plate cartilage. Bone histomorphometrical analysis was also performed.

Results.

Radiological and histological evidence in the ground control group showed progress the rounding deformity with time as previously reported. Formation of normal cancellous bone was observed radiologically over time in the tail suspension group, indicating correction of rounding deformity. Histologically, the site showing radiological evidence of correction was derived from cartilage tissue. After starting tail suspension, the growth plate stained positive for type X collagen and the corrected site stained for types II and X collagen in a mosaic pattern. Chondrocytes expressing types I and II collagen and tartrate-resistant acid phosphatase-positive cells were also present at the corrected site. Histomorphometrically, more endochondral bone was detected at the corrected site than in the posterior aspect of the normal growth plate.

Conclusion.

Correction of vertebral rounding deformity was associated with improvement of chondrocyte differentiation; furthermore, there is possible involvement of a third mechanism, namely transchondroid bone ossification.

Level of Evidence: N/A
Reliability and Validity of the Thai Version of the Swiss Spinal Stenosis Questionnaire
Authors: Wilartratsami Sirichai , Santipas Borriwat , Jerapornprapa Rutchchayuth , Vamvanij Visit , Luksanapruksa Panya
Published: November 2020

The original Swiss Spinal Stenosis (SSS) questionnaire was translated into the Thai version and culturally adapt for use in Thailand. The Thai version—SSS is valid and reliable to use in both clinical and research to address the functional, symptom severity, and satisfaction in Thai lumbar spinal stenosis patients.

Study Design..

Cross-sectional study.

Objective..

To evaluate the reliability and validity of the Thai version of the Swiss Spinal Stenosis (SSS) questionnaire.

Summary of Background Data..

The SSS questionnaire was developed to assess symptom severity, physical functional status, and patient satisfaction in spinal stenosis patients that was previously reported to have good reliability and validity. There is currently no Thai version of the SSS questionnaire.

Methods..

The SSS questionnaire was translated into Thai language to create the Thai version of the Swiss Spinal Stenosis (Thai-SSS) questionnaire. Translation was performed according to international standards using a forward-backward translation protocol. Translation was performed by two expert translators and one physician, and the final version was approved by an expert committee. Thai patients with degenerative lumbar spinal stenosis were enrolled and evaluated using the Thai-SSS questionnaire, the Thai version of the Short Form-36 (SF-36), and a visual analogue scale (VAS) before and after treatment. Reliability and validity of the Thai-SSS were assessed via comparison with the SF-36 and the VAS.

Results..

One hundred seven patients were included. Eighty patients underwent decompression and fusion surgery, and the others underwent decompression alone. Cronbach's alpha of all domains of the Thai-SSS showed excellent internal consistency (0.869–0.921). The intraclass correlation coefficient for test–retest reliability was 0.77 (95% CI: 0.65–0.85). Regarding concurrent validity, the physical function scale of the Thai-SSS was strongly correlated with the physical functioning domain of the SF-36 (r = 0.70). The symptom severity domain of the Thai-SSS was strongly correlated with the bodily pain domain of the SF-36 and the VAS (r = 0.76 and 0.78, respectively).

Conclusion..

The Thai-SSS was found to be a valid and reliable tool for evaluating symptom severity, physical function, and patient satisfaction after treatment in Thai patients with spinal stenosis.

Level of Evidence: 4
Novel Mutations in UTS2R are Associated with Adolescent Idiopathic Scoliosis in the Chinese Population
Authors: Dai Zhicheng , Wang Yuwen , Wu Zhichong , Feng Zhenhua , Liu Zhen , Qiu Yong , Cheng Jack Chun-Yiu , Xu Leilei , Zhu Zezhang
Published: November 2020

Study Design.

A case-control study.

Objectives.

To investigate the association of urotensin II (UTS2) signals with the susceptibility of adolescent idiopathic scoliosis (AIS) in the Chinese Han population.

Summary of Background Data.

Dysregulated UTS2 signals induced by impaired cerebrospinal fluid flow have been implicated in the development of idiopathic scoliosis through studies on zebrafish. Furthermore, mutations in urotensin II receptor (UTS2R) were reported to cause severe scoliosis in zebrafish. In spite of the evidence presented in animal models, there is still a lack of knowledge concerning the role of UTS2 signaling related genes in AIS.

Methods.

In the discovery stage, exons of UTS2, UTS2R, and UTS2D were sequenced for 200 AIS patients and 200 healthy controls. Newly identified mutations were further genotyped in another independent cohort of 1000 AIS patients and 1000 controls by allelic-specific multiple ligase detection reactions. Gene expression analysis was performed in 36 AIS patients and 36 age-matched congenital scoliosis patients. The Chi-square test was used to compare the genotyping data between the groups. Gene expression analysis was compared with the Student t test.

Results.

Association between two novel mutations (rs11654140, c.51T > C; rs568196624, c.1146C > G) and the development of AIS was identified. Allele C of rs11654140 and allele G of rs568196624 were significantly associated with the risk of AIS (1.5% vs. 0.5%, odds ratio = 3.02, P = 0.01 for rs11654140; 1.41% vs. 0.58%, odds ratio = 2.29, P = 0.04 for rs568196624). The mRNA expression of UTS2R in the AIS group was significantly higher as compared with that in the control group (0.059 ± 0.015 vs. 0.035 ± 0.013, P < 0.01).

Conclusions.

Rare mutations in UTS2R were significantly associated with AIS. Expression of UTS2R was significantly increased in AIS patients. The role of UTS2 signaling in the development of AIS is worthy of further investigation.

Level of Evidence: N/A
Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope
Authors: Tao Chun-Yan , Chen Selena , Li Xue-Ying , Tang Chao-Shu , Du Jun-Bao , Jin Hong-Fang
Published: November 2020

Background:

Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment.

Methods:

Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed.

Results:

Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m2
vs. 20.7 ±e6 kg/m2, P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex (r = 0.256, 95% confidence interval [CI]: 0.067–0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704–0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m2 yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS.

Conclusion:

Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.
NLRP3 inflammasome: a new therapeutic target for high-risk reproductive disorders?
Authors: Zhou Feng , Li Chao , Zhang Song-Ying
Published: November 2020

The NOD-like receptor protein 3 (NLRP3) inflammasome is a key regulator of the host's immune response, and many immune and metabolic disorders are linked to its activation. This review aimed to investigate and clarify the relationship between this inflammasome and high-risk reproductive disorders. Papers cited here were retrieved from PubMed up to August 2020 using the keywords “NLRP3” or “NALP3”, “caspase-1”, “endometriosis”, “gestational diabetes”, “interleukin (IL)-18”, “IL-1β”, “pre-eclampsia (PE)”, “preterm birth”, “polycystic ovarian syndrome (PCOS)”, “recurrent spontaneous abortion (RSA)”, and combinations of these terms. The results show that NLRP3 inflammasome is associated with various high-risk reproductive disorders and many inflammatory factors are secreted during its activation, such as IL-1β induced during the development of endometriosis. PCOS is also associated with activation of the NLRP3 inflammasome, especially in overweight patients. It also participates in the pathogenesis of RSA and is activated in fetal membranes before preterm birth. The placentas of pregnant women with PE show higher expression of the NLRP3 inflammasome, and gestational diabetes mellitus occurs simultaneously with its activation. Current evidence suggest that the NLRP3 inflammasome plays an important role in female reproductive disorders. New treatment and management methods targeting it might help reduce the incidence of such disorders and improve neonatal outcomes.
A Case of Eosinophilic Pustular Folliculitis Associated With Herpes Zoster
Authors: Lee Jae-Ho , Lee Soo-Kyung , Kim Joong-Ho , Kim Ho-Young , Kim Myoung-Shin , Lee Un-Ha
Published: November 2020

Patients with eosinophilic pustular folliculitis (EPF), a sterile eosinophilic infiltration of hair follicles, often present with papulopustules that tend to form annular plaques. Histopathologic examination revealed eosinophilic infiltration around the pilosebaceous units and eosinophilic microabscess formation. Although the pathogenesis of EPF is unknown, T-helper type 2 immune responses were suggested to be important based on their stimulating effect on the sebaceous glands. Here, we report the first case of EPF associated with herpes zoster, indicating that herpes zoster and EPF are correlated with T-helper type 2 immune responses.
COVID Purpura (Toes) Case Series: A Chilblains-Like Vasculopathy
Authors: Olsen Thomas G. , Shrit M. Atef , Feeser Theresa A. , Wargo Jeffrey J.
Published: November 2020

Biopsies were taken from 4 patients who presented to their dermatologist with violaceous papules and plaques of the dorsal toes (COVID Toes) associated with varying degrees of severe acute respiratory syndrome coronavirus 2 exposure and COVID-19 testing. Major histopathologic findings were lymphocytic eccrine inflammation and a spectrum of vasculopathic findings to include superficial and deep angiocentric–perivascular lymphocytic inflammation, lymphocytes in vessel walls (lymphocytic vasculitis), endothelial swelling, red blood cell extravasation, and focal deposits of fibrin in both vessel lumina, and vessel walls. Interface changes were observed to include vacuolopathy and apoptotic keratinocytes at the basement membrane. Immunostains showed a dominant T-cell lineage (positive for T-cell receptor beta, CD2, CD3, CD5, and CD7). B-cells were rare and clusters of CD123-positive dermal plasmacytoid dendritic cells were observed surrounding eccrine clusters and some perivascular zones. The consistent perieccrine and vasculopathic features represent important pathologic findings in the diagnosis of COVID toes and are suggestive of pathogenetic mechanisms. Clinicopathologic correlation, the epidemiological backdrop, and the current worldwide COVID-19 pandemic favor a viral causation and should alert the physician to initiate a workup and the appropriate use of COVID-19 testing.
Systematic Review: Effects of Pterygium and Pingueculum on the Ocular Surface and Efficacy of Surgical Excision
Authors: Linaburg Taylor , Choi Daniel , Bunya Vatinee Y. , Massaro-Giordano Mina , Briceño César A.
Published: November 2020

Purpose:

This systematic review examines the specific effects of pingueculum and pterygium on the ocular surface and evaluates the efficacy of surgical excision in reversing those effects.

Methods:

A systematic review was performed according to the Preferred Reporting Items for the Systematic Review and Meta-Analyses statement and included 59 articles studying the effects of pterygium and pingueculum on the ocular surface as measured by tear break-up time (TBUT), Schirmer testing, tear osmolarity, Ocular Surface Disease Index (OSDI), and the effects of surgical removal on these ocular surface parameters.

Results:

In most studies, eyes with pterygium or pingueculum when compared with control eyes had a statistically significantly lower TBUT (average 3.72 s), lower Schirmer I without anesthesia (average 3.01 mm), lower Schirmer II (average 4.10 mm), higher tear osmolarity (average 12.33 mOsm/L), and higher OSDI (average 6.82 points). Moreover, excision of pterygium and pingueculum led to a statistically significantly higher TBUT (average 3.15 s higher at 1 mo postexcision), lower tear osmolarity (average 3.10 mOsm/L lower at 3 mo postexcision), and lower OSDI score (average 2.86 points lower 1 mo postexcision) in most of the studies. The effect of excision on Schirmer test scores was equivocal because most studies did not reach significance.

Conclusions:

Our data confirm the relationship between pterygium and pingueculum and abnormal tear function and symptoms of dry eye disease. Furthermore, the data suggest that tear film parameters might improve after surgical removal of pterygium or pingueculum. Future studies would be helpful in exploring the potential role of pterygium and pingueculum excision in the management of dry eye disease.
Long-Term Visual Outcomes and Clinical Course of Patients With Peters Anomaly
Authors: Elbaz Uri , Strungaru Hermina , Mireskandari Kamiar , Stephens Derek , Ali Asim
Published: November 2020

Purpose:

To present long-term clinical and visual outcomes of patients with Peters anomaly.

Methods:

The charts of all patients diagnosed with Peters anomaly from January 2000 to December 2012 were reviewed retrospectively. Peters anomaly was classified as type I (with no lens involvement) or type II (presence of keratolenticular adhesions or cataract), with further severity grading to mild, moderate, and severe disease depending on corneal opacity location and size. Mild cases were observed. Moderate cases were managed with pupillary dilation either pharmacologically or surgically. Penetrating keratoplasty (PKP) was reserved for more severe opacity. The main outcome measures were final best spectacle-corrected visual acuity (BSCVA), incidence of glaucoma, graft survival, and nystagmus rates.

Results:

Sixty eyes of 40 patients were included in the study. The median age of patients at presentation was 0.5 ± 20.7 months (range, 0.0–111.0 months), with a mean follow-up time of 75.8 ± 52.9 months (range, 12.1–225.3 months). Overall, final best spectacle-corrected visual acuity ranged from 0.1 logMAR to no light perception with 33 eyes (55.9%) achieving vision of 1.0 logMAR or better. Clear grafts at the last follow-up were obtained in 67.6% (25/37) of transplanted eyes, 76.0% (19/25) in Peters type I, and 50.0% (6/12) in Peters type II (P = 0.11). The probability of a clear graft at 10 years was 74.2% and 38.9% for type I and type II, respectively. Glaucoma was diagnosed in 33.3% eyes, 90.0% of which occurred after PKP. Nystagmus was highly associated with PKP intervention, occurring in 81.1% (30/37) of eyes undergoing PKP compared with 34.8% (8/23) of eyes with no PKP (P = 0.0003).

Conclusions:

Visual rehabilitation in Peters anomaly remains a challenge, but outcomes can be optimized using a comprehensive clinical management algorithm according to disease severity.
Microthin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty: A Randomized Clinical Trial
Authors: Matsou Artemis , Pujari Rathin , Sarwar Hammad , Rana Mrinal , Myerscough James , Thomson Susan M. , Nandakumar Girinath , Zhang Jufen , Rajan Madhavan S.
Published: November 2020

Purpose:

To compare visual outcomes, complications, and vision-related quality of life (QoL) after microthin Descemet stripping automated endothelial keratoplasty (MT-DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK) for the management of corneal endothelial dysfunction in Fuchs dystrophy.

Methods:

This is a prospective, double-blinded randomized controlled clinical trial. Patients with visually significant endothelial decompensation from Fuchs dystrophy were prospectively randomized to receive MT-DSAEK or DMEK surgery. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 12 months. Secondary outcomes included refraction, keratometry, endothelial cell count, complications, and vision-related QoL at 6 and 12 months postoperatively.

Results:

A total of 56 eyes of 56 patients were enrolled, 28 in each group. Postoperatively, LogMAR mean BSCVA in the MT-DSAEK group was 0.17 ± 0.08 and 0.11 ± 0.09 at 6 and 12 months compared with 0.09 ± 0.13 and 0.04 ± 0.13 after DMEK (P = 0.03, P = 0.002 respectively) with the DMEK cohort achieving 3.5 logarithm of the minimum angle of resolution letters better BSCVA at 1 year compared with MT-DSAEK. Complication rates were similar with 3.5% rebubbling rate in both groups, 1 primary graft failure in DMEK and a single endothelial rejection in the MT-DSAEK arm. Vision-related QoL was comparable at 6 and 12 months postoperatively, and no eyes demonstrated loss of vision from preoperative BSCVA.

Conclusions:

DMEK surgery resulted in significantly better BSCVA at 1, 3, 6, and 12 months postoperatively compared with MT-DSAEK. Patient satisfaction was similar with no differences reported in vision-related QoL scores, as was the complications profile between groups. Thus, our results favor DMEK as the better choice procedure for eyes with Fuchs-related corneal decompensation without ocular comorbidities.
Sebaceous Gland Carcinoma: Influence of Age at Presentation on Outcomes
Authors: Kaliki Swathi , Morawala Ashi , Krishnamurthy Ajay , Divya Jajapuram Sai , Mohamed Ashik
Published: November 2020

Purpose:

To assess the relationship between age at presentation and outcomes of patients with periocular sebaceous gland carcinoma.

Methods:

Retrospective case series of 241 patients.

Results:

Of 241 cases, 29 (12%) were young adults (≤40 years), 122 (51%) were middle-aged adults (41–60 years), and 90 (37%) were older adults (>60 years). Based on the eighth edition of American Joint Committee on Cancer, most tumors belonged to T1 category (n = 78, 32%) on presentation. Wide excisional biopsy was the most common treatment modality (n = 183, 79%). There were no statistically significant differences in the clinical presentation, treatment approaches, and histopathology features amongst different age groups, except pagetoid spread which was higher in middle-aged adults (61%, p = 0.004). The incidence of tumor recurrence was higher in older age group compared to younger age groups, with 5-year, 10-year Kaplan-Meier estimate at 31%, 31% in young adults, 38%, 38% in middle-aged adults, and 45%, 100% in older adults (p = 0.03), respectively. The 10-year Kaplan-Meier estimate rate of locoregional lymph node metastasis, systemic metastasis, and death was higher in young adults (51%, 48%, and 48%, respectively) compared to middle-aged (30%, 17%, and 12%, respectively) and older adults (24%, 25%, and 27%, respectively), but the differences were not statistically significant.

Conclusions:

There is no difference in the clinical presentation of periocular sebaceous gland carcinoma based on age. However, the tumor recurrence rate is much higher in the older age group and death higher in younger patients despite the same treatment strategies in all age groups.
Intracranial Abnormalities of Infantile Hemangiomas in the Head and Neck Regions: A Retrospective MRI Study
Authors: Gao Ying , Yi Xiao-Li
Published: November 2020

Objective:

Few reports have described intracranial hemangiomas and structural brain and/or arterial anomalies in patients with infantile hemangiomas. This study was performed to examine the magnetic resonance imaging findings of intracranial abnormalities in a group of infants with hemangiomas in the head and neck regions.

Methods:

We reviewed our hemangioma treatment center database from January 2010 to July 2018 to assess the prevalence of intracranial abnormalities in infants with hemangiomas in the head and neck regions. Clinical and electronic magnetic resonance imaging data were also retrieved from the patients’ medical charts.

Results:

Of 436 patients with infantile hemangiomas in the head and neck regions, 23 (5%) had intracranial abnormalities, including 20 (23%) with segmental hemangiomas and 3 (1%) with focal hemangiomas. In total, 14 patients had intracranial hemangiomas located within the ventricle and cisterns or ipsilateral lesions involving the extradural space. Eight patients had intracranial structural abnormalities, such as cerebellar dysplasia, Dandy-Walker malformation, and hydrocephalus. Five patients had intracranial arterial anomalies, and three patients had arteriovenous malformations.

Conclusions:

These findings support the hypothesis that intracranial hemangiomas are commonly associated with segmental infantile hemangiomas in the head and neck regions.
Endoscopic Intervention of Aberrant Carotid Artery in the Middle Ear
Authors: Hashim Noor Dina , Jang Seung H. , Moon In Seok
Published: November 2020

Objective:

To describe surgical management for transcanal endoscopic ear surgery (TEES) in two patients with aberrant internal carotid artery (ICA) in the middle ear.

Patients:

A young girl who complained of pulsatile tinnitus and an elderly man who presented with ear bleeding. Otoendoscopy examination revealed a pulsatile reddish mass protruding through the tympanic membrane in both patients.

Interventions:

A combination of clinical assessments and imaging supported the diagnosis of aberrant ICA in the middle ear. Transcanal endoscopic reinforcement of the artery was performed; tragal cartilage was used as a shield to strengthen the carotid canal defect.

Results:

Assisted by fine endoscopic instruments, the protruding arteries were separated without damage to the surrounding structures and reinforced using tragal cartilage. Both patients’ symptoms improved postoperatively; they reported tinnitus relief and hearing improvement.

Conclusion:

To prevent catastrophic events, diagnosis of aberrant ICA is important before any surgical intervention. With appropriate management, surgical intervention using transcanal endoscopic ear surgery offers a clear view of the surgical field and is an excellent choice for management of aberrant ICA.
Effect of Personal Protection Equipment (PPE) and the Distance From the Eye Piece of Surgical Microscope on the Field of Vision; An Experimental Study
Authors: Iyer Arunachalam , Tikka Theofano , Calder Nicholas , Qamar Sabih Nadeem , Chin Andy
Published: November 2020

Background:

During the Covid-19 pandemic, otolaryngologists are at risk due to aerosol-generating procedures such as mastoidectomy and need enhanced personal protective equipment (PPE). Eye protection can interfere with the use of a microscope due to a reduction in the field of vision. We aimed to study the effect of PPE on the microsurgical field.

Methods:

Five surgeons measured the visual field using digital calipers at different power settings. They were done with no PPE, a surgical mask, FFP3 mask (N99), and with the addition of small goggles, large vistamax goggles, vistamax plus a face shield, and only a face shield. The measurements were repeated with rings of 5 mm increments. We also measured the “eye relief” of the microscope which is the ideal distance for maximum field of view.

Results:

There was no major reduction of the field with the surgical or FFP3 mask. But even simple goggles reduced the field up to 31.6% and there were progressive reductions of up to 75.7% with large goggles, 76.8% when a face shield was added, and 61.9% when only face shield was used. The distance rings more than 5 mm also affected the field of view.

The eye relief of our eyepiece was found to be 15 mm.

Conclusion:

The current PPE eye protection is not compatible with the use of a microscope. There is scope for research into better eye protection. Mitigation strategies including barrier drapes and alternative techniques such as endoscopic surgery or use of exoscopes should also be considered.
Addressing Positionality Within Case-Based Learning to Mitigate Systemic Racism in Health Care
Authors: Altman Molly R. , Kantrowitz-Gordon Ira , Moise Elba , Malcolm Katie , Vidaković Milan , Barrington Wendy , O'Connor M. Rebecca , de Castro A. B.
Published: November 2020

Background

Case-based learning has historically focused on the individual patient; however, there is often little consideration within this teaching method of how social determinants of health, such as structural racism and its adverse health effects, bear upon patients' health status and consequent patient outcomes.

Problem

Implementing case studies necessitates taking into account the positionality of patients, as well as health care providers, to counter the racial oppression and discrimination embedded in existing health care and educational systems.

Approach

We describe a process for creating an inclusive, antiracist environment for case-based learning within nursing education, outlining steps for preparing students to more effectively examine case studies through social determinants of health framing and lens to mitigate harmful impacts from systemic racism and racial discrimination in clinical care.

Conclusions

Addressing positionality in case-based learning is one antiracist strategy to begin rectifying health disparities and moving health care toward equity.
Pilot study of educational interventions for pediatric hematopoietic stem cell sibling donors to increase knowledge of donation and transplantation procedures
Authors: Wiener Lori , Childs Richard W. , Shah Nirali N.
Published: November 2020

Background:

Siblings are frequently identified as a tissue match for patients with malignant and nonmalignant diseases and are selected to donate hematopoietic stem cells (HSCs). Research on preparing siblings donors for stem cell donation is limited. Even after donation procedures are explained, siblings have been found to have difficulty understanding the information and may experience anxiety, particularly among younger donors. No prospective studies examining educational tools and transplant knowledge in sibling stem cell donors are currently available. This pilot study assessed donor comprehension of HSC donation procedures and compared knowledge before and after an educational intervention.

Methods:

Assessment of baseline knowledge regarding HSC donation was assessed before and after the consent/information meeting with the medical team. Donors were then stratified into 2 groups by age. Donors aged 10 to 15 years played an adapted version of the therapeutic game ShopTalk and donors aged 16 to 25 years were provided a workbook designed for sibling stem cell donors. Assessment of knowledge was repeated 24 hours after the intervention.

Results:

Participants included 17 siblings of pediatric transplant recipients, aged 10 to 25 years. Mean knowledge scores increased from 59.6% to 68.8% following the meeting with the medical provider and further increased to 88.5% after an educational intervention. Results suggest that education that provides information via a game or workbook increases knowledge in sibling donors.

Conclusion:

Limited interactive educational material on stem cell donation is available for pediatric HSC donors. Additional visual and/or interactive information for sibling donors may increase knowledge and perhaps comfort with the donation process, beyond that which is provided by the medical teams. Providing detailed information about donation and discussion of procedures should be tailored to the individual learning style and supplemented with additional visual information.