bluuebunny/crossref_metadata_2025 huggingface dataset:
Abklärung und Behandlung des benignen paroxysmalen Lagerungsschwindels mittels manueller und motorisierter Drehstühle
Authors: Tarnutzer Alexander Andrea
Published: November 2022

Der benigne paroyxsmale Lagerungsschwindel (BPLS) ist die häufigste Ursache eines episodischen Schwindels. Während die Diagnose anhand einer gezielten Anamneseerhebung und anschließender Provokationsmanöver auf der Untersucherliege meist zuverlässig gestellt und die Behandlung eingeleitet werden kann, können diese Manöver bei Patienten mit bestimmten Vorerkrankungen (z. B. des Bewegungsapparates oder Nervensystems) nicht oder nur eingeschränkt durchgeführt werden. Gleichzeitig zeigt sich ein Teil der Patienten mit BPLS therapierefraktär. Die Verwendung eines manuellen oder motorisierten Drehstuhls erweitert sowohl die diagnostischen wie auch die therapeutischen Möglichkeiten beim BPLS. So ermöglicht sie einzelnen Patientengruppen aufgrund von Vorerkrankungen eine gezielte Abklärung bei entsprechendem Verdacht und, sofern erforderlich, eine evidenzbasierte Behandlung. Ebenso erweitert der Drehstuhl das Abklärungsspektrum und die Auswahl an Repositionsmanövern in unklaren oder therapierefraktären Fällen. In diesem Übersichtsartikel werden potenzielle Indikationen beschrieben und die Evidenz für die Abklärung und Behandlung des BPLS auf einem Drehstuhl diskutiert.
Sturzprävention im Alltag
Authors: Basta Dietmar , Ernst Arne
Published: November 2022

Stürze im Alltag treten mit zunehmendem Alter viel häufiger auf und deren Folgen sind oft schwerwiegender. Die Sturzgefahr ist jedoch besonders im Alter sehr heterogen verteilt. Somit ist die individuelle Beurteilung des Sturzrisikos eine grundlegende Aufgabe der Sturzprävention. Die Erfassung des individuellen Sturzrisikos ist noch sehr subjektiv und hat eine geringe Sensitivität und Spezifität. Dabei sind seit längerer Zeit objektive Verfahren mit einer hohen diagnostischen Güte verfügbar.

Auf Basis der individuellen Ermittlung des Sturzrisikos sollte das weitere Vorgehen bei der Sturzprävention entschieden werden. Ein zentraler Punkt ist dabei das Gleichgewichtstraining. Dieses sollte besonders in der Hauptzielgruppe, den älteren Patienten, sehr effektiv und somit wenig körperlich anspruchsvoll gestaltet sein. Aktuell erfüllen individualisierte Trainingsansätze unter Verwendung von sensorischem Feedback, insbesondere vibrotaktilem Feedback, diese Kriterien. Der Langzeiterfolg jeglicher Trainingsansätze hängt jedoch davon ab, wie gut der Patient durch das Training mobilisiert werden konnte und Bewegung wieder in den Alltag integriert.
Mykosen
Authors: Wanitschek Anne , Thumm Anusati , Kraft Susanne , Spajic Emilia
Published: November 2022

Vier Experten stellen Behandlungsansätze bei Mykosen mithilfe von Phytotherapie, Aromatherapie, Propolis und TCM vor.
Was ist Candida albicans und wie kann eine Anti-Candida-Diät aussehen?
Authors: März Henrike
Published: November 2022

Bei einer unphysiologischen Candida-albicans-Vermehrung im Darm kann eine angepasste Ernährung hilfreich sein.
Trio im Fokus
Authors: Lang Eva
Published: November 2022

In der Klassischen Homöopathie werden auch Pilze eingesetzt, 3 Beispiele sind Fliegenpilz, Staubpilz und Mutterkorn. Einige Themen sind bei Pilzmitteln in der Klassischen Homöopathie besonders im Fokus, zum Beispiel das zentrale Nervensystem. In diesem Beitrag werden die 3 vorgestellten homöopathischen Pilzmittel durch ihre Symptome und ein Fallbeispiel aufgegriffen.
Effects of High-Fructose Corn Syrup Intake on Glucocorticoid
Metabolism in Rats During Childhood, Adolescence and Adulthood
Authors: Nouchi Yuki , Munetsuna Eiji , Yamada Hiroya , Yamazaki Mirai , Ando Yoshitaka , Mizuno Genki , Fujii Ryosuke , Kageyama Itsuki , Wakasugi Takuya , Sakakibara Tomohide , Teshigawara Atsushi , Ishikawa Hiroaki , Shimono Yohei , Suzuki Koji , Hashimoto Shuji , Ohashi Koji
Published: November 2022

The consumption of high-fructose corn syrup (HFCS) has been increasing in recent
decades, especially among children. Some reports suggest that children and
adolescents are more sensitive to the adverse effects of fructose intake than
adults. However, the underlying mechanism of the difference in vulnerability
between adolescence and adulthood have not yet been elucidated. In this study,
we attempted to elucidate the different effects of HFCS intake at different
growth stages in rats: childhood and adolescence (postnatal day (PD)
21–60), young adulthood (PD60–100), and adulthood
(PD100–140). Since alterations in hepatic glucocorticoid (GC) metabolism
can cause diseases including insulin resistance, we focused on GC metabolizing
enzymes such as 11 beta-hydroxysteroid dehydrogenase 1 and 2 (Hsd11b1 and
Hsd11b2) and steroid 5 alpha-reductase 1 (Srd5a1). Western blotting showed an
increase in Hsd11b1 expression and a decrease in Hsd11b2 expression in childhood
and adolescence but not in adulthood. We also observed changes in Hsd11b1 and
Hsd11b2 activities only in childhood and adolescence, consistent with the
results of mRNA and protein expression analysis. The effect of high-fructose
intake with regards to GC metabolism may therefore vary with developmental
stage. This study provides insight into the adverse effects of fructose on GC
metabolism in children in the context of increasing rates of HFCS
consumption.
Nährstoffquelle mit Wermutstropfen
Authors: März Henrike
Published: November 2022

Weil sie meist in Symbiose mit Bäumen leben, lassen sich Pilze nur sehr bedingt kultivieren und unterteilen sich in wenige Kultur- und viele Wildarten. Obwohl Pilze unter anderem aufgrund ihres Chitinanteils eher schwer verdaulich sind, eignen sie sich in Maßen hervorragend als vielseitige und kalorienarme Nahrungs- und Gewürzbeigabe und Quelle für B-Vitamine, Vitamin D sowie essenzielle Fett- und Aminosäuren. Als Bioakkumulatoren speichern Pilze neben Nährstoffen auch Schadstoffe wie Schwermetalle und verderben zudem schnell, sodass für das Sammeln und Zubereiten einige Regeln zu beachten sind.
Laissez-faire Technique in Periocular Reconstructive Surgery following Tumour Resection
Authors: Linntam Delis , Klett Artur
Published: November 2022

The laissez-faire technique, although not widely used by oculoplastic surgeons, is a valuable option in the reconstruction of periocular defects following tumour resection. In the authorsʼ
experience, the most suitable location is the medial canthal area. Primary surgery is often simpler and better tolerated by the patient compared with alternative, more complex surgical
procedures. The final functional and cosmetic outcome is highly dependent on patient selection and for an excellent result, certain modifications in surgical technique and additional
manipulations in the early postoperative period must be considered. The technique is not usually the first choice, due to fear of a prolonged and complicated wound healing period. The
unpredictability of the results may also be of concern to oculoplastic surgeons. This case series illustrates some modifications of surgery and postoperative care that can help optimise the
outcome and reduce postoperative complications. As wound healing and scarring are influenced by contraction in the wound bed, tension guiding sutures are a valuable adjunct to laissez-faire
techniques. They improve the predictability of the result after healing, and this is important primarily in reducing the risk of cicatricial ectropium, but also in the cosmetic result.
Although there is a risk of infection with any open wound, in general, thorough patient education usually suffices to avoid postoperative complications. Appropriate wound care in the
laissez-faire technique is fairly simple and easily achievable.
Tinea: Von Kopf bis Fuß
Authors: Schmid Eva C.
Published: November 2022

Als Tinea bezeichnet man eine Infektion mit Dermatophyten – Fadenpilzen, die vorwiegend Haut, Nägel und Haare befallen und den Gattungen Trichophyton, Microsporum und Epidermophyton zugerechnet werden. Infektionen können alle Hautareale betreffen, breiten sich aber besonders gut an feuchten und warmen Stellen aus – häufig zeigen sich Pusteln, Papeln oder typisch runde, abgegrenzte Herde. Zu den wichtigsten Differenzialdiagnosen zählen allergisches und atopisches Ekzem, Candidose, Autoimmunerkrankungen, Reizzustände und bakterielle Infektionen.
Von A wie Agaricus bis X wie Xerocomus
Authors: Jahn Claus
Published: November 2022

Pilzmittel können neben ihrem Einsatz in der Klassischen Homöopathie (siehe S. 34) auch indikationsbezogen verordnet werden, teilweise synergistisch als Komplexmittel. Die Anwendungsgebiete sind sehr vielfältig und reichen je nach Pilzmittel von Mykosen (siehe S. 50, 57) über gastrointestinale Beschwerden bis hin zu neurologischen Störungen. Manche Pilze sind aufgrund ihrer Toxizität als Homöopathikum erst ab einer bestimmten Potenz einsetzbar. So wird zum Beispiel der hochgiftige Grüne Knollenblätterpilz – erlaubt ab einer D6 – zu einem effektiven homöopathischen Lebermittel.
Saliva Sampling in Therapeutic Drug Monitoring and Physiologically
Based Pharmacokinetic Modeling: Review
Authors: Almukainzi May
Published: November 2022

Therapeutic drug monitoring investigations based on saliva samples can be
utilized as an alternative to blood sampling for many advantages. Moreover, the
development of physiologically based pharmacokinetic (PBPK) modeling tools can
further help to estimate drug exposure from saliva. This review discusses the
use of saliva samples and illustrates the applications and examples of PBPK
modeling systems for estimating drug exposure from saliva.
Ein Männlein steht im Walde
Authors: Stern Cornelia
Published: November 2022

Der Fliegenpilz (Amanita muscaria LAMARCK) ist giftig, kann aber homöopathisch oder spagyrisch zubereitet auch als Heilmittel eingesetzt werden.
A Double-blind, Placebo-controlled, Randomized, Single Ascending, and
Multiple Dose Phase 1 Study to Evaluate the Safety, Tolerability, and
Pharmacokinetics of Oral Dose Isomyosamine Capsules in Healthy Adult
Subjects
Authors: Brager Jenna , Chapman Chris , Dunn Leonard , Kaplin Adam
Published: November 2022

Background Aging is tightly linked to chronic disease, frailty, and death.
Multi-morbidity, defined as the presence in the same patient of three or more
conditions such as neoplastic, cardiovascular, neurodegenerative, metabolic, or
autoimmune diseases, becomes more common with age.

Methods The study was performed in a double-blind fashion. Subjects within
each dose cohort (Cohorts 1, 2, 3, and 4) were randomly assigned to receive
Isomyosamine doses (between 150 mg to 600 mg or placebo) or
placebo in a 3:1 ratio (6 active: 2 placebo).

Results Isomyosamine single daily doses each of 150 mg,
300 mg, and 450 mg for 3 days and multiple daily doses of
600 mg for 6 days were safe and well tolerated in healthy subjects. In
one dose group, there was a decrease in TNF-α levels found in
Isomyosamine treated subjects, but no change in the levels in subjects given
placebo. The increase in Isomyosamine exposure was proportional to dose across
the dose range of 300 mg to 600 mg when administered as a single
dose. There was minimal accumulation of Isomyosamine following 5 days of once
daily dosing of Isomyosamine 600 mg. Isomyosamine half-life ranged from
approximately 15 minutes to 45 minutes across all doses in the
single ascending dose and multiple ascending dose portion of the study.
Elimination of Isomyosamine included the renal pathway as a minor route.

Conclusion Isomyosamine will continue to be investigated in phase 2
clinical trials for the treatment of sarcopenia/frailty,
hashimoto’s thyroiditis and rheumatoid arthritis.
DDG und DGE warnen davor, den Zugang zu CGM-Systemen zu erschweren
Authors: Richter Michaela
Published: November 2022

Immer mehr Diabetespatientinnen und -patienten greifen auf kontinuierliche Glukosemessgeräte (CGM) zurück. Diese ermöglichen ihnen, den Gewebezuckerwert rund um die Uhr zu messen und sich damit den Alltag zu erleichtern und sicherer zu machen. Nun stellt die Barmer Krankenkasse den Zusatznutzen dafür in Frage und fordert in ihrem aktuellen Hilfsmittelreport 2022 künftig einen Nutzencheck für solche Apparaturen, um für Krankenkassen explodierende Kosten einzudämmen 1. Die Deutsche Diabetes Gesellschaft (DDG) und die Deutsche Gesellschaft für Endokrinologie (DGE) begrüßen zwar generell eine Überprüfung aller therapeutischen Hilfsmittel auf ihren medizinischen Nutzen. Sie warnen aber zugleich davor, aus finanziellen Gründen und mithilfe vorschneller Beurteilungen der CGM Patientenwohl zu gefährden. Dies sei ein Rückschritt zu Lasten von Patienten, die eindeutig davon profitieren. Die Fachgesellschaften haben ein entsprechendes Gutachten dem Gemeinsamen Bundesausschuss (G-BA) vorgelegt.
Stereo- and Regioselective Synthesis of (E,E)-Dienes: Evolution from the Transition-Metal-Catalyzed Cross-Coupling to Titanium Alkoxide-Based Alkyne–Alkyne Reductive Coupling
Authors: Wu Jie , Panek James S. , Cai Bin , Toh Ren Wei , Ang Hwee Ting
Published: November 2022

The pursuit of step- and atom-economy in natural product and complex molecule syntheses continuously inspires the development of synthetic methodologies. In this context, to enable efficient synthesis of (E,E)-dienes as common structural subunits in natural products, our lab has established robust protocols based on modified Negishi cross-couplings and evolved them to more concise titanium-mediated alkyne–alkyne reductive coupling. In this review, we summarize the natural product synthesis driven methodology development and their applications in the total synthesis of complex molecules, focusing on the studies from our laboratory.

1 Introduction

2 Transition-Metal-Catalyzed Cross-Coupling in Natural Product Synthesis

2.1 Synthesis of Branched Trisubstituted Conjugated Dienes by Negishi Coupling

2.2 Stereo- and Regiocontrolled Synthesis of Branched Trisubstituted Conjugated Dienes by Modified Negishi Coupling

2.3 Enantioselective Total Synthesis of Reveromycin B by Drouet & Theodorakis

2.4 Enantioselective Synthesis of the Protein Phosphatase Inhibitor (–)-Motuporin by Hu & Panek

2.5 Total Synthesis of (–)-Callystatin A by Langille & Panek

2.6 Total Synthesis of Brevisamide by Lee & Panek

3 Titanium Alkoxide-Mediated Reductive Coupling in Natural Product Synthesis

3.1 Titanium Alkoxide-Mediated Alkyne–Alkyne Reductive Coupling

3.2 Total Synthesis of Callystatin A by Reichard & Micalizio

3.3 Total Synthesis of (–)-Virginiamycin M2 by Wu & Panek

3.4 Total Synthesis of Nuclear Factor of Activated T-Cells-68 (NFAT-68) by Cai & Panek

3.5 Titanium Alkoxide-Based Regioselective Alkyne–Alkyne Reductive Coupling Mediated by in situ Generated Arylamidate

4 Summary
Observation of Rare Tri6Di9 Imine Cages Using Highly Fluorinated Building Blocks
Authors: Fleck-Kunde Tom , Wolpert Emma H. , zur LauraHorst zur , Oestreich Robert , Janiak Christoph , Jelfs Kim E. , Schmidt Bernd M.
Published: November 2022

The first synthesis of organic Tri 6 Di 9 cages is presented. Two structurally distinct Tri 6 Di 9 cages were synthesised by combining a highly fluorinated aldehyde with two ditopic amines. Although the pure compounds could not be isolated despite many attempts, the information obtained is critical for the future design of large supramolecular structures. Computational and experimental methods indicate that the addition of perfluorinated aromatic linkers in the assembly of porous organic cages opens up new possibilities for influencing the reaction pathway towards rare and unknown structures.
Protective Effects of Lactobacillus reuteri on Intestinal Barrier Function in a Mouse Model of Neonatal Necrotizing Enterocolitis
Authors: Lai Zhuoli , Gong Fang
Published: November 2022

Objective The intestinal mucosal and immune barriers play considerable roles in the pathogenesis of necrotizing enterocolitis (NEC). The present research was designed to assess the protective effects of Lactobacillus reuteri (LR) DSM 17938 (LR 17938) on the intestinal barriers and its beneficial effects on inflammation in a neonatal mouse model of NEC.

Study Design Overall, 7-day-old 75 C57BL/6 neonatal mice were separated into three groups (n = 25) as follows: (1) control, (2) NEC, and (3) NEC + LR17938 (LR group). NEC mice were administered a hypertonic feeding formula and subjected to asphyxia and hypothermia. Hematoxylin and eosin (HE) staining and pathological scores were used to assess the pathological changes in the intestine. Oxidative stress was evaluated based on the levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels were detected to assess inflammation. Gut permeability levels, bacterial translocation, and the levels of secretory idioglobulin A (sIgA), β-defensin, and tight junction (TJ) proteins were detected to evaluate gut mucosal and immune barrier function, and gut microbial diversity was detected to assess the composition of the gut flora.

Results LR 17938 administration decreased the NEC-induced increase in intestinal scores, mortality rate, gut damage, the MDA level, and TNF-α and IL-1β expressions. Besides, LR 17938 improved the survival rate of NEC mice. Moreover, LR 17938 administration improved gut permeability levels, SOD activity and the bacterial translocation, ameliorated the expression of TJ proteins, and improved the gut microbiota compared with those of NEC mice.

Conclusion LR 17938 reduced intestinal inflammation and played a protective role in a neonatal animal model of NEC, possibly by regulating oxidative stress and exerting a protective effect on the gut mucosal and immune barriers.

Key Points
New Horizons in Fetal and Neonatal Alloimmune Thrombocytopenia
Authors: Barg Assaf , Bonstein Lilach
Published: November 2022

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a common cause of severe thrombocytopenia in newborns. Intracranial bleeding may lead to severe neurological sequelae and mortality. Current management of pregnancies at risk is suboptimal. Prenatal FNAIT diagnosis commonly requires invasive procedures and therapy is associated with a high treatment burden. The present review explores advances in the field and their potential contribution to modification of the diagnostic and therapeutic landscape. Topics addressed include the role of noninvasive prenatal testing using fetal cell free DNA, insights into novel and prospective therapeutic options achieved through the development of murine models of FNAIT as well as the forecast for the progress in pregnancy risk stratification through advancement in the investigation of biological characteristics of alloantibodies and their association with the risk of fetal bleeding.
A Novel Strategy for the Mechanical Subpulmonary Support in Failing Fontan Patients
Authors: Dal Sasso Eleonora , Schöndorf Thomas , Schlüter Kim-John , Miera Oliver , De Rita Fabrizio , Menon Ares K. ,   on behalf of the European EXCOR® Pediatric Investigator Group (EEPIG)
Published: November 2022

Background The number of single ventricle patients undergoing Fontan palliation and surviving to adulthood worldwide has steadily increased in recent years. Nevertheless, the Fontan circulation is destined to fail. Ultimately, heart transplantation (HTx) remains the definitive treatment option. Due a shortage of organs, mechanical circulatory support in the form of ventricular assist devices (VADs) is widely used to bridge heart failure patients to HTx, but these devices have been mainly developed to address the needs of normal anatomies. A novel venous cannula has been developed as part of the EXCOR® VAD to provide subpulmonary support in these patients. Its clinical application is investigated in the “Registry to Assess the Safety and Feasibility of the Subpulmonary Support with the Novel Venous Cannula in Patients with Failing/Absence of the Right Heart” (RegiVe study, NCT04782232).

Methods RegiVe is a multicenter, international, observational, prospective, non-randomized registry aiming to collect the routine clinical data of up to 20 patients. The primary endpoints address device performance and safety, while the secondary endpoints target organ status and overall safety (according to the Interagency Registry for Mechanically Assisted Circulatory Support – INTERMACS – definitions). Data analysis will be performed by means of descriptive statistics.

Results RegiVe has received the favorable opinion of an independent ethics committee and enrollment has recently started.

Conclusion RegiVe is the first study evaluating the use of a medical device specifically developed for subpulmonary support of failing Fontan patients. The study will provide important insight and further information on this cohort and help to improve a dedicated VAD strategy.
The ART of Thromboprophylaxis in the Prevention of Gestational Venous Thromboembolism
Authors: Grandone Elvira , Barcellona Doris , Intrieri Mariano , Tiscia Giovanni , Nappi Luigi , Othman Maha
Published: November 2022

Assisted reproductive techniques (ART) allow infertile couples to conceive. Use of hormones to obtain a controlled ovarian stimulation and an adequate growth of the endometrium preparatory for embryo implantation are not riskless. Among others, thrombotic events can occur during the ovulation induction or pregnancy following ART. As the number of women approaching ART to conceive is steadily increasing, the issue of thrombotic risk in this setting is relevant. Data on the weight of each risk factor and on potential benefit of thromboprophylaxis are largely lacking. In this review, we discuss risk of venous thromboembolism during pregnancy following ART, with a focus on general (i.e.: age, body mass index, thrombophilia, bed rest, transfusions) and ART-specific (i.e., polycystic ovarian syndrome, ovarian hyperstimulation syndrome) risk factors. We also attempt to provide some suggestions to guide clinical practice, based on available data and studies performed outside ART.
Planning Pregnancy and Birth in Women with Inherited Bleeding Disorders
Authors: Malinowski A. Kinga , Abdul-Kadir Rezan
Published: November 2022

Inherited bleeding disorders are characterized by a diverse clinical phenotype within and across specific diagnoses. von Willebrand disease (VWD), hemophilia A, and hemophilia B comprise 95 to 97% of inherited bleeding disorders, with the remaining 3 to 5% attributed to rare bleeding disorders, including congenital fibrinogen disorders, factor deficiencies (affecting FII, FV, FV + FVIII, FVII, FX, FXI, and FXIII), and platelet function defects. The pregnancy, birth, and the puerperium may be adversely influenced in the setting of an inherited bleeding disorder depending on its type and clinical phenotype. Obstetric hemostatic challenges may sometimes also unmask the presence of a previously unknown inherited bleeding disorder. This review aims to address the approach to pregnancy and birth in the context of an inherited bleeding disorder and highlights the significance of multidisciplinary input into the care of these women.
Early Results of Total Coronary Revascularization via Left Anterior Thoracotomy
Authors: Sellin Christian , Asch Silke , Belmenai Ahmed , Mourad Fanar , Voss Meinolf , Dörge Hilmar
Published: November 2022

Background Avoidance of sternotomy while preserving complete revascularization remains challenging in multivessel coronary disease. Technical issues and in-hospital outcomes of total coronary revascularization via a small left anterior thoracotomy (TCRAT) in nonselected patients with multivessel disease are reported.

Methods From November 2019 to September 2021, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed in 102 patients (92 males; 67 ± 10 [42–87] years). Slings were placed around ascending aorta, left pulmonary veins, and inferior vena cava for exposure of lateral and inferior ventricular wall. All patients had multivessel coronary disease (three-vessel disease: n = 72; two-vessel disease: n = 30; left main stenosis: n = 44). We included patients at old age (> 80 years, 14.7%), with severe left ventricular dysfunction (ejection fraction < 30%, 6.9%), massive obesity (body mass index > 35, 11.6%), and at increased risk (EuroSCORE II > 4, 15.7%).

Results Left internal thoracic artery (n = 101), radial artery (n = 83), and saphenous vein (n = 39) grafts were used for total (61.8%) or multiple (19.6%) arterial grafting. A total of 323 distal anastomoses (3.2 ± 0.7 [2–5] per patient) were performed to revascularize left anterior descending (100%), circumflex (91.2%), and right coronary artery (67.7%). Complete revascularization was achieved in 95.1%. In-hospital mortality was 2.9%, stroke rate was 1.0%, myocardial infarction rate was 2.9%, and repeat revascularization rate was 2.0%.

Conclusion This novel surgical technique allows complete coronary revascularization in the broad majority of multivessel disease patients without sternotomy. TCRAT can be introduced into clinical routine safely. Long-term results remain to be investigated.
Pathophysiology and Management of Heart Failure in the Elderly
Authors: Dewaswala Nakeya , Mishra Vinayak , Bhopalwala Huzefa , Minhas Abdul Khan , Keshavamurthy Suresh
Published: November 2022

The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.
Impact of Ultrasound-Guided Foam Sclerotherapy for Pain Control in Patients with Chronic Venous Disease and Great Saphenous Vein Reflux
Authors: Poschinger-Figueiredo Douglas , Virgini-Magalhães Carlos Eduardo , Amorim Claudia Salvador , Poschinger Alessandra Krykhtine Peres , Chequer Fernanda Pires
Published: November 2022

Chronic venous disease (CVD) associated with great saphenous vein (GSV) reflux has a higher prevalence of pain in the lower limbs. This study evaluates the impact of ultrasound-guided foam sclerotherapy (UGFS) for GSV and symptom control, accessed by the visual analogue scale (VAS). Patients with CVD who underwent GSV-UGFS were included in this retrospective cohort (417 limbs). The pain was measured before and after the treatment. The scale alteration was assessed as a function of age, sex, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classes, total of sclerotherapy sessions, GSV occlusion patterns, and ulcer healing. Majority of patients were female (59.2%), and the mean age was 56 ± 11.5 years. In the total sample, 78.2% of the GSVs were fully occluded, 19.7% had partial occlusion, 2.2% remained open, and 3.2 ± 1.9 (median = 3.0) sessions were performed. The reduction of symptoms occurred in 88.3% of participants (VAS drop median = 4.8). Patients younger than 50 years and females had the greatest VAS decreases. When comparing the outcomes of complete occlusion versus partial occlusion, there was no significant difference in VAS pain reduction (p = 0.14). The comparison between CEAP clinical classes also did not show statistically significant differences in delta VAS (p = 0.71). GSV-UGFS was effective for pain control. However, this improvement does not appear to be related to the pattern of occlusion, indicating that in the short term, the outcomes of total and partial occlusion suggest successful management of symptoms. Other aspects such as gender, age, pretreatment pain intensity, and CEAP classes seem to play a role in the clinical outcome.
Determinants of Quality of Life after Pediatric Traumatic Brain Injury
Authors: Ulgen Tekerek Nazan , Dursun Oguz , Karalok Selen , Koker Alper , Duman Ozgur , Haspolat Senay
Published: November 2022

Introduction Pediatric traumatic brain injury (TBI) is a significant cause of death and long-term disability. There is a paucity of data on quality of life in survivors of pediatric TBI. The aim of this study is to determine the factors affecting the quality of life after TBI in children.

Methods Consecutively admitted 104 of 156 patients to the pediatric intensive care unit (PICU) with TBI between 1 month and 18 years were included in the study. Demographics were obtained from electronic records. Injury severity and mortality scores were calculated. The Pediatric Quality of Life Inventory (PedsQL) scale and Glasgow Outcome Scale (GOS) score were evaluated by interview with patient or the caregiving parents. The Rotterdam computed tomography (CT) score was calculated from the radiology images taken within the first 24 hours after admission to the emergency service.

Results Severe TBI, multiple trauma, intracranial hemorrhage from multiple sites, convulsions, high intracranial pressure, emergency operation on admission, and hypotension on admission were associated with low PedsQL values according to results of univariate analysis (p < 0.05). There was a negative correlation between PedsQL and GOS, mechanical ventilation duration, PICU length of stay (LOS), and hospital LOS. In the linear regression model made by considering the univariate analysis results, it was shown that Rotterdam CT score and PICU LOS are independent variables that determine low PedsQL score. PedsQL scores were lower in children ≥ 8 years of age and in those evaluated within the first year after discharge (p = 0.003).

Conclusion In pediatric TBI, Rotterdam CT score and PICU LOS were found as independent variables determining PedsQL score after discharge.
Interest group preferences towards trade agreements: institutional design matters
Authors: Dür Andreas , Huber Robert A. , Mateo Gemma , Spilker Gabriele
Published: November 2022

Interest groups play a key role in the political economy of preferential trade agreements (PTAs). Their support for or opposition to a planned PTA tends to be crucial in determining the fate of PTAs. But which PTAs receive support from (which) interest groups? Clearly, the design of a PTA, that is, which types of provisions are (not) included in the agreement, is essential in that respect. We argue that trade and trade-related provisions, such as those that regulate services trade or the protection of intellectual property rights, mainly increase support for PTAs among export-oriented business groups. In contrast, the inclusion of non-trade provisions, namely clauses aimed at the protection of environmental and labour standards, makes citizen groups, labour unions, and import-competing business groups more supportive of trade agreements. Relying on original data from a survey of interest groups across the globe, including a conjoint experiment, we find support for the argument that different types of interest groups value the inclusion of trade and non-trade provisions in PTAs differently. Interestingly, however, we find little difference between export-oriented and import-competing business interests. Our study speaks to research on interest groups and trade policy.
Counterfactual analysis of the impact of the first two waves of the COVID-19 pandemic on the reporting and registration of missing people in India
Authors: Paramasivan Kandaswamy , Subramani Brinda , Sudarsanam Nandan
Published: November 2022

The primary duty of law enforcement agencies is to ensure that a victim has the necessary information and access to the relevant tools required to seek justice. In India, complex cases such as bodily offences and property crimes capture the work and efforts of many agencies involved; however, cases related to missing persons are not often accorded similar priority or seriousness. The COVID-19 pandemic and subsequent lockdowns have added further challenges to this scenario. The government-mandated lockdowns in Tamil Nadu generally exacerbated difficult socio-economic and living conditions, thereby directly or indirectly contributing to an increased load of missing person cases. This study aims to assess and identify the impact of mobility on reporting and registration of missing persons. By adopting an auto-regressive neural networks method, this study uses a counterfactual analysis of registered missing person cases during the government-mandated lockdowns in response to the global pandemic in 2020 and 2021. The registered cases are calculated based on the daily count of cases for eleven years in Tamil Nadu, India. The lockdowns identify eight different time windows to determine the impact of mobility on the registration of cases. While there has been no significant or drastic change over the pre-pandemic period, during the pandemic, especially during the restrictive phases of the pandemic, there was a sharp fall in cases compared to the counterfactual predicted (effect sizes: −0.981 and −0.74 in 2020 and 2021), signalling towards a choked mechanism of reporting. In contrast, when most mobility restrictions were removed, an increase in cases (effect sizes of +0.931 and 0.834 in 2020 and 2021) pointed to restored and enabled reporting channels. The research findings emphasise the significance of mobility as a factor in influencing the reporting and registration of missing persons and the need to ensure this continues to help families find redress.
Multi-scale proper orthogonal decomposition analysis of instabilities in swirled and stratified flames
Authors: Procacci A. , Kamal M. M. , Mendez M. A. , Hochgreb S. , Coussement A. , Parente A.
Published: November 2022

This study examines the flow field dynamics of bluff-body stabilized swirling and non-swirling flames produced from the Cambridge/Sandia Stratified Swirl Burner. This burner has been used in previous studies as a benchmark for high-resolution scalar and velocity measurements and for validating numerical models. The burner was designed to create reacting flow conditions that are representative of turbulent flows in modern combustion systems, including sufficiently high turbulence levels, and to operate under both premixed and stratified conditions. High-speed stereoscopic particle image velocimetry was used to acquire time-resolved velocity data for a series of turbulent methane/air flames at both premixed and stratified conditions. We employ the multi-scale proper orthogonal decomposition (mPOD) to identify the main flow patterns in the velocity field and isolate coherent structures linked to various flow instabilities. The results show that the most energetic structures in the flow are consistent with the Bénard–von Kármán (BVK) instability due to the presence of the bluff-body and the Kelvin–Helmholtz (KH) instability caused by the shear layer between the inner and the outer flow. In both the swirling and non-swirling cases, the BVK is suppressed by the combustion, except for the most stratified swirling case. Moreover, the results show that combustion does not affect the KH instability because the shear layer does not coincide with the flame position.
Laser cladding Co-based coating coupled with electromagnetic/ultrasonic compound energy field
Authors: Xu Jiale , Hu Zengrong , Wang Songtao , Tan Wensheng , Zhou Jianzhong
Published: November 2022

Co-based coatings were fabricated by laser cladding coupled with electromagnetic/ultrasonic compound energy field. The microstructural evolution and wear resistance were investigated. The experiment results indicate that the number of coarse dendrites is continuously reduced and that of fine grains is gradually increased as the energy field changes from single to compound energy field. The compound energy field makes the cladding layer microstructure more uniform and refined, leading to the cladding layer showing the best wear resistance, in terms of highest microhardness (531.95 Hv0.2), lowest friction coefficient (0.259), minimum wear rate (8.96 × 10−2mm3 (Nm)−1). The solidification structure of cladding layer can be effectively controlled by applying an external physical field in the process of laser cladding with obvious improvements in mechanical properties, especially for the compound energy field.
Videonystagmography (VNG) and video head impulse test (vHIT) analysis of patients with migraine who had first episode of vertigo
Authors: Yetiser Sertac , Ince Dilay
Published: November 2022

Objective

This study reviews the pattern of vestibular disturbance by videonystagmography (VNG) and video head impulse (vHIT) tests in patients with migraine during first attack of vertigo.

Method

Thirty-four patients with migraine (21 female, 13 male) were recruited. The main outcome measure is to analyze the spontaneous nystagmus, VNG findings, and the pattern of vHIT abnormality. Patients were grouped as those with (Group-I, 24 patients) or without (Group-II, 10 patients) spontaneous nystagmus. One-way analysis of variance (ANOVA test) was used to analyze the groups.

Results

Normal vHIT responses without refixation saccades but with lower gain were detected in 10 patients (29.4%). Fourteen patients (41%) showed abnormal vHIT results either in the form of normal or low VOR gain with refixation saccades. Six patients (42%) demonstrated dysfunction of both vestibular nerves. Of the 8 patients with unilateral refixation saccades, 2 patients (25%) had involvement of both vestibular nerve divisions, 2 patients had (25%), the superior vestibular nerve, and 4 patients (50%) had inferior vestibular nerve involvement.

Conclusion

Results suggest that the peripheral vestibular system is likely affected during migraine-associated vertigo. Re-fixation saccades were detected by vHIT in nearly half of the patients (42%). However, no specific pattern has been found. Inferior vestibular nerve involvement was more frequent.
The Use of the International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy
Authors: Nikas Ilias P , Vey Johannes A , Proctor Tanja , AlRawashdeh Mousa M , Ishak Angela , Ko Hyang Mi , Ryu Han Suk
Published: November 2022

Objectives

To perform the first meta-analysis regarding the pooled risk of malignancy (ROM) of each category of the Yokohama system for reporting breast fine-needle aspiration, as well as assess the latter’s diagnostic accuracy using this new system.

Methods

Two databases were searched, followed by data extraction, study quality assessment, and statistical analysis.

Results

The “Insufficient,” “Benign,” “Atypical,” “Suspicious,” and “Malignant” Yokohama system categories were associated with a pooled ROM of 17% (95% CI, 10%-28%), 1% (95% CI, 1%-3%), 20% (95% CI, 17%-23%), 86% (95% CI, 79%-92%), and 100% (95% CI, 99%-100%), respectively. When both “Suspicious” and “Malignant” interpretations were regarded as cytologically positive, sensitivity (SN) was 91% (95% CI, 87.6%-93.5%) and false-positive rate (FPR) was 2.33% (95% CI, 1.30-4.14%). A summary receiver operating characteristic curve was constructed and the pooled area under the curve was 97.3%, while the pooled diagnostic odds ratio was 564 (95% CI, 264-1,206), indicating a high level of diagnostic accuracy. When only “Malignant” interpretations were regarded as cytologically positive, the pooled FPR was lower (0.75%; 95% CI, .39%-1.42%) but at the expense of SN (76.61%; 95% CI, 70.05%-82.10%).

Conclusions

Despite Yokohama’s system early success, more data would be needed to unravel the system’s value in clinical practice.
Identification and reduction of hazardous drug surface contamination through the use of a novel closed-system transfer device coupled with a point-of-care hazardous drug detection system
Authors: Brechtelsbauer Erich
Published: November 2022

Purpose

Minimizing hazardous drug (HD) contamination is critical for protecting the health of healthcare workers (HCWs) and patients. Alarmingly, widespread HD contamination has been documented across a variety of clinical settings. Quantitative wipe sampling presents significant time and cost barriers, resulting in routine monitoring adherence rates around 25%. Closed-system drug transfer devices (CSTDs) and qualitative point-of-care tests can be implemented to overcome these barriers.

Methods

In this study, we tested the effects of the BD PhaSeal Optima (Becton, Dickinson and Company), a recently introduced CSTD, on HD contamination at 2 chemotherapy infusion centers. Wipe samples were taken at 29 workstations at each location prior to and a year following CSTD implementation. Additionally, traditional liquid chromatography with mass spectrometry (LCMS/MS) analyses were compared against a novel lateral flow immunoassay HD testing device (BD HD Check; Becton, Dickinson and Company) to determine the validity of the qualitative assay.

Results

We found a 46% reduction in HD contamination after incorporating the CSTD into clinical workflows. Across time points and sites, HD contamination reported by the BD HD Check device was 91% accurate against LCMS/MS and 98% accurate within its limits of detection.

Conclusion

Collectively, the evaluated CSTD and lateral flow immunoassay device may help to reduce HD contamination and provide real-time measures of contamination, respectively. As part of a multifaceted approach, these devices may help minimize barriers to routine monitoring, ultimately improving the safety of HCWs and patients.
Building a pharmacy technician structure for the future: A lesson from a multihospital academic health system
Authors: O’Neil Daniel P , Henderson Jennifer M , Gifford Hannah R , Karpinski Todd A , Kaminsky Leeann
Published: November 2022

Purpose

Over the past decade there has been increased attention on the need for highly skilled and trained pharmacy technicians; however, few best practices to assist health-system pharmacies in meeting technician workforce challenges have been identified. These challenges have been further revealed since 2019 through rising inflation, increased cost of living, and competing opportunities for skilled technical workers. This article describes an 18-hospital academic health system’s experience implementing an innovative pharmacy technician career structure focused on increasing pharmacy technician engagement as well as improving recruitment and retention.

Methods

Prior to creating a new career structure, the department of pharmacy had one development track for pharmacy technicians, which included only 2 nonsupervisory job titles. Due to recruitment, retention, and employee engagement challenges, the department of pharmacy, in collaboration with the human resources department, developed a new pharmacy technician structure that included 3 pharmacy technician tracks and 4 nonsupervisory levels. Outcomes collected to determine the success of the program included pharmacy technician engagement survey scores, annual voluntary turnover rate, rolling 12-month voluntary turnover rate, monthly vacancy rate, and average years of service at termination. The monthly discharge prescription capture rate was also measured to support efforts to keep the cost of the new structure budget neutral.

Conclusion

The change in career structure assisted in the improvement of each outcome identified. The close collaboration of the departments of pharmacy and human resources can lead to positive solutions of national problems and have a sustained impact on department operations.
The ‘Screw Boys’ and the ‘Businessmen’: Re-Negotiating Penal Power, Governance and Legitimate Authority Through a Prison Violence Reduction Scheme
Authors: Gooch Kate , Treadwell James
Published: November 2022

Drawing on ethnographic and qualitative research, this article explores how both prisoners and staff wield authority in prison and with what effects. It combines legitimacy theory and governance theory to consider the relationship between legitimate and illegitimate governance by prisoners and officers, as well as establishing the limits of prisoner governance in remedying the deficits in State illegitimacy. It is argued that legitimate governance by prisoners (in the form of peer-support roles) must be coupled with the legitimate use of authority by prison officers to avoid the emergence, or expansion, of illegitimate prisoner governance. When this does not exist, such peer-support roles can distort the system of power and stimulate, rather than arrest, greater decline in social and moral order.
Five-year follow-up of a randomized clinical trial comparing bursectomy and omentectomy alone for resectable gastric cancer (JCOG1001)
Authors: Kurokawa Yukinori , Doki Yuichiro , Mizusawa Junki , Yoshikawa Takaki , Yamada Takanobu , Kimura Yutaka , Takiguchi Shuji , Nishida Yasunori , Fukushima Norimasa , Cho Haruhiko , Kaji Masahide , Hirao Motohiro , Sasako Mitsuru , Terashima Masanori
Published: November 2022

Background

Bursectomy, the total resection of the bursa omentalis, is a standard procedure in gastrectomy for resectable gastric cancer. A phase III trial (JCOG1001) comparing bursectomy and omentectomy alone was terminated early at the interim analysis. The final results of the updated analysis after a minimum follow-up of 5 years are reported here.

Methods

Patients with histologically proven adenocarcinoma of the stomach (cT3–T4a) were randomized (1 : 1) during surgery to bursectomy or omentectomy-alone groups and then underwent D2 gastrectomy. The primary endpoint was overall survival, analysed on an intention-to-treat basis.

Results

A total of 1204 patients (602 bursectomy and 602 omentectomy alone) were enrolled between June 2010 and March 2015. The bursectomy group had a significantly higher incidence of Clavien–Dindo grade III–IV intra-abdominal abscess than the omentectomy-alone group (5.5 versus 2.5 per cent respectively; P = 0.008). The updated 5-year overall survival rates were 74.9 (95 per cent c.i. 71.2 to 78.2) per cent in the bursectomy group and 76.5 (72.8 to 79.7) per cent in the omentectomy-alone group; the adjusted HR for death in the bursectomy group was 1.03 (95 per cent c.i. 0.83 to 1.27) (1-sided P = 0.598). Bursectomy did not decrease peritoneal recurrence (12.1 versus 12.3 per cent respectively; P = 1.000). In a multivariable analysis, old age (above 65 years), tumour located in the lower third or posterior wall of the stomach, macroscopic type 3/5, total gastrectomy, and cT4a were independent predictors of poor overall survival, but omentectomy alone was not.

Conclusion

In D2 gastrectomy, bursectomy is not recommended as a standard procedure for cT3–T4a gastric cancer. Registration number: UMIN000003688 (https://www.umin.ac.jp/ctr/).