bluuebunny/crossref_metadata_2025 huggingface dataset:
Sovereignty and Reason of State
Authors: Mortimer Sarah
Published: September 2021

In the wake of the upheavals of the 1560s, new ideas about strengthening the power of rulers began to emerge. The central concept was sovereignty, first brought to public attention by the French jurist and lawyer Jean Bodin. Bodin wanted to defend the sovereign against external and internal threats, anchoring its power in divine and natural law but also giving him (or it) considerable scope for discretion. This chapter explores the origins and implications of this new interest in sovereignty, showing how it focused attention on the power of the ruler in relation to other sources of authority, notably the Church and the conscience of individuals. At Rome, Cardinal Bellarmine argued for the limits of state authority and for the indirect power of the papacy over magistrates, but other Catholics took different approaches. In particular, Giovanni Botero’s The Reason of State offered an approach to statecraft in which Church and state worked together. Meanwhile, in the Netherlands Justus Lipsius wove together classical texts, especially Tacitus, offering a route to stability and unity in a time of conflict; he acknowledged that conventional morality was sometimes inappropriate for a statesman who would need to adapt to the times. In France, Michel de Montaigne’s ground-breaking Essays combined personal reflection with subtle commentary on the world around him, as he sought to preserve his own integrity and maintain stability within his local community.
The Limits of Obedience
Authors: Mortimer Sarah
Published: September 2021

The murder of Henry III in 1589 plunged France further into crisis, raising questions not only of succession but also of the limits of royal power and the legitimacy of resistance. Leading figures in the French Catholic League, along with the Spanish Jesuit Juan de Mariana, defended this act of tyrannicide. Meanwhile, the ageing English queen Elizabeth I was still childless, and anxiety about the succession was exacerbated by Catholic writers, notably Robert Parsons. In these debates, appeal was made once more to the idea of ‘the people’, but now the role of clergy, kings and magistrates in transforming a multitude into a people was examined more explicitly. In response, James VI of Scotland began to defend ‘free monarchy’ and the divine right of kings; while the jurist William Barclay defended monarchy against those he called ‘monarchomachs’—Catholic and Protestant advocates of resistance. The Venetian Interdict and James’s Oath of Allegiance brought into focus the question of where sovereignty lay and the relationship between Church and state. In this context, the Jesuit Francisco Suarez offered a series of texts which not only reaffirmed papal indirect power but were also designed to make sense of the Christian’s relationship to the civil and ecclesiastical authorities and to provide effective, authoritative counsel for Christian souls.
Sexual consent norms in a cross-sectional national sample of the UK
Authors: Willis Malachi , Marcantonio Tiffany L
Published: September 2021

Background

Sexual assault is a pervasive problem in the UK, and young women are disproportionately affected. We sought to provide an initial account of sexual consent norms in the UK and whether they differ by gender and age.

Method

The present study was a secondary analysis of data collected by the Family Planning Association, which conducted an online survey (N = 2003) to assess experiences with, knowledge of, and attitudes toward consent. The sample represented all regions of the UK and spanned ages 14–55.

Results

Definitions of sexual consent endorsed by women and older age groups more closely aligned with the tenets of affirmative consent compared with men and younger age groups. Women and older age groups were also more likely to perceive that various nonverbal cues may be used to interpret sexual consent or refusal and were more supportive of people being able to withdraw their sexual consent.

Conclusion

Maladaptive sexual consent norms seemed to be prevalent among men and young people in the UK, which may contribute to young women’s elevated risk of experiencing sexual assault. Our findings support the UK’s recent relationships and sex education curriculum that actively promotes healthy sexual consent norms.
International Spillovers and Local Credit Cycles
Authors: di Giovanni Julian , Kalemli-Özcan Şebnem , Ulu Mehmet Fatih , Baskaya Yusuf Soner
Published: September 2021

This article studies the transmission of the Global Financial Cycle (GFC) to domestic credit market conditions in a large emerging market, Turkey, over 2003–13. We use administrative data covering the universe of corporate credit transactions matched to bank balance sheets to document four facts: (1) an easing in global financial conditions leads to lower borrowing costs and an increase in local lending; (2) domestic banks more exposed to international capital markets transmit the GFC locally; (3) the fall in local currency borrowing costs is larger than foreign currency borrowing costs due to the co-movement of the uncovered interest rate parity (UIP) premium with the GFC over time; (4) data on posted collateral for new loan issuances show that collateral constraints do not relax during the boom phase of the GFC.
Polygenic Risk for Schizophrenia, Brain Structure, and Environmental Risk in UK Biobank
Authors: Zhu Xingxing , Ward Joey , Cullen Breda , Lyall Donald M , Strawbridge Rona J , Smith Daniel J , Lyall Laura M
Published: September 2021

Schizophrenia is a heritable neurodevelopmental disorder characterized by neuroanatomical changes in the brain, but exactly how increased genetic burden for schizophrenia influences brain structure is unknown. Similarly, how environmental risk factors for schizophrenia impact brain structure is not fully understood. Here we investigated how genetic burden for schizophrenia (indexed by a polygenic risk score, PRS-SCZ) was associated with cortical thickness (CT), surface area (SA), cortical volume (CV), and subcortical structures within 18 088 White British ancestry participants with derived brain phenotypes from UK Biobank. We also explored whether environmental risk factors for schizophrenia (childhood trauma, cannabis use, birth weight, season of birth, and Townsend social deprivation index) exacerbated the impact of PRS-SCZ on brain structure. We found that PRS-SCZ was associated with lower CT in the frontal lobe, insula lobe, lateral orbitofrontal cortex, medial orbitofrontal cortex, posterior cingulate cortex, and inferior frontal cortex, and reduced SA and CV in the supramarginal and superior temporal cortex, but not with subcortical volumes. When models included environmental risk factors as covariates, PRS-SCZ was only associated with lower SA/CV within the supramarginal cortex, superior temporal cortex, and inferior frontal cortex. Moreover, no interactions were observed between PRS-SCZ and each of the environmental risk factors on brain structure. Overall, we identified brain structural correlates of PRS-SCZ predominantly within frontal and temporal regions and some of these associations were independent of environmental risk factors, suggesting that they may represent vulnerable biomarkers of genetic risk for schizophrenia. Future research is warranted to establish these associations beyond older White British individuals.
Medical cannabis and cannabinoids for impaired sleep: a systematic review and meta-analysis of randomized clinical trials
Authors: AminiLari Mahmood , Wang Li , Neumark Samuel , Adli Taranah , Couban Rachel J , Giangregorio Aidan , Carney Colleen E , Busse Jason W
Published: September 2021

Study Objectives

We conducted a systematic review to explore the effectiveness of medical cannabis for impaired sleep.

Methods

We searched MEDLINE, EMBASE, CENTRAL, and PsychINFO to January 2021 for randomized trials of medical cannabis or cannabinoids for impaired sleep vs. any non-cannabis control. When possible, we pooled effect estimates for all patient-important sleep-related outcomes and used the GRADE approach to appraise the certainty of evidence.

Results

Thirty-nine trials (5100 patients) were eligible for review, of which 38 evaluated oral cannabinoids and 1 administered inhaled cannabis. The median follow-up was 35 days, and most trials (33 of 39) enrolled patients living with chronic cancer or noncancer chronic pain. Among patients with chronic pain, moderate certainty evidence found that medical cannabis probably results in a small improvement in sleep quality versus placebo (modeled risk difference [RD] for achieving the minimally important difference [MID], 8% [95% CI, 3 to 12]). Moderate to high certainty evidence shows that medical cannabis vs. placebo results in a small improvement in sleep disturbance for chronic non-cancer pain (modeled RD for achieving the MID, 19% [95% CI, 11 to 28]) and a very small improvement in sleep disturbance for chronic cancer pain (weighted mean difference of –0.19 cm [95%CI, –0.36 to –0.03 cm]; interaction p = .03). Moderate to high certainty evidence shows medical cannabis, versus placebo, results in a substantial increase in the risk of dizziness (RD 29% [95%CI, 16 to 50], for trials with ≥3 months follow-up), and a small increase in the risk of somnolence, dry mouth, fatigue, and nausea (RDs ranged from 6% to 10%).

Conclusion

Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.
Duration of Downy Mildew Control Achieved with Fungicides on Cucumber Under Florida Field Conditions
Authors: Shirley Andrew M. , Vallad Gary E. , Dufault Nicholas , Raid Richard , Quesada-Ocampo Lina
Published: September 2021

Cucurbit production in Florida is impacted by downy mildew on a yearly basis. Cucurbit downy mildew (CDM), caused by Pseudoperonospora cubensis, is one of the most devastating cucurbit diseases and can lead to complete yield loss. Nearly continuous production of cucurbits occurs temporally throughout Florida, which puts extensive pressure on the pathogen population to select for individuals that are resistant to fungicides in use labeled for CDM. Loss of efficacy as a result of fungicide resistance developing is becoming a major concern for Florida cucurbit growers who rely on these products to manage CDM. This study was established to evaluate the field activity of 11 utilized fungicides by determining their duration of activity when applied at various intervals for the management of CDM in cucumber under Florida field conditions. By comparing levels of percent CDM control and area under the disease progress curve values, the fungicide’s duration of field activity was established. Field activities were <1 week for dimethomorph and fluopicolide; 1 week for cymoxanil; 1 to 2 weeks for chlorothalonil and mancozeb; 2 weeks for ethaboxam; 1 to 3 weeks for propamocarb, cyazofamid, and ametoctradin + dimethomorph; and 2 to 4 weeks for oxathiapiprolin and fluazinam. Knowledge of duration of field activity can potentially improve the development of CDM management programs and slow the resistance selection.
Virulence Characterization of Puccinia graminis f. sp. avenae and Resistance of Oat Cultivars in China
Authors: Li Tianya , Xu Yiwei , Zhang Xue , Wu Xianxin , Zhang Yazhao , Xuan Yuanhu , Wang Shu
Published: September 2021

Oat stem rust, caused by Puccinia graminis f. sp. avenae, is one of the most devastating diseases of oat. The most cost-effective and environmentally friendly strategy to control this disease is the use of resistant cultivars. However, P. graminis f. sp. avenae can overcome the resistance of cultivars by rapidly changing its virulence. Thus, information on the virulence of P. graminis f. sp. avenae populations and resistance of cultivars is critical to control the disease. The current study was conducted to monitor the virulence composition and dynamics of the P. graminis f. sp. avenae population in China and to evaluate resistance of oat cultivars. Oat leaves naturally infected by P. graminis f. sp. avenae were collected in 2018 and 2019, and 159 isolates were derived from single uredinia. The isolates were tested on 12 international differential lines, and eight races, TJJ, TBD, TJB, TJD, TJL, TJN, TGD, and TKN, were identified for the first time in China. The predominant race was TJD, virulent against Pg1, Pg2, Pg3, Pg4, Pg8, Pg9, and Pg15, accounting for 35.8 and 37.8% in 2018 and 2019, respectively. The sub-predominant races were TJN (30.2% in 2018, 28.3% in 2019) and TKN (20.8% in 2018, 12.3% in 2019). All isolates were virulent to Pg1, Pg2, Pg3, and Pg4, and avirulent to Pg6 and Pg16. The three predominant races (TJD, TJN, and TKN) were used to evaluate resistance in 30 Chinese oat cultivars at the seedling and adult plant stages. Five cultivars, Bayan 1, Baiyan 2, Baiyan 3, Baiyan 5, and Baiyan 9, were highly resistant to the three races at both seedling and adult plant stages. The results of the virulences and frequencies of P. graminis f. sp. avenae races and the resistant cultivars will be useful in elucidating the pathogen migration and evolution and for breeding oat cultivars with stem rust resistance.
The Value of Nurses Specialized in Wound, Ostomy, and Continence: A Systematic Review
Authors: Heerschap Corey , Duff Victoria
Published: September 2021

OBJECTIVE

To critically appraise peer-reviewed evidence concerning the value, or implied sense of worth or benefit, of nurses specialized in wound, ostomy, and continence (WOC) care.

DATA SOURCES

The Preferred Reporting Items for Systematic Reviews and Meta-analyses was used to systematically review current literature in a single database from 2009 to the date of search (July 2019).

STUDY SELECTION

The initial search retrieved 2,340 elements; 10 studies were retained following removal of duplicate records, title and abstract reviews, and application of the inclusion/exclusion criteria.

DATA EXTRACTION

Literature was graded and critiqued with regard to design and research quality and then synthesized using a narrative approach.

DATA SYNTHESIS

Nine values that WOC nurses demonstrate were identified: improved quality of life for patients, teaching and mentoring, cost reduction, improved efficiency, improved wound outcomes, improved incontinence outcomes, advanced treatments, research, and leadership.

CONCLUSIONS

Although current studies suggest that there is value in the WOC nurse role, in all areas of the trispecialty, there is a need for high-quality literature with higher-level designs focused on bias reduction.
An immunologist's perspective on anti-COVID-19 vaccines
Authors: Milota Tomas , Strizova Zuzana , Smetanova Jitka , Sediva Anna
Published: September 2021

Purpose of review

Antisevere acute respiratory syndrome-corona virus 2 (SARS-CoV-2) vaccines may provide prompt, effective, and safe solution for the COVID-19 pandemic. Several vaccine candidates have been evaluated in randomized clinical trials (RCTs). Furthermore, data from observational studies mimicking real-life practice and studies on specific groups, such as pregnant women or immunocompromised patients who were excluded from RCTs, are currently available. The main aim of the review is to summarize and provide an immunologist's view on mechanism of action, efficacy and safety, and future challenges in vaccination against SARS-CoV-2.

Recent findings

mRNA and recombinant viral vector-based vaccines have been approved for conditional use in Europe and the USA. They show robust humoral and cellular responses, high with efficacy in prevention of COVID-19 infection (66.9 95%) and favorable safety profile in RCTs. High efficacy of 80–92% was observed in real-life practice. A pilot study also confirmed good safety profile of the mRNA vaccines in pregnant women. Unlike in those with secondary immunodeficiencies where postvaccination responses did not occur, encouraging results were obtained in patients with inborn errors of immunity.

Although both RCTs and observational studies suggest good efficacy and safety profiles of the vaccines, their long-term efficacy and safety are still being discussed. Despite the promising results, clinical evidence for specific groups such as children, pregnant and breastfeeding women, and immunocompromised patients, and for novel virus variants are lacking.

Video abstract

http://links.lww.com/COAI/A21.
Human factors affecting intraoperative patient safety
Authors: De Hert Stefan
Published: September 2021

Purpose of review

This review addresses the importance of some of the human factors for intraoperative patient safety with particular focus on the active failures. These are the mishaps or sentinel events related to decisons taken and actions performed by the individual at the delivery end of a system. Such sentinel events may greatly affect intraoperative patient safety.

Recent findings

Intimidating, aggressive and disruptive communication is a cause of adverse staff interaction, which may then represent an important patient safety threat. Also, anaesthesiologist's physical and mental state and limitations may interfere with patient safety.

The concept of physician well being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Creating optimal safe conditions for patients, therefore, requires actions at both the personal level and the working conditions. Also, initiatives to ban rude and dismissive communication should be implemented in order to further improve intraoperative patient safety.
Cost-effectiveness analysis of short versus long cephalomedullary nails for treatment of stable intertrochanteric femoral fractures: a theoretical cohort study
Authors: Fuller Carson C. , Kweon Christopher , Baker Timothy , Reese Carlie , Lack William D.
Published: September 2021

Background:

Cephalomedullary nails are the current preferred method of fixation for the treatment of intertrochanteric fractures. Both short and long nails are currently used, and physician and institutional preferences are highly variable.

Methods:

Literature on intertrochanteric fracture types as categorized by the AO/Orthopaedic Trauma Association (AO/OTA) 31-A1, A2, and A3, was reviewed to determine failure rates requiring reoperation and health utility values. A decision-tree baseline followed by a Monte Carlo simulation was used to determine cost-effectiveness of each nail length at an incremental cost-effectiveness ratio threshold of $100,000 per quality-adjusted life-year. Procedural costs were derived from Medicare reimbursement rates and incremental costs of long nails were calculated using primary literature.

Results:

The model demonstrates short nails to be the more cost-effective implant. At the mean incremental long nail cost of $1,950 the short nail had an incremental cost-effectiveness ratio greater than $100,000/quality-adjusted life-year when the secondary fracture rate of short nails was at the mean value of 1.5%. At a short nail fracture rate greater than 2.4%, long nails were more cost-effective. In our theoretical cohort, a probabilistic sensitivity analysis demonstrated the short nail to be the cost-effective method 70% of the time at a willingness to pay of $100,000.

Conclusions:

Given the current reported failure ranges, short nails are the more cost-effective approach for the treatment of stable intertrochanteric femoral fractures. These conclusions are highly sensitive to the secondary fracture rate, which could confound our analysis because of limitations in length and quality of follow-up in the available primary literature.

Level of Evidence:

Level III.
The effect of COVID-19 on children with congenital talipes equinovarus in a tertiary service in the United Kingdom
Authors: Firth Gregory B. , Peniston William , Ihediwa Ugwunna , Bijlsma Paulien , Walsh Linda , Ramachandran Manoj
Published: September 2021

During the coronavirus disease 2019 (COVID-19) pandemic, many aspects of healthcare have been hindered. The primary aim of this study was to identify what the impact of COVID-19 was on the delivery of outpatient care for children with congenital talipes equinovarus deformity (CTEV) at a large tertiary hospital in the UK. This study reviewed the patients who commenced their Ponseti treatment between March and September 2020, representing the cohort who received hands-on care during the first wave of the COVID-19 pandemic. Equivalent 6-month periods were searched in 2019 and 2018 as control cohorts. This study included a total of 45 children (72 affected feet) presenting for treatment of clubfoot. Twenty-three babies were seen with CTEV in 2020. For the same time period in 2018 and 2019, 11 babies were treated each year. The distance commuted to by families was higher in 2020 compared to 2019 and 2018, although the difference did not reach statistical significance (P = 0.301). Treatment with Ponseti casting was commenced at a mean age of 52 days, with no statistically significant differences between cohorts (P = 0.758). Using strict precautions, the Ponseti service at a large tertiary hospital in the UK grew in size and successfully provided treatment for children presenting with CTEV during the first wave of the COVID-19 pandemic. This study has shown that with careful protocols in place, children with CTEV can be treated successfully during times of pandemic, thereby reducing the post-pandemic burden of older children requiring treatment.
Complications With Surgical Treatment of Pediatric Supracondylar Humerus Fractures: Does Surgeon Training Matter?
Authors: Sullivan Mikaela H. , Stillwagon Matthew R. , Nash Alysa B. , Jiang Huijun , Lin Feng-Chang , Chen Andrew T. , Louer Craig R.
Published: September 2021

Introduction:

National trends reveal increased transfers to referral hospitals for surgical management of pediatric supracondylar humerus (SCH) fractures. This is partly because of the belief that pediatric orthopaedic surgeons (POs) deliver improved outcomes compared with nonpediatric orthopaedic surgeons (NPOs). We compared early outcomes of surgically treated SCH fractures between POs and NPOs at a single center where both groups manage these fractures.

Methods:

Patients ages 3 to 10 undergoing surgery for SCH fractures from 2014 to 2020 were included. Patient demographics and perioperative details were recorded. Radiographs at surgery and short-term follow-up assessed reduction. Primary outcomes were major loss of reduction (MLOR) and iatrogenic nerve injury (INI). Complications were compared between PO-treated and NPO-treated cohorts.

Results:

Three hundred and eleven fractures were reviewed. POs managed 132 cases, and NPOs managed 179 cases. Rate of MLOR was 1.5% among POs and 2.2% among NPOs (P=1). Rate of INI was 0% among POs and 3.4% among NPOs (P=0.041). All nerve palsies resolved postoperatively by mean 13.1 weeks. Rates of reoperation, infection, readmission, and open reduction were not significantly different. Operative times were decreased among POs (38.1 vs. 44.6 min; P=0.030). Pin constructs were graded as higher quality in the PO group, with a higher mean pin spread ratio (P=0.029), lower rate of “C” constructs (only 1 “column” engaged; P=0.010) and less frequent crossed-pin technique (P<0.001). Multivariate analysis revealed minimal positive associations only for operative time with MLOR (odds ratio=1.021; P=0.005) and INI (odds ratio=1.048; P=0.009).

Conclusions:

Postsurgical outcomes between POs and NPOs were similar. Rates of MLOR were not different between groups, despite differences in pin constructs. The NPO group experienced a marginally higher rate of INI, though all injuries resolved. Pediatric subspecialty training is not a prerequisite for successfully treating SCH fractures, and overall value of orthopaedic care may be improved by decreasing transfers for these common injuries.

Level of Evidence:

Level III—retrospective cohort study.
Should Q-CT Be the Gold Standard for Detecting Spinal Osteoporosis?
Authors: Kulkarni Arvind G. , Thonangi Yeshwanth , Pathan Sharukh , Gunjotikar Sharvari , Goparaju Praveen , Talwar Inder , Jaggi Sunila , Shah Sonali , Shah Neha , Kursija Girish
Published: September 2021

Study Design.

Prospective comparative study.

Objective.

Refinement of the guidelines for screening of osteoporosis and considering quantitative computed tomography (Q-CT) for detecting spinal osteoporosis.

Summary of Background Data.

Spinal osteoporosis is often underestimated and under-evaluated due to either lack of availability of the diagnostic modality or lack of awareness about the possibility of overestimation by dual X-ray absorptiometry (DXA) scan. There is a need for reconsidering osteoporosis evaluation with a site specific and patient specific inclination.

Methods.

Post-menopausal women that underwent bone mineral density (BMD) evaluation from January-2018 to December-2020 with either Q-CT or DXA were evaluated. Comparison studies of the distribution of age and T-scores of the bone densities obtained from the two study groups: age-matched, sex-matched, and common skeletal site of interest (L1-4 vertebrae) were performed. Mann–Whitney U test, correlation and regression analyses were performed and bell curves were plotted.

Results.

Of the 718 women evaluated, 447 underwent Q-CT and 271 underwent DXA. There was no significant difference among the age distribution of the two study groups (P-value > 0.05). The mean and mode T-scores obtained by Q-CT and DXA were found to be –2.71, –3.8 and –1.63, –1.7 respectively. A highly significant difference in the T-scores was observed in the Q-CT and DXA groups (P-value < 0.0001). Among those who were screened by Q-CT, 58.16% were osteoporotic, 37.58% were osteopenic, and 4.25% were normal. The respective percentages in the DXA group were 30.63%, 49.82%, and 19.55%.

Conclusion.

Q-CT provides more precise estimation of cancellous bone mineral density than DXA. With the reliance on DXA for spinal BMD estimation being questionable, new standards have to be established for spinal osteoporosis evaluation. Q-CT can be a better alternative to replace DXA as the gold standard for the evaluation of spinal osteoporosis.

Level of Evidence: 2
Insufficient Recovery From C5 Palsy Following Anterior Cervical Decompression and Fusion
Authors: Odate Seiichi , Shikata Jitsuhiko , Yamamura Satoru , Okahata Akinori , Kawaguchi Shinji , Tanaka Chiaki
Published: September 2021

Study Design.

Retrospective study.

Objective.

To determine the risk factors for insufficient recovery from C5 palsy (C5P) following anterior cervical decompression and fusion (ADF).

Summary of Background Data.

Postoperative C5P is a frequent but unsolved complication following cervical decompression surgery. Although most patients gradually recover, some recover only partially. When we encounter new-onset C5P following ADF, the question that often arises is whether the palsy will sufficiently resolve.

Methods.

We retrospectively reviewed consecutive patients who underwent ADF at our institution. We defined C5P as postoperative deterioration of deltoid muscle strength by two or more grades determined by manual muscle testing (MMT). We evaluated the following demographic data: patient factors, surgical factors, and radiological findings. C5P patients were divided into two groups: sufficient recovery (MMT grade≧4) and insufficient recovery (MMT grade < 4). Each parameter was compared between the two groups.

Results.

Of 839 patients initially included in the study, 57 experienced new-onset C5P (6.8%). At the final follow-up (mean, 55 ± 17 months), 41 patients experienced sufficient recovery, whereas 16 (28%) still exhibited insufficient recovery. Compared with the sufficient recovery group, patients with insufficient recovery exhibited a higher decompression combination score, a larger anterior shift in preoperative cervical sagittal balance, less lordosis of the pre- and postoperative C4/C5 segment, more frequent stenosis at the C3/C4 segment, lower deltoid strength at C5P onset, more frequent co-occurrence of biceps weakness, greater postoperative expansion of the dura mater, and more frequent presence of postoperative T2 high-intensity areas. Multivariate analysis revealed that co-occurrence of biceps muscle weakness, less lordosis at the preoperative C4/C5 segment, and postoperative expansion of the dura mater were independent predictors of insufficient recovery.

Conclusion.

The combination of unfavorable conditions, such as potential spinal cord disorder, cervical malalignment, and excessive expansion of the dura mater after corpectomy, predicts insufficient recovery from C5P.

Level of Evidence: 4
Gallbladder disease and pancreatic cancer risk: a multicentric case-control European study
Authors: Rosato V. , Gómez-Rubio P. , Molina-Montes E. , Márquez M. , Löhr M. , O’Rorke M. , Michalski C. W. , Molero X. , Farré A. , Perea J. , Kleeff J. , Crnogorac-Jurcevic T. , Greenhalf W. , Ilzarbe L. , Tardón A. , Gress T. , Barberá V. M. , Domínguez-Muñoz E. , Muñoz-Bellvís L. , Balsells J. , Costello E. , Iglesias M. , Kong Bo , Mora J. , O’Driscoll D. , Poves I. , Scarpa A. , Ye W. , Hidalgo M. , Sharp L. , Carrato A. , Real F. X. , La Vecchia C. , Malats N.
Published: September 2021

Background and aims:

The overall evidence on the association between gallbladder conditions (GBC: gallstones and cholecystectomy) and pancreatic cancer (PC) is inconsistent. To our knowledge, no previous investigations considered the role of tumour characteristics on this association. Thus, we aimed to assess the association between self-reported GBC and PC risk, by focussing on timing to PC diagnosis and tumour features (stage, location, and resection).

Methods:

Data derived from a European case-control study conducted between 2009 and 2014 including 1431 PC cases and 1090 controls. We used unconditional logistic regression models to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for recognized confounders.

Results:

Overall, 298 (20.8%) cases and 127 (11.6%) controls reported to have had GBC, corresponding to an OR of 1.70 (95% CI 1.33–2.16). The ORs were 4.84 (95% CI 2.96–7.89) for GBC diagnosed <3 years before PC and 1.06 (95% CI 0.79–1.41) for ≥3 years. The risk was slightly higher for stage I/II (OR = 1.71, 95% CI 1.15–2.55) vs. stage III/IV tumours (OR = 1.23, 95% CI 0.87–1.76); for tumours sited in the head of the pancreas (OR = 1.59, 95% CI 1.13–2.24) vs. tumours located at the body/tail (OR = 1.02, 95% CI 0.62–1.68); and for tumours surgically resected (OR = 1.69, 95% CI 1.14–2.51) vs. non-resected tumours (OR = 1.25, 95% CI 0.88–1.78). The corresponding ORs for GBC diagnosed ≥3 years prior PC were close to unity.

Conclusion:

Our study supports the association between GBC and PC. Given the time-risk pattern observed, however, this relationship may be non-causal and, partly or largely, due to diagnostic attention and/or reverse causation.
Interaction between occupational exposure to diesel exhaust and tobacco smoking in determining lung cancer risk: a meta-analysis
Authors: Rizzello Emanuele , Denti Pompiani Ilaria , Violante Francesco , Boffetta Paolo
Published: September 2021

Background

While an association between exposure to diesel exhaust (DE) and risk of lung cancer has been reported in several studies, its interaction with tobacco smoking in determining lung cancer risk is not well characterized. This study aims at performing a systematic review and meta-analysis of results of epidemiology studies on this.

Methods

Studies included in the systematic review were identified from PubMed, Scopus, and Embase, without limitation of year of publication or language. Two reviewers independently reviewed the studies and abstracted relevant data from selected studies, applied a customized quality assessment tool and calculated the relative risks (RRs) and 95% confidence intervals (CIs) for the interaction between DE exposure and tobacco smoking on a multiplicative scale. Next, a random-effects meta-analysis of the interaction RR was conducted.

Results

Seven studies were included in the meta-analysis, of which two were cohort and five case-control studies. Results on the interaction were heterogeneous (I
2 = 45.6%). The summary RR for interaction was 0.79 (95% CI, 0.42–1.46). There was no indication of publication bias. There was no increased risk of lung cancer among non-smoking workers exposed to DE.

Conclusions

This meta-analysis suggested a less-than-multiplicative effect between DE exposure and tobacco smoking in determining lung cancer risk, but the hypothesis of multiplicative interaction cannot be rejected. The small number of relevant studies and the high heterogeneity among them prevent from definite conclusions.
Regional variability of melanoma incidence and prevalence in Hungary. Epidemiological impact of ambient UV radiation and socioeconomic factors.
Authors: Janka Eszter A. , Ványai Beatrix , Dajnoki Zsolt , Szabó Imre L. , Reibl Dániel , Komka Ida , Blasszauer Celia , Várvölgyi Tünde , Szegedi Andrea , Emri Gabriella
Published: September 2021

Background

The incidence of cutaneous melanoma has risen faster than almost any other type of cancer in the last 50 years. Ultraviolet (UV) radiation and genetic susceptibility are the most important risk factors.

Objective

We aimed to determine the epidemiologic indicators of melanoma in Hungary, a country with an estimated population of 9.8 million and an area of 93 030 km2.

Methods

Anonymized patient records from the National Health Insurance Fund Management covering the entire population were used to determine the incidence and prevalence of melanoma in the counties of Hungary from 2013 to 2017. Altogether 20 030 melanoma cases were identified for inclusion in this study.

Results

The prevalence of melanoma increased over the investigated period and was significantly higher among women than men. The incidence of melanoma stagnated during this period and the incidence rate was the highest among the elderly. Interestingly, the incidence was higher in males in the elderly population, while the incidence was higher in females in the younger (<60 years) population. Geographical variations in ambient UV radiation did not show statistically significant correlation with the regional variability of epidemiologic indicators, probably due to small differences in the number of bright sunshine hours per year between regions. Although Hungary is a relatively small country, we observed regional heterogeneity in socioeconomic factors. Notably, a significant and strong negative correlation was found between single-person household rates and melanoma prevalence.

Conclusion

In addition to ambient UV radiation, melanoma incidence and prevalence appear to be related to age, gender and socioeconomic factors.
AEOL 10150 Alleviates Radiation-induced Innate Immune Responses in Non-human Primate Lung Tissue
Authors: Cui Wanchang , Zhang Pei , Hankey Kim G. , Xiao Mang , Farese Ann M. , MacVittie Thomas J.
Published: September 2021

To study the molecular and cellular mechanisms of radiation-induced lung injury (RILI) in a non-human primate model, Rhesus macaques were irradiated with lethal doses of radiation to the whole thorax. A subset of the irradiated animals was treated with AEOL 10150, a potent catalytic scavenger of reactive oxygen and nitrogen species. Lung tissues were collected at necropsy for molecular and immunohistochemical (IHC) studies. Microarray expression profiling in the irradiated lung tissues identified differentially expressed genes (DEGs) and pathways important in innate immunity. The elevated expression of cytokines (CCL2, CCL11, IL-8), complement factors (CFB, C3), apoptosis-related molecules (p53, PTEN, Bax, p21, MDM2, c-Caspase 3), and adhesion molecules (fibronectin, integrin β6, ICAM-1) were further studied using real-time PCR, Western blot, or IHC. Oxidative stress and pulmonary inflammatory cell infiltration were increased in the irradiated lungs. Treatment with AEOL 10150 significantly decreased oxidative stress and monocyte/macrophage infiltration. Cytokine/chemokine-induced excessive innate immune response after thoracic irradiation plays an important role in RILI. To our knowledge, this is the first study to highlight the role of cytokine/chemokine-induced innate immune responses in radiation-induced pulmonary toxicity in a NHP model.
Complementary Lipidomic, Proteomic, and Mass Spectrometry Imaging Approach to the Characterization of the Acute Effects of Radiation in the Non-human Primate Mesenteric Lymph Node after Partial-body Irradiation with Minimal Bone Marrow Sparing
Authors: Muller Ludovic , Huang Weiliang , Jones Jace W. , Farese Ann M. , MacVittie Thomas J. , Kane Maureen A.
Published: September 2021

Radiation sequelae is complex and characterized by multiple pathologies, which occur over time and nonuniformly throughout different organs. The study of the mesenteric lymph node (MLN) due to its importance in the gastrointestinal system is of particular interest. Other studies have shown an immediate post-irradiation reduction in cellularity due to the known effects of irradiation on lymphoid cell populations, but the molecular and functional mechanisms that lead to these cellular alterations remain limited. In this work, we show the use of lipidomic, proteomic, and mass spectrometry imaging in the characterization of the effects of acute radiation exposure on the MLN at different time points after ionizing radiation (IR) from 4 d to 21 d after 12 Gy partial body irradiation with 2.5% bone marrow sparing. The combined analyses showed a dysregulation of the lipid and protein composition in the MLN after IR. Protein expression was affected in numerous pathways, including pathways regulating lipids such as LXR/RXR activation and acute phase response. Lipid distribution and abundance was also affected by IR in the MLN, including an accumulation of triacylglycerides, a decrease in polyunsaturated glycerophospholipids, and changes in polyunsaturated fatty acids. Those changes were observed as early as 4 d after IR and were more pronounced for lipids with a higher concentration in the nodules and the medulla of the MLN. These results provide molecular insight into the MLN that can inform on injury mechanism in a non-human primate model of the acute radiation syndrome of the gastrointestinal tract. Those findings may contribute to the identification of therapeutic targets and the development of new medical countermeasures.
Metabolomics of Multiorgan Radiation Injury in Non-human Primate Model Reveals System-wide Metabolic Perturbations
Authors: Kumar Praveen , Wang Pengcheng , Farese Ann M. , MacVittie Thomas J. , Kane Maureen A.
Published: September 2021

Exposure to ionizing radiation following a nuclear or radiological incident results in potential acute radiation syndromes causing sequelae of multi-organ injury in a dose- and time-dependent manner. Currently, medical countermeasures against radiation injury are limited, and no biomarkers have been approved by regulatory authorities. Identification of circulating plasma biomarkers indicative of radiation injury can be useful for early triage and injury assessment and in the development of novel therapies (medical countermeasures). Aims of this study are to (1) identify metabolites and lipids with consensus signatures that can inform on mechanism of injury in radiation-induced multi-organ injury and (2) identify plasma biomarkers in non-human primate (NHP) that correlate with tissues (kidney, liver, lung, left and right heart, jejunum) indicative of radiation injury, assessing samples collected over 3 wk post-exposure to 12 Gy partial body irradiation with 2.5% bone marrow sparing. About 180 plasma and tissue metabolites and lipids were quantified through Biocrates AbsoluteIDQ p180 kit using liquid chromatography and mass spectrometry. System-wide perturbations of specific metabolites and lipid levels and pathway alterations were identified. Citrulline, Serotonin, PC ae 38:2, PC ae 36:2, and sum of branched chain amino acids were identified as potential biomarkers of radiation injury. Pathway analysis revealed consistent changes in fatty acid oxidation and metabolism and perturbations in multiple other pathways.
Effect of Radiation on the Essential Nutrient Homeostasis and Signaling of Retinoids in a Non-human Primate Model with Minimal Bone Marrow Sparing
Authors: Yu Jianshi , Huang Weiliang , Liu Tian , Defnet Amy E. , Zalesak-Kravec Stephanie , Farese Ann M. , MacVittie Thomas J. , Kane Maureen A.
Published: September 2021

High-dose radiation exposure results in hematopoietic (H) and gastrointestinal (GI) acute radiation syndromes (ARS) followed by delayed effects of acute radiation exposure (DEARE), which include damage to lung, heart, and GI. Whereas DEARE includes inflammation and fibrosis in multiple tissues, the molecular mechanisms contributing to inflammation and to the development of fibrosis remain incompletely understood. Reports that radiation dysregulates retinoids and proteins within the retinoid pathway indicate that radiation disrupts essential nutrient homeostasis. An active metabolite of vitamin A, retinoic acid (RA), is a master regulator of cell proliferation, differentiation, and apoptosis roles in inflammatory signaling and the development of fibrosis. As facets of inflammation and fibrosis are regulated by RA, we surveyed radiation-induced changes in retinoids as well as proteins related to and targets of the retinoid pathway in the non-human primate after high dose radiation with minimal bone marrow sparing (12 Gy PBI/BM2.5). Retinoic acid was decreased in plasma as well as in lung, heart, and jejunum over time, indicating a global disruption of RA homeostasis after IR. A number of proteins associated with fibrosis and with RA were significantly altered after radiation. Together these data indicate that a local deficiency of endogenous RA presents a permissive environment for fibrotic transformation.
Fournier's gangrene complicating severe acute pancreatitis: a case report and literature review
Authors: Krishnamurthy Gautham , Radhakrishna Patta , Khanna Aswin , Damodaran Karthikeyan
Published: September 2021

Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier's gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier's gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier's gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.
Acute Effects of Concussion in Adolescent Athletes With High Preseason Anxiety
Authors: Champigny Claire , Roberts Samantha D. , Terry Douglas P. , Maxwell Bruce , Berkner Paul D. , Iverson Grant L. , Wojtowicz Magdalena
Published: September 2021

Objective:

To examine associations between pre-existing anxiety symptoms, and symptoms and cognitive functioning acutely following a suspected concussion.

Design:

Nested case–control study.

Setting:

High schools in Maine, USA.

Participants:

Participants were identified from a dataset of 46 920 student athletes ages 13 to 18 who received baseline preseason testing. A subset of 4732 underwent testing following a suspected concussion. Of those, 517 were assessed within 72 hours after their suspected concussion and met other inclusion criteria. Nineteen injured athletes endorsed anxiety-like symptoms on the Post-Concussion Symptom Scale (PCSS) during baseline testing and were placed in the high anxiety group. Each athlete was matched to 2 injured athletes who did not endorse high levels of anxiety-like symptoms (N = 57).

Main Outcome Measures:

Immediate Post-Concussion Assessment and Cognitive Testing cognitive composite scores, PCSS total score, and symptom endorsement.

Results:

Cognitive composite scores were similar between groups across testing times (

= 0.004-0.032). The high anxiety group endorsed a greater number of symptoms than the low anxiety group (

= 0.452) and rated symptoms as more severe (

= 0.555) across testing times. Using a modified symptom score that excluded anxiety-like symptoms, a mixed analysis of variance indicated a group by injury interaction (

= 0.079); the high anxiety group reported greater increases in overall symptom severity following injury.

Conclusions:

Adolescent athletes who have an anxious profile at baseline are likely to experience greater symptom burden following injury. Consideration of pre-injury anxiety may inform clinical concussion management by tailoring intervention strategies (eg, incorporating mental health treatments) to facilitate concussion recovery.
Amateur Boxing and Dementia: Cognitive Impairment Within the 35-Year Caerphilly Cohort Study
Authors: Gallacher John , Pickering Janet , Bayer Anthony , Heslop Luke , Morgan Gareth , Watkins Angela , Martin Rhodri , Elwood Peter
Published: September 2021

Objective:

To examine the long-term effects of amateur boxing in a representative population sample of men.

Design:

The sample was examined every 5 years for 35 years. Cognition was assessed repeatedly from the third examination. Previous boxing experience and dementia were assessed at the fifth examination, and dementia assessed subsequently through medical records.

Setting and Assessment of Rick Factors:

The Caerphilly Prospective Study investigates risk factors for a range of chronic diseases of diseases. These include life style and behavior, together with biological factors relevant to vascular disease.

Participants:

1123 adult men aged 45 to 59 years at baseline, followed for 35 years.

Main Outcome Measures:

Cognitive impairment.

Results:

A report by a subject of having boxed “seriously” when younger was associated with a 2-fold increase in cognitive impairment [odds ratio (OR) = 2.27; 95% confidence intervals = 1.18-4.38]. For amnestic (Alzheimer-like) impairment, this rises to OR = 2.78 (95% confidence limits 1.37–5.65). Having boxed is associated with an “advancement” in the onset of the dementia (4.8 years; 95% confidence limits 0.9-8.8 years).

Conclusions:

Amateur boxing is associated with an increased risk and an earlier onset of cognitive impairment and dementia.