bluuebunny/crossref_metadata_2025 huggingface dataset:
Incentives for Smoking Cessation During Pregnancy: An Ethical Framework
Authors: Breunis Leonieke J , Been Jasper V , de Jong-Potjer Lieke , Steegers Eric Ap , de Beaufort Inez D , de Kroon Marlou La , Ismaili M’hamdi Hafez
Published: December 2019

Introduction

Smoking during pregnancy increases the risk of morbidity and mortality of the mother and child. The inability of the unborn child to protect itself, raises the social and academic responsibility to protect the child from the harmful effects of smoking. Interventions including rewards (incentives) for lifestyle changes are an upcoming trend and can encourage women to quit smoking. However, these incentives can, as we will argue, also have negative consequences, for example the restriction of personal autonomy and encouragement of smoking to become eligible for participation. To prevent these negative consequences, we developed an ethical framework that enables to assess and address unwanted consequences of incentive-based interventions whereby moral permissibility can be evaluated.

Aims and Methods

The possible adverse consequences of incentives were identified through an extensive literature search. Subsequently, we developed ethical criteria to identify these consequences based on the biomedical ethical principles of Beauchamp and Childress.

Results

Our framework consists of 12 criteria. These criteria concern (1) effectiveness, (2) support of a healthy lifestyle, (3) motivational for the target population, (4) stimulating unhealthy behavior, (5) negative attitudes, (6) personal autonomy, (7) intrinsic motivation, (8) privacy, (9) fairness, (10) allocation of incentives, (11) cost-effectiveness, and (12) health inequity. Based on these criteria, the moral permissibility of potential interventions can be evaluated.

Conclusions

Incentives for smoking cessation are a response to the responsibility to protect the unborn child. But these interventions might have possible adverse effects. This ethical framework aims to identify and address ethical pitfalls in order to avoid these adverse effects.

Implications

Although various interventions to promote smoking cessation during pregnancy exist, many women still smoke during pregnancy. Interventions using incentives for smoking cessation during pregnancy are a promising and upcoming trend but can have unwanted consequences. This ethical framework helps to identify and address ethical pitfalls in order to avoid these adverse effects.

It can be a practical tool in the development and evaluation of these interventions and in evaluating the moral permissibility of interventions using incentives for smoking cessation during pregnancy.
Retail food environment around schools and overweight: a systematic review
Authors: da Costa Peres Carla Marien , Gardone Danielle Soares , Costa Bruna Vieira de Lima , Duarte Camila Kümmel , Pessoa Milene Cristine , Mendes Larissa Loures
Published: December 2019

Context

The presence of retail food establishments around schools can be a potentiating or protective factor for overweight in students, depending on access to these places as well as types of foods available therein. The hypothesis for this study was that a greater density and proximity of retail food establishments around schools influence the weight of students.

Objective

To systematically review the available observational literature on the association between retail food establishments around schools and the occurrence of overweight and obesity in schoolchildren and adolescents.

Data Sources

Observational studies were searched in the MEDLINE, EMBASE, and SCOPUS databases published until May 2019.

Data Extraction

Two independent reviewers extracted relevant data.

Data Analysis

Data on the 31 included studies were summarized with narrative synthesis according to meta-analyses of observational studies in epidemiology, exploring the type of food establishments around schools and analyzing qualitatively the impact of proximity or density on overweight and obesity rates.

Conclusion

Of the 31 articles, a direct association between proximity or density of establishments (mainly fast food restaurants, convenience stores, grocery stores) around schools and overweight and obesity in children and adolescents were found in 14 studies. However, authors of 13 papers found no association and inverse association was presented in 4 papers. The studies presented different methods of classification, location, and analysis of retail food establishments, making it difficult to conclude the real influence that the presence of these establishments near schools have on the nutritional status of children and adolescents. Therefore, future studies should consider the use of longitudinal designs and standardized analysis of the food environment around schools to better understand this food environment and its influence on health-related behaviors.
Care through cohort studies: sociological survey of the PROOF cohort study on vascular and cognitive aging
Authors: Savall A , Charles R , Bujon T , Roche F , Barthélémy J C , Rabeharisoa V
Published: December 2019

Background

The success of health research depends on the involvement of participants. Few studies have examined the participation of subjects in cohorts. Drawing on a sociological survey on a French cohort around aging, this study proposes to question the nature of interactions between researchers and subjects that would help to understand the motivations of subjects to participate and remain in health research studies.

Methods

Qualitative study combining participant observation within the research laboratory that conducted the cohort and semi-structured interviews with subjects included in the cohort and with members of the research team.

Results

This study highlights the existence of two-way care: from the laboratory to the subjects and from the cohort to researchers. Health research seems to correspond to a complex association between subjects concerned with aging and the expected benefits of exceptional monitoring. Research is incorporated into subjects’ daily lives, allowing a shift in the purpose of research from overmedicalization to medical safety that subjects experienced as a form of care.

Conclusions

In cohort studies, care is understood as a form of attention to the person through high-quality medical follow-up. Aging is turned into a matter of concern that subjects, in collaboration with researchers, strive to control.
The Promise and Demise of LSD Psychotherapy in Norway
Authors: Haave Per , Pedersen Willy
Published: December 2019

In the early-to-mid 1960s, there was considerable use of LSD in psychotherapy in several countries. However, its use gradually levelled off. Two explanations have been suggested: The first revolves around a ‘moral panic’ in the wake of the introduction of cannabis and LSD by subcultural youth groups. The second focuses on the lack of proof for the therapeutic efficacy of LSD at a time when double-blind designs became the gold standard. Using available sources, we explore the Norwegian case. Both explanations are supported: Even before illegal drug use had taken root in youth subcultures, scepticism was gradually building among key figures in the Norwegian healthcare system due to lack of evidence for therapeutic efficacy. This scepticism only increased when the new youth subcultures became visible in the mid-1960s and when the ‘war on drugs’ transformed the drug policy.
‘You Have Lost All That Is German of You in the Dock’: Immigrant Communities and the Wartime State in London, 1914–18
Authors: Auerbach Sascha
Published: December 2019

This article presents the wartime state in the local context and looks at how the daily activity of local courts and police changed dramatically during the wartime period. It also assesses the complex role that police and local courtrooms played with regards to ethnicity and nationalism. The increasing authority of local courtrooms and the enhanced powers of policing, I argue, amplified the role of the state in certain aspects of London life, but reduced it in others. New demands on local courtrooms and policing could only be accommodated by the redirection of their efforts from pre-war priorities. The traditional roles of the police in addressing ‘moral’ crimes such as public drunkenness and gambling declined dramatically as policy redirected police resources towards the enforcement of wartime regulations, the support of military conscription and discipline, and the policing of immigrant communities and ethnic minorities, and of ‘enemy aliens’ in particular. Although the balance of power in the latter case was highly asymmetrical, those brought before the courtroom on accusations of being ‘outsiders’ or ‘enemies’ in the national community were not entirely without recourse. The public nature of courtrooms meant that, in some circumstances, they could become sites for the affirmation of rights and national belonging in wartime Britain, rather vehicles for their abrogation.
Investigating Phenylamide Insensitivity in Wisconsin Populations of Pseudoperonospora humuli
Authors: Marks Michelle E. , Gevens Amanda J.
Published: December 2019

Hop downy mildew caused by the oomycete Pseudoperonospora humuli is primarily managed with fungicides because commercial varietal resistance is unavailable. Mefenoxam, a phenylamide-class fungicide, is highly effective for systemic disease control but is at high risk for the development of pathogen insensitivity. Due to the recent expansion of hop production in Wisconsin, it was unknown if P. humuli could be managed with mefenoxam because insensitivity has been documented in other regions. During 2015 to 2017, isolates of P. humuli were collected from commercial yards throughout Wisconsin. Isolates were screened for insensitivity using a leaf disk assay with fungicide-amended water agar. Insensitivity was determined using a single discriminatory dose of 25 μg/ml of mefenoxam, and isolates were considered insensitive if they exhibited at least 50% sporulation on amended media relative to nonamended water agar. Over all years, nearly 48% of all isolates were insensitive to mefenoxam. The incidence of insensitivity varied between individual hop yards, with most yards exhibiting a mixture of sensitive and insensitive isolates. At this time, mefenoxam-insensitive populations do not appear to be predominant in Wisconsin. Growers should monitor the effectiveness of mefenoxam applications in their hop yards and be responsive to changes in crop response.
Student Perspectives of Interprofessional Group Debriefing: Use of the National League for Nursing Guide for Teaching Thinking
Authors: Glatts Linda , Clark Nancy , Clarke Shirley , Fukuyama Kathy
Published: December 2019

This innovative pilot study used the Critical conversations: The NLN Guide for Teaching Thinking monograph to promote critical conversation during debriefing in an interprofessional education group setting following a disaster preparedness simulation. Interprofessional health care students (n = 120) participated in the Debriefing Assessment for Simulation in Healthcare survey as well as four focus groups to understand student perspectives related to the Context, Content, and Course format used to cocreate meaning related to the simulation experience. Findings revealed that use of this method promoted critical dialogue underscored by self-efficacy, critical reflection, safety, group size, and interdisciplinary learning.
Prevention of baker's asthma
Authors: Jeebhay Mohamed F. , Baatjies Roslynn
Published: December 2019

Purpose of review

Baker's allergy and asthma continue to represent an important contributor of occupational asthma globally. This review identified recent studies related to the prevention of baker's allergy and asthma.

Recent findings

Studies with respect to regulatory exposure standards, workplace control measures aimed at reduction of flour dust exposures, surveillance programmes (exposure monitoring, medical surveillance) and workplace information, education and training programmes were identified.

Detailed knowledge on risk factors and detection methods to assess exposure and early identification of high-risk workers exist, but workplace control measures remain sub-optimal because they are rarely multifaceted. This is compounded by the lack of health-based exposure standards globally. Exposure level monitoring and medical surveillance are integral to assessing effectiveness of preventive strategies. Triage systems for optimizing the efficiency of medical surveillance programmes show promise, but need replication in different contexts. Future studies need to focus on evaluating the relevance and quantification of peak exposures in increasing risk; developing standardized respiratory questionnaires for medical surveillance; and further exploration of serial fractional exhaled nitric oxide (FeNO) measurements as an adjunct to allergic sensitization for the early identification of baker's asthma and assessing the long-term impact of interventions.
Correlation of Thromboelastography with Apparent Rivaroxaban Concentration
Authors: Myers Sara P. , Dyer Mitchell R. , Hassoune Adnan , Brown Joshua B. , Sperry Jason L. , Meyer Michael P. , Rosengart Matthew R. , Neal Matthew D.
Published: December 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Concern remains over reliable point-of-care testing to guide reversal of rivaroxaban, a commonly used factor Xa inhibitor, in high-acuity settings. Thromboelastography (TEG), a point-of-care viscoelastic assay, may have the ability to detect the anticoagulant effect of rivaroxaban. The authors ascertained the association of apparent rivaroxaban concentration with thromboelastography reaction time, i.e., time elapsed from blood sample placement in analyzer until beginning of clot formation, as measured using TEG and TEG6S instruments (Haemonetics Corporation, USA), hypothesizing that reaction time would correlate to degree of functional factor Xa impairment.

Methods

The authors prospectively performed a diagnostic accuracy study comparing coagulation assays to apparent (i.e., indirectly assessed) rivaroxaban concentration in trauma patients with and without preinjury rivaroxaban presenting to a single center between April 2016 and July 2018. Blood samples at admission and after reversal or 24 h postadmission underwent TEG, TEG6S, thrombin generation assay, anti–factor Xa chromogenic assay, prothrombin time (PT), and ecarin chromogenic assay testing. The authors determined correlation of kaolin TEG, TEG6S, and prothrombin time to apparent rivaroxaban concentration. Receiver operating characteristic curve compared capacity to distinguish therapeutic rivaroxaban concentration (i.e., greater than or equal to 50 ng/ml) from nontherapeutic concentrations.

Results

Eighty rivaroxaban patients were compared to 20 controls. Significant strong correlations existed between rivaroxaban concentration and TEG reaction time (ρ = 0.67; P < 0.001), TEG6S reaction time (ρ = 0.68; P < 0.001), and prothrombin time (ρ = 0.73; P < 0.001), however reaction time remained within the defined normal range for the assay. Rivaroxaban concentration demonstrated strong but not significant association with coagulation assays postreversal (n = 9; TEG reaction time ρ = 0.62; P = 0.101; TEG6S reaction time ρ = 0.57; P = 0.112) and small nonsignificant association for controls (TEG reaction time: ρ = −0.04; P = 0.845; TEG6S reaction time: ρ = −0.09; P = 0.667; PT-neoplastine: ρ = 0.19; P = 0.301). Rivaroxaban concentration (area under the curve, 0.91) and TEG6S reaction time (area under the curve, 0.84) best predicted therapeutic rivaroxaban concentration and exhibited similar receiver operating characteristic curves (P = 0.180).

Conclusions

Although TEG6S demonstrates significant strong correlation with rivaroxaban concentration, values within normal range limit clinical utility rendering rivaroxaban concentration the gold standard in measuring anticoagulant effect.
Cross-Sectional Analysis of Cognitive Dysfunction in Patients With Vestibular Disorders
Authors: Rizk Habib G. , Sharon Jeffrey D. , Lee Joshua A. , Thomas Cameron , Nguyen Shaun A. , Meyer Ted A.
Published: December 2019

Objective:

The relationship of cognitive dysfunction and vestibular dysfunction has been established by various studies. However, the available Patient-Reported Outcome Measures questionnaires that address the main vestibular complaint fail to highlight this domain of dysfunction in this patient population. The objective of this study was to quantify and compare cognitive impairment using a validated cognitive questionnaire across several vestibular diagnoses.

Study Design:

Cross-sectional study of 186 patients presenting to a tertiary care vestibular clinic with a diagnosis of vestibular migraine, Meniere’s disease (MD), benign positional paroxysmal vertigo, or persistent postural-perceptual dizziness (PPPD). Patients completed the Cognitive Failures Questionnaire (CFQ) and the Dizziness Handicap Inventory (DHI).

Results:

Mean CFQ scores for this cohort were significantly higher than similarly aged published controls (34.9/100 versus 31.3/100; p < 0.01; mean age, 45 years) as well as published controls between 65 and 74 years of age (34.9/100 versus 31.2/100; p < 0.05). Patients with PPPD or combined vestibular migraine and MD scored the highest on the CFQ and significantly higher than controls (45.1/100, p = 0.001; and 44.1/100, p = 0.006, respectively). Patients with benign positional paroxysmal vertigo had lower scores than normal controls. There is a weak but significant correlation between CFQ and DHI (r = 0.31; p < 0.001). Multivariate linear regression shows that CFQ scores were largely driven by the duration of symptoms (p < 0.001), type of diagnosis (notably PPPD; p = 0.026), and DHI (p < 0.001).

Conclusions:

Our results indicate that cognitive impairment is prevalent with chronic vestibular disorders, even in peripheral disorders such as MD. The duration of vestibular symptoms before diagnosis (and management), as well as certain etiologies, may play a bigger role in cognitive disability than age. This is not currently well-addressed in Patient-Reported Outcome Measures questionnaires and may be overlooked at the time of the diagnosis. Appropriate identification may help tailor treatment, namely rehabilitation programs, to individual patients.
Immune mechanisms of fibrosis and inflammation in IgG4-related disease
Authors: Pillai Shiv , Perugino Cory , Kaneko Naoki
Published: December 2019

Purpose of review

To summarize recent advances in the understanding of the pathogenesis of IgG4-related disease.

Recent findings

Limited data exist to explain genetic susceptibility to IgG4-related disease and the underlying triggers for this disease have not yet been identified. Cytotoxic CD4+ T cells and activated B cells infiltrate affected organs and express proinflammatory and profibrotic molecules. Antigen presented by activated B cells likely reactivates cytotoxic CD4+ T cells in disease tissues and these T cells in turn induce the targeted apoptotic death of host cells in certain organs – which presumably present the same antigenic peptide on human leukocyte antigen class II molecules of relevance that was also presented on B cells during reactivation. A subsequent exaggerated tissue remodeling process is orchestrated by cytokines, chemokines, and enzymes secreted by both activated B cells and CD4+CTLs. These molecules induce an overexuberant repair process resulting in fibrosis and loss of target organ function.

In IgG4-related disease, presumably self-reactive cytotoxic CD4+ T cells infiltrate tissues, are reactivated by T cells and induce apoptotic death. Molecules secreted by activated B cells and by CD4+CTLs drive an exaggerated wound healing response resulting in fibrosis and compromised tissue function.
Predicting Functional Outcomes Following Fracture Nonunion Repair—Development and Validation of a Risk Profiling Tool
Authors: Konda Sanjit R. , Carlock Kurtis D. , Hildebrandt Kyle R. , Egol Kenneth A.
Published: December 2019

Objectives:

To develop a tool that can be used preoperatively to identify patients at risk of poor functional outcome following operative repair of fracture nonunion.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Academic medical center.

Patients/Participants:

Three hundred twenty-eight patients who underwent operative repair of a fracture nonunion were prospectively followed for a minimum of 12 months post-operatively.

Intervention:

After randomization, 223 (68%) patients comprised an experimental cohort and 105 (32%) patients comprised a separate validation cohort. Within the experimental cohort, forward stepwise multivariate logistic regression was applied to 17 independent variables to generate a predictive model identifying patients at risk of having a poor functional outcome [Predicting Risk of Function in Trauma-Nonunion (PRoFiT-NU) Score].

Main Outcome Measurements:

Functional outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA). Poor outcome was defined as an SMFA function index greater than 10 points above the mean at 12 months post-operatively.

Results:

Significant predictors of poor outcome were lower extremity nonunion [odds ratio (OR) = 3.082; P = 0.021], tobacco use (OR = 2.994; P = 0.009), worker's compensation insurance (OR = 3.986; P = 0.005), radiographic bone loss (OR = 2.397; P = 0.040), and preoperative SMFA function index (OR = 1.027; P = 0.001). The PRoFiT-NU model was significant and a good predictor of poor functional outcome (χ2(5) = 51.98, P < 0.0005; area under the receiver operating curve = 0.79). Within the separate validation cohort, 16% of patients had a poor outcome at a PRoFiT-NU score below 25% (low risk), 39% of patients had a poor outcome at a PRoFiT-NU score between 25% and 50% (intermediate risk), and 63% of patients had a poor outcome at a PRoFiT-NU score above 50% (high risk).

Conclusions:

The PRoFiT-NU score is an accurate predictor of poor functional outcome following fracture nonunion repair.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence description of levels of evidence.
Incidence and Risk Factors of Superior Facet Joint Violation in Percutaneous and Open Instrumentation Using Cortical Bone Trajectory Technique
Authors: Le Xiaofeng , Shi Zhan , Xu Yunfeng , Wang Qilong , Zhao Jingwei , Tian Wei
Published: December 2019

Study Design:

A retrospective study evaluating cranial facet joint violation (FJV) by cortical bone trajectory (CBT) screw.

Objective:

To determine the incidence and risk factors of FJV following CBT screw placement for different techniques.

Summary of Background Data:

CBT is a novel technique for lumbar fusion, and FJV is one of the most common complications, leading to poor prognosis. No studies have investigated the incidence and risk factors of FJV for the CBT technique during different methods.

Methods:

The authors reviewed 91 consecutive patients who underwent CBT screw instrumentation from June 2015 to August 2018. In the fluoroscopic-open group (FOG), 42 patients received an open procedure. In the navigation-open group (NOG), 24 patients underwent open instrumentation. In the navigation-percutaneous group, 25 patients underwent percutaneous instrumentation. Postoperative computed tomography scans were obtained to determine the degree and incidence of FJV. Clinical and imaging data were analyzed to clarify the risk factors of FJV.

Results:

The incidence of FJV occurred in 35.7% of patients and 16.9% of screws in the FOG, 4.2% of patients and 3.8% of screws in the NOG, and 8.0% of patients and 8.0% of screws in the navigation-percutaneous group. Open instrumentation using navigation led to a lower risk of FJV compared with the conventional approach. There was no difference in the rate of FJV between percutaneous and open surgery with navigation assistance. Risk factors affecting FJV include: (1) left-side screw, facet angle ≥45 degrees, and scoliosis for fluoroscopy-assisted CBT instrumentation; (2) body mass index ≥30 kg/m2, facet angle ≥45 degrees, and scoliosis for navigation-assisted CBT instrumentation.

Conclusions:

Lumbar fusion through CBT instrumentation would reduce FJV. Computer-assisted navigation resulted in a lower incidence of FJV. Percutaneous instrumentation with navigation assistance is not a risk factor for FJV. Special care should be taken in patients with body mass index ≥30 kg/m2, left-side screw, facet angle ≥45 degrees, and scoliosis.

Level of Evidence:

Level III.
Reconstruction of the Tibial Collateral Ligament With Bone Tunnels and Double Strand of the Semitendinosus Tendon
Authors: Canuto Sergio Marinho Gusmão , Sadigursky David , Amaral Thiago Alvim do , Pádua Vitor Barion de , Barros Cleber Barbosa , Sonnery-Cottet Bertrand
Published: December 2019

Different surgical techniques for the reconstruction of the medial collateral ligament (MCL) have been developed. Despite advances in the understanding and improvement of the reconstruction techniques for MCL, there is still no consensus as to the gold-standard procedure, mainly due to the fact that clinical evidence regarding the results of these procedures is lacking. Studies have shown that the reconstruction of MCL based on its anatomical insertions has led to less biomechanical variation and to good functional results. We describe a surgical technique of anatomical reconstruction with a double band of the superficial MCL through a minimally invasive approach using semitendinosus autograft. This technique has the advantage of restoring valgus and rotational stability of the knee with low surgical morbidity.
Treatment of Infectious Sacroiliitis in Pregnant Patients: A Case for Surgical Debridement
Authors: Vajapey Sravya P. , Brown Chelsea , Sullivan Anne , Van Hoff Corey
Published: December 2019

Infectious sacroiliitis is a rare disease entity that can mimic other conditions. If recognized early and treated appropriately, most patients experience favorable outcomes. Pregnant patients with infectious sacroiliitis pose a unique challenge for the physician. We report 3 cases of pregnant patients with infectious sacroiliitis, describe the surgical technique used to debride the sacroiliac joint in pregnant patients, report their outcomes, and provide a treatment algorithm for management of this condition in this patient population. All patients failed initial conservative treatment with antibiotics and underwent surgical debridement. All 3 had history of intravenous drug use, which is one of the predisposing factors. All 3 patients had favorable outcomes after surgery. Surgical debridement of infectious sacroiliitis is a viable treatment option in the pregnant patient with infectious sacroiliitis resistant to conservative treatment.
Inhibiting α5 Subunit-Containing γ-Aminobutyric Acid Type A Receptors Attenuates Cognitive Deficits After Traumatic Brain Injury
Authors: Khodaei Shahin , Avramescu Sinziana , Wang Dian-Shi , Sheng Heping , Chan Nathan K. , Lecker Irene , Fernandez-Escobar Alejandro , Lei Gang , Dewar Michael B. , Whissell Paul D. , Baker Andrew J. , Orser Beverley A.
Published: December 2019

Objectives:

Cognitive deficits after traumatic brain injury are a leading cause of disability worldwide, yet no effective pharmacologic treatments exist to improve cognition. Traumatic brain injury increases proinflammatory cytokines, which trigger excess function of α5 subunit-containing γ-aminobutyric acid type A receptors. In several models of brain injury, drugs that inhibit α5 subunit-containing γ-aminobutyric acid type A receptor function improve cognitive performance. Thus, we postulated that inhibiting α5 subunit-containing γ-aminobutyric acid type A receptors would improve cognitive performance after traumatic brain injury. In addition, because traumatic brain injury reduces long-term potentiation in the hippocampus, a cellular correlate of memory, we studied whether inhibition of α5 subunit-containing γ-aminobutyric acid type A receptors attenuated deficits in long-term potentiation after traumatic brain injury.

Design:

Experimental animal study.

Setting:

Research laboratory.

Subjects:

Adult male mice and hippocampal brain slices.

Interventions:

Anesthetized mice were subjected to traumatic brain injury with a closed-head, free-weight drop method. One week later, the mice were treated with L-655,708 (0.5 mg/kg), an inhibitor that is selective for α5 subunit-containing γ-aminobutyric acid type A receptors, 30 minutes before undergoing behavioral testing. Problem-solving abilities were assessed using the puzzle box assay, and memory performance was studied with novel object recognition and object place recognition assays. In addition, hippocampal slices were prepared 1 week after traumatic brain injury, and long-term potentiation was studied using field recordings in the cornu Ammonis 1 region of slices that were perfused with L-655,708 (100 nM).

Measurements and Main Results:

Traumatic brain injury increased the time required to solve difficult but not simple tasks in the puzzle box assay and impaired memory in the novel object recognition and object place recognition assays. L-655,708 improved both problem solving and memory in the traumatic brain injury mice. Traumatic brain injury reduced long-term potentiation in the hippocampal slices, and L-655,708 attenuated this reduction.

Conclusions:

Pharmacologic inhibition of α5 subunit-containing γ-aminobutyric acid type A receptors attenuated cognitive deficits after traumatic brain injury and enhanced synaptic plasticity in hippocampal slices. Collectively, these results suggest that α5 subunit-containing γ-aminobutyric acid type A receptors are novel targets for pharmacologic treatment of traumatic brain injury–induced persistent cognitive deficits.
Tele-Critical Care: An Update From the Society of Critical Care Medicine Tele-ICU Committee*
Authors: Subramanian Sanjay , Pamplin Jeremy C. , Hravnak Marilyn , Hielsberg Christina , Riker Richard , Rincon Fred , Laudanski Krzysztof , Adzhigirey Lana A. , Moughrabieh M. Anas , Winterbottom Fiona A. , Herasevich Vitaly
Published: December 2019

Objectives:

In 2014, the Tele-ICU Committee of the Society of Critical Care Medicine published an article regarding the state of ICU telemedicine, one better defined today as tele-critical care. Given the rapid evolution in the field, the authors now provide an updated review.

Data Sources and Study Selection:

We searched PubMed and OVID for peer-reviewed literature published between 2010 and 2018 related to significant developments in tele-critical care, including its prevalence, function, activity, and technologies. Search terms included electronic ICU, tele-ICU, critical care telemedicine, and ICU telemedicine with appropriate descriptors relevant to each sub-section. Additionally, information from surveys done by the Society of Critical Care Medicine was included given the relevance to the discussion and was referenced accordingly.

Data Extraction and Data Synthesis:

Tele-critical care continues to evolve in multiple domains, including organizational structure, technologies, expanded-use case scenarios, and novel applications. Insights have been gained in economic impact and human and organizational factors affecting tele-critical care delivery. Legislation and credentialing continue to significantly influence the pace of tele-critical care growth and adoption.

Conclusions:

Tele-critical care is an established mechanism to leverage critical care expertise to ICUs and beyond, but systematic research comparing different models, approaches, and technologies is still needed.
Global longitudinal strain is a better metric than left ventricular ejection fraction: lessons learned from cancer therapeutic-related cardiac dysfunction
Authors: Patel Jay , Rikhi Rishi , Hussain Muzna , Ayoub Chadi , Klein Alan , Collier Patrick , Moudgil Rohit
Published: December 2019

Purpose of the review

This review aims to highlight the utility of global longitudinal strain (GLS) in cancer therapeutic-related cardiac dysfunction (CTRCD), with an attempt to stipulate that GLS might be a better measure than left ventricular ejection fraction (LVEF).

Recent findings

Increasingly, GLS quantification has been employed in various cardiovascular diseases especially with its ability to detect left ventricular dysfunction subclinically, even before a change in LVEF is visualized. In fact, several studies reveal that GLS may be a superior predictor of mortality and morbidity than LVEF in this context. A recent metaanalysis supported the prognosticating value of GLS in CTRCD, however, endorsed the need for larger multicenter studies to establish the value of this metric. Studies in other cardiovascular disease processes showed GLS as a better metric than LVEF.

GLS has been heralded as a new echocardiographic measure that can detect subclinical cardiac disease. At a minimum, GLS can provide incremental value in prognosticating, diagnosing, and predicting LVEF recovery and at best, a better measure of left ventricular dysfunction.
REPAIR OF COMBINED TRACTION-RHEGMATOGENOUS RETINAL DETACHMENT AFTER CRYOABLATION OF A RETINAL CAPILLARY HEMANGIOBLASTOMA
Authors: DeSouza Philip J. , Greven Craig M.
Published: December 2019

Purpose:

To describe a case of surgical repair of a total, combined traction-rhegmatogenous, retinal detachment with proliferative vitreoretinopathy after cryoablation of a retinal capillary hemangioblastoma.

Methods:

A case of a 47-year-old man presenting with a solitary, superotemporal retinal capillary hemangioblastoma in the right eye with serous retinal detachment and subfoveal fluid and exudates is reported. The hemangioblastoma was treated with cryoablation, but despite regression of the lesion, the patient developed a total combined traction-rhegmatogenous retinal detachment 6 weeks later. Vitrectomy, endolaser photocoagulation to tears adjacent to the original hemangioblastoma lesion, and silicone oil exchange was performed to repair the detachment.

Results:

Eighteen months after initial repair, the patient had silicone oil removal and cataract extraction with lens implantation. Final visual acuity improved from counting fingers to 20/50 with total retinal reattachment and regression of the retinal capillary hemangioblastoma.

Conclusion:

Although uncommon, combined traction-rhegmatogenous retinal detachment can occur after cryoablation of a retinal capillary hemangioblastoma.
The Biostability of Gold Nanoparticles for Cancer Treatment
Authors: Attaalmanan Ethar M. , Mohammed-Ahmed Heba K. , Hussein Shayma A. , Farag Marina , Eltayeb Megdi , Fragoon Ahmed
Published: December 2019

Nanotechnology is the latest technology in this century where it has a wide field of healthcare applications. In this research, gold nanoparticles are synthesized by using green method in which the reducing agent is a black seed extract and the stabilizing agent is gum Arabic, where this method is fast, low cost, and eco-friendly, which make it preferable for medical applications such as cancer treatment. The synthesized gold nanoparticles are characterized by using UV-visible spectroscopy, transmission electron microscopy, and x-ray diffraction, and then the biological stability of gold nanoparticles has been monitored for 15 days in the presence of bovine serum albumin, L-histidine, L-cysteine, and normal saline by using UV-visible spectroscopy. This research obtained that synthesized gold nanoparticles are characterized by a high crystalline structure, with suitable size, and stability.
Psychosocial Correlates of Body Image and Lipodystrophy in Women Aging With HIV
Authors: Raggio Greer A. , Looby Sara E. , Robbins Gregory K. , Park Elyse R. , Sweek Elsa W. , Safren Steven A. , Psaros Christina
Published: December 2019

Body image disturbance is increasingly relevant as women living with HIV (WLWH) live longer. We explored body image disturbance and changes in fat distribution (lipodystrophy) in 63 WLWH (mean age = 51 years) and evaluated associations among lipodystrophy, body image, and psychosocial variables. Eighty-one percent of participants reported one or more body parts (of six assessed) demonstrating lipodystrophy, and more than one third reported three or more affected body parts. Increased belt/waist (58%) and increased chest/breast (39%) sizes were most common. More diffuse lipodystrophy was significantly associated with poorer body image (F[2,54] = 11.86, p < .001, partial η2 = .313) and anxiety (F[2,52] = 3.82, p = .029, partial η2 = .133) after controlling for age and duration of infection. Lipodystrophy was prevalent in our sample; more diffuse lipodystrophy was associated with anxiety and poor body image. Providers should assess lipodystrophy in older WLWH and provide referrals for mental health services.
Mechanisms of Sporadic Control Failure Related to the Skin-Electrode Interface in Myoelectric Hand Prostheses
Authors: Stavdahl Øyvind , Mugaas Terje , Ottermo Maria Vatshaug , Magne Tordis , Kyberd Peter
Published: December 2019

Introduction

This study is concerned with the control of hand prostheses based on electromyograms. As the prosthesis is moved in space, the socket and electrodes can shift on the residual limb, causing changes in the observed electromyograms. These changes can be misinterpreted by the electronic controller and cause the hand to move unintentionally or fail to execute solicited movements. The goal of this study was to explore the mechanisms related to these myoelectric control failures.

Materials and Methods

To study these phenomena, conventional prosthetic EMG electrodes were augmented with force sensors to record the forces through the devices. These multimodal sensors were then used to control prosthetic hands by 15 users with losses below the elbow. The subjects performed four tasks resembling activities of daily living while the electromyogram signals, force signals, and the performance of the hands (including video images) were recorded. Eight subjects reported a total of 38 control errors, each of which was assigned to one of four failure classes and analyzed.

Results

The article shows examples of the electromyogram and force signals recorded during the control failures and discusses possible causes of the failures. Involuntary opening of the hand was identified as the most common failure, and these failures seemed to be associated with changes in the electrode-skin contact forces. It was not possible to attribute clear causes for 26.2% of the failures.

Conclusions

Knowledge of common failure mechanisms can guide improved design of sockets and electrodes and signal processing to reduce the errors experienced by prosthesis users.
Establishing Test–Retest Reliability and Reliable Change for the King–Devick Test in High School Athletes
Authors: Elbin R. J. , Schatz Philip , Mohler Samantha , Covassin Tracey , Herrington Jesse , Kontos Anthony P.
Published: December 2019

Objective:

To establish test–retest reliability in nonconcussed high school athletes and compare absolute change, reliable change indices (RCIs), and minimal detectable change (MDC) methods for classifying impairment after sport-related concussion.

Design:

Prospective, repeated measures.

Setting:

High schools from the Midwest and Central regions of the United States.

Participants:

A convenience sample of 772 nonconcussed high school athletes (n = 546 men) completed preseason K–D testing. In addition, 69 athletes completed a second postseason K–D test, and 54 athletes sustained a concussion and completed postconcussion K–D tests.

Intervention:

K–D test.

Main Outcome Measures:

Data for age, sex, and concussion history were determined using preseason K–D test outcomes. Test–retest reliability, RCIs, and MDCs were calculated using postseason K–D tests (M = 98.9, SD = 9.1 days). Postinjury K–D assessments within 5 days of injury (M = 1.5, SD = 1.5 days) were used to classify impairment on K–D using absolute change, RCI, and MDC methods.

Results:

Significant effects for age (P < 0.001) and history of concussion (P = 0.001) were supported on baseline K–D time, with no sex differences (P = 0.21). Preseason to postseason reliability for K–D times was 0.60 (intraclass correlation coefficient, 95% CI, 0.43-0.73), although 38% of athletes exhibited slower postseason K–D times compared with baseline. Impairment on K–D exhibited for 72% of the concussed sample using absolute change, 48% using MDC, and 44% using RCI methods.

Conclusions:

K–D exhibited moderate test–retest reliability across 1 season. Absolute change yielded the highest sensitivity for preinjury to postinjury impairment on the K–D compared with RCI and MDC methods.
Case report: successful endoscopic treatment of a large bowel perforation caused by chicken bone ingestion
Authors: Simunic Miroslav , Zaja Ivan , Ardalic Zarko , Stipic Radoslav , Maras-Simunic Marina
Published: December 2019

Rationale:

Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract.

Patient concerns:

The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months

Diagnosis:

A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve.

Interventions:

A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing.

Outcomes:

The patient was discharged three days after colonoscopy with normal laboratory results and without any pain.

Lessons:

In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.
Spinal epidural abscess successfully treated with biportal endoscopic spinal surgery
Authors: Kang Taewook , Park Si Young , Lee Soon Hyuck , Park Jong Hoon , Suh Seung Woo
Published: December 2019

Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscess (SEA). Surgical treatment included decompression, evacuation of abscess, and debridement. Recently, minimal invasive surgery has been introduced more widely, and biportal endoscopic spinal surgery have shown satisfactory clinical outcomes compared with traditional open surgery. The purpose of this study was to evaluate the efficacy of biportal endoscopic spinal surgery for the treatment of SEA .

From January 2016 to June 2017, 13 patients who underwent biportal endoscopic spinal surgery under the diagnosis of SEA were retrospectively enrolled in this study. The surgical indications of the enrolled patients included SEA with or without early stage spondylodiscitis who had neurological symptoms. Periopertaive data and clinical outcomes were assessed by regular serologic testing, imaging studies, physical examination, visual analog scale, Oswestry Disability Index and modified Macnab criteria.

Offending pathogens were identified in seven (54%) of 13 biopsy specimens. Appropriate intravenous antibiotics for the identified pathogens isolated from infected tissue biopsy cultures were administrated to patients for at least 30 days. All patients reported satisfactory relief of pain and neurological symptoms after surgery. No surgery-related complications and recurrences were found after 2 years follow up.

Biportal endoscopic spinal surgery may be an effective alternative to traditional open surgical decompression for the treatment of SEA.
Nonossified cervical vertebrae in Wolf-Hirschhorn Syndrome
Authors: Hong You Mi , Cho Dong Hyu , Kim Jin Kyu
Published: December 2019

Rationale:

Wolf-Hirschhorn Syndrome (WHS) is a rare disorder caused by the loss of the distal part of the short arm of chromosome 4, and has various phenotypes depending on the deletion size. Although many articles report on urinary tract malformations or ophthalmologic abnormalities, there are few descriptions of the skeletal anomalies. This is an extremely rare case of cervical dysplasia in WHS.

Patient concerns:

A 24-year-old pregnant woman was transferred to our hospital at 21 gestational weeks for intrauterine growth retardation and oligohydramnios and decided to preserve the pregnancy after evaluation. A female was born at full term by normal vaginal delivery, weighing 1791 g. The patient was suspected to have congenital dysplasia of the cervical vertebrae on the routine newborn chest radiograph, and cervical spine magnetic resonance imaging revealed nonossification of the C3 and C4 vertebral bodies.

Diagnosis:

The newborn had the “Greek warrior helmet” face typical of WHS. A deletion was detected in the distal portion of the short arm of chromosome 4 (p 16.3) by fluorescence in situ hybridization analysis.

Interventions:

She was hospitalized for nutritional management and congenital anomaly evaluation for a month before being discharged with rehabilitation and antiepileptic drugs.

Outcomes:

The patient has been readmitted with seizure attacks 5 times to date. At one year of age, she still shows severe head lag and feeding problems. Her last weight was below the 3rd centile.

Lessons:

Although cervical dysplasia is a rarely reported morphology in WHS, it may provide artefacts for diagnosing WHS as cervical anomalies, unlike facial anomalies or developmental delays, are seldom found in congenital disease.
Gastrinoma in multiple endocrine neoplasia type 1 after total pancreatectomy
Authors: Gong Shu , Li Zhi , Liu Xu-Bao , Wang Xin , Shen Wen-Wu
Published: December 2019

Rationale:

Surgery for patients with multiple endocrine neoplasia type 1(MEN-1) related gastrinoma remains controversial and total pancreatectomy (TP) has rarely been performed. We reported a case of patient with MEN-1 related gastrinoma treated by TP.

Patient concerns:

A 46-year-old female was admitted to our hospital due to abdominal distension and diarrhea for 2 years. The patient underwent pituitary tumor resection and kidney stone lithotripsy 10 years ago.

Diagnoses:

Abdominal computed tomography showed single lesion in the duodenum and multiple lesions throughout the pancreas. The patient's gastrin level was significantly increased (1080 pg/ml). These findings in combination with the pituitary tumor history suggested the presence of gastrinoma associated with MEN-1 syndrome.

Intervention:

An exploratory laparotomy was performed. Intraoperative ultrasound confirmed the numerous tumors diffusely distributed throughout the pancreas and the patient eventually underwent TP.

Outcomes:

Twelve months later, the patient was hospitalized again for anastomotic fistula and underwent a partial gastrectomy, small bowel resection and drainage of the abscess. One month later, she received gastrostomy and jejunostomy due to digestive tract fistula, and died a month later (14 months after TP).

Lessons:

There still might be the possibility of recurrence even after radical surgical resection of gastrinomas, and we suggest the need to measure the basal acid output and maintain regular anti-acid therapy in the long-term follow-up of patients with MEN-1 related gastrinoma.