bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflections on the Role of Control in Meditation
Authors: Shapiro Deane H.
Published: December 2020

Spiritual, religious, and secular traditions emphasize the importance of control over one’s thoughts, feelings and behavior, and the relevance of meditation in achieving this control. Meditation practices, in particular, can be understood as one strategy amongst others for achieving self-regulation. While the main focus in Western psychology has been on active instrumental control, other traditions have emphasized the importance of a more accepting/yielding mode of control. This chapter distinguishes between different forms of control and how some of these may be enhanced by meditation practices. While over-control and passive resignation can have negative consequences for a person’s well-being, there is evidence for the beneficial role of the active/assertive and positive accepting/yielding modes of control. Selecting the most appropriate meditation strategy for a particular person is dependent upon a wide range of factors, including the person’s control profile, their sensory orientation, and their belief systems. The chapter concludes with the description of the author’s personal journey in exploring meditation and theories and practices of control—and a note of gratitude.
Strategic Knowledge Creation in Multinational Enterprises
Authors: Håkanson Lars , Kappen Philip , Zander Ivo
Published: December 2020

Unique knowledge and proprietary innovations are key to the competitive advantages on which most multinational enterprises (MNEs) are expected to base their initial international expansion. Moreover, their subsequent fortunes and survival typically depend on MNEs’ continued ability to upgrade and renew these advantages, as competition, imitation, and environmental change erode the value of existing ones. This chapter reviews key literatures around the nature, management, and effects of knowledge creation in MNEs. The chapter centers on the processes through which geographical patterns of international R&D have evolved, along with the structures, systems, and procedures through which MNEs have sought to govern and coordinate these activities. Finally, the chapter offers a summary and critique of the way that much of the inherited literature has portrayed and interpreted the strategic knowledge creation process in MNEs.
Egypt in the Late Period
Authors: Leahy Tony
Published: December 2020

Our understanding of the internal history of Egypt from 664 to 332 bc rests on a limited patchwork of hieroglyphic inscriptions and cursive texts in hieratic or demotic, Aramaic or Greek. By contrast, Egypt’s place in the wider world has to be reconstructed from foreign sources—Assyrian, Babylonian, Hebrew, and Greek—supplemented by Egyptian artefacts from the Mediterranean and Near East. At the interface sits the account of Egypt written by Herodotus in the fifth century bc. The ways in which this diversity of evidence has shaped modern interpretation of Egyptian history in this period are here explored.
Scripts
Authors: Stauder Andréas
Published: December 2020

Egyptian writing comprises a variety of structurally and historically related scripts (hieroglyphic, hieratic, demotic), distributed according to historically shifting spheres of use. Egyptian scripts are mixed systems that represent both meaning and sound of language, allowing for a remarkable variety of historically changing spelling patterns. In relation to its enduring pictorial commitment, hieroglyphic writing had major aesthetic and sacralizing functions. Beyond its defining function of representing speech, Egyptian writing was also used to express non-linguistic dimensions of meaning. This chapter discusses categories of signs, different types of spellings of words, the roles played by determinatives and classifiers, and the nature of linear hieroglyphs, hieratic, abnormal hieratic and demotic. It also considers cultural contacts and influences on the various Egyptian scripts, and the eventual process of their obsolescence.
Philosophy of Language
Authors: Appelqvist Hanne
Published: December 2020

This chapter explores connections between the philosophy of language and the philosophy of music, starting from questions of meaning and understanding that the two fields arguably share. It considers how such notions as reference, representation, expression, communication, logic, rules, and grammar have been used to explain the semantic content of music. Tracing the development of the comparison between language and music from the linguistic phase of analytic philosophy to its subsequent decline and the emergence of metaphysics and naturalism as the dominant explanatory frameworks, the chapter provides a diagnosis of the reasons behind the current misgivings about the comparison. It closes by arguing, pace many contemporary accounts of musical meaning, that the comparison between language and music has not been exhausted as a source of philosophical illumination.
Authenticity
Authors: Dodd Julian , Irving John
Published: December 2020

Work authenticity in the performance of a work of Western classical music is faithfulness to the work performed. This essay distinguishes two kinds of such work authenticity: score-compliance authenticity (accurately rendering the work’s score into sound); and interpretive authenticity (delivering a performance that evinces a deep or profound understanding of the work). Both forms of authenticity are performance values (that is, good-making features of performances), and both, we also claim, are constitutive norms governing work performance: norms that arise out of the practice’s teleology. And yet there are occasions on which these two work authenticities conflict with each other: situations when performers feel that bringing out some of the work’s deep musical content pushes them towards compromising score compliance. We believe that such conflict is genuine, and we float the idea that, when it occurs, performers can be justified in deliberately deviating from the score. In our view, a performance of a work is sometimes better overall for departing from scored instructions in this manner.
Building bulk from Wilson loops
Authors: Hashimoto Koji
Published: December 2020

We provide formulas for holographically building a bulk metric from given expectation values of rectangular Wilson loops. As a corollary, we prove that any confining quark potential necessarily leads to the existence of a bulk infrared bottom.
Disappearances from The Dunciad: Pope’s Late Use of the Grub-Street Journal
Authors: Rogers Pat
Published: December 2020

Over time Pope made extensive alterations to The Dunciad, within the text but also in the surrounding apparatus. One short-lived change concerned an appendix in Robert Dodsley’s octavo edition of the Works, Volume III, Part II (ESTC T5425; Griffith 566). This appeared only in the earliest state of the volume, published in 1742, as it was deleted in subsequent printings (Griffith 567, 579). The first of four elements in the appendix, ‘Of the Poet Laureate’, was restored in 1743, but banished in 1751 to a separate volume, not to be included with The Dunciad again until 1882. The three remaining portions have never been reprinted in any collection of Pope’s works since 1742. They consist of items reprinted from the Grub-Street Journal in 1730 and 1731. Two concern James Moore Smythe, depicted in The Dunciad as ‘the phantom poet’ accused of plagiarism and deception. They also involve the ‘worm doctor’ John Moore, an object of derision by Pope and John Arbuthnot since 1716. All four items in the appendix are likely to have come from Pope or his circle. The article seeks to place these attacks in the context of their appearance in the Journal; to relate them to the Scriblerian campaign against shoddy writing habits and the activities of quacks; and to offer some explanation for their sudden emergence and instant disappearance from all versions of the poem. Consideration of a segment that has been totally ignored until now casts some light on the poet’s aims in reordering all parts of The Dunciad.
Incentivizing Financial Regulators
Authors: Kalmenovitz Joseph
Published: December 2020

I study how promotion incentives within the public sector affect financial regulation. I assemble individual data for all SEC enforcement attorneys between 2002 and 2017, including enforcement cases, salaries, and ranks. Consistent with tournament model, attorneys with stronger promotion incentives are involved in more enforcement, especially against severe misconduct, and in tougher settlement terms. For identification, I rely on cross-sectional tests within offices and ranks and on exogenous variation in salaries resulting from a conversion to a new pay system. The findings highlight a novel link between incentives and regulation and show that the regulator’s organizational design affects securities markets.
Fintech Borrowers: Lax Screening or Cream-Skimming?
Authors: Di Maggio Marco , Yao Vincent
Published: December 2020

We study the personal credit market using unique individual-level data covering fintech and traditional lenders. We show that fintech lenders acquire market share by lending first to higher-risk borrowers and then to safer borrowers, and rely mainly on hard information to make credit decisions. Fintech borrowers are significantly more likely to default than neighbor individuals with the same characteristics borrowing from traditional financial institutions. Furthermore, they tend to experience a short-lived reduction in the cost of credit, because their indebtedness increases more than non-fintech borrowers after loan origination. However, fintech lenders’ pricing strategies are likely to take this into account.
Anti-NuMA antibodies: clinical associations and significance in patients with primary Sjögren’s syndrome or systemic lupus erythematosus
Authors: Arcani Robin , Bertin Daniel , Bardin Nathalie , Mazodier Karin , Jean Rodolphe , Suchon Pierre , Venton Geoffroy , Daumas Aurélie , Jean Estelle , Villani Patrick , Kaplanski Gilles , Jarrot Pierre-André
Published: December 2020

Objective

To determine the clinical significance of anti-nuclear mitotic apparatus (NuMA) antibodies (AC-26 or AC-25) in patients with primary Sjögren’s syndrome (pSS) and SLE.

Methods

Between 2013 and 2018, clinical and immunological features of pSS and SLE patients with anti-NuMA antibodies were compared with anti-NuMA antibodies-negative pSS and SLE cohorts.

Results

Among 31 284 sera positive for antinuclear antibodies, 90 patients (0.29%) had anti-AC-26 (anti-NuMA1) and AC-25 (anti-HsEg5) antibodies (73.3% and 26.7%, respectively). Autoimmune diseases, mainly consisting in pSS (28.9%) and SLE (21.1%), were found in 67.8%. Anti-NuMA antibodies represented the unique ANA in 60% and 50% of patients with pSS and SLE patients, respectively. Compared with 137 anti-NuMA-negative pSS patients, 20 anti-NuMA-positive pSS presented with less frequent ocular sicca syndrome (70.0% vs 89.1%, P=0.031), dryness complications (15.0% vs 39.4%, P=0.045), or detectable anti-SSa and/or anti-SSb antibodies (40.0% vs 66.4%, P=0.027). Compared with 80 anti-NuMA-negative SLE patients, 14 anti-NuMA-positive SLE patients had no lupus nephritis (0.0% vs 28.8%, P=0.049), less frequent dsDNA antibodies (42.9% vs 75.0%, P=0.025) and complement consumption (21.4% vs 53.8%, P=0.040). Anti-NuMA-positive pSS and SLE patients less frequently required treatments compared with anti-NuMA-negative patients.

Conclusion

Although rare, anti-NuMA antibodies are mainly associated with pSS and SLE and may be useful for diagnosis when other auto-antibodies are negative. PSS and SLE patients with anti-NuMA antibodies have less severe clinical and biological profiles, suggesting that anti-NuMA antibodies may constitute a good prognosis marker in both autoimmune diseases.
Total plaque area and plaque echogenicity are novel measures of subclinical atherosclerosis in patients with systemic lupus erythematosus
Authors: Croca Sara C , Griffin Maura , Farinha Filipa , Isenberg David A , Nicolaides Andrew , Rahman Anisur
Published: December 2020

Objectives

Patients with SLE have an increased risk of developing cardiovascular disease (CVD). Multiple studies have shown that these patients have increased numbers of carotid plaques and greater intima-media thickness (IMT) than healthy controls. Measures such as total plaque area (TPA) and plaque echogenicity may be more sensitive and more relevant to cardiovascular risk than presence of plaque and IMT alone. Our objective was to produce the first report of TPA and echogenicity in a population of patients with SLE.

Methods

One hundred patients with SLE and no history of clinical CVD were recruited. Clinical, serological and treatment variables were recorded and serum was tested for antibodies to apolipoprotein A-1 and high-density lipoprotein. Both carotid and both femoral artery bifurcations of each patient were scanned to determine IMT, TPA and echogenicity of plaques. Univariable and multivariable statistical analyses were carried out to define factors associated with each of these outcomes.

Results

Thirty-six patients had carotid and/or femoral plaque. Increasing age was associated with presence of plaque and increased IMT. Triglyceride levels were associated with presence of plaque. Mean (s.d.) TPA was 60.8 (41.6) mm2. Patients taking prednisolone had higher TPA. Most plaques were echolucent, but increased echogenicity was associated with prednisolone therapy and persistent disease activity.

Conclusion

TPA and plaque echogenicity in patients with SLE are associated with different factors than those associated with presence of plaque and IMT. Longitudinal studies may show whether these outcome measures add value in the management of cardiovascular risk in SLE.
Contribution of abnormal BMI to adverse health-related quality of life outcomes after a 52-week therapy in patients with SLE
Authors: Borg Alexander , Gomez Alvaro , Cederlund Arvid , Cobar Flordelyn , Qiu Victor , Lindblom Julius , Emamikia Sharzad , Enman Yvonne , Pettersson Susanne , Parodis Ioannis
Published: December 2020

Objectives

To investigate whether abnormal BMI is associated with adverse health-related quality of life (HRQoL) outcome, including severe fatigue, after 52 weeks of standard therapy plus belimumab or placebo in patients with SLE.

Methods

We analysed data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (n = 1684). Adverse HRQoL was defined as SF-36 scores ≤ the fifth percentile in age- and sex-matched US population-based subjects, and FACIT-F scores <30. We compared BMI groups using the Pearson’s χ2 test, and assessed independence with multivariable logistic regression analysis.

Results

Overweight (BMI ≥25 kg/m2) and obese (BMI ≥30 kg/m2) patients showed increased likelihood to exhibit adverse SF-36 physical component summary (OR: 1.8; 95% CI: 1.4, 2.3; P <0.001 and OR: 2.4; 95% CI: 1.8, 3.2; P <0.001, respectively) and FACIT-F (OR: 1.3; 95% CI: 1.1, 1.6; P = 0.010 and OR: 1.5; 95% CI: 1.2, 2.0; P = 0.002, respectively) scores at week 52. Underweight was associated with adverse SF-36 mental component summary scores, also after adjustment for sex, ancestry, age, disease duration, disease activity, organ damage and prednisone dose during the study period (OR: 2.1; 95% CI: 1.2, 3.6; P = 0.007). Addition of belimumab to standard therapy independently protected against adverse SF-36 general health (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.025) and FACIT-F < 30 (OR: 0.8; 95% CI: 0.6, 1.0; P = 0.018).

Conclusion

Overweight and obesity contributed to adverse physical and mental HRQoL outcomes after therapeutic intervention in SLE patients, and underweight contributed to adverse mental HRQoL outcome. A protective effect of belimumab against adverse general health and severe fatigue was implicated.
The Prevalence and Potential Role of Pain Beliefs When Managing Later-Life Pain
Authors: Shalev Ariel , Henderson Charles R. , Gutierrez Iliana , Mullen Evan , Reid M. Carrington
Published: December 2020

Objectives:

In this study of 154 community-dwelling older adults with chronic noncancer pain, we sought to assess participants’ beliefs about pain as well as pain management treatments and to determine the influence of those beliefs on participants’ willingness to undertake 3 physician-recommended pain treatments, that is, a pharmacologic, physical, and psychological therapy.

Materials and Methods:

A 16-item questionnaire was employed to ascertain participants’ pain beliefs, divided into 4 subscales representing: (1) negative beliefs about pharmacological treatments, (2) positive beliefs about physical treatment approaches, for example, exercise, (3) positive beliefs about psychological treatments, and (4) fatalistic beliefs about pain. Participants were asked to rate their willingness to undertake a pharmacologic, physical, or psychological therapy if their physician recommended that they do so. Agreement with each belief was measured, and we examined willingness to undertake each treatment as a function of pain belief subscale scores after controlling for relevant covariates.

Results:

Positive beliefs about physical treatments (eg, benefits of exercise) were the most strongly endorsed items on the pain beliefs questionnaire. All 3 treatment-focused pain beliefs subscales were significantly associated with willingness to undertake that form of treatment (eg, negative beliefs about pain medication use were associated with decreased willingness to take pain medication). Fatalistic attitudes were significantly associated with a decreased willingness to undertake physical treatments.

Discussion:

These results support the notion that patients’ beliefs about pain and pain treatments can have important effects on treatment engagement and, if assessed, can help guide clinical management of chronic pain in older adults.
Intraoperative Neurological Monitoring in Lower Limb Surgery for Patients With Mucopolysaccharidoses
Authors: Georgiadis Andrew G. , Koester Trever M. , Mackenzie William G. , Nahm Nickolas J. , Novotny Susan A. , Rogers Kenneth J. , Siljander Breana R. , Sousa Ted C. , White Klane K. , Walker Kevin R.
Published: December 2020

Background:

There are reports of spinal cord injury (SCI) occurring after lower extremity (LE) surgery in children with mucopolysaccharidoses (MPS). Intraoperative neurological monitoring (IONM) has been adopted in some centers to assess real-time spinal cord function during these procedures. The aim of this investigation was to review 3 specialty centers’ experiences with MPS patients undergoing LE surgery. We report how IONM affected care and the details of spinal cord injuries in these patients.

Methods:

All pediatric MPS patients who underwent LE surgery between 2001 and 2018 were reviewed at 3 children’s orthopaedic specialty centers. Demographic and surgical details were reviewed. Estimated blood loss (EBL), surgical time, positioning, use of IONM, and changes in management as a result of IONM were recorded. Details of any spinal cord injuries were examined in detail.

Results:

During the study period, 92 patients with MPS underwent 252 LE surgeries. IONM was used in 83 of 252 (32.9%) surgeries, and intraoperative care was altered in 17 of 83 (20.5%) cases, including serial repositioning (n=7), aggressive blood pressure management (n=6), and abortion of procedures (n=8). IONM was utilized in cases with larger EBL (279 vs. 130 mL) and longer operative time (274 vs. 175 min) compared with procedures without IONM. Three patients without IONM sustained complete thoracic SCI postoperatively, all from cord infarction in the upper thoracic region. These 3 cases were characterized by long surgical time (328±41 min) and substantial EBL (533±416 mL or 30.5% of total blood volume; range, 11% to 50%). No LE surgeries accompanied by IONM experienced SCI.

Conclusions:

Patients with MPS undergoing LE orthopaedic surgery may be at risk for SCI, particularly if the procedures are long or are expected to have large EBL. One hypothesis for the etiology of SCI in this setting is hypoperfusion of the upper thoracic spinal cord due to prolonged intraoperative or postoperative hypotension. IONM during these procedures may mitigate the risk of SCI by identifying real-time changes in spinal cord function during surgery, inciting a change in the surgical plan.

Level of Evidence:

Level III—retrospective comparative series.
Intraobserver and Interobserver Reliability of the Peritubercle Lucency Sign in Slipped Capital Femoral Epiphysis
Authors: Brown Daniel W. , Iorio Thomas J. , Mosher Zachary A. , Beaty James H. , Warner William C. , Sawyer Jeffrey R. , Spence David D. , Sheffer Benjamin W. , Kelly Derek M.
Published: December 2020

Background:

An area of enlargement of the metaphyseal socket around the epiphyseal tubercle, termed the peritubercle lucency sign, has recently been introduced as a possible predictor of contralateral slipped capital femoral epiphysis in patients with previous unilateral slipped capital femoral epiphysis. This study aimed to assess intraobserver and interobserver reliability for detecting the presence or absence of the peritubercle lucency sign.

Methods:

Thirty-five radiographs were presented to 6 fellowship-trained pediatric orthopaedic surgeons on 2 separate occasions 30 days apart, ensuring that the images were shown in a different order on the second exposure. Both times the reviewers recorded whether the peritubercle lucency sign was present or absent in each of the radiographs. Statistical analysis was performed to determine the intraobserver and interobserver reliability.

Results:

In the intraobserver analysis, percent agreement between the first and second time the radiographs were reviewed varied between 62.9% and 85.7%, for an average intraobserver agreement of 74.8%. κ values for the 6 reviewers varied between 0.34 and 0.716, with an average intraobserver κ value of 0.508. The interobserver percent agreement was 40.0% for the first time the radiographs were reviewed, 42.9% the second time, and the overall interobserver percent agreement was 29%. The interobserver κ value was 0.44 the first time the radiographs were reviewed, 0.45 the second time, and the overall interobserver κ value was 0.45.

Discussion:

On the basis of our findings, the peritubercle lucency has modest intraobserver and interobserver reliability at best and should be used with other currently used factors, such as age, presence of endocrinopathy, status of triradiate cartilage, posterior sloping angle, and modified Oxford score, in determining the need for prophylactic pinning. Further refinement of the definition of the peritubercle lucency sign may be needed to improve agreement and reliability of the sign.

Level of Evidence:

Level III—prognostic study.
Timing, Outcome, and Risk Factors of Intracranial Hemorrhage in Acute Respiratory Distress Syndrome Patients During Venovenous Extracorporeal Membrane Oxygenation
Authors: Hunsicker Oliver , Beck Lukas , Krannich Alexander , Finger Tobias , Prinz Vincent , Spies Claudia , Weber-Carstens Steffen , Wolf Stefan , Graw Jan Adriaan , Menk Mario
Published: December 2020

Objectives:

Intracranial hemorrhage is a serious complication in patients receiving venovenous extracorporeal membrane oxygenation during treatment of the acute respiratory distress syndrome. We analyzed timing, outcome, and risk factors of intracranial hemorrhage in patients on venovenous extracorporeal membrane oxygenation.

Design:

Retrospective cohort study.

Setting:

Single acute respiratory distress syndrome referral center.

Patients:

Patients receiving venovenous extracorporeal membrane oxygenation were identified from a cohort of 1,044 patients with acute respiratory distress syndrome. Patients developing an intracranial hemorrhage during venovenous extracorporeal membrane oxygenation therapy were compared with patients without evidence for intracranial hemorrhage. The primary objective was to assess the association of intracranial hemorrhage with 60-day mortality. Further objectives included the identification of risk factors for intracranial hemorrhage and the evaluation of clinical cutoff values.

Interventions:

None.

Measurements and Main Results:

Among 444 patients treated with venovenous extracorporeal membrane oxygenation, 49 patients (11.0% [95% CI, 8.3–14.4%]) developed an intracranial hemorrhage. The median time to intracranial hemorrhage occurrence was 4 days (95% CI, 2–7 d). Patients who developed an intracranial hemorrhage had a higher 60-day mortality compared with patients without intracranial hemorrhage (69.4% [54.4–81.3%] vs 44.6% [39.6–49.6%]; odds ratio 3.05 [95% CI, 1.54–6.32%]; p = 0.001). A low platelet count, a high positive end expiratory pressure, and a major initial decrease of Paco
2 were identified as independent risk factors for the occurrence of intracranial hemorrhage. A platelet count greater than 100/nL and a positive end expiratory pressure less than or equal to 14 cm H2O during the first 7 days of venovenous extracorporeal membrane oxygenation therapy as well as a decrease of Paco
2 less than 24 mm Hg during venovenous extracorporeal membrane oxygenation initiation were identified as clinical cutoff values to prevent intracranial hemorrhage (sensitivity 91% [95% CI, 82–99%], 94% [85–99%], and 67% [48–81%], respectively).

Conclusions:

Intracranial hemorrhage occurs early during venovenous extracorporeal membrane oxygenation and is a determinant for 60-day mortality. Appropriate adjustment of identified modifiable risk factors might lower the prevalence of intracranial hemorrhage during venovenous extracorporeal membrane oxygenation therapy.
Changes in the Plethysmographic Perfusion Index During an End-Expiratory Occlusion Detect a Positive Passive Leg Raising Test*
Authors: Beurton Alexandra , Gavelli Francesco , Teboul Jean-Louis , De Vita Nello , Monnet Xavier
Published: December 2020

Objectives:

The end-expiratory occlusion test for assessing preload responsiveness consists in interrupting mechanical ventilation for 15 seconds at end-expiration and measuring the cardiac index changes. The perfusion index is the ratio between the pulsatile and the nonpulsatile portions of the plethysmography signal and is, in part, determined by stroke volume. We tested whether the end-expiratory occlusion-induced changes in perfusion index could detect a positive passive leg raising test, suggesting preload responsiveness.

Design:

Observational study.

Setting:

Medical ICU.

Patients:

Thirty-one ventilated patients without atrial fibrillation.

Interventions:

We measured perfusion index (Radical-7 device; Masimo Corp., Irvine, CA) and cardiac index (PiCCO2; Pulsion Medical Systems, Feldkirchen, Germany) before and during a passive leg raising test and a 15-second end-expiratory occlusion.

Measurements and Main Results:

In 19 patients with a positive passive leg raising test (increase in cardiac index ≥ 10%), compared to the baseline value and expressed as a relative change, passive leg raising increased cardiac index and perfusion index by 17% ± 7% and 49% ± 23%, respectively, In these patients, end-expiratory occlusion increased cardiac index and perfusion index by 6% ± 2% and 11% ± 8%, respectively. In the 12 patients with a negative passive leg raising test, perfusion index did not significantly change during passive leg raising and end-expiratory occlusion. Relative changes in perfusion index and cardiac index observed during all interventions were significantly correlated (r = 0.83). An end-expiratory occlusion-induced relative increase in perfusion index greater than or equal to 2.5% ([perfusion index during end-expiratory occlusion–perfusion index at baseline]/perfusion index at baseline × 100) detected a positive passive leg raising test with an area under the receiver operating characteristic curve of 0.95 ± 0.03. This threshold is larger than the least significant change observed for perfusion index (1.62% ± 0.80%).

Conclusions:

Perfusion index could be used as a reliable surrogate of cardiac index for performing the end-expiratory occlusion test. Confirming previous results, the relative changes in perfusion index also reliably detected a positive passive leg raising test.
CNS Complications in Adult Patients Treated With Extracorporeal Membrane Oxygenation
Authors: Chapman Jason T. , Breeding Jeff , Kerr Stephen J. , Bajic Marko , Nair Priya , Buscher Hergen
Published: December 2020

Objectives:

To describe the incidence and outcomes of radiologically confirmed acute CNS complications in extracorporeal membrane oxygenation patients at an Australian extracorporeal membrane oxygenation referral center and identify associated patient characteristics.

Design:

Retrospective cohort study.

Setting:

Single-center tertiary institution.

Patients:

Four-hundred twelve consecutive adult patients supported with extracorporeal membrane oxygenation from 2009 to 2017.

Results:

Fifty-five patients (13.3%) had a CNS complication confirmed by CT or MRI, including ischemic stroke (7.0%), intracerebral hemorrhage (3.4%), hypoxic ischemic encephalopathy (3.6%), and spinal cord injury (1.2%). CNS complication rates in the venoarterial, venovenous, and veno-pulmonary artery extracorporeal membrane oxygenation subgroups were 18.0%, 4.6%, and 13.6%, respectively. Neurologic complications were independently associated with the use of venoarterial extracorporeal membrane oxygenation (p = 0.002) and renal replacement therapy (p = 0.04). Sixty-five percent of patients with a neurologic complication died during their hospital admission compared with 32% of patients without this complication (p < 0.001). Venoarterial extracorporeal membrane oxygenation, renal replacement therapy, and days of extracorporeal membrane oxygenation support were also associated with hospital mortality and remained so after adjustment in a multivariable regression model (p = 0.01, p < 0.001, and p = 0.003, respectively).

Conclusions:

CNS complications appear to occur more frequently in patients requiring circulatory as opposed to respiratory support on extracorporeal membrane oxygenation and are independently associated with mortality. It remains unclear if these complications are causative of a poor outcome or a marker of severity of the underlying condition. Further research is required to better elucidate modifiable or preventable aspects through better patient selection and change in ongoing care.
Checkpoint Inhibitor-associated Cutaneous Small Vessel Vasculitis: A Review of the Literature
Authors: Ho Bernard , Larkin James , Heelan Kara
Published: December 2020

Checkpoint inhibitor therapy is an established cancer treatment option often complicated by the development of immune-related adverse events. Vasculitis has been reported with a broad spectrum of both cutaneous and systemic manifestations and can be complicated by delayed diagnosis. The authors report 2 histologically proven cases of cutaneous leucocytoclastic vasculitis induced by programmed cell-death 1 inhibitor inhibitor nivolumab. As physicians, including medical oncologists and dermatologists, we need to be aware of this clinical entity and the importance of clinicopathological confirmation in this setting to confirm the diagnosis to help guide the management of these complex patients.
Primary Biliary Cirrhosis and Granulomatous Hepatitis After Immune Checkpoint Blockade in Patients With Metastatic Melanoma: Report of 2 Cases and Literature Discussion
Authors: Ruini Cristel , Haas Carolin , Mastnik Sebastian , Knott Maximilian , French Lars E. , Schlaak Max , Berking Carola
Published: December 2020

Immune-related adverse events (irAEs) of immune checkpoint inhibitors can potentially affect every organ system, are sometimes challenging, and require a multidisciplinary approach. Most common irAEs are very well characterized, but some other such rare autoimmune liver diseases are probably underdiagnosed and less explored. We present here the case of a 69-year-old man with metastatic melanoma developing a severe primary biliary cirrhosis under pembrolizumab, and of a 52-year-old woman with metastatic melanoma with granulomatous hepatitis in the context of an immune-related multiorgan inflammatory reaction due to ipilimumab and nivolumab. Both cases were in part steroid refractory and required a complex diagnostic assessment and long-term therapeutic management. The liver biopsy was crucial for ensuring a correct diagnosis. Clinicians should be aware of rare liver diseases in the context of increased liver enzymes under immune checkpoint inhibitors, especially if not responding to corticosteroids. The primary diagnostic workup should localize the liver damage (biliary or parenchymal) and distinguish irAEs from other pathologic conditions such as metastasis, second benign and malignant tumors, viral hepatitis, and cholelithiasis. If in doubt, a liver biopsy should be performed. Early diagnosis and accurate assessment of hepatic adverse events is necessary for prompt and effective treatment, with reduction of inappropriate discontinuation of immunotherapy, morbidity, and mortality.
MAFLD vs. NAFLD: shared features and potential changes in epidemiology, pathophysiology, diagnosis, and pharmacotherapy
Authors: Xian Ying-Xin , Weng Jian-Ping , Xu Fen
Published: December 2020

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, placing an increasing burden on human health. NAFLD is a complex multifactorial disease involving genetic, metabolic, and environmental factors. It is closely associated with metabolic syndrome, obesity, and type 2 diabetes, of which insulin resistance is the main pathophysiological mechanism. Over the past few decades, investigation of the pathogenesis, diagnosis, and treatments has revealed different aspects of NAFLD, challenging the accuracy of definition and therapeutic strategy for the clinical practice. Recently, experts reach a consensus that NAFLD does not reflect the current knowledge, and metabolic (dysfunction) associated fatty liver disease (MAFLD) is suggested as a more appropriate term. The new definition puts increased emphasis on the important role of metabolic dysfunction in it. Herein, the shared features and potential changes in epidemiology, pathophysiology, diagnosis, and pharmacotherapy of the newly defined MAFLD, as compared with the formerly defined NAFLD, are reviewed for updating our understanding.
Morphea following treatment with pembrolizumab for melanoma with metastatic lymph nodes: case report and review of literature
Authors: Zafar Faraaz S. , Richey Patricia , Okereke Uchenna , Milhem Mohammed , Abid Roshan , Powers Jennifer G.
Published: December 2020

Pembrolizumab is a humanized IgG4 isotype mAb that the targets and blocks the programmed cell death protein 1 receptor on lymphocytes. Its use in treating metastatic melanoma is associated with increased overall survival compared to other older immunotherapies. Several adverse effects have been noted including both systemic and cutaneous manifestations. As a relatively novel treatment option, many new cutaneous manifestations are still being observed, occurring at various times after initiation of therapy. Previously noted cutaneous adverse effects include sarcoid-like reactions, rash, and changes in preexisting lesions or scars. Here we present a case in which biopsy-proven morphea developed after completion of pembrolizumab therapy.
PENTOSAN POLYSULFATE AND VISION
Authors: Uner Ogul E. , Shah Megha K. , Jain Nieraj
Published: December 2020

Purpose:

To investigate patient-reported visual function among individuals taking pentosan polysulfate (PPS) for interstitial cystitis.

Methods:

A 27-item online survey was distributed to an international mailing list of individuals with interstitial cystitis in November 2018. Demographic characteristics, PPS exposure history, subjective visual function, and previous macular diagnoses were queried. The impact of PPS use, grouped by tertile of cumulative exposure, on visual function and macular diagnoses was assessed with multivariate logistic regression.

Results:

The survey was completed by 912 respondents. Eight hundred and sixty-one (96.4%) were women, and the median age was 55 [interquartile range (IQR), 45–64 years]. Among PPS users, the median exposure was 547.5 g (IQR, 219–1,314 g). Respondents in the highest PPS exposure tertile were more likely to report difficulty with reading small print [adjusted odds ratio 2.29, 95% confidence interval (CI) 1.15–4.57] and to have a diagnosis of macular degeneration and/or pigmentary maculopathy (adjusted odds ratio 2.41, 95% CI 1.44–4.03) than unexposed respondents.

Conclusion:

In this large sample of individuals with interstitial cystitis, those in the highest PPS exposure category were more likely to have difficulties reading small print and to report a previous diagnosis of macular disease. Further study of objective measures of visual function in PPS users is warranted.
SYPHILITIC OUTER RETINOPATHY: A MASQUERADING DIAGNOSIS REVEALED AFTER STEROID-INDUCED PROGRESSION TO PANUVEITIS
Authors: Zafar Sidra , Mishra Kapil , Sachdeva Mira M.
Published: December 2020

Purpose:

To report a case of syphilitic outer retinopathy revealed after progression to panuveitis after a course of oral steroids for suspected poison ivy.

Methods:

Retrospective case report.

Results:

A 44-year-old diabetic man presented with progressive symptoms of nyctalopia and color vision changes associated with outer retinal disruption on macular imaging but minimal evidence of intraocular inflammation on examination. A short course of oral steroids for an unrelated skin condition induced rapid progression to frank panuveitis with retinal vascular sheathing and retinal whitening. Systemic workup identified syphilis as the etiology. The patient's visual symptoms and disruption of the photoreceptor and retinal pigment epithelial layers on OCT improved after treatment with IV penicillin.

Conclusion:

Syphilitic outer retinopathy represents an unusual manifestation of ocular syphilis that can present with minimal examination findings. We present here a case of oral steroid use resulting in the progression of syphilitic outer retinopathy to a more fulminant form of syphilitic uveitis that ultimately revealed the correct diagnosis and prompted the correct intervention. This case highlights the importance of maintaining a high level of suspicion for this treatable condition.
Tolerance to Residual Refractive Errors After Trifocal and Trifocal Toric Intraocular Lens Implantation
Authors: Rementería-Capelo Laureano A. , Contreras Inés , García-Perez Jorge L. , Carrillo Virginia , Gros-Otero Juan , Ruiz-Alcocer Javier
Published: December 2020

Objective:

The objective of this study was to assess the impact of 0.50 diopter (D) positive or negative defocus on visual function in patients implanted with trifocal and trifocal toric intraocular lenses (IOLs).

Methods:

The study included patients implanted with the AcrySof IQ PanOptix IOL or the PanOptix Toric. Visual acuity (VA) at high (100%), medium (50%) and low (10%) contrast, contrast sensitivity function (CSF), and halo perception were assessed three months after surgery. Explorations were performed with corrected distance visual acuity (CDVA), with a positive defocus of +0.50D (myopization) and with a negative defocus of −0.50D (hyperopization).

Results:

The study included 60 eyes of 60 patients (30 eyes with PanOptix and 30 eyes with PanOptix Toric). For both groups, VA was better for all contrast settings at the CDVA situation (P<0.05 in all cases). For low spatial frequencies, no differences in CSF were found among the three refractive situations in either group. For higher frequencies, the results showed an overall trend for better CSF results for the CDVA situation. The halo effect was lower for the CDVA situation if compared to myopization and hyperopization in both the PanOptix and the PanOptix Toric groups (P<0.05 for all cases).

Conclusions:

There is an impact on visual quality and halo perception in patients implanted with trifocal or trifocal toric IOLs even for low residual refractive errors.
Ocular Surface Biomarkers
Authors: Simsek Cem , Dogru Murat
Published: December 2020

Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease of the lacrimal and salivary glands. Salivary gland biopsy is still one of the most valuable and acceptable diagnostic tests for SS, which however, is an invasive test. Therefore, noninvasive diagnostic biomarkers with high specificity and sensitivity are required for the diagnosis and assessment of SS. Because ophthalmological testing constitutes to an important part for the diagnosis of SS. Tears harbor biomarkers with a high potential to be used for differential diagnosis and assessment of treatment in many systemic disorders, including SS. This review aims to summarize recent advances in the identification of tear biomarkers of SS, trying to identify reliable, sensitive, and specific biomarkers that can be used to guide treatment decisions.
Design and Construction of a Smart Mattress for Monitoring Bedsore Ulcer Prevention in Sedentary Patients
Authors: Memari Asiye , Golpaygani Ali Tavakoli , Hassani Kamran , Hoseinzadeh Mohammad Saleh
Published: December 2020

Pressure sore or bedsore is an injury to an area of body tissue that has been disrupted or lacked blood supply due to long-term pressure. The risk of developing a bedsore is usually higher in the bony areas of the body because there is more pressure on the skin and less fat in these areas. This complication is very common among the elderly and sedentary patients, which requires the need for care and nursing of these people all day. In this article, design and implementation of a smart mattress are demonstrated; this system can estimate the time to reach the stage of bedsore and set an essential warnings or call for caregiver or nurse to move the body area at risk. Our designed smart mattress consists of several pressure sensors assembled under a sheet, which is possible to measure the pressure intensity of different areas of the body arising from the patient's weight while lying down on the mattress. By processing the gathered information against time, the necessary warnings can be processed and send to the nurse based on the patient's weight per area and the risk factor related to patient's age. Our proposed system is based on a real-time pressure-sensing algorithm cognitive support system that augments the ability of a caregiver, allowing them to provide better care to more patients in less time. The operation and development of this system will have an effective point in preventing and reducing bedsore on patients who have medical conditions that limit their ability to change positions or cause them to spend most of their time in a bed or chair.
Sledding-Related Injuries Among Children and Adults Treated in US Emergency Departments From 2008 to 2017
Authors: Evans Kris H.C. , McAdams Rebecca J. , Roberts Kristin J. , McKenzie Lara B.
Published: December 2020

Objective:

To describe the epidemiology of sledding-related injuries among children and adults treated in US emergency departments (EDs).

Design:

The researchers performed a retrospective analysis using data from the National Electronic Injury Surveillance System (NEISS).

Setting:

The NEISS collects data on consumer products-related and sports-related injuries treated in US EDs from approximately 100 hospitals that represent a probability sample of >5000 hospitals.

Patients:

Children (≤19 years of age) and adults who were treated for sledding-related injuries in EDs from 2008 to 2017.

Independent Variables:

The researchers analyzed characteristics that included sex, body part injured, injury diagnosis, disposition from the ED, injury locale, injury mechanism, and sled type.

Main Outcome Measures:

All cases of sledding-related injuries were identified using NEISS product codes for sleds (1217), toboggans (1273), snow disks (1274), and snow tubes (1299).

Results:

An estimated 220 488 patients [95% confidence interval (CI): 169 839-271 137] were treated in EDs for sledding-related injuries. Overall, the injury rate decreased significantly for both children and adults. Children accounted for 69.7% of the injury cases. Fractures were the most common injury diagnosis for children (23.9%) and adults (27.4%). Compared to adults, children were more likely to sustain a head injury [relative risk (RR): 1.91 (95% CI: 1.73-2.13)] and be diagnosed with a concussion or closed-head injury (CHI) [RR: 1.58 (95% CI: 1.35-1.84)]. Most patients were injured by a collision (63.2%). Snow tube and disk riders were more likely to sustain a concussion or CHI compared to sled and toboggan riders [RR: 1.53 (95% CI: 1.18-1.99)]. Injuries predominantly occurred when patients collided with objects in the environment (47.2%).

Conclusions:

Although sledding-related injuries decreased over the study period, more research and education to prevent these injuries is needed. The injury patterns and risk of injury type differed by age, with more head injuries sustained by children. Sledding should be performed in obstacle-free areas to reduce the risk of collision and while wearing helmets to mitigate head injuries.
Global brain glucose uptake on 18F-FDG-PET/CT is influenced by chronic cardiovascular risk
Authors: Borja Austin J. , Hancin Emily C. , Zhang Vincent , Koa Benjamin , Bhattaru Abhijit , Rojulpote Chaitanya , Detchou Donald K. , Aly Mahmoud , Kaghazchi Fatemeh , Gerke Oke , Patil Shivaraj , Gonuguntla Karthik , Werner Thomas J. , Revheim Mona-Elisabeth , Høilund-Carlsen Poul F. , Alavi Abass
Published: December 2020

Purpose

The goal of this study was to assess global cerebral glucose uptake in subjects with known cardiovascular risk factors by employing a quantitative 18F-fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) technique. We hypothesized that at-risk subjects would demonstrate decreased global brain glucose uptake compared to healthy controls.

Methods

We compared 35 healthy male controls and 14 male subjects at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation (SCORE) tool. All subjects were grouped into two age-matched cohorts: younger (<50 years) and older (≥50 years). The global standardized uptake value mean (Avg SUVmean) was measured by mapping regions of interest of the entire brain across the supratentorial structures and cerebellum. Wilcoxon’s rank-sum test was used to assess the differences in Avg SUVmean between controls and at-risk subjects.

Results

Younger subjects demonstrated higher brain Avg SUVmean than older subjects. In addition, in both age strata, the 10-year risk for fatal CVD according to the SCORE tool was significantly greater in the at-risk groups than in healthy controls (younger: P = 0.0304; older: P = 0.0436). In the younger cohort, at-risk subjects demonstrated significantly lower brain Avg SUVmean than healthy controls (P = 0.0355). In the older cohort, at-risk subjects similarly had lower Avg SUVmean than controls (P = 0.0343).

Conclusions

Global brain glucose uptake appears to be influenced by chronic cardiovascular risk factors. Therefore, FDG-PET/CT may play a role in determining the importance of CVD on brain function and has potential for monitoring the efficacy of various therapeutic interventions.