bluuebunny/crossref_metadata_2025 huggingface dataset:
Mary Ainsworth and the Strange Situation Procedure
Authors: Duschinsky Robbie
Published: August 2022

Attachment as an empirical research paradigm may be regarded as having fully commenced only with Ainsworth’s work. This chapter begins by introducing the biographical context of Ainsworth’s work, including her early work at Toronto University. Ainsworth’s concept of ‘security’ and her attempt to develop self-report measures of security are reappraised, placing Ainsworth’s work in the context of her debt to her teacher Blatz. The chapter then draws on Ainsworth’s published and unpublished writings to consider the strengths and limitations of her Uganda ethnography and Baltimore longitudinal study. This helps clarify Ainsworth’s goals in her development of a scale to measure sensitivity and in developing the Strange Situation procedure. The chapter also considers the work of Ainsworth’s collaborator and student Everett Waters. In addition, it addresses other concerns that have been raised regarding Ainsworth’s work, including the extent of its cross-cultural validity.
Alan Sroufe, Byron Egeland, and the Minnesota Longitudinal Study of Risk and Adaptation
Authors: Duschinsky Robbie
Published: August 2022

This chapter considers the work of Alan Sroufe, Byron Egeland, and the Minnesota Longitudinal Study of Risk and Adaptation. It presents the first sustained commentary on Sroufe’s ideas about emotion, attachment, and development. Headline concepts like ‘felt security’ were influential for subsequent attachment theory. However, other ideas like affects as social currency, and intrusive intimacy, are still less well known. The chapter examines the antecedents and sequelae of attachment in the Minnesota Longitudinal Study of Risk and Adaptation. The legacy of Sroufe and Egeland is discussed for two former students who have subsequently returned to take leadership roles at Minnesota: Dante Cicchetti and Glenn Roisman. The chapter also discusses ways in which Sroufe and Egeland’s theoretical commitment to holism has contributed to both strengths and limitations in their work.
Pregnancy Ultrasound
Authors: Tamborski Maria , Medeiros Sarah , Weingrow Daniel , Dyne Pamela
Published: August 2022

This chapter uses clinical vignettes and multiple-choice questions to explore core and advanced principles of ultrasound applicable to pregnant patients. The cases assess image acquisition pearls and pitfalls, image interpretation, false positive and negative findings, and integration into patient management. Clinical vignettes include stable and unstable patients presenting with undifferentiated symptoms such as abdominal pain, flank pain, or hypotension. Each case includes detailed explanations for correct and incorrect answer choices, incorporating landmark studies as well as the latest literature that clinical sonographers will find of interest. Relevant references and sources for each case are also included, as well as keywords for each section.
Gynecological Ultrasound
Authors: Esener Dasia , Betta M. Bryan Dalla
Published: August 2022

This chapter uses clinical vignettes and multiple-choice questions to explore core and advanced principles gynecological ultrasound, including evaluation of vaginal bleeding, pelvic pain, tubo-ovarian abscess, ovarian cysts, ovarian cancer and more. The cases will assess image acquisition pearls and pitfalls, image interpretation, false positive and negative findings, and integration into patient management. Clinical vignettes will include patients presenting with a wide variety of gynecological pathology that are commonly seen in emergency departments and other clinics. Each case will include detailed explanations for correct and incorrect answer choices, incorporating landmark studies as well as the latest literature that clinical sonographers will find of interest.
Soft Tissue Ultrasound
Authors: Liu Yiju Teresa , Bellman Lilly , Shibata Jackie , Khiyani Sheetal
Published: August 2022

This chapter uses clinical vignettes and multiple-choice questions to explore core and advanced principles of soft tissue ultrasound, including foreign body, cellulitis, abscess, necrotizing fasciitis, simple and complex cysts, and benign and malignant soft tissue masses. The cases assess image acquisition pearls and pitfalls, image interpretation, false positive and negative findings, and integration into patient management. Clinical vignettes include patients presenting with a wide variety of soft tissue pathology that are commonly seen in emergency departments and other clinics. Each case includes detailed explanations for correct and incorrect answer choices, incorporating landmark studies as well as the latest literature that clinical sonographers will find of interest.
Bowel and Appendix Ultrasound
Authors: Takemoto Andrea , Ball Lindsey , Fields J. Matthew
Published: August 2022

This chapter uses clinical vignettes and multiple-choice questions to explore core and advanced principles of gastrointestinal ultrasound. The cases will assess image acquisition pearls and pitfalls, image interpretation, false-positive and false-negative findings, and integration into patient management. Clinical vignettes will include stable and unstable patients presenting with undifferentiated symptoms such as abdominal pain, nausea, vomiting, and flank pain. Each case will include detailed explanations for correct and incorrect answer choices, incorporating landmark studies as well as the latest literature that clinical sonographers will find of interest.
Neocortical Epilepsy
Authors: Teton Zoe E. , Raslan Ahmed M.
Published: August 2022

Temporal lobe epilepsy (TLE) is the most common form of adult localization-related epilepsy. While 80% of patients have mesial temporal seizure onset, neocortical TLE encompasses a broader group of epilepsies generally characterized by an aura and contralateral clonic activity that will very often generalize. Thirty percent of these patients will remain refractory to medication. In patients whose thorough phase I and phase II evaluation has determined a neocortical seizure onset zone, anterior temporal lobectomy has been shown to be superior to medication alone in achieving seizure freedom and does so in up to 80% of these patients. Mortality in ATL is less than 1%, with morbidity rates around 5%, most commonly visual field defects. Neuropsychological performance may decline in up to 50% of cases, though it will improve in up to one-third of cases if seizure freedom is obtained.
Cortical Dysplasia With Extratemporal Epilepsy
Authors: Selden Nathan R.
Published: August 2022

Medically refractory focal epilepsy in childhood is often related to the presence of focal cortical dysplasia, which may occur in temporal or extra-temporal locations. Normal findings with standard MR imaging is not unusual in such cases, related to immature myelination or insensitive imaging protocols, or both. High Tesla MR imaging and re-imaging at an older age may provide evidence of focal dyplasia as a possible cause for seizure onset. Invasive epilepsy and functional mapping in children and adolescents may require the placement of subdural grid and/or intraparenchymal depth electrodes, with extra-operative mapping of seizure foci and functional brain tissue. Second stage surgery is then utilized for hardware removal and simultaneous cortical resection to treat the epileptic focus. Although the prognosis for Engel Class I result is lower with extra-temporal foci, it is higher with Type II focal cortical dyplasia, particularly balloon cell dysplasia (Type IIb).
Genetic Epilepsy
Authors: Selden Nathan R.
Published: August 2022

Genetic epilepsies may present early in childhood with multiple seizure types, including tonic, atonic, and partial seizures. In patients refractory to management with anti-convulsant medications and/or ketogenic diet, as appropriate, and who do not have any imaging or electrophysiological evidence of focality, additional therapy may be undertaken using vagal nerve stimulation (VNS). The VNS lead is generally implanted in the mid-cervical region on the left (due to lesser effects on cardiac rhythm), with the generator placed in a subclavicular position. Like anti-convulsant drugs, VNS is palliative, and requires system upkeep, including but not limited to generator changes for battery life. Risks of VNS including treatment failure due to infection or device malfunction, hoarseness due to recurrent laryngeal nerve palsy, or rarely more serious surgical complications related to anterior neck dissection.
Dystonia
Authors: Teton Zoe E. , Raslan Ahmed M.
Published: August 2022

Dystonia is a lifelong condition that arises from dysfunction of the motor control components of the central nervous system and results in significant pain and disability. While the pathophysiology remains unclear, neuroimaging indicates an association with reduced inhibitory basal ganglia output. Interventions are aimed at improving quality of life. In patients whose conditions are refractory to medications, deep brain stimulation of the globus pallidus interna and subthalamic nucleus has been shown to significantly reduce symptoms, leading to an improvement in disability and overall quality of life. Efficacy rates range anywhere from 20% to 85%, depending on the patient as well as the subtype of dystonia being treated. Complications include hardware malfunction, infection, and intracranial hemorrhage, though rates of each of these that require reoperation are consistently less than 3%.
Heart Failure and Cardiomyopathies
Authors: Timimi Farris K.
Published: August 2022

Heart failure is a clinical syndrome characterized by inability of the heart to maintain adequate cardiac output to meet the metabolic demands of the body while still maintaining normal or near-normal ventricular filling pressures. Heart failure may be present at rest, but often it is symptomatic only during exertion because of the dynamic nature of cardiac demands. For optimal treatment of heart failure, the mechanism, the underlying cause, and any reversible precipitating factors must be identified. Typical manifestations of heart failure are dyspnea and fatigue, limiting activity tolerance, and fluid retention leading to pulmonary or peripheral edema.
Cystic Fibrosis, Bronchiectasis, and Pleural Effusion
Authors: Iyer Vivek N.
Published: August 2022

This chapter describes the presentation, symptoms, causes, diagnoses, and treatments for cystic fibrosis, bronchiectasis, and pleural effusion. Laboratory tests and biopsy are also covered.
Interstitial Lung Diseases
Authors: Clain Jeremy M. , Aksamit Timothy R.
Published: August 2022

An estimated 1 in 3,000 to 1 in 4,000 persons in the general population have a diagnosis of interstitial lung disease (ILD), and ILDs account for about 15% of all consultations for general pulmonologists. These diseases encompass a group of heterogeneous lung conditions characterized by diffuse involvement of the lung parenchyma and pulmonary interstitium. Infections, pulmonary edema, lung malignancies, and emphysema are excluded by convention, but they should be carefully considered as part of the differential diagnosis.
Connective Tissue Diseases
Authors: Ernste Floranne C.
Published: August 2022

This chapter describes the various clinical manifestations, laboratory findings, diagnoses, and treatments for a number of connective tissue diseases, including systemic lupus erythrmatosus, drug-induced lupus, mixed connective tissue disease, undifferentiated connective tissue disease, antiphospholipid antibody syndrome, Raynaud phenomenon, systemic sclerosis (scleroderma), and Sjogren syndrome.
Musculoskeletal Disorders
Authors: Mohabbat Arya B. , Wittich Christopher M.
Published: August 2022

This chapter describes the various causes, diagnoses, and treatment for disorders of the neck, lower back, shoulder, elbow, hand and wrist, hip, knee, ankle and foot, and also fibromyalgia.
Fundamentals of HIV Medicine 2021
Authors: Hardy W. David , The American Academy of HIV Medicine
Published: August 2022

This book discusses the global prevalence as well as the geographic distribution of HIV-1 and HIV-2 infections and updates on recent shared global initiatives. The demographic trends in HIV in the United States, especially regarding gender, sexuality, race, ethnicity, age, injection-drug use, socioeconomic status, and recent initiatives are reviewed. Special attention is paid to HIV among communities of color, as well as women, children, and adolescences. The role of HIV in men who have sex with men and the transgender community is reviewed in detail. HIV Testing and Counselling lists and describes the various types of HIV testing available. The book also presents an overview of HIV counselling. HIV testing terminology and algorithms are presented to the reader along with descriptive figures. Laboratory markers for HIV are reviewed. The chapter describes who should be tested, as well as pre and post-test counselling elements. A section of the chapter is dedicated to special populations and environments (blood supply screening, prenatal screening, testing settings) Strategies to improve uptake of HIV testing are discussed.
Mechanisms of HIV Transmission
Authors: Nambiar Puja H.
Published: August 2022

This chapter outlines the various ways that HIV is transmitted, including sexual transmission, transmission in the healthcare setting, transmission through the use of injection drugs, and mother-to-child transmission. The significance of viral load quantity and its relationship to transmission risk is discussed as well as the impact of co-occurring sexually transmitted diseases in HIV transmission.
Scientific Basis of Antiretroviral Therapy
Authors: Koren David E. , Pandit Neha Sheth , Heil Emily
Published: August 2022

This chapter opens with a discussion about classes and mechanisms of antiretroviral agents. The mechanisms of action of the traditional versus newer antiretroviral classes are reviewed as well as the five major categories of antiretroviral agents. Key characteristics and findings of recent clinical trials involving the regimens recommended by the US Department of Health and Human Services are reported. The chapter concludes with a discussion about what is on the horizon for antiretroviral therapy.
Antiretroviral Resistance
Authors: Chu Carolyn , Pollock Lealah , Shafer Robert
Published: August 2022

This chapter outlines various mechanisms of HIV drug resistance as well as HIV drug resistance testing assays and clinical considerations. Transmitted HIV drug resistance and acquired HIV drug resistance are discussed in detail. Unique considerations regarding evaluation of HIV drug resistance and management for select clinical scenarios are reviewed. These scenarios include switches or simplification of the antiretroviral regimen, pregnancy, recent use of preexposure prophylaxis, “rapid” antiretroviral therapy, and care of persons with HIV in low- and middle-income countries.
Antiretrovirals During and After Hospitalization, Including Bariatric Surgery
Authors: Koren David E.
Published: August 2022

This chapter discusses the issues involved in determining the relative priority of initiating and/or maintaining antiretroviral therapy in hospitalized people with HIV with significant comorbid conditions as well as the continuity of care after discharge from the inpatient setting. It defines antiretroviral stewardship and allows the learner to understand its potential benefit in implementation. Important consideration in the preoperative care of people with HIV are described. Lastly, the chapter covers the pharmacologic complications that may result from bariatric surgery.
Multilingualism in the Roman World
Authors: Biville Frédérique
Published: August 2022

Situated at the intersection of various academic disciplines, multilingualisim has attracted the attention of several categories of researchers specializing in studying the ancient Roman world, including historians, philologists, linguists, literary scholars, epigraphists, and papyrologists. While Greek-Latin bilingualism, which constitutes the most remarkable aspect of ancient multilingualism, has been the subject of landmark, comprehensive studies, and although it is now well described and theorized, there still is not a single study on the relationships between Latin and the other languages of the Empire that takes into account the various aspects of the question and synthesizes the data that have emerged from these disciplines. Looking closely at the lexicon used by the Romans to describe the phenomenon of multilingualism and linguistic interference also shows that, contrary to a commonly held opinion, not only did the Romans not demonstrate an “incuriosity” regarding foreign languages, but they even developed their own linguistic reflection on the subject.
Political Accountability and Selective Perception in the Time of COVID
Authors: Freeder Sean , O’Brian Neil A
Published: August 2022

That voters punish the incumbent president in bad times, and reward them in good times, has become a stylized fact of elections. Despite COVID-19 representing an unprecedented catastrophe, Trump’s approval ratings, unlike other world leaders, remained stable throughout 2020. To explore this puzzle, we surveyed the same Americans twice before the 2020 election—a period when COVID cases spiked. Instead of finding that the crisis’s severity affected Trump’s approval, we find the reverse—perception of the crisis depended on one’s prior political predispositions. People who already supported Trump were more likely to underestimate COVID fatalities and case rates, and less likely to perceive the crisis as worsening over time (daily infections doubled between interviews). Those who perceived the crisis to worsen, but continued to support Trump, expressed unwillingness to blame the president. A public so polarized that it fails to acknowledge disaster, or attribute blame, cannot hold its government accountable.
Identification of Quantitative Trait Loci for Resistance to Wheat Sharp Eyespot in the Einstein × Tubbs Recombinant Inbred Line Population
Authors: Liu Jiang , Cobertera David C. , Zemetra Robert S. , Mundt Christopher C.
Published: August 2022

Wheat sharp eyespot (SES), caused by the soilborne pathogen Rhizoctonia cerealis Van der Hoeven (teleomorph: Ceratobasidium cereale), is a common stem disease of wheat globally. The disease caused a severe and extensive epidemic throughout the Willamette Valley of Oregon in 2014 and has remained one of the most important wheat diseases in this region. However, little was known about the genetics of host resistance to this disease. A recombinant inbred line (RIL) population with 257 lines developed from a cross of Einstein × Tubbs was used to study SES resistance of wheat. The phenotyping was conducted at two locations and in 3 years. Genotyping by sequencing was done by using Illumina HiSeq 3000. Low broad-sense heritability across four environments was obtained. The results of analysis of variance demonstrated that disease severity was significantly different among RILs for the data combined over environments and for one of the individual environments. Four SES resistance quantitative trait loci (QTL) were detected, including QSES-1A, QSES-2B, QSES-6A, and QSES-7A, and explained 5.9, 5.9, 8.8, and 8.3%, respectively, of the phenotypic variance. All four QTL overlapped or are in close proximity with one or more plant defense genes, and could lay the foundation for marker-assisted breeding.
CE: Pain and Mental Health Symptoms After Traumatic Orthopedic Injury
Authors: Breazeale Stephen , Barrett Stephanie , Holland William , Webb Megan
Published: August 2022

This article highlights the need to screen survivors of traumatic orthopedic injuries for postinjury symptoms associated with stressor-related disorders such as acute stress disorder and posttraumatic stress disorder, including pain, sleep disturbances, anxiety, and depression. The authors discuss the presentation of these postinjury symptoms, the instruments used to screen for each, the various pharmacological and nonpharmacological treatments, and the nursing implications for managing postinjury symptoms in traumatic orthopedic injury survivors.
Carbon Dioxide, Blood Pressure, and Perioperative Stroke: A Retrospective Case–Control Study
Authors: Vlisides Phillip E. , Mentz Graciela , Leis Aleda M. , Colquhoun Douglas , McBride Jonathon , Naik Bhiken I. , Dunn Lauren K. , Aziz Michael F. , Vagnerova Kamila , Christensen Clint , Pace Nathan L. , Horn Jeffrey , Cummings Kenneth , Cywinski Jacek , Akkermans Annemarie , Kheterpal Sachin , Moore Laurel E. , Mashour George A.
Published: August 2022

Background

The relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke.

Methods

We conducted a retrospective, case–control study via the Multicenter Perioperative Outcomes Group. Noncardiac, nonintracranial, and nonmajor vascular surgical cases (18 yr or older) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (less than 55 mmHg, less than 60 mmHg, less than 65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (30 mmHg or less, 35 mmHg or less, 45 mmHg or greater) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders.

Results

In total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n = 1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with mean arterial pressure less than 55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% CI, 1.10 to 1.23], P < 0.0001) and end-tidal carbon dioxide 45 mmHg or greater (adjusted odds ratio per 10 mmHg-min, 1.11 [95% CI, 1.10 to 1.11], P < 0.0001). There was no interaction effect observed between blood pressure and carbon dioxide.

Conclusions

Intraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Assessing the Impact of Meteorological Conditions on Outpatient Visits for Childhood Respiratory Diseases in Urumqi, China
Authors: Yang Zhen , Li Cheng , Wang Chenchen , Nie Yanwu , Zhang Yuxia , Tian Maozai , Zhang Liping
Published: August 2022

Objectives

The aims of this study were to explore the impact of meteorological factors on respiratory diseases in children and to provide recommendations to local governments and health agencies to prevent respiratory diseases.

Methods

The exposure-lag effect between meteorological factors and the number of outpatients was investigated by constructing a distributed lag nonlinear model.

Results

Both high and low temperature will increase the risk of respiratory diseases in children, but low temperatures have a stronger effect compared with high temperatures (except for bronchopneumonia). High and low wind speeds can adversely affect respiratory diseases in children.

Conclusions

Temperature and wind speed have an effect on children's respiratory diseases in Urumqi, and this effect has a time lag. Attention should be paid to the impact of adverse weather conditions on children's health.
A Prospective Cohort Study of Presenteeism and Increased Risk of Divorce Among Japanese Workers
Authors: Fujino Yoshihisa , Okawara Makoto , Hino Ayako , Muramatsu Keiji , Nagata Tomohisa , Tateishi Seiichiro , Tsuji Mayumi , Ogami Akira , Ishimaru Tomohiro ,   for the CORoNaWork Project
Published: August 2022

Objective

We examined the association between the presenteeism and the risk of divorce among Japanese workers during the COVID-19 pandemic.

Methods

A prospective study of 27,036 individuals was conducted starting in December 2020, with 18,560 (68.7%) participating in the follow-up in December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment.

Results

Compared with the group with the lowest WFun score, the odds ratio for the group with moderate WFun was 1.16 (95% confidence interval, 0.74 to 1.82;P= 0.525), and the odds ratio for the group with the highest WFun was 1.76 (95% confidence interval, 1.18 to 2.62;P= 0.006).

Conclusions

This study suggests that supporting workers with presenteeism has important implications not only from the perspective of labor productivity in management but also for the individual's quality of life in terms of family relationships.
COVID-19 Traumatic Disaster Appraisal and Stress Symptoms Among Health Care Workers
Authors: Olson Kristine D. , Fogelman Nia , Maturo Laura , Alvarado Javier , Ball Samuel , Forray Ariadna , Hu Mary , Ivy Michael , Kapo Jennifer , Krystal John , Mayes Linda , Rohrbaugh Robert , Southwick Steven , Tebes Jacob , Wassel Bud , Sinha Rajita
Published: August 2022

Objective

To determine to what extent did health care workers experience the pandemic as a severe stress event.

Methods

This cross-sectional evaluation of 8299 health care workers, representing a 22% response rate, utilized machine learning to predict high levels of escalating stress based on demographics and known predictors for adverse psychological outcomes after trauma.

Results

A third of health care workers experienced the pandemic as a potentially traumatic stress event; a greater proportion of health care workers experienced high levels of escalating stress. Predictive factors included sense of control, ability to manage work-life demands, guilt or shame, age, and level of education. Gender was no longer predictive after controlling for other factors. Escalating stress was especially high among nonclinical academics and clinical private practitioners.

Conclusion

Findings suggest adverse effects on total worker health, care quality, professionalism, retention, and acute and chronic mental health.
The Potential for Total Worker Health ® Approaches in State and Territorial Health Departments
Authors: Leff Maija S. , Martini Marisa , Baron Sherry , Hannon Peggy A. , Walton AnnMarie , Linnan Laura A.
Published: August 2022

Objective

To document the extent to which state and territorial health departments (SHDs) integrate their occupational safety and health (OSH) and workplace health promotion (WHP) activities consistent with a Total Worker Health (TWH) approach.

Methods

Nationally representative survey of OSH and WHP practitioners at 56 SHDs followed by in-depth interviews.

Results

Despite reporting limited awareness of the TWH initiative and TWH resources, most respondents (57% OSH, 64% WHP) reported collaboration between OSH and WHP staff in their departments. Collaborations were described in-depth. Barriers to OSH-WHP collaborations included resource insufficiencies, organizational structure in the SHD, and conflicting practices. Facilitators included knowledge of TWH approaches, proximity to TWH Centers of Excellence, proximity between OSH/WHP programs, and leadership initiative. Motivations for collaboration were enumerated.

Conclusions

Strategies for building TWH capacity and activity among SHDs are discussed.
The Future of Occupational and Environmental Medicine
Authors: Green-McKenzie Judith , Khan Alya , Redlich Carrie A. , Margarin Aisha Rivera , McKinney Zeke J.
Published: August 2022

Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions.
Dysphagia Worsens With Increasing Ineffective Swallows Among Patients With Ineffective Esophageal Motility
Authors: Rangan Vikram , Nee Judy , Li Brian , Lembo Anthony J. , Leiman David A.
Published: August 2022

Introduction:

Ineffective esophageal motility (IEM) is the most common motility disorder identified on esophageal high-resolution manometry (HRM), but patients with this finding may be asymptomatic. Therefore, we aimed to identify specific HRM findings predictive of symptoms in IEM.

Methods:

Adult patients (≥18 y) who underwent HRM between March 2016 and July 2019 were retrospectively evaluated and reclassified according to Chicago Classification 4.0 (CC4.0). Demographic information, HRM parameters, and gastroesophageal reflux disease Health-Related Quality of Life Questionnaire responses were captured among those with normal manometry or IEM. We evaluated the association between heartburn, regurgitation, and dysphagia, with respect to HRM findings including ineffective swallows.

Results:

Of 379 patients, 243 (64.1%) had a normal manometry, 136 (35.9%) were on IEM spectrum, and 73 (19.3%) had conclusive IEM by CC4.0. Mean dysphagia scores were significantly higher in those with conclusive IEM compared with those with normal HRM (2.00 vs. 1.36,P=0.002), as was the percentage of individuals reporting dysphagia affecting daily activities (21.9% vs. 11.4%,P=0.02). Heartburn and regurgitation symptoms did not differ between groups. In a multivariable model of IEM patients, the percentage of ineffective swallows independently predicted a higher dysphagia burden (β regression coefficient: 0.032,P=0.04).

Conclusions:

Applying the CC4.0 definition for conclusive IEM identifies a group of patients with worse dysphagia symptoms. Within this group, the percentage of ineffective swallows was an independent predictor of dysphagia severity. These findings may help practitioners and patients contextualize the heterogeneous diagnosis of IEM.
Efficiency of Japanese herbal medicine shokenchuto for nocturnal enuresis: An observational study
Authors: Ogawa-Ochiai Keiko , Ohama Kazunori
Published: August 2022

Japanese traditional (Kampo) medicine has been empirically used for nocturnal enuresis (NE). This study aims to investigate the efficacy of one of the most popular formulas, shokenchuto (SKT). We retrospectively analyzed 110 patients with NE who were referred to our department. Following the diagnosis of NE, treatment was started with either alarm or/and desmopressin (DDAVP) therapy. Patient refractory to DDAVP monotherapy or to combination therapy consisting of DDAVP and bedwetting alarm were selected. SKT (Tsumura Co., Tokyo, Japan) extract at a dose of 2.5 g was administered orally to all intractable cases twice daily before meals. The treatment outcomes and safety were assessed. In total, 24 cases were patient refractory to DDAVP monotherapy or to combination therapy consisting of DDAVP and bedwetting alarm. SKT was highly effective in 8, effective in 7, and ineffective in 9. A significant difference was observed between ages 10 and over (P = 0.031). SKT was significantly effective as a treatment for NE in patients aged ≥10 years and could be a good alternative if alarm or DDAVP therapies are ineffective. We proposed evaluating SKT prospectively for NE.
Complete response of advanced rectal gastrointestinal stromal tumors after imatinib treatment: A case report and literature review
Authors: Wu Tingting , Cheng Xiaobin , Chen Wenbin
Published: August 2022

Rationale:

Patients with rectal gastrointestinal stromal tumors (GISTs) who achieve a complete response (CR) with imatinib therapy have rarely been reported in the literature. Moreover, no treatment guidelines have been established for rectal GIST patients with CR after imatinib treatment, warranting further studies.

Patient concerns:

A 51-year-old man presented to our outpatient clinic in October 2013 with complaints of difficulty to defecate and a change in stool characteristics. During digital rectal examination, a mass was palpated within 5 cm from the anal verge. Contrast-enhanced computed tomography revealed a 8.1 × 7.2-cm rectal mass with significant enhancement during the arterial phase.

Diagnoses:

A diagnosis of GIST was established after conducting needle biopsy and immunohistochemistry staining.

Interventions:

Imatinib therapy (400 mg/d, oral administration) was immediately started. When the patient achieved clinical CR (cCR), the oncologist recommended the patient to continue imatinib treatment.

Outcomes:

At 7 months after imatinib administration, the patient achieved cCR. As suggested by the oncologist, the patient continued to receive imatinib treatment after cCR. After 13 months, the patient spontaneously stopped imatinib. Finally, tumor recurrence was observed 7 months later.

Lessons:

Surgery remains the mainstay of treatment for advanced rectal GIST patients who achieve cCR after imatinib treatment. Close follow-up and continuous imatinib treatment are indicated in patients who cannot undergo surgery.
Susceptibility-weighted imaging of cerebral fat embolism: A case report
Authors: Zhang Xianwen , Zheng Liaoyuan , Duan Jinfeng , Zhang Shunyuan , Zhou Ying , Tang Yufeng
Published: August 2022

Rationale:

Cerebral fat embolism (CFE) is a rare but critical disease in a clinical setting. Considering that manifestations and CT findings of CFE tend to be atypical, this condition is very difficult to diagnose. The purpose of this article was to assess the value of susceptibility-weighted imaging (SWI) in the diagnosis of CFE.

Patient concerns:

Our patient was an 80-year-old woman who developed hypoxemia, quadriplegia, and progressive confusion after fracture of the right femoral neck and right superior ramus of pubis within 24 hours.

Diagnosis:

T2-weighted magnetic resonance imaging (T2 W MRI), fluid-attenuated inversion recovery sequences, and diffusion-weighted imaging showed numerous hyperintense foci in the subcortex and white matter of both cerebral hemispheres, some of which were confluent and SWI showed multiple symmetrical punctate microhemorrhages in both hemispheres. Base on the history and MRI findings, the patient was diagnosed with CFE.

Interventions:

The patient received anticoagulation and lipid-lowering therapy.

Outcomes:

The patient regained consciousness, and her muscle strength in the limbs gradually recovered. One year after discharge, the patient could independently walk on her own.

Lession:

This case report shows the characteristics of CFE on SWI, which can help clinicians in diagnosing which can help clinicians in diagnosing CFE.
Prognostic value of neutrophil-lymphocyte ratio and lactate dehydrogenase in melanoma patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis
Authors: Zhang Yongchao , Liu Bozhi , Kotenko Sergei , Li Wei
Published: August 2022

Background:

Immune checkpoint inhibitors (ICIs) showed promising therapeutic efficacy on melanoma. Neutrophil-to-lymphocyte ratio (NLR) and serum lactate dehydrogenase (LDH) showed predictive values on prognosis of various tumors, but not on melanoma yet. This meta-analysis was conducted to investigate the prognostic role of NLR and LDH levels in melanoma treated with ICIs.

Methods:

A search was conducted for all reports published till March 2020 in PubMed, Web of Science, Cochrane Library, EMBASE, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). Studies were included if they investigated the association between pretreatment NLR/LDH and prognosis in melanoma patients treated with ICIs. Subgroup analysis, publication bias, and meta-regression were conducted to investigate heterogeneity.

Results:

A total of 6817 melanoma patients were included. Overall, high pretreatment NLR and LDH were associated with poor overall survival (OS) (P < .001) and PFS (P < .001). Subgroup analyses revealed that elevated NLR and LDH levels were associated with poor OS and PFS in patients treated with anti-CTLA-4 or anti-PD-1/PD-L1 alone. NLR level was superior in predicting OS if compared with LDH level in patients treated with anti-PD-1/PD-L1 + anti-CTLA-4. In subgroup analysis stratified by cutoff value, high NLR level was associated with poor OS and PFS regardless of cutoff value, but LDH works when cutoff value = upper normal limit (UNL). The predictive value of NLR and LDH levels on OS and PFS was partially compromised in the Asian populations, compared with the Western countries.

Conclusion:

Blood NLR and LDH levels showed great potential to be used as early prognostic biomarkers in melanoma patients treated with ICIs.
Synchronous surgery and immediate reconstruction of double primary cancers of the ovary and breast
Authors: Huang Chao-Hsin , Kuo Yur-Ren , Chen Yu-Chieh , Shih Shen-Liang
Published: August 2022

Introduction:

There has been an ongoing debate about the benefits and risks between synchronous surgery and two independent surgery of ovary tumor removal and breast reconstruction. Here we report a synchronous oncological surgery and immediate postmastectomy reconstruction of double primary cancers of the ovary and breast.

Patient concerns:

A 58-year-old woman presented with a right breast lump and ascites.

Diagnosis:

Computed tomography (CT) indicated synchronous breast and ovarian cancer with multiple metastases. Double primary mammary and ovarian cancer was confirmed after a series of evaluations, such as core needle biopsy of the breast tumor.

Interventions and outcomes:

Synchronous surgery and immediate reconstruction of double primary cancers of the ovary and breast were performed. Post-operative results showed complete resection of ovarian tumor, no post-operative complication, and excellent life quality.

Conclusion:

Synchronous surgery is warranted as a treatment option for selected cases of double primary cancer. The surgery not only achieved complete removal of one cancer and reduction of the other but also reached excellent breast reconstruction and body shape recovery.
Comparison of prediction accuracies between two mathematical models for the assessment of COVID-19 damage at the early stage and throughout 2020
Authors: Chuang Hua-Ying , Chien Tsair-Wei , Chou Willy , Wang Chen-Yu , Tsai Kang-Ting
Published: August 2022

Background:

The negative impacts of COVID-19 (ImpactCOVID) on public health are commonly assessed using the cumulative numbers of confirmed cases (CNCCs). However, whether different mathematical models yield disparate results based on varying time frames remains unclear. This study aimed to compare the differences in prediction accuracy between 2 proposed COVID-19 models, develop an angle index that can be objectively used to evaluate ImpactCOVID, compare the differences in angle indexes across countries/regions worldwide, and examine the difference in determining the inflection point (IP) on the CNCCs between the 2 models.

Methods:

Data were downloaded from the GitHub website. Two mathematical models were examined in 2 time-frame scenarios during the COVID-19 pandemic (the early 20-day stage and the entire year of 2020). Angle index was determined by the ratio (=CNCCs at IP÷IP days). The R2 model and mean absolute percentage error (MAPE) were used to evaluate the model’s prediction accuracy in the 2 time-frame scenarios. Comparisons were made using 3 visualizations: line-chart plots, choropleth maps, and forest plots.

Results:

Exponential growth (EXPO) and item response theory (IRT) models had identical prediction power at the earlier outbreak stage. The IRT model had a higher model R2 and smaller MAPE than the EXPO model in 2020. Hubei Province in China had the highest angle index at the early stage, and India, California (US), and the United Kingdom had the highest angle indexes in 2020. The IRT model was superior to the EXPO model in determining the IP on an Ogive curve.

Conclusion:

Both proposed models can be used to measure ImpactCOVID. However, the IRT model (superior to EXPO in the long-term and Ogive-type data) is recommended for epidemiologists and policymakers to measure ImpactCOVID in the future.
Deciphering the molecular mechanism underlying the effects of epimedium on osteoporosis through system bioinformatic approach
Authors: Wu Keliang , Han Linjing , Zhao Ying , Xiao Qinghua , Zhang Zhen , Lin Xiaosheng
Published: August 2022

Epimedium has gained widespread clinical application in Traditional Chinese Medicine, with the functions of promoting bone reproduction, regulating cell cycle and inhibiting osteoclastic activity. However, its precise cellular pharmacological therapeutic mechanism on osteoporosis (OP) remains elusive. This study aims to elucidate the molecular mechanism of epimedium in the treatment of OP based on system bioinformatic approach.

Predicted targets of epimedium were collected from TCMSP, BATMAN-TCM and ETCM databases. Differentially expressed mRNAs of OP patients were obtained from Gene Expression Omnibus database by performing Limma package of R software. Epimedium-OP common targets were obtained by Venn diagram package for further analysis. The protein-protein interaction network was constructed using Cytoscape software. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were carried out by using clusterProfiler package. Molecular docking analysis was conducted by AutoDock 4.2 software to validate the binding affinity between epimedium and top 3 proteins based on the result of protein-protein interaction.

A total of 241 unique identified epimedium targets were screened from databases, of which 62 overlapped with the targets of OP and were considered potential therapeutic targets. The results of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis revealed that these targets were positive regulation of cell cycle, cellular response to oxidative stress and positive regulation of cell cycle process as well as cellular senescence, FoxO, PI3K-Akt, and NF-kappa B signaling pathways. Molecular docking showed that epimedium have a good binding activity with key targets.

Our study demonstrated the multitarget and multi-pathway characteristics of epimedium on OP, which elucidates the potential mechanisms of epimedium against OP and provides theoretical basis for further drug development.
Total shoulder arthroplasty versus reverse total shoulder arthroplasty: Outcome comparison in osteoarthritis patients with or without concurrent rotator cuff deficiency
Authors: Liu Haifeng , Huang Tony Chieh-Ting , Yu Hanzhong , Wang Yicun , Wang Daping , Long Zeling
Published: August 2022

Osteoarthritis (OA) is a common shoulder disorder that impacts shoulder functions. Shoulder arthroplasty is often required to restore function and quality of life. Reverse total shoulder arthroplasty (RSA), which was originally designed mainly for irreparable rotator cuff damage, has gained popularity in recent years for the treatment of advanced shoulder OA instead of the clinically standard total shoulder arthroplasty (TSA). However, this RSA has some nonnegligible flaws such as higher complications rate and economic cost, not mention the following problems caused by irreversible physical structural damage. Therefore, the employment of RSA needs to be carefully considered. This study aimed to compare TSA and RSA in OA patients with or without rotator cuff damage to better guide clinical decision making. We believe the radical use of RSA in patients without rotator cuff deficiency may cause more harm than good.

We queried the Nationwide Inpatient Sample (NIS) database from 2011 to 2014 to collect information on OA patients who received TSA and RSA. Patients were divided into 2 groups of comparison according to the presence of rotator cuff deficiency and matched with propensity score analysis.

A total of 57,156 shoulder arthroplasties were identified. RSA patients in the rotator cuff deficiency group had significant higher transfusion rates and longer hospital stays. RSA patients without rotator cuff deficiency had a statistically significantly higher number of implant-related mechanical complications, acute upper respiratory infections and postoperative pain. Overall, RSA incurred higher costs in both groups.

For OA patients with rotator cuff deficiencies, RSA has its benefits as complication rates were comparable to TSA. For those patients without rotator cuff deficiencies, the use of RSA should be reconsidered as there were more complications with higher severity.
Identify differential inflammatory cellular and serology pathways between children and adult patients in the lupus registry
Authors: Hsu Chung-Yuan , Chiu Wen-Chan , Huang Yi-Ling , Su Yu-Jih
Published: August 2022

Background:

Age variances in systemic lupus erythematosus (SLE) may reflect different patterns and consequences. Monocyte differentiation is critical, and cytokine and chemokine milieu may be associated with long term outcome and treatment responses. This study aims to evaluate the inflammatory cellular and serology pathways associated with age in our lupus registry.

Methods:

We included patients with SLE and divided them into 2 groups according to age, ≤18 or >18 years old. We performed flow cytometry analysis to define the peripheral blood monocyte differentiation pattern and phenotypes and used the multiplex method to detect cytokine and chemokine panels. The results were then compared between the 2 subgroups.

Results:

In total, 47 SLE patients were included in this study. Of those, 23 patients were 18 years old or younger, and 24 patients were over the age of 18 years old. An increased distribution of circulating Type 2b macrophage (M2b) subsets was found in patients over 18 years old (P < 0.01), and we found the Type 1 macrophage (M1) to demonstrate a marked increase in those patients ≤18 years old (P = .05). Eotaxin values were significantly higher in patients >18 years old (P = .03), and Macrophage Inflammatory Protein (MIP)-1alpha, MIP-1beta, Interleukine (IL)-1Ra, Interferon (IFN)-alpha2, IL-12, IL-13, IL-17A, IL-1beta, IL-2, IL-4, IL-5, IL-7, IL-9, Monocyte Chemoattractant Protein (MCP)-3, Transforming Growth Factor (TGF)-alpha, and Tumor necrosis factor (TNF)-beta were significantly higher in patients ≤18 years old (all P < .05).

Conclusions:

We found significant M2b polarization in adult SLE patients, and several cytokines and chemokines were significantly higher in SLE patients ≤ 18 years old. Peripheral blood mononuclear cell differentiation and cytokine milieu could represent composite harm from both Type 2 helper T cells (Th2) and Type 17 helper T cells (Th17) pathways and may thus be a potential therapeutic target in younger SLE patients.