bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Analysis of Hydrogen Fluoride-Exposed Patients Based on Major Burn Criteria After the 2012 Gumi City Chemical Leak Disaster
Authors: Shin Heejun , Oh Se Kwang , Lee Han You , Chung Heajin , Yoon Seong Yong , Choi Sung Yong
Published: October 2021

This study conducted to analyze and compare the epidemiological and clinical characteristics of hydrogen fluoride-exposed patients based on major burn criteria for the appropriate emergency department (ED) response to a mass casualty chemical spill. This retrospective cross-sectional study included the records of patients (n = 199) who visited the ED of Gumi City University Hospital from September 27, 2012, to October 20, 2012. Subjects were included in the major burn group (MBG) if they presented with wounds that required referral to a burn center according to the American Burn Association guidelines or in the nonmajor burn group (NMBG) if not. Males were predominant in both the MBG (n = 55, 48 males) and NMBG (n = 144, 84 males; P < .05). The most prevalent timeline for visiting the ED was the phase which included 9–32 hours post-leak of hydrogen fluoride, including 45 patients (81.8%) in the MBG and 122 patients (84.7%) in the NMBG (P < .001). The respiratory tract was the site of greatest damage in patients in both the MBG and NMBG (n = 47, 85.5% vs n = 142, 98.6%, P < .001). Regarding dispositions, all patients in the NMBG were discharged (n = 144, 100%); however, eight patients (14.5%) in the MBG underwent other dispositions (discharge against medical advice, five patients; admission, one patient; death, two patients, P < .05). Patient outcomes after major chemical contamination events should be characterized in future studies to maximize the quality of patient care.
Susceptibility of the Cowpea Aphid (Hemiptera: Aphididae) to Widely Used Insecticides in Australia
Authors: Umina P A , Reidy-Crofts J , Edwards O , Chirgwin E , Ward S , Maino J , Babineau M
Published: October 2021

Globally, 27 aphid species have evolved resistance to almost 100 insecticide active ingredients. A proactive approach to resistance management in pest aphids is needed; this should include risk analysis, followed by regular baseline susceptibility assays for species deemed at high risk of evolving resistance. The cowpea aphid (Aphis craccivora Koch) has evolved insecticide resistance to multiple insecticides outside Australia and was recently identified as a high-risk species in Australia. In this study, we generated toxicity data against four insecticides (representing four unique chemical Mode of Action groups) for populations of A. craccivora collected across Australia. Alpha-cypermethrin was the most toxic chemical to A. craccivora in leaf-dip laboratory bioassays with an average LC50 value across nine populations of 0.008 mg a.i./L, which was significantly lower than dimethoate (1.17 mg a.i./L) and pirimicarb (0.89 mg a.i./L). Small, but significant, differences in sensitivity were detected in some populations against pirimicarb and dimethoate, whereas responses to alpha-cypermethrin and imidacloprid were not significantly different across all aphid populations examined in this study. For all insecticides, the field rate controlled 100% of individuals tested. The data generated will be important for future monitoring of insecticide responses of A. craccivora. Proactive management, including increased reliance on non-chemical pest management approaches and routine insecticide baseline sensitivity studies, is recommended for A. craccivora.
Effect of Breathable Row Covers and Ground Cover on Pest Insect Levels and Cucurbit Yield
Authors: Athey Kacie J , Peterson Julie A , Dreyer Jamin , Harwood James D , Williams Mark A
Published: October 2021

Organic control measures in muskmelon and squash production are part of an integrated pest management approach that can include using floating row covers, generalist predators, and ground cover. These are used in Kentucky, allowing for a reduction in insecticide use and diminished virus incidence while increasing yield. Commonly used row covers are made from spunbonded fabric that retains heat and must be removed at anthesis and kept off until the end of the season. Thus, a new farming regime containing breathable mesh covers which can be replaced after anthesis was tested for longer season insect exclusion across two growing seasons. Additionally, ground cover treatments, consisting of mulch or bare ground were tested for their effect on pest insect abundance and fruit yield. Pest insect numbers were usually lower in plots with mesh row covers and in some cases, mulch ground cover also contributed to lower pest numbers. A stronger impact on pest numbers was observed in melon than squash. Melon yield was always significantly higher in plots with mesh row covers and mulch ground cover. This trend was not observed with squash in 2014 but was true in 2015. In 2015, most plants under the fabric row covers died because of high temperatures immediately after transplanting highlighting the need for breathable mesh row covers.
Feeding Behavior and Fruiting Form Damage by Bollworm (Lepidoptera: Noctuidae) in Bt Cotton
Authors: Godbold R E , Crow W D , Catchot A L , Gore J , Cook D R , Dodds D M , Musser F M , Little N S
Published: October 2021

Bt technologies have played a major role in the control of bollworm, Helicoverpa zea (Boddie) (Lepidoptera: Noctuidae), in cotton. Variation in expression levels among varieties and plant parts, along with selection pressure on bollworm populations, has led to the development of resistance to some Bt proteins. Trials were conducted to evaluate how cotton varieties expressing different Bt proteins affect bollworm larval behavior and their damage in flowering cotton. Differences in larval recovery were observed among cotton varieties at 3 d with 3-gene Bt cotton having the lowest recovery and non-Bt cotton having the greatest recovery. Loss of bloom tags and abscission of small bolls at the site of infestation affected bollworm larval recovery among varieties. Day after infestation was the main factor that affected bollworm movement across all varieties. Number of total damaged fruiting forms by an individual bollworm larva was different among all varieties. Overall, flower bud (square) and fruit (boll) damage by an individual larva was lower on 3-gene cotton than 2-gene cotton and non-Bt cotton. An individual larva damaged fewer squares on 2-gene cotton than non-Bt cotton, but boll damage from bollworm was similar among 2-gene cotton and non-Bt cotton. The level of square and boll damage in 2-gene cotton has increased compared to previous research further supporting the occurrence of bollworm resistance to Cry proteins. The 3-gene cotton containing the Vip3A gene experienced low levels of damage and survival. These results will be important for improving management recommendations of bollworm in Bt cotton technologies.
Postmortem Interval Estimation and Validation Through a Comparative Study of South American Flies Reared in the Field Versus Laboratory Conditions
Authors: Acosta Ximena , Corronca José A , González-Reyes Andrea X , Centeno Néstor D
Published: October 2021

Studies under constant temperatures are the most common to estimate the Postmortem Interval (PMI). It is imperative that forensic sciences have data from studies carried out in the field. Therefore, this work aims to: (1) evaluate the parameters (weight, length, development time) associated with the life cycles of Lucilia ochricornis (Wiedemann) (Diptera: Calliphoridae) and Lucilia purpurascens (Walker) under experimental conditions in the field considering fluctuating temperatures, and (2) compare these results with those known and published by the same authors for cultures realized in the laboratory under constant temperatures; which will permit us to contrast the most widely used existing methodologies for forensic application in estimating the minimum postmortem interval (PMImin). For each season of the year, cultures of both species were made in the field, collecting information on temperature, humidity, and photoperiod to perform laboratory cultures, later comparing: development time, length, weight, and Accumulated Degree-Hours (ADH) in both types of cultures. Methods for estimating the PMI were obtained and validated with the information of the cultures grown in the field. The two types of cultures showed differences between each other for both species. The forensic use methods to estimate PMI were enhanced and their precision increased when maximum larval length data were used, and it was also concluded that feeding larval stages are the most accurate to be used in making estimates because the larva is growing. The estimation of the PMI through the use of necrophagous flies development remains reliable for obtaining the PMImin.
Unexpected intraoperative finding of gallbladder torsion
Authors: Krishna P Sai , Somasekar R D R , Sankar A Siva
Published: October 2021

Gallbladder (GB) torsion or volvulus is a rare entity affecting elderly women. Only ~500 cases have been reported in the literature. Incidence is rare seen in ~1 in 365 520.

A constant finding is the presence of the GB on a mobile mesentery. Torsion, or volvulus, of the GB occurs when it twists axially, with the subsequent obstruction of bile and/or blood flow.

We briefly describe a 75-year-old female patient with acute abdomen and ultrasound and Computed tomography of abdomen revealed a distended GB. On laparotomy, we encountered a twisted GB with gangrene and cholecystectomy was done.

GB volvulus is a rare occurrence and clinically mimic’s acute cholecystitis and should be sought with high suspicion especially when encountering a thin elderly woman. Immediate diagnosis is prime as delay may be fatal.

Even with recent advances in imaging, it is difficult to make a correct preoperative diagnosis of GB torsion.
Does free movement of workers boost immigrant employment? New evidence from Germany
Authors: Kosyakova Yuliya , Brücker Herbert
Published: October 2021

Extending free movement of workers (FMW) to the new Member States from Central and Eastern Europe was one of the most controversial political decisions in the history of the European Union. In this article, we study how the introduction of FMW affected immigrants’ labor market integration in Germany. Using data from the IAB-SOEP Migration Sample,1 we show that the introduction of FMW was associated with a higher influx of skilled workers. Moreover, FMW has increased the probability of labor market entry within one year after arrival by 12 percentage points. Correspondingly, FMW improved welfare not only by increasing the scale of migration but also by raising immigrants’ skill level and reducing the time before entry into the labor market. Our findings thus yield new insights on the beneficial effects of FMW on labor market integration of immigrants in the Common Market.
AstroSat observations of long-duration X-ray superflares on active M-dwarf binary EQ Peg
Authors: Karmakar Subhajeet , Naik Sachindra , Pandey Jeewan C , Savanov Igor S
Published: October 2021

We present a comprehensive study of three large long-duration flares detected on an active M-dwarf binary EQ Peg using the Soft X-Ray Telescope of the AstroSat observatory. The peak X-ray luminosities of the flares in the 0.3–7-keV band are found to be within ∼5–10 ×  1030$\rm {erg}~\rm {s}^{-1}$. The e-folding rise- and decay-times of the flares are derived to be in the range of 3.4–11 and 1.6–24 ks, respectively. Spectral analysis indicates the presence of three temperature corona with the first two plasma temperatures remain constant during all the flares and the post-flare observation at ∼3 and ∼9 MK. The flare temperature peaked at 26, 16, and 17 MK, which are 2, 1.3, and 1.4 times more than the minimum value, respectively. The peak emission measures are found to be 3.9–7.1 ×  1053 cm−3, whereas the abundances peaked at 0.16–0.26 times the solar abundances. Using quasi-static loop modelling, we derive loop lengths for all the flares as 2.5 ± 0.5 ×  1011, 2.0 ± 0.5 ×  1011, and 2.5 ± 0.9 ×  1011 cm, respectively. The density of the flaring plasma is estimated to be 4.2 ± 0.8 ×  1010, 3.0 ± 0.7 ×  1010, 2.2 ± 0.8 ×  1010 cm−3 for flares F1, F2, and F3, respectively. Whereas the magnetic field for all three flares is estimated to be <100 G. The estimated energies of all three flares are ≳ 1034–1035erg, putting them in a category of superflare. All three superflares are also found to be the longest duration flares ever observed on EQ Peg.
Ram pressure candidates in UNIONS
Authors: Roberts Ian D , Parker Laura C , Gwyn Stephen , Hudson Michael J , Carlberg Raymond , McConnachie Alan , Cuillandre Jean-Charles , Chambers Kenneth C , Duc Pierre-Alain , Furusawa Hisanori , Gavazzi Raphael , Hill Vanessa , Huber Mark E , Ibata Rodrigo , Kilbinger Martin , Mei Simona , Mellier Yannick , Miyazaki Satoshi , Oguri Masamune , Wainscoat Richard J
Published: October 2021

We present a search for disturbed, candidate ram pressure stripping galaxies across more than 50 spectroscopically selected SDSS groups and clusters. 48 ram pressure candidates are visually identified in these systems using high-quality UNIONS imaging from the Canada-France-Hawaii Telescope, covering ${\sim }6200\, \mathrm{deg^2}$ and ${\sim }2800\, \mathrm{deg^2}$ in the u- and r-bands, respectively. Ram pressure candidates are found in groups and clusters spanning a wide range in halo mass and include ∼30 ram pressure candidates in the group regime (Mh < 1014). The observed frequency of ram pressure candidates shows substantial scatter with group/cluster mass, but on average is larger in clusters ($M_h \ge 10^{14}\, \mathrm{M_\odot }$) than groups ($M_h \lt 10^{14}\, \mathrm{M_\odot }$) by a factor of ∼2. We find that ram pressure candidates are most commonly low-mass galaxies and have enhanced star formation rates relative to star-forming field galaxies. The enhancement in star formation is largely independent of galaxy mass and strongest for galaxies in clusters. As a result of the large survey footprint and excellent image quality from UNIONS, we are able to identify disturbed galaxies, potentially affected by ram pressure stripping, across a wide range of host environment.
Modulating the chemo-mechanical response of structured DNA assemblies through binding molecules
Authors: Lee Chanseok , Kim Young-Joo , Kim Kyung Soo , Lee Jae Young , Kim Do-Nyun
Published: October 2021

Recent advances in DNA nanotechnology led the fabrication and utilization of various DNA assemblies, but the development of a method to control their global shapes and mechanical flexibilities with high efficiency and repeatability is one of the remaining challenges for the realization of the molecular machines with on-demand functionalities. DNA-binding molecules with intercalation and groove binding modes are known to induce the perturbation on the geometrical and mechanical characteristics of DNA at the strand level, which might be effective in structured DNA assemblies as well. Here, we demonstrate that the chemo-mechanical response of DNA strands with binding ligands can change the global shape and stiffness of DNA origami nanostructures, thereby enabling the systematic modulation of them by selecting a proper ligand and its concentration. Multiple DNA-binding drugs and fluorophores were applied to straight and curved DNA origami bundles, which demonstrated a fast, recoverable, and controllable alteration of the bending persistence length and the radius of curvature of DNA nanostructures. This chemo-mechanical modulation of DNA nanostructures would provide a powerful tool for reconfigurable and dynamic actuation of DNA machineries.
BAF155 methylation drives metastasis by hijacking super-enhancers and subverting anti-tumor immunity
Authors: Kim Eui-Jun , Liu Peng , Zhang Shengjie , Donahue Kristine , Wang Yidan , Schehr Jennifer L , Wolfe Serena K , Dickerson Amber , Lu Li , Rui Lixin , Zhong Xuehua , Wisinski Kari B , Yu Min , Suzuki Aussie , Lang Joshua M , Ong Irene M , Xu Wei
Published: October 2021

Subunits of the chromatin remodeler SWI/SNF are the most frequently disrupted genes in cancer. However, how post-translational modifications (PTM) of SWI/SNF subunits elicit epigenetic dysfunction remains unknown. Arginine-methylation of BAF155 by coactivator-associated arginine methyltransferase 1 (CARM1) promotes triple-negative breast cancer (TNBC) metastasis. Herein, we discovered the dual roles of methylated-BAF155 (me-BAF155) in promoting tumor metastasis: activation of super-enhancer-addicted oncogenes by recruiting BRD4, and repression of interferon α/γ pathway genes to suppress host immune response. Pharmacological inhibition of CARM1 and BAF155 methylation not only abrogated the expression of an array of oncogenes, but also boosted host immune responses by enhancing the activity and tumor infiltration of cytotoxic T cells. Moreover, strong me-BAF155 staining was detected in circulating tumor cells from metastatic cancer patients. Despite low cytotoxicity, CARM1 inhibitors strongly inhibited TNBC cell migration in vitro, and growth and metastasis in vivo. These findings illustrate a unique mechanism of arginine methylation of a SWI/SNF subunit that drives epigenetic dysregulation, and establishes me-BAF155 as a therapeutic target to enhance immunotherapy efficacy.
Taking Identity Seriously: On the Politics of the Individuation of Legal Systems
Authors: Mac Amhlaigh Cormac
Published: October 2021

This article examines the question of the identity of legal systems of non-monistic accounts of law. It critically analyses approaches to individuation based on validity, the nature of individual norms and the purposes for which they are applied, arguing that the latter approach, as endorsed particularly by Raz, offers the most convincing approach to the question of individuation. The article argues that Raz’s own criterion, however, is under-inclusive and misses important reasons why a norm should be individuated in a particular way. The article defends an approach to individuation which builds upon and expands Raz’s approach. This approach emphasises the political importance of legal systems as providing the basis for criteria of individuation. These criteria are also relevant for Dworkin’s account of law as integrity, which, the article argues, also relies on an understanding of individuation notwithstanding Dworkin’s claims to the contrary.
N-mixture models estimate abundance reliably: A field test on Marsh Tit using time-for-space substitution
Authors: Neubauer Grzegorz , Wolska Alicja , Rowiński Patryk , Wesołowski Tomasz
Published: October 2021

Imperfect detection in field studies on animal abundance, including birds, is common and can be corrected for in various ways. The binomial N-mixture (hereafter binmix) model developed for this task is widely used in ecological studies owing to its simplicity: it requires replicated count results as the input. However, it may overestimate abundance and be sensitive to even small violations of its assumptions. We used a 33-year dataset on the Marsh Tit (Poecile palustris), a sedentary forest passerine, from Białowieża Forest, Poland, to validate inference from binmix models by comparing model-estimated abundances to the true number of breeding pairs within the plots, determined by exhaustive population study. The abundance estimates, derived from 6 springtime (April and May) counts of males on each plot in each year, were highly reliable: 116 out of 132 year-plot estimates (88%) included the true number of pairs within the 95% confidence intervals. Over- and under-estimations were thus rare and similarly frequent (9 and 12 cases, respectively), with a tendency to overestimate at low densities and underestimate at high densities. Marsh Tits sing rarely but the frequency of countersinging increases with abundance, leading to nonindependence in detections. When accounted for in a submodel for detection, the per-survey number of countersinging events positively affected detection probability but only weakly affected abundance estimates. Simulations further demonstrate that this property, overestimation at low densities and underestimation at high densities, may be a systematic bias of binmix model even if density-dependent detection is absent. While the behavior of binmix models in specific situations requires more study, we conclude that these models are a valid tool to estimate abundance reliably when intensive population monitoring is not feasible.
Regret
Authors: Warren James
Published: October 2021

A study of ‘regret’ (metameleia) in the moral psychology of Plato, Aristotle, and the Stoics. It was important for all these philosophers to insist that regret is a characteristic of neither fully virtuous nor wholly irredeemable characters. Rather, regret is taken to be something that affects people who retrospectively feel pain at realizing an earlier mistaken action. This study sets out in full the nature of regret in these philosophers’ works, puts it into the context of their respective accounts of virtuous and non-virtuous agents, ethical progress, the role of knowledge in producing good actions, and compares it with modern philosophical notions of ‘agent regret’.
Lower AM-PAC 6-Clicks Basic Mobility Score Predicts Discharge to a Postacute Care Facility Among Patients in Cardiac Intensive Care Units
Authors: Whitlock Katelyn C , Mandala Mahender , Bishop Kathy Lee , Moll Vanessa , Sharp Jennifer J , Krishnan Shilpa
Published: October 2021

Objective

The objective of this study was to determine the ability of the Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Short Form to predict patient discharge destination (home vs postacute care [PAC] facility) from the cardiac intensive care unit (ICU), including patients from the cardiothoracic surgical ICU and coronary care unit.

Methods

This retrospective cohort study utilized electronic medical records of patients in cardiac ICU (n = 359) in an academic teaching hospital in the southeastern region of United States from September 1, 2017, through August 31, 2018.

Results

The median interquartile range age of the sample was 68 years (75–60), 55% were men, the median interquartile range 6-Clicks score was 16 (20–12) at the physical therapist evaluation, and 79% of the patients were discharged to home. Higher score on 6-Clicks indicates improved function. A prediction model was constructed based on a machine learning approach using a classification tree. The classification tree was constructed and evaluated by dividing the sample into a train-test split using the Leave-One-Out cross-validation approach. The classification tree split the data into 4 distinct groups along with their predicted outcomes. Patients with a 6-Clicks score >15.5 and a score between 11.5 and 15.5 with primary insurance other than Medicare were discharged to home. Patients with a 6-Clicks score between 11.5 and 15.5 with Medicare insurance and those with a score ≤11.5 were discharged to a PAC facility.

Conclusion

Patients with lower 6-Clicks scores were more likely to be discharged to a PAC facility. Patients without Medicare insurance had to be significantly lower functioning, as indicated by lower 6-Clicks scores for PAC facility placement than those with Medicare insurance.

Impact

The ability of 6-Clicks along with primary insurance to determine discharge destination allows for early discharge planning from cardiac ICUs.
Identification of Adhesins in Plant Beneficial RhizobacteriaBacillus velezensisSQR9 and Their Effect on Root Colonization
Authors: Huang Rong , Feng Haichao , Xu Zhihui , Zhang Nan , Liu Yunpeng , Shao Jiahui , Shen Qirong , Zhang Ruifu
Published: October 2021

Probiotic Bacillus colonization of plant root surfaces has been reported to improve its beneficial effect. Chemotaxis, adhesion, aggregation, and biofilm formation are the four steps of root colonization by plant growth–promoting rhizobacteria (PGPRs). Compared with the other three well-studied processes, adhesion of PGPRs is less known. In this study, using mutant strains deleted for potential adhesin genes in PGPR strain Bacillus velezensis SQR9, adherence to both cucumber root surface and abiotic surface by those strains was evaluated. Results showed that deletion mutations ΔlytB, ΔV529_10500, ΔfliD, ΔyhaN, and ΔsacB reduced the adhesion to root surfaces, while, among them, only ΔfliD had significant defects in adhesion to abiotic surfaces (glass and polystyrene). In addition, B. velevzensis SQR9 mutants defective in adhesion to root surfaces showed a deficiency in rhizosphere colonization. Among the encoded proteins, FliD and YhaN played vital roles in root adhesion. This research systematically explored the potential adhesins in a well-studied PGPR strain and also indicated that adhesion progress was required for root colonization, which will help to enhance rhizosphere colonization and beneficial function of PGPRs in agricultural production.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Clarireedia hainanense: A New Species Is Associated with Dollar Spot of Turfgrass in Hainan, China
Authors: Zhang Huangwei , Dong Yinglu , Zhou Yuxin , Hu Jian , Lamour Kurt , Yang Zhimin
Published: October 2021

The genus Clarireedia contains multiple species causing dollar spot (DS) on turfgrass worldwide. In November 2020, 119 Clarireedia isolates were obtained from symptomatic seashore paspalum at golf courses in Hainan province and identified to species level based on partial sequence of the internal transcribed spacer (ITS) region. A total of 45 and 22 isolates were identified as C. paspali and C. monteithiana, respectively; the remaining 52 isolates defined a new clade. Isolates from this clade were further selected for phylogenetic, morphological, and biological analyses. Maximum likelihood and Bayesian methods were implemented to obtain phylogenetic trees for partial sequences of the ITS, EF-1α, and McM7 genes. The selected isolates consistently fell into a distinct, well-supported clade within Clarireedia. Morphological and biological characteristics were observed among the different species in Clarireedia. Altogether, this study described a new species, Clarireedia hainanense, which has widespread distribution in Hainan, China. These findings may have important implications for the management of DS disease.
Be Sweet to Hospitalized Toddlers During Venipuncture
Authors: Modanloo Shokoufeh , Barrowman Nick , Martelli Brenda , Yoxon Helen , Wilding Jodi , Dragic Sandra , Vaillancourt Régis , Long Deborah , Larocque Catherine , Reszel Jessica , Harrison Denise
Published: October 2021

Objectives:

High-quality evidence demonstrates analgesic effects of sweet-tasting solutions for infants during painful procedures. However, evidence of the analgesic effects of sucrose beyond 12 months of age is less certain. The aim of this study was to ascertain the efficacy of oral sucrose in hospitalized toddlers (ages 12 to 36 mo) compared with placebo (water) during venipuncture.

Materials and Methods:

Blinded, 2-armed randomized controlled trial including hospitalized toddlers aged 12 to 36 months. Toddlers were randomized to either 25% sucrose or water before venipuncture, stratified by age (12 to 24 mo and more than 24 to 36 mo). Standard of care included topical anesthetics for both groups. Pain assessment included cry duration and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Descriptive statistics and linear models were used to report the percentage of time crying and mean differences in FLACC scores. Data analysis was performed using R, version 3.6.3.

Results:

A total of 95 toddlers were randomized and 85 subsequently studied. The median percentage of time spent crying between insertion of the first needle and 30 seconds after the end of procedure in both groups was 81% (interquartile range=66%). There was no significant difference in crying time and FLACC scores between groups (P>0.05). When examining effects of sucrose for the younger toddlers (less than 24 mo of age) there was a reduction in crying time of 10% and a 1.2-point reduction in mean FLACC scores compared with the toddlers older than 24 months.

Discussion:

Findings highlight that toddlers become highly distressed during venipuncture, despite the standard care of topical anesthetics. In addition, sucrose does not effectively reduce distress especially in the older group of toddlers.
Takayasu arteritis
Authors: Esatoglu Sinem Nihal , Hatemi Gulen
Published: October 2021

Purpose of review

The purpose of this review is to summarize the recent advances in Takayasu arteritis (TAK), mainly focusing on pathogenesis, imaging modalities, and management.

Recent findings

Three novel clusters based on angiographic findings were identified in the Indian cohort and replicated in the North American cohorts. Different new imaging modalities have been tried in the assessment of arterial inflammation with promising results. There is more evidence on the long-term use of tocilizumab, but relapses are common. In light of the recent findings on the pathogenesis of TAK, Janus kinase inhibitors seem to be promising.

Improvement in imaging modalities and in our understanding of the disease pathogenesis will allow us to better assess the disease activity and identify effective therapeutic agents.
Leptomeningeal dissemination as a first sign of progression in metastatic melanoma: a diagnostic lesson
Authors: Parietti Michele , Marra Elena , Ribero Simone , Abate Simona Osella , Francia di Celle Paola , Rudà Roberta , Quaglino Pietro , Fierro Maria Teresa
Published: October 2021

One of the most serious complications of advanced melanoma is the diffusion of cancer cells to the central nervous system. The diagnosis of leptomeningeal metastasis (LMM) is notoriously challenging and requires a combination of consistent MRI and cerebrospinal fluid (CSF) cytology. In ambiguous cases, mutations like BRAF V600E in CSF-cell-free (cf)DNA may help to clarify diagnosis of LMM. Here we present the case of a young woman who developed isolated LMM after the diagnosis of a node-positive primary melanoma with normal LDH. The CSF was negative for tumour cells by cytology but positive for cfDNA BRAF V600E mutation, thus allowing us to diagnose LMM. To our knowledge, this is the first case where CSF sampling for the detection of BRAF mutation was used to identify leptomeningeal disease in the presence of negative MRI and without involvement of any other distant sites.
Longitudinal association of midlife vision impairment and depressive symptoms: the study of Women's Health Across the Nation, Michigan site
Authors: Karvonen-Gutierrez Carrie A. , Kumar Navasuja , Hood Michelle M. , Musch David C. , Harlow Sioban , Moroi Sayoko E.
Published: October 2021

Objective:

Poor vision affects physical health but the relationship with depressive symptoms among midlife adults (40-65 y), who often present with early stage vision impairment (VI), is not well understood. The goal of this study was to assess the impact of vision on depressive symptoms during midlife.

Methods:

The Michigan site of the Study of Women's Health Across the Nation conducted assessments of distance visual acuity at six consecutive, near-annual follow-up visits. At each visit, depressive symptoms (Center for Epidemiological Studies-Depression Scale) were assessed. VI was defined as mild (20/30-20/60) or moderate-severe (20/70 or worse). Multivariable logistic regression models using generalized estimating equations were used to assess the association of VI and reporting of depressive symptoms at the subsequent visit.

Results:

At analytic baseline, the mean age of participants (N = 226) was 50.0 years (standard deviation = 2.6). More than half (53.5%) of women had mild VI and 8.0% had moderate-severe VI. Adjusting for age, preexisting depressive symptoms, race, education, economic strain, body mass index, and smoking, participants with mild and moderate-severe VI had 68% (95% C (0.97-2.90)) and 2.55-fold (95% CI 1.13-5.75) higher odds of reporting depressive symptoms at their subsequent study visit as compared with women without VI. Further adjustment for diabetes, hypertension, and osteoarthritis attenuated the estimates and the associations were no longer statistically significant.

Conclusion:

VI was associated with increased odds of future depressive symptoms among mid-life women. Timely detection and appropriate correction of VI may be important to consider in maintaining the mental health status of midlife women.
Employment and Career Choice Satisfaction among Saudi Plastic Surgeons: A Cross-sectional, Questionnaire-based Study
Authors: Mortada Hatan , Mustafa Nashwa , Bamakhrama Basma , Alshateb Marwa , Gelidan Adnan G. , Arab Khalid
Published: October 2021

Background:

Career choice satisfaction among plastic surgeons has a significant effect on the quality of patient care and workforce shortages. This study investigated career choice satisfaction among Saudi plastic surgeons to identify associated factors.

Method:

A cross-sectional study was conducted via an online self-administered questionnaire sent in April 2021 to all Saudi plastic surgeons. The questionnaire was composed of 23 items in four domains: demographics, plastic surgery training, current practice workload, and job satisfaction. The analysis was performed at a 95% confidence interval using the Statistical Package for Social Sciences, version 23.0 (IBM, Armonk, N.Y.).

Results:

A total of 63 plastic surgeons were included in this study (82.5% men; 17.5% women), with an overall response rate of 76.8%. The leading cause of job dissatisfaction for women was financial remuneration (28.8%) (P = 0.008). The main factor for men was work–life balance (38.5%) (P = 0.028). Of the different backgrounds, the highest satisfaction was among those with a background in German residency programs, and the lowest was among those with French residency programs (P = 0.045). Surgeons from the southern region had a higher satisfaction rate than those from other regions; those from the central region had the lowest rate (P < 0.001).

Conclusions:

Our survey-based study found that Saudi plastic surgeons with German residency training, practicing in the southern region or who exceeded 11–20 years post-training had the highest job satisfaction. As such, surgeons’ job satisfaction can be improved by ensuring work–life balance.
Cerebrospinal fluid and ophthalmic disease
Authors: Ford Richard L. , Frankfort Benjamin J. , Fleischman David
Published: October 2021

Purpose of review

The purpose of this review is to discuss the contemporary body of literature examining the relationship between cerebrospinal fluid (CSF) and ophthalmic disease. This review focuses on diseases that have a pathogenesis related to the translaminar pressure difference, defined as the pressure difference between the orbital subarachnoid space (OSAS) and the intraocular pressure. The diseases discussed include glaucoma, idiopathic intracranial hypertension, and spaceflight associated neuro-ocular syndrome.

Recent findings

The relationship between cerebrospinal and ophthalmic disease has been investigated for over 100 years. Recent research provides insight into the mechanisms that dictate CSF circulation in the OSAS and how alterations in these mechanism lead to disease. This review discusses these recent findings and their relationship to major ophthalmic diseases.

The recent findings provide insight into diseases that have pathogenic mechanisms that are not fully understood. This information will help physicians gain a clearer understanding of the relationship between CSF and ophthalmic disease and guide future research.
Surgical management of a white cataract induced by a metallic intralenticular foreign body
Authors: Vasco Alessandro , Caruso Giulia , Vasco Eugenia
Published: October 2021

Introduction:

A patient with an intralenticular metal foreign body in the right eye who, following initial antibiotic treatment for a corneal wound, developed a traumatic cataract a month after the initial event.

Patient and clinical findings:

Upon presentation, the clinical examination of the patient showed just a small corneal leucoma, no signs of inflammation in the anterior segment, and a white cataract.

Diagnosis, intervention, and outcomes:

Ultrasound B-scan and orbital computed tomography were performed, which suggested the presence of a metallic foreign body in the crystalline lens. The surgical management of the case, where, given the integrity of the posterior capsule and verified intraoperatively, a triple procedure was performed, with foreign body extraction, phacoemulsification, and IOL implantation, resulting in a good visual outcome.

Conclusions:

Metallic intralenticular foreign bodies represent a rare finding that sometimes goes unnoticed in the clinical examination, but which can lead to serious sight-threatening complications and should therefore not be underestimated. When a foreign body sensation is referred, an accurate examination of the anterior segment is necessary. The surgery required in case of complications can be challenging and demands attentive preoperative evaluation and readiness to adapt to conditions found intraoperatively.
Evaluation of a New Bone Conduction Device for the Rehabilitation of Single-Sided Deafness: Effects on Speech Understanding in Noise
Authors: Potier Morgan , Seldran Fabien , Sonthonnax Mélanie , Péan Vincent , Berger Paul , Norena Arnaud , Gallégo Stéphane
Published: October 2021

Introduction:

A new external, adhesive, no-pressure bone-conduction device provides rehabilitation for conductive hearing loss and single-sided deafness (SSD). The purpose of the study is to evaluate speech recognition performance with the bone-conduction contralateral routing of signal (aBC-CROS) and compare it to an air-conduction CROS (AC-CROS) used by subjects for at least 1 year.

Methods:

Ten SSD patients underwent speech understanding in noise tests with their AC-CROS, the aBC-CROS, and unaided. The 1st test session took place the day the aBC-CROS was fitted, with the second session after 2 weeks of aBC-CROS use. Two configurations were used: speech presented on the deaf side and noise on the normal side and the reverse.

Results:

The speech recognition threshold (SRT) improved with both devices when speech was presented to the deaf side. Nine patients showed significant improvement (p < 0.016) with the AC-CROS (mean: 2.8 dB) and the aBC-CROS (mean: 3.0 dB). Mean difference of improvement was significant between unaided and aBC-CROS (p = 0.001) or AC-CROS (p = 0.006). The SRT deteriorated by an average of 2.3 dB with the AC-CROS with noise presented on the deaf side, with significance found for six patients (p < 0.016). The aBC-CROS did not affect performance in this configuration (mean improvement: 0.3 dB) and only one patient had a significant SRT degradation (p < 0.016). Mean difference of improvement was significant between the AC-CROS and aBC-CROS (p = 0.021) or unaided (p = 0.05).

Discussion:

The aBC-CROS is a good alternative to the existing CROS devices for SSD rehabilitation, as it offers the same benefit with none of the drawbacks when noise is on the patient's deaf side.
Nitric Oxide Is Locally Produced in the Human Middle Ear and Is Reduced by Acquired Cholesteatoma
Authors: Westerberg Johanna , Granath Anna , Drakskog Cecilia , Tideholm Ellen , Kumlien Georén Susanna , Weitzberg Eddie , Cardell Lars-Olaf
Published: October 2021

Objective:

To find out if nitric oxide (NO) can be locally produced in the middle ear and if chronic otitis media (COM) and acquired cholesteatoma affect the production.

Design:

Case-control study.

Setting:

Two tertiary-referral hospitals.

Patients:

Gaseous NO from 11 patients with unilateral perforations or grommet openings was measured with chemiluminescence. Middle ear mucosa from 48 patients with COM and 26 patients with cholesteatoma was investigated.

Main Outcome Measures:

Detection of NO. Expression of nitric oxide synthase (NOS) mRNA, in mucosa from COM, cholesteatoma and healthy controls, quantified using polymerase chain reaction.

Results:

The gaseous NO from ears with a unilateral tympanic membrane perforation or a grommet was higher (9 ± 3 ppb, n = 11) than among the controls (4 ± 1 ppb, n = 11, p = 0.04). Lower levels of eNOS (2.64 ± 0.86 mol/100,000 mol ACTB) were detected in the pooled samples from the COM group (n = 48), compared with the control group (140.48 ± 92 mol/100,000 mol ACTB, n = 45, p = 0.010). In the cholesteatoma group (n = 26), a lower expression of nNOS (5.78 × 10−6 ± 1.13 × 10−6 ΔCt) was found in comparison with the controls (1.23 × 10−4 ± 3.18 × 10−5 ΔCt, n = 15, p = 0.011).

Conclusions:

NO is likely a natural and permanent part of the gas mixture in the human middle ear. The presence of NOS enzymes in the middle ear mucosa indicates an ongoing NO production and the reduction of NOS in ears with cholesteatoma, and pooled samples from ears with COM, suggest a role for locally produced NO in middle ear disease.
Revision Surgery for Pediatric Nontumor Auditory Brainstem Implant Users: Audiological, Rehabilitative, and Surgical Outcomes
Authors: Yarali Mehmet , Aslan Filiz , Çinar Betül Çiçek , Batuk Merve Özbal , Bajin Münir Demir , Sennaroğlu Gonca , Bilginer Burçak , Sennaroğlu Levent
Published: October 2021

Objective:

To report the audiological, rehabilitative, and surgical outcomes of revision surgery for pediatric auditory brainstem implant (ABI) users.

Study Design:

Retrospective cohort.

Setting:

Tertiary referral center.

Patients:

Five pediatric ABI users who had revision surgery for device malfunctions.

Intervention(s):

Revision surgery for ABI malfunctions.

Main Outcome Measures:

The findings of free-field audiometry with the device, the Meaningful Auditory Integration Scale, and the pattern discrimination, word identification, sentence recognition, and expressive and receptive language tests before the device failure and after revision surgery were obtained from the patient records and compared.

Results:

The revision rate for pediatric ABI was 6.45%. The Meaningful Auditory Integration Scale and expressive-receptive language scores showed improvements following revision surgery, while the aided thresholds, pattern perception, and word identification scores did not change. Individual differences in performance for these measures were observed.

Conclusion:

Equal or improved performance after the revision surgeries in the current study showed that revision surgery is successful and important for pediatric ABI users. It is essential to consider remedying the loss of auditory input in sensitive periods of pediatric development.
The relationship between sarcopenia and central hemodynamics in older adults with falls: a cross-sectional study
Authors: Öztorun Hande Selvi , Bahsi Remzi , Turgut Tugba , Surmeli Deniz Mut , Cosarderelioğlu Caglar , Atmis Volkan , Yalcin Ahmet , Aras Sevgi , Varli Murat
Published: October 2021

Purpose

Falls are an important cause of morbidity and mortality in geriatric patients. Sarcopenia and central blood pressure may be associated with falls. This study aimed to investigate the association between sarcopenia and blood pressure parameters in older patients with falls.

Methods

A comprehensive geriatric evaluation of 72 elderly patients was performed using established assessment tests. Peripheral and central hemodynamic measurements, including office DBP and SBP, daytime-night peripheral and central DBP and SBP, cardiac output, augmentation index, pulse wave velocity (PWV), pulse rate, and peripheral resistance and reflection, were measured with a 24-hour ambulatory blood pressure measuring device.

Results

Of 72 patients with a mean age of 77.51 ± 6.5 years, 12 (16.7%) were non-sarcopenic, 32 (44.4%) were probable, nine (12.5%) were confirmed, and 19 (26.4%) were severe sarcopenic. PWV, which is an indicator of arterial stiffness, was found to be significantly higher in the sarcopenic group. The other cardiac risk markers [daytime peripheral SBP, mean arterial pressure (night), pulse pressure (daytime), and peripheral resistance (daytime and night)] were significantly lower in the sarcopenic patients. PWV correlated with gait speed, Katz score, and hand grip strength (Spearman’s rho: −0.337, −0.310, and −0.334; P < 0.001, 0.008, and 0.001, respectively). Age and hypertension were the most important factors increasing the risk of falls.

Conclusion

Sarcopenia is associated with central and peripheral blood pressure changes in patients with falls. When sarcopenia is diagnosed in older people with falls, 24-hour ambulatory peripheral and central pressures should be evaluated for cardiac risk screening.
Sneddon Syndrome: Case Report and Literature Review
Authors: Hardy Naomi , Markidan Janina , Pfau Richard , Ma Linglei
Published: October 2021

Sneddon syndrome (SS) is a rare disorder that has a variety of pathologic associations, often described as the first cutaneous manifestation of antiphospholipid syndrome. Sneddon syndrome is characterized by livedo racemosa (LR), cerebrovascular symptoms, and microangiopathic disease in the deep vessels on skin biopsy. We discuss a case of a 55-year-old woman with a complex history of arterio-occlusive disease who presented with a violaceous and painful rash on her thigh. Skin biopsy showed thrombotic vasculopathy. Her clinical and cutaneous manifestations led to the question and the diagnosis of SS. Our case is one of the few cases of SS where LR occurred long after cerebrovascular disease. We discuss the range of skin biopsy findings of LR and approach to SS from a dermatopathologic perspective.
Celiac Plexus Block to Treat Refractory Feed Induced Dystonia in Children with Severe Neurodisability: A Single Center Case Series
Authors: Campbell David I. , Rabone Rosalind M. , Fadilah Ala , Raghavan Ashok , Urs Arun N. , Eissa Ayman , Lindley Richard M. , Mordekar Santosh
Published: October 2021

Objectives:

This observational study describes the procedure technique, safety outcomes, and patient responses to celiac plexus blockade (CPB) in children with severe neurodisability with refractory feed intolerance, feed induced pain or feed induced dystonia (FID).

Method:

A review of the pathophysiological response to feeding in children with significant neurodisability and the effect on the neuroenteric system. A 2-stage CT-guided temporary celiac plexus blockade followed by neurolysis technique is described. We compile a case series of 5 patients with life limiting conditions and significant disability undergoing CPB in a single tertiary pediatric hospital.

Results:

A total of 10 separate procedures in 5 children were completed. A positive outcome was observed in 3 out of 4 cases of pediatric FID. Two of the three patients on parenteral nutrition had improved feed tolerance postprocedure. All children tolerated the procedure well, no postprocedure complications were documented.

Conclusions:

In selected cases, children with life-threatening feed induced dystonia or effective intestinal failure can be safely treated with celiac plexus blockade when other therapies have failed.
ACEP Emergency Department COVID-19 Management Tool
Authors: Hill April Turner
Published: October 2021

This review examines the American College of Emergency Physicians' (ACEP) Emergency Department COVID-19 Management Tool (2021). The authors and contributors developed a tool to provide a framework to assist with severity classification, risk assessment, diagnostic workup, disposition, and treatment of patients with suspected or confirmed COVID-19 in the emergency department. By utilizing the tool from this study, the emergency nurse practitioner can confidently treat COVID-19 and reduce patient risks from unnecessary treatments or unneeded admissions.