bluuebunny/crossref_metadata_2025 huggingface dataset:
Chinese Loans and African Structural Transformation
Authors: Brautigam Deborah
Published: June 2019

This chapter explores Chinese loan finance in Africa and its relevance for Africa’s economic modernization and structural transformation between 1960 and 2016. Drawing on an original database of Chinese loan finance China–Africa Research Initiative at Johns Hopkins University’s School of Advanced International Studies (SAIS-CARI), the chapter begins by outlining the changing actors involved in lending from China and the different kinds of loan instrument. It then examines the sectors in which Chinese lending clusters, shedding light on the degree to which African borrowers use these loans directly or indirectly to support structural transformation projects in industrialization and agro-finance, and related infrastructure. The chapter pays special attention to the modalities of structuring loan finance and providing guarantees of repayment in risky environments when many countries have only recently emerged from a long debt crisis. Finally, it considers concern over rising debt levels in a number of African countries.
An Experiment in Coercive Consociation
Authors: O’Leary Brendan
Published: June 2019

The making of the Anglo-Irish Agreement (AIA) of 1985 is examined in detail, and interpretations of its significance are assessed. Was the AIA simply a form of inter-governmentalism, or was it tacitly or unintentionally a project to incentivize unionists to favor power-sharing? That is, is it best interpreted as a coercive way of promoting consociation? The impact of the 1985 AIA is assessed across parties, movements, and paramilitaries, and in particular its impact on the administration of justice, and on social justice within Northern Ireland, is discussed. Its foundational role in making the Good Friday Agreement possible is also highlighted.
The Making, Meaning(s), and Tasks of the 1998 Agreement
Authors: O’Leary Brendan
Published: June 2019

This chapter provides a detailed account of the contents and significance of the Belfast or Good Friday Agreement of 1998, and of its consociational and non-consociational components. It conforms to all aspects of a consociational settlement—namely, parity, proportionality, autonomy, and veto rights among the partners—but it is not just a consociation. The agreement encompasses a peace agreement, a substantive program to complete the reform of Northern Ireland, cross-border cooperation across Ireland, and intergovernmental cooperation between Ireland, Northern Ireland, and all the British Isles. It can be seen as creating a “federacy” in Irish eyes; in unionist eyes every component of the agreement can be modified by normal UK legislation. An assessment of why the agreement was made is offered, as well as a preliminary evaluation of its early difficulties in implementation.
Rules and Rule Breaking in Teacher Training Colleges
Authors: Bischof Christopher
Published: June 2019

Chapter three, ‘Rules and Rule Breaking in Teacher Training Colleges’, taps into the rich and virtually unused archives of seven training colleges in England and Scotland to show how tremendously liberating these institutions could be in practice despite their oppressive rules and infinitesimally detailed timetables. For instance, teachers-in-training reacted to bans on romantic relationships by creating a cult of the romantic. They celebrated courtship and more casual flirtation in poems, paintings, and short stories of their real-world exploits, all of which they circulated widely in ‘friendship albums’ and college ‘literary magazines’. This defiance became the basis of lifelong friendships—and a professional culture that pushed back against the imposition of policies.
The Over-Pressure Controversy and Everyday Expertise
Authors: Bischof Christopher
Published: June 2019

Chapter eight, ‘The Over-Pressure Controversy and Everyday Expertise’, examines the public debate in the wake of a sensational 1884 report claiming that the annual examination of children in elementary schools was driving them to do school work in their sleep, stunting their development, and leading dozens of them to commit suicide each year. In testimonies to government inquiries and articles in the press, teachers demonstrated how intimately they knew about children’s home situations and their health—and how much the doctors and educational policymakers who were trying to co-opt the debate over what to do about ‘over-pressure’ depended on that knowledge. Their testimony also revealed how desperately poor and working-class children needed more protection and help from the state. This was an important moment in the democratization of expertise and the making of the welfare state.
Regime Shocks in India, Mexico, and Eritrea
Authors: Gamlen Alan
Published: June 2019

Chapter 4 provides new information about specific case studies of three well-known diaspora engagement efforts: the Institute for Mexicans Abroad, the Ministry of Overseas Indian Affairs, and the Department of Eritreans Abroad. Emphasizing the strengths of a mixed-methods approach, the chapter quotes and comments on extensive passages from in-depth elite interviews with senior policy makers in these countries. The chapter fleshes out the dynamics of regime shock and diaspora institution formation introduced previously. In all three cases, diaspora institutions have, in various ways, responded to major territorial reconfigurations and involved elements of human geopolitical claims over population rather than territory.
Labour Export from the Asian Body Shops
Authors: Gamlen Alan
Published: June 2019

Chapter 5 covers the emergence of diaspora institutions in countries across South and Central Asia and elsewhere from the 1970s. In these regions, the trend has been less about exile in-gathering and more about avoiding regime shocks through ‘safety-valve’ emigration and labour export, to support the consolidation of authoritarianism. Unemployment may fuel social and political unrest and destabilize governments. Using emigration as an economic and socio-political safety valve has allowed governments to keep disgruntled unemployed workers, dissenting labour unions, and other organizations representing them, from contesting or destabilizing the regime. This strategy has typified the labour export policies of a number of developing states across Asia since the 1970s.
Hellenistic and Roman Military Epitaphs on Stone and on Papyrus
Authors: Barbantani Silvia
Published: June 2019

Chapter 10 studies Hellenistic and Roman military epitaphs and addresses a number of interconnected issues: the unpopularity of epitaphs for individual soldiers in the Greek Anthology (only a dozen of such epigrams are present, leaving side fictitious pieces for literary or historical figures); the near absence of inscribed epitaphs in literary sources, despite the fact that they are often of good literary quality; and the question of their authorship: there is no evidence that any epigrammatist known from the Greek Anthology also acted as a professional writer of military epitaphs, as Simonides did. Epitaphs for common soldiers were usually commissioned to professional poets, most of whom now remain anonymous; in some cases the deceased, especially when he presents himself as a veteran belonging to the local elite, may have had his say on the contents and form of his future epitaph.
Scratches across the Heart
Authors: O’Leary Brendan
Published: June 2019

RRThis chapter clarifies the concept of partition, and then evaluates the partition of Ireland, comparing it with the colonial partitions of Palestine and British India, as well as other cases. Types of partition are carefully distinguished, and explanations for their emergence are evaluated, as well as the justifications that usually accompany them. The actual partition of Ireland is appraised against potentially fairer partitions. The failure of the Irish Boundary Commission provided for in the Treaty of 1921 ratified by the Westminster and Dublin parliaments is explained. An assessment is made of the degree to which fraud and deceit occurred in the making of the treaty that specified how partition might be modified.
The Proper Treatment of Identity in Dialetheic Metaphysics
Authors: Jones Nicholas K
Published: June 2019

According to one prominent strand of mainstream logic and metaphysics, identity is indistinguishability. Priest has recently argued that this permits counterexamples to the transitivity and substitutivity of identity within dialetheic metaphysics, even in paradigmatically extensional contexts. This paper investigates two alternative regimentations of indistinguishability. Although classically equivalent to the standard regimentation, on which Priest focuses, these alternatives are strictly stronger than it in dialetheic settings. Both regimentations are transitive, and one satisfies substitutivity. It is argued that both regimentations provide better candidates to occupy the core theoretical role of numerical identity than does the standard regimentation.
Impact of individual- and area-level race/ethnicity on illness intrusiveness among cancer survivors
Authors: Leach Corinne R , Vereen Rhyan N , Rao Arthi V , Ross Katherine , Diefenbach Michael A
Published: June 2019

For many people with a recent history of cancer, their cancer experience intrudes into various aspects of daily life. The neighborhood in which one lives can impact how much cancer intrudes into their life.
A New Future of Nursing Report
Authors: Hassmiller Susan B.
Published: June 2019

Nurses have a historic opportunity to address social determinants of health in America.
The National Library of Medicine
Authors: Ortelli Tracy A.
Published: June 2019

Free, evidence-based resources for health care providers, patients, and consumers.
Milieu Simulation for BSN Students in a Psychiatric Course
Authors: Kemery S. , Newsom Brittany
Published: June 2019

Students entering the inpatient psychiatric clinical rotation are faced with a new practice environment that may cause varying levels of anticipatory anxiety. A simulation was developed to provide the opportunity to rotate through four different patient types and experience an introduction to the inpatient psychiatric milieu. This simulation is a novel method to prepare students for inpatient psychiatric clinical experiences and is easily adaptable to fit the needs of a variety of programs. Feedback from clinical faculty and students has been overwhelmingly positive.
Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study
Authors: Shannon Steven F. , Yuan Brandon J. , Cross William W. , Barlow Jonathan D. , Torchia Michael E. , Holte Pamela K. , Sems Stephen A.
Published: June 2019

Objective:

To compare functional and clinical outcomes in patients with pertrochanteric hip fractures treated with either a short (SN) or long (LN) cephalomedullary nail.

Design:

Prospective, randomized.

Setting:

Clinical investigation was performed at the Mayo Clinic's Level 1 Trauma Center in Rochester, MN.

Patients/Participants:

Two hundred twenty patients with intertrochanteric fractures were prospectively randomized to an SN or LN cohort. A total of 168 patients (SN, n = 80; LN, n = 88) had a mean follow-up of 13.9 months. Fifty-two patients did not meet the minimum 3-month follow-up. Demographics were comparable between the cohorts.

Main Outcome Measures:

The primary outcome measurement was functional outcome evaluated by Short Form (SF-36) and Harris Hip scores (HHS) at 3 months. Secondary outcomes included implant failure, peri-implant fracture, mortality, operative time, estimated blood loss, and reoperation.

Results:

SN and LN cohorts were comparable in all aspects of the SF-36. There was a clinically insignificant difference in the HHS between cohorts. Patients treated in the SN cohort experienced shorter operative times but did not differ in tip-to-apex distance or subtrochanteric fracture extension. There was no difference in implant cutout, deep surgical site infection, or peri-implant fractures.

Conclusions:

Patients treated with SNs or LNs for pertrochanteric femur fractures experienced comparable functional outcomes as measured by SF-36 and HHS. When compared with the LN cohort, SN patients experienced no difference in peri-implant fracture or lag-screw cutout and tolerated up to 3 cm of subtrochanteric fracture line extension.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Competitive Bodybuilding: Fitness, Pathology, or Both?
Authors: Steele Ian H. , Pope Harrison G. , Kanayama Gen
Published: June 2019

The sport of competitive bodybuilding requires an intense regimen of weightlifting and dieting, often aided with muscle-building or fat-burning drugs, and culminating in an on-stage posing competition. Despite these rigorous demands, competitive bodybuilding is popular, with thousands of competitions performed annually around the world. Although many studies have addressed the psychological features of various sports and the athletes who compete in them, few have examined the psychological aspects of bodybuilding. Even fewer studies have specifically examined competitive bodybuilders, as opposed to the much larger group of “recreational” bodybuilders who do not compete. The limited available literature suggests that competitive bodybuilders may show an increased risk for four categories of psychopathology: muscle dysmorphia, eating disorders, abuse of appearance- and performance-enhancing drugs, and exercise dependence. However, in each of these categories, one must carefully distinguish between the planned and dedicated behaviors required for success in the sport, as opposed to frankly pathological behaviors that impair social or occupational function, cause subjective distress, or lead to adverse health consequences. Future work should attempt to better assess the nature and prevalence of these conditions among competitive bodybuilders, with perhaps greatest attention to the issue of drug use.
Distribution of Keratoconus Indices in Normal Children 6 to 12 Years of Age
Authors: Hashemi Hassan , Heydarian Samira , Khabazkhoob Mehdi , Emamian Mohammad Hassan , Yekta Abbasali , Fotouhi Akbar
Published: June 2019

Objectives:

To determine the distribution of keratoconus indices in normal children 6 to 12 years of age.

Methods:

This cross-sectional study was conducted in children living in urban and rural areas of Shahroud, northeast Iran in 2015. After careful optometric examinations, the Pentacam was used for corneal imaging and measurement of keratoconus indices.

Results:

Of 5,620 students who participated in the study, the data of the right eye of 4,947 children were analyzed after applying the exclusion criteria. The mean age of all children was 9.23±1.71 years (range: 6–12 years). The mean and 95% confidence intervals (in the parentheses) of index of surface variance (ISV), index of vertical asymmetry, keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry, index of height decentration (IHD), and average pachymetric progression index (PPIAve) was 17.770 (17.610–17.930), 0.137 (0.135–0.139), 1.022 (1.022–1.023), 1.010 (1.010–1.010), 3.299 (3.230–3.368), 0.007 (0.007–0.008), and 0.948 (0.943–0.952), respectively. The results of multilevel mixed-effects linear regression analysis showed that ISV, KI, CKI, IHD, and PPIAve were significantly higher in girls. Index of surface variance and CKI were higher in urban students, and PPIAve was higher in rural students. Except for PPIAve, which was increased with increasing age, the mean values of other keratoconus indices were significantly lower in 12-year-old students compared with 6-year-old ones.

Conclusion:

The results provide valuable information about normal distribution of keratoconus indices in children aged 6 to 12 years. These findings can be used in future research and detection of abnormal cases in the clinical setting.
Precision Medicine Success Requires Informatics Know-How
Authors: Diamond Joel
Published: June 2019

This article takes a hard look at the relationship among precision medicine, genomics, and daily medical practice. The article examines what’s happening in the new era of Big Data and information technology interoperability.
“It makes such a difference”: An examination of how LGBTQ youth talk about personal gender pronouns
Authors: Brown Camille , Frohard-Dourlent Hélène , Wood Brittany A. , Saewyc Elizabeth , Eisenberg Marla E. , Porta Carolyn M.
Published: June 2019

Background and purpose:

The World Health Organization has developed standards for youth-friendly health services to support adolescents and encourage health care utilization among youth. Necessary building blocks for youth-friendly care include strong interpersonal relationships between youth and health care providers. Nurse practitioners (NPs) may be particularly well positioned to form these relationships. This study explored a core aspect for building youth–provider relationships. The study examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents discussed use of personal pronouns (e.g., he, she, they, ze) in relation to transgender and gender diverse (TGD) people.

Methods:

A secondary qualitative analysis of 66 in-depth interviews with LGBTQ youth from across Minnesota, Massachusetts, and British Columbia, Canada was conducted. Results were sorted into four main themes describing different aspects of personal pronoun use as related to TGD individuals.

Conclusions:

Stories and experiences shared by participants illustrate how to assess which pronouns to use for a given person, how to use pronouns in different contexts, why respecting pronouns is important to TGD people, and flexibility as an integral component of the learning process when it comes to appropriate pronoun use.

Implications for practice:

Understanding how youth discuss personal pronouns could improve practice with TGD youth. Each of the four themes can be applied to clinical encounters to ensure culturally sensitive care. Practice recommendations include asking adolescents what pronouns they prefer clinic staff to use on intake forms and having NPs and clinic staff provide their own pronouns to patients in introductions.
Genomic Profiling of Vulvar Lichen Sclerosus Patients Shows Possible Pathogenetic Disease Mechanisms
Authors: Haefner Hope K. , Welch Kathryn C. , Rolston Aimee M. , Koeppe Erika S. , Stoffel Elena M. , Kiel Mark J. , Berger Mitchell B.
Published: June 2019

Objective

Vulvar lichen sclerosus (LS) is known to occur in families, suggesting a genetic link. Genomic profiling of patients with vulvar LS was investigated to find underlying pathogenetic mechanisms, with the hope that targeted therapies and future clinical research will arise.

Methods

Two unrelated families with vulvar LS were investigated using whole-exome sequencing. Five affected sisters from 1 family were compared with their unaffected paternal aunt (unaffected control). A mother-daughter pair from a second affected family was compared with the first family. The results of the sequencing were compared with population-specific allele frequency databases to prioritize potential variants contributing to vulvar LS development.

Results

Recurrent germ-line variants in 4 genes were identified as likely to be deleterious to proper protein function in all of the 7 affected patients, but not in the unaffected control. The genes with variants includedCD177(neutrophil activation),CD200(inhibitory signal to macrophages),ANKRD18A(ankyrin repeat protein, epigenetic regulation), andLATS2(co-repressor of androgen signaling).

Conclusions

Although many providers may see a mother and daughter with vulvar LS, this condition is rarely seen in multiple family members who are available for genetic testing. This is the first report to detail genomic profiling related to a familial association of vulvar LS.
Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation
Authors: Lee Yong-Joon , Hong Sung-Jin , Kim Byeong-Keuk , Shin Sanghoon , Suh Yongsung , Kim Seunghwan , Ahn Chul-Min , Kim Jung-Sun , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo
Published: June 2019

Background

For diabetic patients with multivessel coronary artery disease (MVD), limited data exist on the long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) according to clinical presentation [stable coronary artery disease (SCAD) or non-ST-elevation acute coronary syndrome (NSTE-ACS)].

Patients and methods

From a Korean multicenter registry, we analyzed 1135 diabetic patients with MVD treated with PCI (n = 660) or CABG (n = 475). After propensity score matching, 8-year major adverse cardiovascular and cerebrovascular events [MACCE; composite of all-cause death, myocardial infarction (MI), or stroke] were compared between PCI and CABG according to clinical presentation.

Results

After matching, MACCE was not different between PCI and CABG for SCAD patients [15.6 vs. 17.2%, hazard ratio (HR)  = 0.94, 95% confidence interval (CI)  = 0.55–1.63, P = 0.837], whereas it was higher in PCI than in CABG for NSTE-ACS patients (31.1 vs. 22.4%, HR = 1.63, 95% CI = 1.03–2.59, P = 0.036), mainly driven by the higher MI occurrence (HR = 2.18, 95% CI = 1.04–4.59, P = 0.035). A significant interaction between revascularization strategy and clinical presentation was observed for MACCE (P-interaction = 0.022). However, when PCI was further classified according to revascularization completeness, the treatment gap between PCI and CABG with respect to MI in NSTE-ACS patients was improved by complete-revascularization PCI.

Conclusion

Among diabetic patients with MVD, the long-term outcomes of PCI versus CABG differed according to clinical presentation. CABG may be more beneficial for NSTE-ACS patients with MVD in reducing MACCE and MI, whereas PCI was as effective as CABG for SCAD patients with MVD. Therefore, clinical presentation must be considered when choosing revascularization strategies in these patients.
Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury
Authors: Pinto Ana Paula , Guimarães Carolina Lobo , Souza Gabriela Aparecida da Silveira , Leonardo Patrícia Sardinha , Neves Marcele Florêncio das , Lima Fernanda Pupio Silva , Lima Mário Oliveira , Lopes-Martins Rodrigo Alvaro Brandão
Published: June 2019

Background:

Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility.

Methods:

This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm2, 100 mW, 3.5 W/cm2, 30 seconds per point, 3 J per point, 107.1 J /cm2 to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR.

Trial registration number:

ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).
MAID chemotherapy regimen as a treatment strategy for metastatic malignant ameloblastoma
Authors: Li Danyang , Xu Shuning , Sun Miaomiao , Qiao Lei , Wang Lifeng , Liu Ying
Published: June 2019

Rationale:

Ameloblastoma is generally characterized as a benign tumor originating in odontogenic epithelium. However, few cases of metastatic malignant ameloblastoma have also been reported. Due to the low incidence of malignant ameloblastoma, there is no established treatment regimen. To explore effective treatment for malignant ameloblastoma, we reported this case study.

Patients concerns:

This report described a case of a 28-year-old malignant ameloblastoma female patient with multiple metastasis (brain and lung).

Diagnoses:

The patient presented ameloblastoma of the left mandible in 2012. Three years later, local recurrence and brain metastasis was observed during a follow-up examination. Five years later, malignant ameloblastoma was detected by imaging and immunohistochemistry in the bilateral multiple pulmonary nodules and mediastinal lymph nodes.

Interventions:

The patient was initially treated with tumor resection. Three years later after local recurrence and brain metastasis, she was accepted the extensive mandibulectomy supplemented with brain stereotactic body radiotherapy (SBRT). When diagnosed with pulmonary metastasis, the patient received combined chemotherapy regimen of MAID (mesna, adriamycin, ifosfamide and dacarbazine) for 6 cycles.

Outcomes:

The efficacy evaluation was partial remission (PR) after the 6 cycles of MAID. The last patient follow-up was July 24th 2018, and no evidence of progression was observed. The progression-free survival (PFS) of the patient was more than 9 months.

Lessons:

Surgical resection is the optimal treatment for locally recurrent ameloblastoma. SBRT may be an effective treatment for unresectable oligometastasis of malignant ameloblastoma. Finally, combined chemotherapy of MAID showed encouraging effects in the management of metastatic malignant ameloblastoma.
A pilot safety study of ublituximab, a monoclonal antibody against CD20, in acute relapses of neuromyelitis optica spectrum disorder
Authors: Mealy Maureen A. , Levy Michael
Published: June 2019

Objective:

To test the safety of ublituximab, a B cell depleting agent, as add-on therapy in the acute treatment of relapses of neuromyelitis optica spectrum disorder.

Methods:

We conducted an open-label phase 1b safety and proof-of-concept trial in 5 subjects with aquaporin-4 (AQP4)-immunoglobulin G (IgG) seropositive neuromyelitis optica spectrum disorder (NMOSD) who presented with acute transverse myelitis and/or optic neuritis. In addition to treating with 1 g of daily intravenous methylprednisolone, we infused a single dose of 450 mg of ublituximab within 5 days of relapse onset. The primary outcome measure was safety, and the secondary efficacy measures included change in Expanded Disability Status Scale (EDSS), durability of remission and B cell counts.

Results:

Five NMOSD subjects were enrolled, 4 of whom presented with acute transverse myelitis and 1 with acute optic neuritis. Ublituximab proved to be safe in all 5 NMOSD subjects, with no serious adverse events recorded. There were no opportunistic infections in any of the subjects; however, 1 subject experienced a transient leukopenia. EDSS scores dropped from a median of 6.5 on admission to 4.0 on 90-day follow up. Two subjects did not achieve total B cell depletion and relapsed within 3 months.

Conclusions:

Ublituximab is a safe add-on therapy for NMOSD patients presenting with acute transverse myelitis and optic neuritis. Preliminary evidence suggests a promising benefit on durability of remission when B cell depletion is achieved. A placebo-controlled trial is necessary to confirm these findings.

Classification of Evidence:

This study provides Class IV evidence that for patients with NMOSD with acute transverse myelitis or optic neuritis, ublituximab is safe and may improve neurological outcome.
Assistive technology based on client-centered for occupational performance in neuromuscular conditions
Authors: Pousada García Thais , Loureiro Javier Pereira , González Betania Groba , Nieto-Rivero Laura
Published: June 2019

Knowledge of the patient's own perception of functioning and dependence, and of environmental factors, is of significant value. The main goals of this study are (1) to obtain a general profile of the occupational performance of persons with neuromuscular disorders (NMD) and their needs related to that performance and (2) to determine the support resources (assistive technologies [AT], adjustment, and/or caregiver) required to improve or maintain their level of independence.

This cross-sectional study involved 24 persons with NMD. The functional independence measure (FIM), the checklist of a home's accessibility level, and a specific questionnaire were administered.

The sample included 14 women (58.3%) and 10 men (41.7%). A mean of 61.7 (standard deviation = 17.2) was obtained for FIM motor, over 91, indicating a moderate level of dependence. The AT most frequently used was a wheelchair (70.8%). Architectural barriers were detected in the majority of users’ homes (87.5%).

Concise assessment of the independence needs of people with NMD, according to their occupational performance, and prescription of resources to meet those needs are required. This procedure should be implemented in healthcare programs, including care to a caregiver.
Intervention of artemisinin in macular edema associated with retinal vein occlusion
Authors: Xu Jing , Hao Xiaofeng , Lu Bingwen , Ming Jing , Li Xiaoyu , Qi Yixin , Xie Like
Published: June 2019

Background:

Artemisinin was discovered to be highly effective antimalarial drugs shortly after the isolation of the parent artemisinin in 1971 in China. It is derived from extracts of sweet wormwood (Artemisia annua) and are well established for the treatment of malaria. Recently, artemisinin has been shown that it might have therapeutic value for several other diseases. The purpose of this review is to assess the efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion.

Methods and analysis:

A systematic literature search will be performed in all available databases to quantitatively review eligible studies and identify all relevant data. We will include randomized controlled trials assessing efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination:

Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.

PROSPERO registration number:

The protocol for this systematic review has been registered on PROSPERO under the number CRD42019131408.
HLA-G +3142 C>G polymorphism and cancer risk
Authors: Jiang You , Li Wenbo , Lu Jun , Zhao Xin , Li Liang
Published: June 2019

Background:

Human leukocyte antigen-G (HLA-G) plays an important role in the development of human cancers. Several published studies have investigated the relationship between the HLA-G +3142 C>G (rs1063320) polymorphism and cancer susceptibility in different populations. However, the results have yet to reach a consensus in different types of cancers. Therefore, we performed a meta-analysis to evaluate the effect of the HLA-G +3142 C>G polymorphism on cancer risk.

Methods:

A systematic literature search was performed in PubMed, Web of Science, CNKI, VIP, and Wanfang databases to acquire eligible studies up to February 20, 2019. The pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to assess the correlation between the HLA-G +3142 C>G polymorphism and cancer risk in a fixed-effects or random-effects model. Publication bias assessments, sensitivity analysis and stratified analyses were performed. To reduce the risk of type I error and assess whether the present evidence of the results was adequate and conclusive, trial sequential analysis (TSA) was also performed.

Results:

Eight case-control studies comprising 1546 cases and 1595 controls were included in the present meta-analysis. The results revealed that the HLA-G +3142 C>G mutation significantly decreased the total cancer risk in recessive comparison model and allelic comparison model. Further stratified analyses showed that the HLA-G +3142 C>G mutation significantly decreases the risk of cancer in Asian populations. No similar relationship was found in other subgroups. No publication bias was identified in our present study. Omitting a single study at a time had no significant impact on the pooled OR of the sensitivity analysis assessing the association between the HLA-G +3142 C>G polymorphism and cancer risk, which demonstrates the stability of the current meta-analysis. TSA also identified our current findings.

Conclusions:

The results of our meta-analysis show that the HLA-G +3142 C>G polymorphism plays a protect role in the occurrence of human cancers, particularly in Asian populations. More case-control studies with different types of cancer in various ethnicities are needed to verify the findings.
Predictive ability of admission neutrophil to lymphocyte ratio on short-term outcome in patients with spontaneous cerebellar hemorrhage
Authors: Zhang Fan , Ren Yanming , Shi Yan , Fu Wei , Tao Chuanyuan , Li Xi , Yang Mu , You Chao , Xin Tao
Published: June 2019

As one of the prototypical intracranial hemorrhage (ICH), spontaneous cerebellar hemorrhage (SCH) is treated with different strategies by comparing with supratentorial hemorrhage (SH). Additionally, SCH patients usually suffer from worse prognosis than patients with other types of ICH. It is well documented that the unique anatomic structures of posterior cranial fossa lead to a higher risk for brainstem compression and/or brain edema in SCH patients. Recently, neutrophil to lymphocyte ratio (NLR) was reported to possess an excellent predictive ability for the prognosis of patients with ICH, and most of those cases are SH. Thus, the potential association between NLR and the prognosis of SCH patients remains to be elucidated. Here, we aim to assess the predictive role of admission NLR and other available inflammatory parameters for the outcomes of patients with SCH.

All patients with acute SCH admitting to West China Hospital from February 2010 to October 2017 were retrospectively enrolled. According to the absolute neutrophil count, absolute lymphocyte count, white blood count and absolute monocyte count extracted from electronic medical records, NLR was calculated. The multivariable logistic regression analysis was applied to analyze the associations between disease outcome and laboratory biomarkers. The comparisons of predictive powers of each biomarker were assessed by receiver operating curves (ROCs). The spearman analyses and multiple linear analyses were also conducted to identify the independent predictors for admission NLR.

Admission NLR independently associated with 30-day status (odds ratio [OR] 1.785, 95% confidence interval [CI] 1.463–2.666, P <.01) and exhibited a better predictive value (AUC 0.751, 95% CI 0.659–0.830, P <.001) with the best predictive cutoff point of 7.04 in 62 patients with unfavorable outcomes. Moreover, absolute neutrophil count, absolute lymphocyte count, presence of intraventricular hemorrhage (IVH) and Glasgow coma scale (GCS) score were also correlated with admission NLR, respectively.

Admission NLR is a potential marker to independently predict the 30 days functional outcome of SCH patients. Based on our results, systemic inflammation in admission might be considered as an important player in participating the pathological process of patients with SCH.
Breast Density Assessment in Young Women with Ultrasound based on Speed of Sound: Influence of the Menstrual Cycle
Authors: Ruby Lisa , Sanabria Sergio J. , Obrist Anika S. , Martini Katharina , Forte Serafino , Goksel Orcun , Frauenfelder Thomas , Kubik-Huch Rahel A. , Rominger Marga B.
Published: June 2019

To investigate changes in breast density (BD) during the menstrual cycle in young women in comparison to inter-breast and -segment changes as well as reproducibility of a novel Speed-of-Sound (SoS) Ultrasound (US) method.

SoS-US uses a conventional US system with a reflector and a software add-on to quantify SoS in the retro-mammillary, inner and outer segments of both breasts. Twenty healthy women (18–40 years) with regular menstrual cycles were scanned twice with two weeks in-between. Three of these were additionally measured twice per week for 25 days. Average SoS (m/s) and ΔSoS (segment-variation SoS; m/s) were measured. Variations between follicular and luteal phases and changes over the four-week period were assessed. Inter-examiner and inter-reader agreements were also evaluated. Variances between cycle phases, examiners and readers were compared.

No significant SoS difference was observed between follicular and luteal phases for the twenty women (P = .126), and between all different days for the three more frequently measured women (P = .892). Inter-reader (ICC = 0.999) and inter-examiner (ICC = 0.990) agreements were high. The SoS variance due to menstrual variations was not significantly larger than the inter-examiner uncertainty (P = .461). Inter-reader variations were significantly smaller than menstrual and examiner variations (P < .001).

SoS-US showed high inter-examiner and inter-reader reproducibility. The alterations during the menstrual cycles were not significantly larger than the confidence interval of measurements.
Association between cholelithiasis and sialolithiasis
Authors: Kim So Young , Kim Hyung-Jong , Lim Hyun , Lim Man Sup , Kim Miyoung , Park Il-Seok , Choi Hyo Geun
Published: June 2019

This study aimed to evaluate the association between cholelithiasis and sialolithiasis using a national sample cohort in Korea.

The Korean National Health Insurance Service-National Sample Cohort (patients ≥20 years old) was collected from 2002 to 2013. In study I, we extracted cholelithiasis patients (n = 21,170) and 1:4 matched control I subjects (n = 84,680) and analyzed the occurrence of sialolithiasis. In study II, we extracted sialolithiasis patients (n = 761) and 1:4 matched control II subjects (n = 3044) and analyzed the occurrence of cholelithiasis. Hazard ratios (HRs) were determined using the stratified Cox proportional hazard model.

The HR for sialolithiasis was 1.49 (95% CI = 0.88–2.52) in the cholelithiasis group (P = .14), and the HR for cholelithiasis was 1.18 (95% CI = 0.53–2.59) in the sialolithiasis group (P = .69).

We did not find an association between cholelithiasis and sialolithiasis.
Pneumonitis and concomitant bacterial pneumonia in patients receiving pembrolizumab treatment
Authors: Jun Jiho , Lee Sang-Ryung , Lee Ji Yean , Choi Min Joo , Noh Ji Yun , Cheong Hee Jin , Kim Woo Joo , Song Joon Young
Published: June 2019

Rationale:

Pembrolizumab, a monoclonal antibody against the programmed cell death 1 (PD-1) protein, can induce a stable regression of some malignancies refractory to conventional chemotherapy. Despite such therapeutic benefits, pembrolizumab can induce immune-related adverse events, with pneumonitis being the most critical problem.

Patient concerns:

All 3 patients complained of fever, cough, and dyspnea after a variable time interval (1–21 days) from pembrolizumab treatment.

Diagnoses:

Chest computed tomography invariably showed ground glass opacity. All tests for possible infectious agents were negative. Based on high procalcitonin level, one of 3 patients was diagnosed to have accompanying bacterial pneumonia.

Interventions:

All patients received antibiotics and steroid treatments (methylprednisolone, 1 mg/kg).

Outcomes:

The 3 patients showed different clinical courses ranging from mild pneumonitis to rapidly progressing respiratory failure. Among the 3 patients, 2 fully recovered with steroid treatment; 1 died from superimposed bacterial pneumonia.

Lessons:

The prognosis of pembrolizumab-induced pneumonitis with a superimposed bacterial pneumonia would be poor. It is important to distinguish pure pneumonitis from that with a superimposed bacterial pneumonia.
Endothelial keratoplasty: The relationship between recipient anterior chamber depth and endothelial cell loss
Authors: Alqudah Asem A. , Bauer Alex J. , Straiko Michael , Terry Mark A.
Published: June 2019

Purpose:

To determine the relationship between anterior chamber depth (ACD) and percent endothelial cell loss (ECL) after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).

Method:

In 78 eyes receiving triple procedure (DSAEK combined with cataract extraction and posterior chamber intraocular lens (PCIOL) implantation), ACD was measured preoperatively with an intraocular lens (IOL) Master and ECL was calculated with specular microscopy at 6 months, 1, 2, 3, and 4 years postoperatively. ACD and ECL from all 78 eyes were compared using correlation analysis and students t test. Eyes were then separated into 2 groups based on ACD, group 1 with ACD < 3mm and group 2 with ACD ≥ 3mm. Students t test was then performed to compare group 1 and group 2 ECL at 6 months, 1, 2, 3, and 4 years postoperative.

Results:

Mean ACD for all 78 eyes was 2.93 ± 0.43 mm. Mean ECL was 32.7%, 27.6%, 29.6%, 32.5%, and 37.2% at 6 months, 1, 2, 3, and 4 years. No significant correlation between ACD and ECL was observed at any time point for the combined analysis of 78 eyes (P > .05). At 2 and 4 years postoperative, mean ECL was 32.6% ± 16.1% and 43.0% ± 23.2% in eyes with ACD < 3mm and 25.3% ± 13.0% and 29.6% ± 18.2% in eyes with ACD ≥ 3 mm (P = .041 at 2 years and .008 at 4 years).

Conclusion:

ACD and ECL were not directly correlated; however, there may be a threshold ACD in which shallower anterior chambers preoperatively result in greater donor ECL over time.
Antithrombin Population Pharmacokinetics in Pediatric Ventricular Assist Device Patients
Authors: Moffett Brady S. , Anders Marc , Humlicek Timothy , Galati Marianne , Teruya Jun , Adachi Iki , Tume Sebastian
Published: June 2019

Objectives:

Describe the pharmacokinetics of antithrombin in pediatric patients undergoing ventricular assist device therapy and provide dosing recommendations for antithrombin in this population.

Design:

A retrospective population pharmacokinetic study was designed.

Setting:

Large tertiary care children’s hospital Subject inclusion criteria consisted of less than 19 years old.

Patients:

Subjects less than 19 years old undergoing therapy with a HeartWare ventricular assist device (HeartWare, Framingham, MA) or Berlin EXCOR ventricular assist device (Berlin GmbH, Berlin, Germany), who received a dose of antithrombin with a postdose antithrombin activity level from January 1, 2011, to June 30, 2017.

Interventions:

Population pharmacokinetic analysis and simulation using NONMEM v.7.4 (Icon, PLC, Dublin, Ireland).

Measurements and Main Results:

A total of 41 patients met study criteria (median age, 5.8 years [interquartile range, 1.6–9.9 yr]), and 53.7% underwent therapy with the pulsatile Berlin EXCOR pediatric ventricular assist device (Berlin Heart GmbH, Berlin, Germany). All patients received unfractionated heparin continuous infusion at a mean ± sd dose of 29 ± 14 U/kg/hr. A total of 181 antithrombin doses (44.1 ± 24.6 U/kg/dose) were included, and baseline antithrombin activity levels were 77 ± 12 U/dL. Antithrombin activity levels were drawn a median 19.9 hours (interquartile range, 8.8–41.6 hr) after antithrombin dose. A one-compartment proportional error model best fit the data, with allometric scaling of fat-free mass providing a better model fit than actual body weight. Unfractionated heparin and baseline antithrombin were identified as significant covariates. A 50 U/kg dose of antithrombin had a simulated half-life 13.2 ± 6.6 hours.

Conclusions:

Antithrombin should be dosed on fat-free mass in pediatric ventricular assist device patients. Unfractionated heparin dose and baseline antithrombin activity level should be considered when dosing antithrombin in pediatric ventricular assist device patients.
Physical Therapy for a Child With Encopresis: A Case Report
Authors: Anderson Brittany
Published: June 2019

Purpose:

To describe the implementation and effectiveness of a multimodal therapeutic approach used to successfully treat a child with encopresis.

Summary of Key Points:

The child demonstrated chronic constipation, poor pelvic floor muscle awareness, weakness, and incoordination during voiding. He participated in 8 sessions of physical therapy intervention including pelvic floor muscle awareness, strengthening and coordination exercises, behavioral adaptations, diet modification, and use of media, art, and interactive visualization activities.

Conclusions:

The child improved pelvic floor muscle strength and coordination and became fully continent of bowel in home and community settings.

What This Case Adds to Evidence-Based Practice:

This case report demonstrates that pediatric age-appropriate educational and motivational tools (media, art, and interactive visualization activities) are readily available, economical, and effective when used in conjunction with current practice to decrease impairments and improve active participation and compliance during treatment of retentive encopresis in the pediatric population.