bluuebunny/crossref_metadata_2025 huggingface dataset:
Excision of visceral pericardium for chronic effusive constrictive pericarditis
Authors: Subtaweesin Thaworn
Published: September 2019

Chronic effusive-constrictive pericarditis was successfully treated by removal of the visceral pericardium in a 15-year-old Thai female. The constrictive visceral pericardium was barely detected by noninvasive studies. This case highlights the importance of removal of the visceral pericardium in this condition. If only the parietal pericardium is removed, the patient will not improve clinically.
Perfusion management of aortic balloon occlusion technique in total arch replacement with frozen elephant trunk
Authors: Yan Shujie , Sun Xiaogang , Guo Hongwei , Li Yunfeng , Zhao Yu , Shi Yi , Lou Song
Published: September 2019

To ensure both cerebral and lower body perfusion during total arch replacement with frozen elephant trunk, aortic balloon occlusion technique has been applied in some cases at our institute. During the procedure, after stented elephant trunk is inserted into the true lumen of the descending aorta, an aortic balloon catheter is placed and inflated within the stented elephant trunk, occluding the orifice of descending aorta. Then, lower body perfusion is provided via femoral cannulae during distal aortic arch anastomosis. We describe the perfusion management strategy of the technique, elucidate intraoperative monitoring parameters, and clarify the feasibility of the method from the aspect of perfusion.
Brief Relaxation Training for the Prevention of Stress-Related Difficulties: A Pilot Study
Authors: Okado Yuko , De Pace Desiree , Ewing Emily , Rowley Christina
Published: September 2019

The present study piloted a brief, single-session behavioral intervention to prevent stress-related illnesses in college students. Participants were recruited at a large public university ( N =  213). A total of 132 participants completed in-person research sessions and were randomly assigned to one of three conditions (two control and one intervention), and another 81 participants completed measures online (online control) without any face-to-face contact. The intervention consisted of brief, one-on-one diaphragmatic breathing training, delivered by trained research assistants. Data were collected at baseline and 2-week follow-up. Participants receiving the intervention provided positive ratings of intervention acceptability and reported utilizing diaphragmatic breathing during the 2-week period. They also reported significant improvements in perceived stress, anxiety, and depressive symptoms. When compared with the control conditions, however, the Intervention condition produced superior improvement in depressive symptoms only. Results suggest that diaphragmatic breathing training can be offered by trained peers to college students to help reduce stress-related symptoms.
High versus standard magnetic resonance image resolution of the cervical spine in patients with axial spondyloarthritis
Authors: Krabbe Simon , Østergaard Mikkel , Sørensen Inge J , Møller Jakob , Jensen Bente , Madsen Ole R , Pedersen Susanne J
Published: September 2019

Background

Sagittal magnetic resonance (MR) images are typically obtained with the same spatial resolution along the entire spine, but cervical vertebrae are smaller and may be harder to assess.

Purpose

To investigate if high-resolution (high-res) short tau inversion recovery (STIR) and T1-weighted turbo spin echo (T1W) MR imaging (MRI) sequences are superior to standard resolution for detecting inflammatory and structural lesions in the cervical spine of patients with axial spondyloarthritis.

Material and Methods

Images were obtained in 36 patients. Voxel sizes at high/standard resolution were 1.99/4.33 mm3 (STIR) and 0.89/3.71 mm3 (T1W). High-resolution and standard-resolution images were scored by two readers according to the Canada-Denmark (CANDEN) MRI spine scoring system.

Results

Higher bone marrow edema scores were obtained at high resolution versus standard resolution (mean 2.1 vs. 1.2, P = 0.040), whereas fat lesion scores (1.8 vs. 1.5, P = 0.27) and new bone formation scores (3.5 vs. 2.8, P = 0.21) were similar. High-resolution MRI did not classify more patients as positive for bone marrow edema, fat, or new bone formation in the cervical spine compared to standard resolution. Using lateral radiographs as reference standard, sensitivity for detecting anterior corner syndesmophytes with both high-resolution and standard-resolution MRI was low (range 7–22%) and sensitivity for detecting ankylosis was low to moderate (20–55%), while specificity was high (≥96%).

Conclusion

High-resolution MRI allowed identification of more inflammatory lesions in the cervical spine in patients with axial spondyloarthritis when compared to standard resolution, but it did not classify more patients as positive for bone marrow edema. The slightly increased sensitivity at high-resolution MRI seemed to be too modest to have any real clinical importance.
Two Sides of Face Learning: Improving Between-Identity Discrimination While Tolerating More Within-Person Variability in Appearance
Authors: Baker K. A. , Mondloch C. J.
Published: September 2019

Two photos of an unfamiliar face are often perceived as belonging to different people—an error that disappears when a face is familiar. Face learning has been characterized as increased tolerance of within-person variability in appearance and is facilitated by exposure to such variability (e.g., differences in expression, lighting, and aesthetics). We hypothesized that increased tolerance of variability in appearance might lead to reduced discrimination and that misidentifications would be reduced if a face was learned in the context of a similar-looking identity. After validating our stimuli (Experiments 1a and 1b), we conducted three experiments investigating face learning. In two of these, participants learned three faces (Experiment 2: 15 images/identity and Experiment 3: 5 images/identity), two of which were similar. In a recognition task, misidentifications did not change as a function of similarity, although participants recognized more images of the target in Experiment 2 (i.e., after learning 15 images). In Experiment 4, participants learned one identity and the number of images studied varied across groups. Recognition of new images increased with the number of images studied, with no changes in false alarms; sensitivity (A′) marginally increased. The results suggest that recognition and discrimination reflect separable processes with minimal influence of between-person similarity on discrimination.
Effect of Orthodontic Treatment With Straight-Wire Appliance on the Incidence of Temporomandibular Disorders—A 3-Year Cohort Study
Authors: Jeelani Waqar , Habib Amna , Ali Batool , Ahmed Maheen
Published: September 2019

Introduction: A change in occlusion during orthodontic treatment can affect muscles and joints surrounding the jaw, resulting in temporomandibular disorders (TMD). The aim of this study was to determine the effect of orthodontic treatment with straight-wire appliance on the incidence of TMD in young adults.

Materials and Methods: A cohort study was carried out involving 177 adult patients (91 in the treatment group and 86 in the control group). Fonseca’s questionnaire was used for TMD evaluation for all patients at the time of obtaining orthodontic pretreatment records (T0). TMD assessment was repeated after an average of 3 years of initial assessment for both the treatment and control groups (T1).

Results: The number of patients with TMD changed significantly ( P < .001) from T0 to T1 in both groups. The prevalence of TMD increased from 36.3% to 41.8% in the treatment group and decreased from 46.5% to 38.4% in the control group after 3 years. The relative risk of developing TMD after orthodontic treatment was 1.16, whereas the odds of TMD resolution after orthodontic treatment was 0.73, both of which were statistically nonsignificant ( P > .05).

Conclusion: Orthodontic treatment with noncustomized straight-wire appliance has nonsignificant effects on the incidence of TMD in young adults.
Re-directing developers: New models of rental housing development to re-shape the post-apartheid city?
Authors: Todes Alison , Robinson Jennifer
Published: September 2019

The role of developers in shaping the built environment has attracted considerable critical attention, often focussing on the overbearing role of powerful, globalised actors in urban development. But there is also evidence that regulatory pathways shape outcomes. Through the case of a large-scale initiative in Johannesburg, South Africa, the “Corridors of Freedom”, we consider whether there is potential for developmental benefit to be gained from redirecting developer interest to create new kinds of built form. Linked to investment in a bus rapid transit system and agile bureaucracy, a model of closely managed low-income rental housing is emerging, although there is evidence of some displacement of the poorest from more informal housing. The study suggests the importance of reassessing the political complexion and potential of state–developer co-operation in urban development, and of looking more closely at the diversity of developers as well as the array of forms of finance mobilised for urban development beyond financialisation.
A Retrospective Review of Angiotensin II Use in Adult Patients With Refractory Distributive Shock
Authors: Wong Adrian , Alkazemi Afrah , Eche I. Mary , Petri Camille R. , Sarge Todd , Cocchi Michael N.
Published: September 2019

Purpose:

Catecholamines are first-line vasopressors for hemodynamic support in distributive shock but are associated with adverse effects, which may be mitigated with noncatecholamine vasopressors. Angiotensin II (ATII) is a noncatecholamine vasopressor recently approved for the management of distributive shock, but limited data support its clinical utility. The purpose of this study was to describe our institution’s usage of ATII including patient outcomes (eg, response to therapy, safety profile).

Materials and Methods:

Patients who received ATII at our institution were included. Patient demographics, degree of concordance with institutional ATII use guidelines, safety profile of ATII, and response to therapy (1 and 3 hours after ATII initiation) were collected.

Results:

A total of 16 patients received ATII for distributive shock. The median Sequential Organ Failure Assessment score at the time of ATII initiation was 16.5 (interquartile range: 15.8-20.0). Fourteen (87.5%) patients met institutional guidelines for ATII use; 10 (62.5%) and 8 (50.0%) patients met our definition for response at 1 and 3 hours, respectively. No patients developed thrombotic or infectious complications after receiving ATII.

Conclusions:

In this cohort, ATII appears to be well tolerated in patients with a high predicted mortality. Future studies evaluating the clinical efficacy of ATII are needed to determine its role in the management of distributive shock.
Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study
Authors: Liang Yan , Chen Yang-Kun , Liu Yong-Lin , Mok Vincent C. T. , Ungvari Gabor S. , Chu Winnie C. W. , Seo Sang Won , Tang Wai-Kwong
Published: September 2019

Objective:

This study investigated the association between small vessel disease (SVD) burden, a combination of multiple SVD markers and cognitive dysfunction after stroke.

Methods:

The study sample comprised 451 patients with first-ever acute ischemic stroke. Cognitive functions were assessed with the Mini-Mental State Examination (MMSE) at 3, 9, and 15 months after the index stroke. Cognitive impairment was defined as an MMSE score of ≤26. A total SVD score, indicating SVD burden, was constructed by summing the scores of the 4 SVD markers (white matter hyperintensities [WMHs], lacunes, cerebral microbleeds, and perivascular spaces) ascertained by magnetic resonance imaging (range: 0-4). The association between SVD burden and cognitive dysfunction was assessed with linear mixed models or generalized estimating equation models, as appropriate.

Results:

The majority of patients had mild-to-moderate stroke and at least one identifiable SVD marker. Cognitive impairment was found in about one-third of patients. After adjusting for confounding factors, the SVD burden was associated with MMSE scores (β = −0.37, P = .003) and cognitive impairment (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.02-1.42). SVD burden was specifically associated with the performance of MMSE subscores including orientation to place and time, calculation, and word recall. Of the SVD markers, WMHs was the most robust predictor of decrease in MMSE scores (β = −0.25, P = .01) and cognitive impairment (OR = 1.14, 95% CI = 1.01-1.29).

Conclusion:

Cerebral SVD burden is associated with decreased MMSE scores, suggesting cognitive dysfunction during the first year after mild-to-moderate acute ischemic stroke.
Characteristics of Cognitive Deficit in Amnestic Mild Cognitive Impairment With Subthreshold Depression
Authors: Sun Zhiyu , Wang Zhijiang , Xu Lujie , Lv Xiaozhen , Li Quanzheng , Wang Huali , Yu Xin
Published: September 2019

It is widely recognized that depression may precipitate the incidence of dementia in the elderly individuals and individuals with amnestic mild cognitive impairment (aMCI) in particular. However, the association between subthreshold depression (SD) and cognitive deficits in patients with aMCI remains unclear. To address this, we collected demographic information and conducted a battery of neuropsychological cognitive assessments in 33 aMCI participants with SD (aMCI/SD+), 33 nondepressed aMCI participants (aMCI/SD−), and 53 normal controls (NC). Both aMCI groups showed significantly poorer performance in most cognitive domains relative to the NC group (ie, memory, language, processing speed, and executive function). Notably, the aMCI/SD+ group showed significantly poorer attention/working memory compared with the aMCI/SD− group. Multiple linear regression analyses revealed a significant negative association between the severity of depressive symptoms and attention/working memory capacity (β = − .024, P = .024), accounting for 8.28% of the variations in this cognitive domain. All statistical analyses were adjusted by age, sex, and years of education. A logistic regression model had an accuracy of 72.4% in discriminating between the aMCI/SD+ and aMCI/SD− groups based on individual cognitive profiles over 6 domains. Our findings indicate that patients with aMCI with and without SD have distinct patterns of cognitive impairment. This finding may facilitate the diagnosis and treatment of SD in patients with aMCI.
A Protracted Sensitive Period Regulates the Development of Cross-Modal Sound–Shape Associations in Humans
Authors: Sourav Suddha , Kekunnaya Ramesh , Shareef Idris , Banerjee Seema , Bottari Davide , Röder Brigitte
Published: September 2019

Humans preferentially match arbitrary words containing higher- and lower-frequency phonemes to angular and smooth shapes, respectively. Here, we investigated the role of visual experience in the development of audiovisual and audiohaptic sound–shape associations (SSAs) using a unique set of five groups: individuals who had suffered a transient period of congenital blindness through congenital bilateral dense cataracts before undergoing cataract-reversal surgeries (CC group), individuals with a history of developmental cataracts (DC group), individuals with congenital permanent blindness (CB group), individuals with late permanent blindness (LB group), and controls with typical sight (TS group). Whereas the TS and LB groups showed highly robust SSAs, the CB, CC, and DC groups did not—in any of the modality combinations tested. These results provide evidence for a protracted sensitive period during which aberrant vision prevents SSA acquisition. Moreover, the finding of a systematic SSA in the LB group demonstrates that representations acquired during the sensitive period are resilient to loss despite dramatically changed experience.
From Rangdāri Tax to Rangrezi: Chromatic Landscape of the Post-colonial
Authors: Jha Sadan
Published: September 2019

Rangrez and Rangdār are two commonly used words in north India. ‘Rangrez’ is a painter/dyer, and in Sufi tradition is also a word for Allah. ‘Rangdāri’ is an illegal extortion tax, and the person who collects this tax is called the ‘Rangdār’. In all likelihood, ‘Rangdāri tax’ originates from the geo-political landscape of coal and mining regions of India (in districts which are now in the state of Jharkhand). The term is closely linked with the rise of mafia/gangsters in the region for usurping coal contracts and for effective/extra-legal management of coal workers from the mid-1940s and in the 1950s. The figure who collects this tax is called ‘Rangdār’. Both terms Rangrez and Rangd a-ri centre upon ‘rang’, which largely means colour across the South Asian milieu. Engaging with different terrains occupied by these terms, this article ventures into a less traversed domain of colours in the South Asian context. It uses this occasion to disentangle some of the knots present in the dark abyss of post-colonial political practices while looking back to the roots of the word ‘rang’ (colour). While tracking the historically changing meanings of the word ‘rang’, the article stumbles upon Sufi tradition and argues that this tradition has decisively structured the association of ‘rang’ with colour in South Asian context. Creatively mobilizing the darkness embedded in the word ‘Rangdāri’ tax, I extend my analytical frame to a larger question of addressing hierarchies which go into the making up of the post-colonial chromatic landscape. It is at this level, the figure of the ‘Rangrez’, shrouded in Sufi mystery, appears laden with a number of possibilities and creative tensions.
Asiasiga: a Samoan intervention to address the immediate mental health needs of Samoan communities after a tsunami
Authors: Tamasese Taimalieutu Kiwi , Parsons Tafaoimalo Loudeen , Waldegrave Charles , Sawrey Richard , Bush Allister
Published: September 2019

Objective:

To describe an Indigenous Samoan psychosocial intervention developed to address the mental health needs of affected communities in Samoa following a tsunami.

Method:

A partnership was established between Samoan therapists, Samoan Catholic pastoral workers and non-Samoan mental health clinicians, informed by Samoan concepts of self and wellbeing. The format developed for visits to significantly affected households was based on a Samoan cultural practice known as asiasiga and was carried out by pastoral workers, with daily group supervision and access to mental health professionals.

Results:

Household visits were offered to affected families in villages throughout southern and eastern Upolu and the island of Manono. There was a high degree of acceptance of the programme by Pulenu’u (village governance leaders) and family leaders and members.

Conclusions:

Mental health responses to the needs of Indigenous Pacific communities following a disaster need to be embedded in the values of those communities. The Samoan practice of asiasiga contributed to the high degree of acceptability of this programme. Partnerships with churches, schools and other local organisations are likely to enhance acceptability and participation. More research is required on Indigenous Pacific post-disaster mental health programmes.
The Transformative Professor: Adapting and Fostering Positive Change
Authors: Kovoor-Misra Sarah
Published: September 2019

Business school faculty can play a critical role in fostering resilience and change in their institutions. This article describes what it means to be a transformative professor and a catalyst for positive change. It suggests that this involves playing both leader and follower roles, such as builders, problem-solvers, and constructive disruptors; having a transformative mind-set; and utilizing multiple forms of intelligence.
Preemptive Dose Adjustment Effect on the Quality of Anticoagulation Management in Warfarin Patients With Drug Interactions: A Retrospective Cohort Study
Authors: Fahmi Amr Mohamed , Mohamed Adham , Elewa Hazem , Saad Mohamed Omar
Published: September 2019

One strategy to manage patients on warfarin starting an interacting drug is to increase the frequency of monitoring. Another strategy is to adjust warfarin dose around the time patient is started on an interacting medication, which is known as “preemptive warfarin dose adjustment.” The main objective of this study is to compare preemptive to nonpreemptive strategy and their impact on the quality of anticoagulation management. This is a retrospective cohort study performed at the pharmacist-managed anticoagulation clinic in a tertiary hospital in the State of Qatar. Over a 4-year period, 340 patients were evaluated, and 58 warfarin–drug interaction encounters were identified. Mean age of the patients was (57.7 ± 13.7), and 50% of them were females. Preemptive dose adjustment was used in 17 (29.3%) cases. Incidence of out-of-target international normalized ratio (INR) was statistically lower in the preemptive arm compared to the control group (41.2% [7/17] vs 69.2% [27/39], P = .048). Incidence of extreme out-of-target INR was numerically lower in the preemptive arm compared to the control but did not reach statistical significance (11.8% [2/17] vs 29.3% [12/41], P = .139). Change in frequency of INR monitoring was not different between the 2 groups. However, overall frequency of INR monitoring after onset/discontinuation of interacting medication increased compared to baseline (7 [9] vs 21 [16] days, P < .001). Preemptive strategy was shown in our study to decrease incidence of the out-of-target INR visits, although patients remained in need for close monitoring.
Comparison of signalment, clinical, laboratory and radiographic parameters in cats with feline asthma and chronic bronchitis
Authors: Grotheer Maike , Hirschberger Johannes , Hartmann Katrin , Castelletti Noemi , Schulz Bianka
Published: September 2019

Objectives

Feline asthma (FA) and feline chronic bronchitis (CB) are common respiratory conditions in cats, frequently referred to as ‘feline lower airway disease’. However, the aetiologies of both inflammatory airway diseases are probably different. Little is known about the differences in signalment, clinical signs, laboratory abnormalities and radiographic features between cats with these two airway diseases. The aim of the study was to investigate whether certain parameters can help in differentiating between both diseases, as distinguished by airway cytology.

Methods

Seventy-three cats with FA and 24 cats with CB were included in the retrospective study. Inclusion criteria were compatible clinical signs and a cytological evaluation of bronchoalveolar lavage fluid indicating either FA (eosinophilic inflammation) or CB (neutrophilic inflammation) without cytological or microbiological evidence of bacterial infection. Parameters of signalment, physical examination, haematology and thoracic radiographs of both disease groups were compared statistically ( P <0.05).

Results

The median age of cats with FA was 6 years, and was 7.5 years in cats with CB ( P = 0.640). The most commonly reported clinical signs in both groups were a cough (95% FA/96% CB; P = 1.000), pathological pulmonary auscultatory sounds (82% FA/79% CB; P = 0.766) and dyspnoea (73% FA/79% CB; P = 0.601). Abnormal radiographic lung patterns were detected in 94% of cats with FA and 91% with CB ( P = 0.629), respectively. Blood eosinophilia was significantly more common in cats with FA (40%) compared with CB (27%) ( P = 0.026).

Conclusions and relevance

The study indicates that a differentiation of FA and CB by means of signalment, a single clinical sign, and haematological and radiographic findings is not possible.
Smartphone-assisted technique in total hip arthroplasty can improve the precision of acetabular cup placement: a randomised controlled trial
Authors: Pongkunakorn Anuwat , Diewwattanawiwat Kittipong , Chatmaitri Swist
Published: September 2019

Background:

Malposition of the acetabular component mainly results from intraoperative pelvic motion and manual errors during cup placement. We investigated the outcomes of a device that uses a level indicator application of a smartphone to function as a pelvic tilt goniometer to assess intraoperative motion. The cup positions outside Lewinnek’s safe zone were compared between the smartphone-assisted technique and the conventional method that uses a mechanical alignment guide.

Methods:

A randomised controlled trial was conducted among 64 patients receiving primary cementless total hip arthroplasties (THAs) via a posterolateral approach from June 2015 to February 2017. Acetabular components were implanted either by conventional technique ( n = 32) or using smartphone technique ( n = 32). Inclination and anteversion angles were measured in supine pelvic radiographs.

Results:

The inclination angle in the smartphone group was not significantly different from the conventional group (41.2° ± 3.9° vs. 40.3° ± 7.9°, p = 0.567). The anteversion angle was also similar (19.3 ± 3.8° vs 19.1° ± 5.9°, p = 0.856). However, the standard deviation of the angle in the smartphone group was significantly lower for inclination ( p < 0.001) and anteversion ( p = 0.016). There were 3 outliers (9.4%) in the smartphone group, but 13 (40.6%) in the conventional group ( p = 0.008). The risk ratio was 0.23 (95% CI, 0.07–0.73). The risk difference was −0.31 (95% CI, –0.51– –0.11).

Conclusion:

The smartphone-assisted technique in THA improves the precision of cup placement and decreases the percentage of safe zone outliers. Thai Clinical Trials Registry (ID: TCTR20151123002).
Analysis of misaligned hydrodynamic porous journal bearings in the steady-state condition with micropolar lubricant
Authors: Baidya Ujjal , Das Sanjoy , Das Santanu
Published: September 2019

Impregnated porous bearings are used in different machines and other applications. In this work, an analytical work is investigated to evaluate the steady-state characteristics of such self-lubricated porous journal bearings in micropolar lubrication with misalignment. Bi-axial misalignments are considered, namely axial (along the vertical direction) and twisting (along the horizontal direction). Reynolds equation is modified to fit bearing misalignment, by incorporating the effects of micropolarity of the lubricant and porosity of the bush. Darcy’s equation that considers porosity and the misalignment Reynolds’s equation applicable for film region are numerically solved using finite difference method applying successive over-relaxation scheme employing appropriate boundary conditions to obtain the dimensionless fluid film pressure at steady state, which is used to get the steady-state characteristics e.g. load parameter, moment of misalignment, frictional force, and friction parameter.
The effect of three-lobed bearing shapes in floating-ring bearings on the nonlinear oscillations of high-speed rotors
Authors: Zhang Congcong , Wang Yongliang , Men Rixiu , He Hong , Chen Wei
Published: September 2019

Floating-ring bearings are widely used in automotive turbocharger machinery because of their robustness, low cost and their suitability under extreme rotation speeds. This type of bearings, however, can become a source of noise due to oil whirl/whip instability. The stabilizing effect of lobed bearing shape is known in the literature, which encourages the researchers to substitute plain cylindrical full floating bearings with lobed geometries in their outer and inner clearances to prevent the rotor-bearing system from developing oil whirl/whip instability or to reduce its amplitude of response when oil whirl/whip instability takes place. In this study, a novel concept of a floating-ring bearing with three-lobed clearances in its inner and outer films is modelled. In order to perform transient simulations, a very time-efficient approximate solution for the Reynolds equation to the geometry of three-lobed bearings is presented. Using the run-up simulation method, the nonlinear dynamic behaviours of a real turbocharger rotor supported by the novel concept of three-lobed floating-ring bearings are systematically investigated. The newly obtained results show that the sub-synchronous vibrations can be thoroughly suppressed with high preload factor at the cost of a moderate increase in the synchronous vibrations. Hence, the three-lobed floating-ring bearings design is an attractive alternative to plain cylindrical floating-ring bearings for automotive turbocharger applications.
Ankle–brachial index and incident heart failure with reduced versus preserved ejection fraction: The Multi-Ethnic Study of Atherosclerosis
Authors: Prasada Sameer , Shah Sanjiv J , Michos Erin D , Polak Joseph F , Greenland Philip
Published: September 2019

This study investigated the relationship between ankle–brachial index (ABI) and risk for heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). ABI has previously been associated with mortality, cardiovascular disease (CVD), and overall HF but the relationship between ABI and risk of HF stratified by EF has not been well characterized. We analyzed data from 6553 participants (53% female; mean age 62 ± 10 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of known clinical CVD/HF at baseline (2000–2002) and had baseline ABI measured. Participants were classified as low (≤ 0.90), borderline-low (0.91–1.00), normal (1.01–1.40), and high (> 1.40) ABI. Incident hospitalized HF was determined over a median follow-up of 14 years; we classified HF events ( n = 321) as HFrEF with EF < 50% ( n = 155, 54%) or HFpEF with EF ⩾ 50% ( n = 133, 46%). Low ABI was associated with incident HFrEF (hazard ratio (HR): 2.02, 95% CI 1.19–3.40, p = 0.01) and had no significant association with HFpEF (HR: 0.67, 95% CI 0.30–1.48, p = 0.32). Borderline-low and high ABI were not significantly associated with HFrEF or HFpEF. Cubic spline analyses showed association with both low and high ABI for HFrEF and high ABI for HFpEF. A 1 SD lower ABI (for ABI < 1.1) was associated with incident HFrEF in multivariable analysis (HR: 1.27, 95% CI 1.05–1.54) but was not significant after additionally adjusting for interim myocardial infarction (HR: 1.21, 95% CI 0.99–1.48). Low ABI was associated with higher risk for incident HFrEF but not HFpEF in persons free of known CVD. Future studies of a larger size are needed for high ABI analyses.
Head injury alert: A new level of trauma activation?
Authors: Ricaurte Daniel , Slack Daniel , Gilson Aaron , Nowicki Michael , Nelson Monika , Feinn Richard , Zdankiewicz Peter
Published: September 2019

Introduction

Trauma activation requires mobilization of significant resources to be available at short notice. In 2014, the American College of Surgeons Committee on Trauma issued its latest recommendations for care of the injured patient. Amongst trauma activation criteria, elderly patients that fell from any height on anticoagulation were included. We hypothesized that a reduced trauma team could preserve patient safety while reducing time and cost spent.

Method

A ‘Head Injury Alert’ was created to denote anti-coagulated patients with a GCS > 14 who fell from a height of <20 feet. An ED attending, surgical resident and one nurse evaluate the patient with the goal of obtaining a head CT within 30 min of presentation. Data were prospectively acquired from June 2017 to August 2018, which included age, anticoagulation, injury severity score (ISS), time-to-CT, outcomes, missed injuries, disposition and activations requiring escalation of care.

Results

Two hundred and seventy-seven head injury activations occurred; 55% of patients were female, while 45% were male. Average age was 78 years old. The most common anticoagulant was Warfarin (31%). 50% of patients were discharged, 47% were admitted, 2% died before disposition and 1% were transferred to a tertiary care center; 7% required admission to the ICU. The average time-to-CT was 25 min and ISS ranged from 0 to 26. Twenty-two patients (7%) presented with positive head CT. Of the five deaths, three patients had intracranial hemorrhage, one pneumonia present on admission and one cardiac arrest.

Conclusion

This level III evidence, prospective study suggests head injury alert can be safely applied as a new level of trauma activation at community hospitals. It helps identify a specific patient population and injury mechanism that can be safely triaged using limited resources. With this, community hospitals can maximize their resources and minimize cost, while maintaining patient safety.
The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China
Authors: Liu Hongpeng , Zhu Dawei , Cao Jing , Jiao Jing , Song Baoyun , Jin Jingfen , Liu Yilan , Wen Xianxiu , Cheng Shouzhen , Nicholas Stephen , Wu Xinjuan
Published: September 2019

Background:

Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke.

Aims:

To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke.

Methods:

A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals.

Results:

In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals.

Conclusions:

A structured and systematic SNIM benefited immobile stroke patients’ clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.
Eradication of Pseudomonas aeruginosa with inhaled colistin in adults with non-cystic fibrosis bronchiectasis
Authors: Blanco-Aparicio Marina , Saleta Canosa Jesús Luis , Valiño López Paz , Martín Egaña María Teresa , Vidal García Iria , Montero Martínez Carmen
Published: September 2019

The persistent isolation of Pseudomonas aeruginosa in the airways of non-cystic fibrosis bronchiectasis (NCFB) patients is associated with a worsening of the symptoms, increase of exacerbations, poor quality of life and functional impairment. The objective of this study was the analysis of the eradication rate of P. aeruginosa in the sputum of patients with NCFB treated with inhaled colistin and the effects of the treatment in the exacerbations. This was a prospective, cohort, study of 67 NCFB patients treated with inhaled colistin at the Hospital of A Coruña (Spain). We recorded dyspnoea, exacerbations, lung function and sputum cultures of P. aeruginosa in the patients. The mean age of the patients was 67.25 ± 14.6 years (59.7% male). The percentages of eradication of P. aeruginosa in sputum at 3, 6, 9 and 12 months were 61.2%, 50.7%, 43.3% and 40.3%, respectively. We observed a significant decrease in exacerbations after 1 year of colistin treatment (1.98 ± 3.62) versus the previous year (3.40 ± 4.21, p < 0.001). We conclude that treatment with inhaled colistin in patients with NCFB and P. aeruginosa in sputum can achieve high rates of eradication even in patients with several previous positive cultures, as well as a significant decrease of exacerbations and hospital admissions.
The Spectrinome: The Interactome of a Scaffold Protein Creating Nuclear and Cytoplasmic Connectivity and Function
Authors: Goodman Steven R. , Johnson Daniel , Youngentob Steven L. , Kakhniashvili David
Published: September 2019

We provide a review of Spectrin isoform function in the cytoplasm, the nucleus, the cell surface, and in intracellular signaling. We then discuss the importance of Spectrin’s E2/E3 chimeric ubiquitin conjugating and ligating activity in maintaining cellular homeostasis. Finally we present spectrin isoform subunit specific human diseases. We have created the Spectrinome, from the Human Proteome, Human Reactome and Human Atlas data and demonstrated how it can be a useful tool in visualizing and understanding spectrins myriad of cellular functions.

Impact statement

Spectrin was for the first 12 years after its discovery thought to be found only in erythrocytes. In 1981, Goodman and colleagues1found that spectrin-like molecules were ubiquitously found in non-erythroid cells leading to a great multitude of publications over the next thirty eight years. The discovery of multiple spectrin isoforms found associated with every cellular compartment, and representing 2-3% of cellular protein, has brought us to today’s understanding that spectrin is a scaffolding protein, with its own E2/E3 chimeric ubiquitin conjugating ligating activity that is involved in virtually every cellular function. We cover the history, localized functions of spectrin isoforms, human diseases caused by mutations, and provide the spectrinome: a useful tool for understanding the myriad of functions for one of the most important proteins in all eukaryotic cells.
Medium- and long-term outcomes for hand and wrist pyrocarbon implants
Authors: Bellemère Philippe
Published: September 2019

The article reviews the techniques and surgical outcomes of arthroplasties of the metacarpophalangeal, carpometacarpal and the wrist joints. In my patients, interposition pyrocarbon implants quickly achieve functional recovery and do not deteriorate time. Bony and articular tolerances are remarkable. These implants are a valid alternative to conventional arthroplasties, such as trapeziectomies, silicone implants and total joint replacements. Because of the implant’s small size, the surgery can be done through minimally invasive approaches especially for young and active patients. A technical key is to properly manage the bone surfaces of the joint and the peri-articular soft tissues to avoid early implant instability.
Insights into the role of cannabis in the management of inflammatory bowel disease
Authors: Picardo Sherman , Kaplan Gilaad G. , Sharkey Keith A. , Seow Cynthia H.
Published: September 2019

Over the last decade, interest in the therapeutic potential of cannabis and its constituents (e.g. cannabidiol) in the management of inflammatory bowel diseases (IBD) has escalated. Cannabis has been increasingly approved for a variety of medical conditions in several jurisdictions around the world. In animal models, cannabinoids have been shown to improve intestinal inflammation in experimental models of IBD through their interaction with the endocannabinoid system. However, the few randomized controlled trials of cannabis or cannabidiol in patients with IBD have not demonstrated efficacy in modulating inflammatory disease activity. Cannabis may be effective in the symptomatic management of IBD. Given the increasing utilization and cultural acceptance of cannabis, physicians need to be aware of its safety and efficacy in order to better counsel patients. The aim of this review is to provide an overview of the role of cannabis in the management of patients with IBD.
A Marxist critique of Sean Walton’s defence of the Critical Race Theory concept of ‘White supremacy’ as explaining all forms of racism, and some comments on Critical Race Theory, Black Radical and socialist futures
Authors: Cole Mike
Published: September 2019

In the context of the ongoing debate between Critical Race Theorists and (neo-) Marxists over the Critical Race Theory concept of ‘White supremacy’, this paper extends the analysis to Black Radicalism in an attempt to further develop the neo-Marxist critique of ‘White supremacy’ deployed as a general descriptor of racism in Western societies. Specifically, the case is made that the neo-Marxist concepts of institutional racism and racialisation are better placed to understand forms of racism such as those beyond the Black/White binary, namely racism that impacts on non-Black people of colour, non-colour-coded racism and hybridist racism. Finally, futures as articulated by Critical Race Theory, Black Radicalism and neo-Marxism are addressed.
Containing a measles outbreak in Minnesota, 2017: methods and challenges
Authors: Banerjee E , Griffith J , Kenyon C , Christianson B , Strain A , Martin K , McMahon M , Bagstad E , Laine E , Hardy K , Grilli G , Walters J , Dunn D , Roddy M , Ehresmann K
Published: September 2019

Aims:

We report on a measles outbreak largely occurring in Minnesota’s under-vaccinated Somali community in the spring of 2017. The outbreak was already into its third generation when the first two cases were confirmed, and rapid public health actions were needed. The aim of our response was to quickly end transmission and contain the outbreak.

Methods:

The state public health department performed laboratory testing on suspect cases and activated an Incident Command staffed by subject matter experts that was operational within 2 h of case confirmation. Epidemiologic interviews identified exposures in settings where risk of transmission was high, that is, healthcare, childcare, and school settings. Vaccination status of exposed persons was assessed, and postexposure prophylaxis (PEP) was offered, if applicable. Exposed persons who did not receive PEP were excluded from childcare centers or schools for 21 days. An accelerated statewide measles, mumps, and rubella (MMR) recommendation was made for Somali Minnesota children and children in affected outbreak counties. Partnerships with the Somali Minnesota community were deepened, building off outreach work done with the community since 2008.

Results:

Public health identified 75 measles cases from 30 March to 25 August 2017: 43% were female, 81% Somali Minnesotan, 91% unvaccinated, and 28% hospitalized. The median age of cases was 2 years (range: 3 months–57 years). Most transmission (78%) occurred in childcare centers and households. A secondary attack rate of 91% was calculated for unvaccinated household contacts. Over 51,000 doses of MMR were administered during the outbreak above expected baseline. At least 8490 individuals were exposed to measles; 155 individuals received PEP; and over 500 persons were excluded from childcare and school. State and key public health partners spent an estimated $2.3 million on response.

Conclusion:

This outbreak demonstrates the necessity of immediate, targeted disease control actions and strong public health, healthcare, and community partnerships to end a measles outbreak.
Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report
Authors: Probst Daniel T. , Mackinnon Susan E. , Prather Heidi
Published: September 2019

An elite high school American football athlete sustained a traumatic, isolated, axillary nerve injury. Axillary nerve injuries are uncommon, but serious injuries in American football. With the advent of nerve transfers and grafts, these injuries, if diagnosed in a timely manner, are treatable. This case report discusses the multidisciplinary approach necessary for the diagnosis and treatment of an elite high school American football player who presented with marked deltoid atrophy. The athlete’s injury was diagnosed via electrodiagnostic testing and he underwent a medial triceps nerve to axillary nerve transfer. After appropriate postsurgical therapy, the athlete was able to return to American football the subsequent season and continue performing at an elite level. This case report reviews the evaluation and modern treatment for axillary nerve injuries in the athlete, including nerve transfers, nerve grafts, and return to play.
Microwave Ablation for the Removal of Benign Lesion of Nasal Cavity: “How I Do It”
Authors: Lou Zheng-cai
Published: September 2019

Background

Isolated benign lesions of the nasal cavity are commonly seen in the rhinology clinic; their treatment using various therapies has been explored in several studies.

Methods

In this retrospective study, isolated lesions of the nasal cavity were removed from 47 patients using microwave ablation (MWA) with a 2450-MHz cooled MWA antenna and sent for histological examination.

Results

The most commonly involved site was the nasal septum (n = 21, 44.7%), followed by the inferior turbinate (n = 12, 25.5%), bulla ethmoidalis (n = 9, 19.1%), and uncinate process (n = 5, 10.6%). The most common pathology was hemangioma (n = 36, 76.6%), followed by nasal polyp (n = 9, 19.1%) and squamous papilloma (n = 2, 4.3%). All lesions were removed endoscopically using MWA in patients administered local anesthesia. The total duration of ablation was 5 to 10 minutes, with an average duration of 7.3 ± 2.6 minutes. Follow-up at 6 months revealed no severe complications, including no cases of recurrent epistaxis, septal perforation, or synechiae of the nasal cavity.

Conclusions

The advantages of MWA are its short ablation time and minimal complications. This was demonstrated in our study in which a single session of MWA was sufficient to excise the isolated lesion while providing hemostasis. Most of the patients well tolerated the procedure, which could be performed using local anesthesia in the outpatient setting.
Medical lessons from a historical case: The disappearance of King Charles IV
Authors: Sharma Aarti Rani
Published: September 2019

Traumatic injury to the brain and its vessels is a major part of medical practice across the world. Its management however has long historical origins, but those beginnings can still teach clinical practitioners about the basic care of an injured patient. We present a little known historical medical case that to this day provides an example of best practice management resulting in successful clinical outcome. Charles IV (1316–1378) was Holy Roman Emperor between 1347 and 1378. During his reign, he disappeared for four months and returned a disfigured hunchback. There has been considerable controversy as to the cause of both his physical change and disappearance. We propose the most likely cause is from an unfortunate consequence of his love of jousting. Despite the damage and management of the traumatic injury endured by Charles IV occurring over 600 years ago, there are still lessons of his clinical management relevant to this day.
Transvaginal uterine evisceration during labor in a Bengal queen
Authors: Freire Mila , Diaw Mouhamadou
Published: September 2019

Case summary

A 2.5-year-old Bengal queen was admitted with a 12-h history of a mass protruding from the vulva during labor. At that time, three healthy kittens had already been delivered. Physical examination identified the mass as a portion of the uterus that was eviscerated without eversion of the mucosa. Exploratory laparotomy revealed a vaginal vault rupture with a large portion of the uterus herniated through the tear and eviscerated through the vulva. Ovariohysterectomy was performed, and a dead fetus was removed with the uterus. Reconstruction of the vaginal rupture required careful dissection and urethral catheterization. The queen recovered without complications.

Relevance and novel information

Uterine evisceration through a vaginal tear is a very rare condition that sometimes is erroneously referred to as ‘prolapse’. Uterine prolapse and uterine evisceration may have similar presenting signs; however, proper identification and surgical correction is key when the uterus is eviscerated. This case highlights the importance of differentiating these two conditions and of rapid identification and surgical intervention for successful patient survival.