bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate reaction to ibrutinib amenable to oral desensitization
Authors: Phadke Neelam A , Luk Samantha O , Hochberg Ephraim P , Banerji Aleena
Published: April 2021

Introduction

Although up to half of patients receiving chemotherapeutic agents develop hypersensitivity reactions to the same, desensitization protocols can induce temporary tolerance to allow patients to continue to receive first-line treatment. Approximately 25% of patients develop cutaneous hypersensitivity reactions to ibrutinib, but there are no published management guidelines.

Case report

We describe the case of a 71-year-old woman with chronic lymphocytic leukemia who developed a delayed maculopapular rash with lip tingling and swelling following ibrutinib therapy.

Management and outcome

We performed a novel 11-step desensitization procedure to ibrutinib allowing us to successfully induce tolerance against IgE-mediated symptoms in this patient.

Discussion

As indications for ibrutinib use expand and more patients present with IgE-mediated symptoms, we expect that this protocol will provide benefit for many such patients.
A possible mechanism of hyperlipidemia in a patient with metastatic non-small cell lung cancer on lorlatinib therapy
Authors: McGee Katherine , Stone Neil J , Wadhwani Shikha , Kanwar Yashpal S , Villaflor Victoria , Akhter Nausheen
Published: April 2021

Introduction

We report the case of a woman who developed hyperlipidemia on lorlatinib therapy found to have minimal change disease. We review therapies for cancer known to alter the lipid profile, in addition to reviewing secondary hyperlipidemia workup. We also propose a mechanism for lorlatinib-induced hyperlipidemia.

Case report

A 63 year old woman with non-small cell lung adenocarcinoma on lorlatinib therapy develops marked hyperlipidemia. Management & outcome: A secondary hyperlipidemia workup is performed which reveals nephrotic range proteinuria. Minimal change disease is found on renal biopsy. The hyperlipidemia was initially responsive to statin therapy, then required addition of ezetimibe.

Discussion

This is a case of hyperlipidemia in a patient on lorlatinib. The case highlights that therapies for lung cancer and other malignancies have the potential to alter the lipid profile. We propose minimal change disease as a possible mechanism for lorlatinib-induced dyslipidemia. Additionally, we discuss the crucial aspects of secondary hyperlipidemia workup.
Prevalence of Psychiatric Diagnoses and Psychiatric Consultation Service Utilization on Inpatient Medical Units
Authors: Reis Bianca , Tsai Jenny Hsin-Chun
Published: April 2021

OBJECTIVE

This practice improvement project sought to determine the prevalence of psychiatric diagnoses among patients admitted to a community hospital’s inpatient medical units and which diagnoses were serviced by the hospital’s psychiatric consultation service.

METHOD

Electronic medical record data on adult patients of five medical units admitted with a psychiatric condition between October 1, 2019, and December 31, 2019, were used. Psychiatric ICD-10 ( International Classification of Diseases, 10th Revision) codes and diagnosis names extracted were categorized into seven major diagnostic groups. A total of 687 adult patients with 82 psychiatric ICD-10 codes were analyzed using descriptive statistics.

RESULTS

Substance-related and addictive disorders were the most prevalent psychiatric diagnoses. Ninety-six percent ( n = 658) of patients residing on medical floors with psychiatric disorders were hospitalized for a principal medical problem. Seventy-three cases received psychiatric consultations during their stay. Sixty percent ( n = 44) of those cases had psychiatric disorders from two or more diagnostic categories.

CONCLUSIONS

Multidisciplinary, team-based health care delivery models that include a psychiatric nurse can provide an effective approach to treat patients in community hospitals with multiple psychiatric and medical comorbidities. Hospitals could take a significant role in providing substance use disorder treatment and equipping medical nurses with training to competently care for patients with psychiatric disorders on medical units. Further research into the prevalence and impact of patients with co-occurring and multiple psychiatric diagnoses in community hospitals is needed to implement effective health care delivery models and provide appropriate treatment options in the community.
High body weight-related retinal vasculopathy in children with obesity
Authors: Dereli Can Gamze , Kara Özlem , Can Mehmet Erol
Published: April 2021

Purpose:

To investigate the foveal avascular zone (FAZ) and the microvascular alterations in both macula and peripapillary region in obese children.

Methods:

We included a total of 222 eyes of 111 children (54 obese children and 57 healthy subjects). Capillary vessel density (VD) of superficial (SCP) and deep (DCP) retinal capillary plexuses were measured in macular slabs. Peripapillary region was also evaluated. The FAZ parameters were measured based on the whole retinal slab. A commercial optical coherence tomography-angiography system was used.

Results:

The mean ages were 13.33 ± 2.55 years (range, 8–17) and 13.41 ± 2.90 years (range, 7–18) in patients with obesity and healthy controls, respectively ( p = 0.84). The mean area of the FAZ were 0.278 ± 0.10 mm2 and 0.272 ± 0.11 mm2 in children with obesity and in control participants, respectively ( p = 0.68). There were significant increases in the superior region of the parafoveal VD of SCP ( p = 0.008 for superior hemisphere and p = 0.003 for superior quadrant). There was no significant difference in any measure of the macular DCP and peripapillary region ( p > 0.05, for all).

Conclusion:

Increased vascular density measurements were found in the superior part of the parafoveal region of SCP in children with obesity. The results of the study should be taken into consideration during the course of the disease to define whole systemic response to obesity in childhood and will be of interest for pediatrician’s clinical practice.
Influence of various types of clays on velocity dependence of friction composites
Authors: Saha Debarghya , Satapathy Bhabani K
Published: April 2021

The stick–slip phenomena of various types (halloysite, montmorillonite and wollastonite) of clay-based composite friction materials were evaluated in terms of their velocity-dependent friction response. Scanning electron microscopy of the contact patches suggested breakage of contact plateaus in the composites with halloysite, whereas relatively small contact patches were developed in montmorillonite-based friction composites. The presence of relatively harder ingredients such as magnesium oxide and iron particles on the worn surface have contributed to the stick–slip phenomenon. The presence of wollastonite in the composites leads to the ploughing effect during sliding. The intensity of creep groan remained controlled by the shear strength of the interfacial junction involving asperity contact/welding whereas dynamic groan remains predominated by the stiffness of the composites.
High school students as researchers about their school: exploring its potential for choices and skills
Authors: Torres Ana Cristina , Mouraz Ana
Published: April 2021

This paper introduces a partnership between researchers in Education Sciences and high school students and discusses the students’ perceptions of the effects of taking on the role of researchers in Education Sciences. These partnerships were established to develop a project in which high school students researched their school’s everyday life in collaboration with academic researchers. The partners are introduced, as well as the partnership and the steps for supporting the student researchers in developing their projects. Drawing on student voice literature, a qualitative evaluation of the students’ products and perspectives regarding their experiences as researchers pointed to the potential of these partnerships for the students’ engagement in discussions about educational trajectories and pathway choices with their peers, teachers and researchers. Moreover, the students’ perceptions indicate an improvement in their inquiry skills and valuing of research in Education Sciences. This paper adds to the existing literature on student voice in schools, by discussing processes to engage students as researchers of school issues and by highlighting the importance of student voice to early awareness and recognition of research in Education Sciences.
Caregiver experiences during their child’s acute medical hospitalization for a mental health crisis
Authors: Bowden Cadence F , Worsley Diana , Pettit Amy R , Doupnik Stephanie K
Published: April 2021

Adolescents in the United States are increasingly seeking treatment for mental health crises in emergency departments and general medical hospitals. Medical needs are often addressed quickly, yet youth remain hospitalized because further psychiatric treatment is not immediately available. We sought to better understand the experiences of caregivers whose children are “boarding” in a medical hospital while awaiting inpatient psychiatric treatment. We conducted semi-structured interviews with caregivers who were recruited, enrolled, and interviewed during their child’s hospital stay. Interviews were audio-recorded, transcribed verbatim, and thematic analysis was facilitated by NVivo 12. Fourteen caregivers enrolled in the study. Themes that emerged included positive hospital and provider experiences; frustration with the medical and mental health care systems; information needs; fears about inpatient psychiatric units; practical challenges and emotional needs; difficulties with caregiver–child communication; difficulties with clinician–caregiver communication; and need for self-care and support. While many caregivers felt positively about the overall experience at the hospital, they also wished for more information about their child’s treatment plan and future, as well as social support, emotional comfort for themselves, and self-care skills and resources. Their experiences illuminate ways in which clinical practice can ameliorate concerns and alleviate stress of caregivers related to their child’s mental health crisis.
Feeling rules and sexualities: Postfeminist men in Swedish television
Authors: Goedecke Klara
Published: April 2021

Postfeminist cultural representations have shown men as bumbling anti-heroes, and as sensitive and supportive of feminism. Research on postfeminist men has mainly been based on UK and US cultural representations, while other contexts have received little attention. In this article, I deepen the understanding of postfeminist portrayals of men by focussing on Sweden and on formulations of men’s emotionality and sexuality. I also develop the idea of postfeminist feeling rules by relating it to men. The material of the study is Boys, a 2015 Swedish TV series about two young feminist men. The article discusses several feminist-inspired discourses present in the series, including narratives of personal development, men’s emotions as in themselves progressive and a (semi)problematization of heterosexuality, all of which reduce gender politics to concern mainly the emotional lives of men. The postfeminist feeling rules formulated in the series privilege reflexiveness and, ostensibly, ‘letting out’ feelings and sexual desires. However, I argue that the series suggests a careful curating of emotional displays, excluding, for instance, aggressiveness. The article demonstrates the importance of critically scrutinizing mediated productions of postfeminist masculine positions in different contexts, and deepens the understanding of how postfeminism addresses and produces masculine subjects.
Ingroup norms shape understanding of outgroup prosocial behaviors
Authors: Borinca Islam , Andrighetto Luca , Valsecchi Giulia , Berent Jacques
Published: April 2021

This research investigated whether ingroup norm moderates the effect of positive or prosocial interactions on the understanding of intergroup prosocial behaviors. Among four experiments in three different cultural samples (U.S. Americans, Kosovan Serbs, and Kosovan Albanians; N = 808), results showed that participants attributed fewer prosocial motives and reported less willingness to accept help when the helper was an outgroup than an ingroup member. However, these effects were weaker or nonsignificant in the tolerant norm condition, as compared to the intolerant norm or control conditions. In addition, participants were more willing to interact with the outgroup (vs. ingroup) helper in the tolerant norm condition, as compared to the intolerant norm or control conditions. Finally, normative expectations, the attribution of prosocial motives to the helper, and the anticipated quality of the interaction with the helper sequentially explained the observed effects. The theoretical and practical implications of these results for intergroup help and intergroup contact literature are discussed.
The Mississippi model: Dangers of prison reform in the context of fiscal austerity
Authors: Cate Sarah D
Published: April 2021

Over the past decade, the political landscape in the realm of criminal justice policy has shifted towards broad support for prison reform. Recent calls for defunding as a solution to the problems of mass incarceration are gaining traction from a diverse group of political actors. The case of prison reform in Mississippi provides important insight on the effects of a reform model that prioritizes cutting costs. This article examines the consequences of pursuing penal reforms in the broader context of fiscal austerity. First, the case of Mississippi shows how local context shapes austerity driven reforms in ways that make them particularly unsuited to address mass incarceration. The development of the carceral state in Mississippi created labor and public-sector dependencies on the correctional system and overcoming these interests will require public investments. Second, the article shows how austerity driven reforms fail to adequately staff and support public sector correctional workers which has rendered prisons in Mississippi even more dangerous and deadly. The Mississippi case indicates that until there are more significant drops in incarceration rates and robust alternatives to the functions of the carceral state, reductions in correctional budgets do not signal downsizing, but rather mass incarceration on the cheap.
Branding a city through journalism in China: The example of Shenzhen
Authors: Xu Deya , Shen Jiao , Xu Jian
Published: April 2021

As a means of communication, city branding can influence public opinion and change the general public’s perceived image of a city. In China, news producers may not regard their activities as city branding. Since they have to follow the view and plan of the Central Committee of the Chinese Communist Party (CCP) in terms of reporting on certain aspects of cities, news media, especially official media, is perform a Chinese way of city branding. This article presents a critical discourse analysis of how the People’s Daily, as the official newspaper of the Chinese Communist Party (CCP), portrays Shenzhen, as the tone and depictions used in this newspaper when describing this city are arguably part of a Chinese approach to city branding through journalism. Through an analysis of 40 years of news coverage regarding Shenzhen in the People’s Daily, this study draws conclusions regarding the features of city branding through journalism in China and how this approach represents a new form of city branding.
Micro-atmospheres of place: light and dark on a modernist housing scheme
Authors: May Vanessa , Lewis Camilla
Published: April 2021

This paper examines the role that light and dark play in how residents of Claremont Court, a modernist housing scheme in Edinburgh, Scotland, form a sense of atmosphere of place. Our findings show that the design of Claremont Court affords particular experiences of light and dark and of related warmth and cold that are meaningful to how residents experience and feel about the Court. While atmospheres tend to be conceptualised as spatially and temporally singular, our analytical focus on light and dark allows us to conceptualise the atmosphere of Claremont Court as made up of simultaneously held but distinct micro-atmospheres, which interact, overlap and even contradict each other. Furthermore, speaking to residents about their home environment revealed the role that memory plays in how people perceive atmosphere. Drawing from Mason’s concept of socio-atmospherics, we theorise atmospheres not as spatially contained, but as trajectories through space, where the experience of atmosphere is one of intertwining (and at times contradictory) atmospheres past and present.
Vitamin D Levels and the Risk of Posttransplant Diabetes Mellitus After Kidney Transplantation
Authors: Quach Kevin , Abdelmasih Monica , Chen Pei Xuan , Li Yanhong , Famure Olusegun , Nash Michelle , Prasad Ramesh , Perkins Bruce A. , Yip Paul M. , Kim S. Joseph
Published: April 2021

Introduction:

Given the burden of posttransplant diabetes mellitus and the high prevalence of low vitamin D levels in kidney transplant recipients, it is reasonable to consider vitamin D as a novel and potentially modifiable risk factor in this patient population.

Research question:

To determine the association between 25- hydroxyvitamin D (25(OH)D) level and posttransplant diabetes among kidney transplant recipients. Design: In a multi-center cohort study of 442 patients who received a kidney transplant between January 1, 2005 and December 31, 2010, serum samples within one-year before transplant were analyzed for 25(OH)D levels. The association between 25(OH)D and posttransplant diabetes were examined in Cox proportional hazard models.

Results:

The median 25(OH)D level was 66 nmol/L. The cumulative probability of diabetes at 12-months by quartiles of 25(OH)D (< 42, 42 to 64.9, 65 to 94.9, and > 95 nmol/L) were 23.4%, 26.9%, 21.4%, and 15.6%, respectively. Compared to the highest 25(OH)D quartile, hazard ratios (95% CI) for the risk were 1.85 (1.03, 3.32), 2.01 (1.12, 3.60), 1.77 (0.96, 3.25) across the first to third quartiles, respectively. The associations were accentuated in a model restricted to patients on tacrolimus. When modeled as a continuous variable, 25(OH)D levels were significantly associated with a higher risk of diabetes (hazard ratio 1.06, 95% CI: 1.01, 1.13 per 10 nmol/L decrease).

Discussion:

Serum 25(OH)D was an independent predictor of posttransplant diabetes in kidney transplant recipients. These results may inform the design of trials using vitamin D to reduce the risk in kidney transplant recipients.
Sex differences in prenatal programming of hypertension by dexamethasone
Authors: Alhamoud Issa , Legan Susan K , Gattineni Jyothsna , Baum Michel
Published: April 2021

Prenatal dexamethasone has been shown to increase blood pressure in male offspring but the mechanism for the increase in blood pressure is unclear. The present study examined if prenatal programming by maternal injection of dexamethasone on days 15 and 16 of gestation affected the blood pressure comparably in female and male offspring. Our hypothesis was that males would be affected by prenatal dexamethasone to a greater extent than females and that either an increase in renal tubular transporter abundance or an increase in renin or aldosterone system would be associated with hypertension with prenatal programming. Prenatal dexamethasone increased blood pressure at two months and six months of age and resulted in proteinuria and albuminuria at six months in male but not female rat offspring. There was no effect of prenatal dexamethasone on blood pressure and proteinuria at one month in male and in female offspring. While prenatal dexamethasone increased male renal thick ascending limb sodium potassium two chloride cotransporter protein abundance at two months, prenatal dexamethasone on days 15 and 16 of gestation did not affect transporter abundance in males at other ages, nor did it affect proximal tubule sodium/hydrogen exchanger or distal convoluted tubule sodium chloride cotransporter protein abundance at any age. There was no difference in systemic renin or aldosterone in the prenatal dexamethasone group compared to same sex controls. In conclusion, male but not female offspring have an increase in blood pressure and urinary protein excretion with prenatal dexamethasone. The increase in blood pressure with prenatal programming was not associated with a consistent increase in renal tubular transporter protein abundance, nor plasma renin activity and serum aldosterone.
Strategies for intra-amniotic administration of fetal therapy in a rabbit model of intrauterine growth restriction
Authors: Kinoshita Mari , Crispi Fàtima , Loreiro Carla , Gratacós Eduard , Illa Míriam , Zamora Mònica
Published: April 2021

Intrauterine growth restriction affects up to 10% of all pregnancies, leading to fetal programming with detrimental consequences for lifelong health. However, no therapeutic strategies have so far been effective to ameliorate these consequences. Our previous study has demonstrated that a single dose of nutrients administered into the amniotic cavity, bypassing the often dysfunctional placenta via intra-amniotic administration, improved survival at birth but not birthweight in an intrauterine growth restriction rabbit model. The aim of this study was to further develop an effective strategy for intra-amniotic fetal therapy in an animal model. Intrauterine growth restriction was induced by selective ligation of uteroplacental vessels on one uterine horn of pregnant rabbits at gestational day 25, and fetuses were delivered by cesarean section on GD30. During the five days of intrauterine growth restriction development, three different methods of intra-amniotic administration were used: continuous intra-amniotic infusion by osmotic pump, multiple intra-amniotic injections, and single fetal intraperitoneal injection. Technical feasibility, capability to systematically reach the fetus, and survival and birthweight of the derived offspring were evaluated for each technique. Continuous intra-amniotic infusion by osmotic pump was not feasible owing to the high occurrence of catheter displacement and amnion rupture, while methods using two intra-amniotic injections and one fetal intraperitoneal injection were technically feasible but compromised fetal survival. Taking into account all the numerous factors affecting intra-amniotic fetal therapy in the intrauterine growth restriction rabbit model, we conclude that an optimal therapeutic strategy with low technical failure and positive fetal impact on both survival and birthweight still needs to be found.
Maximizing network throughput by cooperative reinforcement learning in clustered solar-powered wireless sensor networks
Authors: Ge Yujia , Nan Yurong , Guo Xianhai
Published: April 2021

Power management in wireless sensor networks is very important due to the limited energy of batteries. Sensor nodes with harvesters can extract energy from environmental sources as supplemental energy to break this limitation. In a clustered solar-powered sensor network where nodes in the network are grouped into clusters, data collected by cluster members are sent to their cluster head and finally transmitted to the base station. The goal of the whole network is to maintain an energy neutrality state and to maximize the effective data throughput of the network. This article proposes an adaptive power manager based on cooperative reinforcement learning methods for the solar-powered wireless sensor networks to keep harvested energy more balanced among the whole clustered network. The cooperative strategy of Q-learning and SARSA( λ) is applied in this multi-agent environment based on the node residual energy, the predicted harvested energy for the next time slot, and cluster head energy information. The node takes action accordingly to adjust its operating duty cycle. Experiments show that cooperative reinforcement learning methods can achieve the overall goal of maximizing network throughput and cooperative approaches outperform tuned static and non-cooperative approaches in clustered wireless sensor network applications. Experiments also show that the approach is effective in response to changes in the environment, changes in its parameters, and application-level quality of service requirements.
Chemical Ablation for Treating Anal Fistulas without Surgical Intervention: Long-Term Results
Authors: Attaallah Wafi , Uprak Tevfik K. , Kara Burak , Sen Aliosman , Tuney Davut , Yegen Cumhur
Published: April 2021

Purposes. This study aimed to evaluate long-term outcomes after the application of a corrosive chemical agent for ablation of epithelial tissue as a non-surgical treatment of anal fistulas. Methods. Adult patients with symptomatic perianal fistula were prospectively included in the study. The fistula tract was irrigated with a 5% silver nitrate solution. The primary outcome measured in this study was the rate of clinical healing after long-term follow-up. Factors that may affect healing were also analysed. Results. A total of 186 patients with anal fistula were analysed. After irrigation with silver nitrate, 82 (44%) patients had complete clinical healing during a median follow-up time of 50 (7–64) months. Patients with intermittent discharge had a significantly higher rate of complete clinical healing than those with continuous discharge ( P < .04). Fistulas without abscesses or secondary tracts had a significantly higher rate of complete clinical healing than the other types ( P = .007). Conclusion. Chemical ablation of the epithelium of the anal fistula yields promising long-term outcomes in the management of anal fistulas without surgical intervention.
“I Can be Who I Am When I Play Tekken 7”: E-sports Women Participants from the Islamic Republic of Pakistan
Authors: Hussain Umer , Yu Bo , Cunningham George B. , Bennett Gregg
Published: April 2021

Extant research on e-sports has focused on the growth and value of the phenomenon, fandom, and participant experiences. However, there is a paucity of e-sports scholarship detailing women’s experiences from marginalized communities living in various conservative Muslim countries. This shortage of literature remains despite different radical Islamic groups’ consistent demand for banning several online video games and the Muslim youth’s resistance to these calls. This study aimed to understand the motives and lived experiences of Muslim women e-sports participants from Gilgit-Baltistan, Pakistan. The authors collected data via observations of online video games and in-depth interviews. The study participants revealed that they use e-sports as a vehicle for an oppositional agency and personal freedom from the patriarchal system. The findings also suggest that participants are facing systematic marginalization and grave intrusion of post-colonization. The study contributes to the limited scholarship concerning Indian subcontinent Muslim women’s e-sports participation.
“I’m Wise to the Game”: How Inner-City Women Experience and Navigate Police Raids
Authors: Greene Carolyn , Urbanik Marta-Marika , Yankey Manzah-Kyentoh
Published: April 2021

Despite the plethora of research on inner-city policing, little is known about how women experience and make sense of involuntary police encounters. Based upon interviews with women who had their homes raided by police in Toronto’s inner-city, this paper explores how these marginalized women perceive, navigate, and resist normative gender expectations in their interactions with police officers during raids. Our findings demonstrate that women believed officers treated them according to gendered stereotypes, and in response, women strategically deployed gendered presentations in an effort to resist, negotiate, and temper anticipated raid related harms. However, participants’ positionality constrained their efforts.
Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison
Authors: Konigsberg Matthew W. , Tedesco Liana J. , Mueller John D. , Ball Jacob R. , Wu Chia H. , Kadiyala R. Kumar , Strauch Robert J. , Rosenwasser Melvin P.
Published: April 2021

Background

This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options.

Methods

We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up.

Results

The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence ( P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups.

Conclusions

Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.
What Is the Infection Rate of Carpal Tunnel Syndrome and Trigger Finger Release Performed Under Wide-Awake Anesthesia?
Authors: Rellán Ignacio , Bronenberg Victorica Pedro , Kohan Fortuna Figueira Surya V. , Donndorff Agustín G. , De Carli Pablo , Boretto Jorge G.
Published: April 2021

Background

High infection rates have been reported in hand procedures using the wide-awake local anesthesia no tourniquet (WALANT) method, causing some to question the validity of this approach. However, little evidence exists surrounding the direct use of WALANT compared with monitored anesthetic care (MAC). This study was conducted to directly compare the postoperative infection rates of carpal tunnel syndrome (CTS) and trigger finger (TF) release surgeries performed under WALANT and MAC.

Methods

A retrospective study comparing postoperative infection rates between patients undergoing CTS and TR releases was conducted. Our primary outcome measure was postoperative infection. Our secondary outcome was postoperative complications. Comparative statistics were used to compare means of infection between the groups.

Results

A total of 526 patients underwent CTS release (255 with WALANT and 271 with MAC), and 129 patients underwent TF release (64 with WALANT and 65 with MAC). Patients undergoing WALANT and MAC were statistically comparable in terms of sex, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. In patients undergoing CTS release, there were no infections with WALANT and 6 infections (2.2%) with MAC. In patients undergoing TF release, there were no infections in either group. There were similar rates of complications in patients undergoing WALANT and MAC for CTS and TF releases.

Conclusion

There was no increased risk of infection with WALANT compared with MAC in CTS or TR surgeries. These surgeries can be safely conducted with lidocaine and epinephrine without a concern for increased risk of infections or complications.
Beyond the Cubital Tunnel: Use of Adjunctive Procedures in the Management of Cubital Tunnel Syndrome
Authors: Evans Adam , Padovano William M. , Patterson J. Megan M. , Wood Matthew D. , Fongsri Warangkana , Kennedy Carie R. , Mackinnon Susan E.
Published: April 2021

Background:

Our management of cubital tunnel syndrome has expanded to involve multiple adjunctive procedures, including supercharged end-to-side anterior interosseous to ulnar nerve transfer, cross-palm nerve grafts from the median to ulnar nerve, and profundus tenodesis. We also perform intraoperative brief electrical stimulation in patients with severe disease. The aims of this study were to evaluate the impact of adjunctive procedures and electrical stimulation on patient outcomes.

Methods:

We performed a retrospective review of 136 patients with cubital tunnel syndrome who underwent operative management from 2013 to 2018. A total of 38 patients underwent adjunctive procedure(s), and 33 received electrical stimulation. A historical cohort of patients who underwent cubital tunnel surgery from 2009 to 2011 (n = 87) was used to evaluate the impact of adjunctive procedures. Study outcomes were postoperative improvements in Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, pinch strength, and patient-reported pain and quality of life.

Results:

In propensity score–matched samples, patients who underwent adjunctive procedures had an 11.3-point greater improvement in DASH scores than their matched controls ( P = .0342). In addition, patients who received electrical stimulation had significantly improved DASH scores relative to baseline (11.7-point improvement, P < .0001), whereas their control group did not. However, when compared between treatment arms, there were no significant differences for any study outcome.

Conclusions:

Patients who underwent adjunctive procedures experienced greater improvement in postoperative DASH scores than their matched pairs. Additional studies are needed to evaluate the effects of brief electrical stimulation in compression neuropathy.
Adverse Childhood Experiences as “Upstream” Determinants of Lifestyle-Related Chronic Disease: A Scoping Perspective
Authors: Egger Garry , Binns Andrew , Morgan Bob , Stevens John
Published: April 2021

We have previously proposed a list of determinants (causes) of modern lifestyle-related chronic disorders, which provides a structure for the emerging discipline of lifestyle medicine. This consists of lifestyle factors with a common immune biomarker ( metaflammation) that interact in a systems fashion linked with chronic disease outcomes. We considered this to be a work in progress and later added 3 psychosocial determinants into the causal mix: meaninglessness, alienation, and loss of culture and identity (MAL). Here, we propose adverse childhood experiences (ACEs) as deeper, or even more distal, disease drivers that may act directly or indirectly through MAL to influence later chronic disease. The links with metaflammation and the need for recognition of these embedded scars in the management of lifestyle-related health problems is discussed.
Influence of finite element mesh size on the carrying capacity analysis of single-row ball slewing bearing
Authors: He Peiyu , Qian Qinrong , Wang Yun , Liu Hong , Guo Erkuo , Wang Hua
Published: April 2021

Slewing bearings are widely used in industry to provide rotary support and carry heavy load. The load-carrying capacity is one of the most important features of a slewing bearing, and needs to be calculated cautiously. This paper investigates the effect of mesh size on the finite element (FE) analysis of the carrying capacity of slewing bearings. A local finite element contact model of the slewing bearing is firstly established, and verified using Hertz contact theory. The optimal mesh size of finite element model under specified loads is determined by analyzing the maximum contact stress and the contact area. The overall FE model of the slewing bearing is established and strain tests were performed to verify the FE results. The effect of mesh size on the carrying capacity of the slewing bearing is investigated by analyzing the maximum contact load, deformation, and load distribution. This study of finite element mesh size verification provides an important guidance for the accuracy and efficiency of carrying capacity of slewing bearings.
Pregnancy-related weight among immigrant and US-born mothers: The role of nativity, maternal duration of residence, and age at arrival
Authors: Green Tiffany L , Simuzingili Muloongo , Bodas Mandar , Xue Hong
Published: April 2021

Objectives:

The goals of this study were to examine the associations between nativity and pregnancy-related weight and to assess the associations between maternal duration of residence and age at arrival in the United States on pregnancy-related weight among immigrants.

Methods:

Using logistic regression and data from the Early Childhood Longitudinal Study–Birth Cohort, we assessed differences in preconception weight and gestational weight gain between US-born and immigrant women (N = 7000). We then analyzed differences in both outcomes by duration of residence among immigrants (n = 1850) and examined whether the identified relationships varied by age at arrival in the United States.

Results:

Compared to US-born mothers, immigrants were less likely to be classified as obese prior to pregnancy (odds ratio 0.435, 95% confidence interval, 0.321–0.590) or experience excessive gestational weight gain (odds ratio 0.757, 95% confidence interval, 0.614–0.978). Among the immigrant sub-sample, living in the United States for 10–15 years (odds ratio 2.737, 95% confidence interval, 1.459–5.134) or 16+ years was positively associated with both preconception obesity (odds ratio 2.918, 95% confidence interval, 1.322–6.439) and excessive gestational weight gain (odds ratio 1.683, 95% confidence interval, 1.012–2.797, 16+ years only). There was some evidence that the duration of residence was positively associated with preconception obesity, but only among women who had moved to the United States at age 18 years and older.

Conclusion:

In sum, while immigrants are less likely than US-born mothers to experience preconception obesity or excessive gestational weight gain, these outcomes vary among the former group by duration of US residence.
Validation of claims-based indicators used to identify flare-ups in inflammatory bowel disease
Authors: Burisch Johan , Zhang He , Choong Casey Kar-Chan , Nelson David , Naegeli April , Gibble Theresa , Goetz Iris , Egeberg Alexander
Published: April 2021

Background & Aims:

There are currently no validated claims-based indicators for identifying a worsening of disease in patients with inflammatory bowel disease (IBD). Therefore, we aimed to develop and validate indicators that identify flare-ups of IBD using data from Danish nationwide registries.

Methods:

Using Danish nationwide administrative data, we identified all patients with Crohn’s disease (CD) or ulcerative colitis (UC) who had at least one measurement of faecal calprotectin between 1 January 2015 and 31 June 2017. We tested several different claims-based indicators of disease flare-ups against levels of faecal (F-)calprotectin (no flare-up: <250 mg/kg; mild flare-up: 250–1000 mg/kg; severe flare-up: ⩾1000 mg/kg). A generalised estimating equation was used to evaluate whether the proposed indicators could predict disease activity.

Results:

A total of 890 children and 4719 adults with CD, and 592 children and 5467 adults with UC were included in the study. During the observation period, 48–61% and 48–55% of the CD and UC patients, respectively, had no flare-up, 26–29% (CD) and 24–26% (UC) experienced a mild flare-up, and 12–23% (CD) and 21–27% (UC) experienced a severe flare-up. Combinations of indicators that could predict a flare-up in CD and UC adults included hospitalisation, surgery, initiation or switch of biological therapy, treatment with systemic steroids, locally acting steroids or topical 5-aminosalicylates, colonoscopy/sigmoidoscopy, and magnetic resonance imaging/computed tomography. In children, only the number of gastroenterology visits was significant as an indicator among UC patients, and none were seen in children with CD. Overall, the indicator combinations resulted in a predictive ability of 0.62–0.67.

Conclusion:

Administrative claims data can be useful for identifying patients exhibiting (F-calprotectin defined) flare-ups of their IBD. Clinically relevant events captured in the Danish national patient registry are associated with increased levels of calprotectin and hence increased disease activity, and can be used as valid outcomes in future studies.
Advanced Placement and Concurrent Enrollment Substitution Effects
Authors: Clayton Grant
Published: April 2021

Advanced placement (AP) and concurrent enrollment (CE) provide high school students with rigorous coursework and possible college credit. Theoretical modeling predicted students would substitute CE for AP courses conditional on their probability of earning university credit, passing AP tests, and college selectivity despite CE costing more than AP. In the current study, CE costs to families drop to zero and students should be expected to maximize substitution. This study uses multiple years of school-level data from Colorado, a state with a growing CE sector to test substitution effects. Using a school fixed-effect Poisson regression of the most commonly taken AP exams, results indicate limited evidence of widespread substitution. The continued preference for AP may increase costs to families and reduce potential college credits.
The Importance of Forest-Nonforest Transition Zones for Avian Conservation in a Vegetation Disturbance Gradient in the Northern Neotropics
Authors: Levey Dallas R. , Estrada Alejandro , Enríquez Paula L. , Navarro-Sigüenza Adolfo G.
Published: April 2021

Tropical landscape connectivity and matrix quality near large stands of primary forest are important factors that dictate biodiversity trends in communities. Suitable matrix management surrounding primary forest may help conserve biodiversity, but areas with poor matrix management need attention to determine their long-term viability to support native levels of biodiversity. We examined variations in species and functional diversity and community composition using point-count surveys placed in preserved (PRES), transition (TRA), and disturbed (DIS) areas according to percent land cover of forest and cattle pasture along a human disturbance gradient in the northern Neotropics during an 8 month period from 2019–2020. We expected the gradient of human disturbance to drive species diversity loss of forest specialists from PRES to DIS, resulting in changes to functional diversity and community composition. We detected 228 species overall, with 163 in PRES (40 unique species), 159 in TRA (9 unique species), and 152 in DIS (20 unique species). TRA supported an avian community with shared aspects of PRES and DIS, leading to the highest functional, Shannon (85.8 estimated species), and Simpson (57.9 estimated species) diversity. Higher diversity of open-area specialists in TRA and DIS has led to shifts in functional traits and different species and functional community compositions relative to PRES. Land management in Neotropical human-modified landscapes must focus on increasing habitat quality in remnant forest fragments in the vicinity of large stands of primary forest to prevent species and ecosystem service loss from preserved areas and the distancing of local community compositions.
Simultaneous therapy-related acute myeloid leukemia and relapse/refractory multiple myeloma: a therapeutic dilemma
Authors: Spree Dewi Nurmaya , Jamaluddin Farhan Rafiuddin , Abd Aziz Suria , Shuib Salwati , Rafeah Tumian Nor
Published: April 2021

We present a case of a 61-year-old woman with relapse/refractory multiple myeloma post-autologous peripheral blood stem cell transplantation who presented with recurrent febrile episodes and infection. Worsening thrombocytopenia during lenalidomide-based therapy for early biochemical relapse warranted further investigations. Even though it was initially attributed to lenalidomide and relapse/refractory multiple myeloma, there was not much improvement in her counts despite adjustment of her medications. Subsequent serial bone marrow results and cytogenetic evolution eventually revealed therapy-related myelodysplastic syndrome progressing to therapy-related acute myeloid leukemia. In view of her age and comorbidities, she was treated with subcutaneous azacytidine with palliative intent which resulted in transient disappearance of blasts in the peripheral blood. She subsequently succumbed to progressive therapy-related acute myeloid leukemia and relapse/refractory multiple myeloma. This case highlights the complexity in diagnosing therapy-related myelodysplastic syndrome earlier as prompt diagnosis is crucial in delaying its progression to therapy-related acute myeloid leukemia. Managing therapy-related acute myeloid leukemia in the setting of relapse/refractory multiple myeloma post-autologous peripheral blood stem cell transplantation is challenging in terms of balancing the treatment toxicity and providing the best possible quality of life.
Case report: successful perioperative management of patients with haemophilia A using an extended half-life factor VIII (Efmoroctocog alfa) during neurosurgical procedures
Authors: Kocher Florian , Seeber Andreas , Kerschbaumer Johannes , Schmidt Stefan , Wolf Dominik , Feistritzer Clemens
Published: April 2021

Patients with haemophilia A (HA) undergoing neurosurgical procedures have a high risk of haemorrhage with potential fatal outcome. Here, we present a successful perioperative haemostatic concept applying an extended half-life factor VIII (EHL FVIII), Efmoroctocog alfa, in two patients with HA undergoing neurosurgery for paramedian right-sided disc herniation (case 1) and astrocytoma (case 2). After adequate EHL FVIII treatment the surgical procedures were performed without any bleeding complications despite the high-risk interventions. Laboratory measurements confirmed stable FVIII levels throughout the hospital stay. We suggest close interdisciplinary collaboration between involved clinicians as mandatory prerequisite for an optimized perioperative management in patients with HA. The presented cases indicate, that the increased stability, safety and fewer injections provide a rationale to use EHL FVIII products in HA patients undergoing surgical interventions with a very high bleeding risk.
Kounis syndrome: Acute myocardial infarction following multiple bee stings
Authors: Pirasath Selladurai , Senthan Vallipuranathan , Seneviratne Manosha Harshani
Published: April 2021

Usually, bee sting systemic envenomation is self-limited mild allergic reaction rarely associated with systemic manifestations such as anaphylaxis, myocardial injury, encephalitis, acute kidney injury and serum sickness. Kounis syndrome also known as allergic myocardial infarction is uncommon clinical feature and reported cases are scarce in literature. Herein, we described a hypothetical case of Kounis syndrome diagnosed in a 74-year-old man initially presenting for anaphylactic reaction.