bluuebunny/crossref_metadata_2025 huggingface dataset:
Vigilance, Popular Control and Neighborhood Surveillance in Besieged Paris (1589–1591)
Authors: Roussel Diane
Published: August 2024

Surveillance studies often recall that Michel Foucault had identified the health crises of the plagues of the Ancien Régime as precursory moments in the establishment of modern surveillance. Episodes of civil wars are certainly another example. This study takes for object the capital of the kingdom of France at the siege of Paris, in 1589–1591, when Henry III and then Henri IV tried to reduce to their authority in the rebellious city, head of the Ultra-Catholic Ligue. This unprecedented experience of fear and generalized suspicion allows us to study how the usual mechanisms of social control are used for political ends, but also how new surveillance procedures emerge, based on the written word and a desire for rationalization. This article uses a wide range of sources, from municipal decisions to the reports of chroniclers, but relies mainly on the judicial archives of the Parlement and the Hôtel de Ville to draw up a social history as close as possible to ordinary Parisians. Taking a ground-level approach, the study is particularly interested in ordinary agents of urban control and forms of day-to-day and face-to-face surveillance. In this exceptional climate, the routine work of watching others in the neighborhood turned to political surveillance. The key actors were the Militia, whose action relied on the Parisians themselves, considered as “the eyes and ears” of the League authorities to know who the enemies were and to testify of the loyalty of the inhabitants.
Popular Control through Public Accountability in Iberia (Thirteenth to Sixteenth Centuries)
Authors: Martín Romera María Ángeles
Published: August 2024

This article analyzes the participation of the people in the Castilian procedure of accountability called juicio de residencia (comparable to the Italian sindacato) as a fertile ground for the development of popular control in urban settings. It adopts a longue-durée approach considering its transformations from its origins in the thirteenth century to the sixteenth century and from Castile to the Spanish Monarchy. In addition, it draws on a bottom-up approach and makes a case for qualitative instead of quantitative research, taking into account the massive but heterogeneous archival material related to residencias from the fifteenth century to the sixteenth century in the Hispanic Monarchy. In order to prove the main hypothesis, after presenting the limits and virtues of the Hispanic sources, I focus on two aspects. The first part presents evidence of people of all sorts consistently participating in the juicios de residencias that held officials accountable, as well as the development of a modality of collective action that was propitious for popular control: the presentaciones de capítulos. The second part shifts from the actors to the effects of that participation, testing different indicators of the potential of residencias for popular control. Ultimately, this article argues that officers’ accountability under the form of residencias was a consistent instrument for Castilian people to exert pressure on authorities and a habitual resource for popular actions.
The Boundaries of Popular Control in Late Medieval English Towns
Authors: Hartrich Eliza
Published: August 2024

Scholarship on pre-modern popular politics often focuses on speech, identifying the ways in which people outside the elite could have a “voice” in government. Using examples from late medieval English towns, this article argues for the existence of a particular kind of popular politics that centered on seeing and hearing rather than speaking. This type of politics—labeled “popular control”—concerned the right of the urban political community at large to observe rituals of governance and to audit financial accounts. Through these acts of collective witnessing, lesser citizens and non-citizens exerted an indirect political power to restrict leaders’ freedom of action and to ensure that their performance of office abided by set rules. The unusually detailed Hall Rolls and Hall Books produced by the civic government of Lynn in 1412–13 and 1418–25 illustrate that “popular control,” far from being a vehicle for increasing the urban commons’ “voice” in municipal decision-making, often stood in opposition to principles of elected representation. After 1418, more people were being admitted to the inner sanctum of virtuous individuals deemed capable of offering rational counsel to mayors and jurats, but there were fewer opportunities for the wider public to witness performances of governance by this expanded group of decision-makers. The crux of debate in fifteenth-century English towns—and, perhaps, in the tumultuous world of late medieval Europe more generally—was often less about who should exercise political influence and more about how popular political power could be exercised most appropriately and effectively.
Improved diagnostic accuracy for leptomeningeal dissemination in pediatric brain tumors using contrast-enhanced FLAIR imaging
Authors: Aygun Berna , Biswas Asthik , Blaaza Mohammed , Cooper Jessica , Gaur Pritika , Avsenik Jernej , Rao Harini R , Stegeman James , Löbel Ulrike , Szychot Elwira , D’Arco Felice , Sudhakar Sniya , Mankad Kshitij
Published: August 2024

Background

Central nervous system cancers are a leading cause of childhood cancer-related mortality. Accurate staging and assessment of leptomeningeal spread, particularly in aggressive neoplasms such as embryonal tumors, is crucial for treatment planning and prognosis. Conventional diagnostic methods, relying on magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology, have limitations, including high false-negative rates and sensitivity issues. In this retrospective study, we aim to compare the diagnostic sensitivity of contrast-enhanced T2-weighted fluid-attenuated inversion recovery (CE-T2W-FLAIR) and 2D and 3D contrast-enhanced T1-weighted imaging (CE-T1WI) for detecting leptomeningeal disease.

Methods

We retrospectively reviewed 1372 MRI brain studies of 297 patients aged 1–19 years. We included only those MRI examinations adhering to our neuro-oncology protocol while excluding incomplete or suboptimal studies. A control group without leptomeningeal disease was matched for disease and age. Three groups of 2 neuroradiologists each, blinded to case status, reviewed the images using various sequences. The results were compared using the McNemar test and chi-squared test for P-values.

Results

The sensitivity of CE-T2W-FLAIR sequence was significantly higher compared with that of CE-T1WI (P = .025). There was no statistically significant difference between the sensitivity of 2D CE-T1WI and 3D CE-T1WI (P = .3173). The specificity of the 3D CE-T1WI was significantly lower compared with those of CE-T2W-FLAIR and 2D CE-T1WI (P = .014). The positive predictive values for CE-T2W-FLAIR, 2D CE-T1WI, and 3D CE-T1WI were 100%, 100%, and 68.4%, respectively, whereas the negative predictive values were 100%, 85.7%, and 85.71%, respectively.

Conclusions

The inclusion of CE-T2W-FLAIR in the MRI protocol improves sensitivity and specificity in diagnosing leptomeningeal spread in pediatric brain tumors.
Association of rare and common genetic variants in MOCOS with inadequate response to allopurinol
Authors: Fanning Niamh C , Cadzow Murray , Topless Ruth K , Frampton Chris , Dalbeth Nicola , Merriman Tony R , Stamp Lisa K
Published: August 2024

Objectives

The minor allele of the common rs2231142 ABCG2 variant predicts inadequate response to allopurinol urate lowering therapy. We hypothesize that additional variants in genes encoding urate transporters and allopurinol-to-oxypurinol metabolic enzymes also predict allopurinol response.

Methods

This study included a subset of participants with gout from the Long-term Allopurinol Safety Study Evaluating Outcomes in Gout Patients (LASSO), whose whole genome was sequenced (n = 563). Good responders had a 4:1 or 5:1 ratio of good [serum urate (SU) <0.36 mmol/l on allopurinol ≤300 mg/day] to poor (SU ≥0.36 mmol/l despite allopurinol >300 mg/day) responses over five to six time points, while inadequate responders had a 1:4 or 1:5 ratio of good to poor responses. Adherence to allopurinol was determined by pill counts, and for a subgroup (n = 303), by plasma oxypurinol >20μmol/l. Using the sequence kernel association test (SKAT), we estimated the combined effect of rare and common variants in urate secretory (ABCC4, ABCC5, ABCG2, SLC17A1, SLC17A3, SLC22A6, SLC22A8) and reuptake genes (SLC2A9, SLC22A11) and in allopurinol-to-oxypurinol metabolic genes (AOX1, MOCOS, XDH) on allopurinol response.

Results

There was an association of rare and common variants in the allopurinol-to-oxypurinol gene group (PSKAT-C = 0.019), and in MOCOS, encoding molybdenum cofactor sulfurase, with allopurinol response (PSKAT-C = 0.011). Evidence for genetic association with allopurinol response in the allopurinol-to-oxypurinol gene group (PSKAT-C = 0.002) and MOCOS (PSKAT-C < 0.001) was stronger when adherence to allopurinol therapy was confirmed by plasma oxypurinol.

Conclusion

We provide evidence for common and rare genetic variation in MOCOS associating with allopurinol response.
Metabolic conditioning enhances human bmMSC therapy of doxorubicin-induced heart failure
Authors: Jacques Virginie , Benaouadi Sabrina , Descamps Jean-Gerard , Reina Nicolas , Espagnolle Nicolas , Marsal Dimitri , Sainte-Marie Yannis , Boudet Alexandre , Pinto Carla , Farge Thomas , Savagner Frédérique
Published: August 2024

The therapeutic potential of bone marrow mesenchymal stromal cells (bmMSCs) to address heart failure needs improvement for better engraftment and survival. This study explores the role of metabolic sorting for human bmMSCs in coculture in vitro and on doxorubicin-induced heart failure mice models. Using functional, epigenetic, and gene expression approaches on cells sorted for mitochondrial membrane potential in terms of their metabolic status, we demonstrated that bmMSCs selected for their glycolytic metabolism presented proliferative advantage and resistance to oxidative stress thereby favoring cell engraftment. Therapeutic use of glycolytic bmMSCs rescued left ventricular ejection fraction and decreased fibrosis in mice models of acute heart failure. Metabolic changes were also related to epigenetic histone modifications such as lysine methylation. By targeting LSD1 (lysine-specific demethylase 1) as a conditioning agent to enhance the metabolic profile of bmMSCs, we deciphered the interplay between glycolysis and bmMSC functionality. Our study elucidates novel strategies for optimizing bmMSC-based treatments for heart failure, highlighting the metabolic properties of bmMSCs as a promising target for more effective cardiovascular regenerative therapies.
LncRNA‐Snhg3 regulates mouse hepatic glycogenesis under normal chow diet
Authors: Xie Xianghong , Gao Mingyue , Wang Heping , Zhang Minglong , Zhao Wei , Li Chunmei , Zhang Weihong , Yang Jiahui , Zhang Yinliang , Chen Enhui , Guo Yanfang , Guo Zeyu , Ngowi Ebenezeri Erasto , Wang Xiaoman , Zhu Yinghan , Wang Yiting , Li Xiaolu , Yao Hong , Yan Li , Fang Fude , Li Meixia , Qiao Aijun , Liu Xiaojun
Published: August 2024

Long noncoding RNAs (lncRNAs) are strongly associated with glucose homeostasis, but their roles remain largely unknown. In this study, the potential role of lncRNA‐Snhg3 in glucose metabolism was evaluated both in vitro and in vivo. Here, we found a positive relationship between Snhg3 and hepatic glycogenesis. Glucose tolerance improved in hepatocyte‐specific Snhg3 knock‐in (Snhg3‐HKI) mice, while it worsened in hepatocyte‐specific Snhg3 knockout (Snhg3‐HKO) mice. Furthermore, hepatic glycogenesis had shown remarkable increase in Snhg3‐HKI mice and reduction in Snhg3‐HKO mice, respectively. Mechanistically, Snhg3 increased mRNA and protein expression levels of PPP1R3B through inducing chromatin remodeling and promoting the phosphorylation of protein kinase B. Collectively, these results suggested that lncRNA‐Snhg3 plays a critical role in hepatic glycogenesis.
The Concept of Treatment-Refractory Addiction: A Call to the Field
Authors: Strain Eric C.
Published: August 2024

Not all patients respond to effective and approved treatment interventions, and there has been growing recognition in the medical field of these “resistant” or refractory illnesses (eg, treatment-resistant depression, resistant hypertension). In the field of substance use disorders, there has not been an explicit acknowledgement of treatment-refractory addiction (TRA) despite substantial evidence that many patients do not respond to standard-of-care treatment interventions. This article provides a justification for TRA as a critically important condition to recognize and define. TRA is not conceptualized as a diagnosis, but as a signal that a current treatment approach has not worked. The article addresses areas in need of research and consensus in order to ensure the approach to TRA is uniform, thoughtfully addressed, and data-driven. By explicitly acknowledging TRA, clinicians, researchers, and patients and their families can begin to explore the unique features of this population and find ways in which substance use disorders for persons with TRA can be more effectively addressed, which in turn will help to expand remission for persons who suffer from these devastating conditions.
Treatment Failure Versus Failed Treatments: The Risks of Embracing Treatment Refractory Addiction
Authors: Fiellin David A.
Published: August 2024

In this issue, Strain advocates for the field of addiction medicine to consider a new diagnostic signal—treatment-refractory addiction. Also in this issue, Nunes and McLellan support the concepts advanced by Strain. I provide an alternate view and propose that it is premature to create such a signal and that doing so could lead to unintended adverse consequences. My argument is based on 4 concerns: (1) the lack of neuroscientific correlates, (2) the profound impact that context has on what patients receive as “treatment,” (3) the rare provision of sequentially stepped treatment, and (4) the potential for misuse of the signal. Addiction medicine should be cautious in introducing concepts such as treatment-refractory addiction to ensure that patients are not seen as “treatment failures.” Our efforts should rather focus on the development of additional effective treatments, improving access to existing effective treatments and a creating a system that does not provide “failed treatments.”
Revisiting Preaddiction
Authors: Miller Shannon C. , Levy Sharon , Saxon Andrew J. , Tetrault Jeanette M. , Rosenthal Richard N. , Wakeman Sarah , Vocci Frank
Published: August 2024

The directors of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism have proposed new efforts to enable earlier identification and intervention for harmful substance use and its consequences. As editors of The ASAM Principles of Addiction Medicine, we fully support this goal. The word “preaddiction” has been suggested as a diagnostic label to describe individuals who would be targeted for early intervention. In this commentary, we offer that “unhealthy substance use” would be a better descriptor than “preaddiction” and review several potential barriers to be addressed in order to maximize the impact of introducing this new paradigm.
Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool in Screening Older Adults for Unhealthy Substance Use
Authors: Han Benjamin H. , Palamar Joseph J. , Moore Alison A. , Schwartz Robert P. , Wu Li-Tzy , Subramaniam Geetha , McNeely Jennifer
Published: August 2024

Objective

This analysis evaluated the validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) tool for older adults.

Methods

We performed a subgroup analysis of older adults aged ≥65 (n = 184) from the TAPS tool validation study conducted in 5 primary care clinics. We compared the interviewer and self-administered versions of the TAPS tool at a cutoff of ≥1 for identifying problem use with a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview.

Results

The mean age was 70.6 ± 5.9 years, 52.7% were female, and 49.5% were non-Hispanic Black. For identifying problem use, the self-administered TAPS tool had sensitivity of 0.91 (95% CI: 0.75–0.98) and specificity of 0.91 (95% CI: 0.85–0.95) for tobacco; sensitivity of 0.68 (95% CI: 0.45–0.86) and specificity of 0.88 (95% CI: 0.82–0.93) for alcohol; and sensitivity 0.86 (95% CI: 0.42–1.00) and specificity 0.94 (95% CI: 0.90–0.97) for cannabis. The interviewer-administered TAPS tool had similar results. We were unable to evaluate its performance for identifying problem use of individual classes of drugs other than cannabis in this population due to small sample sizes.

Conclusions

While the TAPS had excellent sensitivity and specificity for identifying tobacco use among older adults, the results for other substances lack precision, and we were unable to evaluate its performance for prescription medications and individual illicit drugs in this sample. This analysis underlines the critical need to adapt and validate screening tools for unhealthy substance use, specifically for older populations who have unique risks.
Interstitial lung disease and myositis
Authors: Gono Takahisa , Kuwana Masataka
Published: August 2024

Purpose of review

In patients with myositis, interstitial lung disease (ILD) is one of the major causes of morbidity and mortality. Given the limited evidence, there is an urgent need to refine the treatment for myositis-ILD. This review aims to highlight recent updates on the management of myositis-associated ILD, focusing on screening, risk stratification, and treatment.

Recent findings

Asian race and/or residence, dermatomyositis, mechanic's hand, antisynthetase antibodies, and antimelanoma differentiation-associated gene 5 antibodies are risk factors for ILD development. Patients with such risk factors should be screened for ILD using high-resolution computed tomography. Various prediction models for mortality or rapidly progressive ILD (RP-ILD) in patients with myositis-ILD have been proposed, but validation of these models in multiple independent studies is required. Academic societies in Japan, the United Kingdom, and the United States have proposed tentative treatment algorithms for myositis-ILD on the basis of the presence or absence of RP-ILD.

Knowledge on myositis-ILD risk stratification, potentially useful for personalized management approaches in clinical practice, is accumulating. However, further global joint efforts are necessary to build a strong evidence base for consensus algorithms for myositis-ILD.
Evaluating Postoperative Pain Management Using the Detroit Interventional Pain Management Tool After Fracture Surgery: How Well Are We Really Doing?
Authors: Boggs Lauryn J. , Stine Sasha A. , Heuvers Eunice , Ross Hunter L. , Vaidya Rahul
Published: August 2024

OBJECTIVES:

To assess patients' opioid prescription usage and pain management satisfaction after fracture surgery.

METHODS:

Design:

An IRB-approved prospective prognostic cohort study for postoperative patients with fracture was conducted. Patients were evaluated by an independent observer at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively where they were given Detroit Interventional Pain Assessment questionnaires regarding their postoperative pain and opioid usage. Opioid prescriptions were verified by the Michigan Automated Prescription System. All patients were divided into major fractures (tibia, femur, acetabulum, pelvis, calcaneus, talus, and polytrauma) and minor fractures (scapula, clavicle, humerus, radius, ulna, scaphoid, carpal/metacarpal, patella, fibula, ankle, and metatarsal) and were followed for 2 years.

Setting:

Single-Center Level One Trauma Center.

Patient Selection Criteria:

Patients presenting to clinic over a 6-month period were invited to participate in this study. Patients who did not consent were excluded.

Outcome Measures and Comparisons:

Outcome measures were the amount of prescribed opioids in daily morphine milligram equivalents (MMEs), opioid usage, DIPA pain scores, and pain management efficiency (percentage of patients reporting no pain or tolerable pain with their regimen). Prescribed MMEs, pain management efficiency scores, and the percentage of patients using opioids were compared across all postoperative periods.

RESULTS:

For 201 patients with fracture, the average age was 47.8 ± 16.3 SD (18–87 years), and there were 116 men (57.8%) and 85 women (42.2%). The percentage of patients using opioids and their daily prescribed MMEs significantly decreased from 2 weeks (48.2%, 21.6 MMEs) to 6 months (10.3%, 8.13 MMEs) (P < 0.001). Fifty-one percent of patients were off opioids at 2 weeks, 64.5% at 6 weeks, 84.2% at 3 months, and 89.7% at 6 months. All opioid prescriptions at 6 months and 2 years were prescribed to patients with polytrauma who underwent sequential surgeries, and these prescriptions originated from outside prescribers. Pain management efficiency scores were worst at 2 weeks (67.2%) but improved at 3 months (82.6%).

CONCLUSIONS:

As patients transitioned further from their surgical date, there was a decrease in opioid prescriptions and patient-reported opioid usage. Despite the opioid tapering practices by surgeons, patients with polytrauma still received prescriptions from outside prescribers for orthopaedic aftercare after 3 months, signaling the necessity for patients to see outside prescribers for their pain management after this time.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Holding the therapy in CLLp53: mechanisms to achieve durable responses
Authors: Cantera Rodrigo , Fernández-Barge Tatiana , Salmanton-García Jon , Yáñez Lucrecia
Published: August 2024

Chronic lymphocytic leukemia (CLL) is a common leukemia, mainly affecting the elderly. Originating in the bone marrow, CLL involves the accumulation of B lymphocytes and progresses slowly, though 50–60% of patients will require therapy. At diagnosis, the presence of p53 protein aberrations, such as 17p deletion and TP53 mutation, arises in approximately one out of 10 patients. Even in the era of targeted therapies, these aberrations remain the most important prognostic factors. Current guidelines favor continuous BTK inhibitor therapy in patients with CLLp53, though adverse events and drug resistance may lead to discontinuation. Herein, we discuss the effects of B-cell receptor and BCL-2 inhibition, as well as the role of the immune system, in two elderly CLLp53 patients with prolonged responses to different therapies.
Machine learning-based integration develops a multiple programmed cell death signature for predicting the clinical outcome and drug sensitivity in colorectal cancer
Authors: Li Chunhong , Mao Yuhua , Liu Yi , Hu Jiahua , Su Chunchun , Tan Haiyin , Hou Xianliang , Ou Minglin
Published: August 2024

Tumorigenesis and treatment are closely associated with various programmed cell death (PCD) patterns. However, the coregulatory role of multiple PCD patterns in colorectal cancer (CRC) remains unknown. In this study, we developed a multiple PCD index (MPCDI) based on 19 PCD patterns using two machine learning algorithms for risk stratification, prognostic prediction, construction of nomograms, immune cell infiltration analysis, and chemotherapeutic drug sensitivity analysis. As a result, in the TCGA-COAD, GSE17536, and GSE29621 cohorts, the MPCDI can effectively distinguished survival outcomes in CRC patients and served as an independent factor for CRC patients. We then explored the immune infiltration landscape in two groups using the nine algorithms and found more overall immune infiltration in the high-MPCDI group. TIDE scores suggested that the increased immune evasion potential and immune checkpoint inhibition therapy may be less effective in the high-MPCDI group. Immunophenoscores indicated that anti-PD1, anti-cytotoxic T-lymphocyte associated antigen 4 (anti-CTLA4), and anti-PD1-CTLA4 combination therapies are less effective in the high-MPCDI group. In addition, the high-MPCDI group was more sensitive to AZD1332, Foretinib, and IGF1R_3801, and insensitive to AZD3759, AZD5438, AZD6482, Erlotinib, GSK591, IAP_5620, and Picolinici-acid, which suggests that the MPCDI can guide drug selection for CRC patients. As a new clinical classifier, the MPCDI can more accurately distinguish CRC patients who benefit from immunotherapy and develop personalized treatment strategies for CRC patients.
Pericardiocentesis, Chest Tube Insertion, and Needle Thoracostomy During Resuscitation of Nontraumatic Adult In-Hospital Cardiac Arrest: A Retrospective Cohort Study
Authors: Andrea Luke , Rahmanian Marjan , Bangar Maneesha , Shiloh Ariel L. , Balakrishnan Rithvik , Soleiman Aron , Carlese Anthony , Gong Michelle N. , Moskowitz Ari
Published: August 2024

IMPORTANCE:

In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the postresuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover IHCA study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort.

OBJECTIVES:

Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practices.

DESIGN, SETTING, AND PARTICIPANTS:

This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individuals enrolling in hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine.

MAIN OUTCOMES AND MEASURES:

The study collects data on patient characteristics, including prearrest frailty, arrest characteristics, and detailed information on postarrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures postarrest temperature control interventions and postarrest prognostication methods.

RESULTS:

The majority of participating hospital systems are large, academic, tertiary care centers serving urban populations. The analysis will evaluate variations in practice and their association with mortality and neurologic function.

CONCLUSIONS AND RELEVANCE:

We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA and be a vital resource for future investigations into best practices for managing patients after IHCA.
Combination of Hydrogen Inhalation and Hypothermic Temperature Control After Out-of-Hospital Cardiac Arrest: A Post hoc Analysis of the Efficacy of Inhaled Hydrogen on Neurologic Outcome Following Brain Ischemia During PostCardiac Arrest Care II Trial
Authors: Tamura Tomoyoshi , Narumiya Hiromichi , Homma Koichiro , Suzuki Masaru ,   Efficacy of Inhaled Hydrogen on Neurologic Outcome Following Brain Ischemia During PostCardiac Arrest Care (HYBRID II) Study Group
Published: August 2024

OBJECTIVE:

The Efficacy of Inhaled Hydrogen on Neurologic Outcome Following Brain Ischemia During Post-Cardiac Arrest Care (HYBRID) II trial (jRCTs031180352) suggested that hydrogen inhalation may reduce post-cardiac arrest brain injury (PCABI). However, the combination of hypothermic target temperature management (TTM) and hydrogen inhalation on outcomes is unclear. The aim of this study was to investigate the combined effect of hydrogen inhalation and hypothermic TTM on outcomes after out-of-hospital cardiac arrest (OHCA).

DESIGN:

Post hoc analysis of a multicenter, randomized, controlled trial.

SETTING:

Fifteen Japanese ICUs.

PATIENTS:

Cardiogenic OHCA enrolled in the HYBRID II trial.

INTERVENTIONS:

Hydrogen mixed oxygen (hydrogen group) versus oxygen alone (control group).

MEASUREMENTS AND MAIN RESULTS:

TTM was performed at a target temperature of 32–34°C (TTM32–TTM34) or 35–36°C (TTM35–TTM36) per the institutional protocol. The association between hydrogen + TTM32–TTM34 and 90-day good neurologic outcomes was analyzed using generalized estimating equations. The 90-day survival was compared between the hydrogen and control groups under TTM32–TTM34 and TTM35–TTM36, respectively. The analysis included 72 patients (hydrogen [n = 39] and control [n = 33] groups) with outcome data. TTM32–TTM34 was implemented in 25 (64%) and 24 (73%) patients in the hydrogen and control groups, respectively (p = 0.46). Under TTM32–TTM34, 17 (68%) and 9 (38%) patients achieved good neurologic outcomes in the hydrogen and control groups, respectively (relative risk: 1.81 [95% CI, 1.05–3.66], p < 0.05). Hydrogen + TTM32–TTM34 was independently associated with good neurologic outcomes (adjusted odds ratio 16.10 [95% CI, 1.88–138.17], p = 0.01). However, hydrogen + TTM32–TTM34 did not improve survival compared with TTM32–TTM34 alone (adjusted hazard ratio: 0.22 [95% CI, 0.05–1.06], p = 0.06).

CONCLUSIONS:

Hydrogen + TTM32–TTM34 was associated with improved neurologic outcomes after cardiogenic OHCA compared with TTM32–TTM34 monotherapy. Hydrogen inhalation is a promising treatment option for reducing PCABI when combined with TTM32–TTM34.
Pain management after laparoscopic cholecystectomy
Authors: Bourgeois Camille , Oyaert Lukas , Van de Velde Marc , Pogatzki-Zahn Esther , Freys Stephan M. , Sauter Axel R. , Joshi Girish P. , Dewinter Geertrui ,   the PROSPECT working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA)
Published: August 2024

Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.
Determinants of thoracic aortic size in normotensive and hypertensive individuals
Authors: Pham Michael H.C. , Kühl Jørgen T. , Fuchs Andreas , Sigvardsen Per E. , Sillesen Henrik , Afzal Shoaib , Nordestgaard Børge G. , Køber Lars V. , Kofoed Klaus F.
Published: August 2024

Aims:

Thoracic aortic diameter is modulated by various factors including both physiological and pathological mechanisms. The aim of this study was to explore the determinants of thoracic aortic size focusing on arterial blood pressure and physical activity in normotensive and hypertensive individuals.

Methods:

Ascending and descending aortic diameters were measured in participants of the Copenhagen General Population Study using thoracic CT angiography. To assess the relation between arterial blood pressure and thoracic aortic diameters, individuals with diabetes, hypercholesterolemia, smoking, and prescribed antihypertensive medication were excluded. Intensity of physical activity was recorded based on self-reported questionnaire data.

Results:

A total of 1214 normotensive and 284 hypertensive individuals were examined. In all individuals, male sex, older age, and body surface area were associated with higher diameters of the ascending and descending aorta (P < 0.01). In normotensive individuals, hard physical activity > 4 h/week was independently associated with higher thoracic aortic diameters (ascending β:1.09[0.52;1.66] and descendingβ: 0.47[0.14;0.80], bothP < 0.01), whereas higher systolic blood pressure was not associated with thoracic aortic diameters (ascendingP = 0.12 and descendingp = 0.33). In hypertensive individuals, higher systolic blood pressure (per 10 mmHg) was independently associated with higher thoracic aortic diameters (ascendingβ: 0.55[0.17;0.94] and descendingβ: 0.23[0.10;0.37] mm/10 mmHg, bothP < 0.01), whereas hard physical activity was not associated with higher aortic diameters (ascendingP = 0.11 and descendingP = 0.51).

Conclusion:

In normotensive individuals hard physical activity, and in hypertensive individuals increasing systolic blood pressure are factors each independently associated with larger thoracic aortic size. These findings suggest a context sensitive mode of aortic vascular response to size modulating adaptation.
Effect of Lens Deviation on Peripheral Defocus and Optic Quality in Adolescents With Moderate and Severe Myopia
Authors: Yu Jia , Zhou Yuehua
Published: August 2024

Objectives:

The aim of this study was to analyze the effects of lens deviation on peripheral defocus and optic quality in adolescents with moderate and severe myopia.

Methods:

This prospective study enrolled 81 children (81 eyes). The spherical equivalent was −5.0≤SE≤−6.0 diopter. The participants were divided into two subgroups based on their eccentricity (inferior temporal) after wearing the lenses for 12 months. Between them, the low eccentric subgroup (A) had a total eccentric distance of less than 0.5 mm, and the moderate and severe eccentric subgroup (B) had a total eccentric distance of ≥0.5 mm. Peripheral defocus and eccentricity were measured before and after wearing the lenses, and the Spearman test was used to compare the parameters.

Results:

Parameters such as the total peripheral defocus (TRDV) were significantly lower in subgroup B than in subgroup A after 12 months of orthokeratology lens usage. The axial length growth (ΔAL) in subgroup A was higher than that in subgroup B. Axial length growth, TRDV, and other parameters were significantly associated with eccentricity. The modulation transfer function cutoff and Strehl ratio were also significantly associated with eccentricity.

Conclusions:

Greater eccentricity within a certain range can induce greater periretinal defocus and improve the ΔAL.
Ocular involvement in Steven-Johnson syndrome/toxic epidermal necrolysis: recent insights into pathophysiology, biomarkers, and therapeutic strategies
Authors: Pisitpayat Punyanuch , Nijvipakul Sarayut , Jongkhajornpong Passara
Published: August 2024

Purpose of review

To review the pathophysiology, recent biomarkers related to the ocular aspects of Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and to highlight notable evidence published in recent years.

Recent findings

Several studies reveal the relationship between tear cytokines and the pathological components in eyes of SJS/TEN patients. Specific clinical features and associated risk factors in the acute stage have shown significant correlations with chronic ocular sequelae. Recent treatment protocols, including early pulse systemic and topical steroids, as well as tumor necrosis factor-α inhibitors, have demonstrated positive effects on ocular outcomes. In addition to conventional surgical treatment, a new surgical technique, simple oral mucosal epithelial transplantation (SOMET), has been introduced as a simple ocular surface reconstruction for patient with SJS.

Advancements in knowledge and management strategies have notably enhanced ocular outcomes for SJS/TEN eyes. A deeper understanding of the biomarker changes in these eyes could facilitate the development of future targeted treatment options.
CYP3A4 Poor and Intermediate Metabolizers Have a Higher Rate of Steroid-Induced Intraocular Pressure Response
Authors: Wright Jessica A. , Xu Sarah C. , Wong Mitchell H. , El Melik Razan M. , Hodge David , Sit Arthur J.
Published: August 2024

Purpose:

Evaluate the relationship between CYP3A4 phenotype, the gene encoding the enzyme that metabolizes exogenous steroids, and the rate of steroid-induced intraocular pressure (IOP) response.

Materials and Methods:

Lymphocyte-derived DNA sequencing of CYP3A4 from 10073 patients was completed using the PGRN-Seq assay. Subjects with CYP3A4 intermediate metabolizer or slower phenotypes were identified and compared with controls matched by age, race, and sex. All subjects had at least 3 eye exams with at least an exam while on topical/systemic/local steroid in any body location except the eye. Patients with pre-existing glaucoma or glaucoma suspects were excluded.

Results:

Of the 10,073 patients, there were 63 patients who had CYP3A4 poor or intermediate metabolizer phenotype. Of the 63 patients, 22 had documented steroid use. Fifty-nine percent (13/22) of patients with CYP3A4 poor/intermediate metabolizer had a steroid-induced IOP response of 3 mm Hg or more, significantly higher compared with 23% (5/22) of matched controls (P=0.031). Although more poor/intermediate metabolizers were steroid responders, the average IOP elevation in steroid responders in both groups was similar (5.0±2.5 mm Hg in CYP3A4 poor/intermediate metabolizers compared with 4.1±2.1 mm Hg in controls, P=0.327). Family history of glaucoma was similar in both groups (7/22 vs. 8/22, P=1.0).

Conclusion:

Reduced CYP3A4 phenotypes may help identify patients at a higher risk of steroid-induced IOP elevation.
Transient receptor potential melastatin 8 contributes to the interleukin-33-mediated cold allodynia in a mouse model of neuropathic pain
Authors: Du Lixia , Zhu Jianyu , Liu Shenbin , Yang Wei , Hu Xueming , Zhang Wenwen , Cui Wenqiang , Yang Yayue , Wang Chenghao , Yang Yachen , Gao Tianchi , Zhang Chen , Zhang Ruofan , Lou Mengping , Zhou Hong , Rao Jia , Maoying Qiliang , Chu Yuxia , Wang Yanqing , Mi Wenli
Published: August 2024

Cold allodynia is a common complaint of patients suffering from neuropathic pain initiated by peripheral nerve injury. However, the mechanisms that drive neuropathic cold pain remain elusive. In this study, we show that the interleukin (IL)-33/ST2 signaling in the dorsal root ganglion (DRG) is a critical contributor to neuropathic cold pain by interacting with the cold sensor transient receptor potential melastatin 8 (TRPM8). By using the St2

−/−
mice, we demonstrate that ST2 is required for the generation of nociceptor hyperexcitability and cold allodynia in a mouse model of spared nerve injury (SNI). Moreover, the selective elimination of ST2 function from the Nav1.8-expressing nociceptor markedly suppresses SNI-induced cold allodynia. Consistent with the loss-of-function studies, intraplantar injection of recombinant IL-33 (rIL-33) is sufficient to induce cold allodynia. Mechanistically, ST2 is co-expressed with TRPM8 in both mouse and human DRG neurons and rIL-33-induced Ca2+ influx in mouse DRG neurons through TRPM8. Co-immunoprecipitation assays further reveal that ST2 interacts with TRPM8 in DRG neurons. Importantly, rIL-33-induced cold allodynia is abolished by pharmacological inhibition of TRPM8 and genetic ablation of the TRPM8-expressing neurons. Thus, our findings suggest that the IL-33/ST2 signaling mediates neuropathic cold pain through downstream cold-sensitive TRPM8 channels, thereby identifying a potential analgesic target for the treatment of neuropathic cold pain.
Acute and preventive medical treatment of cluster headache in Taiwan: A narrative review
Authors: Yang Fu-Chi , Tsai Chia-Lin , Lin Guan-Yu , Yang Chun-Pai , Chen Wei-Ta
Published: August 2024

Cluster headache (CH) is a debilitating neurological disorder characterized by severe, unilateral pain, and ipsilateral autonomic symptoms. Chronic CH is exceedingly rare in Taiwan, constituting approximately 1% of all CH cases. This narrative review provides an up-to-date overview of the acute and preventive treatment strategies for CH in Taiwan, focusing on currently available pharmacological options in the country. The treatment approach for CH in Taiwan involves a stepwise strategy. High-flow oxygen and triptan nasal sprays are the mainstays of acute treatment, providing rapid relief, and good tolerability. Transitional treatments, such as oral steroids and suboccipital steroid injections, serve as a crucial bridge between acute and long-term preventive therapies, offering temporary relief while minimizing side effects through a carefully limited duration. For preventive treatment, verapamil is the first-line option, with lithium and topiramate being the second-line alternatives. Among the calcitonin gene-related peptide (CGRP) monoclonal antibodies, galcanezumab has demonstrated efficacy in the prevention of episodic CH. Preventive treatments are personalized to individual patients, starting with low doses and close monitoring for adverse effects. Neuromodulatory therapies, such as noninvasive vagus nerve stimulation, show promise for chronic and refractory CH but have limited availability in Taiwan. In conclusion, despite the availability of various acute and preventive treatment options, unmet needs in the management of CH in Taiwan remain. In particular, increased awareness and education among healthcare professionals to improve the diagnosis and management of CH in Taiwan should be implemented.
The Antigravity Treadmill as a Postoperative and Injury Rehabilitation Tool: Reduction in Contact Forces and Muscle Activity With Reduced Weight Running
Authors: Alexeev Sergei O. , Trikha Rishi , Short Steven , Hunt Kenneth J.
Published: August 2024

Objective:

To investigate the effects of reduced weight running on the antigravity (AG) treadmill on maintenance of normal muscle activation and reduction of plantar forces in healthy subjects.

Design:

Descriptive laboratory study.

Setting:

Clinical sports medicine center.

Participants:

Twenty healthy subjects (10 male and 10 female) aged 18 to 29 years.

Independent Variables:

Subjects running at 6.5 miles per hour on a standard treadmill and on the AG treadmill at 100%, 90%, 80%, 70%, 60%, and 50% of bodyweight levels.

Main Outcome Measures:

Dynamic plantar loading data were recorded using pressure insoles. Surface electromyography electrodes with imbedded accelerometers were used to estimate timing and magnitude of muscle activity, stride length, and cadence.

Results:

There was a significant, sequential reduction in peak pressure, maximum force, and force time integral (FTI) with decreasing bodyweight. A 50% bodyweight reduction resulted in a 51% reduction in maximum force and a 59% reduction in FTI in the heel, as compared with 19% to 28% at the metatarsal heads. There was reduced contact area in the heel and midfoot at and below 70% BW. Lower limb muscle activity decreases with reduced bodyweight while maintain normal muscle recruitment timing.

Conclusions:

The AG treadmill provides a reduction in loading forces while maintaining normal muscle recruitment patterns. Decreased BW running preferentially unloads the hindfoot. The AG treadmill can be an effective rehabilitation tool following foot or ankle injury and may prove superior to other limited weight-bearing methods.
Faculty Behaviors and Beliefs About Teaching Gun Violence Prevention in Undergraduate Nursing Programs
Authors: Holmes Sarah M. , Moorman Margaret M. , Draucker Claire , Perkins Susan M.
Published: August 2024

Background:

Gun violence is a public health crisis, but nurses report receiving little education related to gun violence prevention (GVP).

Purpose:

This study aimed to describe undergraduate nursing faculty teaching behaviors and perceptions related to GVP and explore factors associated with teaching it.

Methods:

A cross-sectional survey design was used.

Results:

Less than one-third of faculty taught GVP. Knowledge, confidence, and beliefs were significantly associated with teaching GVP. Most were favorable to include GVP in curricula and agreed assessing for gun access, counseling about safe gun storage, and counseling about lethal means restriction should be taught. Key barriers included content saturation, political atmosphere, lack of educational materials, and lack of topic expertise.

Conclusion:

Faculty agree that GVP should be taught, but most do not teach it in undergraduate nursing programs. Faculty development programs focused on GVP and support from national nursing organizations may decrease barriers in incorporating GVP into curricula.
Comparison of Outcomes After Cochlear Implantation in a Veteran Versus Nonveteran Population
Authors: Tripathi Siddhant H. , Adams Sarah M. , Wong Eric M. , Petito Gabrielle , Shapiro Scott , Grisel Jedidiah , Breen Joseph , Dhanda Patil Reena
Published: August 2024

Objective:

To evaluate for equivalence in postoperative changes of speech recognition scores in a veteran patient population undergoing cochlear implantation (CI) compared to matched nonveteran patients.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

A total of 83 veteran patients who underwent CI at a single Veterans Affairs Medical Center (VA cohort) were matched to 83 nonveteran patients from the Health Insurance Portability and Accountability Act-secure, Encrypted, Research, Management and Evaluation Solution database (HERMES cohort) based on age, sex, and baseline Consonant–Nucleus–Consonant (CNC) scores.

Intervention:

Patients underwent CI.

Main Outcome Measures:

Comparison of postoperative CNC and Arizona Biomedical Institute recognition scores.

Results:

The mean difference and lower confidence interval of CNC scores between matched Veterans Affairs and HERMES cohorts were within a −ΔNI boundary of −15% at the 3-month (mean = 6.15, lower confidence interval = −2.38), 6-month (mean = 7.36, lower confidence interval = −2.21), and 12-month (mean = 4.03, lower confidence interval = −4.88) postoperative time points. The mean difference and lower confidence interval of Arizona Biomedical Institute scores between cohorts were within the −ΔNI boundary of −30% at 3 months (mean = 1, lower confidence interval = −8.71), 6 months (mean = 0.31, lower confidence interval = −12.30), and 12 months (mean = 0.72, lower confidence interval = −10.48).

Conclusion:

Our veteran population demonstrated improvements in speech recognition scores after CI comparable to a matched nonveteran population. Although veterans face unique factors that affect their hearing, access to medical care, and baseline general health, these findings affirm appropriate veteran candidates should be offered CI.