bluuebunny/crossref_metadata_2025 huggingface dataset:
Telltale Signs of Idiopathic Intracranial Hypertension With Normal Opening Cerebrospinal Fluid Pressure
Authors: Foska Aikaterini , Palaiodimou Lina , Stefanou Maria Ioanna , Alonistiotis Dimitrios , Bakola Eleni , Papagiannopoulou Georgia , Arvaniti Chrysa , Bonakis Anastasios , Lachanis Stefanos , Tsivgoulis Georgios
Published: October 2022

Introduction

Idiopathic Intracranial Hypertension (IIH) with normal opening cerebrospinal fluid (CSF) pressure comprises a rare IIH variant.

Case Report

We report the case of a non-obese Caucasian woman, who presented with asymmetrical papilledema, typical IIH-findings on optic nerve sonography and brain magnetic resonance imaging (MRI), and was diagnosed with IIH despite normal opening CSF pressure. Following treatment with acetazolamide, a complete remission of her symptoms was achieved, accompanied by significant improvement of the fundoscopy findings.

Conclusion

Although normal opening CSF pressure in IIH patients is rare, clinicians should be aware of this IIH variant and promptly indicate IIH treatment in patients presenting with typical clinical symptoms and neuroimaging findings suggestive of IIH.
Circulating HMGB1 is increased in myelodysplastic syndrome but not in other bone marrow failure syndromes: proof-of-concept cross-sectional study
Authors: Apodaca-Chávez Elia , Demichelis-Gómez Roberta , Rosas-López Adriana , Mejía-Domínguez Nancy R. , Galvan-López Isabela , Addorosio Meghan , Tracey Kevin J. , Valdés-Ferrer Sergio Iván
Published: October 2022

Background:

Myelodysplastic syndrome (MDS) is associated with persistent immune activation. High mobility group box-1 (HMGB1) is a ubiquitous, functionally diverse, non-histone intranuclear protein. During acute and chronic inflammatory states, HMGB1 is actively released by inflammatory cells, further amplifying the inflammatory response. A role in MDS and other hypoplastic bone marrow (BM) disorders is incompletely understood.

Objectives:

The objective of the study is to evaluate whether circulating HMGB1 is elevated in patients with MDS and other BM failure syndromes [namely, aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH)].

Design:

This is a observational, cross-sectional, single-center, exploratory study.

Methods:

We evaluated circulating concentrations of HMGB1, interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α in patients with MDS and age-matched hematologically healthy controls as well as patients with AA and PNH.

Results:

We included 66 patients with MDS and 65 age-matched controls as well as 44 patients with other BM failures (AA = 27, PNH = 17). Circulating levels of HMGB1 were higher in patients with MDS [median, 4.9 ng/ml; interquartile range (IQR): 2.3–8.1] than in AA (median, 2.6 ng/ml; IQR: 1.7–3.7), PNH (median, 1.7 ng/ml; IQR: 0.9–2.5), and age-matched healthy individuals (median, 1.9 ng/ml; IQR: 0.9–2.5) ( p = 0.0001). We observed higher concentrations of HMGB1 in the very low/low-risk MDS patients than in the intermediate/high/very high-risk ones ( p = 0.046). Finally, in comparison with patients with AA, those with hypocellular MDS (h-MDS) had significantly higher levels of circulating HMGB1 ( n = 14; median concentration, 5.6 ng/ml, IQR: 2.8–7.3; p = 0.006). We determined a circulating HMGB1 value of 4.095 ng/ml as a diagnostic cutoff differentiator between h-MDS and AA.

Conclusion:

These observations indicate that circulating HMGB1 is increased in patients with MDS. HMGB1 (but not IL-1β or TNF-α) differentiated between MDS and other BM failures, suggesting that HMGB1 may be mechanistically involved in MDS and a druggable target to decrease inflammation in MDS.
The Poggendorff illusion in Ruben's Descent from the Cross in Antwerp: Does the illusion even matter?
Authors: Daneyko Olga , Stucchi Natale , Zavagno Daniele
Published: October 2022

Two experiments are described, the purpose of which was to investigate the presence of a misalignment illusion caused by Poggendorff-like conditions in two paintings by Peter Paul Rubens, both depicting the Descent from the Cross, one located in Antwerp (Belgium), the other in Lille (France). The first shows a geometrical misalignment made by Rubens in a minor detail, which is considered proof that the artist observed the Poggendorff illusion. The second painting, instead, shows a perfect geometrical alignment in a similar detail. In experiment 1, participants were asked to align a top segment to a lower one in two types of stimuli: a full-size digitally manipulated reproduction of the painting and a Poggendorff-like configuration that recalled the painting's lines displacement and tilt. Adjustments were performed from two distances, one up close (painting distance) and one from below and far (observation distance). Results confirmed the presence of the Poggendorff illusion, but mean adjustments significantly differed from the misalignment perpetrated by Rubens. Experiment 2 was set up in a similar fashion with the Lille painting. Results confirmed the presence of the Poggendorff illusion also in this painting; however, the alignment by Rubens coincides with the geometrical one. Results from both experiments do not support the claim that Rubens observed the Poggendorff illusion and therefore corrected for it in the Antwerp painting. An alternative account is discussed, which relates to the structural layout of the painting.
Not waving but drowning
Authors: Phelps Nicholas A.
Published: October 2022

Disciplinary perspectives on the city and its materiality are as splintered as the contemporary city itself. This forum article offers a sympathetic critique of planning's contributions to discussions of the compact city idea. However, it also reproduces some of the misconceptions geography and planning scholars have of each other and their work in which waving is mistaken for drowning.
Assessment of suitable referral, effectiveness and long-term outcomes of standard vs intensive pain management programmes for people with chronic pain
Authors: Hearn Jasmine H. , Martin Sarah , Smith Melanie
Published: October 2022

Background

Chronic pain is a leading cause of disability, often requiring multidisciplinary management. 2021 NICE guidance has questioned the quality of the evidence surrounding the efficacy of pain management programmes (PMPs), with only minor benefit demonstrated in psychological and physical outcomes. There is need for further high-quality evidence for the efficacy of PMPs for a range of chronic pain conditions and to identify barriers to successful management of chronic pain.

Objective

This service evaluation utilised routinely collected outcome data of 508 PMP attendees to investigate change in pain- and patient-related outcomes across two distinct PMPs; a standard and an intensive PMP, and establish their longer-term efficacy and appropriateness for patients with differing degrees of need.

Results

More people with chronic widespread pain, fibromyalgia, and osteoarthritis were referred to the intensive PMP (reflecting greater disability and distress in these conditions). Those referred to the intensive PMP demonstrated greater distress (such as more severe depression and anxiety), lower pain acceptance and poorer physical function. Improvements were observed in all outcomes across both PMPs (including physical function, pain catastrophising and pain acceptance). Depression and disability demonstrated clinically meaningful improvements in the intensive PMP, and pain severity showed clinically meaningful improvement in both PMPs. However, depression severity, disability, pain severity, and pain interference significantly deteriorated at 6-month follow-up for those on the intensive PMP, with pain severity increasing to a clinically meaningful degree (by more than 10%), though these outcomes remained better than at baseline.

Conclusion

This evaluation identified that people with chronic pain most at risk of deterioration in physical and psychological wellbeing after completing a PMP require early identification to mitigate such deterioration. Established and emerging PMPs need to be tailored to the needs of this group, particularly at follow-up to reduce risks of pain severity increasing, alongside establishing/reinforcing safeguards against deterioration post-PMP.
Tooth aspiration in two cats following maxillofacial trauma
Authors: Bar Giora Yael , Weingram Tomer , Altabet Lior , Yair Nadav , Kachtan Ido , Bar Am Yoav
Published: October 2022

Case series summary

Tooth aspiration is a rare occurrence in human medicine, and even more so in veterinary medicine. This report describes two cats that aspirated a tooth (one canine tooth and one premolar tooth) following maxillofacial trauma. One cat presented with dyspnoea, while the other showed no respiratory clinical signs. In both cases diagnosis was reached by obtaining routine thoracic radiographs, and successful retrieval of the teeth was achieved by bronchoscopy. Both cats recovered uneventfully.

Relevance and novel information

To our knowledge, this is the first report in the veterinary literature of tooth aspiration into the tracheobronchial tree following maxillofacial trauma. The scope of this case series is to raise awareness that tooth aspiration can occur following maxillofacial trauma and has the potential for serious complications if not diagnosed and treated promptly. Therefore, an oral examination must be performed in every maxillofacial trauma patient and missing teeth should be accounted for, even when respiratory clinical signs are not detected.
Issues with the Swedish e-prescribing system – An analysis of health information technology-related incident reports using an existing classification system
Authors: Rahman Jabin Md Shafiqur , Hammar Tora
Published: October 2022

Objective

To identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges.

Methods

A number of health information technology-related incidents were collected retrospectively from various sources using purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents ( n = 24) were subjected to an existing framework, i.e., the Health Information Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis.

Results

Several types of software-related issues ( n = 22) were identified: system configuration, interface with other software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges.

Conclusions

This study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.
Challenges facing Pakistan in the interconnected and interdependent global world
Authors: Aamir Samreen Bari
Published: October 2022

Globalization is a trendy, intriguing, and compelling term, but it is also divisive, contentious, and problematic. It is also one of the 21st century's most talked-about economic, political, social, and cultural phenomena. Globalization, according to several writers, is a multifaceted phenomenon. Internationalization and cosmopolitanism, assimilation and fragmentation, universalization and homogenization are all part of this process, which is essentially an unavoidable dialectical mechanism involving rapid social, cultural, political, and technical change. As a result, these changes are occurring concurrently in many directions, at various sizes, and in various regions, demonstrating the interdependence and interconnection of all these disciplines, sizes, and scenarios. There are various facets of globalization that are influencing the current world, and each of these dimensions is inextricably linked to the others. Interdependency and interconnectivity are the two main processes and key tools of globalization that are responsible for creating a homogenized and deterritorialized world. Pakistan attempted to cultivate excellent connections with the rest of the world immediately after independence in order to capitalize on the opportunities created by globalization. However, it is critical to determine whether Pakistan can make use of the prospects as a developing country or whether the opportunities are solely available to industrial and developed countries. It is also important to examine Pakistan's efforts to integrate into the global community and to investigate its repercussions. This research article is a case study of Pakistan to study the implications of globalization on local culture and common citizens. For this purpose, a simple and direct research methodology was adopted by using both primary (including scholarly works, research articles, reports, case studies, and dissertations) and secondary sources (qualitative and quantitative data supplied by other scholars and agencies).
Identification of Community-Dwelling Older Adults With Shoulder Dysfunction: A Pilot Study to Evaluate the Disabilities of the Arm, Shoulder and Hand Survey
Authors: Davis Derik L. , Almardawi Ranyah , Terrin Michael L.
Published: October 2022

Introduction

The Disabilities of the Arm, Shoulder and Hand (DASH) survey estimates the upper limbs’ dysfunction in one score, but limited evidence exists to justify use of DASH to screen older adults for shoulder dysfunction at routine health maintenance primary care visits. We sought (1) to determine if the DASH, American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) surveys are related to one another and (2) to determine the relationship of DASH, ASES and SST scores with 36-Item Short Form (SF-36) subscales, shoulder forward flexion range of motion (FF-ROM) and abduction (ABD-ROM) in older adults.

Methods

Prospective pilot study of 23 community-dwelling adult volunteers [mean age (± standard deviation), 69.3 ± 6.7 years; range, 61-84 years, with no rotator cuff repair or joint replacement. Shoulder MRI, ROM testing, DASH, ASES, SST, SF-36, Katz activities of daily living (ADLs), and Lawton-Brody instrumental ADLs (IADLs) were completed at one time point. Descriptive and correlation analyses were performed.

Results

Means: DASH, 17.4 ± 19.5; ASES, 81.3 ± 19.7; SST, 71.7 ± 28.5; Katz ADLs, 5.9 ± .3; Lawton-Brody IADLs, 8.0 ± .0; FF-ROM, 140.2° ± 31.5°; and ABD-ROM, 128.3° ± 31.9°. Nearly 48% had supraspinatus tendon tear. Correlation among DASH, ASES, and SST was strong (|rho ≥.88|; P < .001). DASH, ASES, and SST had strong correlation (|rho ≥.71|; P < .001) with shoulder FF-ROM and ABD-ROM. DASH had near equivalent or slightly stronger correlation for all SF-36 subscales relative to ASES and SST. DASH showed strong or moderate correlation ( P < .05) to most SF-36 subscales.

Conclusion

DASH, ASES and SST strongly correlated with one another. DASH, relative to ASES and SST, has similar correlation to shoulder FF-ROM, ABD-ROM and SF-36 subscales in older adults. Our pilot study suggests that the DASH survey has potential utility to identify occult shoulder dysfunction in community-dwelling older adults who have normal Katz ADLs and Lawton-Brody IADLs if administered during routine health maintenance primary care visits.
Depression Screening Implementation: Quality Improvement Project in a Primary Care Clinic for First Responders
Authors: Blake Canaan
Published: October 2022

Background:

Depression in the U.S. population affects approximately 17.5 million people, with an approximate annual economic cost of US$326 billion. The overall objective of this quality improvement program was implementation of a standardized screening protocol using a validated screening instrument to identify depression in first responders in a primary care setting.

Methods:

This program applied the Knowledge-to-Action framework utilizing the 9-question Patient Health Questionnaire (PHQ-9) screening tool. The outcome measure was screening completion with a process measure of depression questionnaires provided to patients, and balance measures of time of visit and referral rate. In a pre-/postintervention project design, clinic staff were trained on depression screening. PHQ-9 questionnaires were placed in all exam rooms for patients and providers to discuss. Referrals were made to the staff psychologist or to medical providers based on evaluations.

Findings:

From pre- to postintervention, screening increased from less than 1% to a screening rate of 92%. Appointments for depression intervention increased to 50%, 44 patients for counseling and 12 for medical therapy.

Conclusions/Applications to Practice:

A standardized screening protocol using a validated self-assessment tool improved depression surveillance and increased referrals for treatment. A training program with an accompanying policy was designed to sustain this program and may serve as a model for other programs serving first responders.
Evaluation of lipid layer tear film changes after femtosecond small incision lenticule extraction
Authors: Al Sabti Khalid , Zechevikj Snezhana , Raizada Seemant
Published: October 2022

Background:

Dry eye disease is common after refractive procedures due to tear film instability. There are several causative factors for tear film instability, but the state of individual components of the tear film is not assessed much in published literature. This article quantifies the lipid layer thickness (LLT) of the tear film using surface interferometry before and after the small incision lenticule extraction (SMILE) refractive procedure.

Objectives:

This study aimed to evaluate the effects of femtosecond SMILE on the postoperative stability of the LLT of the tear film.

Design:

This was a prospective, interventional, non-case–control study.

Methods:

A total of 160 eyes of 80 patients were enrolled in the study. The follow-up period was 6 months after surgery. A noninvasive surface interferometer was used to measure the thickness of the lipid layer before surgery and was repeated at 3 and 6 months after surgery. The main outcome measure was the change in average LLT at 3 and 6 months after SMILE and its statistical significance.

Results:

There were 48 women and 32 men. Age ranged from 21 to 42 years (mean = 27 ± 6.4). Mean LLT at baseline was [oculus dextrus (OD) = 53.38 (±7.24) nm; oculus sinister (OS) = 52.21 (±6.95) nm], at 3 months [OD = 54.38 (±5.75) nm; OS = 53.26 (±5.70)], and at 6 months [OD = 53.31 (±5.66) nm; OS = 52.39 (±5.94)]. Mean LLT showed mild improvement at 3 months after surgery (OD = 53.38–54.38 mm, p = 0.0417; OS = 52.21–53.26 mm, p = 0.0398). There was no significant change in LLT from the baseline before surgery to levels 6 months after surgery ( p = 0.8914 OD; p = 0.7368 OS).

Conclusion:

The SMILE refractive procedure did not alter the LLT that remained stable and adequate at 6 months postoperative follow-up.
Stress Overload and DNA Methylation in African American Women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study
Authors: Kalinowski Jolaade , Huang Yunfeng , Rivas Martin A , Barcelona Veronica , Wright Michelle L , Crusto Cindy , Spruill Tanya , Sun Yan V , Taylor Jacquelyn Y
Published: October 2022

Introduction:

Experiencing psychosocial stress is associated with poor health outcomes such as hypertension and obesity, which are risk factors for developing cardiovascular disease. African American women experience disproportionate risk for cardiovascular disease including exposure to high levels of psychosocial stress. We hypothesized that psychosocial stress, such as perceived stress overload, may influence epigenetic marks, specifically DNA methylation (DNAm), that contribute to increased risk for cardiovascular disease in African American women.

Methods:

We conducted an epigenome-wide study evaluating the relationship of psychosocial stress and DNAm among African American mothers from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) cohort. Linear mixed effects models were used to explore the epigenome-wide associations with the Stress Overload Scale (SOS), which examines self-reported past-week stress, event load and personal vulnerability.

Results:

In total, n = 228 participants were included in our analysis. After adjusting for known epigenetic confounders, we did not identify any DNAm sites associated with maternal report of stress measured by SOS after controlling for multiple comparisons. Several of the top differentially methylated CpG sites related to SOS score ( P < 1 × 10−5), mapped to genes of unknown significance for hypertension or heart disease, namely, PXDNL and C22orf42.

Conclusions:

This study provides foundational knowledge for future studies examining epigenetic associations with stress and other psychosocial measures in African Americans, a key area for growth in epigenetics. Future studies including larger sample sizes and replication data are warranted.
Reintervention for Achalasia: A Review of the Literature
Authors: Weir William B. , Chang Andrew C.
Published: October 2022

Achalasia is a complex, debilitating, and incurable disease. Several treatment modalities exist for palliation of symptoms. Up to 25% of patients will require reintervention yet no gold standard treatment for reintervention has emerged. Cumulative experience suggests reoperative Heller esophagomyotomy (HM) is a safe and viable option after previous myotomy or pneumatic dilation. Peroral endoscopic myotomy (POEM) has shown promising results for index treatment and reintervention. Single center studies suggest HM after POEM carries a lower success rate and should be chosen in select situations. Disease progression, sigmoid or megaesophagus favor esophagectomy as a definitive option.
Achalasia in Children and Adolescents
Authors: Ambartsumyan Lusine
Published: October 2022

Pediatric achalasia is a rare disorder of the esophagus that results in functional obstruction at gastroesophageal junction and impedes antegrade movement of bolus into stomach. Children present with vomiting/regurgitation, dysphagia, weight loss, and nocturnal and respiratory symptoms. Diagnosis may be delayed as symptoms mimic common pediatric disorders. Diagnosis follows adult diagnostic pathways yet remains challenging given absence of normative values in children. Treatment goals are to reduce symptoms, improve esophageal emptying, and prevent megaesophagus. Laparoscopic myotomy, pneumatic dilation, and peroral endoscopic myotomy are definite treatment options in children. Follow-up is necessary to monitor/treat reflux and complications, disease recurrence/persistence, and megaesophagus.
Litus Ignotus: Lost coasts of Terra Nova in the sixteenth century
Authors: Bouchard Jack
Published: October 2022

What do we do with coasts that have been lost? What are we to do with places and stories large and small which once embodied the lived experience of life and work on the fishing coats of North America? This essay, following the work of the historian John Gillis, explores lost coasts from the sixteenth-century European fishery in the northwest Atlantic, a place known as Terra Nova to the mariners who went there. The essay dwells upon imagined islands, missing harbours, enigmatic fortifications and other places that existed in the earliest years of the fishery but which have since disappeared. In so doing, it shows how coasts can change and be lost over time, and how historians can try to recover these unknown shores.
A diagnostic classifier for pediatric chronic graft-versus-host disease: results of the ABLE/PBMTC 1202 study
Authors: Cuvelier Geoffrey D. E. , Ng Bernard , Abdossamadi Sayeh , Nemecek Eneida R. , Melton Alexis , Kitko Carrie L. , Lewis Victor A. , Schechter Tal , Jacobsohn David A. , Harris Andrew C. , Pulsipher Michael A. , Bittencourt Henrique , Choi Sung Won , Caywood Emi H. , Kasow Kimberly A. , Bhatia Monica , Oshrine Benjamin R. , Chaudhury Sonali , Coulter Donald , Chewning Joseph H. , Joyce Michael , Savaşan Süreyya , Pawlowska Anna B. , Megason Gail C. , Mitchell David , Cheerva Alexandra C. , Lawitschka Anita , Ostroumov Elena , Schultz Kirk R.
Published: October 2022

The National Institutes of Health Consensus criteria for chronic graft-versus-host disease (cGVHD) diagnosis can be challenging to apply in children, making pediatric cGVHD diagnosis difficult. We aimed to identify diagnostic pediatric cGVHD biomarkers that would complement the current clinical criteria and help differentiate cGVHD from non-cGVHD. The Applied Biomarkers of Late Effects of Childhood Cancer (ABLE) study, open at 27 transplant centers, prospectively evaluated 302 pediatric patients after hematopoietic cell transplant (234 evaluable). Forty-four patients developed cGVHD. Mixed and fixed effect regression analyses were performed on diagnostic cGVHD onset blood samples for cellular and plasma biomarkers, with individual markers declared relevant if they met 3 criteria: an effect ratio ≥1.3 or ≤0.75; an area under the curve (AUC) of ≥0.60; and a P value <5.814 × 10−4 (Bonferroni correction) (mixed effect) or <.05 (fixed effect). To address the complexity of cGVHD diagnosis in children, we built a machine learning–based classifier that combined multiple cellular and plasma biomarkers with clinical factors. Decreases in regulatory natural killer cells, naïve CD4 T helper cells, and naïve regulatory T cells, and elevated levels of CXCL9, CXCL10, CXCL11, ST2, ICAM-1, and soluble CD13 (sCD13) characterize the onset of cGVHD. Evaluation of the time dependence revealed that sCD13, ST2, and ICAM-1 levels varied with the timing of cGVHD onset. The cGVHD diagnostic classifier achieved an AUC of 0.89, with a positive predictive value of 82% and a negative predictive value of 80% for diagnosing cGVHD. Our polyomic approach to building a diagnostic classifier could help improve the diagnosis of cGVHD in children but requires validation in future prospective studies. This trial was registered at www.clinicaltrials.gov as #NCT02067832.
Pre-operative screening for sleep disordered breathing: obstructive sleep apnoea and beyond
Authors: Cheng Michael C.F. , Steier Joerg
Published: October 2022

Sleep disordered breathing describes an important group of conditions that causes abnormal nocturnal gas exchange, with important implications in the peri-operative management plan. An understanding of the pathophysiology behind obstructive sleep apnoea and other disorders that may lead to hypoventilation can help to prevent complications. Patients with these disorders may be minimally symptomatic and it requires careful screening in the pre-operative assessment process for a diagnosis to be made. Decisions regarding initiation of therapy, such as positive airway pressure, and delay of the operation need to be carefully weighed up against the urgency of the surgical intervention. Planning of the peri-operative care, including the use of positive airway pressure therapy and appropriate post-operative monitoring, can help to avoid respiratory and cardiovascular morbidities and improve clinical outcomes.

Educational aims

To review different types of sleep disordered breathing and available screening methods in pre-operative assessment.

To understand the pathophysiology behind sleep disordered breathing and how it can lead to complications in the peri-operative setting.

To review the planning and treatment strategies that should be considered as part of peri-operative management.
Recent advances in paediatric sleep disordered breathing
Authors: Garde Alison J.B. , Gibson Neil A. , Samuels Martin P. , Evans Hazel J.
Published: October 2022

This article reviews the latest evidence pertaining to childhood sleep disordered breathing (SDB), which is associated with negative neurobehavioural, cardiovascular and growth outcomes. Polysomnography is the accepted gold standard for diagnosing SDB but is expensive and limited to specialist centres. Simpler tests such as cardiorespiratory polygraphy and pulse oximetry are probably sufficient for diagnosing obstructive sleep apnoea (OSA) in typically developing children, and new data-processing techniques may improve their accuracy. Adenotonsillectomy is the first-line treatment for OSA, with recent evidence showing that intracapsular tonsillectomy results in lower rates of adverse events than traditional techniques. Anti-inflammatory medication and positive airway pressure respiratory support are not always suitable or successful, although weight loss and hypoglossal nerve stimulation may help in select comorbid conditions.

Educational aims

To understand the clinical impact of childhood sleep disordered breathing (SDB).

To understand that, while sleep laboratory polysomnography has been the gold standard for diagnosis of SDB, other diagnostic techniques exist with their own benefits and limitations.

To recognise that adenotonsillectomy and positive pressure respiratory support are the mainstays of treating childhood SDB, but different approaches may be indicated in certain patient groups.
E2F1 promotes cell cycle progression by stabilizing spindle fiber in colorectal cancer cells
Authors: Fang Zejun , Lin Min , Chen Shenghui , Liu Hong , Zhu Minjing , Hu Yanyan , Han Shanshan , Wang Yizhang , Sun Long , Zhu Fengjiao , Xu Chengfu , Gong Chaoju
Published: October 2022

Background

E2F1 is a transcription factor that regulates cell cycle progression. It is highly expressed in most cancer cells and activates transcription of cell cycle-related kinases. Stathmin1 and transforming acidic coiled-coil-containing protein 3 (TACC3) are factors that enhance the stability of spindle fiber.

Methods

The E2F1-mediated transcription of transforming acidic coiled-coil-containing protein 3 (TACC3) and stathmin1 was examined using the Cancer Genome Atlas (TCGA) analysis, quantitative polymerase chain reaction (qPCR), immunoblotting, chromatin immunoprecipitation (ChIP), and luciferase reporter. Protein–protein interaction was studied using co-IP. The spindle structure was shown by immunofluorescence. Phenotype experiments were performed through MTS assay, flow cytometry, and tumor xenografts. Clinical colorectal cancer (CRC) specimens were analyzed based on immunohistochemistry.

Results

The present study showed that E2F1 expression correlates positively with the expression levels of stathmin1 and TACC3 in colorectal cancer (CRC) tissues, and that E2F1 transactivates stathmin1 and TACC3 in CRC cells. Furthermore, protein kinase A (PKA)-mediated phosphorylation of stathmin1 at Ser16 is essential to the phosphorylation of TACC3 at Ser558, facilitating the assembly of TACC3/clathrin/α-tubulin complexes during spindle formation. Overexpression of Ser16-mutated stathmin1, as well as knockdown of stathmin1 or TACC3, lead to ectopic spindle poles including disorganized and multipolar spindles. Overexpression of wild-type but not Ser16-mutated stathmin1 promotes cell proliferation in vitro and tumor growth in vivo. Consistently, a high level of E2F1, stathmin1, or TACC3 not only associates with tumor size, lymph node metastasis, TNM stage, and distant metastasis, but predicts poor survival in CRC patients.

Conclusions

E2F1 drives the cell cycle of CRC by promoting spindle assembly, in which E2F1-induced stathmin1 and TACC3 enhance the stability of spindle fiber.
Prevalence of sexual harassment among young Spaniards before, during, and after the COVID-19 lockdown period in Spain
Authors: Casanovas Laura Vall-Llosera , Serra Laura , Canals Carme Saurina , Sanz-Barbero Belén , Vives-Cases Carmen , López Maria José , Otero-García Laura , Pérez Gloria , Renart-Vicens Gemma
Published: October 2022

Background

Sexual harassment is a type of coercion, including social pressure, intimidation, physical force, and verbal acts, in addition to other forms such as cyber-harassment, recognized as a major important public health problem.

Methods

This cross-sectional study, based on a survey administered online to men and women aged 18 to 35 years and living in Spain throughout 15th and 28th October 2020, aims to analyze the prevalence and factors associated with sexual harassment among young people in Spain within the last 12 months, particularly according to the COVID-19 lockdown period. It has been conducted by bivariate analysis and robust Poisson regression models. The final sample includes 2.515 participants.

Results

The results indicate that women were almost twice as likely as men to experience sexual harassment (49% vs 22.2%). Also, among heterosexual men and women, the estimated prevalence was lower concerning that observed among bisexuals, gays, and lesbians (31.5% vs 53, 39.2, and 34.6% respectively). The prevalence percentage in the 18–24 age group was twice high as that observed in the 30–35 age group. Finally, during the lockdown period, the harassment through electronic channels increased (32.6% vs 16.5 and 17.8% before and after this period, respectively) and decreased on public roads (22.9% vs 63.4 and 54.4% pre-lockdown and post-lockdown periods, respectively).

Conclusion

These findings highlight that sexual harassment presents a high prevalence among young people, especially cyber-harassment, and workplace harassment and it is important to be aware that young women are more likely to suffer harassment and even more if they do not have a partner or have LGB orientation. During the lockdown sexual harassment has moved from public spaces to the social network.
Different tibial rotational axes can be applied in combination according to the tibial tuberosity–posterior cruciate ligament distance in total knee arthroplasty
Authors: Zhang Le-Shu , Zhou Hang , Zhang Jin-Cheng , Zhang Qiang , Chen Xiang-Yang , Feng Shuo
Published: October 2022

Purpose

The purpose of this study was to investigate whether tibial tuberosity–posterior cruciate ligament (TT-PCL) distance is representative of the true lateralization of tibial tuberosity in isolation and its influence on the accuracy of the Akagi line and medial third of the tibial tuberosity (MTTT).

Methods

A total of 135 osteoarthritis patients with varus knees who undergoing computed tomography scans were enrolled to establish three-dimension models of the knees. Tibial width (TW), tibial tuberosity lateralization (TTL), posterior cruciate ligament lateralization (PCLL), knee rotation angle (KRA) and tibial rotational axes were measured and investigated their correlations with TT-PCL distance. Based on the analysis of receiver operating characteristic (ROC) curve, the influence of TT-PCL distance on the distributions of mismatch angles of tibial rotational axes was investigated with a safe zone (-5° to 10°).

Results

TT-PCL distance was in significantly positive correlation with TW (r = 0.493; P < 0.001) and TTL (r = 0.378; P < 0.001) which was different with PCLL (r = 0.147; P = 0.009) and KRA (r = -0.166; P = 0.054). All tibial rotational axes were significantly positively correlated with TT-PCL distance (P < 0.001). The mismatch angles between the vertical line of the surgical epicondylar axis (SEA) and the Akagi line and MTTT were -1.7° ± 5.3° and 7.6° ± 5.6° respectively. In terms of the optimal cut-off value of 19 mm for TT-PCL distance, the Akagi line applied as tibial rotational axis ensures 87.3% of the positions of tibial components within the safe zone when TT-PCL distance > 19 mm, and MTTT ensures 83.3% when TT-PCL distance ≤ 19 mm.

Conclusion

TT-PCL distances cannot reflect the true lateralization of tibial tuberosity in isolation but can aid in the combination of the Akagi line and MTTT in varus knees. The patients with TT-PCL distance > 19 mm are recommended to reference the Akagi line for tibial rotational alignment. MTTT is recommended to the patients with TT-PCL distance ≤ 19 mm. The study will aid surgeons in deciding which reference may be used by measuring TT-PCL distance using a preoperative CT.
Contribution of coronal vertebral and IVD wedging to Cobb angle changes in adolescent idiopathic scoliosis during growth
Authors: Cheung Wing Ki , Cheung Jason Pui Yin
Published: October 2022

Study design

Prospective study

Background

Vertebral and intervertebral disc (IVD) wedging are often seen in patients with adolescent idiopathic scoliosis (AIS). However, the relationship between wedging and curve progression, and the change of wedging before bracing to final weaning is unknown. The aim of this study was to investigate the pattern and sequence of vertebral and IVD wedging development, and to determine the relationship between the change of wedging and curve progression in AIS during growth.

Methods

This was a prospective study of 32 AIS females with right-sided thoracic curves and/or left-sided lumbar curves who completed brace treatment. They were classified into progression and non-progression groups. Vertebral and IVD wedging were calculated for each spinal segment. The wedging pattern was first identified and then used to determine the sequence of wedging development. Percentage change in the sum of wedging during growth was calculated and compared.

Results

The sum of vertebral wedging for both groups was 2.4° to 8.7° more than that of IVD wedging in the thoracic spine but 8.7° to 17.7° less in the lumbar spine. Out of the 20 curves assessed, 5 thoracic curves and 1 lumbar curve developed vertebral wedging before IVD wedging, and 3 thoracic curves and 4 lumbar curves had the opposite pattern. The progression group had larger increases in sum of vertebral (40%) and IVD (28.6%) wedging as compared to the non-progression group (both 16.7%). A significant difference in wedging between the first and the latest visits was found in the progression group only (p < 0.05).

Conclusion

Pattern and sequence of vertebral and IVD wedging were related to the location of the curve rather than the presence of curve progression. Progressed curves were associated with increased wedging during growth.

Level of evidence

II
Interprofessional student-led clinics: the volunteer patient experience
Authors: Burgess Annette , Roberts Chris
Published: October 2022

Background

Learning from patients and gaining an understanding of their lived experience plays an important role in improving health professions education. However, opportunities for students to engage in interprofessional learning activities involving patients as partners remain limited. In 2018, we developed an interprofessional student-led clinic where people living with Parkinson’s Disease voluntarily participated as ‘patient-partners’. The aim of this pilot study was to explore patients’ experience and motivation for participation.

Methods

In 2018 the clinic was implemented five times. Four patient volunteers and six to eight students from a mix of disciplines attended each clinic. Qualitative data were collected via semi-structured focus groups with patients. Data were analysed using thematic analysis.

Results

Eleven patients participated in the focus groups. Patients found the interprofessional nature of the clinic beneficial to their health goals. Their interactions with students from different disciplines helped to build their healthcare knowledge and confidence to ask additional questions of health professionals. Patients felt they offered unique perspectives to students of their own lived experiences. They found sharing their stories with students and each other built a sense of community.

Conclusion

Patients felt they enriched the learning environment, helping students to build their knowledge and skills by providing authentic patient perspectives. The interprofessional aspect enhanced the patient experience in a number of ways. Patients found the multiple perspectives of healthcare helped them to build their own knowledge, and reflect on their changing needs. Warranting further investigation, our findings indicate that participation in the clinics may have positively influenced patients’ health seeking behaviours.
A differentiated digital intervention to improve antiretroviral therapy adherence among men who have sex with men living with HIV in China: a randomized controlled trial
Authors: Jiao Kedi , Wang Chunmei , Liao Meizhen , Ma Jing , Kang Dianmin , Tang Weiming , Tucker Joseph D. , Ma Wei
Published: October 2022

Background

Antiretroviral therapy (ART) adherence is still suboptimal among some key populations, highlighting the need for innovative tailored strategies. This randomized controlled trial (RCT) aimed to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men (MSM) living with HIV in China.

Methods

The two-armed parallel RCT was conducted at one HIV clinic in Jinan of China from October 19, 2020, to June 31, 2021. Men were referred by health providers to join the study and then choose one of three digital strategies—text message, only instant message, or instant message plus social media. They were assigned in a 1:1 ratio to the intervention arm or control arm using block randomization, and inside each arm, there were three groups depending on the type of delivering the message. The groups were divided according to participants’ preferred digital strategies. The intervention arm received ART medication messages, medication reminders, peer education, and involved in online discussion. The control arm received messages on health behavior and nutrition. The primary outcome was self-reported optimal ART adherence, defined as not missing any doses and not having any delayed doses within a one-month period. Secondary outcomes included CD4 T cell counts, viral suppression, HIV treatment adherence self-efficacy, and quality of life. Intention-to-treat analysis with generalized linear mixed models was used to evaluate the intervention’s effect.

Results

A total of 576 participants were enrolled, including 288 participants assigned in the intervention arm and 288 assigned in the control arm. Most were ≤ 40 years old (79.9%) and initiated ART ≤ 3 years (60.4%). After intervention, the proportion of participants achieving optimal ART adherence in the intervention arm was higher than in the control arm (82.9% vs 71.1%). The differentiated digital intervention significantly improved ART adherence (RR = 1.74, 95%CI 1.21–2.50). Subgroup analysis showed one-to-one instant message-based intervention significantly improved ART adherence (RR = 2.40, 95% CI 1.39–4.17).

Conclusions

The differentiated digital intervention improved ART adherence among MSM living with HIV in China, which could be integrated into people living with HIV (PLWH) management and further promoted in areas where PLWH can access text messaging and instant messaging services.

Trial registration

ChiCTR2000041282. Retrospectively registered on 23 December 2020.
Establishment of a recombinase polymerase amplification (RPA) fluorescence assay for the detection of swine acute diarrhea syndrome coronavirus (SADS-CoV)
Authors: Cong Xiao , Zhu Yujun , Liu Xinchao , Lian Yuexiao , Huang Bihong , Luo Yinzhu , Gu Youfang , Wu Miaoli , Shi Yue
Published: October 2022

Background

Swine acute diarrhea syndrome coronavirus (SADS-CoV) causes acute vomiting and diarrhea in piglets, leading to significant financial losses for the pig industry. Recombinase polymerase amplification (RPA) is a rapid nucleic acid amplification technology used under constant temperature conditions. The study established a real-time reverse transcription (RT)-RPA assay for early diagnosis of SADS-CoV. 

Results

The detection limit of the real-time RT-RPA was 74 copies/µL of SADS-CoV genomic standard recombinant plasmid in 95% of cases. The assay was performed in less than 30 min and no cross-reactions were observed with eight other common viruses that affect swine, including classical swine fever virus (CSFV), porcine reproductive and respiratory syndrome virus (PRRSV), pseudo rabies virus (PRV), swine influenza virus (SIV), seneca valley virus (SVA), transmissible gastroenteritis virus (TGEV), porcine epidemic diarrhea virus (PEDV) and porcine deltacoronavirus (PDCoV). The coefficient of variation (C.V.) values of the two standards dilutions and three positive clinical sample ranged from 2.95% to 4.71%. A total of 72 clinical fecal samples from swine with diarrheal symptoms were analyzed with the developed RT-RPA and quantitative RT-PCR. There was 98.61% agreement between the RT-RPA and the quantitative real-time PCR results.

Conclusions

These results indicated that the developed RT-RPA assay had good specificity, sensitivity, stability and repeatability. The study successfully established a broadly reactive RT-RPA assay for SADS-CoV detection.
Neutralizing GM-CSF autoantibodies in pulmonary alveolar proteinosis, cryptococcal meningitis and severe nocardiosis
Authors: Salvator Hélène , Cheng Aristine , Rosen Lindsey B. , Williamson Peter R. , Bennett John E. , Kashyap Anuj. , Ding Li , Kwon-Chung Kyung J. , Namkoong Ho , Zerbe Christa S. , Holland Steven M.
Published: October 2022

Background

Anti GM-CSF autoantibodies (aAb) have been related to acquired pulmonary alveolar proteinosis (PAP) and described in cases of severe infections such as cryptococcosis and nocardiosis in previously healthy subjects. Whether there are different anti-GM-CSF autoantibodies corresponding to these phenotypes is unclear. Therefore, we examined anti-GM-CSF autoantibodies to determine whether amount or neutralizing activity could distinguish between groups.

Methods

Plasma samples gathered in the National Institute of Health from patients with anti GM-CSF aAb and either PAP (n = 15), cryptococcal meningitis (n = 15), severe nocardiosis (n = 5) or overlapping phenotypes (n = 6) were compared. The relative amount of aAb was assessed using a particle-based approach, reported as a mouse monoclonal anti-human GM-CSF as standard curve and expressed in an arbitrary Mouse Monoclonal Antibody Unit (MMAU). The neutralizing activity of the plasma was assessed by inhibition of GM-CSF-induced intracellular phospho-STAT5 (pSTAT5) in monocytes.

Results

Anti-GM-CSF aAb relative amounts were higher in PAP patients compared to those with cryptococcosis (mean 495 ± 464 MMAU vs 197 ± 159 MMAU, p = 0.02); there was no difference with patients with nocardiosis (430 ± 493 MMAU) nor between the two types of infections.

The dilution of plasma resulting in 50% inhibition of GM-CSF-induced pSTAT5 (approximate IC50) did not vary appreciably across groups of patients (1.6 ± 3.1%, 3.9 ± 6% and 1.8 ± 2.2% in PAP patients, cryptococcosis and nocardiosis patients, respectively). Nor was the concentration of GM-CSF necessary to induce 50% of maximal GM-CSF-induced pSTAT5 in the presence of 10 MMAU of anti-GM-CSF aAb (EC50). When studying longitudinal samples from patients with PAP or disseminated nocardiosis, the neutralizing effect of anti-GM-CSF aAb was relatively constant over time despite targeted treatments and variations in aAb levels.

Conclusions

Despite different clinical manifestations, anti-GM-CSF antibodies were similar across PAP, cryptococcosis and nocardiosis. Underlying host genetics and functional analyses may help further differentiate the biology of these conditions.