bluuebunny/crossref_metadata_2025 huggingface dataset:
Four new species of the diving beetle genus Laccophilus Leach, 1815 from Madagascar (Coleoptera, Dytiscidae, Laccophilini)
Authors: MANUEL MICHAËL , RAMAHANDRISON ANDRIAMIRADO T.
Published: August 2020

Four new Laccophilus species are described from Madagascar, three belonging to the L. alluaudi-group (Laccophilus leguyaderi sp. nov., endemic of the Andringitra massif, L. bergsteni sp. nov., endemic of central highland mountains, and L. makay sp. nov., endemic of the Makay massif) and one belonging to the L. laeticulus group (L. rakouthae sp. nov., endemic of the Ankaratra massif). Habitus in dorsal and ventral views and male genitalia are illustrated for the new species (and for comparison, L. alluaudi and L. transversovittatus); furthermore, their habitat preferences and geographical distributions are described and illustrated. An identification key for all species of the L. alluaudi group is provided. The discussion is focused on the interest of the newly described taxa in the context of species radiations in Madagascar.
Multimodal Analgesia and Decreased Opioid Use in Adult Trauma Patients
Authors: Drahos Andrew L. , Scott Anthony M. , Johns Tracy J. , Ashley Dennis W.
Published: August 2020

Background

There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center.

Methods

In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group.

Results

A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease ( P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55).

Discussion

Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.
SETD1 and NF-κB Regulate Periodontal Inflammation through H3K4 Trimethylation
Authors: Francis M. , Gopinathan G. , Salapatas A. , Nares S. , Gonzalez M. , Diekwisch T.G.H. , Luan X.
Published: August 2020

The inflammatory response to periodontal pathogens is dynamically controlled by the chromatin state on inflammatory gene promoters. In the present study, we have focused on the effect of the methyltransferase SETD1B on histone H3 lysine K4 (H3K4) histone trimethylation on inflammatory gene promoters. Experiments were based on 3 model systems: 1) an in vitro periodontal ligament (PDL) cell culture model for the study of SETD1 function as it relates to histone methylation and inflammatory gene expression using Porphyromonas gingivalis lipopolysaccharide (LPS) as a pathogen, 2) a subcutaneous implantation model to determine the relationship between SETD1 and nuclear factor κB (NF-κB) through its activation inhibitor BOT-64, and 3) a mouse periodontitis model to test whether the NF-κB activation inhibitor BOT-64 reverses the inflammatory tissue destruction associated with periodontal disease. In our PDL progenitor cell culture model, P. gingivalis LPS increased H3K4me3 histone methylation on IL-1β, IL-6, and MMP2 gene promoters, while SETD1B inhibition decreased H3K4me3 enrichment and inflammatory gene expression in LPS-treated PDL cells. LPS also increased SETD1 nuclear localization in a p65-dependent fashion and the nuclear translocation of p65 as mediated through SETD1, suggestive of a synergistic effect between SETD1 and p65 in the modulation of inflammation. Confirming the role of SETD1 in p65-mediated periodontal inflammation, BOT-64 reduced the number of SETD1-positive cells in inflamed periodontal tissues, restored periodontal tissue integrity, and enhanced osteogenesis in a periodontal inflammation model in vivo. Together, these results have established the histone lysine methyltransferase SETD1 as a key factor in the opening of the chromatin on inflammatory gene promoters through histone H3K4 trimethylation. Our studies also confirmed the role of BOT-64 as a potent molecular therapeutic for the restoration of periodontal health through the inhibition of NF-κB activity and the amelioration of SETD1-induced chromatin relaxation.
Numerical analysis of drainage rate for multilayer drainage coalbed methane well group in Southern Qinshui basin
Authors: Hu Qiujia , Liu Shiqi , Sang Shuxun , Fang Huihuang , Tripathy Ashutosh , Yan Ling , Qin Mengfu , Mao Chonghao
Published: August 2020

Multilayer drainage is one of the important technologies for coalbed methane (CBM) production in China. In this study, a multi-field fully coupled mathematical model for CBM production was established to analyze the multilayer drainage of CBM well group in southern Qinshui basin. Based on the numerical simulation results, the characteristics of CBM well production under different drainage rates and key factors influencing the CBM production were further discussed. The results show that the effect of an increased drainage rate on gas production of CBM wells and CBM recovery of No.3 coal seam is not significant. However, it significantly improved the gas production of CBM wells and CBM recovery of No.15 coal seam. After a long period of production, the CBM content in No.3 coal seam has reduced to a low level and the pressure drop potential of No.3 coal seam is insignificant, which are important reasons for the insignificant increase of CBM production even under a drainage rate of 2 to 7 times. Conversely, No.15 coal seam has larger residual CBM content and increasing the drainage rate can significantly improve the pressure drop and superimposed well interference of No.15 coal seam, which means No.15 coal seam has greater production potential than No.3 coal seam. Therefore, it is recommended to improve the gas production and CBM recovery in No.15 coal seam by increasing the drainage rate, and the average hydraulic pressure drop should be 0.018–0.031 MPa/day. The influence of effective stress is weak in No.3 and No.15 coal seam, and the coal seam permeability is largely influenced by the shrinkage of coal matrix caused by CBM desorption. This indicates the feasibility of increase in gas production from CBM wells by increasing the drainage rate.
Does Caregiving Influence Planning for Future Aging?: A Mixed Methods Study Among Caregivers in Canada
Authors: Gorenko Julie A. , Konnert Candace , Speirs Calandra
Published: August 2020

A mixed method design was used to examine how caregiving and transitioning a family member into long-term care (LTC) influence planning. Participants, aged 50+ from the community, completed self-report questionnaires. Quantitative data evaluated differences between three groups (non-caregivers, caregivers, caregivers with experience in assisting with a LTC transition); and predictive effects of caregiving, care expectations and social support to planning. Interviews among a subsample of caregivers examined how experiences of caregiving, including assisting in a transition to LTC, and social support influenced planning. Results indicated that: (1) caregivers with LTC transition experience planned significantly more than non-caregivers, (2) caregiving, care expectations, and social support significantly predicted of planning, and (3) future care expectation was an important mechanism in the relationship between caregiving and planning. These findings underscore the impact of caregiving experiences on expectations of future care needs and preparation for future care needs, and the importance of social support.
The Dynamics of Interethnic Friendships and Negative Ties in Secondary School: The Role of Peer-Perceived Ethnicity
Authors: Boda Zsófia , Néray Bálint , Snijders Tom A. B.
Published: August 2020

This study examines ethnic integration in secondary school. Social identity theory suggests that perception of relevant individual attributes plays a crucial role in defining ingroups and outgroups, contributing to befriending, and disliking others. Therefore, we analyze the role of peer-perceived ethnicity in social ties. Networks of friendship, dislike, and perceived ethnicity were modeled together using dynamic stochastic actor-oriented models, separating the effect of perceived ethnicity on social ties from that of social ties on perceived ethnicity. Data came from a Hungarian sample of 12 school classes with one minority group: the Roma. Treating friendship and dislike as mutually exclusive and comparing them to neutral relations, we found evidence for the role of perceived ethnicity in dislike—majority students disliked those they perceived as minority peers. However, we saw no direct effect of ethnicity on the friendship network. Implications of the joint modeling of mutually exclusive relationship aspects are discussed.
The Accuracy of Peer Comparison Observations: A Simulated Analysis
Authors: Radley Keith C. , Dart Evan H. , Schrieber Stefanie R. , Davis John L.
Published: August 2020

Classroom observations are frequently conducted with the purpose of comparing the behavior of a target student to that of other peers within the same classroom. A variety of procedures may be utilized by researchers and practitioners to collect such data; however, little is known of the accuracy of estimates of behavior produced by such procedures relative to continuous behavior recording for the target student, peers sampled as a representation of the class, and the class as a whole. The purpose of the present study was to evaluate the accuracy of estimates of frequently utilized peer comparison observation procedures relative to duration recording. Data were simulated for 4,000 classroom observations, with variations in level of classroom behavior and length of observation being simulated. Results indicated that an Every Fifth interval procedure resulted in the lowest levels of absolute error during single observations for target students, with planned activity checks resulting in the most accurate estimates of class-wide behavior. Despite differences being apparent in level of accuracy of single observations, differences in accuracy across procedures were not apparent when all observations of the same type (i.e., duration, level of classroom behavior, and observation procedure) were compared.
Extracorporeal cardiopulmonary resuscitation with low pump flow for blocked modified Blalock–Taussig shunt followed by spontaneous recanalization
Authors: Bakos Matija , Dilber Daniel , Belina Drazen , Rubic Filip , Matic Toni
Published: August 2020

A 2-week-old male newborn with a double inlet left ventricle developed a cardiac arrest following modified Blalock–Taussig anastomosis in pediatric intensive care unit. Probable causes of the arrest were hemodynamic instability and thrombosed shunt, which was later recanalized on extracorporeal membrane oxygenation therapy, which was successfully used with a pump flow lower than recommended in these patients—without the shunt clip, but without any complications.
The effects of acute cannabidiol on cerebral blood flow and its relationship to memory: An arterial spin labelling magnetic resonance imaging study
Authors: Bloomfield Michael A P , Green Sebastian F , Hindocha Chandni , Yamamori Yumeya , Yim Jocelyn Lok Ling , Jones Augustus P M , Walker Hannah R , Tokarczuk Pawel , Statton Ben , Howes Oliver D , Curran H Valerie , Freeman Tom P
Published: August 2020

Background:

Cannabidiol (CBD) is being investigated as a potential treatment for several medical indications, many of which are characterised by altered memory processing. However, the mechanisms underlying these effects are unclear.

Aims:

Our primary aim was to investigate how CBD influences cerebral blood flow (CBF) in regions involved in memory processing. Our secondary aim was to determine if the effects of CBD on CBF were associated with differences in working and episodic memory task performance.

Methods:

We used a randomised, crossover, double-blind design in which 15 healthy participants were administered 600 mg oral CBD or placebo on separate days. We measured regional CBF at rest using arterial spin labelling 3 h after drug ingestion. We assessed working memory with the digit span (forward, backward) and n-back (0-back, 1-back, 2-back) tasks, and we used a prose recall task (immediate and delayed) to assess episodic memory.

Results:

CBD increased CBF in the hippocampus (mean (95% confidence intervals) = 15.00 (5.78–24.21) mL/100 g/min, t14 = 3.489, Cohen’s d = 0.75, p = 0.004). There were no differences in memory task performance, but there was a significant correlation whereby greater CBD-induced increases in orbitofrontal CBF were associated with reduced reaction time on the 2-back working memory task ( r= −0.73, p = 0.005).

Conclusions:

These findings suggest that CBD increases CBF to key regions involved in memory processing, particularly the hippocampus. These results identify potential mechanisms of CBD for a range of conditions associated with altered memory processing, including Alzheimer’s disease, schizophrenia, post-traumatic stress disorder and cannabis-use disorders.
Selling-to-Teach: A Didactical Look at the Natural Integration Between Teaching and Selling
Authors: Rippé Cindy B. , Weisfeld-Spolter Suri , Yurova Yuliya
Published: August 2020

This article examines whether educators’ use of selling activities (selling-to-teach) based on the seminal sales process can improve perceived and actual learning. By viewing the teaching interaction as a sales situation, the authors suggest professors can help students realize their need for learning just as a salesperson helps a prospect realize a need for a product or service. Leveraging the theoretical communication commonalities in teaching and selling, we posit that selling-to-teach will positively affect perceived and actual learning. Using a mixed-methods approach through two studies, we find qualitative and quantitative (n=616) support for selling-to-teach. Instead of examining pedagogy in sales, we suggest that sales is a pedagogy to be used across disciplines. This fuller examination unveils the sales process as a pedagogical tool to empower instructors and to maximize the student learning experience through different selling steps used as teaching method.
Circulating IGFBP-2 levels are inversely associated with the incidence of nonalcoholic fatty liver disease: A cohort study
Authors: Yang Ji , Zhou Wenjing , Wu Yue , Xu Liqian , Wang Yuming , Xu Zherong , Yang Yunmei
Published: August 2020

Objective

The insulin-like growth factor (IGF) axis is essential for the body’s metabolism. The hepatokine, insulin-like growth factor-binding protein 2 (IGFBP-2), acts as a major regulator of this metabolism. We aimed to evaluate the role of serum IGFBP-2 in the incidence of nonalcoholic fatty liver disease (NAFLD).

Methods

This hospital-based prospective cohort study recruited residents from a health program from January to November 2013, and re-invited them for follow-up in 2016. The occurrence of NAFLD was noted and IGFBP-2 levels were evaluated by enzyme-linked immunosorbent assay at both visits.

Results

Of 763 participants at baseline, 296 completed the re-evaluation. Baseline serum IGFBP-2 levels were significantly lower in subjects with NAFLD compared with those without NAFLD. Circulating IGFBP-2 levels were negatively correlated with body mass index, waist-to-hip ratio, alanine transaminase, triglycerides, fasting glucose, and insulin. IGFBP-2 levels at follow-up decreased in subjects who developed NAFLD compared with those who did not. Higher circulating levels of IGFBP-2 at baseline were negatively associated with the incidence of NAFLD.

Conclusion

These results indicate that IGFBP-2 levels are inversely associated with the risk of NAFLD. This offers new insights into the role of circulating IGFBP-2, as an IGF-axis hepatokine, in the pathogenesis of hepatic steatosis.
A diagnostic model of idiopathic central precocious puberty based on transrectal pelvic ultrasound and basal gonadotropin levels
Authors: Yuan Bo , Pi Ya-Lei , Zhang Ya-Nan , Xing Peng , Chong He-Meng , Zhang Hui-Feng
Published: August 2020

Objective

To establish a diagnostic model of idiopathic central precocious puberty on the basis of transrectal pelvic ultrasound and basal gonadotropin.

Methods

A total of 669 girls with Tanner breast development stage II were enrolled in this study from January 2015 to December 2018. The participants were divided into the ICPP group and the premature thelarche group. We analyzed various variables, including age at initial diagnosis, basal luteinizing hormone levels, the long diameter of the uterus, the transverse diameter of the uterus, the anterior–posterior diameter of the uterus, the volume of the uterus, maximum ovarian diameter, average ovarian volume, maximum ovarian volume, number of follicles (≥4 mm), maximum follicular diameter, endometrial thickness, and vaginal wall thickness.

Results

The following diagnostic model was established: Y=−14.123 + 0.630 × age at initial diagnosis + 1.119 × transverse diameter of the uterus + 1.278 ×  anterior–posterior diameter of the uterus + 0.637 × average ovarian volume + 1.316 × maximum ovarian diameter + 0.146 ×number of follicles ≥4 mm + 2.925 × endometrial thickness + 0.559 × basal luteinizing hormone value. The area under curve was 0.922, sensitivity was 84.9%, and specificity was 86.2%.

Conclusion

Basal LH levels and transrectal pelvic ultrasound should be applied together to improve the accuracy of diagnosis in ICPP.
Accessory spleen originating from the intrinsic muscularis of the stomach misdiagnosed as gastrointestinal stromal tumor: a case report
Authors: Zhang Jing , Zhong Jin-Wei , Lu Guang-Rong , Zhou Yu-Hui , Xue Zhan-Xiong , Ye Meng-Si
Published: August 2020

A 34-year-old man presented to our hospital with a 2-month history of repeated dull upper abdominal pain. Gastroscopy and endoscopic ultrasonography indicated a hemispherical mass at the junction of the greater curvature and the gastric fundus, with hypoechogenicity originating from the intrinsic muscular layer. He was diagnosed with a gastric body submucosal lesion and gastrointestinal stromal tumor, and underwent endoscopic full-thickness resection. However, postoperative pathological examination of the mass unexpectedly revealed heterotopic spleen tissue (accessory spleen). Intragastric ectopic spleen tissue originating from the intrinsic muscular layer of the stomach is a rare clinical condition, with no specific clinical symptoms. This finding is of great clinical significance for the identification of gastric submucosal tumors.
Management of bleeding associated with radiofrequency ablation of benign thyroid nodules
Authors: Hu Kunpeng , Lian Yufan , Wang Jinfen , Li Wenchao , Yao Zhicheng , Liu Bo , Ren Jie
Published: August 2020

Objective

This study was performed to explore the effective management of bleeding associated with radiofrequency ablation (RFA) of benign thyroid nodules.

Methods

Thirty-five patients with benign thyroid nodules who were treated with ultrasound-guided RFA from July 2015 to December 2016 at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed. The technique efficacy, bleeding, and other complications were assessed during the follow-up period.

Results

The mean technique efficacy was 55.6%±22.8% at 1 month and 24.1%±17.1% at 6 months after the procedure. One case of an intranodular haematoma and two cases of voice change (>1 month) were observed. All patients recovered with corresponding treatment.

Conclusion

Although the incidence of haemorrhage is low, serious haematomas are life-threatening. Therefore, having a comprehensive understanding of the potential complications, an accurate clinical strategy, and adequate technical skills may prevent or help to properly manage these complications.
Disease Progression in Frontotemporal Dementia and Alzheimer Disease: The Contribution of Staging Scales
Authors: Lima-Silva Thaís Bento , Mioshi Eneida , Bahia Valéria Santoro , Cecchini Mário Amore , Cassimiro Luciana , Guimarães Henrique Cerqueira , Gambogi Leandro Boson , Caramelli Paulo , Balthazar Márcio , Damasceno Benito , Brucki Sônia M. D. , de Souza Leonardo Cruz , Nitrini Ricardo , Yassuda Mônica Sanches
Published: August 2020

Introduction:

There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD).

Objectives:

To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale−frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR).

Methods:

The sample consisted of 70 individuals, aged 40+ years, with at least 2 years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant), and 27 with AD. The FTD-FRS, the CDR, and the 2 additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke Cognitive Examination-Revised was completed by patients. After 12 months, the same protocol was applied.

Results:

The FTD-FRS, CDR-FTLD, and CDR detected significant decline after 12 months in the 3 clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages.

Conclusions:

The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum.
Effect of introduction of fluoromonomer copolymerization on properties of polyimide hollow fibers
Authors: Li Yinong , Zhang Mengying , Han Enlin , Zhu Li , Xiao Meifeng , Lei Huanyu , Niu Hongqing , Wu Dezhen
Published: August 2020

The novel copolymerization polyimide (PI) hollow fibers (HFs) of 4,4′-(hexafluoroisopropylidene) diphthalic anhydride (6FDA) containing –CF3 groups were prepared and investigated through both simulation and experiment. To demonstrate the alteration attributable to the introduction of fluoromonomers, the condensed states of pyromellitic dianhydride (PMDA)/4,4′-oxybisbenzenamine (ODA), PMDA/6FDA/ODA, and 6FDA/ODA PI were constructed by Material Studio, and we simulated the mobility of molecular chain, free volume fraction, and O2/N2 dissolution–diffusion process. The molecular dynamics simulation results demonstrated that the properties of the copolymerized PI system with 6FDA were significantly improved, while the selectivity remained almost unchanged. Then, the films of copolymerized PI and HFs were prepared by the two-step method, and O2/N2 permeability of the PI copolymer films was characterized, indicating that although the gas permeation performance was greatly improved, the selectivity was not so satisfactory. However, the selection factor increased heavily after polydimethylsiloxane coating.
Impact and internal pressure failure of E-glass and S-glass epoxy composite elbow pipe joints influenced by sea water
Authors: Bobba Sujith , Leman Z , Zainuddin ES , Sapuan SM
Published: August 2020

Consequences of sea water absorption on the impact behaviour of glass/epoxy composite elbow pipe joints were experimentally investigated. Glass-epoxy elbow pipe joints using E-glass and S-glass were fabricated via the hand layup method. The pipe joints were immersed in water as per the current conditions for 0, 3 and 6 months. The relation between the unaged and aged samples was studied by calculating the contact force, displacement and absorbed energy values from the impact tests. Therefore, it is concluded that sea water raised the ageing period of both E-glass/epoxy and S-glass/epoxy fibre-reinforced composite elbow pipe joints which resulted in the degradation between the fibre and resin interface and which was prominent in the elbow joints fabricated with E-glass rather than the one’s fabricated with the proposed S-glass fibre.
Indian Pharmaceuticals Industry in Global Scenario: An Appraisal
Authors: Chakraborty Prabal
Published: August 2020

Today, the Indian pharmaceuticals industry is recognised the world over due to the quality and cost-effectiveness of its products. At present, globally it is one of the fastest-growing industries and contributes 2.4 per cent value wise and 10 per cent volume wise globally. India alone accounts for 20 per cent of global exports in generics. In 2016, the Indian pharma industry exported USD16.89 billion and is expected to touch USD40 billion by 2020. The present generics market has immense potentiality for foreign direct investment (FDI) inflows, and worth USD14.53 billion of FDI inflows came in between April 2000 and December 2016. We have witnessed that Indian pharma companies go for joint ventures with multinational companies, make strategic alliances and co-promotions, contract research and manufacturing services, export, acquisitions and mergers, focus on new markets other than the USA and Europe, buy offshore plants and increase stakes in other companies. India is also becoming an attractive investment for the clinical trials market. The objective of this paper is to analyse the Indian pharmaceuticals industry—opportunity and threats, strategies of the Indian companies particularly after trade-related aspects of intellectual property rights (TRIPS).
Sahiyo Stories: Shattering the Silence on Female Genital Mutilation/Cutting
Authors: Taher Mariya
Published: August 2020

Sahiyo Stories brought together women from across the United States to create personalized digital stories narrating the experience of undergoing female genital mutilation/cutting (FGM/C). FGM/C continues because people believe that if a girl does not undergo it, she will not grow up to be a “good woman.” For centuries, then, women have been afraid to speak about FGM/C for fear of ostracization from their communities, getting loved ones in trouble, and other reasons. Sahiyo Stories shatters this silence and the digital stories collection is woven together by a united sentiment to protect future generations of girls from this harm.
Agency and Paternalism: Balancing Acts Between a Domestic Violence Survivors’ Task Force and a State Coalition
Authors: Miller Susan L. , Kafonek Katherine , Iovanni LeeAnn
Published: August 2020

This research explores the dissonance between feminist ideology and practice as it manifests in an activist group of intimate partner violence/aggression (IPV/A) survivors under a state coalition on domestic violence serving multiple stakeholders. A gendered organizations framework reveals the activist group resisting paternalism and colonization in their efforts to achieve their goals and maintain their identity. Two-and-a-half years of observational field work reveals a complex dynamic, simultaneously feminist and patriarchal, with the activist group experiencing growing pains and internal conflict, emotion regulation, as well as empowerment. We offer suggestions for further exploration of the ways survivor–activist groups and coalitions can pursue collaborative partnerships.
Classical Hodgkin lymphoma-like post-transplant lymphoproliferative disease after allogeneic stem cell transplantation for primary myelofibrosis is successfully treated with nivolumab: A case report
Authors: Gunes Ahmet K. , Demir Ilknur , Pehlivan Mustafa
Published: August 2020

Introduction

Post-transplant lymphoproliferative disease (PTLD), a lymphoid proliferation observed after the solid organ transplantation or allogeneic stem cell transplant, is an important and mortal complication that can occur during the post-transplant period. Classical Hodgkin lymphoma-like PTLD is the least form of PTLD. We are presenting an adult case of classical Hodgkin lymphoma-like PTLD which was successfully treated with nivolumab.

Case report

A 31-year-old female was diagnosed with primary myelofibrosis and we performed allogeneic stem cell transplantation from her HLA fully matched brother in 2015. Two years after transplant, classical Hodgkin lymphoma-like PTLD was diagnosed. The patient was resistant to six cycles of ABVD chemotherapy and four cycles of brentuximab vedotin.

Management and outcome

After the failure of ABVD and brentuximab vedotin, we started nivolumab therapy at a dose of 3 mg/kg every 2 weeks. After six cycles, we achieved a PET negative complete remission. After 10 cycles of nivolumab, the patient is still followed with a complete remission. Still, there is no evidence of acute or chronic GvHD, and therefore no need for immunosuppressive treatment. No auto-immune complication was observed. It is planned to give nivolumab treatment to the patient until the progression.

Discussion

Our case has depicted that the classical Hodgkin lymphoma type PTLD may be resistant to the conventional treatments and anti-CD30 brentuximab vedotine. In such cases, nivolumab may be an effective and worth assessing agent in terms of both activity and safety profile.
Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty
Authors: Wilson Jacob M , Farley Kevin X , Erens Greg A , Bradbury Thomas L , Guild George N
Published: August 2020

Background:

The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures. The purpose of this study was to investigate whether or not there was a relationship between preoperative opioid use and surgical complications, medical complications, and healthcare utilisation following revision THA.

Methods:

This is a retrospective cohort study using the Truven Marketscan database. Patients undergoing revision THA were identified. Preoperative opioid prescriptions were queried for 1 year preoperatively and were used to divide patients into cohorts based on temporality and quantity of opioid use. This included an opioid naïve group as well as an “opioid holiday” group (6 months opioid naïve period after chronic use). Demographic and complication data were collected and both univariate and multivariate analysis was then performed.

Results:

62.5% of patients had received an opioid prescription in the year preceding surgery. Patients with continuous preoperative opioid use had higher odds of the following: infection (superficial or deep surgical site infection; OR 1.29; 95% CI, 1.03–1.62, p  = 0.029), wound complication (OR 1.36; 95% CI, 1.02–1.82, p = 0.037), sepsis (OR 1.90; 95% CI 1.08–3.34, p = 0.026), and revision surgery (OR 1.54, 95% CI, 1.28–1.85, p < 0.001). This group also had higher care utilisation including extended length of stay, non-home discharge, 90-day readmission, and emergency room visits ( p < 0.001). An opioid holiday mitigated some of this increased risk as this cohort has baseline (i.e. same as opioid naïve) risk ( p > 0.05 for all comparison).

Conclusions:

Opioid use prior to revision THA is common and is associated with increased risk of postoperative complication. Given that risk was reduced by a preoperative opioid holiday, this represents a modifiable risk factor which should be discussed and addressed preoperatively to optimise outcomes.
Diagnostic Accuracy of Magnetic Resonance Images and Weight-Bearing Radiographs in Patients With Arthroscopic-Proven Medial Osteoarthritis of the Knee
Authors: Muñoz-García Nuria , Cordero-Ampuero José , Madero-Jarabo Rosario
Published: August 2020

Aims:

The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the “gold standard” to compare with.

Methods:

A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria.

Results:

Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone ( P < .001).

Conclusions:

Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone.
Live-archiving the crisis: Instagram, cultural studies and times of collapse
Authors: Prins Annelot
Published: August 2020

As COVID-19 hit the world, social media formed an immediate online archive of the crisis that enfolded. This essay examines how this moment of collapse intersects with Instagram as a platform specifically. How do we exist on a platform built up around notions of aspiration and happiness while being in crisis? And what can cultural studies scholars add to such a platform in these times?
Supporting Local Health Departments to Lead Multisectoral Youth Violence Prevention Efforts
Authors: Dymnicki Allison B. , Katz Jason , Young Xan J. , Thorngren Mary , Orazi Jazmine , Marshall Khiya J. , Lumpkin Corey D.
Published: August 2020

This article examines organizational-level outcomes achieved during a technical assistance (TA) initiative designed to increase the capacity of local health departments (LHDs) to prevent youth violence (YV) via a multisectoral approach. This effort was designed to address the knowledge gap regarding how to provide effective TA to LHDs, specifically in YV. Twelve communities with high rates of YV were selected to participate using a multistage process. TA provided to LHD representatives (and other community partners) included monthly calls with TA specialists, group online learning events, community-of-practice calls, and access to an online portal offering additional resources. Data sources were used to determine the extent to which communities achieved the initiative’s intended outcomes, including increased infrastructure to support youth violence prevention (YVP) at LHDs and the creation of community-wide violence prevention plans. Data sources included an online TA tracking system, annual semistructured group interviews, and point-of-contact surveys. While results indicated variation in TA uptake across sites, several target outcomes were achieved including increased representation and engagement of diverse perspectives in local YVP efforts and strengthened infrastructure and integration of YVP at LHDs. Findings highlight the importance of supporting LHDs to align YVP work with other priorities and funded activities, building a larger role for leadership in providing organizational support for YV, supporting the development of multisector coalitions or partnerships to decrease silos among different sectors focused on similar populations or communities. Implications from this initiative suggest that LHDs can be supported to convene local, multisector YVP efforts, which can be sustained if local YVP infrastructure is enhanced.
The AFL Pick Trading Market as a Coasian Utopia
Authors: Chandrakumaran Jemuel
Published: August 2020

Sporting leagues have various competitive balance measures including player drafts, where teams are awarded picks based on prior performance. Teams, however, have the option to either exercise this pick or trade it as they see fit. An analysis of this trading market in the NFL stated that players obtained through traded picks contributed more to their recruiters in comparison to their counterparts. This paper retested this within the AFL and disproved this fact, establishing the Coasian notion of the efficient allocation of resources, based on some differences between the list management systems between the two leagues.
Evaluating an Algorithm and Clinical Prediction Rule for Diagnosis of Bone Stress Injuries
Authors: Nye Nathaniel S. , Covey Carlton J. , Pawlak Mary , Olsen Cara , Boden Barry P. , Beutler Anthony I.
Published: August 2020

Background:

A novel algorithm and clinical prediction rule (CPR), with 18 variables, was created in 2014. The CPR generated a bone stress injury (BSI) score, which was used to determine the necessity of imaging in suspected BSI. To date, there are no validated algorithms for imaging selection in patients with suspected BSI.

Hypothesis:

A simplified CPR will assist clinicians with diagnosis and decision making in patients with suspected BSI.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 3.

Methods:

A total of 778 military trainees with lower extremity pain were enrolled. All trainees were evaluated for 18 clinical variables suggesting BSI. Participants were monitored via electronic medical record review. Then, a prediction model was developed using logistic regression to identify clinical variables with the greatest predictive value and assigned appropriate weight. Test characteristics for various BSI score thresholds were calculated.

Results:

Of the enrolled trainees, 204 had imaging-confirmed BSI in or distal to the femoral condyles. The optimized CPR selected 4 clinical variables (weighted score): bony tenderness (3), prior history of BSI (2), pes cavus (2), and increased walking/running volume (1). The optimized CPR with a score ≥3 yielded 97.5% sensitivity, 54.2% specificity, and 98.2% negative predictive value. An isolated measure, bony tenderness, demonstrated similar statistical performance.

Conclusion:

The optimized CPR, which uses bony tenderness, prior history of BSI, pes cavus, and increased walking/running volume, is valid for detecting BSI in or distal to the femoral condyles. However, bony tenderness alone provides a simpler criterion with an equally strong negative predictive value for BSI decision making.

Clinical Relevance:

For suspected BSI in or distal to the femoral condyles, imaging can be deferred when there is no bony tenderness. When bony tenderness is present in the setting of 1 or more proven risk factors and no clinical evidence of high-risk bone involvement, presumptive treatment for BSI and serial radiographs may be appropriate.
Perioperative Complications of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): 10 Years of Experience With MI-TLIF
Authors: Patel Jwalant , Kundnani Vishal , Raut Saijyot , Meena Mohit , Ruparel Sameer
Published: August 2020

Study Design:

A prospective study.

Objectives:

We present a largest study until date performed over a period of 10 years assessing the perioperative complications. The primary aim of this study was to review the incidence of perioperative complications of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in single-level lumbar degenerative diseases.

Methods:

A prospective study performed over a period of 10 years involving 560 patients who underwent single-level lumbar MI-TLIF. Perioperative clinical and radiological parameters, postoperative complications, and satisfactory outcomes in the form of Wang’s criteria were evaluated. All patients were scrutinized into 5 different categories based on the descriptive classification for perioperative complications suggested by the authors.

Results:

The mean age was 61.8 ± 12.7 years and male to female ratio was 0.8:1. The overall incidence of the perioperative complication was 25.5%. In all, 19.64% patients developed single complication, 4.64% patients were with 2 complications, and 1.25% patients developed 3 complications from the described categories. A total of 16.78% patients developed early (<6 months postsurgery) and 8.75% patients developed late (>6 months postsurgery) complications.

Conclusion:

This study showed 25.5% incidence of perioperative complications in MI-TLIF for degenerative lumbar disease over a period of 10 years with a higher incidence rate during the initial 3 years of practice. The described classification for perioperative complications is helpful to record, to evaluate and to understand the etiology based on its duration of occurrence in the perioperative period. MI-TLIF is an effective procedure with substantial clinical benefits in the form of excellent to good clinical-radiological outcomes.
Prolonged QT Interval in a Patient With Coronavirus Disease-2019: Beyond Hydroxychloroquine and Azithromycin
Authors: Anupama B K , Adhikari Soumya , Chaudhuri Debanik
Published: August 2020

Recent reports have suggested an increased risk of QT prolongation and subsequent life-threatening ventricular arrhythmias, particularly torsade de pointes, in patients with coronavirus disease-2019 (COVID-19) treated with hydroxychloroquine and azithromycin. In this article, we report the case of a 75-year-old female with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable QT prolongation (>700 ms), precipitating recurrent self-terminating episodes of torsade de pointes that necessitated temporary cardiac pacing. Despite the correction of hypoxemia and the absence of reversible factors, such as adverse medication effects, electrolyte derangements, and usage of hydroxychloroquine/azithromycin, the QT interval remained persistently prolonged compared with the baseline with subsequent degeneration into ventricular tachycardia and death. Thus, we highlight that COVID-19 illness itself can potentially lead to further prolongation of QT interval and unmask fatal ventricular arrhythmias in patients who have a prolonged QT and low repolarization reserve at baseline.
Renal injury in the setting of immune checkpoint inhibitor: Report of a case of hypothyroidism and the role of positron emission tomography
Authors: Heybeli Cihan , Nathan Mark A , Herrmann Sandra M
Published: August 2020

The use of immune checkpoint inhibitors has been increasing rapidly. Numerous untoward immune-related adverse events due to immune checkpoint inhibitors have been reported. Acute interstitial nephritis due to immune checkpoint inhibitors is one of these immune-related adverse events. Although gold standard, it is not always straightforward to perform a kidney biopsy in oncological patients. Helpful diagnostic methods are lacking. In this case report, we discuss the potential role of positron emission tomography–computed tomography on supporting the diagnosis of acute interstitial nephritis or ruling it out in the setting of acute kidney injury following treatment with immune checkpoint inhibitors. Studies are needed to assess the possible role of positron emission tomography–computed tomography for the diagnosis of acute interstitial nephritis in these subjects.
Fears, Depression, and Anxieties of Patients With Diabetic Retinopathy and Implications for Education and Treatment
Authors: Bloom Jeffrey M. , Mason John O. , Mason Lauren , Swain Thomas A.
Published: August 2020

Objective:

This study investigates undiagnosed depression and anxiety related to diabetes in patients with diabetic retinopathy and identifies commonly feared complications that these patients experience.

Methods:

The 74 consecutive individuals with diabetes were recruited for this investigation from the office of a retina specialist, and data were obtained from the participants through a self-report survey given to the patients before their appointment.

Results:

The most feared complication reported by patients surveyed was blindness (38.36%). When asked about depression and anxiety related to their diabetes, 20.27% of patients stated they have depression related to their diabetes, whereas 18.92% had anxiety related to their diabetes. Only 17.57% of the patients said they were being treated for their depression and/or anxiety at the time of the survey.

Conclusions:

This study demonstrates that many patients with diabetic retinopathy have coexisting fears and mental health concerns. Because most retina specialists treat a high number of patients with diabetes, it is crucial to understand the barriers and comorbidities related to this patient population. Retina specialists may play a role in identifying the hidden and underlying fears, depression, and anxieties in patients with diabetes so that these patients can get the necessary help and counseling they need.
Emicizumab for the treatment of acquired hemophilia A
Authors: Knoebl Paul , Thaler Johannes , Jilma Petra , Quehenberger Peter , Gleixner Karoline , Sperr Wolfgang R.
Published: August 2020

Acquired hemophilia A (AHA) is a severe bleeding disorder caused by inhibiting autoantibodies to coagulation factor VIII (FVIII). For hemostatic treatment, bypassing agents and human or porcine FVIII are currently standard of care. Emicizumab is a bispecific, FVIII-mimetic therapeutic antibody that reduced the annualized bleeding rates in congenital hemophiliacs. Here, we report on 6 male and 6 female patients with AHA treated with emicizumab (all data medians and interquartile range), age 74 (64-80) years, initial FVIII <1%; inhibitor titer 22.3 Bethesda units (BU)/mL (range, 3-2000). Eight patients had severe bleeding. Emicizumab was started, 3 mg/kg subcutaneously, weekly for 2 to 3 doses, followed by 1.5 mg/kg every 3 weeks to keep the lowest effective FVIII levels. For FVIII monitoring, chromogenic assays with human and bovine reagents were used. All patients received immunosuppression with steroids and/or rituximab. After the first dose of emicizumab, activated partial thromboplastin time normalized in 1 to 3 days, FVIII (human reagents) exceeded 10% after 11 (7.5-12) days. Hemostatic efficacy was obtained and bypassing therapy stopped after 1.5 (1-4) days. FVIII (bovine reagents) exceeded 50%, indicating complete remission after 115 (67-185) days, and emicizumab was stopped after 31 (15-79) days. A median of 5 injections (range, 3-9) were given. No patient died of bleeding or thromboembolism, and no breakthrough bleeding was observed after the first dose of emicizumab. In conclusion, emicizumab seems to be an effective hemostatic therapy for AHA, with the advantages of subcutaneous therapy, good hemostatic efficacy, early discharge, and reduction of immunosuppression and adverse events.