bluuebunny/crossref_metadata_2025 huggingface dataset:
A Narrative Approach to Career Education
Authors: Cochran Larry , Cochran Larry
Published: August 2020

A major function of career education is to provide career information, such as information about occupations and convictions about how to make one's way in a career. Traditionally, career information is offered in a form that emphasises rationality and objectivity. Using a narrative approach, this article describes alternative procedures for heightening career awareness that emphasise meaning-making and accommodation to the subjective orientations of developing persons. The first procedure involves a strategy for transforming occupational information into occupational narratives. The second procedure involves four different strategies for revising flawed convictions into more adequate and fruitful plots to enact in career.
Inflammatory Pseudotumor-Like Follicular/Fibroblastic Dendritic Cell Sarcomas of the Spleen Are EBV-Associated and Lack Other Commonly Identifiable Molecular Alterations
Authors: Bruehl Frido K. , Azzato Elizabeth , Durkin Lisa , Farkas Daniel H. , Hsi Eric D. , Ondrejka Sarah L.
Published: August 2020

Inflammatory pseudotumor-like follicular/fibroblastic dendritic cell sarcoma (IPT-like FFDCS) is a rare, indolent neoplasm that occurs in the spleen or liver and harbors Epstein-Barr virus (EBV) integrated into the host genome. The molecular genetic characteristics of IPT-like FFDCS have not been well studied and there are no established and actionable molecular features to guide treatment decisions or diagnosis beyond the recognition of viral genome integration. We subjected two cases of IPT-like FFDCS to a comprehensive next-generation sequencing analysis. Several variants of uncertain clinical significance were detected in both tumors. No variants of potential or strong clinical significance were detected within the targeted regions of the evaluated genes. Additionally, no fusion events were detected involving the genes in either tumor. The performed molecular analysis identified no genetic aberrations in IPT-like FFDCS and its genomic landscape remains, with the exception of a monoclonal EBV gene, largely undefined.
Rituximab desensitization in pediatric acute lymphoblastic leukemia with severe anaphylaxis
Authors: V Villarreal-González Rosalaura , E de Lira-Quezada Cindy , N González-Díaz Sandra , L Carrasco-Díaz Ligia , González-Llano Oscar
Published: August 2020

Introduction

Hypersensitivity reactions (HSRs) to rituximab occur during the first infusion in 29% to 40% of patients. Commonly, these hypersensitivity reactions are the result of a release of cytokines, although IgE mediated reactions have also been reported.

Case Report

A 7-year-old female patient with diagnosis of CD-20 positive acute lymphoblastic B-cell leukemia was included in a pilot study that consisted of two doses of rituximab treatment in the induction to remission phase by the pediatric hematology service; 30 minutes after the first administration of 300 mg of rituximab the patient started with generalized rash, nausea, vomiting, tachycardia, dyspnea, foreign body sensation in throat, oxygen desaturation until 89% and hypotension; therefore, the infusion of rituximab was suspended, and intramuscular epinephrine was administered as well as intravenous hydrocortisone and chlorphenamine and supplemental oxygen supply with adequate resolution of symptoms.

Management & Outcome

Intradermal skin testing with rituximab at the concentration 1 mg/ml (dilution 1:10), was positive. Desensitization to rituximab was indicated by our service with 4 bags – 16 steps protocol with an initial concentration dose of 1/1,000 of the total dose. The patient was premedicated 1 hour prior with intravenous chlorphenamine, methylprednisolone and ondansetron. Intravenous prophylactic fluids with normal saline solution were administered during the infusion. The procedure was carried out with close monitoring of vital signs in a course of 6.67 hours, without presenting hypersensitivity reactions.

Discussion

HSR to rituximab may be induced by the activation of mast cells and basophils. Desensitization protocols are developed when there is no alternative drug for the underlying condition.
Novel Toxicology Program to Support the Development of Inhaled VentaProst
Authors: Tepper Jeffrey , Pfeiffer Juergen , Bujold Kim , Fink James B. , Malcolmson Richard , Sullivan Dennis , Authier Simon , Entcheva-Dimitrov Plamena , Clark Andrew
Published: August 2020

Currently, off-label continuous administration of inhaled epoprostenol is used to manage hemodynamics during mitral valve surgery. A toxicology program was developed to support the use of inhaled epoprostenol during mechanical ventilation as well as pre- and postsurgery via nasal prongs. To support use in patients using nasal prongs, a Good Laboratory Practice (GLP), 14-day rat, nose-only inhalation study was performed. No adverse findings were observed at ∼50× the dose rate received by patient during off-label use. To simulate up to 48 hours continuous aerosol exposure during mechanical ventilation, a GLP toxicology study was performed using anesthetized, intubated, mechanically ventilated dogs. Dogs inhaled epoprostenol at approximately 6× and 13× the dose rate reported in off-label human studies. This novel animal model required establishment of a dog intensive care unit providing sedation, multisystem support, partial parenteral nutrition, and management of the intubated mechanically ventilated dogs for the 48-hour duration of study. Aerosol was generated by a vibrating mesh nebulizer with novel methods required to determine dose and particle size in-vitro. Continuous pH 10.5 epoprostenol was anticipated to be associated with lung injury; however, no adverse findings were observed. As no toxicity at pH 10.5 was observed with a formulation that required refrigeration, a room temperature stable formulation at pH 12 was evaluated in the same ventilated dog model. Again, there were no adverse findings. In conclusion, current toxicology findings support the evaluation of inhaled epoprostenol at pH 12 in surgical patients with pulmonary hypertension for up to 48 hours continuous exposure.
Respiratory Rates Derived From Arterial Blood Pressure Waveforms in Telemetered Dogs
Authors: Tang Hai-Ming , Laduke Carrie , Reynolds Dave , Carey Cynthia , Hahn Suzette , Friedrichs Gregory S.
Published: August 2020

The objective of this study was to extract low frequency respiratory “artifacts” from a standard arterial blood pressure (ABP) waveform to simultaneously derive reliable breathing rates (BR). Arterial blood pressure derived BR values were characterized against respiratory rates simultaneously obtained from the Respiratory Inductive Plethysmography (RIP) system (EMKA). Reference compounds were introduced to evaluate responsiveness of the derived measures to respiratory depressants and stimulants. Male beagle dogs (n = 3) were instrumented with minimally invasive telemetry devices for measurements of ABP and heart rate. The RIP system was utilized simultaneously to collect respiratory rate, tidal volume, and minute volume of each animal following pharmacological challenges. Early results revealed the derived BR’s from ABP waveforms did not correlate well with those measured from the RIP system. Post study X-ray visualization revealed suboptimal catheter positioning, causing poor concordance of BR tallied from the ABP waveforms. Follow-up evaluations were conducted using additional animals instrumented with the ABP catheter tip placement advanced proximal to the thoracic diaphragm. Preliminary data from this subset of animals significantly improved the correlation of BR derived from ABP and respiratory rates recorded by the RIP. This proof of concept investigation was intended to evaluate an algorithm designed to extract additional data from routine cardiac waveforms. We clearly demonstrated that with optimal blood pressure catheter placement and acquisition algorithm, a reliable breathing rate can also be extracted from safety studies without the need for additional studies/animals to capture those respiratory end points.
Pediatric Soft Tissue Tumors With BCOR ITD Express EGFR but Not OLIG2
Authors: Salgado Claudia M. , Zin Angelica , Garrido Marta , Kletskaya Irina , DeVito Rita , Reyes-Múgica Miguel , Bisogno Gianni , Donofrio Vittoria , Alaggio Rita
Published: August 2020

Introduction

Somatic internal tandem duplication of 3’ of BCOR ( BCOR ITD) has been found in clear cell sarcomas of the kidney (CCSK), soft tissue undifferentiated round cell sarcomas/primitive myxoid mesenchymal tumors of infancy (URCS/PMMTI), and a subgroup of central nervous system high-grade neuroepithelial tumors (CNS-HGNET). BCOR ITD+ tumors share morphologic features. Expression of OLIG2 and epidermal growth factor receptor (EGFR) has been reported in CNS-HGNET with BCOR ITD. Here, we characterize OLIG2 and EGFR expression in URCS/PMMTI with BCOR ITD.

Methods

Paraffin blocks of 9 polymerase chain reaction-confirmed soft tissue BCOR ITD+ tumors (URCS/PMMTI) were immunophenotyped for OLIG2 and EGFR expression and scored semiquantitatively by percentage of positive cells and intensity of staining as negative, 1+, 2+, and 3+. Fluorescence in situ hybridization (FISH) for EGFR amplification was performed (amplification EGFR/CEP7 ratio ≥2.0).

Results

All 9 tumors showed membrane/cytoplasmic expression of EGFR, strong and diffuse (3+) in 8 cases; weak (+2) in 1. FISH detected no EGFR amplification. OLIG2 was negative in all.

Conclusions

EGFR is overexpressed in pediatric URCS/PMMTI with BCOR ITD and may be related to transcriptional upregulation of EGFR by BCOR ITD. OLIG2 negative staining differentiates URCS/PMMTI from CNS-HGNET. This finding may further support the possibility that these tumors have a different stem cell of origin.
Surgical technique: Autologous scleral flap for optic disk pit maculopathy
Authors: Abdala-Caballero Carlos , Vidal Sofia , Unigarro Juan , Salgado Carlos , Cabal Pablo , Maeda Hiroshi , Bueso Ponce Diego
Published: August 2020

Purpose:

To present a clinical case and surgical technique for management of optic disk pit (ODP) maculopathy.

Methods:

Surgical technique video of lens sparring pars plana vitrectomy, autologous scleral flap insertion and gas tamponade.

Results:

After 1 year follow-up visual acuity was restored to 20/25, retinal serous detachment and schisis were resolved and the autologous scleral flap remained in the (ODP).

Conclusion:

In this case, treatment with pars plana vitrectomy autologous scleral flap insertion and gas tamponade for optic pit maculopathy provided satisfactory anatomical and functional results.
Applying the hip-spine relationship in total hip arthroplasty
Authors: Wiznia Daniel H , Buchalter Daniel B , Kirby David J , Buckland Aaron J , Long William J , Schwarzkopf Ran
Published: August 2020

Total hip arthroplasty dislocations that occur inside Lewinnek’s anatomical safe zone represent a need to better understand the hip-spine relationship. Unfortunately, the use of obtuse and redundant terminology to describe the hip-spine relationship has made it a relatively inaccessible topic in orthopaedics. However, with a few basic definitions and principles, the hip-spine relationship can be simplified and understood to prevent unnecessary dislocations following total hip arthroplasty.

In the following text, we use common language to define a normal and abnormal hip-spine relationship, present an algorithm for recognising and treating a high-risk hip-spine patient, and discuss several common, high-risk hip-spine pathologies to apply these concepts. Simply, high-risk hip-spine patients often require subtle adjustments to acetabular anteversion based on radiographic evaluations and should also be considered for a high-offset stem, dual-mobility articulation, or large femoral head for additional protection against instability and dislocation.
Misplacement of a central venous catheter into azygos vein via the right internal jugular vein
Authors: Wang Minjia , Xu Liang , Feng Yue , Gong Shijin
Published: August 2020

For critically ill patients, central venous catheterization may not always be placed in a correct tip position, even when guided by ultrasound. A case of inadvertent catheterization into azygos vein is described.
Māori agribusinesses: the whakapapa network for success
Authors: Rout Matthew , Reid John , Mika Jason
Published: August 2020

Reviews of Māori land generally focus on how the 80% identified as “under-performing” or “under-utilised” can be more productive. This article analyses the 20% of Māori Land Incorporations and Trusts classified as “high-performing” to identify what enabled their success, but to also determine any remaining constraints. It uses thematic analysis to both refine themes initially obtained during a literature review and examine the interviews. The five key themes explored are legal framework (whakaritenga), finance (huamoni), capability (matatau), relationships (whakawhānaungatanga), and paths to market (whakatairanga). While many of the findings corroborate industry best practice, it also found provisional evidence of the role of whakapapa networks—that is, formal or informal Māori collectives—in the success of Māori Land Incorporations and Trusts.
The Natural Course of Cigarette Smoking among Adolescent Daily Smokers in France and Quebec
Authors: Minary Laetitia , Agrinier Nelly , Dugas Erika N , Sylvestre Marie-Pierre , O’Loughlin Jennifer
Published: August 2020

Objective:

To describe the natural course of cigarette smoking and nicotine dependence (ND) over 1-year in daily smokers ages 15 to 17 living in different social contexts.

Method:

Cigarette smoking and ND indicators were measured at baseline and 3- and 12-months thereafter among 95 daily smokers with a total of 123 observations from the Nicotine Dependence in Teens (NDIT) Study in Quebec, Canada, and in 111 daily smokers from the TABagisme chez les ADOlescents (TABADO) Study in Lorraine, France.

Results:

NDIT and TABADO participants initiated smoking a mean (SD) of 3.9 (1.6) and 3.7 (2.0) years prior to baseline, respectively. Despite baseline differences in age, sex, age at initiation, number of cigarettes smoked per day and social context, 85% of participants in both samples reported cravings and responded “yes” to “felt like you really need a cigarette”. Mean (SD) number of cigarettes smoked per day increased from 9.4 (8.1) to 11.8 (8.0) over 1 year in NDIT (adjusted mean difference (95% CI) = 2.4 (0.8, 3.0)), and from 11.5 (6.5) to 13.5 (6.7) in TABADO (adjusted mean difference (95% CI) = 2.0 (0.8, 3.1)). However, most ND indicators in both samples were stable over time and cessation was infrequent.

Conclusion:

Despite notable differences across samples, the natural course of cigarettes smoked per day, ND symptoms and cessation was similar, suggestive of an underlying biologic rather than social process. To quit, adolescents who smoke daily will likely need (pharmacologic) intervention to counter the biological mechanisms underpinning ND, as well as complementary strategies targeting the social context such as creating social environments favoring cessation success.
Developing a Guided Imagery Telephone-Based Tobacco Cessation Program for a Randomized Controlled Trial
Authors: Armin Julie S , Nair Uma , Giacobbi Peter , Povis Gayle , Barraza Yessenya , Gordon Judith S
Published: August 2020

Background/Aims:

Guided imagery is an evidence-based, multi-sensory, cognitive process that can be used to increase motivation and achieve a desired behavior. Quitlines are effective, standard care approaches for tobacco cessation; however, utilization of quitlines is low. Using guided imagery-based interventions for smoking cessation may appeal to smokers who do not utilize traditional quitline services. This paper reports the development of program materials for a randomized controlled feasibility trial of a guided imagery-based smoking cessation intervention. The objective of the formative work was to ensure that program materials are inclusive of groups that are less likely to use quitlines, including men and racial/ethnic minority tobacco users.

Methods:

A three-phase process was used to complete formative assessment: (1) integration of evidence-based cessation practices into program development; (2) iterative small group interviews (N = 46) to modify the program; and (3) pilot-testing the coaching protocol and study process among a small sample of smokers (N = 5).

Results:

The Community Advisory Board and project consultants offered input on program content and study recruitment based on their knowledge of minority communities with whom they conduct outreach. Small group interview participants included members of underserved quitline populations (52.37% non-white; 55.56% men). Only 28.26% of participants had prior experience with guided imagery, but others described the use of similar mindfulness and meditation practices. Participant feedback was incorporated into program materials and protocols.

Discussion:

Iteratively collected feedback and pilot testing influenced program content and delivery and informed study processes for a randomized controlled feasibility trial of a telephone-delivered, guided imagery-based intervention.
Human rights education and the plight of vulnerable groups with specific reference to people with albinism in Tanzania
Authors: Mubangizi John Cantius , Kajiru Ines
Published: August 2020

Although all human beings are vulnerable, some are more vulnerable than others, for example, people with albinism. Similarly, although albinism occurs in all parts of the world, it is more prevalent in some societies than in others. For example, Tanzania, in common with other countries in sub-Saharan Africa, has a high prevalence of albinism. Apart from being subjected to blatant discrimination and abuse, people with albinism suffer atrocious attacks sometimes resulting in death. This paper explores the nature and extent of discrimination and human rights violations of people with albinism in Tanzania in the context of the relevant legal framework available for their protection. Using people with albinism in Tanzania as a proxy, the paper argues that there is a need for human rights education not only to empower vulnerable people to defend and protect their rights but also to sensitize societies to respect and not violate the rights of such people. The paper concludes with several recommendations that apply to people with albinism in Tanzania as much as they would apply to any vulnerable group anywhere else in the world.
Becoming a complementary health practitioner: The construction of alternative medical knowledge
Authors: Roichman Maayan
Published: August 2020

Complementary and alternative medicine (CAM) has become widely popular in many countries, yet little is known about the actual training of CAM practitioners. This article employs ethnographic research methods to closely examine the meaning-making processes used in such training at a complementary and alternative medical college. It delineates how CAM practitioners in training, specialising in naturopathy, make sense of alternative medical knowledge and transform it into medical truth. The study indicates that the core of CAM training rests on overturning the biomedical epistemological hierarchy between the objectification of disease and the experience of illness through extended intersubjective sharing by instructors and students. This study therefore adds to the extensive CAM literature by carefully examining the way naturopathic knowledge is inculcated during practitioner training. The emerging insight is that introspection and the search for authenticity, a central narrative of modernity, have become powerful resources in CAM’s construction of alternative medical truth.
Seismic assessment of a cable-stayed arch bridge under three-component orthotropic earthquake excitation
Authors: Farahmand-Tabar Salar , Barghian Majid
Published: August 2020

The occurred damages during the past significant earthquakes have proved that vertical seismic excitation has tremendous effect on bridges. Three-component earthquake excitations are preferred to resemble the earthquakes. In this article, a cable-stayed arch bridge, a new type of bridge with the hybrid system of half-through arch and stay-cables, was analyzed under a set of different earthquake excitations (more than 21 ground motion records). Both vertical and horizontal components of the ground motions were considered to act simultaneously at the bridge supports. By using different three-component earthquake excitations, the dynamic responses of the bridge, including the displacements and accelerations of the main parts of the bridge, were obtained. The effects of various parameters such as soil type, epicentral distance, spatial variation of the ground motions, and dimensional variation of the structure were investigated. The results of the numerical study indicate that the cable-stayed arch bridge subjected to both horizontal and vertical components of earthquakes are more vulnerable than those subjected to horizontal ground motion only.
Control strategies to reduce occupational dust exposure at a mechanical grinding workshop
Authors: Wu Jun , Shen Heng-Gen , Zhan Xia-Fei
Published: August 2020

In this research, real-time changes in dust concentration were monitored at a typical grinding and sealing workshop during actual operation. Results indicated that particle size was between 10.0 and 50.0 µm, and the most abundant elements were Si and Al. The average daily dust exposure value (ADD) was taken as basis when performing the occupational risk assessment. The largest ADD values for the workshop were obtained at heights between 1.5 and 3.0 m. In order to reduce workers exposure to dust, a new type of circulating ventilation and dust removal system was designed. Operation of the new system showed that the shortest response time occurred a ratio of 60.0% of circulating air and 40.0% of fresh air. These data was compared with the ADD obtained under the conventional displacement ventilation system. The results indicated that the new system designed in the present research might significantly improve the environmental quality of the whole workshop (reducing the PM10 concentration in the breathing zone by nearly 9 times) and provide a fast response (reducing the response time to half). The system could provide an efficient measure in reducing hazards in industrial grinding workshops in the future.
The new suit of the Centre for Social Research on Alcohol and Drugs (SoRAD): A well-tailored costume for tackling research and challenges ahead
Authors: Storbjörk Jessica , Landberg Jonas , Room Robin
Published: August 2020

This overview reviews the establishment and evolution of the Centre for Social Research on Alcohol and Drugs (SoRAD). It outlines its current organisation and updated research direction, and discusses SoRAD’s future challenges and opportunities. SoRAD was established at Stockholm University to strengthen and support Swedish social science research on alcohol and drugs. It became active in 1999, and quickly grew in research efforts and reputation, while experiencing setbacks around 2006 and 2017. In 2018 SoRAD merged with the Centre for Health Equity Studies (CHESS), to form a new Department of Public Health Sciences. In its new suit, SoRAD acts as a research centre within the teaching department. The research activities on alcohol and other drugs and gambling behaviour and problems may be categorised into four main areas: social epidemiology; subcultures and social worlds of use and heavy use; policy formation, implementation and societal responses; and societal and other collective definitions of problems and solutions. The new arrangements, with an increased staff pool and close interplay with higher education, provide a more stable and long-term platform for achieving the main mission of promoting and developing social science research on addictive substances and behaviours and related problems.
Framing racial position and political standing: Hmong Americans in the Wisconsin State Journal and the Chico Enterprise-Record
Authors: Xiong Yang Sao , Thornton Michael C
Published: August 2020

Although membership is regarded as an important condition of immigrants’ capacities to influence the political system, the literature on immigrant political incorporation has tended to focus on formal citizenship status, giving the impression that other forms of membership matter less for immigrants’ political capacity. Arguing for the need to account for ethnic groups’ perceived racial position within local contexts, this paper explores how media outlets, as public institutions, construct the identity of Hmong Americans in ways that affect their political standing. Using a textual analysis approach, we examine how two newspapers within two US communities frame Hmong’s group identity. Our findings show that the papers situate Hmong within a field of racial positions, albeit, not in the same ways that past research predicts would apply to Asian Americans. While differing in the particulars, the two newspapers are quite similar in the frames they use to depict Hmong Americans: civic ostracism, racial ambiguity, and threat. The media neither refer to Hmong as Asians nor valorize them vis-a-vis another racial category. Nevertheless, media representations frequently sully Hmong as a threat to the community. We discuss the implications of our findings for immigrant political incorporation.
How does education function?
Authors: Vanderstraeten Raf
Published: August 2020

Niklas Luhmann speaks of the function of education in relation to modern society. Only within modern society, he argues, is it possible to speak of the differentiation of a specific function system of education. It is, more particularly, the differentiation of other function systems that leads to the question about the function of education. I look closely at Luhmann’s analyses of the function of education and make a plea for a socio-historical approach, which looks at the ways in which education “functions” within society. Depending on the situation, beliefs in the functionality of education have given form to specific characteristics of the contemporary world society.
Computational screening-LCA tools for early design stages
Authors: Budig Michael , Heckmann Oliver , Hudert Markus , Ng Amanda Qi Boon , Xuereb Conti Zack , Lork Clement Jun Hao
Published: August 2020

Life Cycle Assessment (LCA) has been widely adopted to identify the Global Warming Potential (GWP) in the construction industry and determine its high environmental impact through Greenhouse Gas (GHG) emissions, energy and resource consumptions. The consideration of LCA in the early stages of design is becoming increasingly important as a means to avoid costly changes at later stages of the project. However, typical LCA-based tools demand very detailed information about structural and material systems and thus become too laborious for designers in the conceptual stages, where such specifications are still loosely defined. In response, this paper presents a workflow for LCA-based evaluation where the selection of the construction system and material is kept open to compare the impacts of alternative design variants. We achieve this through a strict division into support and infill systems and a simplified visualization of a schematic floor layout using a shoebox approach, inspired from the energy modelling domain. The shoeboxes in our case are repeatable modules within a schematic floor plan layout, whose enclosures are defined by parametric 2D surfaces representing total ratios of permanent supports versus infill components. Thus, the assembly of modular surface enclosures simplifies the LCA evaluation process by avoiding the need to accurately specify the physical properties of each building component across the floor plan. The presented workflow facilitates the selection of alternative structural systems and materials for their comparison, and outputs the Global Warming Potential (GWP) in the form of an intuitive visualization output. The workflow for simplified evaluation is illustrated through a case study that compares the GWP for selected combinations of material choice and construction systems.
The Effect of the Covid-19 Pandemic on Global Armed Conflict: Early Evidence
Authors: Mehrl Marius , Thurner Paul W
Published: August 2020

As Covid-19 spreads around the world, international actors, including the United Nations, have called for a stop to armed conflict to facilitate efforts to fight the pandemic. At the same time, coronavirus may also trigger and intensify armed conflict due to its negative economic consequences and by offering windows of opportunity to opposition movements to attack distracted and weakened incumbents. We use real-time data on the spread of Covid-19, governmental lockdown policies, and battle events to study the causal short-term effect of the pandemic on armed conflict. Our results suggest that both the spread of Covid-19 and lockdown policies exhibit a global Null effect with considerable regional heterogeneity. Most importantly, governmental lockdowns have increased armed conflict in the Middle East. In contrast, reported combat has decreased in Southeast Asia and the Caucasus as the pandemic has spread.
“Feel Like More than a Number in the Classroom:” Faculty Perceptions of Professional Development for Student Success
Authors: Amaro-Jimenez Carla , Martinez-Cosio Maria , Patterson Oliver K. , Clark Kametrice , Luken-Sutton Jennifer
Published: August 2020

Students benefit when faculty develop their teaching practice. This study aimed to identify why faculty seek professional development (PD), barriers to addressing classroom needs, and the benefit of PD in developing an understanding of classroom diversity at an HSI. Data from over 400 participants indicate a desire for classroom and online engagement activities. Faculty also described PD as facilitating the building of a community of peers engaged in student success while better understanding shifting demographics.
Urgent Endovascular Repair of an Anterior Tibial Artery Aneurysm: Case Report and Literature Review
Authors: Madison Mackenzie K. , Wang S. Keisin , King Justin R. , Motaganahalli Raghu L. , Sawchuk Alan P.
Published: August 2020

True aneurysms of the anterior tibial artery are rare with less than 20 published reports in the literature. We report an urgent endovascular repair of a true anterior tibial artery aneurysm in a patient with Ehlers-Danlos type IV, vascular type. This approach resulted in an uneventful recovery without the elevated risks associated with open vascular repair in the setting of connective tissue disorder. Continuous follow-up in the subsequent 4 years has demonstrated durability and efficacy of the original intervention.
Role of Remote Ischemic Preconditioning in Hepatic Ischemic Reperfusion Injury
Authors: Choi Eun Kyung , Jung Hoon , Jeon Sungmin , Lim Jung A. , Lee Jungwon , Kim Hyunjee , Hong Seong Wook , Jang Min Hye , Lim Dong Gun , Kwak Kyung Hwa
Published: August 2020

The effect of remote ischemic preconditioning (RIPC) has been proposed that mediates the protective response in ischemia reperfusion injury (IRI) of various organs. In this study, we investigated the effect of RIPC in hepatic IRI, by assessing biomarker of oxidative stress and inflammatory cytokines. Moreover, we intended to demonstrate any such protective effect through nitric oxide (NO). Twenty-five rats were divided into the 5 groups: (1) Sham; (2) RIPC; (3) hepatic IRI; (4) RIPC + hepatic IRI; (5) C-PTIO, 2-(4-carboxyphenyl)-4,5dihydro-4,4,5,5-tetramethyl-1H-imidazolyl-1-oxy-3oxide, + RIPC + hepatic IRI. RIPC downregulated the level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), histologic damage, and activity of Malondialdehyde (MDA). However, there was no significant reduction in the level of tumor necrosis factor-alpha (TNF-α) and nuclear factor kappa B (NF-κB). AST and ALT levels, and hepatic tissue morphology in the C-PTIO group showed a significant improvement compared to those of the RIPC + hepatic IRI group. The application of RIPC before hepatic ischemia downregulated the oxidative stress, not the inflammatory cytokines. Moreover, these protective effect of RIPC would be mediated through the activation of NO as well as anti-oxidant effect.
Indoor environmental quality and energy use evaluation of a three-star green office building in China with field study
Authors: Zhou Yan , Cai Jianmin , Xu Yiwen
Published: August 2020

In order to get more comprehensive operation performance on indoor environment quality (IEQ) and energy consumption, a long-time measurement and a field occupants’ satisfaction survey on IEQ performance of the first three-star-operation-certified green office building in Ningbo city of China have been conducted, and environmental energy efficiency (EEE) also has been analyzed. Moreover, IEQ and energy consumption of the green case office building are compared with other green office example buildings of the same climate zone in other literatures. The results show that the actual indoor thermal environment of the green case office building isn’t quite achieving the design goals with the Chinese standard of thermal comfort level II (GB 50736). Although indoor air quality of CO2 concentration and visual environment are consistent with the design goals, the indoor relative humidity doesn’t reach the design goal in most of the year. The questionnaire survey results illustrate that the green case building has a high occupants’ satisfaction on IEQ. The comparison results show that there is no obvious difference in indoor temperature and visual environment between the green case building and the green office example buildings in other studies. The results of occupant’s satisfaction and CO2 concentration of the green case building are better than in other studies. However, the indoor relative humidity of the green case building in every season is much higher than in other researches. Energy use intensity (EUI) of the green case building is about 56.5 kWh/m2·a, which is much lower than the constraint value of the Chinese standard. The actual performance of the green case building is also evaluated by the indicator of EEE. The results of this article can provide useful reference for green building operational performance promotion and feedback for design phase optimization.
Endoplasmic reticulum–mitochondria interplay in chronic pain: The calcium connection
Authors: Yousuf Muhammad Saad , Maguire Aislinn D , Simmen Thomas , Kerr Bradley J
Published: August 2020

Chronic pain is a debilitating condition that affects roughly a third to a half of the world’s population. Despite its substantial effect on society, treatment for chronic pain is modest, at best, notwithstanding its side effects. Hence, novel therapeutics are direly needed. Emerging evidence suggests that calcium plays an integral role in mediating neuronal plasticity that underlies sensitization observed in chronic pain states. The endoplasmic reticulum and the mitochondria are the largest calcium repositories in a cell. Here, we review how stressors, like accumulation of misfolded proteins and oxidative stress, influence endoplasmic reticulum and mitochondria function and contribute to chronic pain. We further examine the shuttling of calcium across the mitochondrial-associated membrane as a mechanism of cross-talk between the endoplasmic reticulum and the mitochondria. In addition, we discuss how endoplasmic reticulum stress, mitochondrial impairment, and calcium dyshomeostasis are implicated in various models of neuropathic pain. We propose a novel framework of endoplasmic reticulum–mitochondria signaling in mediating pain hypersensitivity. These observations require further investigation in order to develop novel therapies for chronic pain.
Continuous Glucose Monitoring System in Acromegalic Patients: Possible Role in the Assessment of Glycemia Control
Authors: Mercuri Valeria , D’Amico Tania , Costa Denise , De Vito Corrado , D’Angelo Luca , Schiaffini Riccardo , Gargiulo Patrizia
Published: August 2020

Background:

Acromegaly is characterized by an insulin resistance condition. There is a significant difference between the different types of therapy in relation to the glycometabolic framework. The blinded continuous glucose monitoring system (CGMS), throughout a period of maximum 6 days for a total of 288 glycemic registrations per day, identifies glycemic excursions and could constitute a valid device to understand the 24-hour glycemic profiles.

Aim of the study:

To compare the oral glucose tolerance test (OGTT) and CGMS methods in acromegalic patients to evaluate their glycemic profiles, in relation to different treatments for acromegaly.

Methods:

Thirty-five acromegalic patients were divided into 18 somatostatin analogs (SSA), 9 pegvisomant, and 8 successfully surgically treated. A 72-hour CGM was performed and, immediately after, an OGTT.

Results:

Results obtained from OGTT: 11/35 impaired fasting glucose, 6/35 impaired glucose tolerance, and 4/35 diabetes mellitus. A positive significant correlation was demonstrated between the OGTT peak and CGM peak in all of the patients, CGM peak of patients treated with SSA and those surgically treated, OGTT average and CGM area under concentration–time curve (AUC) for hyperglycemia of patients treated with SSA and those surgically treated, and CGM AUC for hyperglycemia of patients treated with SSA and those surgically treated.

Conclusions:

Our results show a significantly higher response in terms of mean and peak OGTT in patients treated with SSA, both compared to the CGM study, and compared to the group of patients receiving pegvisomant. The CGM system could represent an instrument for the evaluation of the glycemic trend of acromegalic patients.
Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures
Authors: Sinha Ajit , Natarajan Srivalli
Published: August 2020

Study Design:

A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures.

Objectives:

To evaluate and compare the primary functional outcome using the Helkimo’s dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches.

Methods:

In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association.

Results:

Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group.

Conclusions:

Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.
A single tertiary centre outlook on the short-term outcome of bariatric surgery in improving pulmonary parameters and sleep apnoea
Authors: Mohd Nasir Ahmad Adib Bin , Ban Andrea Yu-Lin , Syed Zakaria Syed Zulkifli , Nik Mahmood Nik Ritza Kosai , Abdul Hamid Mohamed Faisal
Published: August 2020

Background:

Obesity is associated with obstructive sleep apnoea (OSA). Weight loss is an effective treatment. Bariatric surgery for obese, symptomatic OSA patients results in weight loss and improvement in lung function and sleep apnoea. This study aimed to determine the effectiveness of bariatric surgery in improving the respiratory mechanics and sleep apnoea using a lung function test and sleep study.

Methods:

A prospective study was conducted at the Pusat Perubatan Universiti Kebangsaan Malaysia Medical Centre involving adults undergoing bariatric work-up, attending respiratory clinic or admitted for bariatric work-up. We included subjects with a body mass index (BMI) >35 kg/m2 and Apnoea–Hypopnoea Index (AHI) of >5 events/hour. Subjects were assessed at baseline and at 12±2 weeks post bariatric surgery using the following methods: a partial sleep study, lung function test, six-minute walk test (6MWT) and Epworth Sleepiness Scale (ESS) score.

Results:

Twelve subjects were analysed. Their mean age was 36±5.7 years, and eight (67%) were female. The baseline mean AHI was 24.75±9.51 events/hour, the nadir mean oxygen saturation during sleep (SpO2) was 83.6±3.8%, the mean ESS score was 16±4, the mean forced expiratory volume in one second (FEV1) was 2.66±0.35 L, the mean forced vital capacity (FVC) was 3.23±0.45 L, the mean total lung capacity (TLC) was 4.97±1.19 L, the mean expiratory reserve volume (ERV) was 0.5±0.46 L, the mean residual volume (RV) was 1.46±0.91 L, the mean adjusted diffusing lung capacity for carbon monoxide (DLCO Adj) was 22.71±5.22 mL/mmHg/min, the mean adjusted diffusing lung capacity corrected for alveolar volume (DLVA Adj) was 5.61±0.90 mL/mmHg/min and the mean 6MWT was 293±49 m. Post surgery (12±2 weeks), the mean BMI decreased from 45.5 kg/m2 to 39.7 kg/m2, with a clinically significant improvement in AHI, ESS score, nadir SpO2, FEV1, FVC, TLC, ERV, RV, DLCO Adj, DLVA Adj and 6MWT ( p<0.05).

Conclusion:

Bariatric surgery improves sleep apnoea and lung function and reduces daytime somnolence.
Inter-professional collaboration to improve outpatient attendance rates on a cochlear implant aural rehabilitation programme
Authors: Chua Kenneth Wei De , Yuen Heng Wai
Published: August 2020

Background:

The cochlear implant (CI) programme at Changi General Hospital started in 2010. As the number of patients gradually increased over the years, a review of attendance rates from 2010 to 2016 showed that CI patients were not compliant in attending post-surgical aural rehabilitation sessions. A significant number of no-shows or appointment cancellations without rescheduling suggest that patients may not be motivated enough to go through aural rehabilitation. Hence, it was hard to evaluate clinical outcomes, which was demoralising for both the patient and health-care professionals involved. As transdisciplinary care is often involved in the aural rehabilitation process, we reviewed the existing CI clinical pathway to identify gaps in services, and with better fostering of inter-professional collaboration (IPC) in 2017, we compared the difference in outpatient aural rehabilitation attendance rates for patients seen before and after 2017.

Methods:

A retrospective review was undertaken of the outpatient administrative system to look at appointment cancellation rates before and after IPC for CI patients undergoing post-surgical aural rehabilitation from 2010 to 2019. A paired-sample t-test of significance was used, with the level of significance set at p=0.05. Problem analysis using the Problem, Intervention, Comparison, Outcomes framework helped in identifying the possible reasons for non-compliance with aural rehabilitation attendance. Inter-professional education among audiologists, otologists and speech therapists allowed for a close-knit IPC.

Results:

There were 78 patients with CIs from 2010 to 2019. Of these, 46 patients were implanted between 2010 and 2016, and 32 were implanted after IPC was introduced in 2017. The median cancellations rates were significantly reduced from 23% to 15%, with a p-value of 0.00. Days to switch-on and aural rehabilitation, number of appointment cancellations and total number of individual visits were significant independent predictors of the percentage of cancellations in regression analysis.

Conclusion:

Future studies are warranted to see if IPC can indirectly drive clinical outcomes, given that IPC encouraged better compliance with aural rehabilitation attendance post CI. It is imperative to have IPC in this dynamic health-care landscape with increasing complexities. IPC cannot be achieved without a close-knit relationship among the relevant health professionals.
Colonic lipoma presenting with intussusception
Authors: Kumar Puneet , Tiwari Mahesh , Khanna Ajay K , Tiwary Satyendra K
Published: August 2020

Colonic lipomas are rare benign tumours, although they constitute the most common non-epithelial neoplasm of the gastrointestinal tract. They mostly remain asymptomatic and rarely present with intussusception. A 62-year-old male presented with acute intestinal obstruction. On laparotomy, intussusception of the descending colon was detected, with a single sessile polyp measuring 3 cm×3 cm as the lead point. A left hemicolectomy was performed, and histopathological examination revealed a lipoma of the colon.
Vitamin D receptor is negatively correlated with interferon-γ-inducible protein-10 in systemic lupus erythematosus with renal involvement
Authors: Wu Xueqin , Zhang Hao , Zhang Shuang , Yuan Jinzhong , Liu Jishi , Tang Juan , Li Yan Chun , Sun Jian
Published: August 2020

The vitamin D receptor (VDR) plays an important role in the pathogenesis of systemic lupus erythematosus (SLE) mainly due to its anti-inflammatory and immunomodulatory activities. Interferon-inducible protein-10 (IP-10) is a chemokine found to be increased in SLE patients and correlated with severity of lupus nephritis. In this case control study, we investigated the connection between VDR expression and chemokine IP-10 in peripheral blood mononuclear cells (PBMCs) of SLE patients with or without renal involvement. 62 SLE patients and 30 healthy subjects were enrolled between 2014 and 2016. PBMC VDR mRNA and IP-10 mRNA were quantified by real-time PCR. PBMC VDR protein was measured by Western blotting. PBMC VDR mRNA and protein were downregulated, whereas IP-10 mRNA was upregulated in SLE patients with renal involvement. VDR mRNA levels were negatively correlated with systemic lupus international collaborating clinics (SLICC) renal activity scores (r = −0.423, P = 0.016) and IP-10 mRNA levels (r = −0.428, P = 0.008) in SLE with renal involvement. This study demonstrates that PBMC VDR was negatively correlated with SLICC renal activity and chemokine IP-10 in SLE patients with renal involvement which suggests that VDR downregulation may be used as an indicator of renal injury in SLE patients.