bluuebunny/crossref_metadata_2025 huggingface dataset:
Born in the USA: The Cigar Box Guitar, Object Displacement and Performative DIY
Authors: Atkinson Paul
Published: November 2020

The cigar box guitar is a long-standing cultural artefact which, over the course of its history, has undergone a series of displacements. Initially an acoustic instrument made by impoverished people in the mid-nineteenth century to fulfil a social need to make music and help the singing of traditional folk songs, it soon became a simple do-it-yourself project associated largely with children, and later, in the 1990s, it was reimagined as a serious, electrified musical instrument employed in a particular, performative form of DIY. In this most recent incarnation, the Internet has enabled the cigar box guitar to break free of its American roots to become the focus of a global practice of Performative DIY and a vehicle through which physical and virtual communities of makers support each other, express themselves, explore their creativity and display their self-identities.
The Human Capital Legacy of a Trade Embargo
Authors: Chakravarty Abhishek , Parey Matthias , Wright Greg C
Published: November 2020

We estimate the effects of in-utero exposure to a trade embargo on survival and human capital in an import-dependent developing country. Using a regression discontinuity design, we find that a nearly comprehensive embargo imposed by India on Nepal in 1989 led to a large decline in reported live births, and increased early life mortality. The decline in births is concentrated in poorer, more remote districts, and is sharper for female births than male births, consistent with documented gender discrimination. Women survivors of exposure are more educated in adulthood than unexposed cohorts.
Clinical implication of psoas muscle mass measurement for predicting death within 3 months in patients with incurable uterine cervical or corpus malignancy
Authors: Kurosu Hiroyuki , Todo Yukiharu , Yamada Ryutaro , Minowa Kaoru , Tsuruta Tomohiko , Minobe Shinichiro , Matsumiya Hiroko , Kato Hidenori , Mori Yoichi
Published: November 2020

Objective

The aim of this study was to find a clinical marker for identifying refractory cancer cachexia.

Methods

We analyzed computed tomography imaging data, which included the third lumbar vertebra, from 94 patients who died of uterine cervix or corpus malignancy. The time between the date of examination and date of death was the most important attribute for this study, and the computed tomography images were classified into >3 months before death and ≤ 3 months before death. Psoas muscle mass index was defined as the left–right sum of the psoas muscle areas (cm2) at the level of third lumbar vertebra, divided by height squared (m2).

Results

A data set of 94 computed tomography images was obtained at baseline hospital visit, and a data set of 603 images was obtained at other times. One hundred (16.6%) of the 603 non-baseline images were scanned ≤3 months before death. Mean psoas muscle mass index change rates at >3 months before death and ≤3 months before death were −1.3 and −20.1%, respectively (P < 0.001). Receiver operating characteristic curve analysis yielded a cutoff value of −13.0%. The area under the curve reached a moderate accuracy level (0.777, 95% confidence interval 0.715–0.838). When we used the cutoff value to predict death within 3 months, sensitivity and specificity were 74.0 and 82.1%, respectively.

Conclusions

Measuring change in psoas muscle mass index might be useful for predicting cancer mortality within 3 months. It could become a potential tool for identifying refractory cancer cachexia.
Isolated Mononeuropathy From Rucksack Palsy: A Case Series
Authors: McShea Jameson P , Powell Jordan E , Dolomisiewicz Edward A , Pasquina Paul F , Miller Matthew E
Published: November 2020

Although there is increasing awareness of brachial plexopathy secondary to rucksack use, isolated mononeuropathies have been less well described. Three cases of mononeuropathy secondary to rucksack use in military personnel are presented, including injuries to the long thoracic and spinal accessory nerves. We also review several different factors in the proper construction, components, and fitting of the rucksack that should be considered in order to prevent rucksack palsy and provide a concise suggestion for rucksack use and education.
Laboratory Acquired Zika Virus Infection Through Mouse Bite: A Case Report
Authors: Talon de Menezes Mariane , Rilo Christoff Raíssa , Higa Luiza M , Pezzuto Paula , Rabello Moreira Filipe Romero , Ribeiro Liane de Jesus , Maia Richard Araujo , Ferreira Júnior Orlando da Costa , Tanuri Amilcar , Pestana Garcez Patrícia , Santana Aguiar Renato
Published: November 2020

Zika virus is an arthropod-borne flavivirus mainly transmitted by the bite of infected mosquitoes. However, alternative transmission routes can occur. In this study, we show the accidental transmission of virus from an infected mouse to a human during the experimental manipulation. This study describes the patient clinical manifestations and virus genome identification.
Large-vessel thrombotic stroke despite concurrent therapeutic anticoagulation in COVID-19-positive patient
Authors: Shoukry Andrew , Kite Thomas A
Published: November 2020

The current COVID-19 pandemic caused by the novel SARS-CoV-2 virus is now recognized to be associated with a coagulopathy that can result in arterial and venous thromboses. In this report, we describe a case of large-vessel cerebrovascular thrombus in a therapeutically anticoagulated 89-year-old male admitted with COVID-19 infection. Despite clinical improvement following COVID-19 pneumonitis, symptoms of an acute left-sided total anterior circulation stroke rapidly developed 10 days after initial COVID-19 symptom onset. Computed tomography angiography imaging confirmed acute large-vessel thrombus in the terminal segment of the internal carotid artery resulting in acute right middle cerebral artery territory infarction. Thromboembolic events in the context of COVID-19 infection have recently been described in critically unwell patients. However, to the best of our knowledge, this is one of the first cases of large-vessel thrombus in a patient with COVID-19 infection receiving concurrent therapeutic anticoagulation.
Case report: potential treatment of metastatic amphicrine carcinoma of the rectum with FOLFOXIRI chemotherapy
Authors: Tamura Nobumasa , Honma Yoshitaka , Sekine Shigeki , Tsukamoto Shunsuke , Hirano Hidekazu , Okita Natsuko , Shoji Hirokazu , Iwasa Satoru , Takashima Atsuo , Kato Ken , Boku Narikazu
Published: November 2020

Amphicrine carcinoma (AmC) is a unique epithelial tumor displaying exocrine and endocrine features in the same cell. It shows an adenocarcinoma-like cellular form and has endocrine granules. There are few reports describing chemotherapy for AmC. Here, we describe a case with metastatic AmC from the rectum that was treated with FOLFOXIRI chemotherapy.

A 64-year-old man was diagnosed with a submucosal lesion on the scar produced after an endoscopic mucosal resection, which had been performed for adenocarcinoma of the rectum 2 years before. The endoscopic submucosal dissection revealed AmC. The abdominoperineal resection including lymph nodes dissection was performed. Thereafter, computed tomography showed multiple liver metastases, and FOLFOXIRI was administered. The best overall response was partial response, and progression-free survival was 8.7 months. After 16.0 months since first-line chemotherapy the patient died. We can therefore conclude that FOLFOXIRI may be effective for AmC of the rectum.
Malignant hyperthermia, a rare perioperative complication: case series and literature review
Authors: Ndikontar Raymond , Etoundi Paul Owono , Tochie Joel Nouktadie , Bengono Roddy Stephan Bengono , Minkande Jacqueline Ze
Published: November 2020

Malignant hyperthermia is a rare complication of general anesthesia appearing as an acute and potentially lethal hypermetabolic state in people carrying a genetic anomaly expressed in skeletal muscles. Malignant hyperthermia has been scarcely described in sub-Saharan Africa. Herein, we present three cases of malignant hyperthermia occurring in the perioperative period in Cameroon. The authors wish to draw attention to the clinical presentation of this rare but potentially lethal emergency, for timely diagnosis, management and follow-up geared at preventing perioperative mortality.
The impact of nature-based education on health-related quality of life among low-income youth: results from an intervention study
Authors: Sprague Nadav L , Ekenga Christine C
Published: November 2020

Background

Nature experiences have been shown to promote physical, emotional, mental and overall health. However, low-income youth often face inequities in access to nature. The purpose of this study was to evaluate the impact of a 15-week nature-based education (NBE) intervention on health-related quality of life (HRQoL) of low-income youth.

Methods

A total of 362 low-income youth (ages 9–15) in St. Louis, MO, USA, participated in this study. Study participants completed a pre- and post-intervention survey that included validated measures of six HRQoL domains (Physical Activity, Emotional Health Functioning, School Functioning, Social Functioning, Family Functioning and overall HRQoL). Random effects analysis of covariance was used to test for significant differences in HRQoL scores between the intervention and control groups, after adjusting for school, age, previous nature exposure, and Science, Technology, Engineering and Mathematics capacity.

Results

After the intervention period, youth in the NBE intervention group experienced improvements in all HRQoL domain scores (P < 0.001), whereas youth in the control group experienced declines in HRQoL domain scores (P < 0.001).

Conclusions

NBE may have a positive impact on the HRQoL of low-income youth. Further investigations examining the influence of nature-based activities on youth health outcomes are warranted.
Gender Dynamics in Crowdfunding (Kickstarter): Evidence on Entrepreneurs, Backers, and Taste-Based Discrimination*
Authors: Gafni Hadar , Marom Dan , Robb Alicia , Sade Orly
Published: November 2020

This study focuses on the launch phase of the leading reward-based crowdfunding market—Kickstarter. It documents the behavior of male and female entrepreneurs in raising early stage capital. We find that women share as entrepreneurs in the platform (34.7%) does not equal to their share in the overall population, and they are concentrated in stereotyped sectors, both as entrepreneurs and as backers. We also find that women do not set lower funding goals than men, they enjoy higher rates of success than men, even after controlling for project categories and funding goals, and that backers of both genders have a tendency to fund entrepreneurs of their own gender. Our survey of Kickstarter backers finds evidence of taste-based discrimination by male backers.
Engineering precision therapies: lessons and motivations from the clinic
Authors: Xie Mingqi , Viviani Mirta , Fussenegger Martin
Published: November 2020

In the past decade, gene- and cell-based therapies have been at the forefront of the biomedical revolution. Synthetic biology, the engineering discipline of building sophisticated ‘genetic software’ to enable precise regulation of gene activities in living cells, has been a decisive success factor of these new therapies. Here, we discuss the core technologies and treatment strategies that have already gained approval for therapeutic applications in humans. We also review promising preclinical work that could either enhance the efficacy of existing treatment strategies or pave the way for new precision medicines to treat currently intractable human conditions.
Loss of Clustered Protocadherin Diversity Alters the Spatial Distribution of Cortical Interneurons in Mice
Authors: Gallerani Nicholas , Au Edmund
Published: November 2020

Cortical interneurons (cINs) are locally projecting inhibitory neurons that are distributed throughout the cortex. Due to their relatively limited range of influence, their arrangement in the cortex is critical to their function. cINs achieve this arrangement through a process of tangential and radial migration and apoptosis during development. In this study, we investigated the role of clustered protocadherins (cPcdhs) in establishing the spatial patterning of cINs through the use of genetic cPcdh knockout mice. cPcdhs are expressed in cINs and are known to play key functions in cell spacing and cell survival, but their role in cINs is poorly understood. Using spatial statistical analysis, we found that the 2 main subclasses of cINs, parvalbumin-expressing and somatostatin-expressing (SST) cINs, are nonrandomly spaced within subclass but randomly with respect to each other. We also found that the relative laminar distribution of each subclass was distinctly altered in whole α- or β-cluster mutants. Examination of perinatal time points revealed that the mutant phenotypes emerged relatively late, suggesting that cPcdhs may be acting during cIN morphological elaboration and synaptogenesis. We then analyzed an isoform-specific knockout for pcdh-αc2 and found that it recapitulated the α-cluster knockout but only in SST cells, suggesting that subtype-specific expression of cPcdh isoforms may help govern subtype-specific spatial distribution.
Inoculation of Stigma-Colonizing Microbes to Apple Stigmas Alters Microbiome Structure and Reduces the Occurrence of Fire Blight Disease
Authors: Cui Zhouqi , Huntley Regan B. , Schultes Neil P. , Steven Blaire , Zeng Quan
Published: November 2020

Flowers secrete nutrient-rich exudates that support the growth of an assemblage of microorganisms, including both beneficial and pathogenic members, most of which belong to the phylum Proteobacteria. Given the potential role of the microbiome in plant health, manipulating the microbiome to promote growth of beneficial members holds promise in controlling plant diseases. In this study, we inoculated four different bacterial strains that were originally isolated from apple stigmas, alone or in mixtures of increasing complexity, onto apple flowers during bloom. We tested whether such treatments would influence fire blight occurrence, a disease caused by Erwinia amylovora, and whether we could detect a shift in the structure of the microbiome due to the treatments. We show that various inoculations did influence the occurrence of fire blight, although the level of disease suppression was dependent upon specific bacterial strains. Furthermore, treatments using different strains or strain mixtures predominantly resulted in increased representation of the inoculated strains, suggesting that disease suppression was due to an alteration of the stigma microbiome structure. Compared with treatments using single strains, a Pantoea–Pseudomonas strain mixture produced a homogeneous microbiome structure with less interflower variability. Findings from this study suggest that the microbiome on the flower stigma can be manipulated through microbial inoculation. Due to flowers’ short life span yet important role in plant disease infection, even a short-term influence on microbiome composition may result in significant decreases in disease susceptibility.
Recognizing mucormycosis in an immunocompromised patient
Authors: Hunt Elicia
Published: November 2020

Mucormycosis is an aggressive, angioinvasive fungal infection with a predilection for the rhino-orbital cavity, predominantly in immunocompromised patients such as patients with uncontrolled diabetes. Prognosis is very poor, with a survival rate of 40% to 50%; therefore, early detection and initiation of treatment is paramount. Presenting symptoms are vague and mucormycosis is rare, so recognition, awareness, and knowledge of this infection are key to timely intervention and enhanced patient survival.
Disuse-Induced Muscle Loss and Rehabilitation: The National Aeronautics and Space Administration Bed Rest Study
Authors: Scott Jessica M. , Downs Meghan , Buxton Roxanne , Goetchius Elizabeth , Crowell Brent , Ploutz-Snyder Robert , Hackney Kyle J. , Ryder Jeffrey , English Kirk , Ploutz-Snyder Lori L.
Published: November 2020

Objectives:

The time course and magnitude of atrophic remodeling and the effects of an acute rehabilitation program on muscle atrophy are unclear. We sought to characterize bed rest–induced leg muscle atrophy and evaluate the safety and efficacy of an acute rehabilitation program.

Design:

Prespecified analysis of a randomized controlled trial.

Setting:

Single-center urban hospital.

Patients:

Adults (24–55 yr) randomized to 70 days of sedentary bed rest.

Interventions:

The 11-day post-bed rest rehabilitation program consisted of low intensity exercise and progressed to increased aerobic exercise duration, plyometric exercises, and higher intensity resistance exercise.

Measurements and Main Results:

Upper (rectus femoris, vastus lateralis, quadriceps, hamstrings, adductors) and lower leg (medial gastrocnemius, lateral gastrocnemius, and soleus) MRI scans were obtained once before, nine times during, and three times after bed rest to assess muscle cross-sectional area. The magnitude and rate of muscle atrophy and recovery were determined for each muscle. Nine participants completed 70 days of sedentary bed rest and an 11-day rehabilitation program. A total of 11,588 muscle cross-sectional area images were quantified. Across all muscles except the rectus femoris (no change), there was a linear decline during bed rest, with the highest atrophic rate occurring in the soleus (–0.33%/d). Following rehabilitation, there was rapid recovery in all muscles; however, the quadriceps (–3.74 cm2; 95% CI, –7.36 to –0.12; p = 0.04), hamstrings (–2.30 cm2; 95% CI, –4.07 to –0.54; p = 0.01), medial gastrocnemius (–0.62 cm2; 95% CI, –1.10 to –0.14; p = 0.01), and soleus (–1.85 cm2; 95% CI, –2.90 to –0.81; p < 0.01) remained significantly lower than baseline.

Conclusions:

Bed rest results in upper and lower leg muscle atrophy in a linear pattern, and an 11-day rehabilitation program was safe and effective in initiating a rapid trajectory of muscle recovery. These findings provide important information regarding the design and refinement of rehabilitation programs following bed rest.
Frequency and Analysis of Unplanned Extubation in Coronavirus Disease 2019 Patients
Authors: Chhina Anoop K. , Loyd Gary E. , Szymanski Trevor J. , Nowak Katherine A. , Peruzzi William T. , Yeldo Nicholas S. , Han Xiaoxia , Kerzabi Lotfi S. , Galusca Dragos M. , Cazacu Simona , Brodie Chaya , Penning Donald H.
Published: November 2020

Objectives:

To determine if patients with coronavirus disease 2019 had a greater number of unplanned extubations resulting in reintubations than in patients without coronavirus disease 2019.

Design:

Retrospective cohort study comparing the frequency of unplanned extubations resulting in reintubations in a group of coronavirus disease 2019 patients to a historical (noncoronavirus disease 2019) control group.

Setting:

This study was conducted at Henry Ford Hospital, an academic medical center in Detroit, MI. The historical noncoronavirus disease 2019 patients were treated in the 68 bed medical ICU. The coronavirus disease 2019 patients were treated in the coronavirus disease ICU, which included the 68 medical ICU beds, 18 neuro-ICU beds, 32 surgical ICU beds, and 40 cardiovascular ICU beds, as the medical ICU was expanded to these units at the peak of the pandemic in Detroit, MI.

Patients:

The coronavirus disease 2019 cohort included patients diagnosed with coronavirus disease 2019 who were intubated for respiratory failure from March 12, 2020, to April 13, 2020. The historic control (noncoronavirus disease 2019) group consisted of patients who were admitted to the medical ICU in the year spanning from November 1, 2018 to October 31, 2019, with a need for mechanical ventilation that was not related to surgery or a neurologic reason.

Interventions:

None.

Measurements and Main Results:

To identify how many patients in each cohort had unplanned extubations, an electronic medical records query for patients with two intubations within 30 days was performed, in addition to a review of our institutional quality and safety database of reported self-extubations. Medical charts were manually reviewed by board-certified anesthesiologists to confirm each event was an unplanned extubation followed by a reintubation within 24 hours. There was a significantly greater incidence of unplanned extubations resulting in reintubation events in the coronavirus disease 2019 cohort than in the noncoronavirus disease 2019 cohort (coronavirus disease 2019 cohort: 167 total admissions with 22 events—13.2%; noncoronavirus disease 2019 cohort: 326 total admissions with 14 events—4.3%; p < 0.001). When the rate of unplanned extubations was expressed per 100 intubated days, there was not a significant difference between the groups (0.88 and 0.57, respectively; p = 0.269).

Conclusions:

Coronavirus disease 2019 patients have a higher incidence of unplanned extubation that requires reintubation than noncoronavirus disease 2019 patients. Further study is necessary to evaluate the variables that contribute to this higher incidence and clinical strategies that can reduce it.
Antimicrobial peptides: bridging innate and adaptive immunity in the pathogenesis of psoriasis
Authors: Ma Jing-Yi , Shao Shuai , Wang Gang
Published: November 2020

Antimicrobial peptides (AMPs) are small molecules produced by a myriad of cells and play important roles not only in protecting against infections and sustaining skin barrier homeostasis but also in contributing to immune dysregulation under pathological conditions. Recently, increasing evidence has indicated that AMPs, including cathelicidin (LL-37), human β-defensins, S100 proteins, lipocalin 2, and RNase 7, are highly expressed in psoriatic skin lesions. These peptides broadly regulate immunity by interacting with various immune cells and linking innate and adaptive immune responses during the progression of psoriasis. In this review, we summarize the recent findings regarding AMPs in the pathogenesis of psoriasis with a main focus on their immunomodulatory abilities.
Research progress and perspective in metabolism and metabolomics of psoriasis
Authors: Lian Ni , Shi Li-Qing , Hao Zhi-Min , Chen Min
Published: November 2020

Psoriasis is considered a systemic disease associated with metabolic abnormalities, and it is important to understand the mechanisms by which metabolism affects pathophysiological processes both holistically and systematically. Metabolites are closely related to disease phenotypes, especially in systemic diseases under multifactorial modulation. The emergence of metabolomics has provided information regarding metabolite changes in lesions and circulation and deepened our understanding of the association between metabolic reprogramming and psoriasis. Metabolomics has great potential for the development of effective biomarkers for clinical diagnosis, therapeutic monitoring, prediction of the efficacy of psoriasis management, and further discovery of new metabolism-based therapeutic targets.
Postpartum health risks among women with hypertensive disorders of pregnancy, California 2008–2012
Authors: Murray Horwitz Mara E. , Rodriguez Maria I. , Dissanayake Mekhala , Carmichael Suzan L. , Snowden Jonathan M.
Published: November 2020

Objectives:

The aim of this study was to understand the associations between hypertensive disorders of pregnancy (HDP) and postpartum complications throughout the newly defined 12-week postpartum transition.

Study design:

We conducted a retrospective cohort study of the associations of HDP (any/subtype) with postpartum complications among 2.5 million California births, 2008–2012. We identified complications from discharge diagnoses from maternal hospital encounters (emergency department visits and readmissions) in the 12 weeks after giving birth. We compared rates of complications, overall and by diagnostic category, between groups defined by HDP. In survival analyses, we calculated the adjusted hazard ratios of postpartum complications associated with HDP. We adjusted for maternal age, race/ethnicity, prepregnancy obesity, chronic diabetes, gestational diabetes, insurance, delivery mode, gestational age and birth outcome (term and size).

Results:

Among women with and without HDP, 12.8 and 7.7%, respectively, had a hospital encounter within 12 weeks of giving birth [adjusted hazard ratio 1.5, 95% confidence interval (95% CI): 1.5–1.5]. HDP was associated with increased risk across all major categories of complications: hypertension-related, adjusted hazard ratio 11.8 (95% CI: 11.2–12.3); childbirth-related, 1.4 (1.3–1.4); and other, 1.4 (1.4–1.4). Risk of any complication differed by hypertensive subtype: chronic hypertension with super-imposed preeclampsia, adjusted hazard ratio 1.8 (95% CI: 1.7–1.8); chronic hypertension, 1.6 (1.6–1.7); preeclampsia/eclampsia, 1.3 (1.3–1.4); and gestational hypertension, 1.2 (1.2–1.3). Over a quarter (28.9%) of maternal hospital encounters occurred more than 6 weeks after giving birth; this did not differ substantially by HDP status.

Conclusion:

Women with HDP are at an increased risk for virtually all postpartum complications, including those not related to hypertension, and may benefit from enhanced and comprehensive postpartum care.
CLINICAL CHARACTERISTICS OF EYES WITH DIFFERENT GRADES OF MYOPIC TRACTION MACULOPATHY
Authors: Li Jun , Liu Bingqian , Li Yonghao , Zhao Xiujuan , Chen Shida , Huang Xia , Lian Ping , Li Tao , Jin Chenjin , Liang Xiaoling , Lu Lin
Published: November 2020

Purpose:

To analyze clinical characteristics in eyes with myopic traction maculopathy (MTM).

Methods:

Nine hundred and ninety-one patients (1,334 eyes) with MTM, who visited Zhongshan Ophthalmic Center from January 2014 to December 2019, were involved. Myopic traction maculopathy was classified into six grades according to the new classification system: no macular schisis (T0), inner or outer foveoschisis (FS) (T1); inner and outer FS (T2), foveal detachment (T3), full-thickness macular hole (T4), and macular hole retinal detachment (T5).

Results:

Seven hundred and seventy-eight (58.32%) eyes were in T0, 157 (11.77%) in T1, 177 (13.27%) in T2, 129 (9.67%) in T3, 45 (3.37%) in T4, and 48 (3.67%) in T5. With the severity of MTM, age increased and the best-corrected visual acuity became worse (P < 0.001). However, no significant differences were found on spherical equivalent refraction or axial length among different grades of MTM (P > 0.05). Moreover, significant differences on best-corrected visual acuity, spherical equivalent refraction, axial length, and staphyloma rate existed between eyes with inner FS and eyes with outer FS (P < 0.01), but not between eyes with outer FS and eyes with both inner FS and outer FS (P > 0.05). Besides, significant differences were found on spherical equivalent refraction, axial length, and staphyloma rate between full-thickness macular hole with and without macular schisis (P < 0.001).

Conclusion:

Spherical equivalent refraction and axial length were not correlated with the severity of MTM in this cohort. It might be preferable to categorize eyes with outer FS and eyes with both inner FS and outer FS as a same grade. Potential difference in the pathogenesis between full-thickness macular hole with and without macular schisis might exist.
Cage-lid hanging behavior as a translationally relevant measure of pain in mice
Authors: Zhang Hantao , Lecker Irene , Collymore Chereen , Dokova Anastassia , Pham Maian Christine , Rosen Sarah F. , Crawhall-Duk Hayley , Zain Maham , Valencia Megan , Filippini Helena Fetter , Li Jerry , D'Souza Abigail J. , Cho Chulmin , Michailidis Vassilia , Whissell Paul D. , Patel Ingita , Steenland Hendrik W. , Virginia Lee Wai-Jane , Moayedi Massieh , Sterley Toni-Lee , Bains Jaideep S. , Stratton Jo Anne , Matyas John R. , Biernaskie Jeff , Dubins David , Vukobradovic Igor , Bezginov Alexandr , Flenniken Ann M. , Martin Loren J. , Mogil Jeffrey S. , Bonin Robert P.
Published: November 2020

The development of new analgesic drugs has been hampered by the inability to translate preclinical findings to humans. This failure is due in part to the weak connection between commonly used pain outcome measures in rodents and the clinical symptoms of chronic pain. Most rodent studies rely on the use of experimenter-evoked measures of pain and assess behavior under ethologically unnatural conditions, which limits the translational potential of preclinical research. Here, we addressed this problem by conducting an unbiased, prospective study of behavioral changes in mice within a natural homecage environment using conventional preclinical pain assays. Unexpectedly, we observed that cage-lid hanging, a species-specific elective behavior, was the only homecage behavior reliably impacted by pain assays. Noxious stimuli reduced hanging behavior in an intensity-dependent manner, and the reduction in hanging could be restored by analgesics. Finally, we developed an automated approach to assess hanging behavior. Collectively, our results indicate that the depression of hanging behavior is a novel, ethologically valid, and translationally relevant pain outcome measure in mice that could facilitate the study of pain and analgesic development.
Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic
Authors: Hruschak Valerie , Flowers K. Mikayla , Azizoddin Desiree R. , Jamison Robert N. , Edwards Robert R. , Schreiber Kristin L.
Published: November 2020

The COVID-19 pandemic has had a tremendous impact, including on individuals with chronic pain. The social distancing policies necessary to slow the spread of SARS-CoV-2 have involved increased levels of social isolation. This cross-sectional survey study examined pain severity and interference among individuals with chronic pain during an early phase of social distancing mandates and identified characteristics of individuals who were most impacted. Approximately 4 to 8 weeks after social distancing mandates commenced in the state of Massachusetts, 150 patients with fibromyalgia, chronic spine, and postsurgical pain completed demographic, pain, social distancing, and validated psychosocial questionnaires. Patients self-reported an overall significant increase in pain severity and pain interference, compared with before social distancing, although both pain severity and interference were quite variable among individuals under conditions of social distancing. Several demographic, socioeconomic, and psychosocial factors were associated with greater pain severity and interference during social distancing. Multivariable linear regression demonstrated that female sex, nonwhite race, lower education, disability, fibromyalgia, and higher pain catastrophizing were independently associated with greater pain severity, while female sex and pain catastrophizing were independently associated greater pain interference. The findings suggest that individual differences among patients with chronic pain should be considered in the planning, development, and prioritization of interventions to improve pain care and to prevent worsening of symptoms during the continuing COVID-19 pandemic.
Diagnostic importance of mean platelet volume, platelet distribution width and platelet large cell ratio as screening tool in immune thrombocytopenia
Authors: Khan Muhammad Ihtesham , Ullah Ihsan
Published: November 2020

Objective:

To determine diagnostic importance of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (PLCR) in diagnosing cases of immune thrombocytopenia.

Methodology:

The study was done in Khyber Teaching hospital from January 2017 to May 2018. Cases with low platelet count of all the ages and both the genders were included in the study by non probability purposive sampling technique and were subjected to bone marrow aspiration to rule out other causes of thrombocytopenia and thus confirm the diagnosis of immune thrombocytopenia. The platelet indices were noted and their sensitivity, specificity and accuracy were determined for immune thrombocytopenia. Mean and standard deviation were used for quantitative data. Percentage and frequency were used to measure qualitative data. Data was analysed by SPSS.

Results:

84 cases with thrombocytopenia of mean age 23.4 ± 12.1 years (range 7–81 years) were included in the study. There were 38 (45.2%) males and 46 (54.8%) females. There were 40 cases of immune thrombocytopenia. The sensitivity and specificity for PDW (59.1% and 43.1%, respectively), MPV (59.1% and 52.9%, respectively), and PLCR (50% and 52.9%, respectively) were found low to be used as screening tool for immune thrombocytopenia.

Conclusion:

The MPV, PDW and PLCR has low sensitivity and specificity and therefore should not be used as reliable screening tool in giving preliminary diagnosis of the immune thrombocytopenia.
Identification of afzelin potential targets in inhibiting triple-negative breast cancer cell migration using reverse docking
Authors: Rachmi Eva , Purnomo Basuki Bambang , Endharti Agustina Tri , Fitri Loeki Enggar
Published: November 2020

Background:

Triple-negative breast cancer (TNBC) tends to be aggressive and metastatic, characteristics attributable to its cellular migration capabilities. Afzelin is a chemical compound with anti-metastatic potentials. This study aimed to predict proteins involved in TNBC cell migration which could be inhibited by afzelin.

Methods:

The protein database was constructed from the Kyoto Encyclopedia of Genes and Genomes pathways collection which related to cell motility, then screened for druggability using SuperTarget and Therapeutic Target Database. The involvement of druggable proteins in the TNBC metastasis process was investigated through existing publications in The National Center for Biotechnology Information PubMed database. Inhibitory potential of afzelin toward target proteins was compared to the proteins’ known-inhibitor, using the reverse docking method.

Results:

Ten proteins identified as potential targets of afzelin, with the top 3 being ERK2, KRas, and FAK, respectively. Afzelin's 3-O-rhamnoside group played a dominant role in forming hydrogen bonds with the target proteins. Further analysis with STRING suggested that afzelin might be able to inhibit chemotaxis and haptotaxis of TNBC cells.

Conclusions:

Afzelin was predicted to inhibit TNBC cell motility, by targeting ERK2, KRas, and FAK activation.
Is Celiac Disease Testing Necessary in Functional Abdominal Disorders? A Study in Predominantly Latino Children
Authors: Falcon Ana C. , Fifi Amanda C. , Valdes Lilibet Fernandez , Jaquez Jessica , Mariaud Carolina , Saps Miguel
Published: November 2020

Background: :

Functional abdominal pain disorders (FAPDs) are among the most common causes of consultation in general pediatrics and pediatric gastroenterology. The Rome IV criteria recommend testing for celiac disease (CD) in children with irritable bowel syndrome‐diarrhea (IBS‐D) and leaves testing in cases of other FAPDs to the practitioner's discretion. These recommendations were based on a single study that showed a 4‐fold increase of CD among patients with IBS in Italy. It is unclear if these findings can be extrapolated to other populations. Understanding whether those results are reproducible in areas with different racial/ethnic backgrounds can optimize patient care.

Aim:

The aim of the study was to assess the prevalence of CD in a sample of children consulting for FAPDs to a tertiary care center in Miami.

Methods:

The charts of all pediatric patients consulting for FAPDs from January 2016 to November 2019 at the University of Miami were reviewed. Demographics, diagnosis, and CD testing for each child were analyzed.

Results:

One hundred eighty‐one children with FAPDs and celiac testing were seen. Mean age of 12.89 years, girls 61.34%. 84 (46.40%) had a diagnosis of IBS and 97 (53.59%) had a diagnosis of other FAPD. One of 181 children with FAPDs (0/84 with IBS and 1/97 with other FAPDs) had positive CD serological testing and EGD confirmation.

Conclusions:

Our study suggests that the prevalence of CD among children with FAPDs is similar to the community prevalence. This data questions the benefit of testing all children FAPDS (including IBS) for CD. Studies with larger sample size and various racial/ethnic makeup should be done to confirm our findings.
Pediatric Patient and Parent Perceptions of Fecal Microbiota Transplantation for the Treatment of Ulcerative Colitis
Authors: Popov Jelena , Hartung Emily , Hill Lee , Chauhan Usha , Pai Nikhil
Published: November 2020

Background:

Fecal microbiota transplantation (FMT) has gained attention for its role in the treatment of ulcerative colitis (UC). Acceptance of this treatment, particularly among children and their parents, is an important aspect of assessing its feasibility for pediatric inflammatory bowel disease care. To date, no studies have assessed FMT acceptance among pediatric patients who underwent FMT treatment. Here, we explored the perceptions and experiences of FMT in a population of pediatric UC patients who participated in a recent FMT pilot randomized controlled trial.

Methods:

Children who received bi‐weekly FMT treatments for 6 weeks through a clinical trial (NCT02606032) and their parents participated in face‐to‐face, semi‐structured interviews led by study investigators. Interviews were audiotaped, transcribed, and analyzed using validated qualitative research methods.

Results:

Eight patients and eight parents were interviewed, with qualitative data summarized across four themes and 11 subthemes. The majority of participants perceived FMT as a “natural treatment” and cited lack of response to conventional medications and fear of medication side‐effects as motivators for pursuing FMT. Pre‐treatment, patients and parents expressed concerns regarding physical discomfort with FMT administration; post‐treatment, most patients reported feeling “completely normal.” Both patients and parents uniformly expressed interest in pursuing FMT again in the future if available. Convenience of medication therapies, and perceived naturality and efficacy of FMT were all endorsed.

Conclusions:

This is the first study to describe pediatric and parent experiences receiving FMT. This information is valuable to develop and encourage future FMT trials involving children. Pre‐treatment, concerns about FMT were common. Post‐treatment, patients reported tolerance to FMT and a desire to continue receiving this therapy if available. Further trials of FMT in UC are needed. Investigators should include pediatric patients without concern of acceptance.
Medical Management of Chronic Pancreatitis in Children
Authors: Freeman A. Jay , Maqbool Asim , Bellin Melena D. , Goldschneider Kenneth R. , Grover Amit S. , Hartzell Cheryl , Piester Travis L. , Szabo Flora , Kiernan Bridget Dowd , Khalaf Racha , Kumar Rakesh , Rios Mirta , Husain Sohail Z. , Morinville Veronique D. , Abu‐El‐Haija Maisam
Published: November 2020

This position paper summarizes the current understanding of the medical management of chronic pancreatitis (CP) in children in light of the existing medical literature, incorporating recent advances in understanding of nutrition, pain, lifestyle considerations, and sequelae of CP. This article complements and is intended to integrate with parallel position papers on endoscopic and surgical aspects of CP in children. Concepts and controversies related to pancreatic enzyme replacement therapy (PERT), the use of antioxidants and other CP medical therapies are also reviewed. Highlights include inclusion of tools for medical decision‐making for PERT, CP‐related diabetes, and multimodal pain management (including an analgesia ladder). Gaps in our understanding of CP in children and avenues for further investigations are also reviewed.
Comorbid Diagnosis of Eosinophilic Esophagitis and Inflammatory Bowel Disease in the Pediatric Population
Authors: Moore Hillary , Wechsler Joshua , Frost Carrie , Whiteside Elizabeth , Baldassano Robert , Markowitz Jonathan , Muir Amanda B.
Published: November 2020

Background and Aims:

The incidence and prevalence of eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are rising with similar patterns. Co‐occurrence of both diseases in the same patient has been increasingly reported. We sought to examine the pediatric population with both EoE and IBD to better understand the epidemiology and clinical implications of this overlap.

Methods:

We conducted a retrospective case‐control study at 2 tertiary care children's hospitals. Subjects with both EoE and IBD were identified and compared with randomly selected controls with EoE and IBD alone in terms of: demographics, atopic conditions, IBD classification, location and phenotype of Crohn disease (CD), IBD medications, endoscopic findings, and histopathology. Descriptive statistics summarized the data.

Results:

Sixty‐seven subjects with dual‐diagnosis were identified across both institutions. The prevalence of IBD in the EoE population was 2.2% and EoE in IBD was 1.5%. Subjects with both diseases were more likely to have IgE‐mediated food allergy compared with IBD alone (36% vs 7%, P < 0.001). Subjects with CD‐EoE were less likely to have perianal disease than CD alone (2% vs 20%, P = 0.004). There was no difference in fibrostenotic EoE between the dual‐diagnosis group and EoE alone. Treatment with a TNF‐alpha inhibitor (anti‐TNF) for management of preexisting IBD was protective against development of EoE with a relative risk of 0.314 [95% confidence interval [CI] 0.159‐0.619].

Conclusions:

This is a unique population in whom the underlying pathway leading to dual‐diagnosis is unclear. Concomitant atopic conditions, especially IgE‐mediated food allergy, and medication exposures, particularly anti‐TNFs, may help predict likelihood of developing dual‐diagnosis.
Metronomic Maintenance With Weekly Vinblastine After Induction With Bevacizumab-Irinotecan in Children With Low-grade Glioma Prevents Early Relapse
Authors: Roux Clémence , Revon-Rivière Gabriel , Gentet Jean Claude , Verschuur Arnauld , Scavarda Didier , Saultier Paul , Appay Romain , Padovani Laetitia , André Nicolas
Published: November 2020

Background:

Pediatric low-grade glioma (pLGG) represents the most common brain tumor in childhood. Previous studies have reported that a therapeutic strategy on the basis of the association of bevacizumab alone (B) or in combination with irinotecan (BI) could produce rapid tumor response and clinical improvement in children with pLGG. Nevertheless, a majority of patients relapses shortly (median, 5 mo) after stopping B or BI treatment. We proposed metronomic maintenance with weekly vinblastine added after a 6 months induction of B/BI to prevent early relapse.

Patients and Methods:

Monocentric retrospective analysis of a patient with pLGG treated with B or BI for 6 months followed by a 12-month maintenance with weekly vinblastine (6 mg/m²) from October 2012 to September 2019 in a single institution.

Results:

In total, 18 patients (7 males and 11 females) were identified. Because of progression during the B or BI induction 2/18 children were excluded. In total, 16 patients were analyzed with a median age of 10 years (range, 4 to 16 y). A total of 13 patients received BI and 3 patients received B alone. The mean duration of induction was 6.2 months (range, 2 to 12 mo). After induction 5/16 patients had a partial radiologic response, 11/16 patients had stable disease. All patients started maintenance (median duration, 12 mo; range, 3 to 12 mo). With a median follow-up of 3.9 years after the end of B or BI (range, 11 mo to 7.2 y), 15/16 patients were alive and 9/16 patients were progression-free. Seven of 16 children progressed with a median time to progression of 23 months (ranges, 5 to 39 mo). Three of 16 (18%) children progressed during vinblastine maintenance and 4/16 (25%) patients after the end of maintenance. After the total duration of treatment, clinical improvement was noted in 4 patients, 9 patients had stable symptoms, and only 3 patients progressed. One and 2-year event-free survival were, respectively, 81.2% and 56.2%. Two-year overall survival was 93.7%.

Conclusions:

We report here, the potential benefit and the improvement of progression-free survival by adding metronomic maintenance with weekly vinblastine after initial induction with B or BI in children with low-grade glioma.
Changes in Care Delivery for Children With Sickle Cell Anemia During the COVID-19 Pandemic
Authors: Noisette M. Laurence , Phillips Shannon , Schlenz Alyssa M. , Mueller Martina , Kanter Julie
Published: November 2020

Background:

Specialty care for children with sickle cell disease (SCD) may be disrupted during the coronavirus (COVID-19) pandemic. Our DISPLACE consortium includes 28 pediatric SCD centers.

Methods:

In May 2020, we surveyed the consortium on the impact of COVID-19 on their practice focusing on transcranial Doppler ultrasound, chronic red cell transfusions, telehealth, and COVID-19 testing.

Observation:

Twenty-four DISPLACE providers completed the survey. Transcranial Doppler ultrasound screening decreased to 67% but chronic red cell transfusions remained at 96%. Most investigators (92%) used telehealth and 40% of providers had patients test positive for COVID-19.

Conclusion:

The COVID-19 pandemic has affected routine care and necessitated changes in practice in SCD.
The Safety and Efficacy of Intermittent Fasting for Weight Loss
Authors: Aoun Antoine , Ghanem Charbel , Hamod Natacha , Sawaya Sabine
Published: November 2020

Intermittent fasting (IF) diets have recently gained popularity as a weight loss and antiaging method that attracts celebrity endorsements and public interest. Despite the growing use of IF, the debate over its safety and efficacy is still ongoing. Defined IF regimens include 5 different types: alternate-day fasting, periodic fasting, time-restricted feeding, less clearly defined IF (fast mimicking diet, juice fasting), and religious fasts. Our literature review highlights the effect of IF essentially on body weight and cardiometabolic risk factors. Intermittent fasting may be effective for weight loss and may improve cardiovascular and metabolic health, although the long-term sustainability of these effects has not been studied. While data on the safety of IF are sparse, the most frequent adverse effects (hunger, irritability, and impaired cognition) may dissipate within a month of the fasting period. Intermittent fasting is not recommended for pregnant or lactating women, children or adolescents during maturation, the elderly or underweight people, and individuals vulnerable to eating disorders.
Type 2 Diabetes Mellitus in China
Authors: Zhu Dongwan , Dwyer Johanna T. , Ouyang Chung-Mei
Published: November 2020

Vast changes in demographics, income, and population health have led to an exponential increase in type 2 diabetes mellitus over the past 3 decades in China. This article discusses some type 2 diabetes mellitus risk factors such as genetics, obesity, and physical inactivity that are similar to those in other populations, coupled with other unique influences that may account for the high prevalence in China. They provide background for planning prevention measures.