bluuebunny/crossref_metadata_2025 huggingface dataset:
Spray cryotherapy prevents need for palliative stenting in patients with esophageal cancer-associated dysphagia
Authors: Hanada Yuri , Leggett Cadman L , Iyer Prasad G , Linn Bryan , Mangels-Dick Tiffany , Wang Kenneth K
Published: July 2021

Background

Dysphagia is the most common symptom in advanced esophageal cancer patients. Esophageal stent placement (SP) is a common palliation method but can be associated with significant morbidity. Limited data exist regarding the ability of spray cryotherapy (SC) prolong time to SP.

Methods

A Mayo Clinic (Rochester, MN) patient database was reviewed for cases with a SC indication of esophageal cancer palliation from 2007–2019. Procedures were performed using a liquid nitrogen SC system to apply 2–5 separate 20 second freeze and 60 second thaw cycles based on tumor characteristics. Primary outcome was time to subsequent palliative SP.

Results

Of 56 patients (71.4% male, mean age 77.8 ± 10.2 years) who underwent a total of 199 SC sessions (mean 3.6 ± 2.7, range 1–12 per patient), 41 had adenocarcinoma and 15 squamous cell carcinoma (SCC). Overall, 13 patients underwent subsequent SP within a mean duration of 15.7 ± 11.0 months over a mean follow-up duration of 25.6 ± 29.4 months. Treatment did produce stenosis in 16 patients, who required dilation within a mean period of 193.1 ± 294.1 days; notably, 10 patients had a history of preceding malignant strictures requiring dilation. Two patients experienced bleeding requiring transfusion, whereas 1 experienced perforation at the start of SC. Prior chemotherapy and/or radiation was not associated with developing an SC-related complication (risk ratio (RR) 1.5; 95% CI 0.6–3.7, P > 0.4).

Conclusions

SC appears to be an effective and safe modality to palliate esophageal cancer in appropriate candidates. Majority of patients who undergo SC avoid the need for future SP. If patients eventually require SP, they are able to, on average, defer stenting for >1 year from SC initiation.
Signs and symptoms of intimate partner violence in women attending primary care in Europe, North America and Australia: a systematic review and meta-analysis
Authors: Vicard-Olagne Mathilde , Pereira Bruno , Rougé Laure , Cabaillot Aurélie , Vorilhon Philippe , Lazimi Gilles , Laporte Catherine
Published: July 2021

Background

Intimate partner violence (IPV) is a prevalent yet underdiagnosed health issue, and primary care practitioners are in a unique front-line position to provide care and counsel for the victims.

Objective

To identify the signs and symptoms of women exposed to IPV who attended primary care, regardless motive of consultation.

Methods

Systematic review and meta-analysis on Cochrane, PubMed, Embase and CINAHL between 1946 and 2020. Eligible studies had to be original quantitative research, on women aged >15 years, attending primary care settings in Europe, North America and Australia and interviewed on their status as victims of IPV and on their signs and symptoms.

Results

Of 1791 articles identified, 57 were selected. Associations were found between IPV and signs and symptoms of depression [19 studies: overall odds ratio (OR) = 3.59, 95% confidence interval (CI; 2.7–4.7, I2 = 94.6%)], anxiety [9 studies: overall OR = 2.19, 95% CI (1.75–2.73, I2 = 84%)], gynaecological and/or sexually transmitted infections [6 studies: overall OR = 2.82, 95% CI (2.1–3.8, I2 = 41%)] and combination of somatic symptoms [5 studies: standard mean deviation = 0.795, 95% CI (0.62–0.97, I2 = 0%)].

Conclusions

Women exposed to IPV may present with clinical symptoms and signs other than bodily injury. Policy implications knowing these symptoms presented by women victims of IPV can help GPs identify and treat them.

Systematic review registration

PROSPERO CRD42018089857.
11. Who Has Parental Responsibility?
Authors: Lowe N V , Douglas G
Published: July 2021

This chapter considers the question of who has parental responsibility, or put another way, who the holders of parental responsibility are. It begins by examining the allocation of parental responsibility at the child's birth and subsequent to the child's birth. It considers over whom such responsibility exists. It concludes by discussing the duration of parental responsibility; the position where responsibility is shared between different holders; the delegation of responsibility; and the legal position of those caring for a child without having parental responsibility.
16. Children and Local Authorities:
Authors: Lowe N V , Douglas G
Published: July 2021

This chapter focuses on the local authorities' investigative powers and duties. It covers general duty of investigation under Section 47 of the Children Act 1989; co-operating with other agencies to discharge investigative duties; emergency protection orders; child assessment orders; and police protection.
22. Financial Remedies on Divorce, Dissolution, Nullity and Separation:
Authors: Lowe N V , Douglas G
Published: July 2021

This chapter discusses the law governing financial remedies in the context of a divorce, dissolution of a civil partnership, nullity, and separation. It deals with the court's powers and the procedures under which these are exercised.
Thrombotic microangiopathy following aortic surgery with hypothermic circulatory arrest: a single-centre experience of an underestimated cause of acute renal failure
Authors: Kamla Christine E , Grigorescu-Vlass Melissa , Wassilowsky Dietmar , Fischereder Michael , Hagl Christian , Schönermarck Ulf , Pichlmaier Maximilian A , Peterss Sven , Jóskowiak Dominik
Published: July 2021

OBJECTIVES

Acute kidney injury (AKI) following surgery involving the heart-lung-machine is associated with high mortality and morbidity. In addition to the known mechanisms, thrombotic microangiopathy (TMA) triggered by the dysregulation of complement activation was recently described as another pathophysiological pathway for AKI following aortic surgery. The aim of this retrospective study was to analyse incidence, predictors and outcome in these patients.

METHODS

Between January 2018 and September 2019, consecutive patients undergoing aortic surgery requiring hypothermic circulatory arrest were retrospectively reviewed. If suspected, diagnostic algorithm was initiated to identify a TMA and its risk factors, and postoperative outcome parameters were comparably investigated.

RESULTS

The incidence of TMA in the analysed cohort (n = 247) was 4.5%. Multivariable logistic regression indicated female gender {odds ratio (OR) 4.905 [95% confidence interval (CI) 1.234–19.495], P = 0.024} and aortic valve replacement [OR 8.886 (95% CI 1.030–76.660), P = 0.047] as independent predictors of TMA, while cardiopulmonary bypass, X-clamp and hypothermic circulatory arrest times showed no statistically significance. TMA resulted in postoperative AKI (82%), neurological disorders (73%) and thrombocytopaenia [31 (interquartile range 25–42) G/l], corresponding to the diagnostic criteria. Operative mortality and morbidity were equal to patients without postoperative TMA, despite a higher incidence of re-exploration for bleeding (27 vs 6%; P = 0.027). After 6 months, survival, laboratory parameters and need for dialysis were comparable between the groups.

CONCLUSIONS

TMA is a potential differential diagnosis for the cause of AKI following aortic surgery regardless of the hypothermic circulatory arrest time. Timely diagnosis and appropriate treatment resulted in a comparable outcome concerning mortality and renal function.
Emergence of transient intersegmental plane by pulmonary circulation single-blocking: is it the true intersegmental plane?
Authors: Chen Liang , Li Qingshu , Chen Xu , Ge Mingjian
Published: July 2021

We report the transient intersegmental plane formed by circulation single-blocking, which is consistent with the true intersegmental plane, and its formation principles, characteristics and potential applications.
The emergence and transmission of COVID-19 in European countries, 2019–2020: a comprehensive review of timelines, cases and containment
Authors: Al-Salem Waleed , Moraga Paula , Ghazi Hani , Madad Syra , Hotez Peter J
Published: July 2021

When it emerged in late 2019, COVID-19 was carried via travelers to Germany, France and Italy, where freedom of movement accelerated its transmission throughout Europe. However, effective non-pharmaceutical interventions introduced by European governments led to containment of the rapid increase in cases within European nations. Electronic searches were performed to obtain the number of confirmed cases, incident rates and non-pharmaceutical government measures for each European country. The spread and impact of non-pharmaceutical interventions throughout Europe were assessed and visualized. Specifically, heatmaps were used to represent the number of confirmed cases and incident rates for each of the countries over time. In addition, maps were created showing the number of confirmed cases and incident rates in Europe on three different dates (15 March, 15 April and 15 May 2020), which allowed us to assess the geographic and temporal patterns of the disease.
The Dog That Did Not Bark, the Dog That Did Bark, and the Dog That Should Have Barked: A Methodology for Cyber Deterrence Research
Authors: Lupovici Amir
Published: July 2021

The study of deterrence presents a number of challenges, mainly to do with identifying deterrence success and defining how deterrence works. Studying cyber deterrence presents even greater challenges, as traditional deterrence challenges are exacerbated and interactions in the cyber domain create further difficulties. When studying cyber deterrence, scholars face uncertainty not only in identifying situations of deterrence success, but also—due to the secrecy surrounding cyber practices—in identifying situations of deterrence failure. Despite the many studies on cyber deterrence, methodological solutions to address these challenges still need to be developed. To this end, I suggest focusing on the adoption and employment of the strategy rather than on its success. I argue that since communicating threats is a core element of deterrence, it is easier to observe how the strategy is adopted and employed than whether it succeeds or fails. This focus provides a promising direction to study cyber deterrence and address these challenges.
Systematic review on the association between respiratory virus real-time PCR cycle threshold values and clinical presentation or outcomes
Authors: Bouzid Donia , Vila Jordi , Hansen Glen , Manissero Davide , Pareja Josep , Rao Sonia N , Visseaux Benoit
Published: July 2021

Objectives

It is unclear whether real-time (rt)-PCR cycle threshold (Ct) values can be utilized to guide clinical and infection-control decisions. This systematic review assesses the association between respiratory pathogen rt-PCR Ct values and clinical presentation or outcomes.

Methods

We searched MEDLINE, EMBASE and Cochrane library databases on 14–17 January 2020 for studies reporting the presence or absence of an association between Ct values and clinical presentation or outcomes, excluding animal studies, reviews, meta-analyses, and non-English language studies.

Results

Among 33 studies identified (reporting on between 9 and 4918 participants by pathogen), influenza (n = 11 studies; 4918 participants), human rhinovirus (HRV, n = 11; 2012) and respiratory syncytial virus (RSV, n = 8; 3290) were the most-studied pathogens. Low influenza Ct values were associated with mortality in 1/3 studies, with increased disease severity/duration or ICU admission in 3/9, and with increased hospitalization or length of hospital stay (LOS) in 1/6. Low HRV Ct values were associated with increased disease severity/duration or ICU admission in 3/10 studies, and with increased hospitalization or LOS in 1/3. Low RSV Ct values were associated with increased disease severity/duration or ICU admission in 3/6 studies, and with increased hospitalization or LOS in 4/4. Contradictory associations were also identified for other respiratory pathogens.

Conclusions

Respiratory infection Ct values may inform clinical and infection-control decisions. However, the study heterogeneity observed in this review highlights the need for standardized workflows to utilize Ct values as a proxy of genomic load and confirm their value for respiratory infection management.
Who Would the Person Be after a Head Transplant? A Confucian Reflection
Authors: Bian Lin , Fan Ruiping
Published: July 2021

This essay draws on classical Confucian intellectual resources to argue that the person who emerges from a head transplant would be neither the person who provided the head, nor the person who provided the body, but a new, different person. We construct two types of argument to support this conclusion: one is based on the classical Confucian metaphysics of human life as qi activity; the other is grounded in the Confucian view of personal identity as being inseparable from one’s familial relations. These Confucian ideas provide a reasonable alternative to the currently dominant view that one’s personal identity “follows” one’s head. Together, these arguments imply that head transplantation is ethically inappropriate.
Predicting Adolescent Electronic Cigarette Use: Differences by Never, Ever, and Current Users
Authors: Enlow Paul T , Williford Desireé N , Romm Katelyn F , Dino Geri A , Blank Melissa D , Murray Pamela J , Banvard Christine A , Duncan Christina L
Published: July 2021

Objective

Rising rates of adolescent electronic cigarette (ECIG) use is concerning because it can lead to adverse health outcomes and increased risk behavior. There are known predictors of ever versus never ECIG use, but less are known about risk factors for ever versus current use of ECIGs. Problem behavior theory (PBT) was used to evaluate possible risk factors for different ECIG use status.

Methods

Participants were 573 high school students who completed questionnaires measuring ECIG use, as well as constructs within the Social Environment, Perceived Environment, Personality, and Behavior domains of PBT. Multinomial logistic regression was used to evaluate how predictor variables differentiated between participants who reported (a) never use, (b) ever ECIG use, or (c) current ECIG use.

Results

Adolescents were more likely to endorse ever ECIG use than never use if they reported peer ECIG use, perceived more benefits and fewer costs (e.g., health) of ECIG use, higher extraversion, alcohol and cigarette use (never vs. ever vs. past 30 days), or attended a school with a higher percentage of socioeconomically disadvantaged students. Adolescents were more likely to report current ECIG use than ever ECIG use if they perceived fewer costs of ECIG use or used cannabis in their lifetime (yes/no).

Conclusions

PBT variables differentiated between ever ECIG use and never ECIG use. However, these variables did not differentiate between ever and current ECIG use. Identifying unique risk factors for current versus ever ECIG use is important to understanding persistent ECIG use and subsequent targeted prevention and intervention programs.
Analyzing the causes of method-to-method variability among Rubisco kinetic traits: from the first to the current measurements
Authors: Iñiguez Concepción , Niinemets Ülo , Mark Kristiina , Galmés Jeroni
Published: July 2021

Due to the importance of Rubisco in the biosphere, its kinetic parameters have been measured by different methodologies in a large number of studies over the last 60 years. These parameters are essential to characterize the natural diversity in the catalytic properties of the enzyme and they are also required for photosynthesis and cross-scale crop modeling. The present compilation of Rubisco kinetic parameters in model species revealed a wide intraspecific laboratory-to-laboratory variability, which was partially solved by making corrections to account for differences in the assay buffer composition and in the acidity constant of dissolved CO2, as well as for differences in the CO2 and O2 solubilities. Part of the intraspecific variability was also related to the different analytical methodologies used. For instance, significant differences were found between the two main methods for the determination of the specificity factor (Sc/o), and also between Rubisco quantification methods, Rubisco purification versus crude extracts, and single-point versus CO2 curve measurements for the carboxylation turnover rate (kcatc) determination. Causes of the intraspecific laboratory-to-laboratory variability for Rubisco catalytic traits are discussed. This study provides a normalized kinetic dataset for model species to be used by the scientific community. Corrections and recommendations are also provided to reduce measurement variability, allowing the comparison of kinetic data obtained in different laboratories using different assay conditions.
Evolution of Renal-Disease Factor APOL1 Results in Cis and Trans Orientations at the Endoplasmic Reticulum That Both Show Cytotoxic Effects
Authors: Müller Daria , Schmitz Jürgen , Fischer Katharina , Granado Daniel , Groh Ann-Christin , Krausel Vanessa , Lüttgenau Simona Mareike , Amelung Till Maximilian , Pavenstädt Hermann , Weide Thomas
Published: July 2021

The recent and exclusively in humans and a few other higher primates expressed APOL1 (apolipoprotein L1) gene is linked to African human trypanosomiasis (also known as African sleeping sickness) as well as to different forms of kidney diseases. Whereas APOL1’s role as a trypanolytic factor is well established, pathobiological mechanisms explaining its cytotoxicity in renal cells remain unclear. In this study, we compared the APOL family members using a combination of evolutionary studies and cell biological experiments to detect unique features causal for APOL1 nephrotoxic effects.

We investigated available primate and mouse genome and transcriptome data to apply comparative phylogenetic and maximum likelihood selection analyses. We suggest that the APOL gene family evolved early in vertebrates and initial splitting occurred in ancestral mammals. Diversification and differentiation of functional domains continued in primates, including developing the two members APOL1 and APOL2. Their close relationship could be diagnosed by sequence similarity and a shared ancestral insertion of an AluY transposable element. Live-cell imaging analyses showed that both expressed proteins show a strong preference to localize at the endoplasmic reticulum (ER). However, glycosylation and secretion assays revealed that—unlike APOL2—APOL1 membrane insertion or association occurs in different orientations at the ER, with the disease-associated mutants facing either the luminal (cis) or cytoplasmic (trans) side of the ER. The various pools of APOL1 at the ER offer a novel perspective in explaining the broad spectrum of its observed toxic effects.
NovelDoublesexDuplication Associated with Sexually Dimorphic Development of Dogface Butterfly Wings
Authors: Rodriguez-Caro Fernando , Fenner Jennifer , Bhardwaj Shivam , Cole Jared , Benson Caleb , Colombara Alexandra M , Papa Riccardo , Brown Matthew W , Martin Arnaud , Range Ryan C , Counterman Brian A
Published: July 2021

Sexually dimorphic development is responsible for some of the most remarkable phenotypic variation found in nature. Alternative splicing of the transcription factor gene doublesex (dsx) is a highly conserved developmental switch controlling the expression of sex-specific pathways. Here, we leverage sex-specific differences in butterfly wing color pattern to characterize the genetic basis of sexually dimorphic development. We use RNA-seq, immunolocalization, and motif binding site analysis to test specific predictions about the role of dsx in the development of structurally based ultraviolet (UV) wing patterns in Zerene cesonia (Southern Dogface). Unexpectedly, we discover a novel duplication of dsx that shows a sex-specific burst of expression associated with the sexually dimorphic UV coloration. The derived copy consists of a single exon that encodes a DNA binding but no protein-binding domain and has experienced rapid amino-acid divergence. We propose the novel dsx paralog may suppress UV scale differentiation in females, which is supported by an excess of Dsx-binding sites at cytoskeletal and chitin-related genes with sex-biased expression. These findings illustrate the molecular flexibility of the dsx gene in mediating the differentiation of secondary sexual characteristics.
Impact of MRI timing on tumor volume and anatomic displacement for brain metastases undergoing stereotactic radiosurgery
Authors: Kutuk Tugce , Tolakanahalli Ranjini , Williams Andre , Tom Martin C , Vadhan Jason D , Appel Haley , Hall Matthew D , Wieczorek D Jay J , Davis Stephen , McDermott Michael W , Ahluwalia Manmeet S , Mehta Minesh P , Gutierrez Alonso N , Kotecha Rupesh
Published: July 2021

Background

The objective of this study was to evaluate the impact of the time interval between planning imaging and stereotactic radiosurgery (SRS) delivery on tumor volumes and spatial anatomic displacements of brain metastases (BM).

Methods

Consecutive patients diagnosed with BM treated with SRS over a 3-year period were evaluated. Only patients who underwent an institutionally standardized diagnostic MRI (MRI-1) and a treatment planning MRI (MRI-2) were included. The impact of histology, inter-scan time interval, lesion location, tumor volume, and diameter were evaluated on final lesion diameter, volume, anatomic displacement, and ultimate need for change in management (ie, expanding margins, rescanning).

Results

101 patients (531 lesions) with a median inter-scan time interval of 8 days (range: 1-42 days) met the inclusion criteria. The median percentage increase in BM diameter and volume were 9.5% (IQR: 2.25%-24.0%) and 20% (IQR: 0.7%-66.7%). Overall, 147 lesions (27.7%) in 57 patients (56.4%) required a change in management. There was a statistically significant relationship between initial tumor diameter (cm) and change in management (OR: 2.69, 95% CI: 1.93-3.75; P < .001). Each day between MRI-1 and MRI-2 was associated with a change in management with an OR of 1.05 (95% CI: 1.03-1.07; P < .001).

Conclusions

Changes in tumor diameter, volume, and spatial position occur as a function of time. Planning imaging for SRS is recommended to occur in close temporal proximity to treatment; for those with delays, a larger setup margin may need to be used to ensure tumor coverage and account for positional changes.
The onset of deep recycling of supracrustal materials at the Paleo-Mesoarchean boundary
Authors: Wang Xiaolei , Tang Ming , Moyen Jeff , Wang Di , Kröner Alfred , Hawkesworth Chris , Xia Xiaoping , Xie Hangqiang , Anhaeusser Carl , Hofmann Axel , Li Junyong , Li Linsen
Published: July 2021

The recycling of supracrustal materials, and in particular hydrated rocks, has a profound impact on mantle composition and thus on the formation of continental crust, because water modifies the physical properties of lithological systems and the mechanisms of partial melting and fractional fractionation. On the modern Earth, plate tectonics offers an efficient mechanism for mass transport from the Earth's surface to its interior, but how far this mechanism dates back in the Earth's history is still uncertain. Here, we use zircon oxygen (O) isotopes to track recycling of supracrustal materials into the magma sources of early Archean igneous suites from the Kaapvaal Craton, southern Africa. The mean δ18O values of zircon from TTG (tonalite–trondhjemite–granodiorite) rocks abruptly increase at the Paleo-Mesoarchean boundary (ca. 3230 million years ago; Ma), from mantle zircon values of 5‰–6‰ to approaching 7.1‰, and this increase occurs in ≤3230 Ma rocks with elevated Dy/Yb ratios. The 18O enrichment is a unique signature of low-temperature water–rock interaction on the Earth's surface. Because the later phase was emplaced into the same crustal level as the older one and TTG magmas would derive from melting processes in the garnet stability field (>40 km depth), we suggest that this evident shift in TTG zircon O isotopic compositions records the onset of recycling of the mafic oceanic crust that underwent seawater hydrothermal alteration at low temperature. The onset of the enhanced recycling of supracrustal materials may also have developed elsewhere in other Archean cratons and reflects a significant change in the tectonic realm during craton formation and stabilization, which may be important processes for the operation of plate tectonics on early Earth.
Occupational management of healthcare workers exposed to COVID-19
Authors: Ochoa-Leite C , Bento J , Rocha D R , Vasques I , Cunha R , Oliveira Á , Rocha L
Published: July 2021

Background

The year 2020 was marked by the new coronavirus pandemic, resulting in millions of cases and deaths, placing healthcare workers at high risk of infection.

Aims

The aim of this study was to describe the role of an occupational health service during coronavirus disease 2019 pandemic in an oncologic hospital and characterize the most likely sources of viral infection.

Methods

The information of all healthcare workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from 11 March to 15 December 2020 was collected through an epidemiological survey conducted during contact tracing. The data extracted included gender, age, comorbidities, occupational group, source of infection, clinical presentation, duration of the disease, need for hospitalization and persistent or late symptoms after disease or upon returning to work.

Results

Out of a total of 2300 workers, 157 were infected, consisting of nurses (36%), nurse assistants (33%) and diagnostic and therapeutic professionals (10%). Physicians and administrative staff accounted for 8% each. The most frequently reported source of infection was occupational (43%), owing to worker-to-worker transmission (45%) and patient-to-worker transmission (36%). The most frequent moments of infection perceived corresponded to the removal of protective equipment during meals and moments of rest in the staff and changing rooms.

Conclusions

The study revealed that occupational transmission from patients and colleagues might be an important source of SARS-CoV-2 infection in healthcare workers. Spread between colleagues accounted for 45% of the occupational source infections reported. Implementing physical distancing measures and limiting the number of people in changing and rest rooms could significantly reduce infection and related absenteeism.
Handheld x-ray fluorescence spectroscopy evaluation of leather chromium and cobalt
Authors: Artounian K , Hamann D
Published: July 2021

We present a 29-year-old non-atopic male apprentice power lineman and recreational cowboy with a case of allergic contact dermatitis due to both occupational and recreational exposure. He presented with a 4-month history of a pruritic, steroid-responsive, intermittent hand, foot and leg dermatitis. Patch testing was positive for chromium, cobalt and a piece of leather from his cowboy boots. His leather work gloves, inner lining of work harness, work boots and cowboy boots were assessed for chromium and cobalt content with handheld fluorescence x-ray spectrometry. Upon replacement of all leather items including the items tested and his leather cowboy saddle, the rash resolved. This case demonstrates the clinical relevance of using a handheld fluorescence x-ray spectrometer to assess for chromium and leather content.
Vaccine-Associated Measles in a Hematopoietic Cell Transplant Recipient: Case Report and Comprehensive Review of the Literature
Authors: Chang Sandy Y , Bisht Anjali , Faysman Karolina , Schiller Gary J , Uslan Daniel Z , Multani Ashrit
Published: July 2021

Measles is a worldwide viral disease that can cause fatal complications in immunocompromised hosts such as hematopoietic cell transplant (HCT) recipients. The live attenuated measles, mumps, and rubella (MMR) vaccine is generally contraindicated post-HCT due to the risk for vaccine-associated measles. This, combined with decreasing vaccination rates due to vaccine hesitancy and the coronavirus disease 2019 pandemic, raises significant concerns for a measles resurgence that could portend devastating consequences for immunocompromised hosts. Multiple guidelines have included criteria to determine which HCT recipients can safely receive the MMR vaccine. Here, we report a case of vaccine-associated measles in a HCT recipient who met guideline-recommended criteria for MMR vaccination. The objective of this article is to query these criteria, highlight the importance of MMR vaccination, and comprehensively review the literature.
La pharyngite à streptocoque du groupe A : un guide pratique pour le diagnostic et le traitement
Authors: Sauve Laura , Forrester A Michael , Top Karina A
Published: July 2021

La pharyngite à streptocoque du groupe A est un syndrome clinique courant en première ligne, mais une controverse subsiste quant à la meilleure démarche diagnostique et thérapeutique, y compris les bienfaits des antibiotiques. Les enfants qui, d’après l’anamnèse ou l’examen physique, risquent de souffrir de ce type de pharyngite, doivent se soumettre à un écouvillonnage de la gorge et recevoir un traitement à l’amoxicilline ou à la pénicilline lorsque le résultat est positif. Le fardeau disproportionné du rhumatisme articulaire aigu dans les populations autochtones du Canada et les considérations particulières en matière de tests et de traitements sont présentés.
Nitric oxide mitigates thalidomide-induced abnormalities during germination and development of fennel seeds
Authors: Swaminathan Akila , Kalyani Koneti Brahma , Sudhagar Senthil Kumar , Bhuvaneswari Srinivasan , Nagalatha S Thupali , Raj T Leon Stephan , Sumantran Venil N , Chatterjee Suvro
Published: July 2021

Thalidomide causes teratogenic effects in several animal species and in humans. Accordingly, the World Health Organization banned thalidomide when mothers who took thalidomide during pregnancy delivered abnormal fetuses. After four decades, thalidomide underwent drug “re-purposing” since its antiangiogenic and immunomodulatory effects were therapeutic for multiple myeloma. There are no reports of thalidomide’s effects on prokaryotes, but it showed teratogenic effects in Arabidopsis thaliana, an ancestor of the plant kingdom. This proof of concept study clearly shows that thalidomide caused a significant and reproducible decrease in germination rate, nitric oxide (NO) production, and chlorophyll content of fennel plantlets. Thalidomide also induced the formation of abnormal fennel plantlets with stunting, wrinkling, and curling of fennel shoots and leaves. Notably, quantitative analysis showed that thalidomide caused a 50% increase in the formation of abnormal fennel plantlets and that these negative effects of thalidomide showed a 2.50- to 4-fold decrease when fennel seeds were co-incubated with an NO donor (Spermine NoNoate) or a stable cGMP analog 8-bromo Guanosine 3′,5′-cyclic monophosphate (8-Bromo-cGMP). This study is important because it confirms that thalidomide’s negative effects on fennel seed germination and growth are mediated by attenuation of NO and disruption of NO signaling. This reproducible model of thalidomide-induced, NO-dependent damage in a plant system can be used to further investigate the molecular mechanisms of thalidomide action in plants. Importantly, this study establishes a link between the evolution of development of higher plants and mammals.
A Rapid In Vitro Phenotypic Assay of Walnut Shoots for Prescreening Resistance to Phytophthora pini
Authors: Zaini Paulo A. , Lee Steven H. , Leslie Charles A. , Walawage Sriema L. , Jiang Cai-Zhong , Browne Gregory T. , Dandekar Abhaya M. , Kasuga Takao
Published: July 2021

Phytophthora species cause crown, root, and aerial canker diseases in diverse horticultural crops, resulting in a loss of yield, loss of quality, and plant death. Breeding programs are interested in developing genotypes resistant to these and other pathogens, but current screening methods for tree crops are time-consuming, potentially spanning many years. Here we present a rapid in vitro assay in which walnut shoots obtained from tissue culture can be challenged with Phytophthora zoospores and monitored for symptom development within a week. As a proof of concept, two cultivars, scion variety ‘Chandler’ and clonal rootstock ‘RX1’, with known different degrees of crown rot susceptibility, were inoculated in vitro with P. pini (formerly included in P. citricola complex), and results of the assay reproducibly matched the differences in disease susceptibility generally observed for these two walnut selections under greenhouse and orchard conditions. In addition, when the in vitro assay was used for inoculations with P. capsici, which is not pathogenic on walnut, no disease development was observable, indicating that the assay can discriminate between species of Phytophthora that are aggressive on walnut and those not known as walnut pathogens. Our results suggest that this in vitro shoot inoculation procedure may provide rapid assessments useful for prescreening resistance to Phytophthora in walnuts. Further testing of the assay is justified to determine whether it can resolve more subtle differences in resistance and whether it can be useful with other perennial hosts of Phytophthora.
Hyperthermic intraperitoneal chemotherapy for treating ovarian cancer
Authors: Gajarawala Shilpa , Pelkowski Jessica , Dorian Rose , Stanton Amanda , Dinh Tri
Published: July 2021

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for decades as a treatment for disseminated abdominal malignancies, including pseudomyxoma peritonei and peritoneal mesothelioma. HIPEC had been used to treat recurrent ovarian cancer only when curative options were lacking, but new data indicate that it may be suitable as a primary treatment for patients with late-stage epithelial ovarian cancer, increasing the recurrence-free time interval and improving quality of life. However, treatment can be challenging because of patient trauma from surgery, combined with the toxicity and high temperature of the chemotherapeutic agents. This article reviews HIPEC and its targeted intraoperative and postoperative management.
Small cell neuroendocrine carcinoma disguised as an external hemorrhoid
Authors: Allmark Amelia , Brubaker Mary L.
Published: July 2021

This article describes a patient who presented to the ED with persistent nausea and vomiting, constipation, weight loss, and a new complaint of an external hemorrhoid and hematochezia with stooling. Comprehensive diagnostic evaluation included imaging studies that showed extensive metastatic disease but did not identify a primary neoplasm. Biopsy of the external hemorrhoid revealed small cell neuroendocrine carcinoma of the anal canal.
Effects of food restriction on the conditioned reinforcing properties of an opioid-associated stimulus
Authors: Robertson Stephen H. , Jutkiewicz Emily M.
Published: July 2021

Food restriction promotes drug self-administration; however, the effects of food restriction on the conditioned reinforcing properties of drug-associated stimuli are less clear. We tested the extent to which food restriction modified the conditioned reinforcing properties of a remifentanil-associated stimulus following conditioning with 3.2 or 1.0 μg/kg/infusion of remifentanil. First, we provided restricted (20 g/day standard chow) or ad libitum access to standard chow to rats. Second, within each feeding condition, we exposed rats to 20 intravenous infusions of remifentanil and 20 stimulus presentations that were delivered response independently each day for 5 days. For the experimental group (paired Pavlovian), the remifentanil infusions and stimulus presentations were delivered concurrently. The control group (random control) received the same number of infusions and stimulus presentations, but were not paired. For 28 sessions, we tested the extent to which the stimulus functioned as a conditioned reinforcer by allowing rats to freely respond for presentations of the remifentanil-associated stimulus. Following conditioning with 3.2 μg/kg/infusion of remifentanil, we found that rats that in the Paired Pavlovian group responded for the remifentanil-associated stimulus significantly more than rats in the Random control group, regardless of feeding condition. Following conditioning with 1.0 μg/kg/infusion of remifentanil, the remifentanil-associated stimulus was not associated with conditioned reinforcing properties, regardless of feeding condition. These findings confirm previous research demonstrating that a remifentanil-associated stimulus takes on conditioned reinforcing properties in a dose-dependent manner.
Association of deleted in liver cancer-1 gene polymorphism with increased risk of chronicity of disease among Malaysian patients with hepatitis B infection
Authors: Riazalhosseini Behnaz , Mohamed Rosmawati , Devi Apalasamy Yamunah , Mohamed Zahurin
Published: July 2021

Objective

The aim of this study is to examine the association between genetic variations in deleted in liver cancer 1 (DLC1) gene with progression of the hepatitis B virus (HBV) infection.

Methods

A total of 623 subjects were included in this study, of whom, 423 were chronic hepatitis B (CHB) patients without liver cirrhosis or hepatocellular carcinoma (HCC), 103 CHB with either liver cirrhosis ± HCC and 97 individuals who had resolved HBV. Two single-nucleotide polymorphisms rs3739298 and rs532841 of DLC1 gene were genotyped using the Sequenom MassARRAY platform.

Results

Our results indicated significant differences between the chronic HBV and resolved HBV groups in genotype and allele frequencies of DLC1-rs3739298 [odds ratio (OR) = 2.23; 95% confidence interval (CI): 1.24–3.99; P = 0.007] and (OR = 1.54; 95% CI: 1.07–2.22; P = 0.021), respectively. Moreover, haplotype analysis revealed significant associations between chronicity of HBV with TG and GA haplotypes (P = 0.041 and P = 0.042), respectively.

Conclusion

A significant association exists between the rs3739298 variant and susceptibility to CHB infection.
The effect of participation in accountable care organization on electronic health information exchange practices in U.S. hospitals
Authors: Nwafor Onyi , Johnson Norman A.
Published: July 2021

Background

Accountable care organizations (ACOs) are a recent incentive program that are designed to address inefficiencies in the U.S. health care sector. To meet their design objectives, ACO participants must engage in greater electronic health information exchange (HIE) practices both internally and externally with care participants, such as patients and other providers.

Purpose

The aim of this study was to examine the relationship between hospital participation in ACOs and electronic HIE practices with different participants of care and how these practices vary differentially across market types.

Approach

Grounding our work in the reward-motivational view of organizational action, we proposed hypotheses that linked hospital participation in ACOs to three dimensions of HIE practices (intraorganizational, interorganizational, and provider–patient HIE practices). We tested our hypotheses by analyzing a sample of 1,926 hospitals.

Results

Hospital participation in ACOs is associated with greater intraorganizational and provider–patient HIE practices, but not interorganizational HIE practices. We also found that whereas the relationship between ACO participation and intra- and interorganizational HIE practices remains unchanged irrespective of the degree of competition in the health care market, the relationship between ACO participation and provider–patient HIE practices holds true only for hospitals operating in noncompetitive markets.

Practice Implications

Our results showed that hospitals participating in ACOs vary in their HIE practices, and attributes of the local market in which ACO participants operate in contribute to this variation. These insights should provide guidance to researchers, policymakers, and hospital administrators who aim to improve the effectiveness of ACOs.
Descemet Stripping Automated Endothelial Keratoplasty in Pediatric Age Group: A Decade of Our Experience
Authors: Ramappa Muralidhar , Mohamed Ashik , Achanta Divya S. Ramya , Tumati Chaitanya S. Kiran , Chaurasia Sunita , Edward Deepak P.
Published: July 2021

Purpose:

This study was to report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in managing corneal endothelial disorders in children less than 14 years of age.

Methods:

Medical records of 180 DSAEK performed, between 2008 and 2020, on 167 eyes of 111 children who had a visually significant endothelial dysfunction were retrospectively reviewed for the primary etiology of corneal decompensation, time of the onset and duration of cloudiness, preoperative visual acuity, the technique of endothelial keratoplasty, surgical modifications, and reintervention.

Results:

Median age at surgical intervention was 7.9 years (interquartile range, 5.2–11.2 years). At a median postinterventional follow-up of 2.5 years (interquartile range, 0.9–3.4 years), 86.2% (144 of 167 eyes, 95% confidence interval 79.9%–90.1%) maintained a clear graft. Median best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.45 ± 0.70 preoperatively to 0.90 ± 0.06 at the last follow-up visit (P < 0.0001). The cumulative overall long-term graft survival was 92.7%, 86.5%, and 77.7% at 1, 3, and 7 years, respectively. Cox proportional hazards regression analysis showed that the indication for DSAEK (P = 0.007; hazards ratio: 2.17 ± 0.62), age at surgery (P = 0.02; hazards ratio: 0.87 ± 0.05), and any subsequent intervention after DSAEK (P = 0.003; hazards ratio: 0.11 ± 0.08) were significant risk factors for DSAEK failure. The endothelial cell loss was 40.1% at 6 months, 45.4% at 1 year, 55.2% at 5 years, and 61.9% at 7 years.

Conclusions:

DSAEK is a safe and effective surgical strategy in managing endothelial disorders among the pediatric age group.
Lipids and cardiovascular calcification: contributions to plaque vulnerability
Authors: Hsu Jeffrey J. , Tintut Yin , Demer Linda L.
Published: July 2021

Purpose of review

Cardiovascular calcification, a common feature of atherosclerotic lesions, has long been known to associate with cardiovascular risk. The roles of lipoproteins in atherosclerosis are also established, and lipid-modifying therapies have shown capacity for plaque regression. However, the association of lipid-modifying therapies with calcification is more complex, and currently no medical therapies have been found to reverse or attenuate calcification in patients. In this review, we summarize recent developments in our understanding of the interplay between lipids and cardiovascular calcification, as well as new imaging modalities for assessing calcified atherosclerotic plaque vulnerability.

Recent findings

Recent clinical studies have highlighted the associations of lipoprotein subtypes, such as low-density and high-density lipoprotein particles, as well as lipoprotein (a) [Lp(a)], with coronary calcification and calcific aortic valve disease. Further, evidence continues to emerge for the utility of fused 18F-sodium fluoride positron-emission tomographic and computed tomographic (18F-NaF PET/CT) imaging in characterizing the microarchitecture and vulnerability of atherosclerotic plaque, in both humans and animal models.

The relationship between lipids and cardiovascular calcification is complex, and new imaging techniques, such as 18F-NaF PET/CT imaging, may allow for better identification of disease-modifying therapies and prediction of calcified plaque progression and stability to help guide clinical management.
Handling Errors in the Use of Inhalation Devices
Authors: Neininger Martina Patrizia , Kaune Almuth , Musiol Juliane , Kiess Wieland , Bertsche Astrid , Prenzel Freerk , Bertsche Thilo
Published: July 2021

Background:

Children suffering from bronchial diseases need assistance from nurses in the use of inhalation devices.

Purpose:

We aimed to assess nurses' skills and knowledge concerning drug administration with inhalation devices in hospitalized pediatric patients.

Methods:

An expert panel defined medication errors in drug administration with inhalation devices in children. We monitored 241 inhalation procedures to investigate nurses' inhalation technique skills. Twenty-nine nurses completed a questionnaire to assess nurses' knowledge.

Results:

Skills: In 93 of 241 (39%) inhalation procedures, the mask/mouthpiece did not fit airtight. In none of the 11 inhalations administering a glucocorticoid, the patient's mouth was thoroughly cleaned afterward. Knowledge: Ten of 29 nurses (34%) thought a distance between mask and the patient's face was acceptable. Only 16 of 29 (55%) knew that it is necessary to thoroughly clean the patient's mouth after the inhalation of budesonide.

Conclusions:

We found that education on inhalation procedures including practical training is required to increase patient safety.
Improving Compliance with a Rounding Checklist through Low- and High-technology Interventions: A Quality Improvement Initiative
Authors: Carr Leah H. , Padula Michael , Chuo John , Cunningham Megan , Flibotte John , O’Connor Theresa , Thomas Beth , Nawab Ursula
Published: July 2021

Introduction:

Checklists aid in ensuring consistency and completeness in medical care delivery. However, using an improvement and safety checklist during rounds was variable in our neonatology intensive care unit (NICU), and completion was not tracked sustainably. This quality improvement (QI) initiative’s primary aim was to increase compliance with checklist completion from 31% to >75% within 1 year.

Methods:

A multidisciplinary QI team identified barriers to checklist completion and implemented a human factors-focused low-technology intervention (redesign of a hard-copy checklist) and later a high-technology clinical decision support tool within the electronic health record. The primary outcome measure was percent compliance with the use of the checklist. Process metrics included the duration of checklist completion. Balancing measures included staff perceptions of work burden and question relevance.

Results:

Major barriers to checklist utilization were inability to remember, rounding interruptions, and perceived lack of question relevance to patients. Average biweekly checklist compliance improved from 31% before interventions to 80% after interventions. Average checklist completion time decreased from 46 to 11 seconds. Follow-up surveys demonstrated more respondents found questions “completely relevant” (34% pre versus 43% post) but perceived increased work burden (26% pre versus 31% post).

Conclusions:

Using QI methodology, human factors-based interventions, and a novel clinical decision support tool, we significantly improved efficiency and checklist compliance and created an automated, sustainable method for monitoring completion and responses. This foundational project provides an infrastructure broadly applicable to QI work in other healthcare settings.