bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Adiponectin is Related to Dementia
Authors: Benavente Kimberly S K , Palmer Raymond F , Royall Donald R
Published: April 2019

Background

The adipokine adiponectin (APN)’s role in Alzheimer’s disease (AD) is controversial. Some studies suggest APN is neuroprotective while others propose it has harmful effects. We have used Multiple Indicators Multiple Causes (MIMIC) models to evaluate the effects of serum protein biomarkers on cognitive performance in the Texas Alzheimer’s Research and Care Consortium (TARCC) (Royall DR, Bishnoi RJ, Palmer RF. Serum IGF-BP2 strongly moderates age’s effect on cognition: a MIMIC analysis. Neurobiol Aging. 2015;36:2232–2240; Bishnoi RJ, Palmer RF, Royall DR. Vitamin D binding protein as a serum biomarker of Alzheimer’s disease. J Alzheimers Dis. 2015;43:37–45; Bishnoi RJ, Palmer RF, Royall DR. Serum interleukin (IL)-15 as a biomarker of Alzheimer’s disease. PLoS One. 2015;10:e0117282).

Methods

MIMIC models were constructed and replicated in randomly selected 50% splits of TARCC’s data (Group 1 N = 1,691; Group 2 N = 1,690) and used to evaluate the relationship between serum APN levels and cognition. Our approach has been to divide general intelligence (Spearman’s g) (Spearman C. The Abilities of Man: Their Nature and Measurement. 1932) into two latent variables, δ (ie, a dementia-specific phenotype representing the disabling fraction of cognitive variance) and g prime (g′) (ie, the residual non-disabling fraction). Only effects on δ are likely to be dementing.

Results

Serum APN was significantly related to δ scores (r = .10, p = .015). APN had no significant effect on g′ (r = −.25, p = .66), nor did it have any independent direct effects on cognitive performance. These results were replicated across random subsets (ΔCHISQ = 2.8(7), p > .90).

Conclusions

APN’s effect on cognition is mediated through intelligence (ie, δ), likely to be disabling, and therefore to mediate one or more dementing processes. We have previously shown APN to partially mediate age’s-specific effect on δ (Royall DR, Al-Rubaye S, Bishnoi R, Palmer RF. Serum protein mediators of dementia and aging proper. Aging (Albany NY). 2016;8:3241–3254). However, because the current model is age adjusted, APN must mediate one or more additional age-independent dementing process(es), possibly AD.
Attachment Beyond the Adhesive System: The Contribution of Claws to Gecko Clinging and Locomotion
Authors: Naylor Emily R , Higham Timothy E
Published: April 2019

Attachment is imperative for many biological functions, such as holding position and climbing, but can be challenged by natural conditions. Adhesive toe pads and claws have evolved in multiple terrestrial lineages as important dynamic attachment mechanisms, and some clades (e.g., geckos) exhibit both features. The functional relationship of these features that comprise a complex attachment system is not well-understood, particularly within lizards (i.e., if pads and claws are redundant or multifunctional). Geckos exhibit highly adept frictional adhesive toe pads that continue to fuel biological inquiry and inspiration. However, gecko claws (the ancestral lizard clinging condition) have received little attention in terms of their functional or evolutionary significance. We assessed claw function in Thecadactylus rapicauda using assays of clinging performance and locomotor trials on different surfaces (artificial and natural) and inclines with claws intact, then partially removed. Area root mean square height (Sq), a metric of 3D surface roughness, was later quantified for all test surfaces, including acrylic, sandpaper, and two types of leaves (smooth and hairy). Maximum clinging force significantly declined on all non-acrylic surfaces after claw removal, indicating a substantial contribution to static clinging on rough and soft surfaces. With and without claws, clinging force exhibited a negative relationship with Sq. However, claw removal had relatively little impact on locomotor function on surfaces of different roughness at low inclines (≤30°). High static and dynamic safety factor estimates support these observations and demonstrate the species’ robust frictional adhesive system. However, maximum station-holding capacity significantly declined on the rough test surface after partial claw removal, showing that geckos rely on their claws to maintain purchase on rough, steeply inclined surfaces. Our results point to a context-dependent complex attachment system within geckos, in which pads dominate on relatively smooth surfaces and claws on relatively rough surfaces, but also that these features function redundantly, possibly synergistically, on surfaces that allow attachment of both the setae and the claw (as in some insects). Our study provides important novel perspectives on gecko attachment, which we hope will spur future functional studies, new evolutionary hypotheses, and biomimetic innovation, along with collaboration and integration of perspectives across disciplines.
International Relations as a Social System: From Sociocybernetics to the Sociology of IR
Authors: Peña Alejandro M
Published: April 2019

Against current developments in the sociology of IR, from new systemic theorizations of world society to Bourdieusian approaches to the practices of IR scholars, this article claims that relevant problems remain regarding how IR theorizes its social location and reconciles the social character of the world it observes with the social character of its observations. To reformulate these problems, the article draws from an underused paradigm of social system theorizing, sociocybernetics, offering a radical constructivist treatment of the problem of observation and reflexivity. Elaborating the notion of second-order cybernetics and Niklas Luhmann's take on the reproduction of observing social systems, the article argues that IR can be conceived as an observing social system that adapts by altering and subdividing the semantic boundaries of its systemic communications, that is, IR theories. This socio-heuristic process structures both the first-order observations IR makes about the world, as well as second-order observations of itself. In this manner, the article argues that sociocybernetics-informed sociology of IR communications can contribute to a more nuanced understanding of IR as a social system that observes society from society.
A Novel Simulated-Use Test for Determining the Efficacy of Insecticides Against Bed Bugs (Hemiptera: Cimicidae)
Authors: Vander Pan Arlette , Schmolz Erik , Krücken Jürgen , Kuhn Carola
Published: April 2019

The common bed bug Cimex lectularius L. has undergone a worldwide expansion in recent years, due to increased opportunities for dispersal and development of insecticide resistance. For successful control, efficacy testing of products against bed bugs and determination of insecticide resistance under practical conditions are of outstanding importance. A new test system mimicking the practical use situation of residual insecticides was developed and evaluated. Bed bugs were attracted by CO2 and heat to cross surfaces treated with alpha-cypermethrin and bendiocarb. In contrast to the complete efficacy of alpha-cypermethrin (less than 1% surviving bed bugs [with one exception of 5%]), only 45.3, 46, and 29% of insecticide-susceptible bed bugs showed lethal damage 7 d after contact with freshly bendiocarb-treated wallpaper or insecticide aged for 1 or 2 wk. Results show that the efficacy of different insecticides can be assessed with this new test system. Moreover, susceptibility to deltamethrin of five bed bug field strains, collected from infested apartments in Berlin, Germany, was determined in a filter paper contact bioassay. Resistance ratios (RRs) ranged between 4.3 and 20.7. In the novel simulated-use test, efficacy of alpha-cypermethrin was tested against the bed bug strain with the highest RR. In contrast to the insecticide-susceptible laboratory strain, alpha-cypermethrin was not effective against the field strain, where 26–50% of the bed bugs survived and even laid eggs. These results provide evidence for the presence of practically relevant pyrethroid resistance in bed bugs in Germany.
Spatial Distribution of German Cockroaches in a High-Rise Apartment Building During Building-Wide Integrated Pest Management
Authors: Zha Chen , Wang Changlu , Eiden Amanda , Cooper Richard , Wang Desen
Published: April 2019

The German cockroach Blattella germanica (L.) (Blattodea, Ectobiidae) is one of the most common indoor pests in multifamily housing communities. Our objectives were to investigate the spatial distribution patterns of German cockroach infestations in a multiunit dwelling before and after building-wide integrated pest management (IPM) implementation. The study was conducted in a high-rise apartment building with 188 residential units in Paterson, New Jersey. All the identified infestations were treated by researchers using IPM implementation, and monitoring was repeated at 6 and 12 mo after the initial survey. We examined cockroach spatial distribution patterns within and between apartments. Traps placed by the stove and refrigerator caught significantly more cockroaches than traps placed in the kitchen cabinet under the sink or in the bathroom. At month 0, cockroach infestations within the building were spatially correlated. At 12 mo after implementation of IPM, only infestations cross the floors remained to be correlated. Therefore, IPM not only eliminates cockroach infestations in individual units, but also reduces cockroach dispersal between units.
Evaluation of Mating Disruption For the Control of Thaumetopoea pityocampa (Lepidoptera: Thaumetopoeidae) in Suburban Recreational Areas in Italy and Greece
Authors: Trematerra Pasquale , Colacci Marco , Athanassiou Christos G , Kavallieratos Nickolas G , Rumbos Christos I , Boukouvala Maria C , Nikolaidou Anastassia J , Kontodimas Demetrius C , Benavent-Fernández Enrique , Gálvez-Settier Santiago
Published: April 2019

Thaumetopoea pityocampa (Denis and Schiffermüller) is a severe defoliator of various species of Pinus and Cedrus, while the urticanting hairs produced by its larvae cause public health problems for humans and pets. In the present study, we report results of trials (from summer 2015 until winter 2017) of mating disruption for management of T. pityocampa in different areas of Italy and Greece. Overall, the total number of male moths captured in mating disruption-treated plots over each season (70) was significantly lower than the respective number in untreated plots (780). The total number of winter nests was likewise significantly less in the mating disruption plots (13) compared with control plots (147). Our results indicate that mating disruption can be an important tool for judicious, insecticide-free control of T. pityocampa in urban, suburban, and recreational areas, where many alternative control measures are not available.
Gender, Parenthood and Feelings of Safety in Greek Refugee Centres
Authors: Bjørneseth Frida , Smidt Martin , Stachowski Jakub
Published: April 2019

Forced migration and displacement are often associated with increased exposure to various risks that negatively affect personal safety. While experiences of displaced populations are heterogeneous, women have been shown to be exposed to intersecting factors, such as vulnerability to gender-based violence, restricting cultural norms and discrimination. Being a mother—or at least responsible for the care of a child—while en route stands as another marginalizing factor. This article’s point of departure is the so-called European ‘refugee crisis’ that peaked in 2015 and examines the effects of gender and family on the experience of safety among refugees in six refugee centres in Greece. We explore how intersecting issues such as gender roles and being responsible for children impact individuals’ feelings of safety. Using descriptive statistics and regression analyses of survey data on 367 migrants in six Greek refugee centres, we find that female migrants are more likely to feel unsafe compared to males. However, our results indicate that gender differences in feelings of safety are minimal for those without children. While having children affects both genders’ feeling of safety, the effect is much greater for women than for men. Our conclusion is that dissimilar experiences of safety along gender dimension are conditioned by norms and obligations inscribed in social roles of parents and care-givers.
A History of Psychotherapy Integration
Authors: Goldfried Marvin R. , Pachankis John E. , Goodwin Brien J.
Published: April 2019

In this chapter, the authors trace the history of psychotherapy integration from the first attempts at rapprochement in the early twentieth century to the recent developments in the twenty-first century. The authors briefly review major contributions to psychotherapy integration from the 1930s to the 1950s, and then focus on rapprochement beginning in the 1960s through the present. In addition to outlining conceptual and theoretical advances, the authors describe structural developments such as societies, journals, and conferences that have facilitated continued research and dissemination of various models of integration. Finally, the impact of ever-changing research, practice, and social climates on rapprochement is discussed.
Training and Supervision in Psychotherapy Integration
Authors: Norcross John C. , Finnerty Marcella
Published: April 2019

This chapter considers training and supervision in psychotherapy integration. The authors begin by identifying an ideal educational sequence for psychotherapists and then discuss training in light of the four principal routes of integration—technical eclecticism, theoretical integration, common factors, and assimilative integration—whose training objectives and sequence differ somewhat. Next, the chapter addresses questions regarding the centrality of personal therapy and the necessity of research training in the preparation of integrative therapists. The authors review integrative supervision, specifically seven of its distinctive practices. The chapter concludes with a discussion of organizational strategies for promoting psychotherapy integration and some future directions for integrative training in mental health.
Outcome Research on Psychotherapy Integration
Authors: Boswell James F. , Newman Michelle G. , McGinn Lata K.
Published: April 2019

Integrative psychotherapies have received increased empirical attention in recent decades, and a number of these treatments have been examined and tested in treatment outcome studies. In this chapter, the authors review and summarize the current state of outcome research on integrative therapies. Such treatments are placed into broad categories based on their foundational pathway to integration, including assimilative, theoretical, and technical eclecticism, as well as whether or not they have been designed to target a specific diagnosis or problem. Many integrative therapies have garnered substantial research support (four or more randomized controlled trials). Empirical support for some treatments continues to accumulate, while other treatments that were previously identified as promising have received limited attention in the past decade. Broad conclusions regarding the state of integrative therapy outcome research are offered, along with future directions.
Future Directions in Psychotherapy Integration
Authors: Eubanks Catherine F. , Goldfried Marvin R. , Norcross John C.
Published: April 2019

Psychotherapy integration has become a well-established and influential movement in mental health. In this chapter, the authors explore where psychotherapy integration may be headed in the areas of theory, practice, research, and training, and as a formal movement. The authors hope to advance discussion about future directions that seem particularly promising. As an indication of therapeutic flexibility, the authors believe that the most valuable aspects of integration may prove to be (1) the enthusiastic, open-minded stance of the integrative therapist who (2) is willing to change his or her approach in order to be responsive to a patient’s needs.
Yeast applied readthrough inducing system (YARIS): an invivo assay for the comprehensive study of translational readthrough
Authors: Beznosková Petra , Pavlíková Zuzana , Zeman Jakub , Echeverría Aitken Colin , Valášek Leoš S
Published: April 2019

Stop codon readthrough—the decoding of a stop codon by a near-cognate tRNA—is employed by viruses to balance levels of enzymatic and structural proteins and by eukaryotic cells to enable isoform-specific protein synthesis in response to external stimuli. Owing to the prevalence of premature termination codons in human disease, readthrough has emerged as an attractive therapeutic target. A growing list of various features, for example the +4 nucleotide immediately following the stop codon, modulate readthrough levels, underscoring the need for systematic investigation of readthrough. Here, we identified and described a complete group of yeast tRNAs that induce readthrough in the stop-codon tetranucleotide manner when overexpressed, designated readthrough-inducing tRNAs (rti-tRNAs). These rti-tRNAs are the keystones of YARIS (yeast applied readthrough inducing system), a reporter-based assay enabling simultaneous detection of readthrough levels at all twelve stop-codon tetranucleotides and as a function of the complete set of rti-tRNAs. We demonstrate the utility of YARIS for systematic study of translation readthrough by employing it to interrogate the effects of natural rti-tRNA modifications, as well as various readthrough-inducing drugs (RTIDs). This analysis identified a variety of genetic interactions demonstrating the power of YARIS to characterize existing and identify novel RTIDs.
A Single Preoperative Administration of Dexamethasone, Low-dose Pregabalin, or a Combination of the 2, in Spinal Surgery, Does Not Provide a Better Analgesia Than a Multimodal Analgesic Protocol Alone
Authors: Momon Aurélien , Verdier Bruno , Dolomie Jacques-Olivier , Gardette Mélanie , Pereira Bruno , Curt Isabelle , Dualé Christian
Published: April 2019

Objectives:

A single perioperative dose of glucocorticoid or gabapentinoid, or a combination of the 2, may improve postoperative analgesia, but data are still insufficient to be conclusive. In this single-center, randomized, double-blind, and double-dummy trial, we aimed to test whether the analgesic effect of adding preoperative pregabalin, at a dose unlikely to induce side effects, to preoperative dexamethasone improves early mobilization after spinal surgery.

Materials and Methods:

A total of 160 patients undergoing scheduled lumbar disk surgery (145 analyzed) comprised the study cohort. The patients received either 0.2 mg/kg intravenous dexamethasone before incision, or 150 mg oral pregabalin 1 hour before surgery, or a combination of the 2, or none of the above (control). Analgesia was supplemented by acetaminophen and ketoprofen, plus oxycodone ad libitum. The primary outcome was pain intensity during the first attempt to sit up, assessed the morning of the first postoperative day on an 11-point Numerical Rating Scale. Pain at rest and when standing up, opioid consumption, and tolerance were also assessed.

Results:

None of the treatments tested differed from the control group in terms of efficacy or tolerance, even 6 months after surgery. The overall quality of analgesia was good, with only 10% and 30% of pain scores exceeding 3/10 for pain at rest and during movement, respectively.

Discussion:

In this surgical model with the given anesthetic and analgesic environment, there was no advantage gained by adding low-dose pregabalin or dexamethasone. The multimodal analgesic protocol applied to all patients may have reduced the size of the effect.
Surveying the POSNA Landscape: What Can We Learn From Society Survey Studies?
Authors: Williams Brendan A. , Guerrero Andres , Blakemore Laurel C. , Frick Steven L.
Published: April 2019

Background:

A growing trend of survey-based research has been seen in the field of pediatric orthopaedics. The purpose of this study was to describe patterns of surveys of Pediatric Orthopaedic Society of North America (POSNA) membership and evaluate for associations between study characteristics and response rates in order to inform future research efforts. We hypothesized that studies with fewer survey questions and study group or committee involvement would demonstrate higher response rates.

Methods:

A systematic review of the literature was performed to identify all peer-reviewed survey publications targeting POSNA members published up to December 2017. Included studies were reviewed to identify author and publication characteristics, survey development and methodology, survey distribution procedures, and response rates. Statistical analyses were performed to describe publication patterns and evaluate for associations between study characteristics and response rates.

Results:

Thirty-four studies published from 1991 to 2017 were identified as meeting inclusion criteria, with a substantial increase noted over the last 3 years. Studies included 4.6 (SD 1.9) authors and 14.7% had affiliations with study groups or committees. Survey development methodology was detailed in only 1 study. Surveys included a median of 19.5 questions (3 to 108) and were primarily electronically distributed. The mean survey response rate was 42% with a downward trend noted over the studied time period. None of the studied author, publication, and design characteristics were associated with increased response rates.

Conclusions:

Survey-based studies of the POSNA membership have become increasingly popular study designs in recent years. Response rates are lower than reports in other physician cohorts, and appear to be declining, possibly representative of respondent fatigue. No associations were identified between response rates and the modifiable study characteristics evaluated (number of authors, committee or subgroup affiliation, number of questions, and mode of distribution). Efforts should be made to identify tactics to sustain participation as these studies become more widely utilized within our field. Optimizing study design and implementation features while valuing physician time and effort spent on survey completion is important to avoid member survey fatigue.

Level of Evidence:

Level V—systematic review of Level V research.
Magnetic Resonance Imaging-Based Morphological Change of Paraspinal Muscles in Girls With Adolescent Idiopathic Scoliosis
Authors: Yeung Kwong Hang , Man Gene Chi Wai , Shi Lin , Hui Steve Cheuk Ngai , Chiyanika Chileka , Lam Tsz Ping , Ng Bobby Kin Wah , Cheng Jack Chun Yiu , Chu Winnie Chiu Wing
Published: April 2019

Study Design.

A cross-sectional study.

Objective.

To investigate and compare any morphological differences in paraspinal muscles (PSM) between adolescent idiopathic scoliosis (AIS) patients (with severe or non-severe curves) and healthy controls.

Summary of Background Data.

Several studies have reported abnormalities in biochemical, electromyographic activity, and histological changes of PSM in AIS. However, these studies only had qualitative data and without comparison with controls. Changes of muscle mass and mean density at the lumbar region have been described for scoliotic spines. All these findings suggested that imbalance of PSM in AIS could be a contributing factor to the development of severe scoliotic curve.

Methods.

T2-weighted MR images with multi-planar reconstruction were acquired in 41 Chinese AIS girls with a primary right-sided thoracic curve and 23 age-matched controls. In AIS, measurements of PSM were taken on both concavity and convexity of scoliosis starting from two vertebrae above and two below the apex. Morphological assessments of the multifidus (MF) and erector spinae (ES) muscles on both sides were made including signal intensity (SI) and fat deposition using manual tracing and thresholding technique, respectively. Same parameters were measured in controls at matched vertebrae. One-way analysis of variance (ANOVA) and Pearson correlation tests were used for statistical analysis.

Results.

Abnormalities were found at concavity of muscles between AIS and controls. Significantly higher SI and fatty components was observed in AIS at MF muscles on concavity than controls (P-value <0.001). Additionally, SI at MF muscles was significantly correlated with Cobb angle.

Conclusion.

Increased SI and fatty components are asymmetrically present in PSM at apex in AIS. Our results showed higher intensity in PSM at concavity in AIS when compared with controls. There was a significant linear correlation between abnormal muscle signal and scoliotic curve. Above features are suggestive of altered muscle composition in concave PSM, possibly due to prolonged compression and reduced muscle activity of PSM caused by the spinal deformity.

Level of Evidence: 4
New Option for Achilles Tendon Ruptures, Combining the Best of All: The PARS-Dresden
Authors: Pellegrini Manuel J. , Butteri Ana , Chaparro Felipe , Carcuro Giovanni , Ortiz Cristian
Published: April 2019

Surgical treatment remains the standard of care for active patients with acute midsubstance Achilles tendon ruptures. Minimal invasive surgery, rupture’s site hematoma preservation, strong fixation, avoidance of sural nerve entrapment, and early rehabilitation are essential concepts desirable for any Achilles tendon repair. Hereby, we present a technique modification that incorporates all these advantages in one single procedure.
Uterine Factor Infertility: A Clinical Review
Authors: HUR CHRISTINE , REHMER JENNA , FLYCKT REBECCA , FALCONE TOMMASO
Published: April 2019

Uterine factor infertility (UFI) may affect up to 1 in 500 reproductive age women. The uterus is an essential component of achieving pregnancy and carrying a pregnancy to term successfully. There are many etiologies of UFI which may be categorized into either congenital or acquired causes. In this review, we discuss the different causes of UFI as well as the treatment options, which now includes uterine transplant.
Validity of the Incremental Shuttle Walk Test to Assess Exercise Safety When Initiating Cardiac Rehabilitation in Low-Resource Settings
Authors: Lelis Joana D'arc , Chaves Gabriela , Ghisi Gabriela Lima de Melo , Grace Sherry L. , Britto Raquel Rodrigues
Published: April 2019

Purpose:

To evaluate the validity of the Incremental Shuttle Walk Test (ISWT) for determining risk stratification in cardiac rehabilitation (CR).

Methods:

This is a cross-sectional study at a major CR center in a middle-income country. Clinically stable adult cardiac patients underwent an ISWT and an exercise test (ET), wore a pedometer for 7 d, and completed the Godin-Shepherd Leisure-Time Physical Activity Questionnaire. Metabolic equivalents of task (METs) achieved on the ISWT were calculated.

Results:

One hundred fifteen patients were evaluated. The mean ± standard deviation distance on the ISWT was 372.70 ± 128.52 m and METs were 5.03 ± 0.62. The correlation of ISWT distance with ET METs (7.57 ± 2.57), steps/d (4556.71 ± 3280.88), and self-reported exercise (13.08 ± 15.19) was r
s = 0.61 (P < .001), r
s = 0.37 (P < .001), and r
s = 0.20 (P = .031), respectively. Distance on the ISWT accurately predicted METs from the ET (area under the receiver operating characteristic curve = 0.774). The ability to walk ≥410 m on the ISWT predicted, with a specificity of 81.5% and a sensitivity of 65.6%, a functional capacity of ≥7 METs on ET.

Conclusion:

The ISWT is an alternative way to evaluate functional capacity in CR and can contribute to the process of identifying patients at low risk for a cardiac event during exercise at moderate intensity.
Optimizing fluid therapy in shock
Authors: Marik Paul E. , Weinmann Maxwell
Published: April 2019

Purpose of review

Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock.

Recent findings

Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. However, in many instances, aggressive fluid resuscitation may be harmful, increasing morbidity and mortality.

We believe that the approach to fluid therapy must be individualized based on the cause of shock as well as the patient's major diagnosis, comorbidities and hemodynamic and respiratory status. A conservative, physiologically guided approach to fluid resuscitation likely improves patient outcomes.
Is microcirculatory assessment ready for regular use in clinical practice?
Authors: De Backer Daniel
Published: April 2019

Purpose of review

The present review discusses the current role of microcirculatory assessment in the hemodynamic monitoring of critically ill patients.

Recent findings

Videomicroscopic techniques have demonstrated that microvascular perfusion is altered in critically ill patients, and especially in sepsis. These alterations are associated with organ dysfunction and poor outcome. Handheld microscopes can easily be applied on the sublingual area of critically ill patients. Among the specific limitations of these techniques, the most important is that these can mostly investigate the sublingual microcirculation. The representativity of the sublingual area may be questioned, especially as some areas may sometimes be more affected than the sublingual area. Also, evaluation of the sublingual area may be difficult in nonintubated hypoxemic patients. Alternative techniques include vasoreactivity tests using either transient occlusion or performing a thermal challenge. These techniques evaluate the maximal dilatory properties of the microcirculation but do not really evaluate the actual microvascular perfusion. Focusing on the glycocalyx may be another option, especially with biomarkers of glycocalyx degradation and shedding. Evaluation of the glycocalyx is still largely experimental, with different tools still in investigation and lack of therapeutic target. Venoarterial differences in PCO2 are inversely related with microvascular perfusion, and can thus be used as surrogate for microcirculation assessment. Several limitations prevent the regular use in clinical practice. The first is the difficult use of some of these techniques outside research teams, whereas nurse-driven measurements are probably desired. The second important limitation for daily practice use is the lack of uniformly defined endpoint. The final limitation is that therapeutic interventions affecting the microcirculation are not straightforward.

Clinical and biological surrogates of microcirculatory assessment can be used at bedside. The role of microvideoscopic techniques is still hampered by the lack of clearly defined targets as well as interventions specifically targeting the microcirculation.
Tai Chi for improving balance and reducing falls
Authors: Zhong Dongling , Xiao Qiwei , He Mingxing , Li Yuxi , Ye Jing , Zheng Hui , Xia Lina , Zhang Chi , Liang Fanrong , Li Juan , Jin Rongjiang
Published: April 2019

Introduction:

To investigate the effectiveness and safety of Tai Chi for improving balance and reducing falls on people.

Methods and analysis:

The following databases will be searched: China Biology Medicine (CBM), China National Knowledge infrastructure (CNKI), Wan Fang Data, the Chinese Science and Technology Periodical Database (VIP), Medline, EMBASE, Web of Science, The Cochrane Library from inception to March 2019. All randomized controlled trials (RCTs) utilized Tai Chi to improve balance ability and reduce falls will be included. Primary outcomes are the fall-related indicators, including the number of falls, fall rate, and other fall-related outcomes. Additional outcomes include the Berg Balance Scale (BBS), standing-walk test, single-legged time, or other balance-related outcomes. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using Review Manager V5.3 software.

Ethics and dissemination:

The findings of this systematic review will be disseminated through peer-reviewed publication or conference presentations.

Trial registration number PROSPERO CRD42019127810
Gradual aggravation of idiopathic glossopharyngeal neuralgia due to chronic tonsillitis
Authors: Kim EunSoo , Do Wangseok , Jung Young-Hoon , Lee Jiyoun , Baik Jiseok
Published: April 2019

Rationale:

Glossopharyngeal neuralgia (GPN) is a rare type of neuralgia. Depending on the cause, it is classified as idiopathic GPN and secondary GPN. Secondary GPN can also be caused by a mass effect or inflammation of the tonsils, the innervation area of glossopharyngeal nerve.

Patient concerns:

The patient was diagnosed idiopathic GPN 8 years ago. The patient had intermittent pain, but the pain was well controlled. From 5 months ago, the pain gradually worsened, the patient complained severe pain which impaired chewing and swallowing function.

Diagnoses:

Idiopathic GPN, secondary GPN, chronic tonsillitis

Interventions:

Percutaneous glossopharyngeal nerve block, glossopharyngeal neurolysis, and pulsed radiofrequency neuromodulation of glossopharyngeal nerve were performed. After the diagnosis of tonsillitis, antibiotic therapy was performed

Outcomes:

Two weeks after the antibiotic treatment, the pain decreased simultaneously with the patient's tonsillitis recovery.

Lessons:

In a Patient who had already been diagnosed with idiopathic GPN, both pain control and its cause should be considered when the pain is aggravated.
Prognostic value of long non-coding RNA ZEB1-AS1 in Chinese cancer patients
Authors: Zhou Xi , Fan Yang-Hua , Wang Yan , Wang Fu , Liu Yong
Published: April 2019

Background:

Aberrant expression of long non-coding RNA Zinc finger E-box binding homeobox 1 antisense 1 (lncRNA ZEB1-AS1) can be detected in numerous malignancies. Therefore, a meta-analysis had been carried out in this study, aiming to examine the prognostic value of lncRNA ZEB1-AS1 in malignancies.

Methods:

Electronic databases, such as PubMed, OVID as well as Web of Science, had been systemically retrieved from inception to February 14th, 2019. Besides, the hazard ratios (HRs), together with the corresponding 95% confidence intervals (CIs), had also been analyzed for determining the association of lncRNA ZEB1-AS1 expression with the overall survival (OS) and recurrence-free survival (RFS). In addition, the pooled odds ratios (ORs) would also be computed using the Stata SE12.0 software for evaluating the relationship of lncRNA ZEB1-AS1 expression with pathological factors.

Results:

A total of 21 original studies involving 1801 cancer patients had been enrolled into the current meta-analysis. As suggested by the pooled HR, high expression of lncRNA ZEB1-AS1 had displayed marked correlation with OS (HR = 2.16, 95% CI: 1.89–2.47) among cancer patients, and no significant heterogeneity was detected. Additionally, high expression of lncRNA ZEB1-AS1 was also markedly associated with RFS among cancer patients (pooled HR = 2.55, 95% CI: 1.61–4.03). Besides, the expression of lncRNA ZEB1-AS1 had displayed marked correlation with poor histological grade (PHG) (OR = 2.86, 95% CI: 2.11–3.87), high tumor stage (HTS) (OR = 3.81, 95% CI: 2.72–5.34) as well as lymph node metastasis (LNM) (OR = 3.33, 95% CI: 2.47–4.49). Additionally, no distinct asymmetry had been detected for RFS, PHG as well as HTS based on Begg funnel plot.

Conclusions:

Taken together, high expression of lncRNA ZEB1-AS1 can predict the dismal OS, RFS, LNM, PHG, and HTS, indicating that lncRNA ZEB1-AS1 can be potentially used as a new biomarker to predict the dismal prognosis for cancer patients.
Topiramate precipitating a manic episode in a bipolar patient comorbid with binge eating disorder
Authors: Duan Jinfeng , Lai Jianbo , Wang Dandan , Zhou Weihua , Huang Manli , Hu Shaohua , Xu Yi , Lu Jing
Published: April 2019

Rationale:

Topiramate is a novel antiepileptic drug that is used as an adjunctive in the treatment of partial and secondary generalized seizures. In recent years, psychiatrists have paid more attention to topiramate as a mood stabilizer and as an agent for treating eating disorders, especially in binge eating disorder (BED) and bulimia nervosa.

Patient concerns and diagnoses:

Herein, we report a case of topiramate precipitating a manic episode in a bipolar patient comorbid with BED, who complained of emotional instability and binge-eating behaviors.

Diagnoses:

In this patient, acute manic episode was induced by topiramate treatment at a daily dose of 75 mg for three days.

Interventions:

The dose of topiramate was decreased to 25 mg per day promptly, and the patient gradually became calm but the BED symptoms recurred, then the dose of topiramate was increased to 50 mg per day again. Meanwhile, the dosage of quetiapine was escalated up to 500 mg per night to stabilize her mood.

Outcomes:

With a combination of quetiapine 500 mg per night and topiramate 50 mg per day, the emotion and eating problems of this patient concurrently improved.

Lessons:

These findings indicated that patients with a history of bipolar disorder and comorbid BED have a tendency to develop manic episode when taking topiramate. Careful monitoring of mood alterations after topiramate supplement to mood stabilizers is necessary in this population.
Extradural anterior clinoidectomy and aneurysm clipping using transcranial neuroendoscopic approach
Authors: Cai Qiang , Guo Qiao , Zhang Wenfei , Ji Baowei , Chen Zhibiao , Chen Qianxue
Published: April 2019

Rationale:

Anterior clinoidectomy is an important technique for neurovascular and skull base surgery. Until now, extradural anterior clinoidectomies have been performed under a microscope in almost all clinical cases, with only one clinical case performed an extradural pathological anterior clinoid process resection using neuroendoscopy. Additionally, no normal ACP resections have been performed extradurally via neuroendoscopy, especially for aneurysms. We tried to perform extradural anterior clinoidectomies by neuroendoscopy.

Patient concerns:

A 63-year-old woman was admitted to hospital presented with sudden onset of headache without any accompanying neurological deficit. A computed tomography (CT) scan of the head revealed a subarachnoid hemorrhage, which was positioned mainly in the left slyvian fissure and interpeduncular and basilar cisterns.

Diagnoses:

1. Left side posterior communicating artery aneurysm; 2. subarachnoid hemorrhage.

Interventions:

Extradural anterior clinoidectomy and aneurysm clipping were performed using transcranial neuroendoscopic approaches.

Outcomes:

The patient recovered well after the procedure, and the post-operative image view revealed that the ACP had been removed and that the clip was located just at the ACP area.

Lessons:

This case provided the first evidence that extradural anterior clinoidectomy could be performed by transcranial neuroendoscopic approach.
Surgical treatment of a posterior inferior cerebellar artery aneurysm via transcranial neuroendoscopic approach
Authors: Cai Qiang , Guo Qiao , Zhang Wenfei , Ji Baowei , Chen Zhibiao , Chen Qianxue
Published: April 2019

Rationale:

Posterior inferior cerebellar artery (PICA) aneurysms are rare and heterogeneous in both location and morphology, and the management of proximal PICA aneurysms is challenging. In 2011, Joaquim reported a successfully treated VA-PICA ruptured aneurysm using a pure endoscopic endonasal transclival approach for the first time. However, the patient suffered CSF rhinorrhea and underwent an additional operation to repair the CSF leak. In this case report, we describe the treatment of proximal PICA aneurysm by transcranial neuroendoscopic approach.

Patient concerns:

A 68-year-old woman presented with a sudden onset of severe headache followed by loss of consciousness and computed tomography of the head showed a mild SAH, located predominantly in the posterior fossa. Clinical signs and symptoms included headache and a positive meningeal irritation sign; no other neurological symptoms were found.

Diagnosis:

A 3-dimensional CT angiography revealed the diagnosis as left VA-PICA junction aneurysm.

Interventions:

After a medical treatment, the patient regained consciousness and the aneurysm was treated by pure neuroendoscopy via a modified far-lateral surgical approach.

Outcomes:

The patient recovered well after the procedure, and the post-operation image view shows a proper placement of the clip, obliteration of the aneurysm, and the parental artery was unobstructed.

Lessons:

To our best knowledge, this is the first reported case of treating aneurysm by neuroendoscopic transcranial approach and the second reported case treated by endoscopy. In the present report, we propose that ruptured VA-PICA junction aneurysms could be treated by a pure transcranial neuroendoscopic approach. The advantages of this approach included no risk of CSF rhinorrhea compared with the endoscopic endonasal transclival approach.
A retrospective study of acupuncture as an adjunctive therapy to topical ibuprofen for chronic knee pain due to osteoarthritis
Authors: Liu Shi-Chen , Qiao Xiao-Feng , Tang Qing-Xi , Li Xiao-Guang , Yang Jian-Hua , Wang Tian-Qi , Xiao Ya-Jie , Qiao Jian-Min
Published: April 2019

This retrospective study investigated the effectiveness and safety of acupuncture as an adjunctive therapy to topical ibuprofen (TIP) for patients with chronic knee pain (CKP) due to osteoarthritis.

This retrospective study analyzed medical records of 84 patients with CKP due to osteoarthritis. These patients were divided into a treatment group (n = 42) and a control group (n = 42). The patients in the treatment group were treated with acupuncture plus TIP, while the subjects in the control group received TIP monotherapy. The primary effectiveness endpoint was assessed by Western Ontario and McMaster Universities osteoarthritis index (WOMAC). The secondary effectiveness endpoints were evaluated by the numeric rating scale (NRS), 12-item Short FormHealth Survey (SF-12, mainly including mental component summary [MCS], and physical component summary [PCS]), and adverse events. All patients received an 8-week treatment. All endpoints were measured pre-treatment and posttreatment.

The patients who received acupuncture plus TIP showed better effectiveness in both primary endpoint of WOMAC scale (pain, P < .01; function, P < .01; and stiffness, P < .01) and secondary endpoints of NRS (P < .01), and SF-12 (MCS, P < .01; and PCS, P < .01), than patients who received TIP monotherapy. In addition, both groups had similar safety profile.

The results of this study showed that the effectiveness of acupuncture plus TIP may be better than TIP monotherapy for patients with CKP due to osteoarthritis.
Clinical characteristics of arytenoid dislocation in patients undergoing bariatric/metabolic surgery
Authors: Hung Kuo-Chuan , Chen Yi-Ting , Chen Jen-Yin , Kuo Chuan-Yi , Wu Shao-Chun , Chiang Min-Hsien , Lan Kuo-Mao , Wang Li-Kai , Sun Cheuk-Kwan
Published: April 2019

Tracheal intubation and the use of a large-bore calibrating orogastric (OG) tube have been reported to increase the incidence of arytenoid dislocation (AD) in patients undergoing bariatric/metabolic surgery. This study aimed at identifying the clinical characteristics of this patient subgroup.

We retrospectively examined the clinical characteristics of 14 patients with AD (study group) who received tracheal intubation and OG insertion for bariatric/metabolic surgery between 2011 and 2016. For comparison, another group of 19 patients with postoperative AD collected from published literature and 3 patients from the authors’ institute served as controls in whom only tracheal intubation was performed. Information on patient characteristics, anesthetic time, symptoms, time of symptom onset, intervention, and postinterventional impact on vocalization of the 2 groups were collected and compared.

Patients in the study group were younger than those in the control group (38 [25–60] vs 54.5 [19–88] years, P = .03). Compared with the control group, anesthetic time (282.5 [155–360] vs 225 [25–480] minutes, P = .041) was longer and symptom onset (1.0 [0–6] vs 1.0 [0–6] days, P = .018) was more delayed in the study group. After closed reduction, the frequency of voice recovery was comparable in both groups in a time interval of 12 weeks (84.6% vs 92.9%, P = .59).

Our report demonstrates that the clinical characteristics of patients with AD who received tracheal intubation and OG insertion for bariatric/metabolic surgery were different from those with postoperative AD receiving only tracheal intubation, highlighting the importance of implementing individualized strategies for AD prevention in this patient population.
Importance of patient history in diagnosis of foreign body aspiration in children
Authors: Cui Yu , Cui Xiangyan , Yu Tingting , Zhu Zhanpeng , Wang Xin
Published: April 2019

Rationale:

Accidental tracheobronchial foreign body aspiration (FBA) is one of the diseases with the highest morbidity and mortality in early childhood. A history of aspiration is very important for diagnosis, as sometimes there are no abnormalities in the physical examination of the patient. Parental negligence and inappropriate treatment may be important reasons for the delay in diagnosis. We describe 2 cases of misdiagnosed children with an unclear history of aspiration.

Patient concerns:

A 5-year-old boy, who fell out of bed when sucking pistachios and landed on his neck, was initially diagnosed as a closed injury of the larynx. An 18-month-old girl, who developed a cough and difficulty breathing after she fell to the ground surrounded by many corn grains.

Diagnosis:

Bronchoscopy examination confirmed the diagnosis of tracheobronchial foreign bodies.

Interventions:

The foreign bodies were removed by bronchoscopy examination.

Outcomes:

Both patients were discharged after removal of the foreign bodies and antibiotic treatment.

Lessons:

Aspiration history is crucial for the correct diagnosis of FBA, and lack of history may lead to the misdiagnosis of FBA. Parents should be educated to increase their awareness of tracheobronchial FBA, and avoid providing their children with small objects that can potentially block the airways. When FBA is suspected, the child should be sent to a hospital immediately. Diagnostic rigid bronchoscopy is recommended.
Prognostic value of tumor necrosis in gastrointestinal stromal tumor
Authors: Yi Mengshi , Xia Lin , Zhou Yan , Wu Xiaoting , Zhuang Wen , Chen Yi , Zhao Rui , Wan Qianyi , Du Liang , Zhou Yong
Published: April 2019

Background and aims:

There is currently no consensus regarding the influence of tumor necrosis on the prognosis of gastrointestinal stromal tumors (GISTs). Therefore, we conducted a meta-analysis to determine the prognostic role of tumor necrosis in patients with GIST.

Methods:

PubMed, Embase, and Web of Science electronic databases were searched from their inception to March 2018. Studies reporting data on the relationship between tumor necrosis and GIST prognosis were eligible. The measure of the effect of interest was the odds ratios (ORs) with 95% confidence intervals (CIs). This study has been registered in the Prospero (number CRD42018096036).

Results:

In total, 18 studies including 2320 patients were identified. The total odds of tumor necrosis were associated with a poor GIST prognosis (OR = 5.54, 95% CI = 4.39–6.99). Subgroup analysis of different observed outcomes indicated that tumor necrosis was associated with a decreased disease-free survival (OR = 7.08, 95% CI = 4.78–10.49), recurrence-free survival (OR = 3.96, 95% CI = 2.48–6.32), and overall survival (OR = 4.29, 95% CI = 2.02–9.13). In addition, any tumor site, tumor size, follow-up time, ethnicity, different outcomes of GIST, and different degrees of positive staining of immunohistochemical markers subgroups showed a significantly increased risk of a poor prognosis.

Conclusions:

Tumor necrosis may likely predict a poorer prognosis for GIST. However, further well-designed prospective studies with large sample size are required in the future.