bluuebunny/crossref_metadata_2025 huggingface dataset:
Poetic Violence in the Book of Jeremiah
Authors: Kalmanofsky Amy
Published: December 2021

This chapter examines poetic images of violence in the book of Jeremiah from a literary perspective. In this analysis, Jeremiah’s images of poetic violence are rhetorically constructed and should not be viewed as descriptive of actual events. Although violent events may lie at the heart of these images, this chapter assumes they are designed primarily for their rhetorical impact and theological meaning, and not for their descriptive accuracy. After discussing broadly the meaning and purpose of poetic violence, the author considers three rhetorically effective images that appear frequently in Jeremiah—the wound, the maternal body, and the unburied corpse. These images share a common focus on the body and are intended to unsettle and to induce change in those who encounter them by communicating the physical threat to individuals within Israel, as well as to the community as a whole. Despite their power to unsettle, these images also convey hope by communicating alternative and positive realities, and by suggesting ways in which violence can be a creative force that transforms individuals and communities. If poetic violence is effective, transformation will occur and the wound, the maternal body, and the unburied corpse will make way for the healing, birth, and regeneration of Israel.
Jeremiah’s Deathscapes
Authors: Mills Mary
Published: December 2021

This chapter explores the rhetorical structures of the book of Jeremiah with regard to its message of violent destruction—a topic that the chapter defines under the heading of “deathscape.” This term is defined as having two sub-strands: embodiment and spatiality. Jeremiah contains much material relating to the experiences of the central prophetic figure, which provides a solid textual resource for examining how the human person is impacted by the task of proclaiming terror and loss. The Confessions especially display a persona traumatized by this task. At the same time, land is rendered desolate, alongside the human inhabitants. Spatiality provides a tool for reading urban destruction via the lens of a withered landscape. Reading Jeremiah as a single work employs the methodological lens of rhetorical criticism, examining the way in which violent imagery expresses the link between historical events and literary depictions of the impact of warfare. Seeking for the cause of great suffering, Jeremiah locates it in the action of divine justice, a manner of providing order for chaos that renders the deity monstrous since it is the divine sphere that contextualizes unbearable human pain. Evaluation of Jeremiah’s urban imaginary aligns not only with material events but also with responses from differing audiences and parallel subject areas, such as gender, disability, and colonialism. Ultimately, the chapter suggests, further reflection on the inanimate agency of urban environments in creating textual poetics of deathscape will be useful.
Jeremiah in Art
Authors: Callaway Mary Chilton
Published: December 2021

The story of Jeremiah in art reveals a dynamic process of traditional tropes that signaled the ancient prophet blended with contemporary features mirroring the viewer. This interplay made artistic representations of Jeremiah at once familiar, yet also at times unsettling in the way they contemporized the prophetic message. The chapter explores the developing image of Jeremiah through the centuries in five media: painted images on ancient frescoes, stone statues in medieval cathedrals and monasteries, illuminations in medieval manuscripts, woodcuts in early modern printed books, and various forms in modernity. Jewish, Christian, and Muslim images of the prophet together display a process in which historically contingent tropes gradually became timeless markers of the prophet. At the same time, these images show the power of Jeremiah to speak prophetically in new circumstances.
Ecological Hermeneutics and Jeremiah
Authors: Clayville Kristel
Published: December 2021

This chapter provides an overview of the relationship between ethics and the Bible, then turns to focus on the specific role of environmental ethics in biblical interpretation and the development of ecological hermeneutics. After this brief history of ethical thinking in and with the Bible, the chapter offers a critical summary of various interpretive typologies that scholars have developed to describe the Israelite relationship to land in the Bible. Building on this background, this chapter offers an analysis of Jeremiah that is informed by ecological hermeneutics. This reading focuses on the role of the land in the Israelite imaginary, the loss of land as punishment, the natural versus unnatural as a diagnostic for moral purity, and reading from the perspective of the land.
Written on the Heart, Erased from the Mind
Authors: Balentine Samuel E.
Published: December 2021

Can there be moral agency without autonomy? Absent the freedom to deliberate, make a choice, and enact a decision, does the covenantal relationship described in Jeremiah 31 understand fidelity to God to be anything more than involuntary obedience? Put differently, if both the covenantal requirements and the decision to obey them are externally inscribed on the human heart, if like computer software they are “programmed” into the operating system, do humans automatically surrender their freedom for thinking about moral decisions? This chapter examines the language of moral selfhood (both divine and human) in Jeremiah, with special attention to trauma theory as a hermeneutical lens for thinking about the “wounding of the mind” wrought by the experience of exile.
Parties and Party Systems
Authors: Lim Sunghack
Published: December 2021

Since the late 1980s, South Korea has established democratic rules and institutions to protect the political freedom and civil rights of its citizens. In this process, political parties played a pivotal role in building democratic institutions and became a necessary actor for democratic governance. The characteristics of South Korean political parties and party system such as non-ideological regional factionalism, personality-based party organization, growing electoral volatility due to party changes, and a cartelized two-party system have contributed to weak party system institutionalization (PSI). Despite weak PSI, South Korea successfully underwent three peaceful power transfers, thus exceeding Huntington’s two turnover test of democratic consolidation. The stability of interparty competition has been maintained despite moderate electoral volatility. While regionalism is still the most important factor in voter decisions, the ideological linkage between parties and voters has been tightening. The South Korean parties and party system have a long way to go before achieving the levels of PSI seen in the West, but they have followed in these countries’ footstep to some extent. More sophisticated measures and concepts should be developed to analyse political parties and party systems in new democracies.
Regionalism
Authors: Yoon Kwang-Il
Published: December 2021

This chapter examines regional division, or regionalism, in South Korea, a dominant factor determining the country’s politics. The conceptual definition of regionalism in the context of South Korean politics refers to regional patterns of voting behaviour, with voters deciding their vote based on their birthplace. But regionalism has been also understood from different perspectives focusing on its history, public emotional antagonism, regional party system, etc. This chapter elaborates the origins of regionalism and conceptualizes regionalism according to the level of analysis and the domain of its manifestation. The chapter then promotes the theoretical understanding of regionalism by drawing on prejudice, social identity, and cleavage theory. It argues that the regional cleavage based on birthplace-based regional prejudice and identity that have determined electoral behaviour and party system will not change significantly in the near future. The chapter concludes with a discussion of recent developments in regionalism.
Language and Domain Specificity: A Chinese Financial Sentiment Dictionary
Authors: Du Zijia , Huang Alan Guoming , Wermers Russ , Wu Wenfeng
Published: December 2021

We use Word2vec to develop a financial sentiment dictionary from 3.1 million Chinese-language financial news articles. Our dictionary maps semantically similar words to a subset of human-expert generated financial sentiment words. In validation tests, our dictionary scores the sentiment of articles consistently with human reading of full articles. In return association tests, our dictionary outperforms and subsumes previous Chinese financial sentiment dictionaries, such as direct translations of Loughran and McDonald’s (2011, Journal of Finance, 66, 35–65) English-language financial dictionary. We also generate a list of politically related positive words that is unique to China; we find that this list has a weaker association with returns than does the list of other positive words. We demonstrate that state media uses more politically related positive and fewer negative words, and exhibits a sentiment bias. This bias renders the state media’s sentiment as less return-informative. Our findings demonstrate that dictionary-based sentiment analysis exhibits strong language and domain specificity.
DNA Sequence-Based Identification ofFusarium: A Work in Progress
Authors: O’Donnell Kerry , Whitaker Briana K. , Laraba Imane , Proctor Robert H. , Brown Daren W. , Broders Kirk , Kim Hye-Seon , McCormick Susan P. , Busman Mark , Aoki Takayuki , Torres-Cruz Terry J. , Geiser David M.
Published: December 2021

Accurate species-level identification of an etiological agent is crucial for disease diagnosis and management because knowing the agent’s identity connects it with what is known about its host range, geographic distribution, and toxin production potential. This is particularly true in publishing peer-reviewed disease reports, where imprecise and/or incorrect identifications weaken the public knowledge base. This can be a daunting task for phytopathologists and other applied biologists that need to identify Fusarium in particular, because published and ongoing multilocus molecular systematic studies have highlighted several confounding issues. Paramount among these are: (i) this agriculturally and clinically important genus is currently estimated to comprise more than 400 phylogenetically distinct species (i.e., phylospecies), with more than 80% of these discovered within the past 25 years; (ii) approximately one-third of the phylospecies have not been formally described; (iii) morphology alone is inadequate to distinguish most of these species from one another; and (iv) the current rapid discovery of novel fusaria from pathogen surveys and accompanying impact on the taxonomic landscape is expected to continue well into the foreseeable future. To address the critical need for accurate pathogen identification, our research groups are focused on populating two web-accessible databases (FUSARIUM-ID v.3.0 and the nonredundant National Center for Biotechnology Information nucleotide collection that includes GenBank) with portions of three phylogenetically informative genes (i.e., TEF1, RPB1, and RPB2) that resolve at or near the species level in every Fusarium species. The objectives of this Special Report, and its companion in this issue ( Torres-Cruz et al. 2022 ), are to provide a progress report on our efforts to populate these databases and to outline a set of best practices for DNA sequence-based identification of fusaria.
Virtual reality-based rehabilitation in patients following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials
Authors: Peng Linbo , Zeng Yi , Wu Yuangang , Si Haibo , Shen Bin
Published: December 2021

Background:

Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty (TKA). The coronavirus disease 2019 (COVID-19) pandemic has made face-to-face rehabilitation inaccessible. Virtual reality (VR) is increasingly regarded as a potentially effective option for offering health care interventions. This systematic review and meta-analysis investigate VR-based rehabilitation's effectiveness on outcomes following TKA.

Methods:

From inception to May 22, 2021, PubMed/Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Scopus, PsycINFO, Physiotherapy Evidence Database, China National Knowledge Infrastructure, and Wanfang were comprehensively searched to identify randomized controlled trials (RCTs) evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions.

Results:

Eight studies were included in the systematic review, and seven studies were included in the meta-analysis. VR-based rehabilitation significantly improved visual analog scale (VAS) scores within 1 month (standardized mean difference [SMD]: −0.44; 95% confidence interval [CI]: −0.79 to −0.08, P = 0.02), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) within 1 month (SMD: −0.71; 95% CI: −1.03 to −0.40, P < 0.01), and the Hospital for Special Surgery Knee Score (HSS) within 1 month and between 2 months and 3 months (MD: 7.62; 95% CI: 5.77 to 9.47, P < 0.01; MD: 10.15; 95% CI: 8.03 to 12.27, P < 0.01; respectively) following TKA compared to conventional rehabilitation. No significant difference was found in terms of the Timed Up and Go (TUG) test.

Conclusions:

VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation. More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation. As the COVID-19 pandemic continues, it is necessary to promote this rehabilitation model.
Conservative Management of Median Nerve Brachial Plexopathy after Microwave-based MiraDry Treatment for Axillary Hyperhidrosis
Authors: Lee Frank G. , Mansour Ahmed M. , Wallace Sean J. , Miller Nathan F.
Published: December 2021

Axillary hyperhidrosis is characterized by excessive sweating of the armpits, which can significantly affect quality of life. A new microwave-based therapy, MiraDry (Miramar labs, Sunnyvale, Calif.), is a promising minimally-invasive treatment option. We report a case of unilateral brachial plexus thermal injury in a thin 19-year-old man treated for axillary hyperhidrosis with the MiraDry system. He initially experienced swelling and pain in the left hand and was prescribed 1 week of methylprednisolone. He then presented 1 week later with induration and swelling of bilateral axillae with swelling of left thumb, left index, and left long fingers, decreased sensation in median nerve distribution of the left hand, and the inability to flex the left index finger DIP joint. EMG showed absent median nerve motor and sensory function, consistent with median nerve plexopathy. He was conservatively managed with close observation and regular occupational hand therapy appointments. At his 12-month follow-up, there was complete return of left pronator teres strength, thumb flexion, and index finger flexion. Decreased sensation remained at the tip of the left index finger. We report the case of median nerve palsy after MiraDry therapy for axillary hyperhidrosis in a thin young man. We recommend using low-energy settings and pre-procedural ultrasound for young, thin patients because of the more superficial course of the brachial plexus within the axilla.
INTERNATIONAL IMPACT OF THE COVID-19 PANDEMIC LOCKDOWN ON INTRAVITREAL THERAPY OUTCOMES
Authors: Zarranz-Ventura Javier , Nguyen Vuong , Creuzot-Garcher Catherine , Verbraak Frank , O´Toole Louise , Invernizzi Alessandro , Viola Francesco , Squirrel David , Barthelmes Daniel , Gillies Mark C. ,   from the FRB International committee
Published: December 2021

Purpose:

To evaluate the impact of the COVID-19 pandemic lockdowns on the outcomes of eyes treated for neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusion in eight countries.

Methods:

A multicenter international database study of 5,782 eyes (4,708 patients) receiving intravitreal antivascular endothelial growth factor injections before, during, and after national lockdowns. The baseline visit was defined as the last visit within 3 months before lockdown, and prelockdown and postlockdown periods were defined as 6 months before and after the lockdown date.

Results:

Eyes with neovascular age-related macular degeneration (n = 4,649) lost vision in all countries in proportion to the reduced number of injections. The mean visual acuity change postlockdown ranged from −0.4 to −3.8 logarithm of the minimum angle of resolution letters, and the median number of injections/visits decreased from 4–5/4–7 to 2–4/2–4 postlockdown. The diabetic macular edema (n = 654) and retinal vein occlusion (n = 479) eyes' mean visual acuity change ranged from −2.8 to +1.7 letters and −1.6 to +0.1 letters, and the median number of injections/visits decreased from 2.5–5/4–6 to 1–3/2–4 and from 3–5.5/4–5 to 1–3.5/2–3.5, respectively. The 6-month dropout rates postlockdown were 20% for neovascular age-related macular degeneration, 27% for diabetic macular edema, and 28% for retinal vein occlusion.

Conclusion:

This international study provides estimates of the impact of COVID-19 pandemic lockdown on intravitreal therapy and suggests that prioritizing neovascular age-related macular degeneration eyes seems appropriate.
FACTORS RELATED TO UNFAVORABLE VISUAL OUTCOME AFTER IDIOPATHIC EPIRETINAL MEMBRANE SURGERY IN PATIENTS WITH GLAUCOMA
Authors: Ko Yu-Chieh , Chen Yen-Cheng , Huang Yi-Ming , Chang Yu-Fan , Chou Yu-Bai , Liu Catherine Jui-ling , Chen Shih-Jen
Published: December 2021

Purpose:

To evaluate the visual outcomes after idiopathic epiretinal membrane surgery in glaucomatous and nonglaucomatous eyes and factors related to unfavorable outcomes in glaucomatous eyes.

Methods:

This was a retrospective cohort study including patients undergoing idiopathic epiretinal membrane surgery with ≥12-month follow-up. Final visual acuity at pseudophakic status was compared among groups of glaucoma, glaucoma suspect, and nonglaucoma and correlated with optical coherence tomography and visual field characteristics in patients with glaucoma.

Results:

Of the 314 patients enrolled, 31 had glaucoma and 22 were glaucoma suspect. Baseline visual acuity and central foveal thickness were similar across the groups. Most patients had improved/stable visual acuity postoperatively, with a lower proportion of 83.9% with glaucoma than 96.9% and 100% without glaucoma and glaucoma suspect, respectively (P = 0.002). The mean visual acuity did not change in the glaucoma group (from 6/29 to 6/23), but it improved from 6/25 to 6/12 (a gain of 16.7 approxETDRS letters) in nonglaucoma and 6/26 to 6/14 in glaucoma suspect (a gain of 14.0 approxETDRS letters) (both P < 0.001). The change of visual acuity was correlated with preoperative visual field defects (P < 0.001, r2 = 0.554). Patients with glaucoma with more advanced, fixation-threatening defects or temporally located inner nuclear layer microcysts were more likely to have worsened visual acuity.

Conclusion:

Visual field testing is imperative for patients with glaucoma before idiopathic epiretinal membrane surgery for outcome assessment.
CLINICAL FEATURES OF INTRAVITREAL DEXAMETHASONE IMPLANTATION IN VITRECTOMIZED EYES OF PATIENTS WITH DIABETIC MACULAR EDEMA
Authors: Kwon Jin-woo , Park Young-Gun
Published: December 2021

Purpose:

To identify the clinical outcomes of intravitreal dexamethasone implantation (IVD) in previously vitrectomized eyes of patients with diabetic macular edema.

Method:

We performed a retrospective observational study. We recorded central subfield thickness, best-corrected visual acuity, and intraocular pressure up to 12 months after IVD implant placement. We compared the duration of IVD action, intraocular pressure trends, and the prevalence of ocular hypertension after the first IVD treatment of nonvitrectomized and vitrectomized eyes. We also compared the central subfield thickness, best-corrected visual acuity, number of IVD treatments, and prevalence of ocular hypertension between the 2 groups after 12 months.

Results:

We found no significant between-group differences in the central subfield thickness, best-corrected visual acuity, or the prevalence of ocular hypertension during treatment. However, the duration of action of the first IVD treatment was significantly shorter in vitrectomized eyes, and these eyes required more IVD treatments during the 12-month follow-up period. The maximal average intraocular pressure was observed at 2 months after the first IVD treatment in the nonvitrectomized group, but 1 month after the first IVD treatment in the vitrectomized group.

Conclusion:

These findings suggest that the IVD pharmacokinetics and pharmacodynamics differ between vitrectomized and nonvitrectomized eyes. Nevertheless, given the relatively long-lasting effectiveness of the treatment and the good clinical results, consecutive IVD treatments may be beneficial for patients with diabetic macular edema with previously vitrectomized eyes.
Correlation of epidermal growth factor receptor mutation status and PD-L1 expression with [18F]FDG PET using volume-based parameters in non-small cell lung cancer
Authors: Ishimura Mariko , Norikane Takashi , Mitamura Katsuya , Yamamoto Yuka , Arai-Okuda Hanae , Murota Makiko , Ibuki Emi , Kanaji Nobuhiro , Nishiyama Yoshihiro
Published: December 2021

Objective

We investigated the relationship between 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET using volume-based parameters and epidermal growth factor receptor (EGFR) mutation status, programmed death-ligand-1 (PD-L1) expression level, and their combination, in pretreated non-small cell lung cancer (NSCLC).

Methods

FDG PET findings and EGFR mutation status and PD-L1 expression level were investigated retrospectively in 93 patients with newly diagnosed NSCLC (77 adenocarcinomas, 16 squamous cell carcinomas). Tumors were divided into six groups: EGFR mutant/negative PD-L1, EGFR mutant/low PD-L1, EGFR mutant/high PD-L1, EGFR wild/negative PD-L1, EGFR wild/low PD-L1, and EGFR wild/high PD-L1. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumor were measured from PET images. The EGFR mutation status and PD-L1 expression level were estimated in tumor tissue specimens and compared with the PET parameters.

Results

None of the PET parameters differed significantly between EGFR-mutated and wild-type EGFR. According to the PD-L1 level, significant differences were detected in SUVmax (P = 0.001) and TLG (P = 0.016), but not MTV. Comparing all six groups, significant difference was detected in only SUVmax (P = 0.011).

Conclusion

Based on the preliminary results of this study, FDG PET may help in the prediction of PD-L1 expression level, but not EGFR mutation status, in patients with newly diagnosed NSCLC. The SUVmax rather than MTV or TLG, may be of value in predicting the six groups according to the combination of EGFR mutation status and PD-L1 expression level.
Dietary fat and carbohydrate affect the metabolism of protein-based high-density lipoprotein subspecies
Authors: Sacks Frank M. , Andraski Allison B.
Published: December 2021

Purpose of review

Dietary fat compared to carbohydrate increases the plasma concentration of high-density lipoprotein (HDL)-cholesterol. However, neither the mechanism nor its connection to cardiovascular disease is known.

Recent findings

Protein-based subspecies of HDL, especially those containing apolipoprotein E (apoE) or apolipoprotein C3 (apoC3), offer a glimpse of a vast metabolic system related to atherogenicity, coronary heart disease (CHD) and other diseases. ApoE stimulates several processes that define reverse cholesterol transport through HDL, specifically secretion of active HDL subspecies, cholesterol efflux to HDL from macrophages involved in atherogenesis, size enlargement of HDL with cholesterol ester, and rapid clearance from the circulation. Dietary unsaturated fat stimulates the flux of HDL that contains apoE through these protective pathways. Effective reverse cholesterol transport may lessen atherogenesis and prevent disease. In contrast, apoC3 abrogates the benefit of apoE on reverse cholesterol transport, which may account for the association of HDL that contains apoC3 with dyslipidemia, obesity and CHD.

Dietary unsaturated fat and carbohydrate affect the metabolism of protein-defined HDL subspecies containing apoE or apoC3 accelerating or retarding reverse cholesterol transport, thus demonstrating new mechanisms that may link diet to HDL and to CHD.
Association of dietary patterns and components with atherosclerosis risk biomarkers in familial hypercholesterolemia
Authors: Antoniazi Luiza , Arroyo-Olivares Raquel , Mata Pedro , Santos Raul D.
Published: December 2021

Purpose of review

Familial hypercholesterolemia (FH) is a relatively common genetic disorder associated with elevated atherosclerotic risk. Dietary interventions can modulate processes associated with cardiovascular risk and potentiate the impact of pharmacological lipid-lowering therapies. This review evaluates recent findings of dietary patterns and their components on risk biomarkers in people with FH.

Recent findings

Diets lower in saturated fatty acids (SFA) may reduce low-density lipoprotein-cholesterol (LDL-C); however, their effects seem to be modest. A Mediterranean style diet apparently exerts more robust effects on plasma LDL-C, apolipoprotein B and C reactive protein concentrations than one restricted in SFA. Supplementation of plant sterols and stanols reduces LDL-C especially in children with FH. Caloric restricted diets may reduce weight and improve triglyceride levels in individuals with FH and excess body weight.

Despite the strong impact of genetic variants, dietary patterns mostly low in SFA and especially the Mediterranean diet may influence risk biomarkers in FH. However, most available studies are limited by cross-sectional design, small number of study subjects and short-term follow-ups. Robust interventional studies are necessary to test the impact of dietary patterns in people with FH.
Pediatric immune deficiencies: current treatment approaches
Authors: Gonzalez Corina
Published: December 2021

Purpose of review

To summarize the currently available definitive therapies for patients with inborn errors of immunity (IEIs) with a strong focus on recent advances in allogeneic hematopoietic cell transplantation (HCT) and gene therapy, including the use of alternative donors, graft manipulation techniques, less toxic approaches for pretransplant conditioning and gene transfer using autologous hematopoietic stem cells.

Recent findings

In the absence of a matched sibling or a matched related donor, therapeutic alternatives for patients with IEIs include alternative donor transplantation or autologous gene therapy, which is only available for selected IEIs. In recent years, several groups have published their experience with haploidentical hematopoietic cell transplantation (HHCT) using different T-cell depletion strategies. Overall survival and event free survival results, although variable among centers, are encouraging. Preliminary results from autologous gene therapy trials with safer vectors and low-dose busulfan conditioning have shown reproducible and successful results. Both strategies have become valid therapeutic options for patients with IEIs. A new promising and less toxic conditioning regimen strategy is also discussed.

Definitive therapies for IEIs with HCT and gene therapy are in stage of evolution, not only to refine their efficacy and safety but also their reach to a larger number of patients.
Non‐Invasive Approaches to Estimate Liver Steatosis and Stiffness in Children With Non‐Alcoholic Fatty Liver Disease
Authors: Yodoshi Toshifumi , Orkin Sarah , Trout Andrew T. , Arce‐Clachar Ana Catalina , Bramlage Kristin , Liu Chunyan , Fei Lin , Dillman Jonathan R. , Xanthakos Stavra A. , Mouzaki Marialena
Published: December 2021

Objectives:

To develop pediatric‐specific models that predict liver stiffness and hepatic steatosis in non‐alcoholic fatty liver disease (NAFLD), based on clinical and laboratory data.

Methods:

Children with NAFLD, who had undergone magnetic resonance imaging with proton density fat fraction (MRI‐PDFF) for steatosis quantification and/or magnetic resonance elastography (MRE) for liver stiffness assessment were included. We used data from patients imaged between April 2009 to July 2018 to develop a predictive model for fat fraction and stiffness. We validated the performance of the models using data from a second cohort, imaged between 2018 and 2019.

Results:

The first cohort (n = 344) consisted of predominantly non‐Hispanic (80%), male (67%) adolescents. MRE data were available for 343 children, while PDFF data were available for 130. In multivariable regression, ethnicity, insulin levels, platelet count, and aspartate aminotransferase independently predicted liver stiffness and these variables were used to develop the predictive model. Similarly, sex, ethnicity, alanine aminotransferase, and triglycerides levels independently predicted liver PDFF and were used in the PDFF model. The AUC of the optimal cutoff for the model that predicted a stiffness of >2.71 kPa was 0.70 and for the model that predicted PDFF >5% was 0.78. The validation group (n = 110) had similar characteristics. The correlation coefficient of the model with the measured liver stiffness was 0.30 and with the measured liver PDFF was 0.26.

Conclusions:

Pediatric‐specific models perform poorly at predicting exact liver stiffness and steatosis; however, in the absence of magnetic resonance imaging can be used to predict the presence of significant steatosis (>5%) and/or significant stiffness (>2.71). Thus, imaging remains an invaluable adjunct to laboratory investigations in determining disease severity.
Is Roux‐en‐Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes
Authors: Cullis Paul S. , Buckle Rheanan E. , Losty Paul D.
Published: December 2021

Objectives:

Roux‐en‐Y jejunostomy (REYJ) may establish feeding in children with foregut dysmotility or severe gastro‐esophageal reflux disease (GERD). Nevertheless, concerns have been raised about safety and efficacy. We, therefore, evaluated outcomes of REYJ by systematic review to determine if this was a satisfactory option for achieving enteral autonomy in children with complex nutritional needs.

Methods:

A PRISMA‐adherent systematic review was conducted of studies reporting children undergoing feeding REYJ. Two authors performed processes independently; the senior author resolved disagreements. Embase, CINAHL and Medline were searched (inception—01/21). Additional databases, references, and ‘grey’ literature were searched. Methodological Index for Non‐randomized Studies (MINORS) and a bespoke system assessed methodological quality.

Results:

Of 362 articles, 10 met eligibility criteria (9 retrospective series; 1 conference proceeding). Unpublished data were also attained. Interobserver agreement for MINORS (kappa = 0.47) and bespoke scoring (kappa = 0.58) were moderate. After consensus, median MINORS score was 37.5% (IQR 6.3%) and bespoke 50% (IQR 20.8%), indicating poor methodological quality. One hundred sixty‐four patients were reported (age range: 2 months to 19 years). Time to full feeds and length of stay were inadequately reported but most achieved enteral autonomy. No studies reported patient/caregiver‐questionnaires. Seventy‐six complications were documented (Clavien‐Dindo grading was infeasible). Morbidity included peristomal leakage (N = 26), internal hernia/volvulus (N = 8), and SSI (N = 7). Thirty‐eight patients died (2 procedure‐attributable) during follow‐up (range: 1 month to 15 years).

Conclusions:

Up to 50% patients experience complications after REYJ (often minor) with 23% patients dying during follow‐up, often comorbidity‐attributable. REYJ can achieve enteral autonomy although parents/caregivers of children should be counselled accordingly.
EZH2 Protein Expression in Triple-negative Breast Cancer Treated With Neoadjuvant Chemotherapy: An Exploratory Study of Association With Tumor Response and Prognosis
Authors: Fineberg Susan , Tian Xuejun , Makower Della , Harigopal Malini , Lo Yungtai
Published: December 2021

Introduction:

Neaodjuvant chemotherapy is used to treat high risk triple-negative breast cancer (TNBC). Residual cancer burden (RCB) is used to predict risk of relapse after neoadjuvant chemotherapy (NAC); however, it cannot predict disease recurrence with certainty. EZH2 is a targetable oncogenic protein overexpressed in TNBC and associated with metastasis and stem cell expansion. We quantified EZH2 protein expression in TNBC before NAC to examine potential utility as a predictive and prognostic biomarker.

Materials and Methods:

We retrospectively identified 63 patients with localized TNBC treated with NAC. We quantified EZH2 nuclear expression in pretherapy biopsies using a score which included intensity and percent of positive cells at each intensity. EZH2 expression was evaluated as a continuous variable and dichotomized at a score of 210. Logistic regression analysis was used to determine association between EZH2 expression and RCB, tumor-infiltrating lymphocytes, clinicopathologic features and disease-free survival.

Results:

There was no significant association between EZH2 score and posttreatment RCB class evaluated as a continuous variable (P=0.831) or dichotomized at 210 (P=0.546). On multivariable logistic regression, adjusted for covariates including RCB, EZH2 >210 was associated with development of metastasis (odds ratio=14.35, 95% confidence interval: 2.69-76.66; P=0.002). Logistic regression was run with EZH2 scores as a continuous variable and increased EZH2 score was associated with metastasis (odds ratio=1.10, 95% confidence interval: 1.00-1.03; P=0.047).

Conclusion:

In our study of TNBC treated with NAC, high EZH2 expression in pretherapy core biopsies was significantly associated with metastatic recurrence independent of RCB. The potential value of EZH2 as a biomarker to improve stratification of outcome after NAC should be explored further.
GLI1 Gene Alterations in Neoplasms of the Genitourinary and Gynecologic Tract
Authors: Argani Pedram , Boyraz Baris , Oliva Esther , Matoso Andres , Gross John , Fridman Eddie , Zhang Lei , Dickson Brendan C. , Antonescu Cristina R.
Published: December 2021

We report 4 neoplasms of the kidney (2 cases) and uterus (2 cases) harboring rearrangements or amplifications of the GLI1 gene, which because of their unusual clinical presentation, morphology, and immunoprofile mimicked other neoplasms, causing significant diagnostic challenge. The neoplasms occurred in 4 female patients ages 33 to 88 years. Histologically they all demonstrated nodular growth, solid architecture, bland epithelioid to ovoid-spindle cells with pale cytoplasm set in a variably myxoid or hyalinized stroma. One uterine tumor also demonstrated a focal round cell pattern, while another demonstrated focal pleomorphism. Unlike most previously reported neoplasms with these genetic abnormalities, the neoplasms in the current series were negative for S100 protein and minimally reactive for actin. All labeled for CD10 and cyclin D1, while 2 labeled for estrogen receptor and BCOR and 1 labeled for desmin, raising consideration of endometrial stromal sarcoma, myxoid leiomyosarcoma, metastatic breast carcinoma, and glomus tumor. One renal neoplasm demonstrated a GLI1-FOXO4 gene fusion and the other harbored a GLI1 gene rearrangement (unknown partner). The 2 uterine neoplasms exhibited GLI1 gene amplifications. GLI1-altered neoplasms (particularly those with GLI1 amplification) show variable morphology and lack a consistent immunophenotype, and thus may trigger diagnostic challenges which can be resolved by molecular testing.
A Multiplex SNaPshot Assay is a Rapid and Cost-Effective Method for Detecting POLE Exonuclease Domain Mutations in Endometrial Carcinoma
Authors: Devereaux Kelly A. , Steiner David F. , Ho Chandler , Gomez Adam J. , Gilks Blake , Longacre Teri A. , Zehnder James L. , Howitt Brooke E. , Suarez Carlos J.
Published: December 2021

Determining the replicative DNA polymerase epsilon (POLE) mutation status in endometrial carcinomas (ECs) has important clinical implications given that the majority of “ultramutated” tumors harboring pathogenic exonuclease domain mutations in POLE (POLEmut) have a favorable prognosis, even among high-grade histotypes. Currently, there are no specific morphologic or immunophenotypic features that allow accurate detection of POLEmut tumors without molecular testing. Consequently, identifying POLEmut tumors has been challenging without employing costly and/or time-consuming DNA sequencing approaches. Here we developed a novel SNaPshot assay to facilitate routine and efficient POLE mutation testing in EC. The SNaPshot assay interrogates 15 nucleotide sites within exons 9, 11, 13, and 14 encoding the POLE exonuclease domain. The variant sites were selected based on recurrence, evidence of functional impact, association with high tumor mutation burden and/or detection in EC clinical outcome studies. Based on the pathogenic somatic variants reported in the literature, the assay is predicted to have a clinical sensitivity of 90% to 95% for ECs. Validation studies showed 100% specificity and sensitivity for the variants covered, with expected genotypic results for both the positive (n=11) and negative (n=20) patient controls on multiple repeat tests and dilution series. Analytic sensitivity was conservatively approximated at a 10% variant allele fraction (VAF), with documented detection as low as 5% VAF. As expected, the SNaPshot assay demonstrated greater sensitivity than Sanger sequencing for VAFs below 20%, an important characteristic for somatic mutation detection. Here we have developed and validated the first SNaPshot assay to detect hotspot POLE mutations. While next-generation sequencing and Sanger sequencing-based approaches have also been used to detect POLE mutations, a SNaPshot approach provides useful balance of analytical sensitivity, cost-effectiveness, and efficiency in a high-volume case load setting.
Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
Authors: Martinez Elizabeth M. , Carr Daniel Timothy , Mullan Paul C. , Rogers Lakisha E. , Howlett-Holley Wendy L. , McGehee Coleman A. , Mangum Christopher D. , Godambe Sandip A.
Published: December 2021

Introduction:

Disparate clinical outcomes have been reported for patients with Limited English Proficiency (LEP) in the emergency department setting, including increased length of stay, diagnostic error rates, readmission rates, and dissatisfaction. Our emergency department had no standard processes for LEP patient identification or interpreter encounter documentation and a higher rate of 48-hour LEP return visits (RV) than English proficient patients. The aim was to eliminate gaps by increasing appropriate interpreter use and documentation (AIUD) for Spanish-speaking LEP (LEP-SS) patients from 35.7% baseline (10/17-05/18) to 100% by October 2020.

Methods:

LEP-SS patient data were reviewed in the electronic medical record to determine the AIUD and RV rates. Using the Model for Improvement and multiple Plan-Do-Study-Act (PDSA) cycles, a multi-disciplinary team encouraged stakeholder engagement and identified improvement opportunities, implemented an electronic tracking board LEP icon (PDSA1), standardized documentation using an LEP Form linked to the icon (PDSA2), and included color changes to the icon for team situational awareness (PDSA3).

Results:

The mean of LEP-SS patients with AIUD improved from 35.7% to 64.5% without significant changes in balancing measures. During the postintervention period (6/1/2018-10/31/2020), no special cause variation was noted from the baseline 48-hour emergency department RV rates for LEP patients (3.1%) or English proficient patients (2.6%).

Conclusions:

While the RV rate was not affected, this project is part of a multi-faceted approach aiming to positively impact this outcome measure. Significant improvements in AIUD were achieved without affecting balancing measures.
Infection in Hospitalized Patients With Systemic Lupus Erythematosus
Authors: Carvalho Joana S. , Carvalho Maria G. , Reis Edna A. , Alves Luan Carlos V. , Ferreira Gilda A.
Published: December 2021

Background

Identification of infection in patients with systemic lupus erythematosus (SLE) is a major challenge in clinical practice.

Objective

This medical records review study evaluated clinical markers, including the performance of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) in the diagnosis of infection in SLE patients.

Methods

One hundred four SLE patients hospitalized between 2014 and 2018 were allocated into 3 groups, namely, infection, infection and disease activity, and isolated disease activity. Groups were compared in relation to clinical and laboratory variables. Accuracy measures were calculated for CRP, NLR, and PLR.

Results

C-reactive protein, NLR, and PLR differed between the groups with higher values observed in the infected group, intermediate values in the mixed group, and lower values in the group with isolated activity—CRP (56 vs 26 vs 15 mg/dL, p = 0.002), NLR (7.9 vs 4.0 vs 3.1, p = 0.005), and PLR (270 vs 227 vs 134, p = 0.025). Fever, tachypnea, and PLR were independently associated with infection. The cutoff points of the CRP of 20 mg/L, NLR of 3.5, and PLR of 151.4 presented values of sensitivity and specificity for the prediction of infection equal to 67% and 67%, 65% and 58%, and 71% and 53%, respectively. The developed algorithm showed a sensitivity of 86.6% and specificity of 81% for the diagnosis of infection.

Conclusions

The combined use of clinical and laboratory markers presented superior accuracy than their isolated use, suggesting a great potential for the application of the algorithm in clinical practice.
Unrecognized Fracture of a Silicone Implant During Closed Rhinoplasty
Authors: Lee Sae Bin , Kim Kyung Soo , Min Hyun Jin
Published: December 2021

Rhinoplasty via a closed approach is rarely performed due to provide limited exposure and inadequate operative field. Nevertheless, there are some cases in which closed approach is performed using L-shaped silicone implants. The authors recently encountered an interesting complication in a 33-year-old woman who had previously undergone rhinoplasty via a closed approach and who sought revision rhinoplasty at our institution. The authors accidently found a fractured silicone implant on lateral nasal x-ray. She had no nasal trauma history since previous rhinoplasty. The authors assumed that the silicone implant can be fractured as 1 of complications during the rhinoplasty via a closed approach.
Mitochondrial Damage-associated Molecular Patterns as Potential Biomarkers in DCD Heart Transplantation: Lessons From Myocardial Infarction and Cardiac Arrest
Authors: Longnus Sarah L. , Rutishauser Nina , Gillespie Mark N. , Reichlin Tobias , Carrel Thierry P. , Sanz Maria N.
Published: December 2021

Heart transplantation with donation after circulatory death (DCD) has become a real option to increase graft availability. However, given that DCD organs are exposed to the potentially damaging conditions of warm ischemia before procurement, new strategies for graft evaluation are of particular value for the safe expansion of DCD heart transplantation. Mitochondria-related parameters are very attractive as biomarkers because of their intimate association with cardiac ischemia-reperfusion injury. In this context, a group of mitochondrial components, called mitochondrial damage-associated molecular patterns (mtDAMPs), released by stressed cells, holds great promise. mtDAMPs may be released at different stages of DCD cardiac donation and may act as indicators of graft quality. Because of the lack of information available for DCD grafts, we consider that relevant information can be obtained from other acute cardiac ischemic conditions. Thus, we conducted a systematic review of original research articles in which mtDAMP levels were assessed in the circulation of patients with acute myocardial infarction and cardiac arrest. We conclude that 4 mtDAMPs, ATP, cytochrome c, mitochondrial DNA, and succinate, are rapidly released into the circulation after the onset of ischemia, and their concentrations increase with reperfusion. Importantly, circulating levels of mtDAMPs correlate with cardiac damage and may be used as prognostic markers for patient survival in these conditions. Taken together, these findings support the concept that mtDAMPs may be of use as biomarkers to assess the transplant suitability of procured DCD hearts, and ultimately aid in facilitating the safe, widespread adoption of DCD heart transplantation.
Development and Application of a Semi quantitative Scoring Method for Ultrastructural Assessment of Acute Stress in Pancreatic Islets
Authors: Dyson Nicola J. , Kattner Nicole , Honkanen-Scott Minna , Hunter Bethany , Doyle Jennifer A. , White Kathryn , Davey Tracey S. , Ploeg Rutger J. , Bury Yvonne A. , Tiniakos Dina G. , Shaw James A. M. , Scott William E.
Published: December 2021

Background.

Pancreas and islet transplantation outcomes are negatively impacted by injury to the endocrine cells from acute stress during donor death, organ procurement, processing, and transplant procedures. Here, we report a novel electron microscopy scoring system, the Newcastle Pancreas Endocrine Stress Score (NPESS).

Methods.

NPESS was adapted and expanded from our previously validated method for scoring pancreatic exocrine acinar cells, yielding a 4-point scale (0–3) classifying ultrastructural pathology in endocrine cell nuclei, mitochondria, endoplasmic reticulum, cytoplasmic vacuolization, and secretory granule depletion, with a maximum additive score of 15. We applied NPESS in a cohort of deceased organ donors after brainstem (DBD) and circulatory (DCD) death with a wide range of cold ischemic times (3.6–35.9 h) including 3 donors with type 1 and 3 with type 2 diabetes to assess islets in situ (n = 30) in addition to pancreata (n = 3) pre- and postislet isolation.

Results.

In DBD pancreata, NPESS correlated with cold ischemic time (head: r = 0.55; P = 0.02) and mirrored exocrine score (r = 0.48; P = 0.01). When stratified by endocrine phenotype, cells with granules of heterogeneous morphology had higher scores than α, β, and δ cells (P < 0.0001). Cells of mixed endocrine-exocrine morphology were observed in association with increased NPESS (P = 0.02). Islet isolation was associated with improved NPESS (in situ: 8.39 ± 0.77 [Mean ± SD]; postisolation: 5.44 ± 0.31; P = 0.04).

Conclusions.

NPESS provides a robust method for semiquantitative scoring of subcellular ultrastructural changes in human pancreatic endocrine cells in situ and following islet isolation with utility for unbiased evaluation of acute stress in organ transplantation research.