bluuebunny/crossref_metadata_2025 huggingface dataset:
Involvement of Pattern Recognition Receptors in the Direct Influence of Bacterial Components and Standard Antiacne Compounds on Human Sebaceous Gland Cells
Authors: Zouboulis Christos C. , Oeff Marina K. , Hiroi Naoki , Makrantonaki Evgenia , Bornstein Stefan R.
Published: March 2021

Introduction: Pattern recognition receptors are involved in innate and adaptive immunity by detecting microbial components. Bacteria have been accused to play a role in inflammatory acne. We investigated the potential involvement of Toll-like receptor (TLR)2, TLR4, TLR6, and CD14 in the direct influence of bacterial components and standard antiacne compounds on human sebocytes. Methods: mRNA and protein expression of TLR2, TLR4, TLR6, and CD14 in SZ95 sebocytes was evaluated by real-time qRT-PCR and immunocytochemistry. The effects of lipopolysaccharides (LPS) and lipoteichoic acid on TLR2, TLR4, and CD14 expression and of cytokine/chemokine secretion by 13-cis-retinoic acid, all-trans-retinoic acid, retinol, and hydrocortisone at the mRNA and protein levels were assessed by real-time qRT-PCR and ELISA and verified by cocultivation with neutralizing antibodies. Results: The constitutive expression of TLR2, TLR4, and CD14 in SZ95 sebocytes was augmented by exposure to LPS. Hydrocortisone induced TLR2, but markedly reduced TLR4 expression. 13-cis-retinoic acid and all-trans-retinoic acid regulated IL-6 release. LPS enhanced and hydrocortisone reduced cytokine and chemokine release. Anti-TLR4 and anti-CD14 mAb blocked LPS-induced IL-8 and IL-6 release. Conclusions: Microbial components use pattern recognition receptors to directly activate sebocytes to express a wide range of proinflammatory molecules and especially IL-8 and IL-6 in a TLR4- and CD14-specific manner. Retinoids, but mostly corticosteroids, also use this pathway to exhibit anti-inflammatory effects.
A Novel Hyperspectral Imaging System for Intraoperative Prediction of Cerebral Hyperperfusion Syndrome after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Patients with Moyamoya Disease
Authors: Iwaki Katsuma , Takagishi Soh , Arimura Koichi , Murata Masaharu , Chiba Toru , Nishimura Ataru , Ren Nice , Iihara Koji
Published: March 2021

Background: Postoperative cerebral hyperperfusion syndrome (CHS) may occur after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for moyamoya disease (MMD). Predicting postoperative CHS is challenging; however, we previously reported the feasibility of using a hyperspectral camera (HSC) for monitoring intraoperative changes in brain surface hemodynamics during STA-MCA bypass. Objective: To investigate the utility of HSC to predict postoperative CHS during STA-MCA bypass for patients with MMD. Methods: Hyperspectral images of the cerebral cortex of 29 patients with MMD who underwent STA-MCA bypass were acquired by using an HSC before and after anastomosis. We then analyzed the changes in oxygen saturation after anastomosis and assessed its correlation with CHS. Results: Five patients experienced transient neurological deterioration several days after surgery. 123I-N-Isopropyl-iodoamphetamine single-photon emission computed tomography scan results revealed an intense, focal increase in cerebral blood flow at the site of anastomosis without any cerebral infarction. Patients with CHS showed significantly increased oxygen saturation (SO2) in the cerebral cortex after anastomosis relative to those without CHS (33 ± 28 vs. 8 ± 14%, p < 0.0001). Receiver operating characteristic analysis results show that postoperative CHS likely occurs when the increase rate of cortical SO2 value is >15% (sensitivity, 85.0%; specificity, 81.3%; area under curve, 0.871). Conclusions: This study indicates that hyperspectral imaging of the cerebral cortex may be used to predict postoperative CHS in patients with MMD undergoing STA-MCA bypass.
Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome
Authors: Tamimi Ahmad F. , Al Ryalat Nosaiba T. , Al Qaisi Amer K. , Juweid Malik E. , Obeidat Fatimah N. , Al Hyasat Tala G. , Ghafel Afnan N. , Almustafa Sahar M. , Al Rashdan Mohamad A. , Kannan Tariq A. , Tamimi Iskandar A.
Published: March 2021

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). Discussion/Conclusion: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.
The Pharmacokinetics of Caffeine in Preterm Newborns: No Influence of Doxapram but Important Maturation with Age
Authors: Engbers Aline G.J. , Völler Swantje , Poets Christian F. , Knibbe Catherijne A.J. , Reiss Irwin K.M. , Koch Birgit C.P. , Flint Robert B. , Simons Sinno H.P.
Published: March 2021

Background: Apnea of prematurity can persist despite caffeine therapy in preterm infants. Doxapram may additionally support breathing. Although multiple small studies have reported the efficacy of doxapram, the structural co-treatment with caffeine impedes to ascribe the efficacy to doxapram itself or to a pharmacokinetic (PK) interaction where doxapram increases the exposure to caffeine. We examined whether there is a PK drug-drug interaction between doxapram and caffeine by developing a PK model for caffeine including infants with and without doxapram treatment. Methods: In preterm neonates receiving caffeine, we determined caffeine plasma concentrations before, during, and directly after doxapram co-treatment and used these to develop a population PK model in NONMEM 7.3. Patient characteristics and concomitant doxapram administration were tested as covariates. Results: 166 plasma samples were collected from 39 preterm neonates receiving caffeine (median gestational age 25.6 [range 24.0–28.0] weeks) of which 65 samples were taken during co-treatment with doxapram (39%, from 32/39 infants). Clearance of caffeine was 9.99 mL/h for a typical preterm neonate with a birth weight of 0.8 kg and 23 days postnatal age and increased with birth weight and postnatal age, resulting in a 4-fold increase in clearance during the first month of life. No PK interaction between caffeine and doxapram was identified. Discussion: Caffeine clearance is not affected by concomitant doxapram therapy but shows a rapid maturation with postnatal age. As current guidelines do not adjust the caffeine dose with postnatal age, decreased exposure to caffeine might partly explain the need for doxapram therapy after the first week of life.
The Use of the Oxygenated AirdriveTM Machine Perfusion System in Kidney Graft Preservation: A Clinical Pilot Study
Authors: Houtzager Julia H.E. , Hemelrijk Sebastiaan David , Post Ivo C.J.H. , Idu Mirza M , Bemelman Frederike J. , van Gulik Thomas M.
Published: March 2021

Background: The shortage of donor kidneys has led to the use of marginal donors, e.g., those whose kidneys are donated after circulatory death. Preservation of the graft by hypothermic machine perfusion (HMP) provides a viable solution to reduce warm ischemic damage. This pilot study was undertaken to assess the feasibility and patient safety of the AirdriveTM HMP system in clinical kidney transplantation. Methods: Five deceased-donor kidneys were preserved using the oxygenated Airdrive HMP system between arrival at the recipient center (Amsterdam UMC) and implantation in the patient. The main study end-points were adverse effects due to the use of Airdrive HMP. Secondary end-points were clinical outcomes and perfusion parameters. All events occurring during the transplantation procedure or within 1 month of follow-up were monitored. Results: Five patients were included in this pilot study. No technical failures were observed during the preservation period using the Airdrive HMP. Mean perfusion parameters were: duration 8.5 h (3–15 h), pressure 25 mm Hg (18–25 mm Hg), flow 49.77 mL/min (19–58 mL/min), resistance 0.57 mm Hg/min/mL (0.34–1.3 mm Hg/min/mL), and temperature 8.2 °C (2–13°C). Mean cold ischemia time (CIT) was 20.2 h (11–29.5 h). No adverse events or technical failures were observed during preservation and transplantation or during the 1-month follow-up. Conclusions: This pilot study showed the feasibility of the use of the Airdrive HMP system with no adverse events in clinical kidney transplantation.
Societal Need for Interdisciplinary Ageing Research: An International Alliance of Research Universities “Ageing, Longevity and Health” Stream (IARU-ALH) Position Statement
Authors: Cherbuin Nicolas , Iijima Katsuya , Kalula Sebastiana , Malhotra Rahul , Rasmussen Lene Juel , Chan Angelique , Lafortune Louise , Harper Sarah , Zheng Xiaoying , Lindeman David , Walsh Erin , Hussain Rafat , Burns Richard , Kristiansen Maria , Sugawara Ikuko , Son Bokyung , Tanaka Tomoki , Buckner Stefanie , Hoffman Jaco , Combrinck Marc
Published: March 2021

Ageing is a global concern with major social, health, and economic implications. While individual countries seek to develop responses to immediate, pressing needs, international attention and collaboration is required to most effectively address the multifaceted challenges and opportunities an ageing global population presents in the longer term. The Ageing, Longevity and Health stream of the International Alliance of Research Universities (IARU-ALH) was built on a solid foundation of first-class interdisciplinary research and on innovative outreach and communication centres. This interdisciplinary network conducts projects that span biology, medicine, social sciences, epidemiology, public health, policy, and demography, and actively engages with the public and other societal stakeholders. Here we posit that such international interdisciplinary networks are needed and uniquely placed to address major challenges related to health and ageing and ultimately will produce new understanding and knowledge to promote the awareness of healthy ageing and encourage societal change via novel, science-informed interventions. Global interdisciplinary research presents great potential and opportunities to accelerate our understanding of human ageing and to produce new, more effective solutions to a pressing, complex problem. However, more focused, strategic efforts and investments are required in order to deliver on these potentials and reap maximum benefits for individuals and societies. IARU-ALH members are determined to contribute, in collaboration with others, to delivering on this vision.
Integrated RNA Sequencing Reveals Epigenetic Impacts of Diesel Particulate Matter Exposure in Human Cerebral Organoids
Authors: Bilinovich Stephanie M , Uhl Katie L. , Lewis Kristy , Soehnlen Xavier , Williams Michael , Vogt Daniel , Prokop Jeremy W. , Campbell Daniel B.
Published: March 2021

Autism spectrum disorder (ASD) manifests early in childhood. While genetic variants increase risk for ASD, a growing body of literature has established that in utero chemical exposures also contribute to ASD risk. These chemicals include air-based pollutants like diesel particulate matter (DPM). A combination of single-cell and direct transcriptomics of DPM-exposed human-induced pluripotent stem cell-derived cerebral organoids revealed toxicogenomic effects of DPM exposure during fetal brain development. Direct transcriptomics, sequencing RNA bases via Nanopore, revealed that cerebral organoids contain extensive RNA modifications, with DPM-altering cytosine methylation in oxidative mitochondrial transcripts expressed in outer radial glia cells. Single-cell transcriptomics further confirmed an oxidative phosphorylation change in cell groups such as outer radial glia upon DPM exposure. This approach highlights how DPM exposure perturbs normal mitochondrial function and cellular respiration during early brain development, which may contribute to developmental disorders like ASD by altering neurodevelopment.
Relationship between Low Pretreatment Geriatric Nutritional Risk Index and Poor Tolerability of Azacitidine in Patients with Myelodysplastic Syndromes
Authors: Kanehira Dan , Koinuma Masayoshi , Kato Toshiaki , Abe Tomoya , Sagara Atsunobu , Sato Fumiaki , Yumoto Tetsuro
Published: March 2021

Background: Predicting tolerability and treatment-related risks associated with azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) before the initiation of therapy is required for appropriate treatment. Thus, in this study, the nutritional status of patients with MDS prior to AZA treatment was evaluated using the geriatric nutritional risk index (GNRI). Tolerability and overall survival (OS) after AZA initiation were also investigated. Methods: This was a single-center retrospective observational study. A total of 59 patients with MDS treated with AZA were assessed using GNRI, and a comparison of undernourished (GNRI <92, n = 27) and non-undernourished (GNRI ≥92, n = 32) patients was performed. Results: The undernourished group had a significant reduction in the number of patients that successfully completed 4 cycles of AZA treatment compared with the non-undernourished group (undernourished group, 11/27 patients, 40.7% vs. non-undernourished group, 24/32 patients, 75.0%; p = 0.009). Factors associated with the difference included karyotype and GNRI. There was also a significant increase in the rate of infectious complications in the undernourished group compared with the non-undernourished group (undernourished group, 33/60 cycles, 55.0% vs. non-undernourished group, 31/92 cycles, 33.7%; p = 0.012). Lastly, a significant reduction in OS was observed in the undernourished group compared with the non-undernourished group (undernourished group, 11.5 months; 95% CI, 5.2–16.7 vs. non-undernourished group, 21.9 months; 95% CI, 13.8–24.0; p = 0.026). Factors associated with OS included both the revised International Prognostic Scoring System (IPSS-R) and GNRI. Conclusions: These results indicate that predicting treatment completion and adverse events in patients with MDS prior to AZA treatment is important. This study suggests GNRI may be a valuable nutritional assessment tool for determining tolerability and OS of AZA treatment.
Ambivalent Effects of Tumor Necrosis Factor Alpha on Apoptosis of Malignant and Normal Human Keratinocytes
Authors: Kokolakis Georgios , Sabat Robert , Krüger-Krasagakis Sabine , Eberle Jürgen
Published: March 2021

Introduction: Tumor necrosis factor alpha (TNFα) is a pro-inflammatory cytokine that may paradoxically induce either apoptosis or cell survival. It mediates its activity through binding of TNF-receptor (TNFR) 1 or 2. TNFR1 is mainly responsible for transmitting apoptotic signals. The activation of apoptotic mechanisms can either be intrinsic (mitochondrial) or extrinsic (death receptors). Death ligands such as TNF-related apoptosis-inducing ligand (TRAIL) specifically induce extrinsic apoptosis, while cytostatic drugs such as 5-fluorouracil (5FU) induce intrinsic apoptosis. Objectives: To investigate the effects of TNFα on apoptosis in malignant and normal human keratinocytes. Methods: Human cutaneous squamous cell carcinoma (SCC) cell line SCC-13 and immortalized human keratinocytes HaCaT as well as primary normal human keratinocytes (PNHK) were stimulated with TNFα and then treated either with TRAIL or 5FU. Cell viability and cell proliferation, DNA fragmentation, apoptosis, and cytotoxicity were determined by WST-1 proliferation assay, ELISA, flow cytometry, and colorimetric analysis of lactate dehydrogenase, respectively. In addition, Western blotting was performed for analysis of caspase-3. Results: TNFα affected viability of SCC-13 and HaCaT cells in combination with 5FU or TRAIL. In contrast, TNFα did not influence cell viability of PNHK. It enhanced the apoptotic effects of both extrinsic and intrinsic stimuli in SCC-13 and HaCaT. In clear contrast, TNFα protected PNHK against TRAIL- and 5FU-induced apoptosis. The effects were dose-dependent and TNFα-specific; furthermore, the apoptosis pathway was caspase-dependent. Conclusions: In summary, opposing effects of TNFα in malignant versus normal human keratinocytes were observed with possibly relevant clinical implications, when patients are treated with TNFα inhibitors.
Fetal-Maternal Hemorrhage in First-Trimester Intrauterine Hematoma
Authors: Narciso Thaisa A.R.M. , Hoshida Mara S , Costa Priscilla R , Niquirilo Andrea , Biancolin Sckarlet E , Lin Lawrence H , Francisco Rossana P.V. , Brizot Maria L.
Published: March 2021

Objective: The objective of this study was to compare the frequency and percentage of fetal hemoglobin (HbF%) by flow cytometry of (1) first-trimester asymptomatic patients with intrauterine hematoma (IUH), (2) first-trimester pregnant patients with vaginal bleeding (VB), and (3) first-trimester asymptomatic pregnant women without hematoma. Methods: Prospective study involving pregnant women in the first trimester of pregnancy. Patients with ultrasound findings of asymptomatic hematoma and with VB were paired with asymptomatic pregnant women of same gestational age without hematoma (control group [CG]). Maternal blood HbF% was evaluated by flow cytometry. The groups were compared in terms of circulating fetal hemoglobin and HbF%. Results: Sixty-six patients were selected, 22 with hematoma, 17 with bleeding, and 27 in the CG. Fetal hemoglobin was detected in 15 patients with hematoma (68.2%) and 13 with bleeding (76.5%) and in 20 of the control (74.1%) (p = 0.830). The mean HbF% of each group was 0.054, 0.012, and 0.042 for hematoma, bleeding, and control, respectively, and differences were not significant (p = 0.141). There was a moderate negative correlation between the volume of hematoma and HbF% (rSpearman = −0.527; p = 0.012). Conclusions: The fetal-maternal hemorrhage expressed by Hbf% in first-trimester pregnancies did not seem to differ between patients with and without ultrasound findings of IUH.
Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures
Authors: Cruz-Martínez Rogelio , Sosa Sosa Cristian , Martínez-Rodríguez Miguel , Gámez-Varela Alma , Villalobos-Gómez Rosa , López-Briones Hugo , Luna-García Jonahtan , Chávez-González Eréndira , Juárez-Martínez Israel
Published: March 2021

Objective: The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. Methods: A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. Results: Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. Conclusion: In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.
Serum Neurofilament Light in Patients with Frontotemporal Dementia Caused by CHMP2B Mutation
Authors: Toft Anders , Roos Peter , Jääskeläinen Olli , Musaeus Christian Sandøe , Henriksen Emil Elbæk , Johannsen Peter , Nielsen Troels Tolstrup , Herukka Sanna-Kaisa , Hviid Simonsen Anja , Nielsen Jørgen Erik
Published: March 2021

Introduction: The potential of neurofilament light (NfL) as a blood-based biomarker is currently being investigated in autosomal dominant neurodegenerative disease. This study explores the clinical utility of serum-NfL in frontotemporal dementia due to CHMP2B mutation (FTD-3). Methods: This cross-sectional study included serum and CSF data from 38 members of the Danish FTD-3 family: 12 affected CHMP2B mutation carriers, 10 presymptomatic carriers, and 16 noncarriers. Serum-NfL levels measured by single-molecule array (Simoa) technology were tested for associations with the clinical groups and clinical parameters. Serum and CSF data were compared, and CSF/serum-albumin ratio was included as a measure of blood-brain barrier (BBB) function. Results: Serum-NfL concentrations were significantly increased in symptomatic CHMP2B mutation carriers compared to presymptomatic carriers and in both groups compared to healthy family controls. Serum-NfL levels appear to increase progressively with age in presymptomatic carriers, and this is perhaps followed by a change in trajectory when patients become symptomatic. Measurements of NfL in serum and CSF were highly correlated and fold-changes in serum and CSF between clinical groups were similar. Increase in serum-NFL levels was correlated with reduced ACE-score. Higher CSF/serum-albumin ratios were demonstrated in FTD-3 patients, but this did not affect the significant associations between serum-NfL and clinical groups. Conclusion: Serum-NfL could be utilized as an accurate surrogate marker of CSF levels to segregate symptomatic CHMP2B carriers, presymptomatic carriers, and non-carriers. The observed indication of BBB dysfunction in FTD-3 patients did not confound this use of serum-NfL. The results support the occurrence of mutation-related differences in NfL dynamics in familial FTD.
The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults
Authors: Isik Ahmet Turan , Kocyigit Suleyman Emre , Kaya Derya , Dost Gunay Fatma Sena , Erken Neziha , Dokuzlar Ozge , Aydin Ali Ekrem , Ates Bulut Esra
Published: March 2021

Background: It is crucial to evaluate the causes of morbidity and mortality in elderly patients with dementia, such as orthostatic hypotension (OH), which may affect their daily life activities, reduce the quality of life, and increase the caregiver burden. Objective: We aimed to investigate the relationship between OH and the most common subtypes of dementia in detail. Methods: A total of 268 older adults with dementia diagnosed with Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and behavioral variant frontotemporal dementia (bvFTD), and 539 older adults without dementia were included in this prospective study. Comprehensive geriatric assessment including comorbidity, medication evaluation, and the head-up tilt test was also performed. Results: Of the participants, 13.8, 8.3, 6.4, and 4.8% had AD, DLB, bvFTD, and VaD, respectively. After adjusting for age, gender, the presence of comorbidities, and usage of OH-induced drugs; AD, DLB, and VaD were associated with OH (odds ratio [OR]: 2.23 confidence interval [CI] 95% 1.31–3.80; p = 0.003; OR: 3.68 CI 95% 1.98–6.83; p < 0.001, and OR: 3.56 CI 95% 1.46–8.69; p = 0.005, respectively). Furthermore, VaD was independently related to diastolic OH (OR: 4.19 CI 95% 1.66–10.57; p = 0.002), whereas AD and DLB were not. Conclusions: This study shows that elderly patients with DLB, AD, and VaD often have OH, a disabling autonomic dysfunction feature. Moreover, diastolic OH may play a role in the development of VaD. Therefore, considering potential complications of OH, it is essential to evaluate OH in the follow-up and management of those patients.
Hidden Error in Optical Stereotactic Navigation Systems and Strategy to Maximize Accuracy
Authors: Holland Marshall T. , Mansfield Kevin , Mitchell Ann , Burchiel Kim J.
Published: March 2021

Background: Optical neuronavigation has been established as a reliable and effective adjunct to many neurosurgical procedures. Operations such as asleep deep brain stimulation (aDBS) benefit from the potential increase in accuracy that these systems offer. Built into these technologies is a degree of tolerated error that may exceed the presumed accuracy resulting in suboptimal outcomes. Objective: The objective of this study was to identify an underlying source of error in neuronavigation and determine strategies to maximize accuracy. Methods: A Medtronic Stealth system (Stealth Station 7 hardware, S8 software, version 3.1.1) was used to simulate an aDBS procedure with the Medtronic Nexframe system. Multiple configurations and orientations of the Nexframe-Nexprobe system components were examined to determine potential sources of, and to quantify navigational error, in the optical navigation system. Virtual entry point and target variations were recorded and analyzed. Finally, off-plan error was recorded with the AxiEM system and visual observation on a phantom head. Results: The most significant source of error was found to be the orientation of the reference marker plate configurations to the camera system, with the presentation of the markers perpendicular to the camera line of site being the most accurate position. Entry point errors ranged between 0.134 ± 0.048 and 1.271 ± 0.0986 mm in a complex, reproducible pattern dependent on the orientation of the Nexprobe reference plate. Target errors ranged between 0.311 ± 0.094 and 2.159 ± 0.190 mm with a similarly complex, repeatable pattern. Representative configurations were tested for physical error at target with errors ranging from 1.2 mm to 1.4 mm. Throughout data acquisition, no orientation was indicated as outside the acceptable tolerance by the Stealth software. Conclusions: Use of optical neuronavigation is expected to increase in frequency and variety of indications. Successful implementation of this technology depends on understanding the tolerances built into the system. In situations that depend on extremely high precision, surgeons should familiarize themselves with potential sources of error so that systems may be optimized beyond the manufacturer’s built-in tolerances. We recommend that surgeons align the navigation reference plate and any optical instrument’s reference plate spheres in the plane perpendicular to the line of site of the camera to maximize accuracy.
Nursing Staff’s Knowledge and Attitudes towards Dementia in an Indian Nursing Home: A Qualitative Interview Study
Authors: Strøm Benedicte Sørensen , Lausund Hilde , Mork Rokstad Anne Marie  , Engedal Knut , Goyal Alka
Published: March 2021

Background: Despite the increased prevalence of dementia in India, there is reported to be little awareness of the disease. This could lead to a late diagnosis, a reduced number of choices regarding future care, and misinterpretation of the symptoms or neglect. Taking into consideration that most nurses caring for older people in the future will work with people with dementia, there is concern that they may not be able to meet the needs of this group of patients unless they have the necessary knowledge and a positive attitude. Aim: To explore the knowledge about and attitude towards dementia among nursing staff working in residential care facilities for older people in India. Method: An explorative and descriptive qualitative design was used. Two semi-structured focus group interviews were conducted with nursing staff working in 6 nursing homes in India. Qualitative content analysis was used. Ethical approval was granted by the Norwegian Social Science Data Services. Findings: The participants highlighted the following 3 dimensions in relation to their knowledge of and attitudes toward dementia in residential care facilities in India: (1) people with dementia – a walking mystery; (2) we need to go along with them, but it is challenging; and (3) if we know, we can care for them in a better way. Conclusion: The findings revealed a wide range of differences in attitude towards and inadequate knowledge of dementia among nursing staff. However, their overall attitudes toward people with dementia was positive.
Utilization of Routine Medical Checkup and Factors Influencing Use of Routine Medical Checkup among Saudi Students Studying in the USA in 2019
Authors: Alzahrani Ali Mohammed A. , Felix Holly C. , Stewart M. Kate , Selig James P. , Swindle Taren , Abdeldayem Mohamed
Published: March 2021

Introduction: The few studies that have investigated patterns of routine checkup (hereafter routine checkups) among Saudis have found overall low rates of use. Those studies focused mainly on understanding the influence of individual characteristics on use of routine checkup. Aims: The main purpose of this study was to consider a wider array of factors beyond individual characteristics, including system-based factors, beliefs, attitudes, and satisfaction, and to examine their influence on use of routine checkup among Saudi students studying in the United States. Methods: A cross-sectional survey targeting Saudi students studying in the United States aged 19 years or older was conducted to gather information about their sociodemographic characteristics, needs for healthcare, use of routine checkup and satisfaction with access to primary care services. Descriptive statistics and logistic regression analysis were conducted to determine factors influencing use of routine checkup among Saudis. Results: 381 surveys were eligible to be included in the analyses. Among the included participants, only 25.5% had a routine checkup after the age of 18 years. The likelihood of having routine checkup after the age of 18 was significantly higher among those who trusted provided primary care, believed in the importance of routine checkup, had health insurance, had chronic conditions and were physically active, and was significantly lower among married individuals. Conclusions: The use of routine checkup is low among Saudis and this study has laid the foundation for future research that can inform policy and decision-making related to improving use of routine care in Saudi Arabia.
Association of Oral Health Literacy and School Factors with Untreated Dental Caries among 12-Year-Olds: A Multilevel Approach
Authors: Neves Érick Tássio Barbosa , Granville-Garcia Ana Flávia , Dutra Laio da Costa , Baccin Bendo Cristiane , Ferreira Fernanda de Morais , Paiva Saul Martins , Horowitz Alice Munkhoff
Published: March 2021

Dental caries are a global health problem that affects all age groups and must be considered a public health priority due to its significant financial costs and impact on the quality of life. This study evaluated the association between oral health literacy (OHL), school factors, and untreated dental caries in 12-year-old Brazilian adolescents using a multilevel approach. A population-based cross-sectional study was carried out with 740 adolescents randomly selected from private and public schools in Campina Grande, Brazil. Two dentists were trained and calibrated to diagnose dental caries using the Nyvad index and OHL using the Brazilian Rapid Estimate of Literacy in Dentistry (BREALD-30). The caregivers of the adolescents reported demographic data (sex, skin color, and socioeconomic status). Data of school factors such as the type of school and the school grade retention rate were classified through a 2-step hierarchical cluster analysis to obtain the school environment. A robust multilevel log-linear negative binomial regression for complex samples was performed (p < 0.05). In the analysis, adjusted by individual determinants, nonwhite skin color (RR = 2.20; 95% CI 1.56–3.12), a low socioeconomic status (RR = 1.60; 95% CI 1.09–2.34), a low OHL score (RR = 0.94; 95% CI 0.91–0.98), and low satisfaction with the last dental appointment (RR = 2.25; 95% CI 1.67–3.04) were associated with untreated dental caries. The following factors remained associated with untreated dental caries in the final model: students from an unfavorable learning environment (RR = 2.20; 95% CI 1.27–3.80), nonwhite skin color (RR = 1.92; 95% CI 1.27–2.91), a low socioeconomic status (RR = 1.82; 95% CI 1.12–2.94), a low OHL score (RR = 0.95; 95% CI 0.91–0.98), and low satisfaction with the last dental appointment (RR = 2.07; 95% CI 1.47–2.91). Untreated dental caries in early adolescence were impacted by the school environment, the socioeconomic status, OHL, and the adolescent’s satisfaction with the last dental appointment.
Long Completely Cystic Sciatic Schwannoma: A Rare Case
Authors: Utomo Sri Andreani , Bajamal Abdul Hafid , Faris Muhammad , Ardiansyah Djohan , Lunardhi Johanes Hadi
Published: March 2021

Schwannomas are the most common peripheral nerve sheath tumors. Benign schwannomas with malignant transformation are rarely reported. Most common schwannomas occur in the head and neck region. Sciatic schwannomas are rare, as are completely cystic schwannomas. Sciatic nerve schwannomas represent less than 1% of all schwannomas. Benign tumors in the sciatic nerve consist of 60% neurofibromas and 38% schwannomas. In general, a schwannoma induces chronic symptoms. It can be misleading, sometimes mimicking degenerative spinal pathology due to disc herniation. Schwannoma involving the sciatic nerve can be asymptomatic or may present with sciatica or neurological deficits. Most schwannomas are solid or heterogeneous tumors, and completely cystic schwannomas are rare. The differential diagnoses of nondiscogenic sciatica include lumbar disc herniation, tumor, abscess, hematoma, facet syndrome, lumbar instability, sacroiliitis, piriformis syndrome, and sciatic neuritis. We report a rare case of a long completely cystic sciatic schwannoma in the left foraminal L5–S1 zone extending to the left ischial groove with chronic sciatica that was diagnosed radiologically with a combination of conventional MRI and MR neurography and confirmed histopathologically by surgical resection. The patient previously had conservative therapy, but the complaints were not reduced. Nonsurgical therapy is considered the first choice, and surgical therapy is indicated in cases that do not respond to conservative therapy, with recurrent cysts, severe pain, or neurological deficits.
Einbeziehung von Komorbiditäten und phänotypbasierter Medizin beim patientenzentrierten COPD-Management
Authors: Lopez-Campos José-Luis , Ruiz-Duque Borja , Carrasco-Hernandez Laura , Caballero-Eraso Candelaria
Published: March 2021

Trotz der jüngsten bedeutenden Innovationen in der Behandlung der chronisch-obstruktiven Lungenerkrankung (chronic obstructive pulmonary disease, COPD) wurden in der patientenzentrierten Medizin keine wesentlichen Fortschritte erzielt. Die Empfehlungen der aktuellen Leitlinien basieren auf den Durchschnittsergebnissen klinischer Studien, was zur Folge hat, dass die medizinische Praxis als «mittelwertbasiert» bezeichnet werden kann. Auf der Patienten­ebene ist das therapeutische Ansprechen jedoch variabel. Zudem führt die Variabilität des klinischen Bildes im Wechselspiel mit den Komorbiditäten dazu, dass ein komplexes klinisches Szenario entsteht, mit dem die Ärzte umgehen müssen. Aus diesem Grund gibt es bislang keinen Konsens über einen praktischen Ansatz bei der Kombination von Komorbiditäten und Markern des klinischen Bildes im Therapie-Algorithmus. Diesbezüglich steht der Arzt ab dem ersten Patientenbesuch vor vier wichtigen Dilemmata: 1. Stellung der korrekten Diagnose «COPD» in Abgrenzung zu anderen Atemwegserkrankungen wie etwa Bronchialasthma; 2. Festlegung des initialen Therapieansatzes auf Grundlage der klinischen Merkmale des jeweiligen Falles; 3. Festlegung der diagnostischen Strategie für Patienten, die nicht auf die Therapie ansprechen; 4. Festlegung einer Strategie für die Verlaufskontrolle mit zwei genau definierten Zeiträumen, je nachdem, ob eine engmaschige oder eine langfristige Verlaufskontrolle erforderlich ist. Die vorliegende Arbeit geht auf die Hauptdilemmata bei der Suche nach einem patientenzentrierten Ansatz für das COPD-Management ein und liefert Vorschläge, wie diese alle in einer einzigen, einfach anwendbaren Strategie kombiniert werden können.
Biomarkers in Irritable Bowel Syndrome: Biological Rationale and Diagnostic Value
Authors: Nakov Radislav , Snegarova Violeta , Dimitrova-Yurukova Desislava , Velikova Tsvetelina
Published: March 2021

Background: Patients with irritable bowel syndrome (IBS) usually suffer from nonspecific and overlapping signs that hamper the diagnostic process. In line with this, biomarkers specific for IBS could be of great benefit for diagnosing and managing patients. In IBS, the need is for apparent distinguishing features linked to the disease that improve diagnosis, differentiate from other organic diseases, and discriminate between IBS subtypes. Summary: Some biomarkers are associated with a possible pathophysiologic mechanism of IBS; others are used for differentiating IBS from non-IBS patients. Implementation of IBS biomarkers in everyday clinical practice is critical for early diagnosis and treatment. However, our knowledge about their efficient use is still scarce. Key Messages: This review discusses the biomarkers implemented for IBS diagnosis and management, such as blood (serum), fecal, immunological, related to the microbiome, microRNAs, and some promising novel biomarkers associated with imaging and psychological features of the disease. We focus on the most commonly studied and validated biomarkers and their biological rationale, diagnostic, and clinical value.
Potential Effects of Bariatric Surgery on the Incidence of Heart Failure and Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus and Obesity and on Mortality in Patients With Preexisting Heart Failure: A Nationwide, Matched, Observational Cohort Study
Authors: Höskuldsdóttir Gudrún , Sattar Naveed , Miftaraj Mervete , Näslund Ingmar , Ottosson Johan , Franzén Stefan , Svensson Ann‐Marie , Eliasson Björn
Published: March 2021

Background

Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM).

Methods and Results

In this register‐based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux‐en‐Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux‐en‐Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m
2
. The follow‐up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19–0.38), 41% for AF (HR, 0.59; CI, 0.44–0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12–0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12–0.43).

Conclusions

Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF.
Status Threat: Moving the Right Further to the Right?
Authors: Parker Christopher Sebastian
Published: March 2021

Over the last few years, right-wing movements have proliferated among Western democracies. Although much of the growth has taken place across the “pond” in Europe, this phenomenon is not confined to that continent. As recent events make clear, the United States is another major case. In this essay, I offer a theory of the emergence of reactionary movements, fueled by status threat, using the United States as a case. To demonstrate the explanatory range of the theory (and measure), I focus on immigration, impeachment, and support for Donald Trump in the 2020 election. Examining self-identified Republicans only, I argue that status threat motivates the reactionary wing of the GOP in the United States. Drawing on data culled from a national sample, I find support for my expectation that, beyond ideology and racism, status threat furnishes a new explanation for reactionary preferences. I close with a discussion of the implications.
Add Business and Stir
Authors: Blanchard Kathryn D.
Published: March 2021

This essay makes a case for teaching an interdisciplinary undergraduate course at the intersection of religion, ecology, and business. At a basic level, this approach gets students with diverse intellectual orientations and career interests in the same room; letting business and environmental studies majors work together on these questions fosters a variation on interfaith engagement. More deeply, it creates space for them to develop critical self-awareness about their own ethical commitments. The fact that no single instructor can be an expert in all three fields should not prevent us from stepping boldly into uncharted territory. The degradation of the earth is an interdisciplinary problem that requires interdisciplinary solutions, and each of us has something to contribute right now even if we cannot do it all. As teachers and lifelong learners, we can and must model intellectual humility even as we look for ways to take decisive individual and collective action.
Echoes of Plato’s Apology of Socrates in Luke-Acts
Authors: Reece Steve
Published: March 2021

As a literate and well-educated person, the author of the Gospel of Luke and the Acts of the Apostles (“Luke”) would have been familiar with Plato’s Apology of Socrates, one of the most widely-known ancient Greek texts in the Mediterranean world in the 1st century CE. Indeed, it appears that “Luke” may have used his, and his readers’, familiarity with stories about the life, trial, and death of Socrates, and with the account in Plato’s Apology of Socrates specifically, as an interpretive tool in three “trial” scenes narrated in Luke-Acts: those of Jesus, Peter, and, most obviously, Paul.
The Named Jew and the Name of God
Authors: Windsor Lionel J.
Published: March 2021

A connection between Paul’s charges against his interlocutor in Rom 2:21–22 and Josephus’s account of a notorious Jewish teacher in Rome (A.J. 18.81–84) is a catalyst for re-examining the purpose, topic, and argument of Rom 2:17–29. The foreground issue is not the soteriological status of Jews, but the effectiveness of typical Jewish law-based teaching to solve human foolishness, wickedness, and impiety. Paul reframes the discourse topic to demonstrate that typical Jewish law-based educational activity is ineffective in bringing about God’s glory among the nations. The interlocutor is thus a foil for Paul’s own eschatologically conceived apostolic ministry.
Size-related boldness is not altered by stomach flushing in a terrestrial salamander
Authors: Salvidio Sebastiano , Costa Andrea , Oneto Fabrizio
Published: March 2021

Animal personality is a relatively neglected field in amphibian research. In this study we assessed the influence of stomach flushing, a non-lethal technique used in amphibian dietary studies, on the boldness behaviour of the cave salamander Speleomantes strinatii. The time of emergence from a shelter located in an unfamiliar environment (a proxy for individual boldness) was measured in 26 cave salamanders before and after stomach flushing, while 14 non-flushed salamanders were tested as controls. Boldness was a repeatable behaviour for salamanders and larger individuals emerged from their shelter more rapidly than smaller ones. Linear mixed model analysis showed that flushing, sex and body condition had no effect on this behaviour. These findings are promising in the framework of the study of salamander personality. In particular, our results will be useful when exploring the relationship between individual trophic strategy and boldness, aggression or exploration behaviours in terrestrial salamanders.
Elsewhere and Otherwise
Authors: Toscano Alberto
Published: March 2021

This text introduces the symposium on Fredric Jameson’s Allegory and Ideology (2019), the second volume in his six-part The Poetics of Social Forms. It frames the debate with a brief exploration of some of the figures and problems of allegory that appear across Jameson’s œuvre, and surveys some of the Marxist conceptualisations of allegory that have shaped Jameson’s approach, as it straddles allegories of the commodity and allegories of utopia. The musical investigation of the nexus of allegory and affect, and the presentation of political allegory as primarily concerned with the disjunction between (national and international) levels are also touched upon as salient dimensions of Jameson’s theorising.
Antoine Lacassagne. De la chaire de Radiobiologie expérimentale (1941-1951) à la chaire de Médecine expérimentale (1951-1954)
Authors: Corvol Pierre
Published: March 2021

Il s’agit de la création de la chaire de Radiobiologie expérimentale, dont Antoine Lacassagne fut le titulaire de 1941 à 1951, et de sa transformation en chaire de Médecine expérimentale pour le même de 1951 à 1954. On étudie les rapports donnés à ces occasions : de Robert Courrier, professeur de Morphologie expérimentale et endocrinologie (1938-1966), présenté à l’assemblée des professeurs du 12 janvier 1941, d’Emmanuel Fauré-Frémiet, professeur d’Embryogénie comparée (1928-1954), ibid., puis la « Présentation des titres et travaux de Lacassagne, candidat à la chaire de Radiobiologie expérimentale », du même auteur, lue le 25 mai 1941. On dispose aussi d’un « Rapport en faveur d’une chaire de Médecine expérimentale », par Robert Courrier, présenté le 26 novembre 1950. L’ensemble montre la place de la recherche sur le cancer dans les chaires de Médecine du Collège de France, où le regroupement de disciplines s’est avéré être un terrain favorable à son essor.