bluuebunny/crossref_metadata_2025 huggingface dataset:
Making Science Indian
Authors: Kumar Arun
Published: October 2021

Science and technology has been an important site of constituting the national-modern. Elites, especially the Tatas, led the way in founding institutions of scientific research and training across the country. Such institutions were supposed to help the country overcome the deficit in scientific infrastructure, institutions, and individuals. Others such as Birlas and Thakurdas took a more pragmatic approach and invested in institutions of applied technologies such as cotton and textiles to fuel India’s industrialization. In addition to funding such ‘big’ science, elites also invested in ‘small’ science—on and off-farms—linking scientific laboratories to the field. Post-1990, elites took on a networking role linking new nexuses across lab–field–policy. At the turn of the twenty-first century, elites are now funding digital infrastructure and platforms over brick-and-mortar institutions from an earlier generation. In their pursuit of modern science, elites’ philanthropy has remained firmly tied to the national question as science has been closely tied to national self-reliance and sovereignty.
Development
Authors: Kumar Arun
Published: October 2021

In their pursuit of national-modern development, elites founded new sabhas, sanghathans, boards, committees, and foundations. Emergent civil society organizations in twentieth-century India, this chapter argues, were animated by elites’ ‘pedagogic reflex’ to train fellow citizens about ways of being and becoming modern. However, new disciplinary knowledge and new cadres of foot-soldiers equipped with such knowledge were required to teach others on how to be and become modern. The burden of such knowledge production and training fell onto institutes of applied social sciences, which elites founded. They also invested in the professional training of development workers who possessed the ‘right’ kind of knowledge, behaviours, and attitudes to development.
The 1993 World Trade Center Bombing
Authors: Klausen Jytte
Published: October 2021

Chapter 3 addresses the events following February 1993, when Islamist militants set off a car bomb in the underground garage of the World Trade Center in Lower Manhattan. The bombing was carried out by a local cell of extremists based in Brooklyn, led by “the Blind Sheikh” Omar Abdel-Rahman. The bombing was a co-production between two Egyptian terrorist groups and Bin Laden. The Brooklyn cell was assisted by operatives on Bin Laden’s payroll. Bin Laden’s operations in the United States grew out of a network made up mainly of Egyptian and North African militants living locally. The network was established in the 1980s to raise money for jihad and to recruit Westerners to fight for the mujahideen against the Soviet-supported regime in Afghanistan. The U.S. authorities swiftly rounded up members of the Brooklyn cell but were slow to recognize the significance of their connections to global terrorist networks, and to Bin Laden. The chapter charts the broader international connections of the Brooklyn militants and places the 1993 bombing in the context of the development of Al Qaeda.
The Sudan Years
Authors: Klausen Jytte
Published: October 2021

Chapter 4 explores the years after 1991, when Bin Laden was given sanctuary in Sudan. Five years later he and his followers were expelled. The Sudan years were an exceptionally busy period of building alliances and laying the groundwork for attacks on U.S. embassies and military installations in Saudi Arabia, Yemen, Nairobi, and Tanzania. At the same time, Bin Laden was supporting militants across the Muslim world and funding military instructors in training camps in Afghanistan, Southeast Asia, and East Africa. He was also seeking out terrorist expertise wherever he could find it. One of those places was Iran, which for a period became a sleeping partner in Bin Laden’s terrorism business. Above all, he was working to integrate Arab and North African exiled militants into a coherent, global organization. From Sudan, Bin Laden assisted his Egyptian allies in their terrorist campaign in Egypt, funded experimentation with the use of liquids bombs to blow up international commercial airliners, made plans to set up a base in the Balkans for Al Qaeda, set up a business office in London, and initiated preparations for the 1998 bombings of the U.S. embassies in Kenya and Tanzania.
The Boston Marathon Bombers
Authors: Klausen Jytte
Published: October 2021

Chapter 10 charts the events following April 15, 2013, when the brothers Tamerlan and Dzhokhar Tsarnaev exploded two bombs as throngs of runners approached the finish line of the Boston Marathon. Three people were killed and 264 injured. The chapter considers why they did it. as well as how. The brothers were Chechen Muslims from the Russian Federation. They had come to the United States with their parents as refugees. The family were not observant Muslims. The brothers were drug dealers and users. Tamerlan was later determined to have committed a triple murder. Dzhokhar, a student at a local state university supported by a merit fellowship was a drug dealer. But the brothers were in some ways typical of one type of violent Western jihadist: involved in crime and with drug habits, but attracted to radical Islamist ideas. They followed online Do-It-Yourself instructions pushed out online in Inspire Magazine, a publication produced by two American citizens, Anwar al-Awlaki and Samir Khan.
The “Communist Beast”
Authors: Fritzsche Peter
Published: October 2021

This chapter assesses how the week that followed the March 1933 elections was the single most consequential in German history. It featured attacks on Jews as well as Communists and Social Democrats and set the stage for the takeover of Germany's political and administrative structures. The Nazis claimed public spaces, tenement buildings, and private apartments and made life-and-death judgments on the people who inhabited them. The violent actions began with the occupation of space and ended with the seizure of bodies and the incarceration of thousands of Germans in concentration camps. In March and April of 1933, government actions in the capital guided the upheavals, but countless grassroots initiatives also moved them forward. They took place simultaneously, in almost all spheres of life, creating an extraordinary turbulence that increased in both intensity and extent and overwhelmed conventional checks and balances regulating social interactions. The chapter then looks at the extraordinary level of anti-Communist violence throughout Germany in March 1933.
Digestif
Authors: McHugh James
Published: October 2021

The Digestif contains some general observations on drink, intoxication, and abstinence in Indian history and religions, along with some suggestions for future research. In the long term, there were many types of alcoholic beverage, and drink culture was also changing and developing. New drugs regularly appeared too, such as betel and cannabis. The concept of intoxication, or mada, was also highly varied and flexible, as was the concept of surā—an ancient word that was ultimately used to refer to many varied entities, from distilled liquor to betel. Liquor was understood as a complex concept at every level, as were its effects, but if there is a common theme to drunk intoxication that emerges from this book, it is that drunkenness creates a misalignment for the drinker with how things are and how things ought to be.
From Automaton to Autonomy
Authors: Begam Richard
Published: October 2021

This essay considers Fritz Lang’s Metropolis (1927) in relation to Walter Benjamin’s “The Work of Art in the Age of Mechanical Reproduction” (1936) and the writings of two other Frankfurt School critics—Theodor Adorno and Siegfried Kracauer. Anticipating the larger argument of Benjamin’s essay, the film situates its central conflict around the “auratic” (as represented by Maria’s Christianity) and the “mechanical” (as embodied by Joh Fredersen’s technology). This conflict is crystallized by the robotic Maria, who is an exact duplicate of the real Maria. The essay highlights Adorno’s correspondence with Benjamin, examining how Metropolis itself engages with the positions these critics take on mechanical reproduction in film. Especially relevant in this regard is Kracauer’s classic study of German cinema, From Caligari to Hitler (1947), a book that levels against Lang the charge that Marxism often levels against modernism: its formalism mystifies its politics. The essay concludes with an analysis of the flood scene from Metropolis, demonstrating that the film’s formalism is not merely “ornamental”—as Kracauer claimed—and that for Lang political autonomy is inextricably linked with aesthetic autonomy.
“A Language Worth the Trouble of Learning”?
Authors: Gąsiorek Andrzej
Published: October 2021

The critical reception of Carl Dreyer’s The Passion of Joan of Arc has tended to focus on the apparent disjunction between the intense naturalism of the main performance by Renée Falconetti and the abstraction of much of the film’s framing and mise en scène. When compared with other modernist works from the period, however, it can be seen as part of a cultural field in which techniques of fragmentation, juxtaposition, and bricolage produce a deliberate aesthetic of disunity—a disunity that is inseparable, in turn, from its challenge to realist narrative conventions and to the norms of an emergent Hollywood cinema.
O14 An atypical femoral fracture without a history of bisphosphonate use
Authors: Ford Mark , Venkatachalam Srinivasan
Published: October 2021

Case report - Introduction

A 60-year-old female presented with an insufficiency fracture of the midshaft of the left femur and a persistently low serum alkaline phosphatase. A diagnosis of adult hypophosphatasia was made. We present this case alongside a series of other cases that we have identified locally and discuss the importance of identifying this condition in clinical practice.

Case report - Case description

A 60-year-old female presented with left thigh pain and an 8-year history of polyarthralgia involving the medium-large sized joints. She had a traumatic fracture of the humerus 4 years previously. She had no history or examination findings suggestive of an inflammatory arthritis, connective tissue disease or systemic illness.

An X-ray of left femur revealed a cortical-based lucency at the lateral cortex of midshaft. An MRI identified a focal area of cortical thickening but no evidence of bone marrow oedema suggestive of an osteoid osteoma. Finally, a CT scan confirmed the diagnosis of a healed stress fracture. The patient had never received any form of bisphosphonate treatment, no previous history of a non-traumatic fracture and no history of dental problems.

Laboratory evaluation revealed persistently low levels of serum alkaline phosphatase (∼23 IU/L) with a normal vitamin D and PTH level. Bone density scan showed a T-score of -1.1 at the femoral neck and -2.6 at the lumbar spine. Serum pyridoxal phosphate level was elevated at 457 nmol/L (35-100). A diagnosis of adult hypophosphatasia was suspected and genetic study for ALPL gene confirmed the diagnosis.

The following table summarises a number of other cases of adult hypophosphatasia, which we have identified locally.

Case report - Discussion

Hypophosphatasia (HPP) is a rare inherited metabolic disease caused by mutations in the alkaline phosphatase liver type (ALPL) gene, localized on the chromosome region 1p36.1–34, encoding the tissue-nonspecific isoenzyme of alkaline phosphatase (TNSALP). The disease is related to a decrease in both level and activity of alkaline phosphatase enzyme (ALP). The clinical expression is highly variable, ranging from lethal forms to mild forms diagnosed in adults. Fractures, chondrocalcinosis, calcific periarthritis, and chronic muscle and bone pain are key features for the diagnosis of HPP in adults. Teriparatide has been used for treatment in some case reports with inconsistent results. Antiresorptive drugs are contraindicated as they can worsen underlying osteomalacia.

Case report - Key learning points

Check for persistent low serum alkaline phosphatase levels in adults presenting with fragility fractures, crystal-related arthropathies and nonspecific generalised aches.

Avoid bisphosphonates in patients with low alkaline phosphatase.
P33 A female with a drooping eyelid and positive autoantibodies: mystery solved?
Authors: Ford Mark , Rajagopala Lavanya , Bhatt R , Mudhar H , Venkatachalam S
Published: October 2021

Case report - Introduction

The presence of autoantibodies in IgG4-related disease (IgG4-RD) can lead to confusion and we present a case to highlight the diagnostic difficulty in this condition.

Case report - Case description

A 63-year-old Indian female presented with progressive ptosis and swelling of the left eyelid for 2 months. She was referred to the stroke clinic where she was found to have left ptosis with associated swelling. An MRI of the orbit revealed an enlarged left lacrimal gland and mucosal thickening in paranasal sinuses. Her ESR was 20, CRP 2, 15% peripheral eosinophils and IgG 17.55 g/L (6-16). A referral was made to rheumatology due to an abnormal immunological profile: cANCA +, MPO ANCA positive 32 IU/ml (0-3.5) and a strongly positive anti-Ro antibody >600 U/ml (0-10). Differential diagnosis considered: ANCA associated vasculitis (AAV), Primary Sjögren’s syndrome (SS), and IgG4-related orbital disease. She was assessed by the ENT surgeon and there was no sinusitis or evidence of vasculitis. Chest X-ray and CT scan of chest were normal.

A left lacrimal gland biopsy revealed reactive lymphoid hyperplasia with numerous plasma cells and eosinophils. Immunohistochemistry revealed over 50% of plasma cells to be IgG4-positive (approximately 100/HPF) suggestive of IgG4-RD. There was no evidence of granuloma formation or malignancy. Serum IgG4 was raised 6.82 g/l (<1.3). A review by ophthalmology revealed no objective evidence of dry eyes. She was treated as IgG4-RD and demonstrated a marked improvement following treatment with oral steroids and azathioprine.

Case report - Discussion

IgG4-RD is an immune-mediated systemic fibro inflammatory disease characterised by tumefactive lesions with abundant IgG4-positive plasma cells infiltrating into multiple organs. Isolated IgG4-related ophthalmic disease is present in 23% of patients with IgG4-RD, in whom the lacrimal gland is the most commonly involved structure, followed by orbital fat and extraocular muscles. IgG4-related ophthalmic disease is rare and we need to exclude commoner causes of orbital inflammation (such as thyroid ophthalmopathy, granulomatosis with poly-angiitis, sarcoidosis, and tuberculosis) or malignancy.

Case report - Key learning points

The diagnosis of IgG4-RD is often challenging. It is well recognised that small vessel vasculitis can increase the number of IgG4-positive plasma cells in tissue biopsies. Additionally, literature reveals biopsy-proven IgG4-RD can have ANCA positivity with and without concomitant presence of ANCA-associated vasculitis and there are case reports of patients who fulfil criteria for both Sjogren’s syndrome and IgG4-RD. As such, diagnosis requires careful correlation of clinical, radiologic and histological features due to the overlapping features in differential diagnoses.
P34 The value of combined ophthalmology and rheumatology review- an unmet need
Authors: Moorthy Arumugam , Kulkarni Priti , Patel V , Kumar Periyasamy
Published: October 2021

Case report - Introduction

Rheumatic diseases manifest in different specialties including ophthalmology. Presentation with eye symptoms may be a sight-threatening emergency such as GCA. Other inflammatory symptoms such as uveitis present to the Eye Casualty frequently, which need prompt rheumatologist input for a holistic management.

Case report - Case description

We present an interesting case with multiple learning points for both rheumatologists as well as ophthalmologists.

We present a case of a 73-year-old Caucasian lady who initially presented to the Eye Department. She was diagnosed as having bilateral uveitis by the ophthalmologist with an interest in uveitis. She had various investigations which showed positive HLA-B27 status, ENA, ANA, serum ACE level were normal; however, she was found to have raised immunoglobulins and plasma viscosity. She was treated with steroid eye drops and intravitreal dexamethasone implant in both eyes. She is a steroid responder and unfortunately developed glaucoma which needed two surgical procedures. She developed chronic cystoid macular oedema in Left eye.

She did not have any symptoms of psoriasis or gut symptoms suggestive of inflammatory bowel disease. She did report symptoms of inflammatory bowel disease. She had an MRI of axial spine as per AS protocol, which confirmed inflammatory spondyloarthropathy. She was diagnosed to have non-radiographic spondyloarthropathy which is managed by simple anti-inflammatories. Her BASDAI is less than 3 and does not qualify for biologic treatment for her axial spondyloarthropathy. Her main symptoms were ocular, which is very active and she is not able to escalate to biologic therapy.

Case report - Discussion

This is a patient presenting with late-onset inflammatory back pain without any articular or extra-articular activity. Her main manifestation is spectrum of spondyloarthropathy with uveitis; however, we could not escalate her to biologics. She has been on topical, intraocular and oral steroids which has led on to complications. The combined clinic between rheumatologists and ophthalmologists is key in managing such patients.

Case report - Key learning points
Targeting neurotrophic factors for low back pain and sciatica: a systematic review and meta-analysis
Authors: Rizzo Rodrigo R N , Ferraro Michael C , Wewege Michael A , Cashin Aidan G , Leake Hayley B , O’Hagan Edel T , Jones Matthew D , Gustin Sylvia M , McLachlan Andrew J , Day Richard , McAuley James H
Published: October 2021

Objectives

This meta-analysis aims to investigate the efficacy and safety of medicines that target neurotrophic factors for low back pain (LBP) or sciatica.

Methods

We searched published and trial registry reports of randomized controlled trials evaluating the effect of medicines that target neurotrophic factors to LBP or sciatica in seven databases from inception to December 2020. Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty in the evidence.

Results

Nine studies (3370 participants) were included in the meta-analyses. Low certainty evidence showed that anti-nerve growth factor (NGF) may reduce pain at 4 weeks (mean difference [MD] −6.75, 95% CI: −8.61, −4.90) and 12 weeks (MD −6.16, 95% CI: −8.38, −3.94), and may increase adverse effects for chronic LBP (odds ratio [OR] 1.18, 95% CI: 1.01, 1.38). Higher doses of anti-NGF may offer a clinically important reduction in pain at the cost of increased adverse effects for chronic LBP. Very low certainty evidence showed that anti-NGF and glial cell line-derived neurotrophic factor (pro-GDNF) may not reduce pain for sciatica at 4 weeks (MD −1.40, 95% CI: −8.26, 5.46), at 12 weeks (MD −2.91, 95% CI: −13.69, 7.67) and may increase adverse effects for sciatica (OR 3.27, 95% CI: 1.78, 6.00).

Conclusion

Anti-NGF may offer small reductions in pain intensity for chronic LBP. The effect may depend on the dose and types of medicines. For sciatica, anti-NGF or pro-GDNF may not reduce pain. Medicines that target neurotrophic factors for LBP or sciatica are associated with different adverse effects compared to those observed in commonly prescribed medicines for these conditions.
Investigation on mechanical properties and water stability of porous polyurethane concrete
Authors: Yang Jie , Li Hui , Harvey John , Yang Bing , Mahmud Saifullah , Zhang Yi , Zuo Xin , Tian Yu
Published: October 2021

Porous polyurethane concrete (PPUC) is a novel material for permeable pavements and is considered as an alternative to porous asphalt or porous cement concrete. However, studies of the mechanical properties of PPUC are still insufficient. In this study, the comprehensive mechanical properties and water stability of PPUC with different gradations and polyurethane dosages were investigated, and its water damage mechanism was preliminarily explored. The results show that the flexural strength and Marshall stability of PPUC can more easily reach the index in the standards of porous cement concrete or porous asphalt, while the compressive strength and abrasion resistance are the weak points of its mechanical properties and need to be further optimized. The mechanical properties and water stability of PPUC were effectively improved by increasing the polyurethane dosage and using continuously graded aggregates. PPUC is more susceptible to water damage because water reacts with the residual isocyanate groups within the polyurethane film to generate carbon dioxide gas, which reduces the cohesion and adhesion performance of polyurethane film. This study provides a comprehensive understanding of the mechanical properties of PPUC and an initial insight into the mechanism of water damage.
Simulated Wound Care as a Competence Assessment Method for Student and Registered Nurses
Authors: Kielo-Viljamaa Emilia , Ahtiala Maarit , Suhonen Riitta , Stolt Minna
Published: October 2021

OBJECTIVE

To describe the development and use of a wound care simulation assessing RNs’ and graduating student nurses’ practical wound care competence and to describe observations of participants’ wound care competence.

METHODS

A descriptive, qualitative design was used. Data were collected in 2019 from 50 healthcare professionals and students using a simulated wound care situation and an imaginary patient case. The simulation was based on a previously developed and tested wound care competence assessment instrument, which included a 14-item checklist that assesses practical wound care competence of chronic wounds. The data were analyzed and described based on the 14 competence areas or as other competencies.

RESULTS

Participants showed competence in identification of wound infection, debridement, dressing selection, tissue type identification, and consultation. Participants’ shortcomings were related to pain assessment and management, asepsis, offloading, and documentation. Simulation was shown to be a promising tool to assess healthcare professionals’ and students’ practical wound care competence in a safe and standardized situation.

CONCLUSIONS

This study provided new information about simulation as a method to assess student nurses’ and RNs’ wound care competence. The results could be used in wound care education planning and development in both undergraduate nursing education and continuing education for nursing professionals.
Comparison of Minimally Invasive Transforaminal and Anterolateral Lumbar Interbody Fusion for Treatment of Low-grade Lumbar Spondylolisthesis
Authors: Zhu Lei , Wang Pingchuan , Zhang Liang , Feng Xinmin , Zhang Wenjie
Published: October 2021

Study Design:

This was a retrospective cohort study.

Objective:

The aim was to compare the clinical outcomes, radiographic parameters and perioperative complications of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and anterolateral lumbar interbody fusion (ALLIF) for the treatment of low-grade lumbar spondylolisthesis.

Summary of Background Data:

Both MIS-TLIF and ALLIF are minimally invasive surgical methods for the treatment of lumbar degenerative diseases. However, few studies have compared the results of MIS-TLIF and ALLIF for the treatment of low-grade lumbar spondylolisthesis.

Materials and Methods:

A total of 112 patients with low-grade lumbar spondylolisthesis were divided as MIS-TLIF group (n=59, mean age 61.7 y) or ALLIF group (n=53, mean age 60.1 y) according to the treatment method. The operative time, intraoperative blood loss, and length of hospital stay were recorded. Besides, clinical outcomes were evaluated by visual analog scale and Oswestry disability index score. Radiographic parameters were assessed by disc height, lumbar lordosis, segmental lordosis, and fusion rate.

Results:

ALLIF significantly reduced operative time, intraoperative blood loss, and length of hospital stay compared with MIS-TLIF. Moreover, ALLIF was superior to MIS-TLIF in the early postoperative relief of back pain and recovery of lumbar function. However, there were no significant differences in the clinical outcomes at final follow-up between the 2 groups. The amount of change between preoperative and postoperative disc height, lumbar lordosis and segmental lordosis in ALLIF group were significantly higher than those in MIS-TLIF group (P<0.05). However, there were no significant differences in fusion rate and incidence of complications between the 2 groups.

Conclusions:

This study indicated that the final follow-up clinical outcomes, complication rate of ALLIF were similar to MIS-TLIF for the treatment of low-grade lumbar spondylolisthesis. However, ALLIF showed advantages in less surgical trauma, faster recovery, early postoperative relief of back pain, and radiographic parameters improvement.
CCL17 and CCL22 induce CCR4 receptor expression and promote cytokine-induced killer cells migration
Authors: Dong Yongjian , Gao Shuhui , Zhang Xuefang , Kou Jing , Liu Jing , Ye Ting , Shen Han
Published: October 2021

Recently, cytokine-induced killer (CIK) cells have been shown to possess effective cytotoxic activity against some tumor cells both in vitro and in clinical research. Furthermore, dendritic cell-activated CIK (DC-CIK) cells display significantly increased antitumor activity compared to unstimulated CIK cells. Study findings indicate DC cells can secrete chemokine C–C motif ligand 17 (CCL17) and chemokine C–C motif ligand 22 (CCL22) with a common receptor molecule, C–C chemokine receptor type-4(CCR4). CCL17 and CCL22 levels were measured by ELISA from CIK cell culture supernatants and the expression of CCR4 on CIK and DC-CIK cells was analyzed by flow cytometry. Through Migration and Killing assays, further analyzed the effects of the altered expression levels of CCR4 on the chemotactic ability and the tumor-killing efficiency of CIK cells. We found markedly increased CCL17 and CCL22 in supernatants of DC-CIK co-cultures. Similarly, the expression of CCR4 was also increased on CIK cells in these co-cultures. Further, the stimulation of CCL17 and CCL22 increased expression of the CCR4 and enhanced the migratory capacity and antitumor efficacy of CIK cells. Simultaneously, similar effects had achieved by transfecting the CCR4 gene into CIK cells. DC cells may promote the expression of CCR4 on CIK cells by secreting CCL17 and CCL22, thereby promoting infiltration of DC-CIK cells into the tumor microenvironment, and exerting stronger antitumor activity than CIK cells.
Treatment of acute pulmonary edema by blocking VEGF-induced vascular leakage
Authors: Cao Yihai
Published: October 2021

Pulmonary edema induces local and systemic hypoxia in lungs and other tissues and organs, entailing the development of acute respiratory distress syndrome (ARDS). Hypoxia triggers a myriad of pathological responses, including angiogenesis and hyperpermeability of blood vessels in the lung and other tissues. Vascular endothelial growth factor, also named vascular permeability factor (VPF), is one of the key hypoxia-targeted genes. It is probably the most potent VPF in the body. In this article, I will discuss the possibilities and mechanistic insights of blocking the VEGF signaling pathway for treating acute pulmonary edema. In particular, anti-VEGF drugs for treating Covid-19-induced pulmonary edema will be discussed.
Malignant hyperthermia in severe COVID-19: 2 case reports
Authors: Ehteshami-Afshar Solmaz , Nikooie Roozbeh , Reddy Pranav , Chichra Astha , Siegel Mark D.
Published: October 2021

Malignant hyperthermia is a rare but potentially fatal condition. We present 2 cases of young patients with coronavirus disease 2019 (COVID-19) requiring intubation for hypoxic respiratory failure who both developed significant hyperthermia post intubation and were suspected to have malignant hyperthermia. However, the 2 patients had different responses to conservative management and dantrolene. These cases highlight the increased challenge imposed by intubation complications when managing patients with COVID-19.
Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis
Authors: Fundaun Joel , Kolski Melissa , Baskozos Georgios , Dilley Andrew , Sterling Michele , Schmid Annina B.
Published: October 2021

There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle–Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD −0.43 [−0.73; −0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD −1.10 [−1.50; −0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
Expression of ectopic heat shock protein 90 in male and female primary afferent nociceptors regulates inflammatory pain
Authors: Wang Yaomin , Scarneo Scott A. , Kim Shin Hyung , Zhang Xin , Chen Jiegen , Yang Kelly W. , Hughes Philip , Haystead Timothy , Nackley Andrea G.
Published: October 2021

Heat shock protein 90 (Hsp90) is a ubiquitously expressed integral cellular protein essential for regulating proteomic stress. Previous research has shown that Hsp90 regulates critical signaling pathways underlying chronic pain and inflammation. Recent discovery of membrane bound ectopic Hsp90 (eHsp90) on tumor cells has shown that Hsp90 induction to the plasma membrane can stabilize disease-relevant proteins. Here, we characterize eHsp90 expression in a mouse model of inflammation and demonstrate its role in nociception and pain. We found that intraplantar complete Freund adjuvant (CFA) induced robust expression of eHsp90 on the cell membranes of primary afferent nociceptors located in the L3-L5 dorsal root ganglia (DRG), bilaterally, with minimal to no expression in other tissues. Complete Freund adjuvant–induced increases in eHsp90 expression on lumbar DRG were significantly greater in females compared with males. Furthermore, exogenous Hsp90 applied to primary Pirt-GCaMP3 nociceptors induced increases in calcium responses. Responses were estrogen-dependent such that greater activity was observed in female or estrogen-primed male nociceptors compared with unprimed male nociceptors. Treatment of mice with the selective eHsp90 inhibitor HS-131 (10 nmol) significantly reversed CFA-induced mechanical pain, thermal heat pain, and hind paw edema. Notably, a higher dose (20 nmol) of HS-131 was required to achieve analgesic and anti-inflammatory effects in females. Here, we provide the first demonstration that inflammation leads to an upregulation of eHsp90 on DRG nociceptors in a sex-dependent manner and that inhibition of eHsp90 reduces nociceptor activity, pain, and inflammation. Thus, eHsp90 represents a novel therapeutic axis for the development of gender-tailored treatments for inflammatory pain.
Disruption of working memory and contralateral delay activity by nociceptive stimuli is modulated by task demands
Authors: Wagenaar-Tison Alice , Deldar Zoha , Northon Stéphane , Brisson Benoit , Blanchette Isabelle , Piché Mathieu
Published: October 2021

Top–down processes allow the selection and prioritization of information by limiting attentional capture by distractors, and these mechanisms depend on task demands such as working memory (WM) load. However, bottom–up processes give salient stimuli a stronger neuronal representation and provoke attentional capture. The aim of this study was to examine the effect of salient nociceptive stimuli on WM while manipulating task demands. Twenty-one healthy participants performed a change detection task during which they had to determine whether 2 successive visual arrays were different or the same. Task demands were modulated by manipulating the WM load (set size included 2 or 4 objects to recall) and by the correspondence between the 2 successive visual arrays (change vs no change). Innocuous stimuli (control) or nociceptive stimuli (distractors) were delivered during the delay period between the 2 visual arrays. Contralateral delay activity and laser-evoked potentials were recorded to examine neural markers of visual WM and nociceptive processes. Nociceptive stimuli decreased WM performance depending on task demands (all P < 0.05). Moreover, compared with control stimuli, nociceptive stimuli abolished the increase in contralateral delay activity amplitude for set size 4 vs set size 2 (P = 0.04). Consistent with these results, laser-evoked potential amplitude was not decreased when task demands were high (P = 0.5). These findings indicate that WM may shield cognition from nociceptive stimuli, but nociceptive stimuli disrupt WM and alter task performance when cognitive resources become insufficient to process all task-relevant information.
Can Quetiapine Prolong the Antidepressant Effect of Ketamine?
Authors: Amiaz Revital , Saporta Rachel , Noy Adam , Berkenstadt Haim , Weiser Mark
Published: October 2021

Purpose

Ketamine, a noncompetitive, high-affinity antagonist of the N-methyl-d-aspartate-type glutamate receptor, has a rapid effect in patients with treatment-resistant disorder, but many patients who respond to intravenous ketamine relapse within several days. The objective of this study was to examine the long-term outcome of patients' mood 5 years after ketamine treatment.

Methods

Sixteen electroconvulsive therapy referrals received at least 1 intravenous ketamine treatment in addition to their stable antidepressant medications. Depression was evaluated using the Inventory of Depressive Symptomatology–Clinician-Rated, Hamilton Rating Scales for Depression, and Montgomery-Åsberg Depression Rating Scale. Anxiety was measured using the Hamilton Rating Scale.

Results

Of 16 patients treated, 6 achieved complete remission, 3 partially responded, and 7 did not respond. At baseline, all patients were treated with antidepressants, 14 patients were also treated with neuroleptics, of whom 5 patients were treated with quetiapine. The time to relapse in the 5 patients taking quetiapine was significantly longer than in patients who were taking other neuroleptics (965.83 ± 824.68 vs 80.5 ± 114.3, Z = 7.001, P = 0.0001). At the 5-year follow-up, 3 of the patients taking quetiapine maintained their remission. Overall levels of depression and anxiety at all times were improved in comparison to baseline.

Conclusions

Our follow-up results suggest that the combination of quetiapine and ketamine can prolong time to relapse after ketamine treatment in patients with treatment-resistant disorder.
Ductus Reuniens and Its Possible Role in Menière's Disease
Authors: Hornibrook Jeremy , Mudry Albert , Curthoys Ian , Smith Christopher M.
Published: October 2021

Objective:

After 160 years the true underlying cause of Meniere's disease remains enigmatic. The aim of our study is to discuss the possible implication of an obstruction of the ductus reuniens as a cause in Menière's disease.

Methodology:

We first conducted an historical study of the description of the ductus reuniens. We then reviewed the literature regarding ductus reuniens obstruction in animal experiments, human post-mortem studies and living ear imaging. We completed its description by modern microCT imaging. Limited knowledge on the fate of dislodged saccular otoconia is summarized. The possible implications for Meniere's attacks are discussed.

Results:

Victor Hensen was the first to describe the ductus reuniens in 1863. He described its length and width and predicted that saccular otoconia might enter the ductus and the cochlea. On microCT the narrowest width of the human ductus reuniens was 0.14 mm. The literature reports cochlear endolymphatic hydrops occurring after animal experimental obstruction of the duct. Human postmortem studies have confirmed saccular otoconial clumps entering the ductus and the cochlea. A postmortem study has shown sites of endolymphatic obstruction, and imaging speculates on blockages in ears with Meniere's disease. Dislodged utricular otoconia can be in clumps of otolithic membranes.

Conclusion:

Blockages of the ductus reuniens and at other endolymphatic system sites appear to be a feature in Meniere's disease ears. The blockages have been postulated to be saccular otoconia either causing or aggravating hydrops. This could be consistent with observed nystagmus reversals during attacks as the endolymphatic sac attempts to clear the hydrops and the otoconia.
Neuroimaging Systematic Review in Persistent Postural-Perceptual Dizziness: The Elaborate Alterations in the Delicate Network to Remain Balanced
Authors: Teh Carren Sui-Lin , Mah Michelle Clare , Rahmat Kartini , Prepageran Narayanan
Published: October 2021

Objectives:

Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that may have normal physical examination, clinical laboratory testing and vestibular evaluation. However, advances in neuroimaging have provided new insights in brain functional connectivity and structure in patients with PPPD. This systematic review was aimed at identifying significant structural or alterations in functional connectivity in patients with PPPD.

Databases Reviewed:

Science Direct, Pubmed, Embase via Ovid databases, and Cochrane library.

Methods:

This review following the guidelines of PRISMA, systematically and independently examined papers published up to March 2021 which fulfilled the predetermined criteria. PROSPERO Registration (CRD42020222334).

Results:

A total of 15 studies were included (MRI = 4, SPECT = 1, resting state fMRI = 4, task-based fMRI = 5, task-based fMRI + MRI = 1). Significant changes in the gray matter volume, cortical folding, blood flow, and connectivity were seen at different brain regions involved in vestibular, visual, emotion, and motor processing.

Conclusion:

There is a multisensory dimension to the impairment resulting in chronic compensatory changes in PPPD that is evident by the significant alterations in multiple networks involved in maintaining balance. These changes observed offer some explanation for the symptoms that a PPPD patient may experience.

Systematic Review Registration: This study is registered with PROSPERO (CRD42020222334).
Grayscale and Spectral Doppler Ultrasound in the Diagnosis of Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome After Hematopoietic Stem Cell Transplantation in Children
Authors: Kaya Nusabe
Published: October 2021

The aim of this study is to determine the ultrasound criteria in the diagnosis of hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) after hematopoietic stem cell transplantation (HSCT) in children. A total of 158 pediatric patients underwent HSCT between January 2016 and January 2018. In all, 71 patients with clinically suspicious hepatic VOD/SOS have been followed with serial ultrasound examinations. Hepatomegaly, gallbladder wall thickening, ascites, pleural effusion, reverse flow in the portal vein, and diameter and peak systolic velocity of the hepatic artery were evaluated. Patients were divided into 2 groups retrospectively: VOD/SOS and non-VOD/SOS. The predictive value of all findings was determined, respectively. Gallbladder wall thickening, increase of diameter and peak systolic velocity of the hepatic artery, and the presence of ascites are highly predictive for VOD/SOS (P=0.001 and < 0.05). The reversed portal venous flow was developed in 3 patients in the VOD/SOS group, no significant difference was found between the 2 groups (P>0.05). Hepatomegaly was recorded in 29 (70.7%) patients in the VOD/SOS group, 13 of them was presented related to a primary disease. Pleural effusion is not associated with the diagnosis of VOD/SOS (P>0.05). Gallbladder wall edema, an increase of peak systolic velocity of the hepatic artery, and the presence of ascites are highly related to the diagnosis of VOD/SOS in children after HSCT. Ultrasound findings must be correlated with clinical criteria.
Optic Nerve Germinoma and Transient Spontaneous Regression—More Than Meets the Eye
Authors: Geurten Claire , Pavon-Mengual Miriam , Lo William B. , Bowen Claire , Gagen Richard , Stirling Heather , Neuling Kim , Painter Sally L. , Williams Jerald , Carr Bryony , English Martin
Published: October 2021

Infiltration of the optic pathway by germ cell tumors is exceptional and can lead to confusion with glioma or inflammatory conditions. We present the case of a 14-year-old girl with an optic nerve germinoma extending to the hypothalamus and manifesting as panhypopituitarism and visual loss. The patient experienced spontaneous regression of the lesion followed by secondary deterioration requiring treatment. Four other cases of spontaneously regressing intracranial germinoma followed by regrowth have been reported in the literature. This report highlights the importance of clinical and radiologic monitoring of intracranial germinoma, even in the event of initial spontaneous improvement.
Relationship Between Handgrip Strength and Metabolic Syndrome Among Middle-Aged and Elderly Cancer Survivors
Authors: Kim Ji-Su , Seo Yeji
Published: October 2021

Background

The number of middle-aged and elderly cancer survivors is rising. Metabolic syndrome, which has been established as an important risk factor for mortality and cardiovascular disease, has also been linked to quality of life in middle-aged and elderly cancer survivors. Recent studies documented a relationship between handgrip strength and metabolic syndrome.

Objective

The aim of this study was to investigate the relationship between relative handgrip strength in middle-aged and elderly cancer survivors and metabolic syndrome in a national population-based sample from Korea.

Methods

This was a cross-sectional, secondary descriptive analysis of data from the sixth to seventh (2014–2018) Korea National Health and Nutrition Examination Survey (KNHANES VI-VII). A final total of 1096 cancer survivors aged 45 years and older were selected.

Results

Lower relative handgrip strength was linked to a higher risk of metabolic syndrome. For men, the adjusted odds ratio for having metabolic syndrome in individuals with a relative handgrip strength score of the 2 Quartile was 4.43 (95% confidence interval, 2.25–8.71) compared with the 4 Quartile (reference) (P < .001), whereas for women, this was 3.67 (95% confidence interval, 2.06–6.53) (P < .001).

Conclusions

Lower relative handgrip strength is correlated with components of metabolic syndrome and is a risk factor for metabolic syndrome among middle-aged and elderly cancer survivors.

Implications for Practice

Physicians and nurses need to identify and monitor the handgrip strength for managing the risk of metabolic syndrome among middle-aged and elderly cancer survivors. Preventive and therapeutic programs that focus on handgrip strength should be developed to prevent metabolic syndrome during their rehabilitation.
Characteristics of Asian-American Breast Cancer Survivors Retained in a 3-Month Technology-Based Intervention
Authors: Yi Jee-Seon , Chee Wonshik , Im Eun-Ok
Published: October 2021

Background

Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities.

Objective

This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study.

Methods

This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale–Breast Cancer. Data analyses were done through χ
2 tests, t tests, and decision tree analyses.

Results

The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers.

Conclusion

This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors.

Implications for Practice

Participants’ characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors.
Nursing Students' Intention to Report Medication Errors
Authors: Secginli Selda , Nahcivan Nursen O. , Bahar Zuhal , Fernandez Ritin , Lapkin Samuel
Published: October 2021

Background

Reporting, investigating, and full disclosure of medication errors (MEs) is a fundamental component of patient safety. Therefore, determining nursing students' intention to report MEs is important.

Purpose

This study examined the factors related to nursing students' intention to report MEs and the use of the Turkish version of the Theory of Planned Behavior Medication Safety Questionnaire (TPB-MSQ-T).

Methods

A descriptive cross-sectional design was used with a sample of 227 undergraduate nursing students in Istanbul, Turkey. Students' intentions to report MEs were measured using an online TPB-MSQ-T. Quantitative analysis was conducted.

Results

Attitudes and perceived behavioral control (PBC) were significant predictors of intention to report MEs (P = .05 and P = .01, respectively), but subjective norms did not predict it (P = .11). The Cronbach's α of the questionnaire was 0.88.

Conclusions

Attitude and PBC are important determinants of nursing students' intention to report MEs. The TPB-MSQ-T can be used for identifying the main determinants of intention to report MEs.