bluuebunny/crossref_metadata_2025 huggingface dataset:
Reward-Related Responses and Tonic Craving in Cocaine Addiction: An Imaging Study of the Monetary Incentive Delay Task
Authors: Zhornitsky Simon , Dhingra Isha , Le Thang M , Wang Wuyi , Li Chiang-shan R , Zhang Sheng
Published: March 2021

Background

Cocaine addiction is associated with altered sensitivity to natural reinforcers and intense drug craving. However, previous findings on reward-related responses were mixed, and few studies have examined whether reward responses relate to tonic cocaine craving.

Methods

We combined functional magnetic resonance imaging and a monetary incentive delay task to investigate these issues. Imaging data were processed with published routines, and the results were evaluated with a corrected threshold. We compared reward responses of 50 cocaine-dependent individuals (CDs) and 45 healthy controls (HCs) for the ventral striatum (VS) and the whole brain. We also examined the regional responses in association with tonic cocaine craving, as assessed by the Cocaine Craving Questionnaire (CCQ) in CDs. We performed mediation analyses to evaluate the relationship between regional responses, CCQ score, and recent cocaine use.

Results

The VS showed higher activation to large as compared with small or no wins, but this reward-related activity did not differ between CDs and HCs. The precentral gyrus (PCG), anterior insula, and supplementary motor area showed higher activation during large vs no wins in positive correlation with the CCQ score in CDs. Mediation analyses suggested that days of cocaine use in the prior month contributed to higher CCQ scores and, in turn, PCG reward responses.

Conclusions

The results highlight a unique relationship between reward responses of the primary motor cortex, tonic cocaine craving, and recent cocaine use. The motor cortex may partake in the cognitive motor processes critical to drug-seeking behavior in addicted individuals.
Islamic Law and the Balancing of Justice and Peace in Iraq’s Post-IS Landscape
Authors: Mojtahedi Mohammad Hossein , van Wijk Joris
Published: March 2021

Balancing justice and long-term peace and security in a postconflict context is highly complex. This article discusses the challenges in Iraq’s post-IS (Islamic State) landscape. Based on a review of relevant Arabic, English and Persian academic scholarship on Islamic law and Islamic political science on accountability and transitional justice, it discusses what Islamic law dictates state authorities to do with detained suspects of atrocity crimes and terrorism and explores possibilities in Islamic law to balance justice and long-term peace and security. The article concludes that crimes against the state should, according to Islamic law, in principle lead to harsh punishments. However, that same body of law also provides for opportunities to adopt non-retributive alternatives, if this allows government to more swiftly handle the security crisis, re-establish public harmony and prevent further bloodshed in the future. The popular perception of the Iraqi people supporting retributive approaches could however pose an important barrier that could block any changes to Iraq’s current transitional justice approach.
WHO/INRUD core prescribing indicators and antibiotic utilization patterns among primary health care facilities in Ilala district, Tanzania
Authors: Kilipamwambu Amosi , Bwire George M , Myemba David T , Njiro Belinda J , Majigo Mtebe V
Published: March 2021

Background

Antibiotic use requires regular monitoring to prevent emergence of antibiotic resistance.

Objectives

To assess antibiotic prescribing patterns at health care facilities (HCF) in Ilala district, Tanzania.

Methods

A 1 year retrospective study was conducted in four HCFs using WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators. Factors associated with antibiotic prescription were analysed using logistic regression model.

Results

A total of 604 prescriptions were reviewed. Patients had median age (IQR) of 15 (4–31) years with majority having upper respiratory tract infection 33.3% (n = 201), urinary tract infection 31.1% (n = 188) or diarrhoea 21.2% (n = 128). Out of 624 prescribed antibiotics, amoxicillin was the most common (22.7%), followed by ciprofloxacin (13.6%) and metronidazole (11.6%). The studied HCFs had an average of 1.99 medicines prescribed per consultation (reference: 1.6–1.8). Of 1203 medicines prescribed, 51.9% (n = 624) were antibiotics (reference: 20.0%–26.8%). Additionally, 97.6% (n = 609) of the antibiotics appeared on the national essential medicines list, whereby 84.4% (n = 510) were prescribed by generic names (reference: 100%). Patients with peptic ulcers had a 4.4-fold higher chance of receiving antibiotics [adjusted odds ratio (aOR) = 4.4, 95% CI = 1.918–10.13, P = 0.0001] while patients with diarrhoea had a 2.6-fold higher chance of receiving at least one antibiotic (aOR = 2.6, 95% CI = 1.206–5.491, P = 0.015).

Conclusions

We found inappropriate use of antibiotics in the studied primary HCFs. Antibiotic stewardship programmes should be extended to primary HCFs found in Ilala district.
Development of a Colloidal Gold Immunochromatographic Strip for the Rapid Detection of Channel Catfish Virus
Authors: Jing Hongli , Li Xiaolin , Xu Lipu , Gao Longying , Lin Xiangmei , Zhang Min , Wang Na , Liu Xiaofei , Wu Shaoqiang
Published: March 2021

Background

Channel catfish virus disease (CCVD) has resulted in great economic losses and has restricted the development of fisheries. There is therefore, a need for rapid and efficient diagnostic methods to control the spread of CCVD.

Objective

A colloidal gold immunochromatographic strip has been developed for the detection of CCVD.

Methods

In this study, a colloidal gold immunochromatographic strip for channel catfish virus (CCV) detection was developed using the monoclonal antibody 8B6 conjugated with colloidal gold as the detector antibody. A rabbit anti-CCV antibody was used as the capture complex at the test line, and a goat anti-mouse IgG antibody was used as the capture antibody at the control line. The strip was characterized in its specificity, sensitivity, and stability. In addition, an infection experiment was performed to test the applicability of the test strip.

Result

The strip was able to detect concentrations of the virus (104 tissue culture infective dose (TCID50)/mL) and showed analytical specificity when tested against other viral pathogens. The strips were still usable after 30 days of storage at 60°C. It was possible to detect CCV experimentally in infected fish within 10–15 min of using the strip.

Conclusions

The strip can be used as a rapid and convenient tool for on-site diagnosis to control outbreaks and the spread of CCVD.

Highlights

The immunochromatographic strip was the first to be developed and applied for the detection of CCVD.
D-Amino acid metabolism in bacteria
Authors: Miyamoto Tetsuya , Homma Hiroshi
Published: March 2021

Bacteria produce diverse d-amino acids, which are essential components of cell wall peptidoglycan. Incorporation of these d-amino acids into peptidoglycan contributes to bacterial adaptation to environmental changes and threats. d-Amino acids have been associated with bacterial growth, biofilm formation and dispersal and regulation of peptidoglycan metabolism. The diversity of d-amino acids in bacteria is primarily due to the activities of amino acid racemases that catalyse the interconversion of the d- and l-enantiomers of amino acids. Recent studies have revealed that bacteria possess multiple enzymes with amino acid racemase activities. Therefore, elucidating d-amino acid metabolism by these enzymes is critical to understand the biological significance and behaviour of d-amino acids in bacteria. In this review, we focus on the metabolic pathways of d-amino acids in six types of bacteria.
Bisecting-GlcNAc on Asn388 is characteristic to ERC/mesothelin expressed on epithelioid mesothelioma cells
Authors: Fujihira Haruhiko , Takakura Daisuke , Matsuda Atsushi , Abe Masaaki , Miyazaki Michiyo , Nakagawa Tomomi , Kajino Kazunori , Denda-Nagai Kaori , Noji Miki , Hino Okio , Irimura Tatsuro
Published: March 2021

Mesothelioma is a highly aggressive tumour associated with asbestos exposure and is histologically classified into three types: epithelioid-type, sarcomatoid-type and biphasic-type. The prognosis of mesothelioma patients is poor and there is no effective molecular-targeting therapy as yet. ERC/mesothelin is a glycoprotein that is highly expressed on several types of cancers including epithelioid mesothelioma, but also expressed on normal mesothelial cells. This is a predicted reason why there is no clinically approved therapeutic antibody targeting ERC/mesothelin. In the present study, we focussed on the differential glycosylation between ERC/mesothelin present on epithelioid mesothelioma and that on normal mesothelial cells and aimed to reveal a distinct feature of epithelioid mesothelioma cells. Lectin microarray analysis of ERC/mesothelin using cells and patient specimens showed significantly stronger binding of PHA-E4 lectin, which recognizes complex-type N-glycans having a so-called bisecting-GlcNAc structure, to ERC/mesothelin from epithelioid mesothelioma cells than that from normal mesothelial cells. Further, liquid chromatography/mass spectrometry analysis on ERC/mesothelin from epithelioid mesothelioma cells confirmed the presence of a bisecting-GlcNAc attached to Asn388 of ERC/mesothelin. These results suggest that this glycoproteome could serve as a potential target for the generation of a highly selective and safe therapeutic antibody for epithelioid mesothelioma.
Artificial Intelligence for a Reduction of False Denials in Refugee Claims
Authors: Cameron Hilary Evans , Goldfarb Avi , Morris Leah
Published: March 2021

Deciding refugee claims is a paradigm case of an inherently uncertain judgment and prediction exercise. Yet refugee status decision-makers may underestimate the uncertainty inherent in their decisions. A feature of recent advances in artificial intelligence (AI) is the ability to make uncertainty visible. By making clear to refugee status decision-makers how uncertain their predictions are, AI and related statistical tools could help to reduce their confidence in their conclusions. Currently, this would only hurt claimants, since many countries around the world have designed their refugee status determination systems using inductive inference which distorts risk assessment. Increasing uncertainty would therefore contribute to mistaken rejections. If, however, international refugee law was to recognize an obligation under the UN Convention to resolve decision-making doubt in the claimant’s favour and use abductive inference, as Evans Cameron has advocated, then by making uncertainty visible, AI could help reduce the number of wrong denied claims.
The Impact of COVID-19 Containment Actions on Extra-Analytical Phases of the Clinical Laboratory: A Case Report
Authors: Mahto Mala , Kumar Mukunda , Banerjee Ayan , Kumar Sushil
Published: March 2021

Laboratory information systems need to adapt to new demands created by the COVID-19 pandemic, which has set up new normals like containment measures and social distancing. Some of these have negatively impacted the pre- and postanalytical phases of laboratory testing. Here, we present an intriguing finding related to the generation of the accession number/specimen number on the investigation module of a hospital management information system and its impact on the dissemination of reports resulting in the wrong release of reports on a female patient amidst the background of COVID-19 containment measures. We analyze the situation that led to this false reporting and the importance of the proper customization of information software in laboratories along with a robust postanalytical framework of laboratory work culture to avert such untoward incidents. This introspection has made us realize that COVID-19 has been a scientific, medical, and social challenge. We need to redefine our priorities in the days to come because SARS-CoV-2 is here to stay.
Medicine in theMonthly Review: Revealing public medical discourse with topic modelling
Authors: Arnold Whitney , Arnold Corey
Published: March 2021

Historians of science and medicine have long argued for the need to recover non-specialist views of medicine and health, as research has often concentrated on practitioner accounts. In this paper, we examine medical discourse in the British periodical the Monthly Review. Published monthly from 1749 to 1844, the Monthly was greatly influential in its time. However, it has received limited scholarly attention, due in part to the unwieldy size of its corpus, which spans 96 years and 246 volumes, each composed of three–six monthly issues. We employ statistical topic modelling to analyse the Monthly, revealing the presentation and prevalence of various public medical discourses, as well as how these discourses varied over the course of the periodical’s almost 100 years. As the Monthly aimed to review every published text, it provides records of and contemporary discussions about thousands of texts currently lost from archives. This analysis of the Monthly ultimately sheds light on the medical topics and texts that featured prominently in British public discourse during the late eighteenth and early nineteenth centuries.
Road home: The role of ethnicity in the post-Soviet regional migration
Authors: Jang Youngook
Published: March 2021

This article investigates the role of ethnicity in determining migration patterns, by using a newly constructed late- and post-Soviet dataset. The members of various indigenous ethnic groups, who had been spread across the Soviet territories, had to decide whether or not to leave the land in which they suddenly became diaspora after the dissolution of the USSR. The post-Soviet case reveals that ethnicity played a crucial and independent role in migration decision and destination choice, as potential migrants were likely to move to the regions where their co-ethnics are prevalent and/or likely to stay if they are already in such regions. This trend of ‘ethnic unmixing’ is observed in a novel dataset regarding the regional migration patterns of major ethnic groups in the post-Soviet space. Econometric analyses using this dataset also confirm that ethnic composition of a region, along with wages and employment, has significant effects on the regional migration patterns. This article also shows that the post-Soviet migration trend was a complete reverse of pre-collapse migration which had been in the direction of ethnic mixing.
Evaluation of mid-term (6-12 months) neurotoxicity in B-cell lymphoma patients treated with CAR T cells: a prospective cohort study
Authors: Maillet Didier , Belin Catherine , Moroni Christine , Cuzzubbo Stefania , Ursu Renata , Sirven-Villaros Lila , Di Blasi Roberta , Thieblemont Catherine , Carpentier Antoine F
Published: March 2021

Background

Chimeric antigen receptor-modified T (CAR T) cells are profoundly changing the standard of care in B-cell malignancies. This new therapeutic class induces a significant number of acute neurotoxicity, but data regarding mid- and long-term neurological safety are scarce. We evaluated mid-term neurological safety, with special emphasis on cognitive functions, in a series of adults treated with CAR T cells.

Methods

Patients treated in a single center with CD19-targeted CAR T cells for a relapsing B-cell lymphoma were prospectively followed up by neurologists. Before CAR T-cell infusion, all patients underwent neurological examinations with neuropsychological testing and filled out questionnaires assessing anxiety, depression, and cognitive complaints. Patients surviving without tumor progression were re-evaluated similarly, 6-12 months later.

Results

In this prospective cohort of 56 consecutive adult patients treated with CAR T cells, 27 were eligible for mid-term evaluation (median time 7.6 months). Twelve patients developed an acute and reversible neurotoxicity with median duration time of 5.5 days. In all patients, neurological examination on mid-term evaluation was similar to baseline. In self-assessment questionnaires, 63% of patients reported clinically meaningful anxiety, depression, or cognitive difficulties at baseline, a number reduced to 44% at the time of mid-term evaluation. On cognitive assessments, no significant deterioration was found when compared to baseline, in any cognitive functions assessed (verbal and visual memory, executive functions, language, and praxis), even in patients who developed acute neurotoxicity.

Conclusion

In this cohort of patients treated with CD19-targeted CAR T cells, we found no evidence for neurological or cognitive toxicity, 6-12 months after treatment.
CD8+ T-Cell Responses in COVID-19 Convalescent Individuals Target Conserved Epitopes From Multiple Prominent SARS-CoV-2 Circulating Variants
Authors: Redd Andrew D , Nardin Alessandra , Kared Hassen , Bloch Evan M , Pekosz Andrew , Laeyendecker Oliver , Abel Brian , Fehlings Michael , Quinn Thomas C , Tobian Aaron A R
Published: March 2021

This study examined whether CD8+ T-cell responses from coronavirus disease 2019 convalescent individuals (n = 30) potentially maintain recognition of the major severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants (alpha, beta, gamma; n = 45 mutations assessed). Only 1 mutation found in Beta variant-spike overlapped with a previously identified epitope (1/52), suggesting that virtually all anti-SARS-CoV-2 CD8+ T-cell responses should recognize these newly described variants.
GLAXO WELLCOME UK LTD v SANDOZ LTD
Authors:   Chancery Division
Published: March 2021

H1 Passing off – Prescription medication – Asthma inhalers – The colour purple – Distinctiveness – Misrepresentation as to source – Misrepresentation as to equivalence – Likelihood of confusion – Survey evidence – Damage – Recklessness – Joint tortfeasance
A metabolomic-based study on disturbance of bile acids metabolism induced by intratracheal instillation of nickel oxide nanoparticles in rats
Authors: Zhang Qiong , Chang Xuhong , Wang Xiaoxia , Zhan Haibing , Gao Qing , Yang Mengmeng , Liu Han , Li Sheng , Sun Yingbiao
Published: March 2021

Nickel oxide nanoparticles (Nano NiO) evoke hepatotoxicity, while whether it affects the hepatic metabolism remains unclear. The aim of this study was to explore the differential metabolites and their metabolic pathways in rat serum and to further verify the potential mechanism of bile acids’ (BAs) metabolism dysregulation after Nano NiO exposure. Sixteen male Wistar rats were intratracheally instilled with Nano NiO (0.24 mg/kg body weight) twice a week for 9 weeks. Liquid chromatography/mass spectrometry was applied to filter the differentially expressed metabolites in rat serum. Western blot was employed to detect the protein contents. Twenty-one differential metabolites that associated with BAs, lipid and phospholipid metabolism pathways were identified in rat serum after Nano NiO exposure. Decreased cholic acid and deoxycholic acid implied that the BAs metabolism was disturbed. The nickel content increased in liver after Nano NiO exposure. The protein expression of cholesterol 7α-hydroxylase (CYP7A1) was down-regulated, and the bile salt export pump was up-regulated after Nano NiO administration in rat liver. Moreover, dehydroepiandrosterone sulphotransferase (SULT2A1) and cytochrome P450 (CYP) 3A4 were elevated in the exposure group. In conclusion, Nano NiO might trigger the disturbances of BAs, lipid and phospholipid metabolism pathways in rats. The diminished serum BAs induced by Nano NiO might be related to the down-regulation of synthetase and to the overexpression of transmembrane protein and detoxification enzymes in BAs metabolism.
Interannual dynamics, diversity and evolution of the virome in Sclerotinia sclerotiorum from a single crop field
Authors: Jia Jichun , Fu Yanping , Jiang Daohong , Mu Fan , Cheng Jiasen , Lin Yang , Li Bo , Marzano Shin-Yi Lee , Xie Jiatao
Published: March 2021

Mycovirus diversity is generally analyzed from isolates of fungal culture isolates at a single point in time as a snapshot. The stability of mycovirus composition within the same geographical location over time remains unclear. Not knowing how the population fluctuates in the field can be a source of unpredictability in the successful application of virocontrol. To better understand the changes over time, we monitored the interannual dynamics and abundance of mycoviruses infecting Sclerotinia sclerotiorum at a rapeseed-growing field for three years. We found that the virome in S. sclerotiorum harbors unique mycovirus compositions each year. In total, sixty-eight mycoviruses were identified, among which twenty-four were detected in all three successive years. These twenty-four mycoviruses can be classified as the members of the core virome in this S. sclerotiorum population, which show persistence and relatively high transmissibility under field conditions. Nearly two-thirds of the mycoviruses have positive-sense, single-stranded RNA genomes and were found consistently across all three years. Moreover, twenty-eight mycoviruses are newly described, including four novel, multi-segmented narnaviruses, and four unique bunyaviruses. Overall, the newly discovered mycoviruses in this study belong to as many as twenty families, into which eight were first identified in S. sclerotiorum, demonstrating evolutionarily diverse viromes. Our findings not only shed light on the annual variation of mycovirus diversity but also provide important virus evolutionary clues.
The Mother Baby Comfort Care Pathway
Authors: Czynski Adam J. , Souza Michelle , Lechner Beatrice E.
Published: March 2021

Background:

Traditionally, the provision of comfort care and support during the dying process for infants born with life-limiting diagnoses has occurred in the neonatal intensive care unit (NICU). A major goal for the families of these infants is often the opportunity to spend as much time as possible with their infant in order to make memories and parent their infant.

Purpose:

The objective of the Mother Baby Comfort Care Pathway is to implement a program of family-centered care with logistically flexible care delivery, allowing mothers and their families to share as normal a postpartum care experience as possible with a focus on quality of life, memory making, and time spent together.

Methods:

The program was developed with the nucleus of care coordination and provision on the Mother Baby Unit (postpartum unit), with involvement from the labor and delivery room, NICU, and other units as necessary to provide the postpartum mother, her dying infant, as well as possible additional siblings (in the case of multiple gestation), postpartum care while rooming-in. The program was rolled out with training workshops for postpartum nurses.

Findings:

Nurses who took part in the workshops and the patient care program rated both highly.

Implications for Practice:

The Mother Baby Comfort Care Pathway aims to offer a framework for providing multidisciplinary family-centered comfort care to newborns during the postpartum period in a compassionate, evidence-based, and individualized manner in order to maximize quality time together for families with a dying infant.
Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study
Authors: Fan Yonggang , Wang Jie , Cai Mandi , Xia Lei
Published: March 2021

Background:

The aim of this study was to investigate whether C7 slope can be used as a substitute for T1 slope in idiopathic scoliosis.

Methods:

From January 2014 to October 2019, 101 patients who received posterior spinal internal fixation and fusion in our hospital were retrospectively analyzed. After analyzing the visibility of vertebral endplates, 46 cases of C7/T1 vertebral endplates were visible, including 14 males and 32 females, aged 9 to 18 years (mean 14.6±2.0 y). The upper C7 slope, lower C7 slope, T1 slope, cervical lordosis and C2 to 7 sagittal vertebral axis were measured before and after operation and at the last follow-up. Pearson correlation coefficient was used to evaluate the correlation strength between upper C7 slope and T1 slope, and lower C7 slope and T1 slope. Through simple linear regression analysis, linear regression equations were generated from the upper and lower C7 slopes to predict T1 slope.

Results:

According to the 2 researchers’ judgment, the visibility rate of the upper C7 endplate was 93.1% before operation, 93.1% after operation, and 91.1% at the last follow-up. The lower C7 endplate’s visible rate was 72.3% before operation, 70.3% after operation and 68.3% at the last follow-up. The visible rate of T1 upper endplate was 52.5% before operation, 48.5% after operation and 50.5% at last follow-up. Linear regression analysis showed that the upper C7 slope and T1 slope in idiopathic scoliosis patients, regardless of preoperative (r=0.908, P<0.01), postoperative (r=0.0.886, P<0.01), follow-up (r=0.899, P<0.01), or overall (r=0.895, P<0.01), both have a close correlation; the lower C7 slope and the T1 slope are the same before surgery (r=0.882, P<0.01), after surgery (r=0.940, P<0.01), follow-up (r=0.952, P<0.01), or overall (r=0.929, P<0.01) all have statistical significance.

Conclusion:

When the upper endplate of T1 is not visible on standard radiographs, the upper or lower C7 slope can be used as a reliable alternative measurement parameter for sagittal balance assessment.
Posterior Tibial Slope is Increased in Patients With Tibial Tubercle Fractures and Osgood-Schlatter Disease
Authors: Sheppard Evan Drew , Ramamurti Pradip , Stake Seth , Stadecker Monica , Rana Md Sohel , Oetgen Matthew E. , Young Megan L. , Martin Benjamin D.
Published: March 2021

Background:

Osgood-Schlatter disease (OSD) and tibial tubercle fractures are pathologies that affect the tibial tubercle apophysis in preadolescents and adolescents. Anatomic alignment of the proximal tibia may explain why some children develop OSD or sustain tibial tubercle fractures and some do not. Recent data has shown an association between posterior tibial slope angle (PTSA) and both OSD and proximal tibia physeal fractures. In this study, we compare radiographic parameters between patients with non-OSD knee pain, knees with OSD, and knees with tibial tubercle fracture to elucidate a difference between these groups.

Methods:

Patients treated for OSD, tibial tubercle fractures, and knee pain, from 2012 to 2018, were retrospectively reviewed. Radiographic parameters for each study group included PTSA, anatomic lateral distal femoral angle, anatomic medial proximal tibial angle, patellar articular height, and the distance from the inferior aspect of the patellar articular surface. Caton-Deschamps index was then calculated. Demographic data was collected including age, sex, and body mass index. Demographic and radiographic data was compared using analysis of variance tests, χ2 tests, 2-sample t tests, and multiple linear regression.

Results:

Two hundred fifty-one knees in 229 patients met inclusion criteria for the study. In all, 76% were male and the average age of the overall cohort was 14 years old. In patients with tibial tubercle fractures, the majority of fractures were Ogden type 3b (65%). After controlling for demographic variability, average PTSA in the fracture cohort was significantly greater than that in the control cohort (β=3.49, P<0.001). The OSD cohort had a significantly greater posterior slope (β=3.14) than the control cohort (P<0.001). There was no statistically significant difference between the fracture and OSD cohorts. There was also no difference in Caton-Deschamps index between the 2 study groups when compared with the control group.

Conclusion:

This study demonstrates that patients with tibial tubercle fractures and patients with OSD have an increased PTSA when compared with the control group. This information adds to the body of evidence that increased tibial slope places the proximal tibial physis under abnormal stress which may contribute to the development of pathologic conditions of proximal tibia such as OSD and tibial tubercle fractures.

Level of Evidence:

Level III; retrospective comparative study.
Arthroscopic Pisiform Excision in Pisotriquetral Osteoarthritis Technique Using a Direct Pisotriquetral Portal
Authors: Carratalá Baixauli Vicente , Pereira Ana Daniela , Lucas García Francisco J. , Guisasola Lerma Eva , Martínez Andrade Cristóbal
Published: March 2021

Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.
Recent data on adipose tissue, insulin resistance, diabetes and dyslipidaemia in antiretroviral therapy controlled HIV-infected persons
Authors: Capeau Jacqueline , Lagathu Claire , Béréziat Véronique , Fève Bruno
Published: March 2021

Purpose of review

Increased total body fat with truncal redistribution is common in antiretroviral therapy (ART)-controlled persons living with HIV(PLWH), leading to insulin resistance, prediabetes/diabetes and dyslipidaemia. We address these topics here.

Recent findings

Most antiretrovirals are associated with gain in trunk fat, including visceral adipose tissue (VAT). Protease-inhibitors could inhibit white fat ability to dissipate energy (i.e. beiging) favouring fat gain. Expansion of VAT is associated with a pro-inflammatory profile linked to the tryptophan-kynurenine pathway and CD4+ subtypes. ART-associated increased adipose tissue (AT) quantity leads to decreased AT density, insulin resistance and dyslipidaemia that could be improved by lifestyle modifications.

PLWH present high level of insulin resistance, regardless of their treatment, and a higher prevalence of prediabetes, but not diabetes, than noninfected persons. Otherwise, HbA1c values appear inaccurate to diagnose prediabetes/diabetes in PLWH.

ART-related-dyslipidaemia is characterized by elevated LDL-C and/or high triglycerides and reduced HDL-C. Whereas treatment with protease inhibitors generally results in worsened lipid values, treatment with integrase-strand-transfer-inhibitors is associated with a better profile. Tenofovir-alafenamide is associated with higher lipid levels than tenofovir-disoproxil-fumarate. Treatment of LDL-C-dyslipidaemia could benefit, in statin-insufficiently controlled patients, from the class of proprotein-convertase-subtilsin-kenin-type-9 (PCSK-9) inhibitors.

Lifestyle modifications are mandatory to reduce fat and improve dysglycaemia/dyslipidaemia. New drugs can efficiently control diabetes and LDL-C-dyslipidaemia.
Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins
Authors: Hsu Chao Chin , Hsu Isabel , Hsu Leonard , Chiu Yi Jen , Dorjee Sonam
Published: March 2021

Objective:

This study was designed to investigate if whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin, in proximity to most ovarian follicles, is effective in restoring ovarian functions in women during early menopause.

Methods:

Platelet-rich plasma, prepared from 40 mL of autologous peripheral blood using the buffy coat method, was injected into extended subcortical area of bilateral ovaries along with recombinant follicle-stimulating hormone (rFSH) (Gonal-F 300IU) under laparoscopic guidance. The posttreatment ovarian folliculogenesis and serum levels of FSH, luteinizing hormone (LH), and estradiol were followed up for 6 months at weekly to monthly intervals. IVF was carried out in women resuming ovulatory functions.

Results:

Twelve early menopausal women with mean age of 44.42 ± 2.84 were enrolled. After treatment, 11 women resumed their menstrual period in 37.1 ± 23.5 days. Their average serum FSH was 70.47 ± 20.92 and 26.22 ± 17.55 IU/L, luteinizing hormone was 34.81 ± 11.86 and 14.3 ± 12.8 IU/L, before and after treatment, respectively. The mid-cycle E2 was 251.1 ± 143.8 pg/mL. Ten oocyte retrievals were carried out among six participants, four of them received controlled ovarian stimulation and another two using natural ovulation cycles. Thirteen mature eggs were retrieved which were then ICSI fertilized to obtain 10 normally fertilized 2PN oocytes. Two participants had cleavage stage embryos transferred of which one achieved clinical pregnancy.

Conclusions:

Whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin was shown to restore ovarian functions, at least temporarily, and could increase the probability of pregnancy using autologous oocytes in women with early menopause.
Wide-awake Local Anesthesia with No Tourniquet: An Updated Review
Authors: Kurtzman Joey S. , Etcheson Jennifer I. , Koehler Steven M.
Published: March 2021

Background:

The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT.

Methods:

A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety.

Results:

The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates.

Conclusions:

The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.
The Farnesoid X Receptor Agonist Tropifexor Prevents Liver Damage in Parenteral Nutrition‐fed Neonatal Piglets
Authors: Liu Yang , Xiao Yongtao , Chen Shanshan , Tian Xinbei , Wang Weipeng , Wang Ying , Cai Wei
Published: March 2021

Objectives:

Intestinal failure‐associated liver disease (IFALD) is a life‐threatening complication for patients with intestinal failure who receive long‐term parenteral nutrition (PN). We evaluated the effects of the farnesoid X receptor agonist tropifexor on a neonatal piglet model of IFALD fed with PN.

Methods:

The piglets received PN and tropifexor for 14 days, then levels of liver enzymes, bile acid metabolism, inflammation, and intestinal barrier markers were assessed using quantitative real‐time PCR. Fibroblast growth factor (FGF) 19 serum levels were determined using enzyme‐linked immunosorbent assays. Bile acids were determined in liver, serum, and intestinal contents, and the microbiome was sequenced in different intestinal segments.

Results:

The PN model was established in newborn piglets. The levels of serum liver enzymes, pro‐inflammatory factors, and oxidative stress increased in the livers of piglets fed with PN, but not in those fed with PN and tropifexor. Tropifexor stimulated FGF19 expression in ileal epithelial cells, increased portal FGF19 levels, then inhibited cholesterol 7α‐hydroxylase expression in the liver. Tropifexor increased the relative abundance of bacteria associated with bile salt hydrolase and 7α‐dehydrogenation in the contents of ileum and altered the composition of bile acids in serum, liver, and intestinal contents. Tropifexor also inhibited intestinal inflammation, alleviated intestinal mucosal atrophy, and improved the intestinal barrier.

Conclusions:

Tropifexor might prevent liver damage in neonatal piglets receiving PN by altering the composition of intestinal microbiota and bile acids. Tropifexor also alleviates intestinal inflammation and preserves the intestinal barrier.
Health Literacy, Health Confidence, and Simulation
Authors: Morley Colleen M. , Levin Scott A.
Published: March 2021

Purpose/Objectives:

The vision for this project was to create an inpatient education intervention to better prepare patients with chronic medical conditions for more effective self-management after discharge using a Skills Simulation Experience and focused one-on-one structured education format in a circuit-based intervention. As an interdisciplinary intervention, the health care team presents standardized education in a circuit training presentation to allow for one-on-one interaction with health care professionals, using multiple teaching/learning strategies, to assist the participant in acquiring or reinforcing skills needed to successfully self-manage his or her conditions postdischarge.

Primary Practice Setting(s):

West Suburban Medical Center (WSMC) is owned by Pipeline Health and is located on the west side of Chicago, IL. WSMC is a 118-year-old community-based teaching facility that has collaboration with a local Federally Qualified Health Center, providing clinic space on-site as well as clinical rotations for OB/GYN. WSMC serves 2 very diverse neighborhoods, Oak Park, IL, home of Frank Lloyd Wright and Ernest Hemingway, and the Austin neighborhood of Chicago, which ranks 11th out of the 77 Chicago communities in violent crime.

Findings/Conclusions:

Data collected included the following:

Implications for Case Management Practice:
Safety-Net Accountable Health Model Partnership Drives Inpatient Connection to Outpatient Social Services, Reducing Readmissions in a Population Experiencing Homelessness
Authors: Rhodes Heather Marie , Simon Heather Lynn , Hume Hillary G. , Strief Dawn , Knutson Alex , Webber Michael C. , Robertshaw Danielle Christine
Published: March 2021

Purpose of Study:

To evaluate whether screening for homelessness during hospitalization and deploying outpatient care managers (CMs) to the inpatient setting to rapidly connect patients to community social services reduce hospital readmissions.

Primary Practice Setting:

A large safety-net hospital in Minnesota.

Methodology and Sample:

A quality improvement pilot proactively engaged hospitalized adults experiencing homelessness and enrolled in the Hennepin Health Accountable Health Model (HH AHM). Patients were screened for homelessness using a novel housing indicator tool, and eligible patients were visited in the hospital by HH AHM community CMs. If patients chose to pursue offered services, they were added to the CM's caseload with whom they met while hospitalized. Outcomes were compared between those patients who engaged in community case management initiated in the hospital (intervention group) and those who declined services or were discharged prior to an inpatient CM visit (control group). Chi-square, Fisher's exact, independent-samples t test, and Mann–Whitney U tests were conducted, as appropriate.

Results:

Seventy-two patients were included in the intervention group and 61 patients were included in the control group. Both groups were primarily English-speaking, African/African American and Native American men in their early to mid-40s. In total, 5.6% and 18% of intervention and control patients were readmitted to the hospital within 30 days. Of note, claims data confirmed that no readmissions occurred at outside hospitals in the first 9 months of the program. Twelve (16.7%) intervention patients were housed over the course of the study period, 5 occurring in the first 6 weeks.

Implications for Case Management Practice:
The Social Determinants of Mental Health
Authors: Fink-Samnick Ellen
Published: March 2021

Purpose:

The social determinants of health are a well-established health care industry priority. Robust data associated with psychosocial circumstances for populations validate poor health outcomes. However, another domain begs for inclusion and industry attention. A mental health chasm has emerged amid a post-COVID-19 landscape fraught with escalating health disparities, morbidity, and mortality. Themes of trauma, diversity, equity, and inclusion are major organizational imperatives. As a result, an expanded focus on the social determinants of mental health (SDoMH) mandates dedicated perspective. Part 1, of this 2 article series, on the SDoMH will provide distinct understanding of relevant industry terminology, historical drivers, and macro factors that influence mental health, along with health disparities. In addition, this article will set the foundation to advance the industry's quality compass, the Triple/Quadruple Aim.

Learning Outcomes:

After reading this article, learners will be able to:

define the social determinants of mental health (SDoMH);

distinguish them from the social determinants of health (SDoH);

explore foundational concepts related to the SDoMH;

understand upstream drivers of the SDoMH; and

present evidence that validates attention to the wholistic health triad.

Finding/Conclusion:

Access to quality wholistic health care encompasses pathophysiology, psychopathology, and psychosocial circumstances, and is a considerable challenge across populations. Mental health, along with health disparities, has been fueled by enduring systematic racism that has facilitated inadequate funding, poor reimbursement, decreased treatment options, and pervasive stigma across diverse patient populations (e.g., race, ethnicity, gender, sexual orientation, familial status, disability, socioeconomic status). These SDoMH mandate a critical fresh lens by case management to ensure the most proactive and comprehensive approach to care. To achieve the successful outcomes mandated by this approach, the industry's quality compass, the Triple/Quadruple Aim must be expanded to include a Quintile Aim of wholistic health equity.

Implications for Case Management Practice:

Case management's unique transdisciplinary composition has the workforce well positioned to effect grand change in population health perspectives. Wider attention to clinical and fiscal outcomes for health and mental health inequities mandates innovative approaches to patient care, which encompass a wholistic health triad of pathophysiology, psychopathology, and psychosocial circumstances.
The Ethical Context of Hope: Case Management's Ongoing Challenge
Authors: Powell Suzanne , Fink-Samnick Ellen
Published: March 2021

Case management's ethical tenets are timeless and remain a foundational pillar of case management practice. These tenets are independent of patient or situation context, even with the tremendous post/parapandemic times. Yet, the question beckons: Despite the times or their circumstances, how do health care professionals engage in ethical practice while still maintaining hope?
Two Symptoms to Triage Acute Concussions
Authors: Robinson Michael , Johnson Andrew M. , Fischer Lisa K. , MacKenzie Heather M.
Published: March 2021

Objective

The objective was to examine the 22 variables from the Sport Concussion Assessment Tool’s 5th Edition Symptom Evaluation using a decision tree analysis to identify those most likely to predict prolonged recovery after a sport-related concussion.

Design

A cross-sectional design was used in this study. A total of 273 patients (52% men; mean age, 21 ± 7.6 yrs) initially assessed by either an emergency medicine or sport medicine physician within 14 days of concussion (mean, 6 ± 4 days) were included. The 22 symptoms from the Sport Concussion Assessment Tool’s 5th Edition were included in a decision tree analysis performed using RStudio and the R package rpart. The decision tree was generated using a complexity parameter of 0.045, post hoc pruning was conducted with rpart, and the package carat was used to assess the final decision tree’s accuracy, sensitivity and specificity.

Results

Of the 22 variables, only 2 contributed toward the predictive splits: Feeling like “in a fog” and Sadness. The confusion matrix yielded a statistically significant accuracy of 0.7636 (P[accuracy > no information rate] = 0.00009678), sensitivity of 0.6429, specificity of 0.8889, positive predictive value of 0.8571, and negative predictive value of 0.7059.

Conclusions

Decision tree analysis yielded a statistically significant decision tree model that can be used clinically to identify patients at initial presentation who are at a higher risk of having prolonged symptoms lasting 28 days or more postconcussion.
Feasibility and Therapeutic Potential of Peptide Receptor Radionuclide Therapy for High-Grade Gliomas
Authors: Nemati Reza , Shooli Hossein , Rekabpour Seyed Javad , Ahmadzadehfar Hojjat , Jafari Esmail , Ravanbod Mohammad Reza , Amini AbdolLatif , Nemati Ali , Ghasemi Mohammad , Keshmiri Saeid , Dadgar Habibollah , Assadi Majid
Published: March 2021

Purpose

This pilot study tested the principle that 177Lu-DOTATATE may be applied to patients with high-grade gliomas (HGGs) that are either inoperable or refractory to the standard conventional treatments and also assessed whether this approach could be a viable therapeutic plan in this dilemma.

Methods

In this prospective study, 16 subjects experiencing HGGs that were either inoperable or refractory to the standard conventional treatments were included. All the patients checked for somatostatin receptor expression on the tumors. The patients were treated with 1 to 4 cycles of IV 177Lu-DOTATATE. The primary end point was radiological response after peptide receptor radionuclide therapy, and the secondary end point was improved quality of life using Karnofsky Performance Score and Eastern Cooperative Oncology Group score.

Results

In total, 16 subjects (10 males and 6 females) with a mean age of 55.68 ± 13.17 years (26–73 years) participated in the study. Of them, 8 patients were new HGG cases, and 8 patients had recurrent tumors. The participants’ responses to treatments were complete remission in 12.5% of (n = 2), partial remission in 31.25% (n = 5), disease stability in 18.7% (n = 3), and disease progression in 37.5% (n = 6). In total, pretreatment and posttreatment Karnofsky Performance Score and Eastern Cooperative Oncology Group scores did not improved (P > 0.05). The patients were followed up from 1 month to 26 months (median, 3 months).

Conclusions

This preliminary result suggests that peptide receptor radionuclide therapy using 177Lu-DOTATATE may be associated with positive effects in patients with HGGs (grade III–IV). However, this approach should be evaluated in a more homogeneous group of patients with more favorable performance status.