bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal, Peripheral Nerve, and Muscle Disorders
Authors: Jones Lyell K. , Crum Brian A.
Published: August 2022

Diseases affecting the spinal cord, peripheral nerves, and skeletal muscles are common in clinical practice. These conditions may occur in isolation or as an associated feature (or complication) of nonneurologic disease. The clinical history and examination are useful for establishing a tentative diagnosis, which can be firmly established with diagnostic testing. Electrodiagnostic testing (nerve conduction studies and electromyography [EMG]) is the most useful method for adjunctive evaluation of patients with suspected nerve or muscle disease. Treatments are targeted to the underlying mechanism of disease.
Sleep Disorders
Authors: Junna Mithri R.
Published: August 2022

This chapter describes the characterization, symptoms, diagnoses, and possible treatments for several sleep disorders, including obstructive sleep apnea, central sleep apnea, sleep-related hypoventilation, insomnia, parasomnia, and restless legs syndrome.
Osteoarthritis, Gout, and Inflammatory Myopathies
Authors: Ernste Floranne C.
Published: August 2022

Osteoarthritis is the failure of articular cartilage and the subsequent degenerative changes in subchondral bone, bony joint margins, synovium, and para-articular fibrous and muscular structures. Osteoarthritis is the most common joint disease. Of patients, 80% have some limitation of their activities, and 25% are unable to perform major activities of daily living. As a consequence, osteoarthritis is a substantial economic burden to society. The prevalence of osteoarthritis is strongly associated with aging. Joints most commonly affected are the knee, hand, spine, metatarsophalangeal, and hip joints. Radiologic evidence of the disease greatly exceeds the prevalence of symptomatic cases.
Vasculitis
Authors: Koster Matthew J. , Warrington Kenneth J.
Published: August 2022

Vasculitis refers to a group of autoimmune disorders characterized by inflammation of blood vessels. The inflammatory process results in vascular damage with stenosis or occlusion of the vessel lumen and consequent end-organ ischemia. Vasculitis can be classified according to the predominant type of vessel involved (referred to as large vessel, medium vessel, or small vessel vasculitis). Most forms of vasculitis are chronic systemic disorders that cause multiorgan damage; yet, vasculitis may be localized to a single organ. The cause of vasculitis is generally unknown, but viral infections, certain medications, and malignancies trigger some forms of vasculitis.
Prescribing Antiretroviral Therapy
Authors: Mathur Poonam , Bandres Maria Veronica , Ajmal Saira , Temesgen Zelalem , Koren David E.
Published: August 2022

This chapter provides an overview of what antiretroviral therapy (ART) is and the current treatment guidelines according to the US Department of Health and Human Services and the International Antiviral Society-USA. Important criteria in selecting an initial treatment regimen are discussed as well as when to switch or simplify the regimen. Factors to consider when selecting an antiretroviral regimen and other information involving ART is presented to the reader via tables.
Understanding and Managing Antineoplastic and Antiretroviral Therapy
Authors: Schafer Jason J. , Sherman Elizabeth M. , Gill Taylor K.
Published: August 2022

This chapter reviews concepts regarding the safe and effective use of antineoplastic and antiretroviral therapy in people living with HIV and cancer. Drug interactions and medication toxicities are discussed as well as drug–disease interactions. The chapter concludes with an overview of strategies for clinical management of people with cancer and HIV.
Opportunistic Infections
Authors: Armitage Lisa Y. , Vigil Karen J. , Pednekar Manali
Published: August 2022

This chapter aids the learner in recognizing and managing the most common opportunistic infections associated with people with HIV. The issues concerning starting antiretroviral therapy in the setting of an opportunistic infection are described, and recommendations are provided for starting antiretroviral therapy in this situation. Learners will be able to delineate the available testing and treatment modalities to manage Mycobacterium tuberculosis, M. avium complex, and M. kansasii, and will be able to discuss the established and evolving science regarding the diagnosis, treatment, and prophylaxis of opportunistic viral infections associated with HIV, including herpes simplex, varicella zoster, cytomegalovirus, human herpesvirus, and John Cunningham (JC) virus.
Endocrine and Metabolic Disorders
Authors: Sekhar Rajagopal V.
Published: August 2022

This chapter helps identify the spectrum of endocrine and metabolic complications affecting people with HIV and the mechanisms and clinical management of endocrine and metabolic diseases associated with HIV and antiretroviral use. Specifically, certain protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors are linked to changes in body morphology, lipohypertrophy, lipoatrophy, dyslipidemia, and weight gain. These manifest in multiple conditions including diabetes mellitus, adrenal disorders, thyroid abnormalities, gonadal dysfunction, metabolic disorders, non-alcoholic fatty liver disease, and premature aging. An overview of these manifesting conditions is provided and treatment options are discussed.
Psychiatric Illness and Treatment in HIV Populations
Authors: David Elizabeth H. , Taylor Erica
Published: August 2022

This chapter discusses the psychiatric concomitants of HIV illness and the role of psychiatric care in the overall treatment of HIV populations. It reviewers the bidirectional causes of the close association between HIV infection and psychiatric illness/symptoms. The learner will recognize symptoms that suggest the presence of a psychiatric component to the patient’s clinical presentation. Lastly, general principles of treatment are offered, and situations when specific intervention by mental health professionals is needed are described.
Renal Complications
Authors: Lim Jonathan , Menez Steven , Fine Derek M.
Published: August 2022

This chapter discusses the continued high prevalence of renal disease in persons with HIV and the broad pathologic spectrum of renal disease, including medication-induced renal injury. It also allows the learner to understand the importance of screening and monitoring people with HIV for chronic kidney disease. Other topics discussed are the indications for nephrology referral and renal biopsy and potential targets of intervention for HIV-associated renal diseases. Treatment options for people with HIV who have end-stage renal disease, including dialysis and solid organ transplant, are also covered.
Incidence and characteristics of pseudoprogression in IDH-mutant high-grade gliomas: A POLA network study
Authors: Seyve Antoine , Dehais Caroline , Chinot Olivier , Djelad Apolline , Cohen-Moyal Elisabeth , Bronnimann Charlotte , Gourmelon Carole , Emery Evelyne , Colin Philippe , Boone Mathieu , Vauléon Elodie , Langlois Olivier , di Stefano Anna-Luisa , Seizeur Romuald , Ghiringhelli François , D’Hombres Anne , Feuvret Loic , Guyotat Jacques , Capelle Laurent , Carpentier Catherine , Garnier Louis , Honnorat Jérôme , Meyronet David , Mokhtari Karima , Figarella-Branger Dominique , Ducray François
Published: August 2022

Background

Incidence and characteristics of pseudoprogression in isocitrate dehydrogenase-mutant high-grade gliomas (IDHmt HGG) remain to be specifically described.

Methods

We analyzed pseudoprogression characteristics and explored the possibility of pseudoprogression misdiagnosis in IDHmt HGG patients, treated with radiotherapy (RT) (with or without chemotherapy [CT]), included in the French POLA network. Pseudoprogression was analyzed in patients with MRI available for review (reference cohort, n = 200). Pseudoprogression misdiagnosis was estimated in this cohort and in an independent cohort (control cohort, n = 543) based on progression-free survival before and after first progression.

Results

In the reference cohort, 38 patients (19%) presented a pseudoprogression after a median time of 10.5 months after RT. Pseudoprogression characteristics were similar across IDHmt HGG subtypes. In most patients, it consisted of the appearance of one or several infracentimetric, asymptomatic, contrast-enhanced lesions occurring within 2 years after RT. The only factor associated with pseudoprogression occurrence was adjuvant PCV CT. Among patients considered as having a first true progression, 7 out of 41 (17%) in the reference cohort and 35 out of 203 (17%) in the control cohort were retrospectively suspected to have a misdiagnosed pseudoprogression. Patients with a misdiagnosed pseudoprogression were characterized by a time to event and an outcome similar to that of patients with a pseudoprogression but presented with larger and more symptomatic lesions.

Conclusion

In patients with an IDHmt HGG, pseudoprogression occurs later than in IDH-wildtype glioblastomas and seems not only frequent but also frequently misdiagnosed. Within the first 2 years after RT, the possibility of a pseudoprogression should be carefully considered.
Effects of whole grain intake on glucagon-like peptide 1 and glucose-dependent insulinotropic peptide: a systematic review and meta-analysis
Authors: Hassanzadeh-Rostami Zahra , Ghobadi Saeed , Faghih Shiva
Published: August 2022

Context

Whole grain intake may control help glycemia and reduce food intake by affecting the secretion of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP).

Objective

This systematic review and meta-analysis aimed to assess the postprandial and long-term effects of whole grains on GLP-1 and GIP levels.

Data Sources

PubMed, Web of Science, and Scopus online databases were searched systematically to identify relevant randomized clinical trials (RCTs) published up to April 2021.

Study Selection

RCTs that evaluated the effects of whole grains, compared with refined grains, on the postprandial area under the curve (AUC) value, the postprandial serum concentration of incretins from 0 to 180 minutes, or the fasting level of incretins after at least 14 days of intervention were included.

Results

Nineteen studies were included in the meta-analysis. The results showed that acute intake of whole grains could not significantly change the AUC value of GLP-1 or GIP. However, the AUC value of GIP was reduced more significantly in (1) unhealthy participants (standard mean difference [SMD] −1.08; 95%CI, −2.07 to −0.10; I2 = 75.9%) compared with healthy participants, and (2) those with a baseline fasting blood glucose of ≥99 mg/dL (SMD −0.71; 95%CI, −1.30 to −0.11; I2 = 74.4%) compared with those with a baseline value of < 99 mg/dL. On the other hand, the results of time-response evaluation during 0 to 180 minutes after the intake of test meals showed that serum concentrations of GIP decreased significantly from 0 to 30 minutes (coefficient = −44.72; P = 0.005), but increased from 60 to 180 minutes (coefficient = 27.03; P = 0.005). However, long-term studies found no significant effects of whole grains on fasting concentrations of GLP-1 or GIP.

Conclusion

Whole grain intake did not affect postprandial levels of GLP-1 but enhanced postprandial levels of GIP from 60 to 180 minutes. Further high-quality trials are required to assess the long-term effects of whole grain intake on serum levels of incretins.

Systematic Review Registration

PROSPERO registration no. CRD42021256695.
Curriculum Design
Authors: American Association for the Advancement of Science
Published: August 2022

Now let us consider the idea of curriculum design. As indicated by the definitions at the beginning of this book, the term “design” is used as a verb to designate a process (as in “designing a curriculum”), or as a noun to denote a particular plan resulting from a design process (as in “a curriculum design”). Never mind that a curriculum is not a garden or a bridge or a traffic pattern; our purpose in this chapter is to see how things play out when we apply the design practices of architects and engineers to the creation of new curricula. And, for the moment, let us put aside the question of precisely what a curriculum is (a matter to be taken up at the beginning of the next chapter), since the process of curriculum design can be explored without first having agreement on a precise definition of curriculum. The purpose of this chapter is to explore ideas, not to provide detailed step-by-step instructions on how to create an actual curriculum design, let alone an actual curriculum. It is as though, by way of analogy, the chapter deals with how general design principles may seem to apply to designing any kind of buildings, but not to how to produce detailed engineering plans for use in constructing actual buildings. To make the argument easy to follow, the chapter parallels the Prologue section by section. This time, instead of the backyard garden of the Prologue, our desired end is an effective K–12 curriculum. Our approach need not be altogether orderly, but we would surely do these things: • We would become gradually clearer on why we want a new curriculum. To have students—some students? all students?—learn more than they learn now? How much more? Learn different things? And which things? To respond to national standards or international comparisons? To raise SAT scores? How far? To increase attendance and the graduation rates? To have more graduates enter college? Certain colleges? To respond to criticism from teachers? Students? Parents? The community? State authorities? All such criticisms, or only some? Which? What if some of our intentions conflict with others?
Design by Assembly
Authors: American Association for the Advancement of Science
Published: August 2022

One can argue that making a series of small improvements in existing curricula will eventually add up to new curricula that accomplish what is desired of them, including producing graduates who are literate in science. That seems an excessively optimistic view. Decades of making incremental adjustments in K–12 curricula have not resulted in much advance toward universal science literacy. If incrementalism has not worked, what will? Surely not instant revolution, since the record of radical curricular reform is no more impressive than that of gradual curricular evolution. The central issue is not speed, but how to get a broadly beneficial transformation to occur at all, however long it takes. The traditional way we go about curriculum change is simply not up to the job. Present curriculum design fails to focus on the attainment of specific learning goals, is piecemeal, expects teachers to design curriculum materials, pays little attention to validating learning, and is technologically archaic. Typically, what is done in the name of curriculum design is to modify slightly the large elements that are already there—by adding units and topics to existing courses (sometimes subtracting, but not often), changing teaching materials and teaching methods, and altering the rules governing the paths that students take through the curriculum. Thought of as adjustments made to improve a curriculum, such changes may make good sense individually, but they still leave unattended the need to create a basic configuration of subjects and courses in the first place. There must be alternatives to the piecemeal approach. The one presented in this chapter is to design curriculum by selecting and configuring large curriculum components called blocks, almost necessarily with the aid of computer software. Imagine there exists a large and diverse inventory of “curriculum building blocks” and a database describing each of these blocks in detail. Given explicit learning goals and constraints and a conception of what the curriculum as a whole should be like, a school district could create its curriculum by choosing and configuring sets of appropriate blocks chosen from the inventory.
Curriculum Blocks
Authors: American Association for the Advancement of Science
Published: August 2022

For millennia, designers of plazas, walls, arches, bridges, and domes have used bricks as their basic construction units. Identical bricks can be arranged in a surprising number of different patterns, and many times more patterns can be created using only a few different kinds of brick. Some aspects of the patterns are essential to the purpose of the structure, whereas other aspects may be merely pleasing. To suit one purpose or another, the bricks can be different in material composition (marble, stone, glass, concrete, metal, plastic, clay, wood), structural properties (size, shape, strength, resilience, durability, response to temperature), appearance (color, transparency, surface texture), and inevitably cost (bare minimum to extravagant). How well the structure will do its basic job depends more on some of these properties than others, but any property may be important in motivating and selling the design. Obviously a designer needs to know what the properties of bricks really are and what features the final design must have. In the 20th century, sad to report, curriculum designers have not been so well blessed. For most of the century, they have had only a few kinds of “bricks” available to them, and those in only two “shapes”—one period, five days a week for one semester and one period, five days a week for one year. To make matters worse, there simply is no agreed-upon set of basic properties to use to describe or talk about curriculum components. For this and other reasons, “honesty in packaging” is rare in the descriptive materials provided by publishers. This chapter supposes that in creating the curriculum equivalent of a brick structure, educators will have access to a large variety of accurate descriptions of bricks in the form of an easily accessible database. After defining what a curriculum block is, the chapter presents a template for describing blocks, some thoughts on how and by whom suitable blocks can be developed, and a brief list of some possible curriculum blocks.
Increasing Curriculum Coherence
Authors: American Association for the Advancement of Science
Published: August 2022

In many school districts, the subjects making up a curriculum in any one year rarely have much to do with one another in practice, even if they do in some abstract description of the curriculum. The treatment of a subject in a given year has little to do with its treatment the prior year or with what its treatment will be the following year. Some topics appear year after year at about the same cognitive level and in the same context, whereas some important topics may never show up in any year at all. Perhaps this lack of intellectual and developmental coherence is not surprising since few K-12 curricula have been designed on the basis of a comprehensive, interconnected set of learning goals—not even within subject areas and certainly not across the entire array of subjects. This chapter begins by looking at the idea of curriculum coherence and then goes on to discuss ways in which developmental and intellectual coherence of existing K-12 curricula can be improved. Throughout, the context is science literacy and the examples are mostly taken from the work of Project 2061, but there is no reason to believe that the ideas and procedures would not apply more generally. In the context of this chapter, a coherent curriculum is one that focuses on the relatedness of particular knowledge and skills needed for science literacy, takes developmental considerations into account in deciding on the grade placement of specific learning goals in science, mathematics, and technology, and provides occasions for exploring thematic connections between science-related subjects and other fields. These three aspects of curriculum coherence—literacy goals, developmental sequence, and thematic connections—are discussed below. It is probably true that in every field there is more we would like students to learn than there is time for them to learn—even in the thirteen years from the start of kindergarten to the completion of high school. Surely this is the case with regard to science, mathematics, and technology. Hence great care must be taken to identify a limited set of essential, mutually supportive science-literacy goals to serve as the basis for making curriculum-content decisions.
LONG-TERM PERFORMANCE OF AN OPTICALLY STIMULATED LUMINESCENT SYSTEM FOR DOSE EQUIVALENT HP(10) MEASUREMENT
Authors: Njiki Calvin Didier , Tella Thierry Christian , Ben Bolie Germain H , Beyala Ateba Jean Félix , Simo Augustin , Ebele Yigbedeck Yolande Huguette , Bokwa Ngombo Diane Elsa
Published: August 2022

The performance of an optically stimulated luminescent (OSL) passive dosimetry system named MicroStar reader manufactured by Landauer Inc and acquired in 2011 is assessed in this study. The assessment carried out is based on the results of the intercomparison (IC) exercises organised by the International Atomic Energy Agency in 2013 and 2021. The IC results show that this OSL reader can maintain good performance after long-term usage provided adequate maintenance and calibration operations are carried out. Moreover, this assessment also reveals the importance of using a higher number of measurements per data point for the non-linearity test of the IEC 62387 standard.
Between a Rock and a Hard Place: a Human Rights Assessment of the Fate of Excluded Asylum-seekers and Criminal Refugees in Australia
Authors: Zomignani Barboza Júlia
Published: August 2022

Migrants fearing harm in their own country may benefit from the protection of refugee law. This protection, however, is not extended to those considered undeserving of it, for example, because they committed atrocities in the past, and may be removed from those who become a threat to the host State’s national security. In practice, States need to find solutions for such migrants, who are often failed asylum-seekers or criminal refugees who lost their protection status. In this regard, Australia is infamous for its extensive use of immigration detention, which is frequently applied to such migrants. The country’s practices have stirred much academic debate and gave rise to a multitude of legal cases and legislation changes. This contribution provides a human rights assessment of Australia’s practices towards failed asylum-seekers and criminal refugees, showing that when faced with such migrants, States may adopt measures that violate their international human rights obligations, such as returning them to harm or placing them in indefinite detention. As States are increasingly adopting similar practices, especially regarding the use of immigration detention, this analysis of the Australian context can inform the assessment of these practices anywhere they may be applied.
Hyper-elite network building in Madagascar: amplification or compensatory strategy?
Authors: Rua Linda , Razafindrakoto Mireille , Roubaud François
Published: August 2022

Research has proved that social networks are unevenly distributed. Qualitative and theoretical work on elite networks raises the question: do they amplify or compensate for inequalities in the powerful other resources? We test these hypotheses using a unique dataset of hyper-elites in Madagascar. We identify three network dimensions: extent, quality and effectiveness. We find that elite groups disadvantaged in terms of social position are generally disadvantaged in terms of social networks. In particular, the caste system is still key to network building at the top. Homophily is the dominant bonding dynamic among elites. However, some compensatory mechanisms are in play. Socially disadvantaged elites tend to make more use of their networks. They also have more upwardly heterophilous potential and mobilized networks. The predominance of the elite network’s amplifying role explains the prevalence of the elite reproduction dynamic. Newcomers, who represent a minority, are excluded from the highest decision-making bodies.
Social Workers’ Views of Ways to Engage Communities in Refugee Resettlement
Authors: Dubus Nicole
Published: August 2022

The refugee crisis has been keenly felt by communities as they perceive the new arrivals as threats to the community’s resources. Preparing the community for future arrivals can help, as can involving the community in the welcoming of refugees. This study explores how social workers engage communities to support refugee resettlement programs. Social workers are on the frontlines of providing services to refugees while also managing the fears and needs of the community members. A community that was once welcoming can become reactionary and xenophobic. This is a qualitative study using the content analysis of 32 social workers in four countries: the United States, Iceland, Switzerland, and Germany. Key factors influenced social workers’ facilitation of community integration among new arrivals and community members: prior experiences with displaced populations, social workers’ expectations, and strengths within the community. Social workers need training and support to include communities in resettlement services. Training and policy implications are discussed. Communities can be a partner in the resettlement process if care is given to work with the community before the arrival of new refugees.
Three New Species of Diaporthe Causing Leaf Blight on Acer palmatum in China
Authors: Wan Yu , Li De-Wei , Si Yuan-Zhi , Li Min , Huang Lin , Zhu Li-Hua
Published: August 2022

Diaporthe spp. are often reported as plant pathogens, endophytes, and saprobes. In this study, three new species (Diaporthe foliicola, D. monospora, and D. nanjingensis) on Acer palmatum were described and illustrated based on morphological characteristics and phylogenetic analyses. Phylogenetic relationships of the new species were determined by multilocus phylogenetic analyses based on partial sequences of the internal transcribed spacer (ITS) region, translation elongation factor 1-α (TEF), β-tubulin (TUB), histone H3 (HIS), and calmodulin (CAL) genes. Genealogical concordance phylogenetic species recognition with a pairwise homoplasy index test was used to verify the conclusions of the phylogenetic analyses. All species were illustrated and their morphology and phylogenetic relationships with other related Diaporthe spp. are discussed. In addition, the tests of Koch’s postulates showed that the three new species were pathogens causing leaf blight on A. palmatum.
Predicting Ripe Rot of Grape, Caused by Colletotrichum fioriniae, with Leaf Wetness, Temperature, and the Crop Growth Stage
Authors: Cosseboom Scott D. , Hu Mengjun
Published: August 2022

The role of wetness duration (LWD) and temperature in the development of ripe rot was evaluated with greenhouse grape clusters and detached berries inoculated with Colletotrichum fioriniae. Five classification methods (decision tree, logistic regression, neural network, random forest, and support vector machine) were used to develop environmental risk models for predicting ripe rot from these variables. Additionally, a phenological stage susceptibility model was derived from results of previously published trials. The environmental risk output multiplied by the phenological risk output resulted in the ripe rot disease risk. The models were then tested for their ability to accurately predict the severity of 45 past ripe rot epidemics and were implemented in virtual fungicide application-triggering ripe rot warning systems. In the greenhouse and detached fruit trials, between 27 and 32°C and longer LWD resulted in the highest incidences of ripe rot. The 27°C and 24-h LWD treatment resulted in 100% ripe rot incidence in both greenhouse trials. Four candidate models were proposed for future field efficacy evaluations due to their ability to accurately predict the severity of past ripe rot epidemics while virtually triggering few, an average 2.5 to 3.0, fungicide applications per season. These models could be used to predict ripe rot infection events and inform management decisions for better control with reduced fungicide inputs.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
VNN1 contributes to the acute kidney injury–chronic kidney disease transition by promoting cellular senescence via affecting RB1 expression
Authors: Chen Jia , Lu Hongxiang , Wang Xiaoyue , Yang Jie , Luo Jia , Wang Limin , Yi Xiangling , He Yani , Chen Kehong
Published: August 2022

The mechanisms underlying acute kidney injury (AKI) and chronic kidney disease (CKD) progression include interstitial inflammation, cellular senescence, and oxidative stress (OS). Although vanin‐1 (VNN1) plays an important role in OS, its contribution to the AKI‐CKD transition remains unknown. Here, we explored the roles and mechanisms of VNN1 in the progression of the AKI‐CKD transition. We observed that VNN1 expression was upregulated after ischemia/reperfusion (I/R) injury and high VNN1 expression levels were associated with poor renal repair after I/R injury. In VNN1 knockout (KO) mice, recovery of serum creatinine and blood urea nitrogen levels after I/R injury was accelerated and renal fibrosis was inhibited after severe I/R injury. Furthermore, in VNN1 KO mice, senescence of renal tubular cells was inhibited after severe I/R injury, as assessed by P16 expression and SA‐β‐Gal assays. However, our results also revealed that VNN1 KO renal tubular cells did not resist senescence when OS was blocked. To elucidate the mechanism underlying VNN1‐mediated regulation of senescence during the AKI‐CKD transition, retinoblastoma 1 (RB1) was identified as a potential target. Our results suggest that the reduced senescence in VNN1 KO renal tubular cells was caused by suppressed RB1 expression and phosphorylation. Collectively, our results unveil a novel molecular mechanism by which VNN1 promotes AKI‐CKD transition via inducing senescence of renal tubular cells by activating RB1 expression and phosphorylation after severe renal injury. The present study proposes a new strategy for designing therapies wherein VNN1 can be targeted to obstruct the AKI‐CKD transition.
Economic Evaluation of a Global Reconstructive Surgery Visiting Educator Program
Authors: Luan Anna , Meyers Natalie , Le Thua Trung Hau , Dang Hoang Thom , Phu Quoc Viet , Auten Brieanne , Chang James
Published: August 2022

Objective:

The objective of this study was to quantify the cost-effectiveness and economic value of a reconstructive surgery visiting educator trip program in a resource-constrained setting.

Background:

Reconstructive surgical capacity remains inadequate in low- and middle-income countries, resulting in chronic disability and a significant economic toll. Education and training of the local surgical workforce to sustainably expand capacity have been increasingly encouraged, but economic analyses of these interventions are lacking.

Methods:

Data were analyzed from 12 visiting educator trips and independently-performed surgical procedures at 3 Vietnamese hospitals between 2014 and 2019. A cost-effectiveness analysis was performed using standardized methodology and thresholds to determine cost-effectiveness. Sensitivity analyses were performed with disability weights, discounting, and costs from different perspectives. Economic benefit was estimated using both the human capital method and the value of a statistical life method, and a benefit-cost ratio was computed.

Results:

In the base case analysis, the visiting educator program was very cost-effective at $581 per disability-adjusted life year (DALY) averted. Economic benefit was between $21·6 million and $29·3 million, corresponding to a 12- to 16-fold return on investment. Furthermore, when considering only costs to the organization, the cost decreased to $61 per DALY averted, with a 113- to 153-fold return on investment for the organization.

Conclusions:

Visiting educator programs, which build local reconstructive surgical capacity in limited-resource environments, can be very cost-effective with significant economic benefit and return on investment. These findings may help guide organizations, donors, and policymakers in resource allocation in global surgery.
Persistently Raised Serum Titanium Levels After Spinal Instrumentation in Children
Authors: Cundy Peter J. , Antoniou Georgia , Freeman Brian J.C. , Cundy William J.
Published: August 2022

Study Design.

Prospective study of patients undergoing elective spinal deformity surgery with repeated testing for circulating metal ions including preoperative levels acting as controls.

Objective.

The aim was to determine if levels of particular circulating metal ions are maintained to two years postsurgery including different implant systems and rods.

Summary of Background Data.

Adults having hip replacements, especially metal-on-metal bearings, may develop high metal ion levels. Pediatric spinal implants are known to cause circulating metal ions, notably titanium, chromium, cobalt, and nickel.

Materials and Methods.

Fifty-six children having spinal deformity surgery were studied with repeated testing for circulating metal ions, using high-resolution inductively coupled plasma mass spectrometry. Linear mixed-effects models adjusting for repeated measurements over time were used to analyze levels of titanium, cobalt, chromium, and nickel.

Results.

Titanium levels showed a rapid increase by seven days and a peak at 30 days that was essentially maintained at the two-year assay. At two years, titanium levels were 5.14 times greater compared with the presurgery control level (P<0.0001). Cobalt levels were shown to gradually rise to a peak at 30 days and then slowly decline but remained 1.74 times above mean baseline level at two years (P=0.0004), with a declining trajectory. Chromium and nickel levels rose immediately postoperatively and then steadily declined to baseline by six months and remained at baseline at two years. The five implant systems tested had generally equivalent results.

Conclusion.

The persistent and rising levels of titanium, in a predominantly female population, is concerning. Titanium is known to cross the placental barrier and enter the circulation of the fetus in rodents and humans, and to accumulate in solid organs especially the liver, spleen, heart, and lymph nodes in humans. This potentially exposes the offspring of mothers with spinal implants to titanium, with potential teratogenic effects.
Bowel Preserving Surgery for Diffuse Stricturing Crohn’s Jejunoileitis
Authors: Duraes Leonardo C. , Holubar Stefan D.
Published: August 2022

CASE SUMMARY:

A 31-year-old man Crohn's disease patient, diagnosed 10 years prior, underwent prior ileocolic resection 8 years ago, presented with worsening postprandial abdominal pain, bloating, and weight loss over the past year. He was receiving biologic therapy but had not received corticosteroids recently. Computed tomographic enterography (CTE) revealed multiple multifocal "tandem" strictures with mural hyperenhancement, wall thickening, and luminal narrowing with upstream dilation (pseudosacculation) of the mid-small bowel. Colonoscopy revealed a healthy colon, patent anastomosis, and distal ileal stricture >10 cm proximal to the anastomosis, not able to be traversed endoscopically. He tolerated exclusive enteral nutrition for >2 weeks and was taken for bowel preserving surgery. During the operation the proximal bowel was dilated upstream from the most proximal ileal stricture, and a total of 6 fibrostenotic strictures over a 60-cm segment of mid-ileum were seen. An enterotomy was made at the distal stricture, and a 2-cm steel sphere inserted into the bowel lumen to assess for occult strictures. A total of 6 Heineke-Mikulicz strictureplasties (HMS) were performed; no bowel was resected. The patient recovered on enhanced recovery and was discharged on postoperative day 3; he had no complications at 30-days.
Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery
Authors: Mulkey Malissa A. , Smith Asa B. , Wion Rachel K. , House Sherita L. , Wierenga Kelly L.
Published: August 2022

Background

More than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews. However, a gap in the literature exists regarding how nonpharmacological interventions can mitigate cognitive impairment in adults undergoing cardiac surgery.

Objective

The aim of this study was to explore the effectiveness of nonpharmacological interventions to reduce the detrimental effects of cardiac surgery on cognitive function in patients after cardiothoracic surgery.

Methods

CINAHL, MEDLINE, PubMed, EMBASE, PsycINFO, and Web of Science databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 2011 to February 2022.

Results

Nineteen studies were included in this review. Researchers defined cognitive impairment differently across studies. Various interventions were used to reduce cognitive impairment post cardiothoracic surgery, with the most common being remote ischemic limb conditioning. The interventions used to reduce cognitive impairment were heterogeneous in outcomes, measurements, and time of assessment, but only 2 interventions were associated with a reduction in cognitive impairment.

Conclusions

This review is a unique synthesis of the quality of interventions that address broader components of cognition. Researchers used various interventions to reduce cognitive impairment; the outcomes, instruments, and time interval for measurements were heterogeneous. Researchers should conduct future studies at multiple time intervals, using a comprehensive measure of cognitive impairment to better understand the impact of cognitive impairment interventions postoperatively.
Factors Associated With Symptoms of Prolonged Grief and Psychological Distress Among Bereaved Family Members of Persons Who Died From Sudden Cardiac Arrest
Authors: Carlsson Nina , Årestedt Kristofer , Alvariza Anette , Axelsson Lena , Bremer Anders
Published: August 2022

Background

Death from sudden cardiac arrest implies a stressful and challenging situation for bereaved family members with an increased risk of prolonged grief disorder and psychological distress.

Objectives

The aims of this study were (1) to explore the associations between symptoms of prolonged grief and psychological distress and (2) to identify factors associated with symptoms of prolonged grief and psychological distress among bereaved family members of persons who died from sudden cardiac arrest.

Methods

This cross-sectional survey included bereaved adult family members. Demographic data and measures of prolonged grief (Prolonged Grief Disorder-13), anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and perceived social support (Multidimensional Scale of Perceived Social Support) were analyzed using Spearman’s correlations (rs
) as well as univariate and multiple linear regression analyses.

Results

In total, 108 family members participated. Significant associations between symptoms of prolonged grief, anxiety, depression, and posttraumatic stress were identified (rs
= 0.69–0.79, P < .001). Offered, sought, and/or received professional support from healthcare, lower levels of perceived social support, being a spouse of the deceased, female sex, younger age, and family presence during resuscitation were significantly associated with higher symptom levels of prolonged grief, anxiety, depression, and/or posttraumatic stress.

Conclusions

The results indicate that family members with higher levels of symptoms were offered, sought, and/or received professional support. However, because a minority are offered professional support after deaths from cardiac arrest, future interventions need to proactively identify family members in need of support. Furthermore, perceived social support seems to be an important factor for family members of persons who died from cardiac arrest.
The application of FAPI-targeted theranostics in pancreatic cancer: a narrative review
Authors: Liu Meixi , Hacker Marcus , Huo Li , Li Xiang
Published: August 2022

Pancreatic cancer is one of the most lethal malignancies in the world. Cancer-associated fibroblasts are one of the main components of tumor microenvironment in pancreatic cancer and play an essential role in tumor progression. Fibroblast activation protein that is expressed in specific subtypes of cancer-associated fibroblasts promotes tumor growth and is related to poor survival. Recent researches have preliminarily demonstrated a promising potential of radiopharmaceuticals targeting fibroblast activation protein in diagnosis and therapy of pancreatic cancer. This article comprehensively reviews the current development and clinical translation of fibroblast activation protein inhibitor-targeting radiopharmaceuticals in pancreatic cancer and provides significant perspectives for future investigations.
Potential active compounds and molecular mechanism of Xuefu Zhuyu decoction for atherosclerosis, based on network pharmacology and molecular docking
Authors: Li Yingyun , Liu Boyu , Liu Lin , Xu Qing , Shen Quan , Li Weikang , Zhao Jingshan
Published: August 2022

To explore the potential active compounds and molecular mechanism of Xuefu Zhuyu decoction (XFZYD) in the treatment of atherosclerosis (AS) based on network pharmacology and molecular docking.

The effective components and action targets of XFZYD were screened by using TCMSP database. And then, the action targets of AS were collected by GeneCards database. The intersection targets between the effective components’ targets of XFZYD and AS-related action targets were used to construct PPI networks. GO and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were performed on these intersection targets. Finally, molecular docking software was used to excavate the active compounds of the core targets VEGFA and AKT1.

We detected 225 active components of XFZYD, and found that quercetin, kaempferol, luteolin, naringenin, β-sitosterol, isorhamnetin, stigmasterol, baicalein, nobiletin, and β-carotene are the potential active compounds of XFZYD; STAT3, IL6, JUN, VEGFA, MAPK14, and AKT1 are the core target proteins of the active compounds, among which VEGFA and AKT1 are the key target proteins. PPI network results showed that β-carotene, quercetin, kaempferol, luteolin, and naringenin had higher degree values and more corresponding targets than other 5 active compounds and had the stable binding ability to regulatory proteins VEGFA and AKT1. The core components β-carotene, quercetin, kaempferol, and luteolin exerted their therapeutic effects on AS by acting on the key target proteins VEGFA and AKT1 to regulate fluid shear stress and the AGE-RAGE signaling pathway and IL-17 signaling pathway of diabetic complications of AS. The molecular docking results showed that VEGFA and AKT1 had great docking ability with the targeted active compounds, and β-carotene is the best.

The active components of XFZYD, including β -carotene, quercetin, kamanol, and luteolin, can act on VEGFA and AKT1. These active ingredients play a role in alleviating and treating AS by regulating fluid shear stress and participating in signaling pathways such AS AGE-RAGE of atherosclerosis and diabetes mellitus complicated with AS. β-carotene is a potential inhibitor of VEGFA and AKT1 and treats AS through antioxidant action.
Correlation between goniometric measurements of range of motion and radiographic scores in osteoarthritis knee: An observational study among females
Authors: Al-Mahmood Md. Rashid , Uddin Md. Taslim , Islam Mohammad Tariqul , Fuad Shamim Md , Rahman Shah Tanvir
Published: August 2022

Osteoarthritis (OA) is a chronic degenerative joint disease. Different radiological changes are found according to grades. Range of motions (ROMs) of knee decreases with severity of OA. Women are more sufferer than men in OA knee. Objective was to correlate goniometric ROM with Kellgren-Lawrence (KL) radiographic score of female osteoarthritic knee. The study was a cross-sectional study conducted in Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, from February 2020 to March 2021. According to ACR (American College of Rheumatology) criteria, total 66 patients with primary OA knee were selected and examined in this study. Maximal flexion, extension, and rotation movements were measured by a universal goniometer. X-ray of standing both (A/P and lateral) view and skyline view of knee joint were taken and assessed with KL radiographic scores for medial, lateral, and patellofemoral compartments. Correlations between ROMs and KL scores were analyzed by Pearson correlation test. Among the 66 patients, mean age was 53.59 ± 7.19 years and mean body mass index was 26.62 ± 3.35. Majority (84.8%) of the patients were housewives. Mean maximum flexion was 126.71 ± 4.88°, maximum extension was –3.98 ± 1.74°, and internal and external rotations were 6.38 ± 1.29 and 8.48 ± 1.55°, respectively. More than half of patients had medial compartment KL score 3 or more while KL score 2 was found in 47% and 62.1% patients, respectively, in lateral and patellofemoral compartments. Statistically significant negative correlations were found between range of motion and radiographic scores. Strong correlation was present between maximal flexion and medial compartment score (r = –0.821, P < .001), whereas moderate correlation with other compartments. Extension values were moderately correlated with patellofemoral scores (r = –0.560, P < .001) and weakly correlated with rest of radiographic scores. Internal and external rotation were more related with medial compartment (r= –0.469, P < .001) and lateral compartment scores (r = –0.481, P < .001), respectively, than other compartment scores. There were significant negative correlations between goniometric measurements of knee ROM and radiographic scores in osteoarthritis knee in female patients.
Paroxysmal sympathetic hyperactivity concurrent with hypothalamic injury in a patient with intracerebral hemorrhage: A case report
Authors: Jang Sung Ho , Choi Kyu Hwan
Published: August 2022

Background:

Paroxysmal sympathetic hyperactivity (PSH) is characterized by exacerbated sympathetic discharge following severe brain injury. Here, we reports a patient diagnosed with PSH after ICH concurrent with hypothalamic injury, as demonstrated by diffusion tensor imaging (DTI).

Methods:

A 27-year-old man patient was diagnosed with spontaneous intraventricular hemorrhage and intracerebral hemorrhage in both frontal lobes. Two months after onset, brain magnetic resonance imaging of the brain revealed a leukomalactic lesion in the hypothalamus. Three months after the onset, he presented with intermittent high fever, tachycardia, tachypnea, systolic hypertension, diaphoresis, and aggravated rigidity. Infection was ruled out by a physical examination, laboratory tests, and radiological studies. After administrating morphine and bromocriptine, the clinical manifestations improved dramatically.

Results:

PSH after intracranial hemorrhage concurrent with the hypothalamic injury. Fractional anisotropy and mean diffusivity values of DTI were obtained in the hypothalamus. No significant difference in fractional anisotropy value was observed between the patient and control group (10 age-matched healthy male subjects) (P > .05). On the other hand, the mean diffusivity value was higher in the patient group than in the control group (P < .05), indicating hypothalamic injury.

Conclusion:

PSH concurrent with hypothalamic injury was observed in a patient with stroke. This study suggests that DTI can be a useful imaging method for evaluating the hypothalamic state of patients presenting with PSH after brain injury.