bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases
Authors: Hosoya Makoto , Fujioka Masato , Ogawa Kaoru
Published: February 2021

Objectives:

Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis.

Methods:

We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications.

Results:

The average postoperative air–bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed.

Conclusions:

The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.
Changes in Single‐Specialty Postoperative Opioid Prescribing Patterns in Response to Legislation: Single‐Institution Analysis Over Time
Authors: Katz Andrew P. , Misztal Carly , Ghiam Michael K. , Hoffer Michael E.
Published: February 2021

Objectives

To determine changes in the prescriptions of postoperative opioids in response to Florida state legislation restricting the number of days for which these medications could be prescribed to 3 days in most circumstances or 7 days at provider discretion.

Study Design

A retrospective review was performed for all patients undergoing 7 common outpatient otolaryngology surgical procedures.

Setting

Single‐institution academic center in Florida.

Methods

Query of the state’s online prescription drug monitoring program was used to compare prescription habits 3 months before and after the law and then again 1 year later.

Results

A total of 561 patients were identified meeting criteria. The number of days that opioids were prescribed decreased significantly, from 6.42 to 4.48 to 3.03 days. There was a significant decrease in the proportion of patients receiving any postoperative opioid prescription, from 0.80 to 0.52 to 0.32. The total morphine milligram equivalents prescribed decreased from 28.4 before the law to 18.4 at 1 year after.

Conclusions

Legislative restrictions on the length of opioid prescriptions were associated with significant decreases in the proportion of patients receiving any opioids, the number of days that opioids were prescribed, and the total morphine milligram equivalents 3 months after the law went into effect, with even more dramatic changes at the 1‐year time point. We opine that these changes are due to providers learning that many procedures do not require postoperative opioids and therefore increasingly considering and utilizing nonopioid alternatives in this setting.
Systematic Review and Meta‐analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation
Authors: Ho Sandra , Patel Prayag , Ballard Daniel , Rosenfeld Richard , Chandrasekhar Sujana
Published: February 2021

Objective

To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches.

Data Sources

PubMed, Embase, and Web of Science.

Review Methods

An electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded.

Results

The database search yielded 1317 studies; 12 remained after dual‐investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta‐analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6‐dB mean improvement in the change in air‐bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous.

Conclusions

Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.
‘Civilized States’ and Situational Sovereignty: The Dilemmas of Romanian Neutrality, 1914–1916
Authors: Prestia Joseph D.
Published: February 2021

At the 1914 Crown Council, which decided to keep Romania neutral in 1914, former Conservative prime minister Petre Carp offered his succinct and direct opinion about the direction of Romanian foreign policy in the opening days of the Great War. He admonished the Council that, if Romania wanted to remain among the ‘civilized states’ ( statele civilizate) it had to follow Germany and Austria-Hungary into war immediately. The idea of ‘civilized states’ that dominated the remainder of the Crown Council was not merely an intersubjective social construction. It was a legal term of art in fin de siècle international law that could be applied in the real world. It was only the legally-civilized states that enjoyed the full panoply of rights, privileges, and protections under international law.

This is a study of how Romania’s policy-making elite, and Ion I. C. Brătianu’s government, in particular, confronted the challenges of ‘situational sovereignty’. It asserts that, during Romania’s two-year Period of Neutrality (3 August 1914–17 August 1916), Brătianu initially used bilateral conventions as both a method to establish recognition of Romania’s status (or at least a guarantee of territorial integrity) and as a litmus test to determine which (if any) foreign powers recognized Romania as a legal equal. Although he was able to achieve a short-term victory of having an equality clause inserted into the August 1916 political convention with the Entente, it is unclear if that clause could have been durable. Ultimately, Brătianu was trapped between a desire to secure Romania’s recognition through international agreement, but confronted with the reality that Romania’s lack of recognition as a legally-civilized equal meant those very conventions could be unenforceable.
Multimodal ultrasound parameters aided carotid plaque risk stratification in patients with asymptomatic carotid stenosis
Authors: Li Yi , Zheng Shuai , Zhang Jinghan , Wang Fumin , He Wen
Published: February 2021

Background

Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice.

Purpose

To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis.

Material and Methods

A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves.

Results

From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822.

Conclusions

In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.
Haemorrhagic ileal haemolymphangioma: a case report and review of the literature
Authors: Yang Shou-Xing , Zhou Yu-Hui , Zhang Jing , Miao Lei , Zhong Jing-Wei , Wang Wen-Xing , Xu Chang-Long , Cai Zhen-Zhai , Lu Guang-Rong
Published: February 2021

We describe herein a 37-year-old woman with a 2-week history of melena who was eventually diagnosed with ileal haemolymphangioma, a rare benign tumour. Local mucosal congestion and swelling were found through single-balloon enteroscopy, which showed an irregular protuberance approximately 10 cm long, located 3.2 m from the Treitz ligament. We performed a laparoscopic-assisted partial resection of the small intestine combined with intestinal adhesiolysis. According to postoperative pathology, the final diagnosis was ileal haemolymphangioma with haemorrhage.
TRESK background potassium channel modifies the TRPV1-mediated nociceptor excitability in sensory neurons
Authors: Lengyel Miklós , Hajdu Dominika , Dobolyi Alice , Rosta Judit , Czirják Gábor , Dux Mária , Enyedi Péter
Published: February 2021

Background

TWIK-related spinal cord potassium channel (TRESK) background potassium channels have a key role in controlling resting membrane potential and excitability of sensory neurons. A frameshift mutation leading to complete loss of TRESK function has been identified in members of a family suffering from migraine with aura. In the present study, we examined the role of TRESK channels on nociceptor function in mice.

Methods

Calcium imaging was used to investigate the role of TRESK channels in the modulation of the response evoked by transient receptor potential vanilloid 1 (TRPV1) receptor stimulation in dorsal root ganglion neurons. Release of calcitonin gene-related peptide from trigeminal afferents and changes in meningeal blood flow were also measured. Experiments were performed on wild-type and TRESK knockout animals.

Results

Inhibition of TRESK increased the TRPV1-mediated calcium signal in dorsal root ganglion neurons and potentiated capsaicin-induced increases in calcitonin gene-related peptide release and meningeal blood flow. Activation of TRESK decreased the capsaicin sensitivity of sensory neurons, leading to an attenuation of capsaicin-induced increase in meningeal blood flow. In TRESK knockout animals, TRPV1-mediated nociceptive reactions were unaffected by pretreatment with TRESK modulators.

Conclusions

Pharmacological manipulation of TRESK channels influences the TRPV1-mediated functions of nociceptors. Altered TRESK function might contribute to trigeminal nociceptor sensitization in migraine patients.
“Because I’ve Got a Learning Disability, They Don’t Take Me Seriously:” Violence, Wellbeing, and Devaluing People With Learning Disabilities
Authors: Wiseman Phillippa , Watson Nick
Published: February 2021

For people with learning disabilities, targeted violence has become routinized. In this article, we seek to explore the impact pervasive victimization has on their experience of community and participation and, through this, their health and wellbeing. People with learning disabilities experience significant inequality in health and wellbeing compared to their non-disabled peers, and the role of violence and victimization remains mostly neglected. By drawing on in-depth qualitative interviews with people with learning disabilities, we argue that abuse, disrespect and devaluing profoundly erode wellbeing. The complex forms of violence experienced by people with learning disabilities are critical to understanding the significant inequalities in health and wellbeing experienced by people with learning disabilities. We focus on community and misrecognition to move the focus from one that examines causation towards one that uncovers the layers of invisibility, and the complex relations that structure experiences from the perspective of people with learning disabilities themselves. By doing this, we locate violence and victimization as health and wellbeing concerns and seek to add a more comprehensive and holistic understanding of the social determinants of health. For the inequalities that structure the lives of people with learning disabilities to be holistically understood, they must be reframed as an issue of social justice, and violence must be identified as a central contributor to these inequalities.
Racial Disparities in Pregnancy-associated Intimate Partner Homicide
Authors: Kivisto Aaron J. , Mills Samantha , Elwood Lisa S.
Published: February 2021

Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention’s National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.
Political Interaction Beyond Party Lines: Communication Ties and Party Polarization in Parliamentary Twitter Networks
Authors: Esteve Del Valle Marc , Broersma Marcel , Ponsioen Arnout
Published: February 2021

A growing body of research has examined the uptake of social media by politicians, the formation of communication ties in online political networks, and the interplay between social media and political polarization. However, few studies have analyzed how social media are affecting communication in parliamentary networks. This is especially relevant in highly fragmented political systems in which collaboration between political parties is crucial to win support in parliament. Does MPs’ use of social media foster communications among parliamentarians who think differently, or does it result in like-minded clusters polarized along party lines, confining MPs to those who think alike? This study analyzes the formation of communication ties and the degree of homophily in the Dutch MPs’ @mention Twitter network. We employed exponential random graph models on a 1-year sample of all tweets in which Dutch MPs mentioned each other ( N = 7,356) to discover the network parameters (reciprocity, popularity, and brokerage) and individual attributes (seniority, participation in the parliamentary commissions, age, gender, and geographical area) that facilitate communication ties among parliamentarians. Also, we measured party polarization by calculating the external–internal index of the mentions. Dutch MPs’ communication ties arise from network dynamics (reciprocity, brokerage, and popularity) and from MPs’ participation in the parliamentary commissions, age, gender, and geographical area. Furthermore, there is a high degree of cross-party interactions in the Dutch MPs’ mentions Twitter network. Our results refute the existence of “echo chambers” in the Dutch MPs’ mentions Twitter network and support the hypothesis that social media can open up spaces for discussion among political parties. This is particularly important in fragmented consensus democracies where negotiation and coordination between parties to form coalitions is key.
Harmonizing child mortality data at disparate geographic levels
Authors: Marquez Neal , Wakefield Jon
Published: February 2021

There is an increasing focus on reducing inequalities in health outcomes in developing countries. Subnational variation is of particular interest, with geographically-indexed data being used to understand the spatial risk of detrimental outcomes and to identify who is at greatest risk. While some health surveys provide observations with associated geographic coordinates (point data), many others provide data that have their locations masked and instead only report the strata (polygon information) within which the data resides (masked data). How to harmonize these data sources for spatial analysis has been previously considered although only ad hoc methods and comparison of methods is lacking. In this paper, we present a new method for analyzing masked survey data, using a method that is consistent with the data-generating process. In addition, we critique two previously proposed approaches to analyzing masked data and illustrate that they are fundamentally flawed methodologically. To validate our method, we compare our approach with previously formulated solutions in several realistic simulation environments in which the underlying structure of the risk field is known. We simulate samples from spatiotemporal fields in a way that mimics the sampling frame implemented in the most common health surveys in low- and middle-income countries, the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. In simulations, the newly proposed approach outperforms previously proposed approaches in terms of minimizing error while increasing the precision of estimates. The approaches are subsequently compared using child mortality data from the Dominican Republic where our findings are reinforced. The ability to accurately increase precision of child mortality estimates, and health outcomes in general, by leveraging various types of data, improves our ability to implement precision public health initiatives and better understand the landscape of geographic health inequalities.
Bilateral Craniofacial Cleft (Tessier Type 4): Case Report and Oculoplastic Reconstruction
Authors: Chahal Harinder S. , Viruni Narine , Patel Rooshil , Glover A. Tyrone
Published: February 2021

Bilateral Tessier type 4 craniofacial clefts are extremely rare and disfiguring malformations with vision-threatening ramifications. To date, there is no consensus in the literature with respect to the ideal surgical technique and management of these patients. Emergent eyelid reconstruction and additional procedures may be required to protect the cornea and avoid further ophthalmic and surgical complications. We present our experience and challenges of managing a case of bilateral Tessier type 4 clefting with an emphasis on oculoplastic considerations.
Laser transmission joining of thermoplastics and thermoset carbon fiber reinforced plastics: Analyzing the occurrence of ablation and pores
Authors: Brodhun J , Dilger K , Hartwig S
Published: February 2021

In this work, laser transmission joining of thermoplastics and thermoset carbon fiber reinforced plastics is analyzed regarding the occurrence of ablation and pores within the interface of the joint. Therefore, the heating behavior of the used carbon fiber reinforced plastics and the ablation of the upper resin layer of the carbon fiber reinforced plastics are characterized, by performing bead on plate welds using a continuous wave fiber laser (µ  ≈  1064 nm) and a scanner optic. The influence of the applied laser-intensity on the ablation threshold is investigated. Additionally, the temperatures before reaching the ablation threshold are measured by an infrared camera to analyze the ablation mechanisms and to derive a process window for the joining process. The findings are validated by creating joints of carbon fiber reinforced plastics and Polyamide 6, evaluating their morphologic characteristics. The results show that the applied laser intensity and the morphological structure of the used carbon fiber reinforced plastics both have a significant influence on the heating behavior, the ablation threshold and the achievable joint characteristics. It was found that large and pore-free joints can be provided when applying low heating rates by using low laser intensities.
Neuromucormycosis of Posterior Tibial Nerve: A Rare Presentation of Mucormycosis
Authors: Tajudeen Muhamed , Shaikh Oseen Hajilal , Gopal Balasubramanian , Dharanipragada Kadambari , Nagarajan Raj Kumar
Published: February 2021

Opportunistic fungal infections are known to occur in immunocompromised patients. Mucormycosis is one of the most common opportunistic fungal infections with significant mortality rates. In this article, we present a case of an adult female, a known diabetic who presented with fever and pus discharge from the amputation site of toes in the left foot with blackening of the foot. Examination revealed gangrenous changes of the left foot with no distal pulses palpable. Computed tomography angiogram revealed no flow of blood in distal vessels of the left lower limb. Left below knee guillotine amputation was done. Intraoperative biopsy of the neurovascular bundle revealed invasive neuromucormycosis. She was started on liposomal amphotericin B. The wound started granulating after a few days with serial dressings and the patient was planned for split skin grafting.
Apathy after stroke: Diagnosis, mechanisms, consequences, and treatment
Authors: Tay Jonathan , Morris Robin G , Markus Hugh S
Published: February 2021

Apathy is a reduction in goal-directed activity in the cognitive, behavioral, emotional, or social domains of a patient’s life and occurs in one out of three patients after stroke. Despite this, apathy is clinically under-recognized and poorly understood. This overview provides a contemporary introduction to apathy in stroke for researchers and practitioners, covering topics including diagnosis, neurobiological mechanisms, associated consequences, and potential treatments for apathy. Apathy is often misdiagnosed as other post-stroke conditions such as depression. Accurate differential diagnosis of apathy, which manifests as reductions in initiative, and depression, which manifests as negative emotionality, is important as it informs prognosis. Research on the neurobiology of apathy suggests that there are few consistent associations between stroke lesion location and the development of apathy. These may be resolved by adopting a network neuroscience approach, which models apathy as a pathology arising from structural or functional damage to brain networks underlying motivated behavior. Importantly, networks can be affected by physiological changes related to stroke, including the acute infarct but also diaschisis and neurodegeneration. Aside from neurobiological changes, apathy is also associated with other negative outcome measures such as functional disability, cognitive impairment, and emotional distress, suggesting that apathy is indicative of a worse prognosis following stroke. Unfortunately, high-quality trials aimed at treating apathy are scarce. Antidepressants may have limited effects on apathy. Acetylcholine and dopamine pharmacotherapy, behavioral interventions, and transcranial magnetic stimulation may be more promising avenues for treatment.
The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity
Authors: Goulart Alessandra C , Olmos Rodrigo Diaz , Santos Itamar S , Tunes Gisela , Alencar Airlane P , Thomas Neil , Lip Gregory YH , Lotufo Paulo A , Benseñor Isabela M
Published: February 2021

Background

Atrial fibrillation is a predictor of poor prognosis after stroke.

Aims

To evaluate atrial fibrillation and all-cause and cardiovascular mortality in a stroke cohort with low socioeconomic status, taking into consideration oral anticoagulant use during 12-year follow-up.

Methods

All-cause mortality was analyzed by Kaplan–Meier survival curve and Cox regression models to estimate hazard ratios and 95% confidence intervals (95% CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, oral anticoagulant use (as a time-dependent variable) and cardiovascular risk factors.

Results

Of 1121 ischemic stroke participants, 17.8% had atrial fibrillation. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with atrial fibrillation (531, IQR: 46–2039) vs. non-atrial fibrillation (1808, IQR: 334–3301), p-log rank < 0.0001). Over 12-year follow-up, previous atrial fibrillation was associated with increased mortality: all-cause (multivariable hazard ratios, 1.82; 95% CI: 1.43–2.31) and cardiovascular mortality (multivariable OR, 2.07; 95% CI: 1.36–3.14), but not stroke mortality. In the same multivariable models, oral anticoagulant use was inversely associated with all-cause mortality (oral anticoagulant time-dependent effect: multivariable hazard ratios, 0.47; 95% CI: 0.30–0.50, p = 0.002) and stroke mortality (oral anticoagulant time-dependent effect ≥ 6 months: multivariable OR, 0.09; 95% CI: 0.01–0.65, p-value = 0.02), but not cardiovascular mortality.

Conclusions

Among individuals with low socioeconomic status, atrial fibrillation was an independent predictor of poor survival, increasing all-cause and cardiovascular mortality risk. Long-term oral anticoagulant use was associated with a markedly reduced risk of all-cause and stroke mortality.
Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion
Authors: Wang Alicia , Zhou Guangwei , Kawai Kosuke , O’Brien Michael , Shearer A. Eliot , Brodsky Jacob R.
Published: February 2021

Background:

Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied.

Purpose:

To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion.

Study Design:

Case-control study.

Level of Evidence:

Level 3.

Methods:

Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness.

Results:

BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13).

Conclusion:

BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients.

Clinical Relevance:

BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.
Counterterrorism and the rule of law in an evolving European Union: plus ça change?
Authors: Mitsilegas Valsamis
Published: February 2021

By taking the European Union (EU) as a principal focal point, this chapter will evaluate critically the rule of law challenges arising from the production and operation of counterterrorism norms. The article will focus on four case studies, two involving the rule of law ex ante (at the stage of adoption of EU law) and two involving the rule of law ex post (looking at its impact). In terms of ex ante rule of law challenges, the chapter will analyse the production of binding standards by the global executive and the trickle-down effect of these standards at the regional, EU and national level and the limits of scrutiny and justification of counterterrorism legislation on emergency grounds. In terms of rule of law ex post, the chapter will examine challenges of counterterrorism law to the principle of legality via over-criminalisation and the adoption of vague and broad definitions of terrorism, as well as challenges to the right to a fair trial and principle of effective judicial protection resulting from state arbitrariness in the mechanism of producing terrorist sanctions. The contribution will question whether the entry into force of the Lisbon Treaty, and the process of constitutionalisation of criminal law it entailed, has made a difference regarding the compliance of EU counterterrorism law with the rule of law.
In vitro models of intestinal epithelium: Toward bioengineered systems
Authors: Creff Justine , Malaquin Laurent , Besson Arnaud
Published: February 2021

The intestinal epithelium, the fastest renewing tissue in human, is a complex tissue hosting multiple cell types with a dynamic and multiparametric microenvironment, making it particularly challenging to recreate in vitro. Convergence of recent advances in cellular biology and microfabrication technologies have led to the development of various bioengineered systems to model and study the intestinal epithelium. Theses microfabricated in vitro models may constitute an alternative to current approaches for studying the fundamental mechanisms governing intestinal homeostasis and pathologies, as well as for in vitro drug screening and testing. Herein, we review the recent advances in bioengineered in vitro intestinal models.
Pediatric subcutaneous treprostinil site maintenance and pain control strategies from the Pediatric Pulmonary Hypertension Network
Authors: Jackson Emma O. , Brown Anna , McSweeney Julia , Parker Claire
Published: February 2021

Pulmonary arterial hypertension is a chronic, progressive, and life‐threatening disease in children with diverse causes of pulmonary arterial hypertension. The most severe cases of pulmonary arterial hypertension require aggressive treatments with systemic administration of continuous prostacyclin therapy, including treprostinil and epoprostenol. The successful use of continuous subcutaneous treprostinil therapy eliminates the need for an indwelling central venous catheter and its associated risks. However, pain at the subcutaneous infusion site, an expected side effect of this therapy, is often a deterrent to its widespread use. Effective subcutaneous treprostinil site maintenance and pain management is essential to achieve success with this therapy, but strategies surrounding site maintenance and pain control vary significantly between pediatric pulmonary hypertension treatment centers. In an attempt to standardize practice, a survey on the use of subcutaneous treprostinil and site maintenance and pain management strategies, as well as its perceived effectiveness, was disseminated to 13 pediatric pulmonary hypertension centers of the Pediatric Pulmonary Hypertension Network. Responses to the survey were collected and analyzed and were developed into a set of formalized strategies to facilitate knowledge sharing and standardization of practice.
When silence is “yeelen” (light): Exploring the corporeality of the mind in a nocturnal solo zikr practice (Odienné, Ivory Coast)
Authors: Chappatte André
Published: February 2021

In the town of Odienné (Ivory Coast), Madou forges his faith in God by performing long sessions of solo zikr (recollection of God) after midnight. This article ethnographically explores the theme of light in this Sufi practice of concentration as an experiential form of being. It first describes how the light and darkness of the penumbra of the night co-initiate what I call “the devotional place” of zikr. Following a phenomenological writing, it then describes how, as hours go by, Madou’s concentration navigates towards “ yeelen” (spiritual light) through the silence of the deep night. In doing so, this article elaborates the “corporeal mind” as synesthetic instants in this journey when the body becomes the mind and the mind faith, as the penumbra becomes silence and silence light. In other words, it explores the sensuous unboundedness of the self that happens in regular and long practice of nocturnal solo zikr. This article therefore offers a corporeal understanding of the light of God among practitioners of prolonged nocturnal solo zikr in West Africa.
Fetal cystic hygroma in the first trimester led to diagnosis of partial trisomy 22
Authors: Phupong Vorapong , Erjongmanee Suchada , Tanbirojn Patau , Lertkhachonsuk Ruangsak
Published: February 2021

Partial trisomy 22 is a rare condition that is found in live birth. In most cases, diagnosis of partial trisomy 22 was made after birth. Herein, we report a prenatal diagnosis of fetal partial trisomy 22 in a 28-year-old pregnant woman presented with fetal cystic hygroma. Structural abnormalities were detected at 16 weeks of gestation: left cleft lip and ventricular septal defect. The G-banding karyotype analysis and fluorescence in situ hybridization showed partial trisomy 22. It is recommended that pregnant women with fetal anomalies should have prenatal genetic diagnosis to ascertain whether the fetus has partial trisomy 22 or other rare chromosomal abnormalities.
Measuring the Efficiency of Football Clubs Using Data Envelopment Analysis: Empirical Evidence From Spanish Professional Football
Authors: Guzmán-Raja Isidoro , Guzmán-Raja Manuela
Published: February 2021

Professional football clubs have a special characteristic not shared by other types of companies: their sport performance (on the field) is important, in addition to their financial performance (off the field). The aim of this paper is to calculate an efficiency measure using a model that combines performance (sport and economic) based on data envelopment analysis (DEA). The main factors affecting teams’ efficiency levels are investigated using cluster analysis. For a sample of Spanish football clubs, the findings indicate that clubs achieved a relatively high efficiency level for the period studied, and that the oldest teams with the most assets had the highest efficiency scores. These results could help club managers to improve the performance of their teams.
Hinduja Brothers: The Edgy Family Business at the Third Generation
Authors: Shukla Hitesh
Published: February 2021

The Hinduja Group, a closely held conglomerate, is among the world’s richest and valued centurion family business. Second-generation brothers are known for fellowship, legacy and togetherness. The four brothers’ sibling partnerships worked successfully for 50 years. They see all businesses as the Hinduja family’s business and not of any individual or any individual branch’s business. The third generation holds the reins and is working closely with the fourth generation. The family has a fortune worth $11.2 billion, which now stands disputed because the letter that all four brothers willingly signed in 2014 is now being contested in a legal battle in 2020. According to the letter, the financial assets of each brother belonged to every other brother and that each of them would appoint the others as their executors. The issue in the Hinduja family came in the light at the cousin’s consortium, when Srichand Hinduja’s daughter Vinoo moved to High Court in England, for the transition of ownership, seeking control of Switzerland-based Hinduja Bank for her family. The Hindujas face the twin threats of embarrassing exposures and a fragmentation of the family fortune at the third generation.
Smell and Taste Impairment in a Nationwide Sample of US Adults With Chronic Rhinosinusitis Symptoms
Authors: Kim James H. , Choi Janet , Jang Sophie S. , Wrobel Bozena B. , Ference Elisabeth H.
Published: February 2021

Objective

To estimate the prevalence of objectively confirmed olfactory and gustatory dysfunction in US adults reporting chronic rhinosinusitis (CRS) symptoms in a nationally representative database.

Study Design

Cross‐sectional epidemiologic analysis.

Setting

Data were analyzed from the smell and taste component of the 2013‐2014 NHANES data set (National Health and Nutrition Examination Survey).

Methods

Individuals reporting the presence of ≥2 cardinal CRS symptoms (nasal blockage, sinus pain, discolored mucus, and dysosmia) were identified as patients with a potential diagnosis of CRS. Associations were examined between the presence of CRS symptoms and both self‐reported and objectively measured smell and taste.

Results

One‐third (33%) of adults who have ≥2 CRS symptoms report subjective olfactory impairment, though only 18% of these adults have quantifiable olfactory dysfunction on objective testing. Of these adults, 27% report subjective taste impairment, but just 17% have quantifiable gustatory dysfunction on objective testing. The presence of ≥2 CRS symptoms was not significantly associated with objective olfactory or gustatory dysfunction, although the individual symptoms of subjective dysosmia and discolored mucus were associated with objectively confirmed olfactory dysfunction.

Conclusion

The prevalence of objective olfactory and gustatory dysfunction was higher among adults reporting the presence of ≥2 CRS symptoms, but the differences were not statistically significant. Specific sinonasal symptoms, including discolored mucus and subjective smell dysfunction, were significantly associated with objective smell impairment.
Role of Interleukin 5 Inhibition in the Treatment of Eosinophilic Otitis Media
Authors: Breslin Nathaniel K. , Heindel N. Hadley , Haberman Rex S.
Published: February 2021

Objective

Eosinophilic otitis media (EOM) is a rare form of middle ear disease characterized by a viscous effusion rich in eosinophils, a resistance to conventional treatments, and an association with bronchial asthma. The relationship between asthma and EOM suggests similarities in pathogenesis and treatment possibilities. Recent biologic therapies, specifically those that target interleukin 5 (IL‐5), have demonstrated efficacy in controlling eosinophil‐driven asthma, yet their impact on the treatment of pathologically similar diseases remains unmeasured. This study identifies patients who have EOM, reviews their otologic clinical course, and investigates the impact of anti‐IL‐5 drugs on chronic ear disease.

Study Design

Retrospective chart review.

Setting

University of Florida Health, an academic medical center.

Methods

A review of 120 patients treated with benralizumab or mepolizumab was performed. Imaging evidence of otomastoiditis was used to identify 9 patients with possible EOM. Two patients were treated with benralizumab, and the remaining 7 received mepolizumab injections.

Results

After starting treatment, 5 patients had complete resolution of middle ear effusions (3 with mepolizumab and 2 with benralizumab); 1 had stable middle ear effusion; and 1 patient’s disease status could not be determined due to a lack of follow‐up. The remaining 2 patients did not have effusions at the time when anti‐IL‐5 therapy was initiated, and they have not relapsed since starting treatment.

Conclusion

EOM is a rare disease that otolaryngologists should include in their differential diagnosis, especially in refractory cases. Anti‐IL‐5 agents show efficacy in treating EOM, and prospective multicenter clinical trials are needed to further characterize the effect of anti‐IL‐5 therapies.
Dynamic angiopoietin-2 assessment predicts survival and chronic course in hospitalized patients with COVID-19
Authors: Villa Erica , Critelli Rosina , Lasagni Simone , Melegari Alessandra , Curatolo Angela , Celsa Ciro , Romagnoli Dante , Melegari Gabriele , Pivetti Alessandra , Di Marco Lorenza , Casari Federico , Arioli Dimitriy , Turrini Fabrizio , Zuccaro Valentina , Cassaniti Irene , Riefolo Mattia , de Santis Elena , Bernabucci Veronica , Bianchini Marcello , Lei Barbara , De Maria Nicola , Carulli Lucia , Schepis Filippo , Gozzi Chiara , Malaguti Silvio , Del Buono Mariagrazia , Brugioni Lucio , Torricelli Pietro , Trenti Tommaso , Pinelli Giovanni , Bertellini Elisabetta , Bruno Raffaele , Cammà Calogero , d’Errico Antonia
Published: February 2021

This study examined the association between dynamic angiopoietin-2 assessment and COVID-19 short- and long-term clinical course. We included consecutive hospitalized patients from 1 February to 31 May 2020 with laboratory-confirmed COVID-19 from 2 Italian tertiary referral centers (derivation cohort, n = 187 patients; validation cohort, n = 62 patients). Serum biomarker levels were measured by sandwich enzyme-linked immunosorbent assay. Lung tissue from 9 patients was stained for angiopoietin-2, Tie2, CD68, and CD34. Cox model was used to identify risk factors for mortality and nonresolving pulmonary condition. Area under the receiver operating characteristic curve (AUROC) was used to assess the accuracy of 3- and 10-day angiopoietin-2 for in-hospital mortality and nonresolving pulmonary condition, respectively. Three-day angiopoietin-2 increase of at least twofold from baseline was significantly associated with in-hospital mortality by multivariate analysis (hazard ratio [HR], 6.69; 95% confidence interval [CI], 1.85-24.19; P = .004) with AUROC = 0.845 (95% CI, 0.725-0.940). Ten-day angiopoietin-2 of at least twofold from baseline was instead significantly associated with nonresolving pulmonary condition by multivariate analysis (HR, 5.33; 95% CI, 1.34-11.77; P ≤ .0001) with AUROC = 0.969 (95% CI, 0.919-1.000). Patients with persistent elevation of 10-day angiopoietin-2 levels showed severe reticular interstitial thickening and fibrous changes on follow-up computed tomography scans. Angiopoietin-2 and Tie2 were diffusely colocalized in small-vessel endothelia and alveolar new vessels and macrophages. Angiopoietin-2 course is strongly associated with COVID-19 in-hospital mortality and nonresolving pulmonary condition. Angiopoietin-2 may be an early and useful predictor of COVID-19 clinical course, and it could be a relevant part of disease pathogenesis. Angiopoietin-2 blockade may be a COVID-19 treatment option.
A novel missense mutation in the gene encoding major intrinsic protein (MIP) in a Giant panda with unilateral cataract formation
Authors: Bai Chao , You Yuyan , Liu Xuefeng , Xia Maohua , Wang Wei , Jia Ting , Pu Tianchun , Lu Yan , Zhang Chenglin , Li Xiaoguang , Yin Yanqiang , Wang Liqin , Zhou Jun , Niu Lili
Published: February 2021

Background

Cataracts are defects of the lens that cause progressive visual impairment and ultimately blindness in many vertebrate species. Most cataracts are age-related, but up to one third have an underlying genetic cause. Cataracts are common in captive zoo animals, but it is often unclear whether these are congenital or acquired (age-related) lesions.

Results

Here we used a functional candidate gene screening approach to identify mutations associated with cataracts in a captive giant panda (Ailuropoda melanoleuca). We screened 11 genes often associated with human cataracts and identified a novel missense mutation (c.686G > A) in the MIP gene encoding major intrinsic protein. This is expressed in the lens and normally accumulates in the plasma membrane of lens fiber cells, where it plays an important role in fluid transport and cell adhesion. The mutation causes the replacement of serine with asparagine (p.S229N) in the C-terminal tail of the protein, and modeling predicts that the mutation induces conformational changes that may interfere with lens permeability and cell–cell interactions.

Conclusion

The c.686G > A mutation was found in a captive giant panda with a unilateral cataract but not in 18 controls from diverse regions in China, suggesting it is most likely a genuine disease-associated mutation rather than a single-nucleotide polymorphism. The mutation could therefore serve as a new genetic marker to predict the risk of congenital cataracts in captive giant pandas.