bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-melanogenic activity of salacinol by inhibition of tyrosinase oligosaccharide processing
Authors: Homma Toshiyuki , Kageyama Shigeki , Nishikawa Atsushi , Nagata Kozo
Published: December 2019

Hyperpigmentation that manifests through melasma and solar lentigo (age spots), although mostly harmless for health, bothers many people. Controlling the rate-limiting activity of tyrosinase is most effective for suppressing excessive melanin formation and accordingly recent research has focused on the maturation of tyrosinase. Salacia, a medicinal plant, has been used to treat diabetes in India and Sri Lanka. Salacia extract reportedly contains components that inhibit the activity of α-glucosidase. Salacinol, the active ingredient in Salacia extract, has unique thiosugar sulphonium sulphate inner salt structure. Here, we observed that the salacinol component of Salacia extract possesses anti-melanogenic activity in comparison to various existing whitening agents. Although the anti-melanogenic mechanism of salacinol is presumably medicated by inhibition of tyrosinase activity, which is often found in existing whitening agents, salacinol did not inhibit tyrosinase activity in vitro. Analysis of the intracellular state of tyrosinase showed a decrease in the mature tyrosinase form due to inhibition of N-linked oligosaccharide processing. Salacinol inhibited the processing glucosidase I/II, which are involved in the initial stage of N-linked glycosylation. Owing to high activity, low cytotoxicity and high hydrophilicity, salacinol is a promising candidate compound in whitening agents aimed for external application on skin.
As Seen on TV? How Gatekeeping Makes the U.S. House Seem More Extreme
Authors: Padgett Jeremy , Dunaway Johanna L , Darr Joshua P
Published: December 2019

Today’s news media environment incentivizes gatekeeping practices that lead to a bias toward content containing partisan conflict and ideological extremity. Using a content analysis of 46,218 cable and broadcast television news transcripts from the 109th through 112th Congresses, we examined the frequency with which members of Congress appeared on cable and broadcast news. When we modelled on-air statements by members of Congress as a function of legislator and institutional characteristics, we revealed a gatekeeping function that vastly overrepresents extreme partisans on both sides of the aisle. The effect is largely consistent for network and cable outlets alike, suggesting that gatekeeping processes under both market and advocacy models bias content towards the extreme and conflictual. This finding is particularly important in light of recent evidence linking media-driven misperceptions about polarization to partisan-ideological sorting and negative political affect in the electorate.
Are Fathering Interventions Acceptable to Veterans? A Needs and Preferences Survey
Authors: Primack Jennifer M , Thompson Matthew , Doyle Rachel , Battle Cynthia L
Published: December 2019

Introduction

Military deployments cause stress for both service members and their families. Returning Veterans often report significant trauma exposure, and experience increased stress and mental health problems following deployment. These factors can in turn increase family problems and parenting strain among Veterans who are parents, exacerbating mental health symptoms. Men are generally less likely to seek treatment for mental health problems, and male Veterans, in particular, report lower rates of mental health treatment use. Interventions that target fathering or parenting skills may be more acceptable and less stigmatizing to male Veterans while serving the dual function of improving parental relationships and reducing mental health symptoms. However, it is unclear whether Veteran fathers will engage in these services.

Materials and Methods

As a preliminary evaluation of the acceptability of fathering interventions, 50 returning Veteran fathers completed an anonymous survey designed to assess their needs and preferences regarding this type of service. All procedures were approved by the local Institutional Review Board and Research and Development Committee.

Results

Ninety-eight percent of participants reported experiencing at least one parenting issue either that started postdeployment or that got noticeably worse following postdeployment. The majority (86%) stated that they would be open to participating in a fathering program if offered.

Conclusions

Returning Veteran fathers demonstrate interest in and willingness to participate in fathering programs suggesting that parenting programs may be a way to engage Veterans in mental health care following deployment.
The Effect of Simulated Field Storage Conditions on Dental Restorative Materials for Military Field Use
Authors: Lemon David J , Chen Wen , Smith Trevor , Ford April A , Moffett Steven X , Hoyle Jeffrey T , Hamlin Nicholas J , Hwang Yoon Y
Published: December 2019

Introduction

Dental readiness, one critical component of medical readiness, is adversely impacted by dental emergencies. Many dental emergencies require restorative materials such as glass ionomers, resins, and zinc oxide eugenols to remedy them. The Authorized Dental Allowance List (ADAL) and Authorized Medical Allowance List (AMAL) contain the equipment and materials used by Navy dentists to treat Sailors and Marines. These supplies are subjected to harsh storage conditions on deployments. Much is known about how materials behave when stored at room temperature, but less is known about how their properties are affected after exposure to high temperatures and humidity. We subjected five dental restorative materials to storage in aggravated conditions, and then tested them to determine which products are more robust.

Materials and Methods

Unopened packages of Fuji Triage, Fuji IX GP (both GC America Inc., Alsip, Illinois), TPH Spectra ST Low Viscosity, Intermediate Restorative Material (both Dentsply Sirona, York, Pennsylvania), and Herculite XRV (Kerr Corporation, Orange, California) were exposed to 0, 5, or 10 days’ storage at 30–60°C with 95% relative humidity. After storage in these aggravated conditions, we tested the compressive strength, hardness, elastic modulus, flexural strength, flexural modulus, sorption, and solubility of each material.

Results

The physical properties of all materials were affected by storage in aggravated conditions, though the properties of some materials degraded more than others. Both glass ionomers, Fuji Triage (P = 0.0012) and Fuji IX GP (P = 0.0031), and the composite Herculite XRV (P = 0.0253) lost compressive strength after 5 or 10 days in aggravated conditions. The hardness values for all materials were affected (P < 0.05) by the aggravated conditions, though the elastic modulus of TPH Spectra was not affected (P > 0.05). None of the materials lost flexural strength (P > 0.05) or had changes in their flexural modulus (P > 0.05). The water sorption behavior of Fuji Triage (P = 0.0426) and Fuji IX GP (P = 0.0201) changed after 10 days of aggravated storage, and the solubility of all materials was altered by the harsh conditions.

Conclusion

Some materials degrade more than others in aggravated conditions. Both resin composite materials were more resistant to high temperatures and humidity levels than the glass ionomers tested. These changes in physical characteristics should be considered when reviewing or optimizing the ADAL/AMAL for different projected operational environments.
Addressing Inter-Rater Variability in the ASA-PS Classification System
Authors: Knuf Kayla M , Manohar Crystal M , Cummings Adrienne K
Published: December 2019

Introduction

The American Society of Anesthesiologists’ Physical Status (ASA-PS) Classification System was established to grade a patient’s physical status prior to surgery. The literature shows inconsistencies in the application of the ASA-PS classification among providers. The many uses of the ASA-PS class require reliable ASA-PS class designations between providers. While much literature illustrates the inconsistency, there is limited research on how to improve inter-rater agreement.

Material and Methods

Following an educational intervention targeted at medicine providers, a retrospective chart review was completed to determine the long-term impact of an educational intervention on ASA-PS class agreement among providers of different specialties. To assess the overall agreement between the data sets following the intervention, kappa statistics were calculated for the medicine and anesthesia data sets. These values were compared to the kappa statistics from a similar study completed prior to the educational intervention.

Results

Overall, the kappa score, or agreement, between medicine and anesthesia providers improved from the range generally accepted to indicate slight agreement to the range indicating moderate agreement.

Conclusions

While there was improvement in agreement following an education intervention, the agreement seen was not statistically significant. More research needs to be done to determine how to improve inter-rater reliability of the ASA-PS classification system with a focus on non-anesthesia providers.
Downregulation of PD-L1 via FKBP5 by celecoxib augments antitumor effects of PD-1 blockade in a malignant glioma model
Authors: Yamaguchi Izumi , Nakajima Kohei , Shono Kenji , Mizobuchi Yoshifumi , Fujihara Toshitaka , Shikata Eiji , Yamaguchi Tadashi , Kitazato Keiko , Sampetrean Oltea , Saya Hideyuki , Takagi Yasushi
Published: December 2019

Background

Antitumor therapies targeting programmed cell death-1 (PD-1) or its ligand-1 (PD-L1) are used in various cancers. However, in glioblastoma (GBM), the expression of PD-L1 varies between patients, and the relationship between this variation and the efficacy of anti-PD-1 antibody therapy remains unclear. High expression levels of PD-L1 affect the proliferation and invasiveness of GBM cells. As COX-2 modulates PD-L1 expression in cancer cells, we tested the hypothesis that the COX-2 inhibitor celecoxib potentiates anti-PD-1 antibody treatment via the downregulation of PD-L1.

Methods

Six-week-old male C57BL/6 mice injected with murine glioma stem cells (GSCs) were randomly divided into four groups treated with vehicle, celecoxib, anti-PD-1 antibody, or celecoxib plus anti-PD-1 antibody and the antitumor effects of these treatments were assessed. To verify the mechanisms underlying these effects, murine GSCs and human GBM cells were studied in vitro.

Results

Compared with that with each single treatment, the combination of celecoxib and anti-PD-1 antibody treatment significantly decreased tumor volume and prolonged survival. The high expression of PD-L1 was decreased by celecoxib in the glioma model injected with murine GSCs, cultured murine GSCs, and cultured human GBM cells. This reduction was associated with post-transcriptional regulation of the co-chaperone FK506-binding protein 5 (FKBP5).

Conclusions

Combination therapy with anti-PD-1 antibody plus celecoxib might be a promising therapeutic strategy to target PD-L1 in glioblastoma. The downregulation of highly-expressed PD-L1 via FKBP5, induced by celecoxib, could play a role in its antitumor effects.
Three-Vessel Anastomosis for Direct Bihemispheric Cerebral Revascularization
Authors: Ravina Kristine , Yim Benjamin , Lam Jordan , Strickland Ben A , Carey Joseph N , Russin Jonathan J
Published: December 2019

BACKGROUND

In rare, complex cerebrovascular pathologies, patients may benefit from simultaneous revascularization of multiple arterial territories. Traditional strategies for these situations include the use of more than 1 interposition graft, multiple microvascular anastomoses, vessel reimplantations, and staged procedures.

OBJECTIVE

To improve upon traditional revascularization strategies by describing a novel 3-vessel microvascular anastomosis. This technique combines a side-to-side and an end-to-side anastomoses to facilitate simultaneous direct revascularization of 2 arterial territories in a single procedure, with a single donor vessel.

METHODS

We present an illustrative case of moyamoya angiopathy in which a 3-vessel anastomosis was performed in the interhemispheric fissure to simultaneously directly revascularize bilateral anterior cerebral artery (ACA) territories. A detailed step-by-step depiction of the anastomosis technique is provided. In the presented case, 3-vessel anastomosis was combined with a radial artery fascial flow-through free flap, allowing for an additional indirect revascularization.

RESULTS

Technical execution of the 3-vessel anastomosis was uncomplicated. The patency of the anastomosis providing direct bilateral ACA territory revascularization was demonstrated intra- and postoperatively.

CONCLUSION

With this report, we demonstrate technical feasibility of a novel 3-vessel anastomosis for direct 2 arterial territory revascularization This single-stage approach combines side-to-side and end-to-side techniques and has benefits over traditional revascularization techniques, as it is not deconstructive, requires only a single craniotomy and a single interposition graft, and does not require lengthy recipient artery dissection.
OCCUPATIONAL RADIATION PROCEDURES AND DOSES AMONG NURSES IN SOUTH KOREA
Authors: Jang Mi Ya , Lee Won Jin , Chun Byung Chul , Cha Eun Shil
Published: December 2019

This study investigated occupational radiation procedures and radiation exposures among nurses in South Korea. A total of 530 nurses were surveyed from 2012 to 2013, and the survey data were linked with the dosimetry data. Multiple regression analysis was used to identify the factors associated with radiation dose. The most frequent procedure performed by the nurses was interventional radiology, followed by fluoroscopy and routine X-ray. The average annual effective dose and the cumulative dose were 0.91 mSv and 4.66 mSv, respectively. Characteristics of nurses exposed to high radiation doses were male, completed graduate school or higher, first worked before 2000 and performing interventional procedures, nuclear medicine test and fluoroscopy. Performing nuclear medicine tests and interventional procedures had a significant positive association with high radiation exposure.
Arabidopsis EDR1 Protein Kinase Regulates the Association of EDS1 and PAD4 to Inhibit Cell Death
Authors: Neubauer Matthew , Serrano Irene , Rodibaugh Natalie , Bhandari Deepak D. , Bautor Jaqueline , Parker Jane E. , Innes Roger W.
Published: December 2019

ENHANCED DISEASE SUSCEPTIBILITY1 (EDS1) and PHYTOALEXIN DEFICIENT4 (PAD4) are sequence-related lipase-like proteins that function as a complex to regulate defense responses in Arabidopsis by both salicylic acid–dependent and independent pathways. Here, we describe a gain-of-function mutation in PAD4 (S135F) that enhances resistance and cell death in response to infection by the powdery mildew pathogen Golovinomyces cichoracearum. The mutant PAD4 protein accumulates to wild-type levels in Arabidopsis cells, thus these phenotypes are unlikely to be due to PAD4 over accumulation. The phenotypes are similar to loss-of-function mutations in the protein kinase EDR1 (Enhanced Disease Resistance1), and previous work has shown that loss of PAD4 or EDS1 suppresses edr1-mediated phenotypes, placing these proteins downstream of EDR1. Here, we show that EDR1 directly associates with EDS1 and PAD4 and inhibits their interaction in yeast and plant cells. We propose a model whereby EDR1 negatively regulates defense responses by interfering with the heteromeric association of EDS1 and PAD4. Our data indicate that the S135F mutation likely alters an EDS1-independent function of PAD4, potentially shedding light on a yet-unknown PAD4 signaling function.
Characterization of Alternaria Species Associated with Leaf Spot Disease of Armoracia rusticana in Serbia
Authors: Blagojević Jovana , Vukojević Jelena , Ivanović Borko , Ivanović Žarko
Published: December 2019

Leaf spot diseases caused by Alternaria species have been reported worldwide in plants in the Brassicaceae family. However, there is little information on Alternaria species causing diseases in horseradish. In the present study, 89 Alternaria spp. isolates from Armoracia rusticana, sampled from nine districts in Serbia, were characterized based on their morphology, physiology, and molecular markers. Morphological characterization and molecular analyses based on ITS, GAPDH, Alt a 1, and PM-ATP sequences identified three distinct species associated with the disease: Alternaria brassicae, A. brassicicola, and A. alternata. For all species, growth and sporulation rates at 0, 5, 10, 15, 20, 25, 30, 35, and 40°C showed a quadratic response, with A. alternata having the widest temperature optimum (20 to 30°C) while A. brassicicola had higher optimum temperatures (20 to 25°C) than A. brassicae (15 to 20°C). To gain a better understanding of the pathogenicity of these species, the influence of leaf age, host susceptibility, and ability to infect artificially wounded and nonwounded leaves were tested. The pathogenicity test identified A. brassicicola and A. brassicae as the main causal agents of horseradish leaf spot disease. Results indicated that young and intact leaves of horseradish and cabbage were less susceptible to infection and also suggested the potential for cross-infection between these two hosts. Haplotype networks showed haplotype uniformity for A. brassicae, two haplotype groups of A. brassicicola, and eight haplotype groups of A. alternata in Serbia and suggest the possible association of some haplotypes with the geographic area. This study is the first to investigate Alternaria leaf spot disease on A. rusticana in Serbia and is the first record of A. brassicicola on horseradish in this country.
Eight Colletotrichum Species, Including a Novel Species, Are Associated With Areca Palm Anthracnose in Hainan, China
Authors: Cao Xueren , Xu Xiangming , Che Haiyan , West Jonathan S. , Luo Daquan
Published: December 2019

Genus Colletotrichum is one of the most important genera of plant-pathogenic fungi affecting numerous species, particularly tropical and subtropical crops and fruit trees. In this study, 43 Colletotrichum strains were isolated from areca palm leaves with anthracnose symptoms in 11 areca palm plantations in eight counties of Hainan, China. Based on the morphology, phylogenetic analysis of six loci (internal transcribed spacer, actin, chitin synthase 1, glyceraldehyde-3-phosphate dehydrogenase, β-tubulin, and mating type locus MAT1-2), and pathogenicity tests, eight Colletotrichum species were distinguished, comprising five previously known species (C. cordylinicola, C. fructicola, C. gloeosporioides, C. siamense, and C. tropicale), one unidentified Colletotrichum species, a new species (C. arecicola) in the gloeosporioides species complex, and C. karstii in the boninense species complex. C. siamense was the most common species found in areca palm in Hainan, followed by C. arecicola. Pathogenicity tests showed that all eight species could cause anthracnose symptoms on areca palm leaves using a wound inoculation method and that the isolates from the gloeosporioides species complex caused larger lesions than the isolates from the boninense species complex. Further research is needed to understand the epidemiology of these pathogenic species on areca palm in order to develop management strategies.
Treatment of Hypertrophic Burn and Traumatic Scars With a 2,940-nm Fractional Ablative Erbium-doped Yttrium Aluminium Garnet Laser: A Pilot Study
Authors: Wulkan Adam J. , Rudnick Ashley , Badiavas Evangelos , Waibel Jill S.
Published: December 2019

BACKGROUND

In recent years, fractional ablative lasers at low density have proven to be the centerpiece in a multimodality approach to treating hypertrophic burn scars.

OBJECTIVE

To determine the safety and efficacy of fractional ablative erbium-doped yttrium aluminium garnet (Er:YAG) laser in the treatment of hypertrophic burn scars.

METHODS

Eleven patients received 3 fractional ablative Er:YAG laser to hypertrophic burn scars at 400 to 800 μm, density 11%, no coagulation, and single pass at 4-week intervals.

RESULTS

Overall, average improvement was noted to be 2.27 of 3 as determined by blinded observers. A significant improvement was noted in all measured parameters including dyschromia, atrophy hypertrophy, vascularity, and texture.

CONCLUSION

This is a pilot study showing the safety and efficacy of fractional ablative Er:YAG laser treatment is a safe and effective treatment modality in the treatment of hypertrophic scars.
Update on Direct Oral Anticoagulants in Atrial Fibrillation Patients Undergoing Cardiac Interventional Procedures: From Clinical Trials to Real-World Evidence
Authors: Melillo Enrico , Carbone Andreina , Rago Anna , Papa Andrea A. , D'. Onofrio Antonio , Nigro Gerardo , Golino Paolo , Russo Vincenzo
Published: December 2019

Direct oral anticoagulants (DOACs) are considered a first-line therapy for long-term stroke prevention in patients with nonvalvular atrial fibrillation (AF) and high thromboembolic risk. The potential role of DOACs in cardiac interventional procedures is a pressing clinical question, considering the increasing number of procedures and the growing prevalence of patients in DOAC therapy. The aim of this review is to provide an update on available evidence about the clinical performance of DOACs in AF patients undergoing different interventional procedures (AF cardioversion and ablation, and percutaneous coronary and structural heart disease interventions) and to explore the possible role of DOACs as an alternative therapeutic strategy in cardiac interventional procedures among non-AF patients.
SUSPENDING TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN CASES OF FUTILITY
Authors: Wong David T. , Lambrou George N. , Loewenstein Anat , Pearce Ian , Okada Annabelle A. ,   on behalf of the Vision Academy Steering Committee
Published: December 2019

Purpose:

To provide guidance on the management of patients with neovascular age-related macular degeneration and its subtypes who respond poorly to anti–vascular endothelial growth factor (anti-VEGF) therapy, and to identify cases where suspending anti-VEGF treatment may be warranted.

Methods:

Through a literature review and the combined knowledge and clinical experience of retinal experts, the Steering Committee of the Bayer-sponsored Vision Academy developed an algorithm for determining when to suspend anti-VEGF treatment of neovascular age-related macular degeneration in cases of futility.

Results:

Consideration of factors that may cause suboptimal response to anti-VEGF therapy, such as undertreatment or misdiagnosis of the underlying condition, and factors that may preclude continued treatment, such as injection- or drug-induced complications, is necessary for adjusting treatment protocols in patients who respond poorly to anti-VEGF. If poor response to treatment persists after switching to an alternative anti-VEGF agent and no change in response is observed after withholding treatment for a predetermined period of time (“treatment pause”), anti-VEGF treatment may be considered futile and should be suspended.

Conclusion:

This publication introduces an algorithm to guide the management of neovascular age-related macular degeneration in patients showing poor response to anti-VEGF treatment and provides expert guidance for suspending anti-VEGF treatment in cases of futility.
Ab Interno Trabeculotomy: Key Prognostic Factors
Authors: Kuusniemi Arvi-Matti , Lindbohm Nina , Allinen Pasi , Koskinen Mira , Harju Mika
Published: December 2019

Précis:

The preoperative factors associated with a decreased survival rate of ab interno trabeculotomy (AbIT) perfomed using a Trabectome in open-angle glaucoma were selective laser trabeculoplasty (SLT) performed previously and axial length (AL) over 23.82 mm.

Purpose:

The purpose of this study was to find preoperative factors that predict outcomes of AbIT by a Trabectome.

Materials and Methods:

This retrospective single-center cohort study involved consecutive patients with primary open-angle glaucoma and exfoliation glaucoma treated at Helsinki University Hospital with AbIT with preoperative intraocular pressure (IOP) ≥18 mm Hg and follow-up of at least 1 year. Success was defined as lowering of their IOP by at least 20% from baseline or reduction in glaucoma medications without any rise in IOP above baseline, and no subsequent glaucoma surgery.

Results:

Of the total 72 eyes of 67 patients, 51 eyes had exfoliation glaucoma and 21 had primary open-angle glaucoma. Mean preoperative IOP was 25.2±5.3 mm Hg, with a mean of 3.2±1.2 glaucoma medications. In the multivariable model, a history of preoperative SLT and higher preoperative AL had hazard ratios of 2.99 [95% confidence interval (CI): 1.26-7.10] and 1.53 (95% CI: 1.12-2.09) with statistical significance (P=0.013 and 0.007). The statistically significant cutoff point was 23.82 mm in AL in relation to the success rate, with success times taken into account (P<0.001). AL over 23.82 mm had hazard ratio of 5.75 (95% CI: 2.57-12.87, P<0.001).

Conclusion:

Previous SLT and AL over 23.82 mm reduce survival after AbIT.
Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics
Authors: Marchisio Paola , Bortone Barbara , Ciarcià Martina , Motisi Marco Antonio , Torretta Sara , Castelli Gattinara Guido , Picca Marina , Di Mauro Giuseppe , Bonino Marisa , Mansi Nicola , Varricchio Alfonso , Marseglia Gian Luigi , Cardinale Fabio , Villani Alberto , Chiappini Elena ,   the Italian Panel for the Management of Acute Otitis Media in Children
Published: December 2019

Background:

In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010.

Methods:

The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts.

Results:

The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended.

Conclusions:

The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.
Recurrent Pneumococcal Meningitis Secondary to Nasoethmoidal Meningocele
Authors: Taylor Amanda , van der Meer Graeme , Perry David , Best Emma , Webb Rachel
Published: December 2019

Since the widespread introduction of the conjugate pneumococcal vaccine and subsequent decline of invasive pneumococcal disease in children, a significant proportion of children with pneumococcal meningitis are identified as having an underlying immunodeficiency or predisposing anatomic abnormality. We present 3 cases of recurrent pneumococcal meningitis where detailed neuro-imaging revealed subtle anterior base of skull defects not detected on initial investigations.
Rhinovirus C Is Associated With Severe Wheezing and Febrile Respiratory Illness in Young Children
Authors: Erkkola Riku , Turunen Riitta , Räisänen Kati , Waris Matti , Vuorinen Tytti , Laine Miia , Tähtinen Paula , Gern James E. , Bochkov Yury A. , Ruohola Aino , Jartti Tuomas
Published: December 2019

Background:

Rhinovirus is the most common virus causing respiratory tract illnesses in children. Rhinoviruses are classified into species A, B and C. We examined the associations between different rhinovirus species and respiratory illness severity.

Methods:

This is a retrospective observational cohort study on confirmed rhinovirus infections in 134 children 3–23 months of age, who were enrolled in 2 prospective studies on bronchiolitis and acute otitis media, respectively, conducted simultaneously in Turku University Hospital, Turku, Finland, between September 2007 and December 2008.

Results:

Rhinovirus C is the most prevalent species in our study, and it was associated with severe wheezing and febrile illness. We also noted that history of atopic eczema was associated with wheezing.

Conclusions:

Our understanding of rhinovirus C as the most pathogenic rhinovirus species was fortified. Existing research supports the idea that atopic characteristics are associated with the severity of the rhinovirus C-induced illness.
Blood Perfusion in Rotational Full-Thickness Lower Eyelid Flaps Measured by Laser Speckle Contrast Imaging
Authors: Tenland Kajsa , Berggren Johanna V. , Dybelius Ansson Cu , Hult Jenny , Dahlstrand Ulf , Lindstedt Sandra , Sheikh Rafi , Malmsjö Malin
Published: December 2019

Purpose:

Large upper eyelid defects can be repaired by rotational full-thickness lower eyelid flaps. The aim was to measure the blood perfusion in such flaps, and how it is affected by the length of the flaps, and the degree of rotation and stretching.

Methods:

Nine patients underwent the Quickert procedure for entropion repair in which a full-thickness eyelid flap of approximate width 0.5 cm and length 2 cm was dissected in the lower eyelid. This generates a full-thickness eyelid flap similar to that used to repair large upper eyelid defects. Perfusion was measured using laser speckle contrast imaging, before and after the flap was rotated 90° and 120°, and stretched using forces of 0.5, 1, and 2 N.

Results:

Blood perfusion decreased gradually from the base to the tip of the flap; being 75% of the reference value 0.5 cm from the base, 63% at 1.0 cm, 55% at 1.5, 23% at 1.75 cm, and 4% at 2.0 cm. Rotating the flaps by 90° or 120° had little effect on the perfusion. Stretching reduced the perfusion from 63% to 32% at 2 N, when measured at 1 cm. The combination of stretching and rotation did not lead to any further decrease.

Conclusions:

Blood perfusion in lower eyelid rotational flaps seems to be more sensitive to stretching than to rotation. Provided the flap is no longer than 1.5 cm, the perfusion will be greater than 20%, even when rotated, which should be sufficient for adequate survival and healing.
Orbital Injuries From Self-Inflicted Gunshots: Patterns, Management, and Visual Outcomes
Authors: Elegbede Adekunle , Drogt Carolyn , Wasicek Philip J. , Dunlow Ryan , Gebran Selim , Ngaage Ledibabari M. , Rasko Yvonne M. , Liang Fan , Nam Arthur J. , Grant Michael P.
Published: December 2019

Purpose:

Self-inflicted facial gunshots (SIGSWs) typically result in a spectrum of severe injuries to facial structures, including the orbit and globe. Roughly three-quarters of those who arrive to the hospital will survive their injuries, and recidivism is typically low. Therefore, effective management is paramount to preserve vision, and long-term quality of life. The objective of this study is to characterize the common injuries to the orbit, globe, and periocular structures following SIGSWs, their management, and their eventual visual and reconstructive outcomes.

Methods:

Retrospective review of trauma registry records at a Level 1 trauma center for patients who presented alive following SIGSWs involving the globe and/or orbit from 2007 to 2016.

Results:

Of the 47 patients who presented with SIGSWs to the orbit, 33 (70%) were discharged alive from the hospital. Management strategies for these patients fell into 3 groups, based on the involved structures: i) Open globe injuries (Type I: n = 12, 34%) ii) Orbital fractures with preserved globe and optic nerve (Type II: n = 15, 43%), and iii) Optic nerve injuries with preserved globe (Type III: n = 8, 23%). Compared with Type II and III injuries, patients who had Type I injuries were more likely to die prior to hospital discharge (46% vs. 20% vs. 12%, p = 0.04), undergo ophthalmologic intervention (73% vs. 6% vs. 11%, p = 0.01), and more surgery (6 vs. 3 vs. 0.5 mean surgeries, p < 0.001). Type II injuries most frequently underwent debridement and reconstruction of the bony orbit. Type III and Type I injuries were associated with worse initial and final visual acuity, with the majority (100% and 75%, respectively) having No Light Perception (NLP) on initial exam, and no visual recovery during the follow-up period (median follow up= 25 months).

Conclusions:

Management and visual outcomes of orbital injuries from SIGSWs is determined by whether the globe and optic nerve are preserved. Open globe injury by itself is associated with higher mortality and significant permanent vision loss.
A Rare Catheter Complication in a Patient With Neuroblastoma: Horner’s Syndrome
Authors: Urfalioglu Selma , Acipayam Can , Güler Mete , Sahin Bedia , Kütükcü Meliha Kübra
Published: December 2019

Neuroblastoma is the most common type of extracranial solid tumor during childhood. Clinical presentation includes ipsilateral ptosis, myosis, anhydrosis and enophthalmos. The case of a 2.5-year-old boy who had a complaint of constriction of the left pupil for 3 days is presented. In the physical examination, the pupil of the OD was moderately dilated; there was myosis on the OS and ptosis on the left eyelid. Horner syndrome was considered due to these findings. History of the patient revealed that a central venous catheter insertion procedure was tried from the left side.
Dacryoadenitis Associated With Juvenile Idiopathic Arthritis
Authors: Idowu Oluwatobi O. , Saifee Murtaza , Copperman Thomas S. , Kersten Robert C.
Published: December 2019

A 14-year-old female with juvenile idiopathic arthritis presented with left-sided recurrent painful periorbital swelling of 5 months duration. MRI revealed enlargement of the left lacrimal gland with extensive inflammatory change involving the orbital and periorbital soft tissues. Lacrimal gland biopsy showed evidence of chronic inflammation, and she had intralesional steroid injection at the time of biopsy. She remained asymptomatic at 6-month follow-up visit. Although juvenile idiopathic arthritis is usually related to intraocular inflammation, it may rarely be associated with dacryoadenitis.
Randomized, self-controlled, prospective assessment of the efficacy of mometasone furoate local application in reducing acute radiation dermatitis in patients with head and neck squamous cell carcinomas
Authors: Liao Yao , Feng Gang , Dai Tangzhi , Long Fengjiao , Tang Junfei , Pu Yuanxue , Zheng Xuhai , Cao Sui , Xu Shan , Du Xiaobo
Published: December 2019

Background:

Acute radiation dermatitis (ARD) is a common adverse effect in patients undergoing radiotherapy. Mometasone furoate cream (MMF) was reported to significantly reduce ARD, especially in breast cancer. Clinically, ARD is more critical and more difficult to prevent in patients with head and neck squamous cell carcinoma (HNSCC) than in those with breast cancer, because a higher dose of radiotherapy is required in HNSCC cases. The aim of this study was to evaluate the effect of MMF local application on radiation dermatitis in patients with HNSCC.

Methods:

HNSCC patients scheduled for bilateral radical radiotherapy to the neck with identical radiation doses were enrolled. One side of the neck skin (test groups) of the patients were randomized to apply a thin layer of MMF once a day from the date of first radiotherapy until either 2 weeks after end of radiotherapy or until the test side skin developed ARD lesions, while the other side of neck (control groups) didn’t apply any medication. The severity of ARD was evaluated weekly by using the modified radiation therapy oncology group score, pain intensity, and itch stages.

Results:

Forty-one patients (82 targets) were analyzed. There was a significant difference between the ARD scores on the test side and the control side. MMF reduced the stages of ARD when the radiotherapy dose was <6000 cGY (P = .01) but showed no improvement when the dose was ≥6000 cGY (P = .699). Compared to the control side, local application of MMF significantly reduced the itch and pain scores of the test side skin regardless of the radiotherapy dose and ARD stage (P < .001) during radiotherapy.

Conclusions:

This study showed that MMF inunction after high-dose radiotherapy (>50 Gy) can prevent ARD, especially when the radiation dose is <6000 cGY.
Intoxication with 3-MeO-PCP alone
Authors: Berar Antoine , Allain Jean-Sébastien , Allard Sophie , Lefevre Charles , Baert Alain , Morel Isabelle , Bouvet Renaud , Gicquel Thomas
Published: December 2019

Rationale:

3-Methoxyphencyclidine (3-MeO-PCP) is a new psychoactive substance derived from phencyclidine. Although it can lead to severe intoxications, the main manifestations and optimal management have not been well characterized. Here, we report 2 cases of 3-MeO-PCP intoxication in the same patient, and summarize the manifestations of this intoxication reported in literature.

Patient concerns:

A 17-year-old male purchased a bag of 3-MeO-PCP on the Internet but took an oral dose (200 mg) that corresponds to the less active isomer 4-MeO-PCP. He developed high blood pressure (158/131 mm Hg), tachycardia (100 bpm), and neurological manifestations (confusion, hypertonia, nystagmus, and then agitation). A maculopapular rash appeared, although this may have been related to the administration of midazolam. Hyperlactatemia (2.6 mmol/L) was the main laboratory finding. Seven days later, he returned to the emergency department after sniffing 50 mg of 3-MeO-PCP. High blood pressure, tachycardia, and neurological manifestations (psychomotor impairment and dysarthria) were present but less severe than after the first intoxication.

Diagnosis:

In the first intoxication, the blood and urine 3-MeO-PCP concentrations were, respectively, 71.1 ng/mL and 706.9 ng/mL. Conventional toxicity tests were all negative. In the second intoxication, biological samples were not available.

Interventions:

In the first intoxication, treatment consisted of intravenous hydration and midazolam. The patient was transferred to an intensive care unit for monitoring. After the second intoxication, he was monitored for 12 hours.

Outcomes:

The patient's condition improved quickly in both cases.

Lessons:

These cases provide additional information on the manifestations of 3-MeO-PCP intoxication. These manifestations are mainly cardiovascular (high blood pressure, tachycardia) and neurological. The fact that second (50 mg) intoxication was less severe than the first (200 mg) is suggestive of a dose–effect relationship for 3-MeO-PCP. The first case also emphasizes the risk of dosing errors caused by the similarity between the names “3-MeO-PCP” and “4-MeO-PCP.”
The effect of text message reminders on medication adherence among patients with coronary heart disease
Authors: Zhao Ya-Yun , Dang Fang-Ping , Zhai Tian-Tian , Li Hui-Ju , Wang Rui-Juan , Ren Jing-Jie
Published: December 2019

Background:

To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes.

Methods:

The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software.

Results:

In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07–7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = −6.51; 95% CI −9.79 to -3.23), cholesterol (standard mean difference = −0.26; 95% CI −0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26–1.54).

Conclusion:

TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.
Bilateral ovarian granulocytic sarcoma as the primary manifestation of acute myelogenous leukemia treated with allogenic stem cell transplantation
Authors: Choi Jung Yoon , Kim Hyun-Young , Kang Min Gyu , Shin Jeong Kyu , Lee Won Seop , Song Haa-Na
Published: December 2019

Rationale:

Granulocytic sarcoma (GS), also known as chloroma, is a tumor comprising myeloblasts or monoblasts, potentially occurring as an extramedullary mass. Systemic chemotherapy should be used to induce complete remission. However, such patients with chloroma have a poorer treatment outcome than those without extramedullary myeloid sarcomas.

Patient concerns:

A 30-year-old woman who initially presented with bilateral ovarian masses and splenomegaly was admitted to hospital. Also, her complete blood cell counts showed pancytopenia and blood smear revealed a few immature cells (3%).

Diagnoses:

A bone marrow biopsy demonstrated acute myelomonocytic leukemia, and the chromosomal analysis revealed a 46, XX, del18 (p11) [20] karyotype and cytogenetics and molecular markers showed all negative results.

Interventions:

Since this diagnosis, she received remission-inducing chemotherapy comprising anthracycline and cytarabine, which is a standard regimen for acute myeloid leukemia (AML), and followed by allogenic hematopoietic stem cell transplantation from Human leukocyte antigen (HLA)-identical sibling donor.

Outcomes:

After transplantation, the bone marrow engrafted successfully without complications. She visited our clinic regularly with no evidence of leukemia relapse or graft-versus host disease.

Lessons:

This report represents the first case of ovarian GS, wherein treatment was successful with high-dose chemotherapy, followed by allogenic hematopoietic stem cell transplantation without oophorectomy.
Using non-contrast-enhanced magnetic resonance venography for the evaluation of May-Thurner syndrome in patients with renal insufficiency
Authors: Hsu Yin-Chen , Huang Yao-Kuang , Hsu Li-Sheng , Chen Pang-Yen , Chen Chien-Wei
Published: December 2019

Rationale:

Contrast-enhanced computed tomographic venography (CTV) or magnetic resonance venography (MRV) are usually used to detect May-Thurner syndrome (MTS). However, both are associated with contrast-induced nephrotoxicity. For patients who cannot receive contrast media, non-contrast-enhanced MRV using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative. We report a case of MTS to describe its clinical utility and advantages.

Patient concerns:

A 49-year-old male experienced isolated left leg swelling and pain for half a month. He had a history of chronic renal insufficiency that made contrast-enhanced imaging studies inadequate.

Diagnoses:

A lower extremity venous Duplex scan showed a thrombus extending from the left distal femoral vein to the popliteal vein with valvular reflux, consistent with infrainguinal deep vein thrombosis (DVT). The suprainguinal DVT was evaluated by non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS.

Interventions:

The patient received angioplasty with the implantation of a balloon-expandable stent over the left common iliac vein.

Outcomes:

Excellent recanalization of the left iliac vein was noted postoperatively.

Lessons:

In the evaluation of suprainguinal venous lesions, non-contrast-enhanced MRV presents the venous structure alone at high resolution without the accompanying arterial structure, which makes it an excellent diagnostic imaging tool for MTS. These findings indicate that non-contrast-enhanced MRV could be useful for detecting systemic venous pathologies in patients with renal insufficiency.
Pronation type Galeazzi-equivalent fracture
Authors: Chae Seung Bum , Kwon Jae Bum
Published: December 2019

Rationale:

Galeazzi fractures are uncommon, and are less common in children than in adults. Galeazzi-equivalent fractures, a variant of the classic Galeazzi fractures, mostly occur in children or adolescents. Galeazzi equivalent fractures may commonly accompany distal radial fractures or injury of the epiphyseal plate of the distal ulna.

Patient concerns:

A 13-year-old man visited our emergency department after stumbling over a rock. Manual reduction and splinting was already done in a nearby medical center. Plain radiographs revealed fractures in the distal radius and fracture of the ulnar epiphyseal plate.

Diagnosis:

Plain radiographs showed Galeazzi-equivalent fracture. The result of primary closed reduction was not enough and there was still displacement of fracture.

Interventions:

Anatomical reduction of distal radius was fixed with a plate and screws, and K-wires were inserted percutaneously for reduction and fixation of ulnar fracture.

Outcomes:

Complete bone union was achieved and normal range of motion is shown 2 years postoperatively. The patient is able to perform daily activities and sport activities without any signs of ulnar growth arrest.

Lessons:

Open reduction is required in patients with malalignment, failure to reduce the DRUJ or maintain its reduction, or older ages which are hard to expect sufficient bone remodeling.