bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Health Aspects of Information Technology
Authors: Nallapula Kishan , Pumariega Andres J.
Published: June 2023

Information technology has permeated every single aspect of social life in the current age. Access to information through different forms of media is an indispensable part of daily life. Sharing information instantly and in real time with many people has changed human communication patterns since the advent of social media and smartphones in the first decade of the twenty-first century. This chapter presents an overview of how these new patterns have impacted mental health in terms of pathology, access to care, and treatment. Advances in videoconferencing technology have certainly improved provision of high-quality mental health treatment to rural areas. Smartphone applications have tremendous value in the process of obtaining real-time data about symptoms and also processing them for easy review during the appointments. They can also be utilized to assist treatment, especially for psychotherapy. Research is underway to screen individuals’ mental status by how they interact with their smartphones.
Imaging of Central Nervous System Tumors
Authors: Garg Shobhit Kumar , Jain Rajan
Published: June 2023

The updated 2016 WHO classification of central nervous system (CNS) tumors and the increasing use of molecular markers to define biological behavior, prognosis, and therapy of CNS tumors has led to rapid changes in neuro-oncologic imaging. These molecular markers have become more important than histology in predicting prognosis and treatment response of certain tumors like gliomas, ependymomas, and medulloblastomas. Imaging is therefore constantly evolving to help predict these tumors and molecular markers preoperatively. This chapter reviews conventional and advanced magnetic resonance imaging (MRI) phenotypes of gliomas and other CNS tumors with a focus on radiogenomics. The authors also discuss imaging in assessment of treatment response in brain tumors.
Meningioma
Authors: Kaley Thomas J.
Published: June 2023

Meningiomas are the most common primary brain tumors and many are found incidentally on imaging performed for alternative reasons. However, meningiomas span a spectrum of illness that also includes symptomatic meningiomas and more aggressive treatment-refractory meningiomas. Despite advances in oncologic treatments, surgery remains the mainstay of therapy, with radiation considered in specific circumstances. Despite best surgical and radiation management, some patients will require further treatment for recurrence, but chemotherapy options are limited. Improved treatments for aggressive meningiomas are needed, which will require a worldwide collaborative effort as these patients are rare. A comprehensive understanding of the presentation, imaging characteristics, natural history, and treatment options is essential to the optimal management of these patients.
Neurologic Complications in Cancer Patients
Authors: Peters Katherine B.
Published: June 2023

Cancer patients are likely to experience neurological complications. These complications can develop due to the underlying illness or treatments, whether from direct extension of cancer into the nervous system, through a paraneoplastic disorder, or through complications of cancer therapeutics. Cancer patients are susceptible to neurological complications at the time of diagnosis, during the treatment course, and in the survivorship period. It is critical to identify neurological complications quickly in order to mitigate further morbidity and ultimately mortality. Even as therapeutics evolve from radiation therapy to cutting edge immunotherapies, toxicities continue to challenge the central and peripheral nervous system. Being aware of neurological complications that can develop in cancer patients allows providers to offer the best care. This chapter highlights the direct complications caused by cancer. The author discusses paraneoplastic disorders in cancer patients and neurological complications of chemotherapy, radiation therapy, and immunotherapy.
The Neurofibromatoses
Authors: Song Kun-Wei , Plotkin Scott R.
Published: June 2023

The neurofibromatoses include neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis. These are genetically distinct tumor suppressor syndromes with increased incidence of central and peripheral nervous system tumors and an autosomal dominant inheritance pattern. It is important to recognize these syndromes in order to provide optimal clinical care and guide genetic counseling for patients and their families. NF1 is caused by pathogenic variants in the NF1 gene, NF2 by pathogenic variants in the NF2 gene, and schwannomatosis by pathogenic variants in SMARCB1 and LZTR1 genes. These disorders have both tumor and non-tumor manifestations but this chapter’s discussion focuses on the oncologic manifestations. NF1 patients are predisposed to neurofibromas, gliomas, pigmented lesions, and bony abnormalities. NF2 patients are predisposed to schwannomas, meningiomas, and ependymomas. SWN predisposes to multiple schwannomas and, less commonly, meningiomas. The neuro-oncologist should understand the genetics, diagnosis, common tumor manifestations, and management of these complex patients.
Procedures and Well-Care Clinics in Neuro-Oncology
Authors: Leese Erika N. , Callela Alyssa , Gatson Na Tosha N.
Published: June 2023

Advanced practice provider (APP)-led procedural and well-care clinics in neuro-oncology are underutilized even though these clinics provide increased APP autonomy and leadership opportunities along with improved standardization of patient care. Common procedures in neuro-oncology include lumbar puncture and Ommaya reservoir access (for cerebral spinal fluid collection or intrathecal chemotherapy administration), ventriculoperitoneal shunt and vagal nerve stimulator interrogation and reprogramming. Well-care clinics typically involve non-acute patient assessments for those on chemotherapy or active surveillance, or they serve those with general complaints and cancer-related neurologic symptoms. These APP-led clinics also allow for increased physician patient-facing time in the non-procedural setting and potentially more time for physician’s administrative duties. Providers in these clinics must be trained to readily identify common therapeutic or procedural side effects, absolute and relative contraindications to therapies, and other common non-neurologic conditions in cancer patients that could result in poorer outcomes. They provide opportunities to escalate or de-escalate care, implement further diagnostic testing, refer to subspecialties, and facilitate communication between all providers involved in patient care. Assessments in these clinics offer opportunities for APPs to build patient and caregiver rapport as they gather important information related to symptom management, medication tolerance, and social work and respite needs. The overarching objective of these clinics is to promote quality survival. This chapter discusses specific clinical procedures and the role and value of APPs in neuro-oncology clinics.
Palliative Care, Rehabilitation, and Supportive Care in Neuro-Oncology
Authors: Mohamud Jamal , Nevel Kathryn S.
Published: June 2023

Palliative care is defined as a multidisciplinary approach oriented toward improvements in quality of life, reduction of symptom burden, and prevention of suffering in patients facing life-limiting conditions. This is of considerable importance in individuals with neuro-oncological diseases given the high symptom burden and disease-related mortality these patients often face. This chapter examines the role of palliative care in neuro-oncology throughout the course of treatment and at the end-of-life (EOL) phase. Palliative care discussions should occur early in the disease course and involve multiple parties, including the patient and caregivers, primary healthcare provider, and dedicated palliative care specialist. Headache, nausea, seizures, and fatigue are among the most prevailing symptoms experienced that can be best addressed with aggressive supportive care measures. Severe debilitation is a common consequence of neuro-oncologic malignancies and the treatments used to combat them, causing drastic physical, cognitive, and psycho-social distress to patients and caregivers. Rehabilitation constitutes a significant portion of the palliative care approach; the goals of rehab should be congruent with expectations of patients’ overall care. This chapter also discusses palliative care strategies in managing patients in the EOL phase.
Neurologic Complications of Critical Illness
Authors: Wijdicks Eelco F.M.
Published: June 2023

Consults in the intensive care unit to evaluate and manage acute neurologic clinical problems are usually of considerable complexity. This comprehensive book will assist the neurologist to recognize and treat complex neurological complications in critically ill patients admitted to medical, surgical, trauma, and transplant intensive care units. Every chapter provides a representative selection of the state-of-the-art management in the intensive care unit, necessary for an understanding of critical care medicine. It offers practical advice on how to best deal with coma after cardiopulmonary resuscitation, failure to awaken after surgery, delirium, new-onset seizures, generalized weakness, acute paraplegia, movement disorders, and many other manifestations of a neurologic emergency. Other topics include neurologic complications after organ transplantation; spinal cord injury after thoracoabdominal surgery; neurologic complications of invasive procedures and devices; complications from cardiac surgery; traumatic brain, spine, and peripheral nerve injury; and less common environmental injuries such as hypothermia and near-drowning. This book also addresses end-of-life care and the responsibilities of the consulting neurologist.
Indications for a Neurologic Consult in the Intensive Care Unit
Authors: Wijdicks Eelco F.M.
Published: June 2023

Critical illness increases the probability of a neurologic complication. There are many reasons to consult a neurologist in a critically ill patient, and most often it is altered content or alertness. Other common clinical neurologic problems facing the intensive care specialist and consulting neurologist in everyday decisions are failure to awaken, newly perceived asymmetry, or an abnormal movement. Generally speaking, consultations may have a varying catalogue of complexity and involve close management of major acute brain injury. This chapter introduces the main principles and scope of this field. An argument can be made to involve neurointensivists or neuro hospitalists in these complicated consults.
Neurologic Complications of Cancer in the ICU
Authors: Wijdicks Eelco F.M.
Published: June 2023

The prognosis of neurologic complications in cancer likely differs from any other medical complication. However, similarities exist during the first days of admission to the intensive care unit (ICU), and these patients are not easily distinguishable from any others. The current ICU management approach to the cancer patient is daily assessment of the severity of organ failure. This paradigm shift over the past decade has resulted in more neurologic consultations in patients with hematological and systemic oncological malignancies. This chapter describes the complications of cancer immunotherapy and paraneoplastic encephalitis; many of these patients present with uncontrolled seizures, agitation, or a decline in consciousness.
Neurologic Complications of Traumatic Brain Injury
Authors: Wijdicks Eelco F.M.
Published: June 2023

Severe traumatic brain injury (TBI) is triaged either to a neurosciences intensive care unit (ICU) or a surgical ICU. Triage is determined by the additional presence of rapidly evolving systemic trauma. Polytrauma relates to two or more injuries, among which at least one injury or the sum of all injuries is life-threatening. Neurologist are often called in to prognosticate after weeks of uncertainty and surgical interventions. In an ideal collaborative environment, patients with polytrauma should be seen not only by trauma surgeons, but also by neurosurgeons and consulting neurointensivists and neurohospitalists. Many patients with severe TBI will develop a clinically relevant neurological worsening during their ICU stay. This chapter provides the latest insights in TBI management including indications for monitoring of intracranial pressure
Outcome of Acute Injury to the Central Nervous System
Authors: Wijdicks Eelco F.M.
Published: June 2023

Prognostication in acute neurologic is very difficult and rarely precise. Precision in determining outcome would be preferred, and the finite resources of the intensive care unit should not be used for patients with neurologic disorders that are inevitably disastrous. Neurologists should identify what degree of disability can be expected in any neurologic catastrophe, although in some situations outcome studies are either conflicting or simply not available, and categorical statements about outcome may be unfounded. This chapter may serve as a reference guide for management decisions in the most important categories of major injury to the CNS.
Forensic Psychiatry
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate
Published: June 2023

This second edition of Forensic Psychiatry covers the clinical, legal, and ethical issues for the treatment of mentally disordered offenders for all of the United Kingdom and Republic of Ireland jurisdictions. Written by an expert interdisciplinary team from the fields of both law and psychiatry, this is a comprehensive and up-to-date guide which includes clinical observations, guidance, and ethical advice across the psychiatric discipline. The title has been updated with expanded topics on developmental disorders, neuroscience and its use in legal settings, human rights law, dementia, and traumatic brain injury. New legal cases have also been incorporated to reflect changes in legislation, including but not limited diminished responsibility, deprivation of liberty, and automatism. There are also new parts on forensic psychotherapy, cross-cultural diagnostic validity, and radicalisation. Alongside practical advice on managing clinical and legal situations, the Handbook provides concise examples, summaries of relevant legislation, and introductions to different ethical approaches and clinical observations. Uniquely focusing on the interface between psychiatry and law, this title is essential reading for the forensic psychiatrist.
Risk management
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate
Published: June 2023

This chapter begins with the general principles of risk management in the secure setting, then goes on to detail the practical management of violence and acute behavioural disturbance. It also covers specific situations that require tailored risk management, such as hostage situations, the risk of suicide and self-harm, problematic sexual behaviour, and absconding and escape. It closes with how to work with the police and other non-health agencies.
Criminal law
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate
Published: June 2023

This chapter begins with an overview of the criminal justice process and the elements of a crime, then goes on to the mental elements of a crime, capacity and criminal responsibility, and who is party to an offence. It covers justifications and partial defences, before going on to outline individual offences. These include homicide, assault, sexual offences, arson and criminal damage, public order offences, acquisitive offences, juvenile offences, terrorism, treason, stalking, and also other defences relevant to psychiatry. It then briefly covers some crimes under international law. The second part of the chapter covers sentencing, including its principles, cautions and warnings, differences for children and young people, the differences between life, indeterminate, and death sentences, determinate prison sentences, community sentences, fines, ancillary orders, and final quasi-punishments.
Mental health and mental capacity law
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate
Published: June 2023

This chapter begins with the historical developments that put mental health and capacity law into context, then moves on to the relationship to other areas of law. It describes the principles, and the roles of professionals and relatives. It goes on to explain the procedures for using civil powers, and civil admission for treatment. Consent to treatment, leave from hospital, civil community treatment, and after-care. The chapter then details police powers under mental health law, court-ordered pre-sentence assessment and sentence of treatment, alongside other court orders. Transfer from prison to treatment is included, with restriction orders, then appeals against treatment and detention is outlined. The subsequent section outlines human rights law, the European Convention of Human Rights, misuse of mental health law, and finishes with mental capacity laws.
Giving evidence
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate
Published: June 2023

This chapter provides a clear, practical overview to giving evidence. It covers preparation that should be undertaken, modes of addressing the court, and specific pitfalls to be aware of. Presenting evidence is different areas, including oral evidence, to a criminal court, for a mental health tribunal, to the Parole Board, civil courts and tribunals, and inquests, are all covered.
Civil law cases
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán
Published: June 2023

This chapter provides eight cases that cover civil law cases as they pertain to the forensic psychiatrist, along with guiding questions on how to consider the case at hand. The cases include clinical negligence in prison suicide, the right to disclose clinical information to third parties, personal injury by nervous shock and PTSD, battery and negligence in the prison setting, the capacity to make a will with a depressive illness, the fitness to parent and assessing the risk to a child, the rules of evidence in family proceedings, and presenting evidence at the Medical Practitioners Tribunal Service. Clinical, legal, clinico-legal, ethical issues are discussed for each of the eight cases.
An Introduction to Clinical Trials
Authors: Cook Jonathan A.
Published: June 2023

Clinical trials are medical experiments on humans and are used to improve healthcare. This book provides a short and accessible introduction to the history, principles, and practices of clinical trials. It presents the why, what, when, and how of clinical trials. Furthermore, it makes clinical trials and the thinking behind them accessible to a wide audience. The book begins with an introduction to the history and development of modern clinical trials. Subsequent chapters address trial design, randomisation, how to choose the sample size, setting the study up, running the study including recruitment and data collection and monitoring, conducting the statistical analysis, and finally the reporting and dissemination of the study findings.
Conducting a clinical trial
Authors: Cook Jonathan A.
Published: June 2023

This chapter discusses the practical considerations of conducting a clinical trial. How to oversee the running of a clinical trial including possible management structures, how to find potential participants, the recruitment process, and how to respond to practical and unexpected problems are covered. The importance of maintaining study documentation and getting study centres ready to recruit is considered. Protocol deviations and serious breaches of good clinical practice or the trial protocol are discussed along with potential implications. Strategies to improve recruitment of participants and retention of them within the study to the end of follow-up and optimising data collection processes are considered.
Analysing a clinical trial
Authors: Cook Jonathan A.
Published: June 2023

The basic principles behind the statistical analysis of a clinical trial, and randomised trials in particular, are considered in this chapter. The statistical approach is considered along with the choice of statistical method, and how data should be used. Three example trials are used for the common outcome types of binary, continuous and time to event outcomes to illustrate how to analyse trial data. Key related aspects which need to be considered (such as dealing with missing data, non-compliance and multiplicity of analyses) are also covered. How to come to an overall interpretation is addressed and considered using the example trials.
The mHz quasi-regular modulations of 4U 1630−47 during its 1998 outburst
Authors: Zhao Q C , Yin H X , Tao L , Yang Z X , Qu J L , Zhang L , Zhang S , Qiao E L , Bu Q C , Zhao S J , Li P P , Huang Y M , Ma R C , Tang R J , Jin P , Yu W , Liu H X , Huang Y , Ma X , Xiao J Y , Zhang X , Zhao K
Published: June 2023

We present the results of a detailed timing and spectral analysis of the quasi-regular modulation (QRM) phenomenon in the black hole X-ray binary 4U 1630−47 during its 1998 outburst observed by the Rossi X-ray Timing Explorer (RXTE). We find that the ∼50–110 mHz QRM is flux dependent, and the QRM is detected with simultaneous low-frequency quasi-periodic oscillations (LFQPOs). According to the behaviour of the power density spectrum, we divide the observations into four groups. In the first group, namely behaviour A, LFQPOs are detected, but no mHz QRM. The second group, namely behaviour B, a QRM with frequency above ∼88 mHz is detected and the ∼5 and ∼7 Hz LFQPOs are almost overlapping. In the third group, namely behaviour C, the QRM frequency below ∼88 mHz is detected and the LFQPOs are significantly separated. In the fourth group, namely behaviour D, neither QRM nor LFQPOs are detected. We study the energy dependence of the fractional rms, centroid frequency, and phase lag of QRM and LFQPOs for behaviour B and C. We then study the evolution of QRM and find that the frequency of QRM increases with hardness, while its rms decreases with hardness. We also analyse the spectra of each observation, and find that the QRM rms of behaviour B has a positive correlation with $F_{\rm power\ law}$/$F_{\rm total}$. Finally, we give our understanding for this mHz QRM phenomenon.
Second-generation protoplanetary discs around evolved binaries: a high-resolution polarimetric view with SPHERE/IRDIS
Authors: Andrych Kateryna , Kamath Devika , Kluska Jacques , Van Winckel Hans , Ertel Steve , Corporaal Akke
Published: June 2023

Binary post-asymptotic giant branch (post-AGB) stars are products of a poorly understood binary interaction process that occurs during the AGB phase. These systems comprise a post-AGB primary star, a main-sequence secondary companion and a stable circumbinary disc. Studying the structure and properties of these circumbinary discs is crucial for gaining insight into the binary interaction process that governs post-AGB binaries as well as comprehending the disc’s creation, evolution, and its interaction with the post-AGB binary system. We aim to use near-infrared polarimetric imaging to investigate the morphology and potential substructures of circumbinary discs around eight representative post-AGB binary stars. To achieve this, we performed polarimetric differential imaging in H and Y bands using the high-angular resolution capabilities of the European Southern Observatory-Very Large Telescope/SPHERE-Infra-Red Dual-beam Imaging and Spectroscopy instrument. We resolved the extended circumbinary disc structure for a diverse sample of eight post-AGB binary systems. Our analysis provided the first estimates of the disc scale height for two of the systems: IW Car and IRAS 15469–5311. We also investigated the morphological differences between the full discs (with the inner rim at the dust sublimation radius) and transition discs (which are expected to have larger inner cavities), as well as similarities to protoplanetary discs around young stellar objects. We found that the transition discs displayed a more intricate and asymmetric configuration. Surprisingly, no correlation was found between the overresolved flux in near-infrared interferometric data and the polarimetric observations, suggesting that scattering of light on the disc surface may not be the primary cause of the observed overresolved flux component.
Emerging Roles of FHY3 and FAR1 as System Integrators in Plant Development
Authors: Zheng Yanyan , Sun Yanzhao , Liu Yang
Published: June 2023

FAR-RED ELONGATED HYPOCOTYL3 (FHY3) and its homolog FAR-RED-IMPAIRED RESPONSE1 (FAR1) are transcription factors derived from transposases essential for phytochrome A–mediated light signaling. In addition to their essential role in light signaling, FHY3 and FAR1 also play diverse regulatory roles in plant growth and development, including clock entrainment, seed dormancy and germination, senescence, chloroplast formation, branching, flowering and meristem development. Notably, accumulating evidence indicates that the emerging role of FHY3 and FAR1 in environmental stress signaling has begun to be revealed. In this review, we summarize these recent findings in the context of FHY3 and FAR1 as integrators of light and other developmental and stressful signals. We also discuss the antagonistic action of FHY3/FAR1 and Phytochrome Interating Factors (PIFs) in various cross-talks between light, hormone and environmental cues.
CONSTANS interacts with and antagonizes ABF transcription factors during salt stress under long-day conditions
Authors: Du Jiancan , Zhu Xiang , He Kunrong , Kui Mengyi , Zhang Juping , Han Xiao , Fu Qiantang , Jiang Yanjuan , Hu Yanru
Published: June 2023

CONSTANS (CO) is a critical regulator of flowering that combines photoperiodic and circadian signals in Arabidopsis (Arabidopsis thaliana). CO is expressed in multiple tissues, including seedling roots and young leaves. However, the roles and underlying mechanisms of CO in modulating physiological processes outside of flowering remain obscure. Here, we show that the expression of CO responds to salinity treatment. CO negatively mediated salinity tolerance under long-day (LD) conditions. Seedlings from co-mutants were more tolerant to salinity stress, whereas overexpression of CO resulted in plants with reduced tolerance to salinity stress. Further genetic analyses revealed the negative involvement of GIGANTEA (GI) in salinity tolerance requires a functional CO. Mechanistic analysis demonstrated that CO physically interacts with 4 critical basic leucine zipper (bZIP) transcription factors; ABSCISIC ACID-RESPONSIVE ELEMENT BINDING FACTOR1 (ABF1), ABF2, ABF3, and ABF4. Disrupting these ABFs made plants hypersensitive to salinity stress, demonstrating that ABFs enhance salinity tolerance. Moreover, ABF mutations largely rescued the salinity-tolerant phenotype of co-mutants. CO suppresses the expression of several salinity-responsive genes and influences the transcriptional regulation function of ABF3. Collectively, our results show that the LD-induced CO works antagonistically with ABFs to modulate salinity responses, thus revealing how CO negatively regulates plant adaptation to salinity stress.
Oxytocinergic modulation of speech production—a double-blind placebo-controlled fMRI study
Authors: Vogt Charlotte , Floegel Mareike , Kasper Johannes , Gispert-Sánchez Suzana , Kell Christian A
Published: June 2023

Many socio-affective behaviors, such as speech, are modulated by oxytocin. While oxytocin modulates speech perception, it is not known whether it also affects speech production. Here, we investigated effects of oxytocin administration and interactions with the functional rs53576 oxytocin receptor (OXTR) polymorphism on produced speech and its underlying brain activity. During functional magnetic resonance imaging, 52 healthy male participants read sentences out loud with either neutral or happy intonation, a covert reading condition served as a common baseline. Participants were studied once under the influence of intranasal oxytocin and in another session under placebo. Oxytocin administration increased the second formant of produced vowels. This acoustic feature has previously been associated with speech valence; however, the acoustic differences were not perceptually distinguishable in our experimental setting. When preparing to speak, oxytocin enhanced brain activity in sensorimotor cortices and regions of both dorsal and right ventral speech processing streams, as well as subcortical and cortical limbic and executive control regions. In some of these regions, the rs53576 OXTR polymorphism modulated oxytocin administration–related brain activity. Oxytocin also gated cortical-basal ganglia circuits involved in the generation of happy prosody. Our findings suggest that several neural processes underlying speech production are modulated by oxytocin, including control of not only affective intonation but also sensorimotor aspects during emotionally neutral speech.
Financial Health of Local Governments: A Gender Approach
Authors: Guillamón María-Dolores , Ríos Ana-María , Cuadrado-Ballesteros Beatriz
Published: June 2023

In recent years, public sector research has developed a line related to women’s participation in government and its effect on public finances. In this vein, this article attempts to empirically analyze the effect women’s presence in local governments has on municipal financial health. For that, we use a sample of the 140 Spanish municipalities with more than 50,000 inhabitants during the period 2008–2018 and we create four indicators that refer to cash, budgetary and service-level solvency, as well as a global index that represents the municipal financial health. Our empirical results show that municipalities with a female mayor and with higher percentages of women in the council tend to have higher levels of these ratios. This supports the view that the entrance of women into the traditionally male-dominated public sphere could benefit governments’ financial health.
Cardiovascular Effects of Cannabinoids
Authors: Wang Andy , Dey Subo , Subhan Sarah , Patel Jay , Frishman William H. , Aronow Wilbert S.
Published: June 2023

Marijuana is now one of the most widely used substances in the United States that has been rising in prevalence given increasing legalization and recreational and medical usage. Despite its widespread use, there have been increasing concerns regarding the cardiovascular safety of marijuana. Recent studies have found a link between marijuana use and the development of cardiovascular disease. Most notably, marijuana has been found to be associated with various cardiac complications, including atherosclerosis, myocardial infarction, stroke, cardiomyopathy, arrhythmia, and arteritis. Given these growing concerns, this article seeks to examine the effects and significance of marijuana on cardiovascular health.
Results of a National Survey on the Definition of Surgical Site Infections After Mohs Micrographic Surgery
Authors: Hanly Ailish M. , Daniel Vijaya T. , Mahmoud Bassel H.
Published: June 2023

BACKGROUND

There is no standardized definition of surgical site infections (SSI) after Mohs micrographic surgery (MMS) used in the clinical or research settings, which may contribute to heterogeneity in the differences in infection rates reported.

OBJECTIVE

To use an electronic survey of Mohs surgeons across the country to better understand how Mohs surgeons define SSI after MMS.

METHODS

A web-based survey was developed and distributed to Mohs surgeons. Respondents were asked to respond to several different scenarios that could represent SSI after MMS.

RESULTS

Of potential 1,500 respondents, 79 (5.3%) responded to the survey. Presentation of a surgical site with warmth, swelling, erythema, and pain at 7 days postoperatively resulted in 79.7% consensus of SSI. Surgical sites that were cultured and found to be Staphylococcus aureus-positive resulted in 100% agreement of SSI. There was no consensus regarding timing after MMS.

CONCLUSION

There is consensus on numerous aspects of SSI after MMS among Mohs surgeons, which may allow for development of standardized definition in the future.
Unanswered questions on coronary artery graft patency and clinical outcomes
Authors: Harik Lamia , Sandner Sigrid , Gaudino Mario
Published: June 2023

Purpose of review

To review current issues related to coronary artery graft patency and outcomes.

Recent findings

The association of coronary artery graft patency with clinical outcomes is a traditional concept; however, it has been challenged by the results of numerous studies. Key limitations of the existing evidence include the lack of a universal definition of graft failure, the absence of systematic imaging in contemporary coronary artery bypass grafting trials, the reliance on observational data with inherent selection and survival bias, and high attrition rates for follow-up imaging. Key modulators of graft failure, and of the relationship between graft failure and outcomes, include the type of conduit and myocardial territory grafted, conduit harvesting technique, and postoperative antithrombotic regimen and patient sex.

The relationship between graft failure and clinical events is complex and variable. Overall, the preponderance of current data suggests a possible association between graft failure and nonfatal clinical events.
Monitoring treatment with cardiac myosin inhibitors in symptomatic obstructive hypertrophic cardiomyopathy
Authors: Chatur Safia , Hegde Sheila M.
Published: June 2023

Purpose of review

Cardiac myosin inhibitors (CMIs) represent a major milestone in the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy. The objective of this review is to discuss the mechanisms of action, clinical trial evidence, safety profile and monitoring of CMIs, which are important to the implementation of these drugs in clinical practice.

Recent findings

Mavacamten and aficamten have both been shown to substantially improve left ventricular outflow tract gradients, biomarkers and symptoms in patients with obstructive hypertrophic cardiomyopathy. Both agents are well tolerated with few adverse events in clinical trial follow up. Transient reductions in left ventricular ejection fraction may be associated with both mavacamten and aficamten but respond to dose reduction.

There is now robust clinical trial evidence base to support the use of mavacamten for patients with symptomatic obstructive hypertrophic cardiomyopathy. Generation of long-term safety and efficacy data and exploring applications of CMI to nonobstructive cardiomyopathy and heart failure with preserved ejection fraction represent important next steps.
First-trimester serum antiphosphatidylserine antibodies serve as candidate biomarkers for predicting pregnancy-induced hypertension
Authors: Li Yan , Niu Yue , Liu Mingxi , Lan Xiangxin , Qin Rencai , Ma Kongyang , Zhao Hong-Jin
Published: June 2023

Objective:

The aim of this study was to explore whether antiphosphatidylserine (aPS) antibodies play roles in the early prediction of pregnancy-induced hypertension (PIH).

Methods:

The serum levels of different isotypes of aPS antibodies were compared in women diagnosed with PIH (PIH group, n = 30) and 1 : 1 matched normotensive controls (control group, n = 30). All patients underwent frozen embryo transfer (FET) cycles, and all serum samples were collected during 11–13 weeks of gestation. Receiver operating characteristic (ROC) curves were drawn to analyze the predictive values of aPS antibodies for PIH.

Results:

The women who developed PIH after FET had higher serum optical density values (450 nm) of aPS immunoglobulin (Ig) A (1.31 ± 0.43 vs. 1.02 ± 0.51, P = 0.022), aPS IgM (1.00 ± 0.34 vs. 0.87 ± 0.18, P = 0.046), and aPS IgG (0.50 ± 0.12 vs. 0.34 ± 0.07, P < 0.001) compared with the normotensive controls. The serum concentration of total IgG [48.29 ± 10.71 (g/dl) vs. 34.39 ± 11.62 (g/dl), P < 0.001] was also higher in the PIH group compared with that in the control group. The aPS IgG alone [area under the curve (AUC): 0.913, 95% confidence interval (CI): 0.842–0.985, P < 0.001] and the combined analysis of aPS IgA, aPS IgM, aPS IgG, and total IgG (AUC: 0.944, 95% CI: 0.888–1.000, P < 0.001) had high predictive values for PIH.

Conclusion:

Serum aPS autoantibody levels during the first trimester of pregnancy are positively associated with the development of PIH. Further validation is needed to clearly identify the distinct contributions and underlying mechanisms for diagnostic applications of aPS autoantibodies in PIH prediction.
Development of a Model to Identify Febrile Children at Low Risk for Multisystem Inflammatory Syndrome
Authors: Lubell Tamar R. , Gorelik Mark , Abel Dori , Fischer Avital M. , Apfel Gabriel , Ryan Katherine , Wang Tian , Anderson Brett R. , Farooqi Kanwal M. , Dayan Peter S.
Published: June 2023

Objectives

The case definition for multisystem inflammatory syndrome in children (MIS-C) is broad and encompasses symptoms and signs commonly seen in children with fever. Our aim was to identify clinical predictors that, independently or in combination, identify febrile children presenting to the emergency department (ED) as low risk for MIS-C.

Methods

We conducted a retrospective single-center study of otherwise healthy children 2 months to 20 years of age presenting to the ED with fever and who had a laboratory evaluation for MIS-C between April 15, 2020, and October 31, 2020. We excluded children with a diagnosis of Kawasaki disease. Our outcome was an MIS-C diagnosis defined by the Centers for Disease Control and Prevention criteria. We conducted multivariable logistic regression analyses to identify variables independently associated with MIS-C.

Results

Thirty-three patients with and 128 patients without MIS-C were analyzed. Of those with MIS-C, 16 of 33 (48.5%) had hypotension for age, signs of hypoperfusion, or required ionotropic support. Four variables were independently associated with the presence of MIS-C; known or suspected SARS CoV-2 exposure (adjusted odds ratio [aOR], 4.0; 95% confidence interval [CI], 1.4–11.9) and the following 3 symptoms and signs: abdominal pain on history (aOR, 4.8; 95% CI, 1.7–15.0), conjunctival injection (aOR, 15.2; 95% CI, 5.4–48.1), and rash involving the palms or soles (aOR, 12.2; 95% CI, 2.4–69.4). Children were at low risk of MIS-C if none of the 3 symptoms or signs were present (sensitivity 87.9% [95% CI, 71.8–96.6]; specificity 62.5% [53.5–70.9], negative predictive value 95.2% [88.3–98.7]). Of the 4 MIS-C patients without any of these 3 factors, 2 were ill-appearing in the ED and the other 2 had no cardiovascular involvement during their clinical course.

Conclusions

A combination of 3 clinical symptoms and signs had moderate to high sensitivity and high negative predictive value for identifying febrile children at low risk of MIS-C. If validated, these factors could aid clinicians in determining the need to obtain or forego an MIS-C laboratory evaluation during SARS-CoV-2 prevalent periods in febrile children.
Median and Ulnar Nerve Compressions: Simplifying Diagnostics and Surgery at the Elbow and Hand
Authors: Hagert Elisabet , Curtin Catherine
Published: June 2023

Learning Objectives:

After studying this article, the participant should be able to: 1. Understand the anatomy of the median and ulnar nerves. 2. Perform clinical examination of the upper limb. 3. Analyze examination results to diagnose level of nerve compression.

Numbness and loss of strength are common complaints in the hand surgery clinic. Two nerves that are commonly entrapped (median and ulnar nerves) have several potential sites of entrapment, and in busy clinical practice, the less common sites may be overlooked, leading to wrong or missed diagnoses. This article reviews the anatomy of the median and ulnar nerves, provides tips to assist the busy clinician in diagnosis of site of entrapment(s), and discusses how to simplify surgery. The goal is to help the clinician be as efficient and accurate as possible when evaluating the patient with numbness or loss of strength in their hand.
Novel Diagnostic Imaging Approach for Patients With Spontaneous Coronary Artery Dissection
Authors: Safiullah Zaid N. , Latina Jacqueline M. , Ziogos Efthymios , Harb Tarek , Schindler Thomas H. , Valenta-Schindler Ines , Alavi Abass , Gerstenblith Gary , Leucker Thorsten M.
Published: June 2023

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed etiology of acute coronary syndrome in women. Accurate diagnosis remains challenging but is imperative for treatment and prevention. We show here the utility of 18F-FDG PET imaging in SCAD diagnosis. We present 1 representative case of 4 women with suspected SCAD on coronary angiography from the EVACS (Evolocumab in Acute Coronary Syndromes) clinical trial. 18F-FDG PET imaging showed acute inflammation in the distribution of the suspected dissected coronary artery identified on angiography. Localized myocardial inflammation identified on 18F-FDG PET imaging can aid in diagnosing SCAD suspected on coronary angiography.
Synchronous Treatment of Breast Cancer Hepatic Metastases by Transarterial Radioembolization and Radiofrequency Thermoablation
Authors: Perrone Elisabetta , Moretti Roberto , Indovina Luca , Iezzi Roberto , Zagaria Luca
Published: June 2023

In a 51-year-old woman affected by breast cancer, hepatic recurrence of disease was managed by concurrent 90Y-labeled glass microsphere embolization (transarterial radioembolization) and radiofrequency thermoablation. Intention-to-treat target, candidate to radioembolization, was in the IV hepatic segment; another lesion, managed with radiofrequency thermoablation, was in the VI–VII hepatic segment. Concomitant correction of a duodenocephalopancreatic shunting was performed as well. Thermoablation did not interfere with distribution of 99mTc–macroaggregated albumin and 90Y-labeled microspheres to the target and healthy liver. At our knowledge, this is the first report that combines 2 locoregional procedures in different hepatic segments on the same day.
Promises and pitfalls of imaging-based biomarkers in motor neuron diseases
Authors: Tan Ee Ling , Bede Peter , Pradat Pierre-Francois
Published: June 2023

Purpose of review

Although neuroimaging in motor neuron diseases (MNDs) continues to generate important novel academic insights, the translation of novel radiological protocols into viable biomarkers remains challenging.

Recent findings

A multitude of technological advances contribute to the success of academic imaging in MND such as the availability of high-field MRI platforms, novel imaging techniques, quantitative spinal cord protocols to whole-brain spectroscopy. International collaborations, protocol harmonization efforts, open-source image analysis suites also fuel developments in the field. Despite the success of academic neuroimaging in MND, the meaningful interpretation of radiological data from single patients and accurate classification into relevant diagnostic, phenotypic and prognostic categories remain challenging. Appraising accruing disease burden over the short follow-up intervals typically used in pharmacological trials is also notoriously difficult.

Although we acknowledge the academic achievements of large descriptive studies, an unmet priority of neuroimaging in MND is the development of robust diagnostic, prognostic and monitoring applications to meet the practical demands of clinical decision-making and pharmacological trials. A paradigm shift from group-level analyses to individual-level data interpretation, accurate single-subject classification and disease-burden tracking is therefore urgently needed to distil raw spatially coded imaging data into practical biomarkers.
Predicting cognitive decline in older people by structural and molecular imaging
Authors: Teipel Stefan , Tang Yi , Boccardi Marina
Published: June 2023

Purpose of review

Availability of possible disease modifying treatments and the recognition of predementia stages of Alzheimer's disease (AD) have raised awareness for the prognostic and predictive role of biomarkers, particularly imaging markers.

Recent findings

The positive predictive value of amyloid PET for the transition to prodromal AD or AD dementia in cognitively normal people is below 25%. Evidence for tau PET, FDG-PET and structural MRI is even more limited. In people with mild cognitive impairment (MCI), imaging markers yield positive predictive values above 60% with moderate advantages for amyloid PET over the other modalities and an added value for the combination of molecular with downstream neurodegeneration markers.

In cognitively normal people, imaging is not recommended for individual prognosis due to lack of sufficient predictive accuracy. Such measures should be restricted to risk enrichment in clinical trials. In people with MCI, amyloid PET and, to a somewhat lesser extent, tau PET, FDG-PET, and MRI yield relevant predictive accuracy for clinical counseling as part of a comprehensive diagnostic program in tertiary care units. Future studies should focus on the systematic and patient-centered implementation of imaging markers in evidence-based care-pathways for people with prodromal AD.
Systolic Blood Pressure and Survival to Very Old Age. Results from the Women’s Health Initiative
Authors: Haring Bernhard , Andrews Chris A. , Hovey Kathleen , Shadyab Aladdin H. , LaCroix Andrea , Martin Lisa Warsinger , Rosal Milagros C. , Kuller Lewis H. , Salmoirago-Blotcher Elena , Saquib Nazmus , Koo Patrick , Laddu Deepika , Stefanick Marcia L. , Manson JoAnn E. , Wassertheil-Smoller Sylvia , LaMonte Michael J.
Published: June 2023

Background

The association between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine survival probabilities to age 90 for various SBP levels among women aged ≥ 65 years with or without BP medication.

Methods

We analyzed blood pressure data from participants in the Women’s Health Initiative (n=16,570) who were aged 65 or older and without history of cardiovascular disease, diabetes or cancer. Blood pressure was measured at baseline (1993-1998) and then annually through 2005. The outcome was defined as survival to age 90 with follow-up until February 28, 2020.

Results

During a follow-up of 18 years, 9,723 (59%) of 16,570 women survived to age 90. The SBP associated with the highest probability of survival was about 120mmHg regardless of age. Compared to an SBP between 110 and 130 mmHg, women with uncontrolled SBP had a lower survival probability across all age groups and with or without BP medication. A 65-year-old women on BP medication with an interpolated SBP between 110 and 130 mmHg in 80% of the first 5 years of follow-up had a 31% (95% confidence interval, 24%, 38%) absolute survival probability. For those with 20% time in range, the probability was 21% (95% confidence interval, 16%, 26%).

Conclusions

An SBP level below 130 mmHg was found to be associated with longevity among older women. The longer SBP was controlled at a level between 110 and 130 mmHg, the higher the survival probability to age 90. Preventing age-related rises in SBP and increasing the time with controlled BP levels constitute important measures for achieving longevity.

Clinical Perspective

What is new ?

The age-related rise in SBP is commonly regarded as inevitable and intensified SBP treatment in older adults is still controversial, as strict BP control in older adults has been related to a higher risk of mortality.

Based on a real-world national cohort, an SBP level below 130 mmHg was associated with the highest survival probability to age 90 years in women with or without BP medication.

The longer the time women had their SBP controlled at ≥ 110 and <130mmHg, the higher the probability of survival to age 90.

What are the clinical implications ?

The age-related BP estimates in conjunction with survival probabilities to age 90 presented clearly emphasize the importance of maintaining well-controlled BP levels even at older age.

Preventive measures and risk factor control to ensure a constant relatively low SBP pattern during ageing are warranted.