bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance
Authors: Thom Paul
Published: December 2020

A musical improvisation, as well as the performance of a musical work, can be understood recursively as a sequence of choices and the successful or unsuccessful implementation of those choices in the light of the implementation of previous choices in the sequence. These sequences take on a different character, depending on whether the music is being improvised or performed in accordance with a pre-existing musical work. In both cases there is potential for artistic creation, and potential for showmanship and charlatanry. The paper advocates a philosophical approach to writing about music that is tempered by an acquaintance with musicology, music criticism, empirical research and music history, and that acknowledges the imperfections in the real world of music-making.
Vocal Music
Authors: Jarman Freya
Published: December 2020

Focusing on the popular Christmas carol “Once in Royal David’s City” and its annual performance at the King’s College, Cambridge Festival of Nine Lessons and Carols, this chapter looks to recent developments in the theorization of subjectivity to open up new questions about the nature of vocal music in a communal context. The chapter starts by situating the carol in its various cultural-historical contexts (notably nineteenth-century church music, congregational singing, and Anglicanism), with a view to understanding the nested relationships between tradition and national identity. In so doing, it pays particular attention to the carol’s composition, to its arrangement for the festival in 1919, and to the festival’s continued annual broadcast on BBC radio. The chapter ultimately argues that congregational singing as developed in the nineteenth century mobilises what Anahid Kassabian has called “distributed subjectivity,” so extending that concept beyond the recording technologies that form the focus of Kassabian’s own work.
Expression
Authors: Bonds Mark Evan
Published: December 2020

Expression is a term that has been applied to music in an extraordinarily wide range of senses; philosophers and musicologists alike remain sharply divided on what musical expression is and how it works. This essay gives a historical account of the ways in which music in and of itself—that is, music independent of words—has been regarded as expressive over the past three hundred years by surveying influences spanning Enlightenment theories of rhetoric and the imitation of emotions, Romantic aesthetics of subjectivity and self-expression, and more contemporary versions of contour, arousal, persona, and intransitive theories of expression. This review reveals the lack of a single satisfactory explanatory framework for musical expression, even while confirming musical expression’s enduring importance as “the soul of music.”
Ethnomusicology and Philosophy
Authors: Koskoff Ellen
Published: December 2020

Ethnomusicology is the study of music in human social and cultural life. Closely related today to the discipline of anthropology, its basic method is ethnographic fieldwork. This chapter begins by presenting a history of the field of ethnomusicology, from its earliest beginnings (as comparative musicology) in late nineteenth-century Europe to its present standing as a major music discipline worldwide. The chapter proceeds by providing a critical analysis of current debates, theoretical directions, new practices, and challenges, before concluding with an examination of some important issues affecting the future of ethnomusicology. These include the effects of postmodernism (such as the development of new paradigms foregrounding fragmentation and multiple subjectivities) on the study of music; the rise of various technologies as harbingers of a new formulation of music as simply one category of sound; the effects of globalism on diasporic studies, conceptions of “musical flow,” and the ethics of fieldwork; and, finally, the roles of sameness and difference as organizing principles of ethnomusicological analysis and practice
Society
Authors: Gallope Michael
Published: December 2020

Since the emergence of European aesthetics in the eighteenth and nineteenth centuries, music’s relationship to society has only occasionally been a privileged topic of philosophical discussion. This chapter surveys and compares the work of five key figures in Western philosophy who thought carefully about the relationship between music and society: Plato, Aristotle, Rousseau, Du Bois, and Adorno. Guiding the discussion are two key motifs: imitation, in which music is taken to manifestly resemble various elements or processes in society; and codes, where, at a deeper and more latent level, music is taken to reflect or reveal some kind of obscure social meaning. In the final section, the chapter submits both categories to critique, contending that, while these philosophers’ writings remain highly instructive points of departure, they are of limited use in accounting for the many complex linkages between music and society within the globalized movements of twentieth-century popular music.
Introduction
Authors: McAuley Tomás , Nielsen Nanette , Levinson Jerrold
Published: December 2020

This Introduction shares the rationale behind the decision to produce this Oxford Handbook of Western Music and Philosophy. It pauses to dwell on the field of “music and philosophy” as a more inclusive, interdisciplinary space than the vital but narrower field of the “philosophy of music,” taking the latter as but one part of the former. It also interrogates issues arising from the volume’s focus on “Western” music and philosophy, considering prominent arguments that there is no such thing as Western culture, and asking whether it would have been more appropriate to speak of a Global North. The Introduction also gives an overview of the contents of the volume’s six parts: Mapping the Field, History, Philosophical Traditions and Practices, Musical Traditions and Practices, Key Concepts, and Collisions and Collaborations. It notes both the diversity of the essays within these parts and the gaps in coverage that remain.
Response to Susan McClary: Subjectivities
Authors: Bicknell Jeanette
Published: December 2020

This response to Susan McClary’s essay on music and subjectivities considers two possible understandings of “subjectivities.” In the first section, the response reviews musical subjectivities as personal and individual responses to music. Addressing arguments made by Peter Kivy and Nelson Goodman, it asks how is it possible that similar listeners hear literally different things in the same music? The second section turns to focus on shared and communal responses to music. What different factors are at play when many different listeners respond in the similar ways to the same performance? The main example in this section is Aretha Franklin’s performance at Barack Obama’s presidential inauguration in 2009.
Ancient Greece
Authors: D’Angour Armand
Published: December 2020

This chapter outlines the evidence for musical history in ancient Greece, connecting it to philosophical approaches represented by Plato and others, as well as to recently elucidated documents with Ancient Greek musical notation. Ideas of ethos and mimesis are related to what may be known about the sounds of ancient Greek music as elicited from descriptions, surviving scores, and replicas of instruments such as the aulos (double pipe). The chapter seeks to elucidate the notion of mousikē (‘music’, as derived from the name of Greek divinities Mousai, the Muses) in its cultural context, and to connect elements of ancient musical traditions such as metre and harmonics to contemporary aural and musical realities.
TheDi2/petVariant in thePETALOSAGene Underlies a Major Heat Requirement-Related QTL for Blooming Date in Peach [Prunus persica(L.) Batsch]
Authors: Cirilli Marco , Gattolin Stefano , Chiozzotto Remo , Baccichet Irina , Pascal Thierry , Quilot-Turion B�n�dicte , Rossini Laura , Bassi Daniele
Published: December 2020

Environmental adaptation of deciduous fruit trees largely depends on their ability to synchronize growth and development with seasonal climate change. Winter dormancy of flower buds is a key process to prevent frost damage and ensure reproductive success. Temperature is a crucial environmental stimulus largely influencing the timing of flowering, only occurring after fulfillment of certain temperature requirements. Nevertheless, genetic variation affecting chilling or heat-dependent dormancy release still remains largely unknown. In this study, a major QTL able to delay blooming date in peach by increasing heat requirement was finely mapped in three segregating progenies, revealing a strict association with a genetic variant (petDEL) in a PETALOSA gene, previously shown to also affect flower morphology. Analysis of segregating genome-edited tobacco plants provided further evidence of the potential ability of PET variations to delay flowering time. Potential applications of the petDEL variant for improving phenological traits in peach are discussed.
Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury
Authors: Sobreira Margarida , Almeida Miguel P , Gomes Ana , Lucas Marlene , Oliveira Ana , Marques Alda
Published: December 2020

Objective

The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation.

Methods

Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean.

Results

Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL.

Conclusion

Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI.

Impact

Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.
Comparing Treatment Outcomes between Confirmed and Non-Confirmed Childhood TB Cases: Study from a Major Tertiary Center in Thailand
Authors: Khantee Puttichart , Laoprasopwattana Kamolwish
Published: December 2020

Background

Tuberculosis (TB) in children is challenging to diagnose due to its non-specific symptoms and difficulties in obtaining confirmatory laboratory results. This study aimed to compare the treatment outcomes of confirmed and non-confirmed TB in children.

Methods

The medical records of children aged ≤ 15 years diagnosed with TB at Songklanagarind Hospital from January 2007 to December 2018 were examined. The TB cases were classified into three groups, confirmed cases (positive culture and/or polymerase chain reaction), probable cases (positive histopathological and/or acid-fast bacilli results) and presumptive cases (clinical manifestations and imaging findings compatible with TB and good response to anti-TB drugs but without microbiological confirmation).

Results

Of 177 children, 66 (37.3%) had a confirmed diagnosis, 57 (32.2%) a probable diagnosis, and 54 (30.5%) a presumptive diagnosis. The successful treatment rates of the confirmed, probable and presumptive TB groups were 80.3%, 87.7% and 92.6%, respectively (p = 0.21). Of the 54 presumptive cases, a history of household contact with TB led to a diagnosis of asymptomatic pulmonary TB in 10 (18.5%) cases. Patients with a presumptive diagnosis were less likely to have disseminated and/or miliary TB (1.9% vs. 7.0% of probable vs. 22.7% of confirmed, p < 0.01).

Conclusions

Only one-third of the study patients had a confirmed TB diagnosis. The successful treatment and mortality rates did not significantly differ among the three groups. To increase the detection rate of early diagnosis of childhood TB, physicians should perform active TB contact investigations in household members of the index case.
Evaluating Fungicide Selections to Manage Pythium Root Rot on Poinsettia Cultivars with Varying Levels of Partial Resistance
Authors: Lookabaugh Emma C. , Kerns James P. , Shew Barbara B.
Published: December 2020

Pythium aphanidermatum is the predominant species causing Pythium root rot of commercially grown poinsettia (Euphorbia pulcherrima Willd. ex Kotzch) in North Carolina. Pythium root rot is managed primarily through a combination of sanitation practices and preventative fungicide applications of mefenoxam or etridiazole. Insensitivity to mefenoxam is common but growers continue to rely on it from lack of inexpensive and efficacious alternatives. This research was conducted to identify alternative fungicides for Pythium root rot control and to evaluate their efficacy on poinsettia cultivars with varying levels of partial resistance. Greenhouse studies were conducted to assess efficacy of fungicide treatments in seven poinsettia cultivars inoculated with a mefenoxam-sensitive isolate of P. aphanidermatum. One study examined control with a single fungicide drench made at transplant and a second study examined repeat fungicide applications made throughout the experiment. Treatments containing etridiazole, mefenoxam, fenamidone, and cyazofamid provided control of Pythium root rot across all cultivars in both experiments whereas Fosetyl-al, potassium phosphite, and Trichoderma spp. failed to offer satisfactory control. Azoxystrobin, pyraclostrobin, and propamocarb reduced disease on some cultivars but failed to control Pythium root rot on highly susceptible cultivars. Four isolates of P. aphanidermatum cultured from plants growing in commercial greenhouses were evaluated for in vitro sensitivity to fungicides labeled for Pythium root rot control at four rates. Etridiazole, fosetyl-al, and potassium phosphite completely inhibited mycelial growth, whereas isolates varied in response to mefenoxam, cyazofamid, propamocarb, fenamidone, azoxystrobin, and pyraclostrobin in vitro. Twenty-one additional isolates then were evaluated at label rates of these fungicides. Seven isolates were insensitive to label rates of all three quinone outside inhibitors and one isolate was insensitive to the quinone outside inhibitors and mefenoxam. These results provide guidelines for selecting fungicides to maximize control of Pythium root rot on poinsettia cultivars.
Evidence of Sexual Reproduction Events in the Dagger NematodeXiphinema indexin Grapevine Resistance Experiments Under Controlled Conditions
Authors: Nguyen Van Chung , Khallouk Samira , Polidori Joël , Truch Julia , Portier Ulysse , Lafargue Maria , Tandonnet Jean-Pascal , Ollat Nathalie , Van Ghelder Cyril , Banora Mohamed Youssef , Esmenjaud Daniel
Published: December 2020

The dagger nematode Xiphinema index has a major economic impact because of its transmission of Grapevine fanleaf virus to grapevines. This vector nematode, which was introduced into Western countries from the Middle East together with the domesticated grapevine, mostly reproduces by meiotic parthenogenesis, but microsatellite multilocus genotype (MLG) analysis has revealed the occurrence of rare sexual reproduction events in field conditions. In a previous 6-year study under controlled conditions, we evaluated the durability of resistance to X. index in accessions derived from a muscadine resistance source and reference accessions. In this previous study, we used an equal-proportion mixture of four lines (from Spain, Italy, Greece, and Iran) representative of X. index diversity as the inoculum, and we collected random samples in 3-, 4-, 5-, and 6-year-old vines. Here, we genotyped the individuals from these samples using the MLG technique, and we analyzed the changes in line frequency and the occurrence of sexual reproduction events between lines over time. The nematode lines differed in aggressiveness and hybrids between lines were detected at a low, but apparently increasing rate. Hybridization events were recovered in all accessions, regardless of resistance status and propagation type. Finally, our data provide the first evidence of sexual reproduction in the nematode X. index under controlled conditions.
Integrated mRNA and Small RNA Sequencing for Analyzing Tea Leaf Spot Pathogen Lasiodiplodia theobromae, Under In Vitro Conditions and the Course of Infection
Authors: Jiang Silong , Yin Qiaoxiu , Li Dongxue , Wu Xian , Wang Yong , Wang Delu , Chen Zhuo
Published: December 2020

Lasiodiplodia theobromae is a phytopathogenic fungus, which can cause many different diseases on different crops. The pathogen can cause leaf spot on tea plants (Camellia sinensis), which negatively affects the productivity and quality of tea leaves in tea plantations in Guizhou Province, China. Although the genome sequence of L. theobromae has been published, no data on the transcriptome or small RNA sequences of L. theobromae under in vitro conditions and the course of infection of tea leaf are available. Here, we report the high-quality transcriptome and small RNA sequences of L. theobromae in vitro conditions and the course of infection of tea leaf using the platform of Illumina HiSeq. This comprehensive expression profiling of the fungal pathogen will provide a valuable resource for future research on trait-specific genes of the pathogen, host−pathogen interactions, and disease resistance in the host.
The Effect of Distance Learning on Knowledge Acquisition in Undergraduate Second-Degree Nursing Students: A Systematic Review
Authors: Sinacori Barbara , Williams-Gregory Mona
Published: December 2020

AIM

The aim of the study was to determine the effect of distance learning on knowledge acquisition in undergraduate second-degree nursing students, a growing population of nursing students.

BACKGROUND

Distance learning is a convenient way of attaining professional training.

METHOD

The study was conducted by critical appraisal and data extraction using Joanna Briggs Institute tools for quasi-experimental, qualitative systematic reviews and research synthesis and randomized control research. Risk for bias was determined using the Cochrane collaboration tool.

RESULTS

Eleven studies from five countries are included in the review: four quantitative, two qualitative, one mixed-method, and four integrative review. Dates range from 2015 to 2018.

CONCLUSION

The evidence suggests that knowledge acquisition is not impacted by educational setting alone. Flipped classroom and mixed-method instruction were found to positively impact knowledge acquisition. Distance learning, coupled with traditional face-to-face instruction, has a greater impact on knowledge acquisition than either method alone. Online methodologies improve clinical skill acquisition more than face-to-face instruction.
Using the Four Pillars of FLIP to Implement Flipped Learning in an Undergraduate Nursing Research and Evidence-Based Practice Course
Authors: Sailsman Sonique
Published: December 2020

Nurse faculty teaching undergraduate nursing research and evidence-based practice are challenged to find creative and engaging instructional strategies that have positive learning outcomes. Utilizing the Flipped Learning Network’s Four Pillars of FLIP, an undergraduate nursing research and evidence-based practice course for an accelerated nursing program was transformed from a traditional classroom to a flipped learning model. This article describes active learning strategies used, along with lessons learned for future implementation.
High-Fidelity Simulation Versus Case Study: Which Is Best for Practical Nursing Students?
Authors: Hudson Sue , Penkalski Melissa R.
Published: December 2020

There is a gap in the literature regarding how simulation affects critical thinking skills for practical nursing students. A quasi-experimental two-group pretest-posttest study was conducted to determine the effects of high-fidelity simulation and interactive case studies on critical thinking scores of 29 practical nursing students. Both interventions had significant results (p = .001) between pretest and posttest; however, significance was not found regarding posttest scores between the high-fidelity simulation and interactive case study groups. Identifying pedagogical strategies that increase critical thinking skills for certificate-seeking practical nursing students is necessary to provide excellent nursing care and promote better patient outcomes.
Understanding Contraceptive Needs of Women Who Inject Drugs in Orange County: A Qualitative Study
Authors: Florsheim Orli K. , Augustine Dallas , Van Ligten Megan M. , Thiel de Bocanegra Heike , Perry Rachel
Published: December 2020

Objectives:

Women with opioid use disorder experience higher rates of unintended pregnancy compared with the general US population. Our aim was to examine the factors that may affect access to desired contraception for women who use injection drugs.

Methods:

Using purposive sampling, we conducted semi-structured interviews pertaining to contraceptive use with 14 women ages 18 to 44 who were current users of injection drugs living in Orange County, CA between March and December 2019. Interviews were transcribed, coded, and analyzed using grounded theory.

Results:

Participants discussed logistical barriers, including homelessness and lack of transportation, as well as perceived barriers, such as a belief in the inability to become pregnant while using drugs, that affect access to contraceptive care. Women also discussed the factors that motivate them to use contraception despite these barriers, including the desire for sobriety before becoming pregnant and fear of harming a fetus while using substances. Some participants expressed feeling uncomfortable disclosing substance use to their healthcare providers out of concern for stigmatization. Several points of access for contraceptive care were elucidated, including visits for primary and postpartum care, as well as in carceral spaces. Finally, participants expressed a desire to obtain contraceptive services at a local syringe exchange program due to trusting relationships with providers and increased ease of access.

Conclusions:

Our findings highlight several causative factors for the unmet contraceptive need among women who use injection drugs, and suggest that syringe exchange programs represent a unique access point for the provision of contraceptive care for this population.
Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis*
Authors: Zhang Shan , Han Yuan , Xiao Qian , Li Haibin , Wu Ying
Published: December 2020

Objective:

To evaluate the impact of bundle interventions on ICU delirium prevalence, duration, and other patients’ adverse outcomes.

Data Sources:

The Cochrane Library, PubMed, CINAHL, EMBASE, PsychINFO, and MEDLINE from January 2000 to July 2020. The protocol of the study was registered in International prospective register of systematic reviews (CRD42020163147).

Study Selection:

Randomized clinical trials or cohort studies that examined the following outcomes were included in the current study: ICU delirium prevalence and duration, proportion of patient-days with coma, ventilator-free days, mechanical ventilation days, ICU or hospital length of stay, and ICU or inhospital or 28-day mortality.

Data Extraction:

Using a standardized data-collection form, two authors screened the studies and extracted the data independently, and assessed the studies’ quality using the Modified Jadad Score Scale for randomized clinical trials and the Newcastle-Ottawa Scale for cohort studies.

Data Synthesis:

Eleven studies with a total of 26,384 adult participants were included in the meta-analysis. Five studies (three randomized clinical trials and two cohort studies) involving 18,638 patients demonstrated that ICU delirium prevalence was not reduced (risk ratio = 0.92; 95% CI, 0.68–1.24). Meta-analysis showed that the use of bundle interventions was not associated with shortening the duration of ICU delirium (mean difference = –1.42 d; 95% CI, –3.06 to 0.22; two randomized clinical trials and one cohort study), increasing ventilator-free days (mean difference = 1.56 d; 95% CI, –1.56 to 4.68; three randomized clinical trials), decreasing mechanical ventilation days (mean difference = –0.83 d; 95% CI, –1.80 to 0.14; four randomized clinical trials and two cohort studies), ICU length of stay (mean difference = –1.08 d; 95% CI, –2.16 to 0.00; seven randomized clinical trials and two cohort studies), and inhospital mortality (risk ratio = 0.86; 95% CI, 0.70–1.06; five randomized clinical trials and four cohort studies). However, bundle interventions are effective in reducing the proportion of patient-days experiencing coma (risk ratio = 0.47; 95% CI, 0.39–0.57; two cohort studies), hospital length of stay (mean difference = –1.47 d; 95% CI, –2.80 to –0.15; four randomized clinical trials and one cohort study), and 28-day mortality by 18% (risk ratio = 0.82; 95% CI, 0.69–0.99; three randomized clinical trials).

Conclusions:

This meta-analysis fails to support that bundle interventions are effective in reducing ICU delirium prevalence and duration, but supports that bundle interventions are effective in reducing the proportion of patient-days with coma, hospital length of stay, and 28-day mortality. Larger randomized clinical trials are needed to evaluate the impact of bundle interventions on ICU delirium and other clinical outcomes.
An update on the role of long non-coding RNAs in psoriasis
Authors: Song Jian-Kun , Yin Shuang-Yi , Li Wei , Li Xiao-Dong , Luo Yue , Luo Ying , Xing Meng , Li Bin , Kuai Le
Published: December 2020

Increasing evidence suggests that long non-coding RNAs (lncRNAs) are of vital importance for various biological processes, and dysregulation of lncRNAs is frequently associated with various diseases such as psoriasis. LncRNAs modulate gene expression at the transcriptional, post-transcriptional, and translational levels; however, the specific regulatory mechanisms of lncRNAs in psoriasis remain largely unexplored. This review provides an overview of recent studies investigating mechanisms and functions of lncRNAs in psoriasis, especially focusing on the role of lncRNAs in keratinocytes, T cells, and dendritic cells.
R-CHOP resistance in diffuse large B-cell lymphoma: biological and molecular mechanisms
Authors: Wang Liang , Li Lin-Rong
Published: December 2020

Although the first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone regimen (R-CHOP) substantially improved outcomes for patients with diffuse large B-cell lymphoma (DLBCL), 40% of the patients suffered from relapsed/refractory disease and had poor survival outcomes. The detailed mechanism underlying R-CHOP resistance has not been well defined. For this review, we conducted a thorough search for literature and clinical trials involving DLBCL resistance. We discussed DLBCL biology, epigenetics, and aberrant signaling of the B-cell receptor (BCR), phosphatidylinositol 3-kinase (PI3K)/Akt, nuclear factor kappa light chain enhancer of activated B-cells (NF-κB), and the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) pathways as defining mechanisms of DLBCL heterogeneity and R-CHOP resistance. The cell of origin, double- or triple-hit lymphoma and double-protein-expression, clonal evolution, tumor microenvironment, and multi-drug resistance help to contextualize DLBCL resistance in an (epi)genetically and biologically comparative manner. With better understanding of the biological and molecular landscape of DLBCL, a more detailed classification system and tailored treatments will ideally become available to further improve the prognosis of DLBCL patients.
ASSOCIATION BETWEEN ANATOMICAL AND CLINICAL OUTCOMES OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATED WITH ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR
Authors: Nguyen Vuong , Puzo Martin , Sanchez-Monroy Jorge , Gabrielle Pierre-Henry , Garcher Catherine C. , Baudin Florian , Wolff Benjamin , Castelnovo Laurent , Michel Guillaume , O'Toole Louise , Barthelmes Daniel , Gillies Mark C.
Published: December 2020

Purpose:

Assess the relationship between subretinal fluid (SRFL), intraretinal fluid, and visual outcomes of neovascular age-related degeneration in routine clinical practice.

Methods:

Treatment-naive eyes enrolled in the Fight Retinal Blindness! registry after January 2017 were identified. Lesion activity was graded at each visit as inactive, active not SRFL only (A-NSRFL only), or active SRFL only (A-SRFL only). Eyes were grouped based on initial activity as follows: 1) initially A-NSRFL only or 2) initially A-SRFL only, and their predominant activity status over 12 months was as follows: 1) mostly inactive, 2) mostly A-NSRFL only, or 3) mostly A-SRFL only.

Results:

Seven hundred and three eyes were eligible for analysis. Initially A-NSRFL only had a similar adjusted mean 12-month visual acuity change to initially A-SRFL eyes (5.7 vs. 6.9 letters; P = 0.165), but their final visual acuity was worse (62.5 vs. 67.5 letters at 12 months; P = 0.003). The adjusted mean 12-month visual acuity change between the predominant activity groups was significantly different (P = 0.005), with mostly inactive (7.6 letters) and mostly A-SRFL only (7.5 letters) eyes gaining more than mostly A-NSRFL only eyes (3.6 letters).

Conclusion:

Eyes with SRFL only had similar outcomes at 1 year to eyes that were mostly inactive. Intraretinal fluid was associated with worse visual outcomes, highlighting the importance of distinguishing between intraretinal fluid and SRFL when managing neovascular age-related degeneration.
INTRACTABLE PAIN AND DIPLOPIA AFTER SCLERAL BUCKLE SURGERY
Authors: Nazari Hossein , Emerson Geoffrey , Tang Peter H.
Published: December 2020

Purpose:

To report a case of early postoperative scleral buckle slippage because of the dehiscence of scleral belt loop tunnels.

Method:

Case report.

Results:

A 54-year-old woman presented with painful diplopia after a combination pars plana vitrectomy and scleral buckling procedure. Ocular movements were limited. Forced duction testing was restricted in all directions. Anterior slippage of the silicone band was suggested on computed tomography (CT) scans and was confirmed with surgical exploration. During surgery, it was found that thin-roofed scleral belt loop tunnels were dehisced in three quadrants leading to anterior slippage of the buckle. The displaced buckle was removed. Diplopia and pain resolved, and ocular motility improved immediately afterward. The retina remained attached at six months follow-up. A supplemental video summarizes the surgical findings and postoperative results.

Conclusion:

Spontaneous dehiscence of scleral belt loops may occur in thinly dissected scleral tunnels. Painful eye movement, diplopia, and a positive forced duction test should raise suspicion about a displaced scleral buckle. A CT scan may help with the diagnosis. Early diagnosis and immediate surgical intervention are needed to minimize patient discomfort and to improve long-term ocular motility.
The Value of Genetic and Genomic Results Within the Clinical Workflow
Authors: Diamond Joel , Thomas Theresa , Johnson Jacob
Published: December 2020

As genetic and genomic testing become accepted as a standard of care across virtually every clinical specialty—beyond oncology—health systems are challenged to ensure this information is placed into the hands of those who need it most: providers as they make critical clinical decisions. Drs Teresa Thomas, Jacob Johnson, and Joel Diamond recently participated in a roundtable discussion on how they are implementing precision medicine at their organizations and where they—and their patients—are finding value. This article details their efforts and outcomes, and where they plan to expand their precision medicine programs.
Quantification of Finger Laxity in Skeletal Dysplasia
Authors: Wee Jinyong , Rahman Tariq , Bober Michael B. , Tomatsu Shunji , Duker Angela L. , Ditro Colleen P. , Mackenzie William G.
Published: December 2020

People with skeletal dysplasia often exhibit hyperlaxity of the joints. Accurate measurement of laxity in certain joints provides a simple noninvasive measure of function, therapeutic efficacy, and disease progression. A simple, reproducible device to measure joint laxity was developed. The device measures the angle and torque at the second metacarpophalangeal joint as it is passively extended. Sixty-one subjects (42 with skeletal dysplasia and 19 age-matched healthy controls) participated in an experiment to quantify laxity. Results show that laxity is significantly different in skeletal dysplasia compared with healthy controls and decreases with age. However, rate of decrease was significantly higher in healthy controls compared with the other groups.
Portal decompression with transjugular intrahepatic portosystemic shunt prior to nonhepatic surgery: a single-center case series
Authors: Goel Ashish , Khanna Amardeep , Mehrzad Homoyon , Bach Simon , Karkhanis Salil , Kamran Umair , Morgan James , Rajoriya Neil , Tripathi Dhiraj
Published: December 2020

Background and aims

Cirrhosis increases perioperative and postoperative mortality in nonhepatic surgery. Transjugular intrahepatic portosystemic shunt (TIPSS), by reducing portal pressure, may reduce intraoperative bleeding and postoperative decompensation. We report our experience of prophylactic TIPSS in nonhepatic surgery.

Methods

Patients who underwent prophylactic TIPSS before nonhepatic surgery were identified from database with retrospective data collection via an e-patient record system. Primary outcome was discharged without hepatic decompensation after a planned surgery.

Results

Twenty-one patients [age (median, range): 55, 33–76 years, Child’s score: 6, 5–9] who underwent prophylactic TIPSS before nonhepatic surgery over a period of 9 years were included. All patients underwent successful TIPSS with a reduction in portal pressure gradient from 21.5 (11–35) to 16 (7–25) mmHg (P < 0.001). Immediate post-TIPSS complications were seen in 7 (33%) patients including hepatic encephalopathy in four. Eighteen patients (86%) underwent planned surgical intervention. Significant postoperative complications included hepatic encephalopathy (3), sepsis (2) and bleed (1). Two patients died postoperatively with multi-organ failure. The primary outcome was achieved in 12 (57%) patients. Post-TIPSS portal pressure gradient was significantly higher in patients with the adverse primary outcome. Over a follow-up period of 11 (1–78) months; 1-, 6- and 12-months’ survival was 90, 80 and 76%, respectively.

Conclusion

Prophylactic TIPSS is associated with complications in up to one-third of patients, with 57% achieving the primary outcome. Careful patient selection in a multidisciplinary team setting is essential. Multicentre studies are necessary before the universal recommendation of prophylactic TIPSS.
Portal hypertension in primary biliary cholangitis: prevalence, natural history and histological correlates
Authors: Warnes Thomas W. , Roberts Stephen A. , Smith Alexander , Cope Victor M. , Vales Patricia , Haboubi Najib Y. , McMahon Raymond F.
Published: December 2020

Objectives

The histopathological mechanisms underlying portal hypertension in primary biliary cholangitis (PBC) are poorly understood, as is its natural history. We have therefore determined the prevalence, severity and progression of portal hypertension in PBC and investigated whether its presence is related to specific histological lesions.

Methods

Hepatic venous pressure gradient (HVPG) was measured in 86 patients, with 186 assessments over up to 7 years of follow-up and the results correlated with a semiquantitative grading of 8 histological features and nodular regenerative hyperplasia (NRH).

Results

Portal hypertension (HVPG >5 mmHg) was present in 88% of all assessments (86% at baseline), and in 45% of patients at baseline was >12 mmHg (high-risk portal hypertension). The rise in portal pressure occurs early in the disease, since 45% of patients with normal serum bilirubin had a raised HVPG, as did 72% of patients with early (Ludwig stages 1 and 2) disease. After baseline, there was a small increase in HVPG over the next 5 years in most patients. In patients with precirrhotic PBC, 82% had portal hypertension and in 34% this was >12 mmHg. Portal pressure correlated significantly with a semiquantitative grading of cholestasis, interface hepatitis and portal tract and sinusoidal fibrosis. NRH was present in only 20% of wedge biopsies.

Conclusions

Portal hypertension commences in the early stages of PBC, long preceding both rises in serum bilirubin and the development of cirrhosis. Around 34% of precirrhotic PBC patients have ‘high-risk’ portal hypertension, which is associated with lesions in the portal tracts and sinusoids rather than with NRH.
Association between acute heart failure and major cardiovascular events in atrial fibrillation patients presenting at the emergency department: an EMERG-AF ancillary study
Authors: Coll-Vinent Blanca , Varona Mercedes , Martin Alfonso , Carbajosa José , Sánchez Juan , Tamargo Juan , Cancio Manuel , Sánchez Susana , del Arco Carmen , Miró Òscar , Ríos José , García Ana , Fernández-Simón Amparo , Miota Natalia , Suero Coral
Published: December 2020

Background

There is little evidence concerning the impact of acute heart failure (AHF) on the prognosis of atrial fibrillation patients attending the emergency department (ED).

Objective

To know the influence of AHF on adverse long-term outcomes in patients presenting with atrial fibrillation in ED.

Design, setting and participants

Secondary analysis of a prospective, multicenter, observational cohort of consecutive atrial fibrillation patients, performed in 62 Spanish EDs.

Exposure

Patients presenting with atrial fibrillation in ED were divided by the presence or absence of AHF at arrival.

Outcome measures and analysis

Primary outcome: combination of 1-year all-cause mortality, major bleeding, stroke and other major cardiovascular events (MACE). Secondary outcomes: each of these events analyzed separately. Cox and logistic regression were used to investigate adjusted significant associations between AHF and outcomes.

Main results

Totally, 1107 consecutive ED patients with atrial fibrillation attending ED were analyzed, 262 (23.7%) with AHF. The primary outcome occurred in 433 patients (39.1%), 1-year all-cause mortality in 151 patients (13.6%), major bleeding in 47 patients (4.2 %), stroke in 31 patients (2.8 %) and other MACE in 333 patients (30.1%). AHF was independently related to the primary outcome [odds ratio (OR), 1.422; 95% confidence interval (CI), 1.020–1.981; P = 0.037)] and 1-year MACE (OR, 1.797; 95% CI, 1.285–2.512; P = 0.001), but not to 1-year all-cause mortality, stroke or bleeding.

Conclusions

The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.
The spectrum of 124I uptake in the lacrimal gland and nasolacrimal sac/duct on PET/CT imaging
Authors: Wu Di , Plyku Donika , Kulkarni Kanchan , Garcia Carlos , Burman Kenneth D. , Wartofsky Leonard , Van Nostrand Douglas
Published: December 2020

Introduction

This study characterizes the spectrum of physiologic 124I uptake of the lacrimal system in patients with a history of differentiated thyroid cancer (DTC) who underwent multi-timepoint 124I PET/CT imaging.

Methods

124I PET/CT in 31 DTC patients was performed at 2, 24, 48, 72, and 96 h after oral administration of 31.5 or 62.9 MBq (0.85 or 1.7 mCi) of 124I after either recombinant human thyroid-stimulating hormone injections or thyroid hormone withdrawal. All but two patients had a history of prior 131I therapy. Patterns of 124I uptake in the lacrimal glands and nasolacrimal sac/ducts (NLD) were assessed.

Results

A total of 173 individual 124I PET/CT scans (forming 35 sets of scans) were reviewed for 31 patients. Lacrimal glands were visualized bilaterally in only 4 patients. The focal mild uptake (grade 2), best seen on the 2-h images, was crescent-shaped and located in the lateral upper quadrant of the orbit. In contrast, the NLDs were identified in all patients (bilateral in 29 of 31 patients) with high focal uptake (grade 4) peaking on the 2- and 24-h timepoints; however, the overall pattern of uptake was variable. Of the 29 patients with prior 131I therapy, three patients had a relatively fixed and unchanging pattern of uptake on at least one side of the NLDs.

Conclusions

In patients with DTC, 124I activity in the NLDs is more frequently visualized, more intense, more prolonged, and more variable than in the lacrimal glands. The lack of clearance may suggest possible obstruction or stasis of an NLD.
Alveolar Soft Part Sarcoma of Uterine Corpus in a Young Female: A Case Report With Review of Literature
Authors: Vishwajeet Vikarn , Elhence Poonam , Singh Pratibha , Ghuman Navdeep K.
Published: December 2020

Alveolar soft part sarcoma (ASPS) is a rare soft tissue sarcoma, often occurs in adolescents and young adults with a particular predilection for the deep soft tissue of extremities. Occurrence of ASPS in the female genital tract is very uncommon and poses a significant diagnostic challenge. A case of ASPS of the uterine corpus is described in a young unmarried female, who presented to the out-patient clinic of our Institute with complaints of abnormal uterine bleeding for the past 9 mo. She was being treated with oral contraceptive pills, progesterone and tranexamic acid. Following radiological imaging and hysteroscopy, a therapeutic curettage of the lesion was done. The histopathologic features raised a differential diagnosis of a myriad of morphologic mimickers. The diagnosis was clinched by exclusion of mimickers by relevant immunohistochemical markers and strong nuclear expression of TFE3 on immunohistochemistry. The patient is on regular follow-up with oral contraceptives and antifibrinolytic medication. Despite being infrequent at this location, ASPS should be kept in differential diagnosis in young females presenting with abnormal uterine bleeding.
Targeted Molecular Sequencing of Recurrent and Multifocal Non–HPV-associated Squamous Cell Carcinoma of the Vulva
Authors: Pors Jennifer , Tessier-Cloutier Basile , Thompson Emily , Almadani Noorah , Ho Julie , Gilks Blake , Huntsman David , Hoang Lynn
Published: December 2020

Recurrent vulvar squamous cell carcinomas (SCCs) are a poorly understood and aggressive group of treatment-resistant neoplasms. Currently, it remains unclear whether these are in fact recurrences of the same primary tumor, or the development of entirely new tumors. Here, to address this question, we examined the mutational profile of a series of patients with recurrent or multifocal non–human papilloma virus (HPV)-associated vulvar SCC. We performed a targeted 33-gene next-generation sequencing panel on a series of 14 patients with recurrent or multifocal non–HPV-associated vulvar SCC and precursor neoplasms. This amounted to 54 cases (33 SCC, 1 verrucous carcinoma, 13 differentiated vulvar intraepithelial neoplasia, and 7 differentiated exophytic vulvar intraepithelial lesion), with 79 mutations detected altogether. TP53 [51/79 (65%)] was the most frequently mutated gene. Mutations in PIK3CA [16/79 (20%)), HRAS [6/79 (8%)], PTEN [4/79 (5%)], EGFR [1/79 (1%)], and GNAS [1/79 (1%)] were occasionally seen. Most patients with SCC [5/9 (56%)] recurrent, 4/5 (80%) multifocal] demonstrated a clonal relationship, and harbored the same mutations in the same genes in metachronous or synchronous tumors. A subset of the recurrent tumors [2/5 (40%)] recurred with additional mutations. These clonal relationships were shared between SCC and differentiated vulvar intraepithelial neoplasia in each case. By contrast, a small number of recurrent tumors [3/9 (33%)] demonstrated novel mutations, entirely different from the primary tumor. Thus, our findings suggest that recurrent non–HPV-associated vulvar SCC can arise from 2 mechanisms.
A Clinical and Pathologic Exploration of Suspected Peritoneal Endometriotic Lesions
Authors: Watkins Jaclyn C. , DiVasta Amy D. , Vitonis Allison F. , Crum Christopher P. , Laufer Marc R. , Terry Kathryn L. , Howitt Brooke E. , Missmer Stacey A.
Published: December 2020

Endometriosis is generally histopathologically defined as the presence of at least 2 of the following: endometrial stroma, Müllerian epithelium, and/or hemosiderin-laden macrophages (HLM). Despite clinically evident endometriotic lesions, biopsies are frequently nondiagnostic. In this study, we conducted a large-scale review of biopsies of lesions clinically thought to represent endometriosis and correlate the histologic findings with clinical appearance to expand sensitivity of the pathologic definition of endometriosis, particularly in patients on hormonal therapy. In all, 112 biopsies from 78 patients (mean age=25, range 18–39 yr) were reviewed for histopathologic features suggestive of or diagnostic for endometriosis including the presence of endometrial stroma, Müllerian epithelium, dystrophic calcifications, HLM, chronic inflammation, adhesions, and vascular proliferation. Endometriosis was confirmed by pathologic criteria in 37 of 78 patients (47%). Biopsies from patients on hormonal therapy (n=62, 80%) were significantly less likely to meet pathologic criteria for endometriosis (P=0.01). Nondiagnostic biopsies (70/112; 63%) frequently displayed HLM (20%), chronic inflammation (29%), dystrophic calcifications (26%), vascular proliferation (20%), or adhesions (20%) and were significantly more likely to have a vascular clinical appearance (P=0.01). Diagnostic biopsies (42/112; 38%) were more likely to have a blue/black clinical appearance (P=0.03), demonstrate HLM (P=0.004), and display pseudodecidualization (P=0.05). Patients with a high clinical suspicion of endometriosis have a range of histologic findings, with less than half meeting the current histopathologic criteria for diagnosing endometriosis. Given the heterogeneous histopathologic appearance, revision of the histologic criteria may be warranted with further exploration, particularly for lesions with predominantly vascular features.