bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac functional consequences of stroke induced by transient middle cerebral artery occlusion in a rodent model
Authors: Olah A , Matyas C , Barta B.A , Sayour A.A , Ruppert M , Braun S , Kovacs A , Merkely B , Nagy Z , Radovits T , Nardai S
Published: November 2020

Background

The cardiac functional consequences of ischaemic stroke are still need to be elucidated, while according to ethical issues only non-inasive measurents were carried out in patients underwent transient cerebral ischaemia.

Purpose

We aimed at investigating left ventricular function using non-invasive and invasive modalities in a rat model of transient focal ischaemia.

Methods

Age-matched, young adult rats were used for this study. Serial left ventricular echocardiographic measurements and speckle-tracking analysis were performed in rats (n=9) underwent transient middle cerebral artery occlusion (MCAO) before, during and immediately after the induction of stroke, with a follow-up at 24, 48, 72 hours; 7, 11 and 14 days. In another experimental setting, 48 hours after stroke induction (MCAO group, n=9) we characterized left ventricular function by pressure-volume analysis, that was compared to sham-operated controls (Co group, n=9).

Results

Serial echocardiographic measurements showed impaired systolic function, that was most severe 48 hours after MCAO (global circumferential strain, GCS: −14.8±2.6% 48 hours after MCAO vs. −19.3±2.4% baseline, p<0.05). A complete recovery of systolic functional deterioration was observed after 14 days (GCS: −19.2±2.5% 14 days after MCAO vs. −19.3±2.4% baseline, n.s.). Heart weight (normalized to tibial weight) did not differ between MCAO and Co animals. Pressure-volume analysis revealed unaltered diastolic function and showed unchanged load-independent contractility index values (slope of end-systolic pressure-volume relationship, ESPVR: 2.56±0.29mmHg/μl MCAO vs. 2.55±0.59 mmHg/μl Co, n.s.) after MCAO. There was a tendency towards increased systolic pressure and deteriorated ventriculo-arterial coupling in animals underwent stroke.

Conclusions

Our data suggests that MCAO is associated with reversible impairment of systolic function during echocardiographic measurements, however without alteration of intrinsic myocardial contractility. The tendency towards increased afterload might explain the observed alterations in rats underwent stroke.

Funding Acknowledgement

Type of funding source: None
Coronary artery calcification and cardiovascular outcomes after chest radiation therapy in breast cancer patients
Authors: Abu Rmilah A , Anevakar N.A , Jouni H.A , Lin G.R , Laack N.A , Herrmann J.O
Published: November 2020

Introduction

Coronary artery calcification (CAC) is associated with and identifies patients at higher risk of major adverse cardiovascular events (MACE). However, the prevalence, characteristics, and outcomes of cancer patients with CAC on CT before or after chest radiation therapy (RT) are not well addressed.

Methods

Retrospective cohort study of all breast cancer patients who underwent chest RT at Mayo Clinic Rochester in 2010. All pre-RT CTs were reviewed and the extent of CAC was recorded in addition to history of pre-RT atherosclerotic risk factors (hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and smoking), history of pre-RT cardiovascular disease (CVD), and RT dosage. MACE (sudden cardiac death (SCD), acute coronary syndrome (ACS), and stroke), and CAC progression in follow-up were recorded. CAC extent was quantified before and on 5-year follow-up CT scan in all patients, and a positive change was considered progression. Patients were divided into 2 groups based on the presence of CAC before RT: present (group 1) or absent (group 2).

Results

Our cohort was comprised of 244 breast cancer patients who received chest RT. A total of 39 patients (16.9%) had evidence of CAC on CT prior to RT. Compared with patients without CAC before RT (n=205), those with CAC before RT were found to be older (71.8±7.7 vs 58.9±11.3, p<0.01), had higher pre-RT history of HTN (84.6% vs 47.8%); p<0.01), DM (20.5% vs 4.4%; p<0.01), dyslipidemia (74.2% vs 40%; p<0.01), CAD (23.1% vs 3.9%; p<0.01), and stroke (7.69% vs 1.45%; p=0.04). Following RT, patients in group 1 were more likely to exhibit ACS (33.3% vs 2.9%; p<0.01), and stroke (22.6% vs 5.2%; p<0.01). Multinomial logistic regression identified pre-RT CAD pre-RT CAC (β=1.01 (0.33–1.69), OR=7.60 (1.93–29.93); p=0.02) pre-RT CAD (β=0.78 (0.06–1.49), OR=4.74 (1.14–19.74); p=0.03) as independent predictors for the development of MACE after RT. Progression in CAC after RT was found in 61.9% of all patients (13/21) who developed MACE.

Conclusion

MACE in breast cancer patients undergoing RT can be predicted before RT based on the CV risk factor and disease profile. The strongest predictor for MACE, however, is evidence of CAC before RT. These data provide a unique window for the identification and follow-up of breast cancer RT patients who have a risk of MACE.

Funding Acknowledgement

Type of funding source: None
Treatment of HIV-associated pulmonary arterial hypertension: single-center experience
Authors: Goncharova N , Zlobina I , Berezina A , Moisseva O
Published: November 2020

Introduction

Currently there is no evidence-based strategy for PAH drug application adjusted for patients with HIV-associated PAH. Data regarding the use of sildenafil and endothelin receptors antagonists (ERA) are limited case series.

Purpose

To present the long-term data on treatment with sildenafil, macitentan and ambrisentan in pts with HIV-PAH.

Material and methods

In prospective study were consecutively enrolled 18 treatment-naïve pts with HIV-PAH (7 males, 34.5 yrs; 29; 53 yrs), mean follow-up was 1.64yrs; 0,16–59–9.28 yrs. 4 pts were in IV FC, 5-III FC and 9 in II FC PAH (WHO). RHC, ECHO, 6MWT, ergospirometry and NTproBNP level were evaluated at a baseline. Intravenous drug abuse reported in 72% pts, all of them were co-infected with hepatitis. Nine pts (50%) treated with HAART therapy at a baseline. Five pts did not have PAH-specific therapy, 11 pts received sildenafil, 1 IV FC PAH pt with HAART – sildenafil+macitentan and 1 III FC PAH pt with HAART-sildenafil+ambrisentan. Follow-up data (FC, 6MWT, ECHO, ergospirometry, NT-proBNP) were available for 8 PAH-treated pts.

Results

Pts on PAH therapy had achieved improvement in 6 MWT with mean distance increase 69.3±52 m (p=0.01); NTproBNP level decrease (p=0.018) and FC PAH improvement in 7 pts. In pts with PAH therapy the size of right atrium decreased (56.4±7.8 vs 47.8±6.7 mm, p=0.027). The combinations of sildenafil and macitentan and sildenafil with ambrisentan were well tolerated and resulted 6MWT increase, low NTproBNP and FC improvement. Nevertheless there was no significant changes in peak VO2 consumption. Two pts with sildenafil therapy lost for follow up. Three pts with sildenafil but without HAART therapy dead: in one case due to pneumonia, other 2 cases due to pulmonary embolism. Four pts without HAART and PAH therapy dead. In our population strong association between survival and HAART therapy presence was revealed (p=0.01).

Conclusion

No adverse reactions of PAH-specific therapy were reported in pts on HAART. PAH therapy had a positive influence on FC, exercise capacity, heart remodeling and NT-proBNP level. There were no deaths in pts who receive HAART and PAH therapy. Nevertheless in our population strong association between survival and HAART therapy presence was revealed.

Funding Acknowledgement

Type of funding source: None
Markers of cholesterol metabolism and cardiovascular outcomes in patients with chronic kidney disease
Authors: Emrich I , Rogacev K , Boehm M , Schulze P.C , Fliser D , Heine G.H , Luetjohann D , Weingaertner O
Published: November 2020

Background

In dialysis patients statins are less effective than in other high risk patients due to a shift from cholesterol synthesis towards cholesterol absorption. The CARE FOR HOMe study investigates whether a shift towards cholesterol absorption occurs in non-dialysis chronic kidney disease (CKD), and whether the ratio of campesterol-to-lathosterol predicts cardiovascular outcomes in non-dialysis CKD patients.

Methods

In this analysis 251 participants suffering from CKD (KDIGO 2–4) without lipid-lowering drugs were included and followed for major atherosclerotic events (MACE). Additionally, all-cause death and the composite endpoint MACE and all-cause death were explored. We performed univariate and multivariate Cox regression analysis, adjusting for age, gender, estimated glomerular filtration rate (eGFR), log-transformed albuminuria, prevalent cardiovascular disease, current smoking, diabetes mellitus, systolic blood pressure and body mass index. The primary hypothesis was that patients with a high campesterol-to-lathosterol ratio had a higher event rate.

Results

Neither lathosterol-to-cholesterol (r=0.022; p=0.730), nor campesterol-to-cholesterol (r=0.041; p=0.519) nor campesterol-to-lathosterol (r=−0.103; p=0.105) correlated with eGFR. During follow-up of 5.1±2.1 years, 47 participants suffered from MACE, 46 participants died and 61 reached the composite endpoint of MACE or all-cause death. In univariate Cox regression analysis, campesterol-to-lathosterol did not predict atherosclerotic cardiovascular events (HR 0.740; 0.368–1.487), all-cause death (HR 0.564; 0.277–1.145) or the composite endpoint (HR 0.652; 0.355–1.196). After full adjustment: campesterol-to-lathosterol was not associated with all three endpoints; MACE (HR 1.064; 0.507–2.231), all-cause death (HR 0.818; 0.420–1.594) and MACE and all-cause death (HR 0.956; 0.525–1.744).

Conclusion

Markers of cholesterol metabolism were not associated with eGFR in patients with impaired renal function (KDIGO 2–4). Campesterol-to-lathosterol did not predict future MACE or all-cause death in non-dialysis CKD. These findings do not support the concept that patients with impaired renal function (KDIGO 2–4) benefit in particular from ezetimibe treatment. Further research is required to address this hypothesis in dialysis patients.

Funding Acknowledgement

Type of funding source: None
LDL-cholesterol decrease by anti-PCSK9 monoclonal antibodies: systematic review, meta-analysis and meta-regression of randomized controlled trials
Authors: Ma I , Angoulvant D , Azzopardi N , Ternant D , Ivanes F , Paintaud G , Bejan-Angoulvant T
Published: November 2020

Background

PCSK9 antibodies are novel potent and expansive lipid lowering agents that demonstrated clinical benefit in high risk patients. We hypothesized that optimization of dose and administration schedule, ideally adapted to the target population, could reduce costs while maintaining the clinical benefit.

Objective

To explore the relationship between LDL-Cholesterol (LDL-C) decrease by anti-PCSK9 monoclonal antibodies and several covariates such as drug dose, administration schedule, baseline LDL-C, population and statins.

Methods

We performed systematic review, meta-analysis and meta-regression of randomized controlled trials that compared alirocumab or evolocumab to placebo or no treatment and reported LDL-C decrease, with a minimum follow-up of 12 weeks and with a sample size of 30 patients or more. Electronic searches of MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov from inception to March 2019. We evaluated the quality of included studies and extracted aggregate data. We used random effect models and multivariate multilevel meta-regression to explore factors influencing LDL-C decrease. All analyses were performed with R.

Results

From 1479 references identified and screened on title/abstract, the full texts of 72 articles were screened. We included 32 studies (31 references.) Anti-PCSK9 mAbs decreased LDL-C by 53%, 95% CI (−56% to −50%), with no significant difference between the two drugs (p=0.07). In univariate meta-regressions, higher baseline LDL-C level, monthly administration, higher percentage of patients with high-dose statins were associated with a lower LDL-C decrease (p<0.0001, p=0.02 and p=0.006 respectively). Drug dose and population did not influence LDL-C decrease in univariate analysis, but with a significant statistical interaction between drug dose and administration schedule (p=0.03). In multivariate meta-regression, LDL-C decrease remained significantly and negatively influenced by baseline LDL-C level

(p<0.0001) and the percentage of patients with high-dose statins (p=0.0009), and was significantly and positively influenced by drug dose (p<0.0001).

Conclusion

Alirocumab and evolocumab showed substantial LDL-C reductions in clinical trials, without significant differences in their biological efficacies. A higher baseline LDL-C, higher intensity of statin co-treatment and a lower dose seemed to negatively influence LDL-C decrease.

Funding Acknowledgement

Type of funding source: None
Selatogrel, the reversible and specific P2Y12 receptor antagonist, does not interfere with haemostasis
Authors: Riederer M.A , Crescence L , Caroff E , Hubler F , Panicot-Dubois L , Dubois C
Published: November 2020

Background

Combination of a P2Y12 receptor (P2Y12R) antagonist (clopidogrel, prasugrel, ticagrelor) with aspirin is the recommended standard of care for patients with acute coronary syndrome. Selatogrel is a reversible and potent antagonist of P2Y12R. Interestingly, in an experimental thrombosis model in rat, at equivalent antithrombotic effect, blood loss was lower in the presence of selatogrel, compared with clopidogrel or ticagrelor.

Purpose

To characterise the lower risk of bleeding previously observed with selatogrel

Methods

Mechanistic studies were performed to profile laser-induced thrombosis in wild-type and P2Y12 deficient mice with real-time intravital microscopy. Ticagrelor and clopidogrel were used as selatogrel comparators.

Results

Selatogrel, ticagrelor and clopidogrel dose-dependently inhibited laser-induced platelet thrombus formation. At maximal antithrombotic effect, only small mural platelets aggregates, corresponding to the haemostatic seals, were present. The phenotype of these haemostatic seals depended on the P2Y12R antagonist used. In the presence of clopidogrel or ticagrelor, the stability of haemostatic seals was reduced. In contrast, in the presence of selatogrel, the apparent stability was not disturbed. Moreover, equivalent antithrombotic dosing regimens of ticagrelor and clopidogrel interfered with laser-induced calcium mobilisation in the endothelium, restricted subsequent neutrophil adhesion and thus reduced fibrin-mediated stabilisation of the haemostatic seals in wild type mice. The effects of ticagrelor were also observed in P2Y12R-deficient mice, indicating that the effects are P2Y12R independent and off-target. In contrast, an equivalent antithrombotic dosing regimen of selatogrel did not interfere with the process of haemostasis in wild-type or P2Y12R-deficient mice. The degree of interference with the stability of the haemostatic seals correlated with the blood loss profile. The dosing regimens of clopidogrel and ticagrelor, corresponding to the equivalent antithrombotic effects, induced a more pronounced increase in blood loss than that observed with selatogrel.

Conclusion

Our data offer a novel mechanistic explanation for the differences in bleeding risk of clopidogrel, ticagrelor and selatogrel. Clopidogrel and ticagrelor were found to interfere with haemostasis due to off-target activities. In contrast, selatogrel did not interfere with haemostasis in wild-type and P2Y12-deficient mice, inferring that the process of haemostasis, as defined by formation of haemostatic seals, is independent of P2Y12R. In addition, our data emphasize that the absence of interference with haemostasis is paramount to preserve the advantage of P2Y12R antagonism.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Idorsia Pharmaceuticals Ltd. Allschwil, Switzerland
Successful case of direct puncture of a prosthetic bypass graft in endovascular treatment for long superficial artery chronic total occlusion: a case report
Authors: Sugihara Makoto , Ueda Yoko , Yano Yuiko , Miura Shin-Ichiro
Published: November 2020

Background

The access site for endovascular therapy (EVT) is often limited because of multi-vascular diseases. Prior lower limb bypass can potentially limit the availability of common femoral artery access when EVT is required.

Case summary

An 88-year-old woman who presented with non-healing ulceration in the dorsalis pedis of the left foot despite treatment for several months was admitted to our hospital. She had undergone axillo-bilateral femoral bypass surgery for right critical limb ischaemia 3 years previously. Ultrasound and contrast computed tomography demonstrated bypass graft occlusion, left superficial femoral artery (SFA)-popliteal artery long chronic total occlusion from the origin with severe calcification and severe stenosis in the bilateral common femoral artery close to the anastomotic site. EVT for the left SFA occlusion was necessary to save the left foot, but access sites for EVT were limited. We decided to puncture an occluded axillo-femoral prosthetic bypass graft. It is difficult to cross the wire with only an antegrade approach. Therefore, it was necessary to use a bi-directional approach with dorsalis pedis artery puncture and the Rendez-vous technique. Finally, angiogram demonstrated improved blood flow to the wound site, and haemostasis at the puncture site could be achieved by manual compression. The ulceration healed within a month.

Discussion

Direct puncture of a prosthetic bypass graft and additional techniques resulted in complete revascularization. Thus, direct puncture of a bypass graft could be a useful EVT strategy for patients with complex and extremely long chronic total occlusion.
A challenging case report of acute sinus of Valsalva aneurysm rupture in cardiogenic shock and multi-organ failure with an emphasis on rapid recognition and ‘never giving up’ in face of futility
Authors: Jin Quah Wy , Jeswant Dillon Jeffrey , Tjen Jhung Lee , Isman Rusani Beni
Published: November 2020

Background 

Sinus of Valsalva aneurysm (SoVA) is a rare anomaly and can be divided into acquired and congenital forms, the latter being commonly associated with ventricular septal defects (VSDs). Rupture is a catastrophic complication with high mortality without urgent surgical intervention. We would like to highlight the use of echocardiography in an emergency setting for diagnosis and surgical intervention in a critically ill patient.

Case summary 

We report a 27-year-old female with history of conservatively managed VSD known since childhood. She presented with acute decompensated cardiac failure requiring intubation and inotropic support. Bedside echocardiography performed in the emergency department suggested a ruptured SoVA at the right coronary cusp with underlying supracristal VSD. Despite the patient being critically ill with multi-organ failure, surgery was performed as it was the patient’s best chance for survival. Intraoperative findings tallied with the early echocardiographic results. She recovered gradually and was eventually discharged despite a stormy post-operative period.

Discussion 

This case report highlights the importance of prompt recognition of SoVA rupture by using bedside echocardiography. Surgical intervention needs to be early despite ongoing sepsis in view of acute mechanical failure. This case was unique as it illustrates a successful management of an acutely ill patient with multi-organ failure through early diagnosis, intensive perioperative stabilization, and surgical intervention.
Projecting the timescale of initial increase in fishery yield after implementation of marine protected areas
Authors: Barceló Caren , White J Wilson , Botsford Louis W , Hastings Alan
Published: November 2020

Adaptive management of marine protected areas (MPAs) to determine whether they are meeting their intended goals requires predicting how soon those goals will be realized. Such predictions have been made for increases in fish abundance and biomass inside MPAs. However, projecting increases in fishery yield (“fishery spillover”) is more complex because it involves both how the fishery is managed and uncertainty in larval connectivity. We developed a two-patch, age-structured population model, based on a renewal equation approach, to project the initial timing of increase in fishery yield from larvae exported from a no-take MPA. Our results link our understanding of the predicted timing of increases in biomass (and thus reproduction) in MPAs with the time-lags associated with new recruits entering the fishery. We show that the time-lag between biomass peaking within the MPA and the increased fishery yield outside the MPA reaching its maximum depends, in a predictable way, on the age-dependent patterns of growth, natural mortality, and fishing mortality. We apply this analysis to 16 fishery species from the US Pacific coast; this difference ranged from 7 to 18 years. This model provides broadly applicable guidance for this important emerging aspect of fisheries management.
Measuring success: perspectives from three optimization programs on assessing impact in the age of burnout
Authors: Lourie Eli M , Stevens Lindsay A , Webber Emily C
Published: November 2020

Electronic health record (EHR) optimization has been identified as a best practice to reduce burnout and improve user satisfaction; however, measuring success can be challenging. The goal of this manuscript is to describe the limitations of measuring optimizations and opportunities to combine assessments for a more comprehensive evaluation of optimization outcomes. The authors review lessons from 3 U.S. healthcare institutions that presented their experiences and recommendations at the American Medical Informatics Association 2020 Clinical Informatics conference, describing uses and limitations of vendor time-based reports and surveys utilized in optimization programs. Compiling optimization outcomes supports a multi-faceted approach that can produce assessments even as time-based reports and technology change. The authors recommend that objective measures of optimization must be combined with provider and clinician-defined value to provide long term improvements in user satisfaction and reduce EHR-related burnout.
Evolution of Forest Policies in Canada
Authors: Wetton Frances
Published: November 2020

The Canadian constitution divides authority for forest and forest industry development between federal and provincial governments and has led to serious jurisdictional disputes and fragmented policy decisions. Cooperation and trust are required for formulating policies for rational forest development and for mutual well-being of provinces.
Forest Resources Research in Canada
Authors: Smith J. Harry G.
Published: November 2020

Developments in Canadian science policy have given impetus to forest research, though funding and staffing are still inadequate. The Canadian Forestry Service (CFS) is responsible for most federal research on forest resources, and the National Research Council has stimulated university and industrial activity. While most provinces rely on CFS for research, Quebec, Ontario, and British Columbia have substantial programs of their own. At the six Canadian forestry schools the need for expansion is appreciated, but there are shortages of scientists and teachers. The Canadian Institute of Forestry is a strong advocate of research.
Managers' Views of Dispersed Recreation along Forest Roads
Authors: Downing Kent B. , Moutsinas Cynthia M.
Published: November 2020

A survey of public and private natural-resource managers in the Pacific Northwest revealed considerable generalized support for dispersed recreation along forest roads. Most managers indicated they would favor some activities, such as hiking, hunting, and fishing. But they would strongly discourage other activities such as extended living and most forms of off-road vehicle use.
Massive inguinoscrotal herniation of the bladder: challenges in non-operative management
Authors: Adasonla Kelvin , Gabriel Joseph , Quraishi Mohammed Kamil , Watson Graham
Published: November 2020

Massive inguinoscrotal hernias containing the bladder are rare but can present with significant complications such as obstructive uropathy and urinary sepsis. A comorbid 71-year-old gentleman presented with an enlarging inguinoscrotal mass and an acute kidney injury (AKI). Imaging revealed a large inguinoscrotal hernia containing the bladder, and bilateral hydronephrosis. Renal function improved on urethral catheterization. Admitted under general surgery originally, the patient declined any surgical intervention and had his catheter removed as an outpatient, without urological follow up. He represented 6 months later with urinary sepsis and a new AKI. Repeat imaging revealed a progression of the bilateral hydronephrosis. Subsequently admitted under urology, bilateral nephrostomies as well as a catheter were inserted. Once stable, he was discharged with both as part of his long-term management. Non-operative management of this condition may occasionally be necessary, and so requires effective multidisciplinary decision making. Real-world organizational and geographical factors contributed to the challenges in this case.
Asian American Mobilization and Political Identities
Authors: Sadhwani Sara , Junn Jane
Published: November 2020

Immigrants from Asia have been a defining feature of demographic change over the last quarter century in the United States. The 2000 US Census identified Asian Americans as the fastest growing immigrant group in the nation and the Pew Research Center estimates that Asian Americans will become the largest immigrant group in the country by 2055. With that growth has come the development of a vibrant scholarly literature examining Asian American political participation in the United States. This article is designed to provide an overview of the major foundational studies that explore Asian American political behavior, including mobilization and participation in American politics. The earliest research began in the fields of political science and sociology and consider the viability of a panethnic Asian American identity as a unit of analysis for group-based behavior and political interests. Numerous scholars have considered the circumstances under which panethnic Asian American identity can be activated toward group behavior, and how differences in national origin can lead to variations in behavioral outcomes. Participation in American politics, however, is rooted in many other factors such as socioeconomics, one’s experience as an immigrant, ties to the home country, and structural barriers to activism. Individual resources have long been considered an essential component to understanding political participation. Yet, Asian Americans present a puzzle in American politics, evincing higher education and income while participating in politics at a more modest rate. In response to this puzzle, scholars have theorized that structural conditions and the experience faced by Asian immigrants are powerful mechanisms in understanding the determinants of Asian American political participation. Once considered to have relatively weak partisan attachment and little interaction with the two major parties in the United States, studies that examine the development of partisan attachment among Asian Americans are explored which, more recently, find that a growing majority of Asian Americans have shown a preference for the Democratic Party. Finally, we detail studies examining the conditions under which Asian American candidates emerge and are successful, the co-ethnic electorate who supports them, and conclude by detailing the opportunities and constraints for cross-racial collaboration and conflict.
Digital Citizenship
Authors: Heath Marie
Published: November 2020

Digital citizenship is a term meant to convey the possibility of a new or different type of citizenship which occurs as digital citizens participate within the constraints and opportunities of the internet. It refers to new possibilities of citizenship outside or beyond our physically bounded space and within cyberspace. Early usages of the term often referred to safety, character, and comportment in a digital space. However, the term now refers to new forms of participation or engagement in the global community. These new forms of participation require specific skills (including media literacy, collaboration, and digital ethics) and access (including access to technology and access to inclusive online spaces), as well as new pedagogies and practices from educators.
Understanding the Psycho-Social Dimensions of Schools and Classrooms
Authors: Berger Nathan , Archer Jennifer
Published: November 2020

Psycho-social refers to the connections between psychological and social aspects of human experience. It describes the ways in which people’s cognition, affect, and behavior, in many ways, are a product of the society or culture in which they were raised. Schools and classrooms are sites of intense psycho-social activity because it is here that young people learn to express their thoughts and emotions via interactions with teachers and other students. The importance of these individual and collective psycho-social experiences cannot be understated. The ultimate purpose of schooling is to enable young people to live fulfilling and productive lives within their cultural and social context. Given the broad scope of the term psycho-social, some difficult decisions had to be made about the content of this article. The overriding focus is given to ways in which teachers can enhance the positive psycho-social aspects of their classrooms, with an emphasis on empirical research (or reviews of empirical research) that investigate the experiences of children and adolescents. It proved impossible to cover all potential theoretical and research perspectives. The choice of research perspectives and citations for this bibliography has been guided by salience. In some cases, citations are seminal contributions to their field. In other cases, they represent particularly impactful or interesting findings.
Sound Studies
Authors: Thompson Marie
Published: November 2020

Sound studies examines concepts, practices, and technologies of sound and listening in different historical and cultural contexts. It is considered a relatively new field, emerging in the first few years of the 21st century. However, texts from the late 20th century—notably Jacques Attali’s Noise: The Political Economy of Music (1985) and R. Murray Schafer’s The Soundscape: The Tuning of the World and Our Sonic Environment (1994)—have been central to the formation and development of sound studies. Common areas of study include sound technologies and media, philosophies of sound and listening, and soundscapes and sound environments. Sound-studies scholarship also addresses specific aspects of auditory culture, such as noise, silence, loudness, vocality, speech, sound art, and music, and their imbrication with ethical, political, and ecological relations. A central contestation of the field is the importance of sound and aurality to the historical developments associated with modernity. Sound studies have sought to challenge the ocularcentric tendencies of cultural and critical analysis, and the associated dualisms of hearing/seeing and sound/vision. Transdisciplinary and interdisciplinary in its scope, research in sound studies works in and across history, musicology, sociology, cinema studies, literary studies, disability studies, American studies, geography, anthropology, media and communication studies, science and technology studies, architecture, gender studies, critical race studies, and art history. Consequently, the field’s analytic approaches and methods are diverse. However, it has often been Eurocentric, centering the West and the white, male innovator. There is a growing body of work that engages with the racial and gendered dimensions of sound and has sought to expand the remit of sound studies beyond the colonial core.
REM sleep behavior disorder and other sleep abnormalities in p. A53T SNCA mutation carriers
Authors: Simitsi Athina Maria , Koros Christos , Stamelou Maria , Papadimitriou Dimitra , Leonardos Athanasios , Bougea Anastasia , Papagiannakis Nikolaos , Pachi Ioanna , Angelopoulou Efthalia , Lourentzos Konstantinos , Bonakis Anastasios , Stefanis Leonidas
Published: November 2020

Study Objectives

Τo assess whether REM Sleep Behavior Disorder (RBD) and other sleep abnormalities occur in carriers of the p.A53T alpha-synuclein gene (SNCA) mutation, using both subjective and objective measures.

Methods

We have assessed 15 p.A53T carriers (10 manifesting Parkinson’s Disease [PD-A53T] and 5 asymptomatic carriers) with simultaneous Video-PSG (polysomnography) recording, the Epworth Sleepiness Scale (ESS) for daytime sleepiness, the Athens Insomnia Scale (AIS), the RBD Screening Questionnaire (RBDSQ) for clinical features of RBD, the Montreal Cognitive Assessment (MOCA) for cognition and the University of Pennsylvania Smell Identification Test (UPSIT) for olfaction.

Results

In our cohort, 90% of PD carriers had at least one sleep disorder and 40% had two: 4 RBD, 1 Periodic Limb Movements (PLM), 1 RBD plus PLM, 2 RBD plus moderate Obstructive Sleep Apnea (OSA), and 1 moderate OSA plus Restless Leg Syndrome. No asymptomatic carrier manifested a confirmed sleep disorder. 6/7 PD carriers with RBD had abnormal olfactory testing and 4/7 MOCA below cut off. There was a correlation of both impaired olfaction and cognition with RBD.

Conclusions

RBD occurs in the majority of PD-A53T, in contrast to most other genetic forms of PD, in which RBD is uncommon. The paucity of a sleep disorder in the asymptomatic carriers suggests that such carriers have not yet reached the prodromal phase when such sleep disorders manifest. Hyposmia in almost all subjects with RBD and cognitive decline in most of them are indicative of the general pattern of disease progression, which however is not uniform.
A Mixed-Methods Study to Investigate Barriers and Enablers to Nurses' Implementation of Nonpharmacological Interventions for Infants With Neonatal Abstinence Syndrome
Authors: Adrian Allison , Newman Susan , Mueller Martina , Phillips Shannon
Published: November 2020

Background:

The incidence of neonatal abstinence syndrome has increased significantly as a result of the opioid epidemic. A lengthy hospitalization is often required to treat the infant's withdrawal symptoms. A comprehensive understanding of factors that influence nurses' implementation of nonpharmacological interventions for infants with neonatal abstinence syndrome is needed.

Purpose:

To investigate barriers and enablers to nurses' implementation of nonpharmacological interventions for infants with neonatal abstinence syndrome through the lens of the Theoretical Domains Framework, which provides a structure to examine factors that influence healthcare providers' behavior related to the implementation of evidence-based practice and interventions in clinical practice.

Methods:

A convergent parallel mixed-methods study was conducted. Qualitative data were collected using semistructured interviews and quantitative data were collected using a tailored Determinants of Implementation Behavior Questionnaire with neonatal nurses. Findings from the interviews and surveys were merged through joint review to compare and contrast themes.

Results:

Enablers and barriers to nurses' implementation of nonpharmacological interventions included education, experience, ability to implement nonpharmacological interventions, parental participation, stigmatization, lack of managerial/organizational support, staffing ratios, internal and external resources, and stress. Knowledge, Skills, Beliefs About Capabilities, Social/Professional Role and Identity, Organization, and Emotion of the Theoretical Domains Framework aligned with these themes.

Implications for Practice and Research:

Findings from this study will inform the development of programs to improve nurses' implementation of nonpharmacological interventions and health and utilization outcomes in infants with neonatal abstinence syndrome. Furthermore, future work should focus on the development of programs to improve nurses' implementation of nonpharmacological interventions, with specific strategies aimed to mitigate marginalization of vulnerable patient populations.
Prognostic factors for postoperative complications after K-wire fixation for paediatric forearm fractures: a multivariate analysis
Authors: Fujihara Yuki , Ota Hideyuki , Sakai Ai
Published: November 2020

Although osteosynthesis using K-wires is a commonly performed procedure, the outcome is not always preferable. We aimed to identify the prognostic factors for postoperative complications in paediatric patients with both-bone forearm fractures. We reviewed 160 paediatric patients who underwent K-wire osteosynthesis for either distal or diaphyseal forearm fractures. We defined the occurrence rate of postoperative complications as the primary outcome and performed a multivariate logistic regression analysis. Variables such as age, sex, mechanism of injury, presence of an open fracture, ulnar or radial fracture and the associated procedure, the K-wire tip procedure and operation time, the duration from injury to operation and operation to implant removal, and duration of casting were included into the model as possible prognostic factors. The mean follow-up period was 51.2 weeks. The total number of complications was 43 (26.2%). Results of the logistic regression analysis indicated that a shorter duration from surgery to K-wire removal caused a significantly higher rate of postoperative complications [odds ratio (OR), 0.99; 95% confidence interval (CI), 0.97–1.0]. The subgroup analyses revealed that intramedullary K-wire fixation for radial fractures (OR, 1.07 × 10−5; 95% CI, 5.46 × 10−10 to 0.211) and a longer casting duration (OR, 0.84; 95% CI, 0.72–0.99) resulted in fewer postoperative infections. An exposed wire tip in the ulna contributed to more postoperative displacement (OR, 6.87; 95% CI, 1.76–26.9). To decrease the risk of postoperative complications, surgeons should bury the wire tip beneath the skin to facilitate a longer duration of K-wire placement.
Predictive ability of scoring systems towards casting in treatment of idiopathic clubfoot by the Ponseti method in infants
Authors: Jain Abhishek , Gupta Parmanand , Kothari Siddharth , Bachhal Vikas
Published: November 2020

A prospective study to find a correlation between the severity of clubfoot and the number of casts required for the correction was conducted. The relationship of early relapse with the severity of the deformity was also studied. A total of 42 infants (61 feet) with primary and idiopathic clubfeet were included in the study. Previously treated and clubfeet due to secondary causes were excluded. All clubfeet were treated by the Ponseti method, and the Pirani score, Dimeglio score and Foot Bimalleolar (FBM) angle were taken at presentation and before every casting and at 6 months of follow-up. The average age of the child at presentation was 24 days, the average initial Pirani score was 4.172, the average initial Dimeglio score was 14.36 and the average FBM angle was 63.87 degrees. The average number of corrective casts given was 5.08 (range 2–8). The regression analysis showed a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Eleven of the 61 feet had a relapse (18%). Ten of 11 relapsed feet had a midfoot Pirani score of equal to or more than 2. The regression analysis shows a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Midfoot score equal to or more than 2 is a significant risk factor for relapse.
Management of Metadiaphyseal Proximal Radius Fractures
Authors: Demetri Leah , Young Charlotte , Patterson Joseph T. , Kandemir Utku , Morshed Saam , Immerman Igor , Lee Nicolas H.
Published: November 2020

Metadiaphyseal proximal radius fractures blur the distinction between the radial neck and radial shaft fractures. Operative management presents unique technical challenges both in terms of surgical approach and fixation method. We discuss relevant anatomy, safe surgical approach, and options and techniques for fracture fixation. We describe 6 patients who achieved satisfactory functional outcomes, even in cases of severe bone loss secondary to ballistic trauma. An extensile dorsal approach with exposure of the posterior interosseous nerve is recommended when normal soft tissue intervals have not already been extensively disrupted. Robust fixation can be achieved by contouring and repurposing a variety of plates such as a variety of mini fragment plates (2.4 mm T or Y-plates), flexible nails, or even distal radius plates.
Infusion reaction to nivolumab in a metastatic melanoma patient. Safe switch to another anti-programmed death-1: a case report
Authors: Núñez Abad Martín , Saval Victoria Ana , Franco La Rosa Milagros , Berrocal Alfonso
Published: November 2020

Nowadays, anti-programmed death-1 (PD-1) antibodies are the first-line treatment for metastatic malignant melanoma. An infusion reaction is an adverse event that could occur due to monoclonal antibodies administration and requires prompt diagnosis and treatment. In this article, we report on a case of stage IV malignant melanoma treated with nivolumab, in which a severe infusion reaction occurred, manifesting as flushing and hypotension followed by bronchospasm. The switch to pembrolizumab was both a well-tolerated and effective therapeutic alternative.
Treatment Modalities for Cherry Angiomas: A Systematic Review
Authors: Buslach Natalie , Foulad Delila P. , Saedi Nazanin , Mesinkovska Natasha Atanaskova
Published: November 2020

BACKGROUND

Cherry angiomas are benign vascular proliferations of endothelial cells associated with aging. Currently, no mainstay of treatment for these vascular anomalies exists.

OBJECTIVE

To review existing evidence-based therapies for the treatment of cherry angiomas.

METHODS

A literature search in May 2019 was performed with PubMed Database and Cochrane Library using the following terms: “cherry angioma,” “senile hemangioma,” “senile angioma,” “cherry hemangioma,” and “Campbell de Morgan spots.”

RESULTS

Ten studies included in this systematic review reported laser therapy and nonlaser therapy as efficacious treatments for cherry angiomas. Among the laser therapies, pulsed dye laser (PDL) was preferred over potassium-titanyl-phosphate (KTP) and electrodessication (ED), based on decreased procedure-related pain. The neodymium-doped yttrium aluminum garnet (Nd:YAG) laser 1064 nm produced less pigmentary complications, whereas KTP and PDL risked pigmentary changes in darker-skinned individuals. Nonlaser therapies included cryotherapy, sclerotherapy, electrosurgery (i.e., ED, electrocoagulation), and radiofrequency ablation. No therapy proved to be superior.

CONCLUSION

A variety of therapeutic modalities exist for the treatment of cherry angiomas. However, a limited number of high-quality studies explored the efficacy of treatments and compared treatment modalities. Light-based methods such as argon, KTP, Nd:YAG, intense pulsed light, and PDL, along with non–light-based interventions such as cryotherapy, electrosurgery, and sclerotherapy effectively treated cherry angiomas.
Dry spinal tap during real-time ultrasound-guided paramedian spinal injection with patient in the lateral decubitus position
Authors: Somani Sunena , Areeruk Pornpatra , Mok Louis Yue Hong , Samy Winnie , Sivakumar Ranjith K. , Karmakar Manoj K.
Published: November 2020

BACKGROUND

Real-time ultrasound-guided (USG) spinal injection is generally performed via the paramedian sagittal oblique (PMSO) ultrasound window.

OBJECTIVE

The aim of this retrospective study was to draw attention to the occurrence of ‘dry tap’ during real-time USG spinal injection.

DESIGN

Single-centre retrospective study.

SETTING

University teaching hospital, Hong Kong, China

PATIENTS

Data from 113 patients (aged 69.2 ± 18.0 years and BMI 22.3 ± 3.6 kg m−2) of American Society of Anesthesiologists physical status 1 to 3 scheduled for surgery under neuraxial blockade between 2007 to 2017 were reviewed.

INTERVENTIONS

Real-time USG spinal injections or combined spinal-epidural (CSE) using the PMSO ultrasound window with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side were studied.

MAIN OUTCOME MEASURES

‘Dry tap’ was defined as a failure of cerebrospinal fluid (CSF) to efflux from the hub of the needle, within 3 min, with the spinal needle visualised sonographically within the thecal sac. ‘Slow CSF efflux’ was defined as efflux of CSF within 1 to 3 min. Irrespective of whether it was a ‘dry tap’ or ‘slow CSF efflux’, the planned dose of local anaesthetic was injected through the spinal needle.

RESULTS

The combined incidence of ‘dry tap’ and ‘slow CSF efflux’ was 23.8% (27/113) with an individual incidence for each event of 9.7% (11/113) and 14.2% (16/113), respectively. Under the conditions of this study, successful spinal anaesthesia developed in all patients.

CONCLUSION

‘Dry tap’ occurs in 9.7% of cases during real-time USG spinal injection using the PMSO ultrasound window, with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side.

TRIAL REGISTRATION

ChiCTR-IOR-1800019011, Chinese Clinical Trials Registry (www.chictr.org.cn).
A Preliminary Evaluation of the Kidney Function of Sugarcane Cutters From Brazil
Authors: Diniz Caíque Olegário , McKenna Zachary , Canuto Lucas , Magalhães Flávio , Machado-Moreira Christiano Antônio , Shibuya Elisa , da Cunha Irlon , Maia Paulo Alves , Roscani Rodrigo Cauduro , Rocha-Vieira Etel , Santiago de Moraes Barros Thais Maria , Bitencourt Daniel , Souza e Silva de Almeida Flávia , Amorim Fabiano Trigueiro
Published: November 2020

Objective:

To evaluate clinical parameters, markers of kidney function, and skeletal muscle damage in a group of sugarcane cutters during harvesting season.

Methods:

Seventeen volunteers were assessed for anthropometrics and cardiorespiratory fitness. Blood and urine samples were collected 48-hours after the last work session. Blood was analyzed for glucose, creatine kinase, cholesterol, and a complete hemogram. Urine and blood samples were also analyzed for markers related to kidney function.

Results:

Volunteers were young (26 ± 6 y), had low body fat (13 ± 5%), and good cardiorespiratory fitness (41 ± 6 mL/kg/min). Classical markers of kidney function (eGFR, creatinine, cystatin C) were within the normal range. However, ten volunteers presented elevated resting serum creatine kinase (221 ± 68 U/L).

Conclusion:

Manual sugarcane harvesting is associated with sustained skeletal muscle damage which may increase the risk for kidney injury in Brazilian sugarcane cutters.
Psychosocial Impact of COVID-19 on Healthcare Workers at a Tertiary Care Cardiac Center of Karachi Pakistan
Authors: Kumar Dileep , Saghir Tahir , Ali Gulzar , Yasin Umamah , Furnaz Shumaila , Karim Musa , Hussain Muhammad , Kumari Rekha , Bai Reeta , Kumar Hitesh
Published: November 2020

Objectives:

Aim of this study was to determine the depression, stress, and anxiety level among healthcare workers working at a tertiary care cardiac center of Karachi Pakistan during COVID-19 pandemic.

Methods:

This survey was conducted at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Participants of the study were fulltime employees of hospital. Data were collected using an online questionnaire and Depression, Anxiety and Stress - 21 (DASS-21) scale was used.

Results:

A total of 224 healthcare workers were included, 46 (20.5%) participants were screened for moderate to severe depression, 20.1% (45) for moderate to severe anxiety, and 14.7% (33) for moderate to severe stress.

Conclusion:

A significant levels of depression, anxiety, and stress were noted with the major concerns of workplace exposure, increased risk of infection, and transmission to their families and friends.