bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter Aortic Valve Replacements: Current Trends and Future Directions
Authors: Goeddel Lee A. , Serini Jessica , Steyn Johannes W. , Evans Adam S. , Dwarakanath Sanjay , Ramakrishna Harish , Augoustides John , Brady Mary Beth
Published: June 2018

Since the 1960s when the first aortic surgical aortic valve replacement (SAVR) was performed, continuous growth in the field of valvular technology has occurred. Although SAVR remains a lifesaving procedure, minimally invasive transcatheter aortic valve replacement has revolutionized and expanded aortic valve replacement to patients who were not previously SAVR candidates, increasing their quality of life and survival. Since its introduction in the United States in 2011, the technology and practice have rapidly expanded. Hybrid techniques have been developed that combine surgical access to the vasculature with valvular deployment over transcatheter systems. This literature review aims to describe the differences between the current available valve technologies, review approaches to surgical technique, discuss anesthetic considerations, and look forward to future directions, trends, and challenges.
Bilateral giant macular holes: A rare manifestation of Alport syndrome
Authors: Raimundo Miguel , Fonseca Cristina , Silva Rufino , Figueira João
Published: June 2018

Purpose:

Alport syndrome is a rare condition characterized by the clinical triad of nephritic syndrome, sensorineural deafness, and ophthalmological alterations. Herein, we present a rare case of a patient diagnosed with Alport syndrome and bilateral giant macular holes.

Case description:

A 40-year-old woman with a previously unreported mutation in the COL4A4 gene suggestive of autosomal-recessive Alport syndrome presented at our department. The patient exhibited bilateral full-thickness macular holes measuring >1500 µm at their smallest diameters. The very large dimensions of both macular holes were indicative of a bad prognosis regarding hole closure, and a conservative approach was adopted. The patient was maintained on renal substitution therapy, and genetic counseling was offered to other family members.

Conclusion:

Ophthalmological findings associated to Alport syndrome commonly include anterior lenticonus and dot-and-fleck retinopathy, although giant macular holes can also be associated with this condition. A multidisciplinary approach is crucial in the management of these patients, as Alport syndrome is an inherited systemic basement membrane disease.
Perspective Review: Type 2 Diabetes and Readmission for Heart Failure
Authors: Thomas Merlin C
Published: June 2018

Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.
A Case of Acute Severe Hepatotoxicity and Mild Constriction of Common Bile Duct Associated With Ingestion of Green Tea Extract: A Clinical Challenge
Authors: Surapaneni Balarama Krishna , Le Michelle , Jakobovits Julian , Vinayek Rakesh , Dutta Sudhir
Published: June 2018

Consumption of herbal and dietary supplements (HDS) has increased worldwide as potential treatment for weight reduction and metabolic enhancement. However, it has been reported that HDS can cause liver injury which accounts for 20% of hepatotoxicity in the United States. Prevention of HDS induced liver injury remains a challenge due to difficulties in identifying the hepatotoxins in these preparations and lack of federal regulations for dietary supplements. We report a case of acute severe hepatic necrosis presumably due to consumption of nutritional supplement advertised to boost vitality and stem cells in human body.
Linkage analysis and whole exome sequencing identify a novel candidate gene in a Dutch multiple sclerosis family
Authors: Mescheriakova Julia Y , Verkerk Annemieke JMH , Amin Najaf , Uitterlinden André G , van Duijn Cornelia M , Hintzen Rogier Q
Published: June 2018

Background:

Multiple sclerosis (MS) is a complex disease resulting from the joint effect of many genes. It has been speculated that rare variants might explain part of the missing heritability of MS.

Objective:

To identify rare coding genetic variants by analyzing a large MS pedigree with 11 affected individuals in several generations.

Methods:

Genome-wide linkage screen and whole exome sequencing (WES) were performed to identify novel coding variants in the shared region(s) and in the known 110 MS risk loci. The candidate variants were then assessed in 591 MS patients and 3169 controls.

Results:

Suggestive evidence for linkage was obtained to 7q11.22-q11.23. In WES data, a rare missense variant p.R183C in FKBP6 was identified that segregated with the disease in this family. The minor allele frequency was higher in an independent cohort of MS patients than in healthy controls (1.27% vs 0.95%), but not significant (odds ratio (OR) = 1.33 (95% confidence interval (CI): 0.8–2.4), p = 0.31).

Conclusion:

The rare missense variant in FKBP6 was identified in a large Dutch MS family segregating with the disease. This association to MS was not found in an independent MS cohort. Overall, genome-wide studies in larger cohorts are needed to adequately investigate the role of rare variants in MS risk.
Refugee rights or refugees as threats? Germany’s new Asylum policy
Authors: Ilgit Asli , Klotz Audie
Published: June 2018

On-going Mediterranean migration highlights serious tensions over asylum policy in Germany, among European Union members, and with neighbouring states. Yet commentaries thus far lack a clear understanding of these complex dynamics and their policy implications, because each typically relies on only one of two analytically distinct frameworks: either refugee rights or refugees as threats. Instead, we integrate these frameworks. Specifically, we juxtapose securitisation theory with the coalition literature from migration studies in order to analyse societal contestation in Germany’s responses to the Syrian refugee crisis. We conclude that, despite tactical political shifts, Germany’s commitment to rights remains fundamental because of a resilient coalition of political parties, economic actors, and rights advocates. Insights about Germany, the country arguably most responsible for pushing a common European Union approach to refugees, also help us understand better regional dynamics.
Lit up and left dark: Failures of imagination in urban broadband networks
Authors: Halegoua Germaine R , Lingel Jessa
Published: June 2018

The design and deployment of urban broadband infrastructures inscribe particular imaginations of Internet access onto city streets. The different manifestations and locations of these networks, their uses, and access points often expose material excesses of urban broadband networks, as well as failures of Internet service providers, urban planners, and public officials to imagine the diverse ways that people incorporate Internet connection into their everyday lives. We approach the study of urban broadband networks through the juxtaposition of invisible networks that are buried under the streets and have always been “turned off” (dark fiber) versus hypervisible that are “turned on” and prominently displayed on city streets (LinkNYC). In our analysis of these two case studies, we critique themes of visibility and invisibility as indexes of power and access. Our findings are meant to provide a critical analysis of urban technology policy as well as theories of infrastructure, visibility, and access.
The politics of impunity: A study of journalists’ experiential accounts of impunity in Bulgaria, Democratic Republic of Congo, India, Mexico and Pakistan
Authors: Harrison Jackie , Pukallus Stefanie
Published: June 2018

Definitions of impunity regarding crimes against journalists have thus far been too narrow. Therefore, we propose a new approach to understanding impunity as also being grounded in journalists’ lived reality and perceptions to better understand the complexity and breadth of impunity. It is based on the findings obtained through a set of semi-structured interviews with 40 editors and senior journalists in five countries and expressed in a new typology of impunity. We argue that what we call the ‘Politics of Impunity’ is a policy of governance whereby impunity is used as a political tool by the state and state-sponsored actors to achieve journalistic self-censorship. This is done through the deliberate deprivation of private autonomy brought about by the enforced exile of journalists into a ‘space of exception’ where they are both within and beyond the law. The exercise of the ‘Politics of Impunity’ in an increasing number of states creates an environment that only allows for politically compliant journalism.
Planned fiscal adjustments: Do governments fulfil their commitments?
Authors: Gupta Sanjeev , Jalles João T , Mulas-Granados Carlos , Schena Michela
Published: June 2018

This article analyzes the causes and consequences of fiscal consolidation promise gaps, defined as the distance between planned fiscal adjustments and actual consolidations. Using 74 consolidation episodes derived from the narrative approach in 17 advanced economies during 1978–2015, the paper shows that promise gaps were sizeable (about 0.3% of gross domestic product per year or 1.1% of gross domestic product during an average fiscal adjustment episode). Both economic and political factors explain the gaps: for example, greater electoral proximity, stronger political cohesion and higher accountability were all associated with smaller promise gaps. Finally, governments that delivered on their fiscal consolidation plans were rewarded by financial markets and not penalized by voters.
Opportunity recognition among migrant entrepreneurs
Authors: Lassalle Paul
Published: June 2018

This article examines the decision-making process of Polish migrant entrepreneurs (MEs) using the theoretical lens of opportunity recognition, which has not yet been applied to MEs. First, the article provides empirical evidence on Polish MEs in Glasgow on the incremental nature of their entrepreneurial decisions, their ability to perceive opportunities in the community niche market located in the local opportunity structure and the role played by the household context, highlighting that starting-up is a household and not an individual decision. Second, building on the opportunity recognition literature, the article proposes the concept of haphazard entrepreneurship in the case of MEs. The concept encompasses notions of serendipity and mixed embeddedness and recognizes the importance of household migration and settlement strategies in entrepreneurial decision-making.
The aesthetics of the hybridization of civility: For inclusion, tolerance and an ethic of difference
Authors: Ranasinghe Prashan
Published: June 2018

Exploring life in an emergency shelter, this article narrates the hybridization of civility – the fusion of civility and a street code premised on the threat of violence. This process does not emerge from agency, but predetermined social and economic factors. The hybridization of civility illuminates the psychic violence that envelops the shelter and its personnel. This is illustrated through the aestheticism of this hybridization (what it looks, feels and sounds like). This aestheticism suggests that civility should not be viewed as a binary between civil(ized) and uncivil(ized), but rather in terms of gradations. So doing permits acknowledging and appreciating ‘otherness’ on its own terms, and – paradoxically – recognizing ‘otherness’ as an extension of an already established norm, and thus, as existentially meaningless. The call for the ‘death’ of ‘otherness’ and championing its assimilation into the norm can sow seeds for inclusiveness, tolerance and an ethic of difference.
426–430 Ashley road
Authors: Hass Gabrielle
Published: June 2018

This visual essay explores the life of an ordinary Dorset Victorian building. It depicts this life as an anthology of change, as shaped by the activities of people. It aims to connect the reader to these changes and to the stories that they yield. The intent is to evoke an awareness of our own stories and the part they play in the changes to our localities, however ordinary.
Insights into temperature effects on structural deformation of a cable-stayed bridge based on structural health monitoring
Authors: Zhou Yi , Sun Limin
Published: June 2018

Structural deformation is an important consideration in the health monitoring of bridges, and its dependence on temperature variations is quite complex. Based on field measurements performed for an operational cable-stayed bridge, the proposed study investigates mechanisms of thermally induced variations in girder length and mid-span deflection through plane geometric and finite element analyses. The objective of this study is to understand the behaviour of such bridges over annual and diurnal cycles. It has been observed that the girder length and mid-span deflection of a cable-stayed bridge exhibit different modes of the temperature–response correlation. Thermally induced changes in girder length are solely governed by the average girder temperature, and its annual variation in amplitude is significantly larger compared to the diurnal variation. However, thermally induced mid-span deflections are simultaneously influenced by the cable temperature and average girder temperature, and these do not vary monotonously with temperature, thereby resulting in nearly equal variation amplitudes over both annual and diurnal cycles. Temperature-induced deformations of a cable-stayed bridge could well be approximated through multiple linear superposition of thermal-expansion effects of individual components. Besides thermal-expansion coefficients of structural materials, the temperature dependency of mid-span deflection of a symmetrical twin-tower cable-stayed bridge is closely related to the ratio of tower height above the deck to central span of the girder as well as span ratio of the side span to central span. The proposed simplified formulae to estimate the sensitivities of temperature effects could be readily extended to other cable-stayed bridges with different geometric arrangements, thereby providing valuable insights into thermally induced deformation of such bridges.
A new procedure for determining the road surface reduced luminance coefficient table by on-site measurements
Authors: Strbac-Hadzibegovic N , Strbac-Savic S , Kostic M
Published: June 2018

Numerous measurements have shown that the standard R classes do not represent adequately many road surfaces used nowadays. Therefore, the construction of portable reflectometers intended for on-site measurements of road surface reflection properties has been given particular attention during the last decade. This paper presents a new procedure for the improvement of the accuracy of such a portable reflectometer. Optimally extrapolating the values of the 20 luminance coefficients (q), each measured by the portable reflectometer for a set of angles of observation (α = 5°–80°), the 20 q-values referring to α = 1° are calculated. This enables their comparison with the corresponding q elements from each of the 447 reduced q-tables derived from the available r-table database, obtained by using a precise laboratory reflectometer on a wide variety of road samples. Selecting the closest reduced q-table, the corresponding r-table and the actual average luminance coefficient can be determined. In order to validate the proposed procedure, which can also be applied to other similar portable reflectometers, measurements of the luminance and overall and longitudinal luminance uniformities were carried out on eleven road-lighting installations. They showed that the results obtained by this procedure deviate only slightly from those obtained using r-tables determined by the laboratory reflectometer.
Subjective and pupil responses to discomfort glare from small, high-luminance light sources
Authors: Tyukhova Y , Waters CE
Published: June 2018

This study examined human subjective and pupil responses to small, high-luminance light sources seen against low-luminance backgrounds. Subjective judgements of glare using a seven-point rating scale and the change in pupil diameters following exposure to glare of 47 subjects were measured during evaluation of 36 conditions comprising three glare source luminances (20,000; 205,000; 750,000 cd/m2), two source positions (0°, 10°), two source sizes (10−5, 10−4 sr) and three background luminances (0.03; 0.3; 1 cd/m2). Data analysis suggests that the relative pupil size is correlated with subjective responses to discomfort glare to some extent (r = 0.659). Analysis of variance of relative pupil size measurements demonstrates a significant main effect of the background luminance suggesting that when the background luminance decreases, the relative pupil size increases. Relative pupil size shows the same trend as the relative change in illuminance at the eyes and the discomfort glare perception.
Biomarkers of vascular injury and endothelial dysfunction after recent glucose intolerance in pregnancy
Authors: Bajaj Harpreet S , Ye Chang , Hanley Anthony J , Sermer Mathew , Zinman Bernard , Retnakaran Ravi
Published: June 2018

Objective:

Women with gestational diabetes mellitus and milder gestational impaired glucose intolerance have elevated future risks of type 2 diabetes and cardiovascular disease. However, it is unclear whether they show postpartum evidence of vascular injury/dysfunction, an early event in the natural history of cardiovascular disease.

Methods:

In total, 337 women underwent a glucose challenge test and oral glucose tolerance test in pregnancy, yielding four gestational glucose tolerance groups: gestational diabetes mellitus, gestational impaired glucose intolerance, abnormal glucose challenge test with normal glucose tolerance on the oral glucose tolerance test and normal glucose challenge test with normal glucose tolerance. At 3 years postpartum, they underwent repeat oral glucose tolerance test (on which 69 women had pre-diabetes/diabetes) and measurement of the following serum markers of vascular injury/dysfunction: thrombomodulin, E-selectin, P-selectin, intercellular adhesion molecule-3 and vascular cell adhesion molecule-1.

Results:

At 3 years postpartum, mean adjusted vascular cell adhesion molecule-1 was the only vascular marker that differed across the previous gestational glucose tolerance groups. On multiple linear regression analysis, each strata of gestational dysglycaemia was an independent predictor of lower vascular cell adhesion molecule-1 at 3 years postpartum (gestational diabetes mellitus: p = 0.005; gestational impaired glucose intolerance: p = 0.003; abnormal glucose challenge test normal glucose tolerance: p = 0.0008), as was current pre-diabetes/diabetes ( p = 0.01).

Conclusion:

Dysregulation of vascular cell adhesion molecule-1 may be an early event in the natural history of cardiovascular disease in women with recent glucose intolerance in pregnancy.
PSMA Theranostics: Current Status and Future Directions
Authors: Rahbar Kambiz , Afshar-Oromieh Ali , Jadvar Hossein , Ahmadzadehfar Hojjat
Published: June 2018

Prostate-specific membrane antigen (PSMA) is a promising target for imaging diagnostics and targeted radionuclide therapy (theranostics) of prostate cancer and its metastases. There is increasing evidence of encouraging response rates and a low toxicity profile of radioligand therapy (RLT) of metastatic castration-resistant prostate cancer using 177Lu-labeled PSMA ligands. In this article, we review the current status of diagnostics and therapy using radiolabeled PSMA ligands. We also suggest protocols for patient selection criteria and conduct of PSMA-based RLT. Challenges and opportunities of PSMA theranostics are discussed.
Celiac Artery Aneurysm With Dissection
Authors: Errigo Angela , Fox Traci B.
Published: June 2018

A 52-year-old male with no history of vascular disease presented with a celiac artery aneurysm. Incidentally, a celiac artery dissection was discovered. The dissection was a result of the aneurysm. The proximal abdominal aorta, celiac artery, and superior mesenteric artery were examined with gray scale, color flow, and spectral Doppler. The proximal abdominal aorta, celiac artery, and superior mesenteric artery were without evidence of atherosclerotic plaque. There was evidence of a celiac artery aneurysm measuring 1.3 cm, which was stable compared with a previous CT (computed tomography) from April 2014. A dissection was visualized within the celiac artery with color flow aliasing and higher velocities visualized in the false lumen, with the highest measuring 402/142 cm/s. The true lumen highest velocity measured 209/56 cm/s. The superior mesenteric artery was patent with normal flow patterns and velocities measuring from 134 to 189 cm/s. Celiac artery aneurysms and dissections are extremely rare and can be difficult to find and treat. By scanning the aneurysm, the dissection could be found, perhaps reducing the risk of embolus or occlusion.
Entry remnants in flow-diverted aneurysms: Does branch geometry influence aneurysm closure?
Authors: Zetchi M Akli , Dmytriw Adam A , Chiu Albert H , Drake Brian J , Alizadeh Niki V , Bharatha Aditya , Kulkarni Abhaya V , Marotta Thomas R
Published: June 2018

Objective

Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates.

Methods

Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified. Two blinded raters prospectively reviewed the imaging performed at the time of the procedure and measured the following geometric variables: inflow jet/incorporated branch direction angle and branch artery/ parent artery ratio. Delayed occlusion was defined as the absence of complete aneurysmal occlusion at one year. Analysis was performed using logistic regression and intra-class correlation co-efficient (ICC).

Results

Twenty-four (30%) aneurysms with 28 incorporated branches were identified. A trend toward higher inflow jet/incorporated branch direction angle was found in the group of aneurysms demonstrating delayed occlusion when compared to the group with complete occlusion. ICC revealed high correlation. Overall lower one-year occlusion rates of 53% versus 73% for aneurysms with and without incorporated branches, respectively, were also noted.

Conclusions

The presence of an incorporated branch conferred a 20% absolute risk increase for delayed aneurysmal occlusion. Incorporated branches with a larger angle between the inflow jet and the incorporated branch direction exhibited a trend toward lower occlusion rates. This might be further investigated using a multicenter approach in conjunction with other potentially relevant clinical and angiographic variables.
Thermo-mechanical coupling–based finite element analysis of the load distribution of planetary roller screw mechanism
Authors: Ma Shangjun , Zhang Chenhui , Zhang Tao , Liu Geng , Liu Shumin
Published: June 2018

In this article, 3D or three-dimensional finite element analysis is used to simulate and evaluate the load distribution characteristics of a planetary roller screw mechanism under thermo-mechanical coupling. The finite element model takes into account the installation modes of the planetary roller screw mechanism, which is verified by comparison with theoretical models for a certain load magnitude in four installation modes. In addition, the effects of the installation mode, load magnitude, and temperature condition on the load distribution are also systematically analyzed. The numerical results reveal a phenomenon of threads separating from the meshing, which indicates that the influence of thermo-mechanical coupling on the load distribution cannot be ignored. Furthermore, the influence of the installation mode on the screw–roller interface is larger than that on the nut–roller interface. Compared with the screw–roller interface, the temperature difference is one of the main conditions affecting the load distribution of the planetary roller screw mechanism and has a significant effect on the nut–roller interface. In addition, the influences of the screw rotational speed and the load magnitude on the load distribution on the screw–roller interface are larger than those on the nut–roller interface for the four installation modes.
Metformin does not reduce inflammation in diabetics with abdominal aortic aneurysm or at high risk of abdominal aortic aneurysm formation
Authors: Wang S Keisin , Green Linden A , Gutwein Ashley R , Kenyon Bianca , Motaganahalli Raghu L , Fajardo Andres , Gupta Alok K , Murphy Michael P
Published: June 2018

Introduction

The protective effect of diabetes mellitus on abdominal aortic aneurysm formation and growth has been repeatedly observed in population studies but continues to be poorly understood. However, recent investigations have suggested that metformin, a staple antihyperglycemic medication, may be independently protective against abdominal aortic aneurysm formation and growth. Therefore, we describe the effect of metformin in abdominal aortic aneurysm and at-risk patients on markers of inflammation, the driver of early abdominal aortic aneurysm formation and growth.

Methods

Peripheral blood was collected from patients previously diagnosed with abdominal aortic aneurysm or presenting for their U.S. Preventive Task Force-recommended abdominal aortic aneurysm screening. Plasma and circulating peripheral blood mononuclear cells were isolated using Ficoll density centrifugation. Circulating plasma inflammatory and regulatory cytokines were assessed with enzyme-linked immunosorbent assays. CD4+ cell phenotyping was performed using flow cytometric analysis and expressed as a proportion of total CD4+ cells. To determine the circulating antibody to self-antigen response, a modified enzyme-linked immunosorbent assay was performed against antibodies to collagen type V and elastin fragments.

Results

Peripheral blood was isolated from 266 patients without diabetes mellitus ( n=182), with diabetes mellitus not treated with metformin ( n=34), and with diabetes mellitus actively taking metformin ( n=50) from 2015 to 2017. We found no differences in the expression of Tr1, Th17, and Treg CD4+ fractions within diabetics ± metformin. When comparing inflammatory cytokines, we detected no differences in IL-1β, IL-6, IL-17, IL-23, IFN-γ, and TNF-α. Conversely, no differences were observed pertaining to the expression to regulatory cytokines IL-4, IL-10, IL-13, TSG-6, or TGF-β. Lastly, no differences in expression of collagen type V and elastin fragment antigen and/or antibodies were detected with metformin use in diabetics.

Conclusion

Metformin in diabetics at-risk for abdominal aortic aneurysm or diagnosed with abdominal aortic aneurysm does not seem to alter the peripheral inflammatory environment.
Moral panics and digital-media logic: Notes on a changing research agenda
Authors: Hier Sean
Published: June 2018

This research note critically comments on the lack of attention that moral panic scholars are devoting to the ways in which changing digital media formats are reshaping the dynamics of interaction involved in public claims-making, modes of audience engagement, and techniques of regulation and control. Angela McRobbie and Sarah Thornton’s seminal deconstruction of conventional moral panic studies is used as a point of departure to supplement the logic of mass mediation with insights into some of the structuring principles that ground the logic of digital mediation.
Plastic change of prefrontal cortex mediates anxiety-like behaviors associated with chronic pain in neuropathic rats
Authors: Sang Kangning , Bao Chaofei , Xin Yushi , Hu Shunan , Gao Xian , Wang Yongsheng , Bodner Mark , Zhou Yong-Di , Dong Xiao-Wei
Published: June 2018

Clinical studies show that anxiety and chronic pain are concomitant. The neural basis for the comorbidity is unclear. The prefrontal cortex (PFC) has been recognized as a critical area for affective disorders and chronic pain modulation. In this study, we examined the role of the PFC in the pathogenesis of anxiety associated with chronic pain in a rat model of neuropathic pain with spare nerve injury (SNI). The SNI rats showed apparent anxiety-like behaviors in both open field (OF) test and elevated-plus maze (EPM) test eight weeks after surgery. Thus, the number of entries to the central area in the OF decreased to 45% (±5%, n = 15) of sham control (n = 17), while the overall motor activity (i.e., total distance) was unaffected. In the EPM, the percentage of entries into the open arms significantly (p < 0.001) decreased in SNI rats (SNI: 12.58 ± 2.7%, n = 15; sham: 30.75 ± 2.82%, n = 17), so did the time spent in the open arms (SNI: 4.35 ± 1.45%, n = 15; Sham: 11.65 ± 2.18%, n = 17). To explore the neural basis for the association between anxiety and chronic pain, local field potentials (LFPs) were recorded from the medial PFC (mPFC) and ventral hippocampus. In SNI rats, there were significantly greater increases in both theta-frequency power in the mPFC and theta-frequency synchronization between the mPFC and ventral hippocampus, when animals were displaying elevated anxiety-like behaviors in avoiding anxiogenic regions in EPM and OF chamber. Western blot analyses showed a significant elevation of serotonin transporter expression in the anxious SNI rats. Inhibition of serotonin transporter effectively alleviated anxiety-like behaviors following sub-chronic (15 days) treatment with systemic citalopram (10 mg/kg/day, intraperitoneally). Moreover, the anxiety-like behaviors in the SNI rats were also suppressed by direct mPFC application of serotonin. Taken together, we conclude that the plasticity of serotonin transmission in the mPFC likely contribute to the promotion of anxiety state associated with neuropathic pain.
Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger
Authors: Toros Tulgar , Gurbuz Yusuf , Kelesoglu Beray , Ozaksar Kemal , Sugun Tahir Sadık
Published: June 2018

This article defines a sensate, pedicled heterodigital flap from the proximal radial side of the index finger for reconstructing large soft tissue defects of the thumb. The pedicle consists of the radial digital artery of the index finger. Dorsal sensory branch of proper digital nerve and one of the terminal sensory branches of radial nerve are included in the flap for sensation. The results of 17 consecutive patients at 24 months revealed mean static two-point discrimination of 7 mm at the reconstruction site and 10 patients were able to feel 4 mm at the reconstructed thumb. The mean range of motion of metacarpophalangeal and interphalangeal joints of operated thumbs reached 94% and 66%, the mean grip span reached 96% compared with the uninjured side. The presented flap provided a simple yet favourable alternative for reconstruction of the thumb tip, with thick and durable tissue requiring minimum dissection and donor side morbidity.

Level of evidence: IV
A blinded, randomized trial comparing bicolumnar arthrodesis to radioscapholunate arthrodesis in scapholunate advanced collapse II arthritis: a pilot study
Authors: Chan Simon S. M. , Sikora Sheena , Harvey Jason N. , Tham Stephen K. Y.
Published: June 2018

The purpose of this study was to compare the outcome of scaphoid excision with capitolunate and triquetrohamate arthrodesis (bicolumnar arthrodesis) to radioscapholunate arthrodesis in patients with scapholunate advanced collapse (SLAC) II wrist arthritis. Twelve patients with symptomatic SLAC II arthritis were recruited and randomized to receive either bicolumnar arthrodesis or radioscapholunate arthrodesis. The primary outcome was wrist function as assessed by the patient rated wrist evaluation. Secondary outcomes included range of motion, grip strength and the Mayo wrist score. A linear mixed-effects model was used to evaluate the effects of bicolumnar arthrodesis and radioscapholunate arthrodesis in treating SLAC II arthritis. Patients receiving bicolumnar arthrodesis had more improvement in their wrist function compared with patients receiving radioscapholunate arthrodesis. A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis. In SLAC II arthritis, the expected benefit of preserving the midcarpal joint was not observed. Scapholunate ligament disruption makes radioscapholunate arthrodesis a technically challenging operation.

Level of evidence: I
Rituximab – A novel therapy for severe ITP in pregnancy: A case report
Authors: Donohoe Fionan , Higgins Mary , Higgins Shane , McAuliffe Fionnuala , Murphy Karen
Published: June 2018

Background

Rituximab is a novel second-line agent for the treatment of immune thrombocytopenic purpura. Minimal data exist on the use of rituximab in pregnancy. This case illustrates the successful treatment of severe immune thrombocytopenic purpura diagnosed in pregnancy, refractory to all other medical management.

Case

A 32-year-old nulliparous woman was diagnosed with severe immune thrombocytopenic purpura at the time of booking for antenatal care (platelet level of 13 × 109/L). Standard treatment failed to adequately increase her platelet count. Therapy with rituximab was instituted, and her platelet count rose to normal levels, without side effects, and remained at a normal level throughout the pregnancy. There were no maternal or neonatal ill-effects of rituximab therapy.

Conclusion

Rituximab is potentially a safe treatment option for the management of immune thrombocytopenic purpura in pregnancy with good maternal and neonatal outcome when conventional treatments have been unsuccessful. Research is limited to case reports, and therefore limited information currently exists to guide clinicians.
The Forensic Pathology of Liver Trauma
Authors: Rogers Christopher B. , Devera Ronald
Published: June 2018

The forensic pathologist is an integral part of the trauma surgery team. Trauma surgeons depend on autopsy descriptions for accurate measurement of the severity of trauma and determination of the chance of mortality. The outcome of liver injury improved greatly during the 20th century, primarily due to improved diagnostic and management techniques. In many trauma cases, survival depends on injuries to areas other than the liver. Measurement of the severity of liver trauma often uses the TRISS (Trauma and Injury Severity Score) method, which depends on the nature, location, and size of injuries. Injuries produced by blunt trauma depend on the direction of the force and its interaction with the anatomic structures that surround the liver. Sharp force and gunshot injuries depend on the portions of the liver involved and the amount of kinetic energy transmitted to the tissue. The liver is susceptible to injury from resuscitation, although these injuries are usually not severe. Acad Forensic Pathol. 2018 8(2): 184-191
Fatty Liver and the Forensic Pathologist
Authors: Milroy Christopher M.
Published: June 2018

Fatty liver is a common finding in clinical practice and at autopsy. It is most commonly seen associated with alcohol abuse and in non-alcoholic fatty liver disease (NAFLD). It may also be seen in many other conditions in both adults and children. It is now recognized that NAFLD, like alcoholic liver disease, may lead to end stage liver disease. Nonalcoholic fatty liver disease is associated with increased mortality from other disorders, particularly cardiovascular diseases. Fatty liver may be seen in many conditions that concern autopsy pathologists, including drug toxicity, anorexia, hepatic ischemia, and heatstroke. In infants, steatosis is common in sudden unexpected deaths. Fatty liver has been associated with sudden death and this review examines the pathology and role of fatty liver in sudden death. Acad Forensic Pathol. 2018 8(2): 296-310
Postmortem Serum Amylase and Lipase Analysis in the Diagnosis of Acute Pancreatitis
Authors: Brown Theodore T. , Prahlow Joseph A.
Published: June 2018

The diagnosis of acute pancreatitis, which can occur due to natural and nonnatural causes, is usually made at autopsy based on gross and microscopic examination. However, some pathologists choose to measure serum amylase and lipase levels in postmortem blood samples, which may provide corroborating evidence of acute pancreatitis when evaluated in the context of the autopsy findings. A small series of autopsy cases of deaths related to acute pancreatitis with corresponding postmortem serum amylase and lipase levels and a review of the literature are used to highlight the potential benefits and interpretation issues of postmortem serum amylase and lipase. In autopsies without decomposition, elevated postmortem serum amylase (greater than 1000 U/L) and lipase can provide supportive evidence of acute pancreatitis as a cause of death. However, relying on postmortem serum amylase and lipase alone to diagnose acute pancreatitis is insufficient and unreliable. Rather, one must have the gross and histologic evidence of acute pancreatitis. Acad Forensic Pathol. 2018 8(2): 311-323
The Utility of Bile in Postmortem Forensic Toxicology
Authors: Bierly Jolene , Labay Laura M.
Published: June 2018

Bile is one matrix type that may be collected at autopsy and submitted to the toxicology laboratory for analysis. Because it is an excretion product of the liver, it can be used for screening purposes and to determine what drugs an individual used or was exposed to prior to death. This paper presents collection and analytical considerations of bile, and provides an overview of its utility from a testing and interpretation perspective. Acad Forensic Pathol. 2018 8(2): 324-327
Autopsy Biosafety
Authors: Brooks Erin G. , Utley-Bobak Suzanne R.
Published: June 2018

Introduction:

As invasive meningococcal disease progresses rapidly, often affects youth, and has a fairly high mortality rate, such cases are likely to fall under medical examiner/coroner (ME/C) jurisdiction. Morgue personnel may be at risk of contracting secondary meningococcal disease. We review the current scientific literature regarding Neisseria meningitidis infection and provide recommendations for the prevention of meningococcal disease at autopsy.

Methods:

A PubMed search utilizing applicable medical subject heading terms was performed retrieving articles for review from the preceding two decades. Pertinent current guidelines from multiple national organizations were also retrieved.

Results:

Invasive meningococcal disease is transmitted by direct contact with large respiratory droplets or oral secretions. While a surgical mask would normally provide adequate protection from large droplet spread, it does not prevent inhalation of smaller aerosolized particles such as those generated at autopsy. Prosectors are advised to routinely wear N-95 respirator masks or powered respirator hoods. All published cases of secondary meningococcal disease transmission to healthcare workers invariably arose in scenarios in which face masks/respirators were not employed; none of these cases involved meningococcal disease transmission to ME/C or other morgue staff.

Discussion:

In the event that no mask—or inadequate coverage such as a surgical mask—is employed during autopsy of a decedent suspected/confirmed to have invasive meningococcal disease, antibiotic prophylaxis is advisable. Assuming appropriate personal protective equipment is utilized, chemoprophylaxis is unnecessary. Routine meningococcal vaccination is not recommended, except for ME/C with specified immunocompromising conditions or traveling to hyperendemic/endemic meningococcal regions. Acad Forensic Pathol. 2018 8(2): 328-339
Improving Forensic Pathologic Investigation of Sudden Death in the Young
Authors: Gulino Sam P. , Burns Kristin , Gunther Wendy M. , MacLeod Heather
Published: June 2018

The Sudden Death in the Young (SDY) Case Registry, a prospective, population-based registry active in ten states, has developed tools to aid pathologists and death investigators in the evaluation and autopsy of unexplained, natural sudden deaths in the pediatric population. The tools were developed by a team of experts representing forensic pathology; pediatric-, cardiac-, and neuropathology; cardiology; neurology/epileptology; pediatrics; genetic counseling; and public health. These tools focus on collecting data relevant to determination of cause of death with a focus on dissection of the cardiovascular system. The tools provide an objective checklist format for ease of use and data extraction. By sharing the tools here and highlighting the examination of the cardiovascular system, the SDY Case Registry encourages a standardized approach to death investigation, autopsy, and data collection for sudden, unexpected deaths in the young towards a goal of informing prevention efforts. Acad Forensic Pathol. 2018 8(2): 347-391
A Case Series of Anterograde and Retrograde Vascular Projectile Embolization
Authors: Chao Jennifer , Barnard Jeffrey , deJong Joyce L. , Prahlow Joseph A.
Published: June 2018

Deaths related to firearms are common within the United States, with most cases having conspicuous projectile wounds found at autopsy. Individual gunshot wounds may be perforating or penetrating. In most cases with penetrating wounds, projectiles are relatively easily found via radiography and by following the pathway on internal examination. When a projectile is not detected in the expected region, intravascular embolization of the projectile should be suspected. Embolization may be arterial or venous, as well as anterograde or retrograde. Typically, such emboli involve small caliber bullets or shot pellets. The authors present three unusual cases of intravascular projectile embolization at autopsy, one involving shotgun slug fragment embolization, one where death was delayed, and one with retrograde embolization into the liver. Acad Forensic Pathol. 2018 8(2): 392-406
A Case of Severe Cardiac Sarcoidosis with Minimal Pulmonary Involvement
Authors: Fowler Mark R. , Mambo Nobby C.
Published: June 2018

Sarcoidosis is a granulomatous disease of unknown etiology. Although sarcoidosis is a systemic disease, there appears to be a predilection for involvement of certain organs. The pulmonary system is the most commonly affected system among all racial groups. Cardiac and respiratory complications are the leading causes of death due to sarcoidosis and in certain patient populations about half of these deaths are attributed to cardiac sarcoidosis. There are few autopsy case reports of cardiac sarcoidosis with minimal respiratory involvement making this case report relevant to the importance of the recognition and awareness of this entity. Acad Forensic Pathol. 2018 8(2): 407-415
Chronic Disturbance Affects the Demography and Population Structure of Beaucarnea inermis, a Threatened Species Endemic to Mexico
Authors: Rubio-Méndez Gabriel , Castillo-Gómez Hugo A. , Hernández-Sandoval Luis , Espinosa-Reyes Guillermo , De-Nova J. Arturo
Published: June 2018

Beaucarnea inermis is a threatened plant of the seasonally dry tropical forests of the northeastern Sierra Madre Oriental mountains. It has been affected by habitat loss and fragmentation, mainly from changes in land use and poaching. The number of B. inermis plants, sexual proportion, and structural parameters were recorded in natural populations inside the Sierra del Abra Tanchipa Biosphere Reserve and unprotected sites. Effects of chronic disturbance on demography parameters and asymmetry coefficient were estimated. Average population density is 280 ind*ha−1 inside the protected area and 186 ind*ha−1 in unprotected sites. Life tables indicate a high seedling to juvenile mortality rate, but life expectancy increases in juveniles, suggesting a survival type III curve. Population size distribution skewness indicates differences associated with disturbance. Sex ratio was 0.93:1 (m:f) inside the protected area and 0.76:1 (m:f) in unprotected sites. Anthropogenic disturbance affects life expectancy and the survival and mortality rates mainly in early life classes; however, once the adult stage is reached, mortality rate is reduced and survival rate increases. The natural protected area represents a refuge for the species from the effects of anthropogenic disturbance and illegal poaching. Additional studies are needed to evaluate the genetic diversity in B. inermis in protected and unprotected sites, and how it is affected by disturbance. Also, it is important to highlight other species inside the protected area such as Dioon edule, Zamia fischeri, and Stanhopea tigrina, which are considered as endangered or threatened.
Bird Diversity and the Resilience of Southwestern Ethiopian Forests
Authors: Rodrigues Patricia , Fischer Joern
Published: June 2018

Coffee forests in southwestern Ethiopia host a diverse community of birds including some endemics. Different ecological bird groups respond differently to coffee management intensity, to amount of forest cover, and to distance to the forest edge. In this commentary, we highlight the implications of these differential responses for the resilience of the forest ecosystem and outline research priorities for future studies of bird diversity in the region.
Animal-Assisted Therapy Supports Student Connectedness
Authors: Fedor Jill
Published: June 2018

Animal-assisted therapy is a complementary approach to supporting the well-balanced student. In particular, therapy dogs in school can have a direct impact on students’ social interactions, class participation, and behavior, as well as strengthening feelings of connectedness in school—a protective factor against risk-taking behaviors. School nurses have the unique charge of acting as liaisons between optimal health and academic success, and they can serve an integral role in animal-assisted therapy programs at school. The benefits of animal-assisted therapy in elementary schools along with the role of the school nurse in the planning and success of the program are described.