bluuebunny/crossref_metadata_2025 huggingface dataset:
English Language
Authors: Pullum Geoffrey K.
Published: June 2020

English is both the most studied of the world’s languages and the most widely used. It comes closer than any other language to functioning as a world communication medium and is very widely used for governmental purposes. This situation is the result of a number of historical accidents of different magnitudes. The linguistic properties of the language itself would not have motivated its choice (contra the talk of prescriptive usage writers who stress the clarity and logic that they believe English to have). Divided into multiple dialects, English has a phonological system involving remarkably complex consonant clusters and a large inventory of distinct vowel nuclei; a bad, confusing, and hard-to-learn alphabetic orthography riddled with exceptions, ambiguities, and failures of the spelling to correspond to the pronunciation; a morphology that is rather more complex than is generally appreciated, with seven or eight paradigm patterns and a couple of hundred irregular verbs; a large multilayered lexicon containing roots of several quite distinct historical sources; and a syntax that despite its very widespread SVO (Subject-Verb-Object) basic order in the clause is replete with tricky details. For example, there are crucial restrictions on government of prepositions, many verb-preposition idioms, subtle constraints on the intransitive prepositions known as “particles,” an important distinction between two (or under a better analysis, three) classes of verb that actually have different syntax, and a host of restrictions on the use of its crucial “wh-words.” It is only geopolitical and historical accidents that have given English its enormous importance and prestige in the world, not its inherent suitability for its role.
Implementation of order sets for opioid alternatives in community hospital emergency departments
Authors: Netley Jared , Armstrong William , Meeks Sarah
Published: June 2020

Purpose

The design and implementation of alternatives to opioids (ALTO) order sets for the treatment of acute pain in a community health system’s emergency departments are described.

Healthcare institutions nationwide have incorporated policies and procedures to assist prescribers in the safe and effective management of pain. These adopted approaches may be targeted at mitigating opioid prescribing as well as promoting the optimization of nonopioid analgesics. Institutions that enact innovations and track outcomes may be eligible for reimbursement through the Centers for Medicare and Medicaid Services’ Merit-based Incentive Payment System. Emergency departments may monitor implementation progress and outcomes through participation in the American College of Emergency Physician’s Emergency Quality Network. Clinical pharmacists were tasked with assisting an institution’s emergency departments to create and implement two order sets containing ALTO analgesics and supportive medications for atraumatic headache and general acute pain management. Key steps of order set implementation included collaborative development with emergency department providers, implementation with information services, and the development of provider-focused education by project pharmacists. The implementation of ALTO order sets has set the foundation for expansion of pain control protocols and algorithms within our institution. Furthermore, the approach detailed in this article can be adapted and implemented by other healthcare systems to help reduce opioid prescribing.

Conclusion

The implementation of ALTO order sets within an electronic health record can encourage decreased prescribing of opioids for the treatment of acute pain, promote and optimize dosing of nonopioid analgesics, and may augment reimbursement for services in the emergency department.
Proteome-wide data analysis reveals tissue-specific network associated with SARS-CoV-2 infection
Authors: Feng Li , Yin Yuan-Yuan , Liu Cong-Hui , Xu Ke-Ren , Li Qing-Run , Wu Jia-Rui , Zeng Rong
Published: June 2020

For patients with COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the damages to multiple organs have been clinically observed. Since most of current investigations for virus–host interaction are based on cell level, there is an urgent demand to probe tissue-specific features associated with SARS-CoV-2 infection. Based on collected proteomic datasets from human lung, colon, kidney, liver, and heart, we constructed a virus-receptor network, a virus-interaction network, and a virus-perturbation network. In the tissue-specific networks associated with virus–host crosstalk, both common and different key hubs are revealed in diverse tissues. Ubiquitous hubs in multiple tissues such as BRD4 and RIPK1 would be promising drug targets to rescue multi-organ injury and deal with inflammation. Certain tissue-unique hubs such as REEP5 might mediate specific olfactory dysfunction. The present analysis implies that SARS-CoV-2 could affect multi-targets in diverse host tissues, and the treatment of COVID-19 would be a complex task.
Gastric conduit perforation after Ivor Lewis esophagectomy successfully treated with endoscopic vacuum therapy (E-VAC): a case report
Authors: Hetoja Selma , De Pasqual Carlo Alberto , Mengardo Valentina , Weindelmayer Jacopo , Giacopuzzi Simone
Published: June 2020

Gastric conduit perforation is a life-threatening complication after esophagectomy and currently there is no consensus about its optimal management. Endoscopic vacuum therapy (E-VAC) is a promising technique for the treatment of leaks and perforations after upper gastro-intestinal surgery. We report the case of a 65 years-old male patient who underwent an Ivor Lewis esophagectomy for esophago-gastric junction adenocarcinoma. He referred to our Emergency Department for septic shock and right hydropneumothorax. We performed an emergency thoracoscopy with intraoperative esophagogastroduodenoscopy which showed a pre-pyloric perforation of the gastric conduit. The perforation was initially treated with unsuccessful primary surgical closure and subsequently by means of E-VAC, firstly placed intraluminal and then intracavitary. With the latter technique, we assisted to a progressive clinical improvement until the definitive healing of the perforation. To our knowledge, this is the first case of a gastric tube perforation after esophagectomy successfully treated with E-VAC.
First-aid Training for Combatants Without Systematic Medical Education Experience on the Battlefield: Establishment and Evaluation of the Curriculum in China
Authors: Qin Hao , Liu Daocheng , Chen Sixu , Lyv Mingrui , Yang Lei , Bao Quanwei , Zong Zhaowen
Published: June 2020

Introduction

For combatants without systematic medical education experience (CSMEE), it is necessary to participate in first-aid on the battlefield, but currently there is no effective training curriculum for CSMEE in Chinese military.

Materials and Methods

A list of first-aid techniques based on expert consensus was formed, and then a curriculum was established according to the list. The effectiveness of the curriculum was further evaluated by comparing the scores among group A (the reserve officers trained by this curriculum), group B (the reserve officers in the military medical college trained by professional medic training system), and group C (the fresh officers trained by the Outline of Military Training and Assessment of Chinese military), through a 5-station assessment in a simulated battlefield environment, which included the following 5 techniques: tourniquet for massive extremities hemorrhage, thyrocricocentesis, thoracentesis, fixation of long bone fractures, and wound dressing with hemostatic bandage.

Results

The training curriculum entitled “Implementation and Assessment Standards of First-aid Training for Combatants on the Battlefield” was established. The comparison of average scores in the 5-station assessment showed that group A had better scores than group C in tourniquet for massive extremity hemorrhage, thyrocricocentesis, and thoracentesis, with no significant differences compared with group B. Also, no significant difference between groups A and B in overall completion time and overall scores was observed, whereas an excellent candidate rate in overall score of group B was better than that of group A (87.4% vs. 80.9%, χ2 = 4.40, p = 0.036), and group A was better than group C (80.9% vs. 37.5%, χ2 = 62.01, p < 0.001).

Conclusion

The established training curriculum is indeed effective, which improved the CSMEE’s first-aid capacity on the battlefield, and is equivalent to the level of medics.
Optimizing Peripandemic Care for Veteran Major Non-Traumatic Lower Extremity Amputees: A Proposal Informed by a National Retrospective Descriptive Analysis of COVID-19 Risk Factor Prevalence
Authors: Dittman James M , Tse Wayne , Amendola Michael F
Published: June 2020

Introduction

In response to the Coronavirus 2019 (COVID-19) pandemic, vascular surgeons in the Veteran Affairs Health Care System have been undertaking only essential cases, such as advanced critical limb ischemia. Surgical risk assessment in these patients is often complex, considers all factors known to impact short- and long-term outcomes, and the additional risk that COVID-19 infection could convey in this patient population is unknown. The European Centre for Disease Prevention and Control (ECDC) published risk factors (ECDC-RF) implicated in increased COVID-19 hospitalization and case-fatality which have been further evidenced by initial reports from the United States Centers for Disease Control and Prevention. CDC reports additionally indicate that African American (AA) patients have incurred disparate infection outcomes in the United States. We set forth to survey the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database over a nearly 20 year span to inform ongoing risk assessment with an estimation of the prevalence of ECDC-RF in our veteran critical limb ischemia population and investigate whether an increased COVID-19 comorbidity burden exists for AA veterans presenting for major non-traumatic amputation.

Materials and Methods

The VASQIP database was queried for all above knee amputation (AKA) and below knee amputation (BKA) completed 1999–2018 after IRB approval (MIRB:#02507). Patient race and ECDC-RF including male gender, age > 60 years, smoking status, hypertension, diabetes, chronic obstructive pulmonary disease, cancer, and cardiovascular disease were recorded from preoperative patient history. AKA and BKA cohorts were compared via χ2-test with Yates correction or unpaired t-test and a subgroup analysis was conducted between AA and all other race patients for COVID-19 comorbidities in each cohort.

Results

VASQIP query returned 50,083 total entries. Average age was 65.1 ± 10.4 years and 68.2 ± 10.5 years for BKA and AKA cohorts, respectively, (P < .0001) and nearly all patients were male (99%). At least one ECDC-RF comorbidity was present in 25,526 (88.7%) of BKA and 17,558 (82.4%) of AKA patients (P < .0001). AA BKA patients were significantly more likely than non-AA BKA patients to present with at least one ECDC-RF comorbidity (P = .01).

Conclusions

According to a large national Veterans Affairs database, there are high rates of ECDC-RF in veteran amputees. During the present crisis, management of these patients should incorporate telehealth, expedient discharge, and ongoing COVID-19 transmission precautions.
Salvinia-like slippery surface with stable and mobile water/air contact line
Authors: Li Xiaomei , Yang Jinlong , Lv Kaixuan , Papadopoulos Periklis , Sun Jing , Wang Dehui , Zhao Yanhua , Chen Longquan , Wang Dapeng , Wang Zuankai , Deng Xu
Published: June 2020

Superhydrophobic surfaces are widely used in many industrial settings, and mainly consist of rough solid protrusions that entrap air to minimize the liquid/solid area. The stability of the superhydrophobic state favors relatively small spacing between protrusions. However, this in turn increases the lateral adhesion force that retards the mobility of drops. Here we propose a novel approach that optimizes both properties simultaneously. Inspired by the hydrophobic leaves of Salvinia molesta and the slippery Nepenthes pitcher plants, we designed a Salvinia-like slippery surface (SSS) consisting of protrusions with slippery heads. We demonstrate that compared to a control surface, the SSS exhibits increased stability against pressure and impact, and enhanced lateral mobility of water drops as well as reduced hydrodynamic drag. We also systematically investigate the wetting dynamics on the SSS. With its easy fabrication and enhanced performance, we envision that SSS will be useful in a variety of fields in industry.
IX The Seventeenth Century: Part I
Authors: Baker William , Gwynn Lucy , Doelman James , James Anne , Mroz Matthew
Published: June 2020

This chapter follows the pattern of last year’s by combining what previously were Chapter IX, focusing on the earlier seventeenth century, and Chapter X, ‘Milton and Poetry 1603–1660’. Some of the content transcends historical dates and covers material from the latter half of the seventeenth century too, in other words, the long seventeenth century. There are seven sections: 1. General; 2. Bacon; 3. Browne; 4. Burton; 5. Herbert; 6. Donne; 7. Milton. Sections 1, 2, and 4 are by William Baker; section 3 is by Lucy Gwynn; section 5 is by James Doelman; section 6 is by Anne James; section 7 is by Matthew Mroz.
Nonoperating room anesthesia for patients with serious comorbidities
Authors: Pöyhiä Reino
Published: June 2020

Purpose of review

To provide aids to deal with increasing amount of several comorbidities in nonoperating room anesthesia (NORA).

Recent findings

New indexes for assessment of comorbidities are described and guidelines for the care of patients with obesity, obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), diabetes and COVID19 in NORA summarized.

In addition to ASA classification, such instruments as Charlson Comorbidity Index, Frailty Index, Surgical Complexity Score and Revised Cardiac Risk could supplement the prospective assessment of the risk of comorbidities. Using institutional protocols patients with significant obesity, obstructive sleep apnea, COPD, diabetes and COVID19 can be safely cared in NORA. However, the individual functioning and the severity are more important than only the number of diseases.
UVEITIS TREATED WITH DEXAMETHASONE IMPLANT
Authors: Mathis Thibaud , Cerquaglia Alessio , Weber Michel , Guillarme-Sallit Rébecca , Malclès Ariane , Voirin Nicolas , Servant Marion , Sudhalkar Aditya , Bilgic Alper , Denis Philippe , Sève Pascal , Bodaghi Bahram , Kodjikian Laurent
Published: June 2020

Purpose:

To evaluate the real-life efficacy and safety of the intravitreal dexamethasone implant in uveitis.

Methods:

This retrospective observational multicentric study included 152 eyes treated exclusively by 358 dexamethasone implant injections. The main outcome measures included change in the best-corrected visual acuity, central macular thickness, and vitreous haze score.

Results:

Patients were treated with dexamethasone implant for macular edema (51.3%), vitritis with macular edema (40.1%), vitritis (5.3%), and other causes (3.3%). The mean duration of follow-up was 19.0 months. The mean gain in best-corrected visual acuity during follow-up was +12.1 letters. An improvement in best-corrected visual acuity ≥5, 10, and 15 letters was found in 64.5, 50.7, and 35.5% of cases, respectively. 59.7% of eyes with macular edema at baseline were found to be anatomical responders. Vitritis resolution (vitreous haze = 0+) was obtained in 81.4% of cases. Ocular hypertension (intraocular pressure ≥25 mmHg and/or gain ≥10 mmHg from baseline) occurred in 28.3% of patients. No filtering surgery/laser therapy was required. A total of 40.2% of phakic subjects underwent cataract surgery on average 11.2 months after the first injection.

Conclusion:

This study confirms the efficacy and safety of the dexamethasone implant in noninfectious uveitis. Cataract and ocular hypertension were not uncommon but easily manageable.
Pharmacological therapies to address obesity in type 1 diabetes
Authors: Casu Anna , Bilal Anika , Pratley Richard E.
Published: June 2020

Purpose of review

Obesity is increasing in prevalence among patients with type 1 diabetes (T1D) and is associated with insulin resistance and increased cardiovascular risk. The management of obesity in this population is complicated by defects in pancreatic islet hormone secretion and the effects of exogenous insulin treatment. Here, we review the effects of antiobesity medications and adjunct-to-insulin medications on body weight in T1D.

Recent findings

There is a profound evidence gap around the use of drugs for the treatment of obesity in T1D since systematic studies have not been performed in this population. Adjunctive-to-insulin therapy with certain antihyperglycemic agents leads to modest weight loss and reductions in insulin dose in T1D. However, only pramlintide has been approved in the United States for clinical use as adjunctive therapy in T1D.

The growing prevalence of obesity in T1D has created an unmet need for safe and effective therapies to treat overweight and obesity in this population. Currently, antiobesity medications are used off-label for the treatment of patients with T1D. Additional studies are needed to understand the role of these medications in the management of obesity in patients with T1D.
Traumatic Axonal Injury
Authors: Szecsi Andras , Danics Krisztina , Kondracs Agoston , Szollosi Zoltan
Published: June 2020

A 17-year-old prisoner was found unconscious during a morning check. The previous night, he had been struck on the chin multiple times by one of the other inmates. The patient remained unconscious and eventually died after nearly 1.5 months of care. The primary task of the forensic pathological examination was to investigate the events leading to his death; therefore, it was necessary to examine whether there was a connection between the abuse and eventual death. In our case, the key element was the repetitive, mild-to-moderate force in abuse, resulting in grade I traumatic diffuse axonal damage. Due to progressive brain edema, aspiration subsequently developed, which eventually resulted in irreversible hypoxic damage of the brain.
Unexpected and Sudden Death Due to Undiagnosed Moraxella catarrhalis Meningoencephalitis in a 40-day-old Infant
Authors: Ventura Francesco , Barranco Rosario , Buffelli Francesca , Fulcheri Ezio , Bandettini Roberto , Palmieri Antonella
Published: June 2020

Acute bacterial meningitis in infants and newborns represents a medical emergency and a significant cause of mortality and morbidity worldwide. Moraxella catarrhalis has been considered a microorganism with low pathogenic potential, and only in exceptional cases has it been found to cause meningitis in infants and immunocompetent people. We will now document an unusual case of an unexpected and sudden death of a 40-day-old infant due to acute meningitis from M. catarrhalis, apparently asymptomatic and subsequently diagnosed by an autopsy. According to our knowledge this is the first case of unexpected infant death due to undiagnosed M. catarrhalis meningitis.

The suggested case, as well as for the rarity of such a fatal event, should be considered a caution to pediatrics and neonatologists for M. catarrhalis can cause paucisymptomatic meningoencephalitis in infants which can be potentially fatal.

From a forensic point of view, an autopsy accompanied by a multidisciplinary assessment is always necessary in cases of unexpected infant deaths to identify the causes.
International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients
Authors: Noël Kim C. , Papenburg Jesse , Lacroix Jacques , Quach Caroline , O’Donnell Shauna , Gonzales Milagros , Willson Douglas F. , Gilfoyle Elaine , McNally James D. , Reynolds Steven , Kazzaz Yasser , Kawaguchi Atsushi , Sato Masanori , Kongkiattikul Lalida , Leteurtre Stéphane , Dubos François , Karaca Yasemin , Chiusolo Fabrizio , Piva Jefferson , Dendukuri Nandini , Fontela Patricia S. ,   on behalf of the Canadian Critical Care Trials Group (CCCTG) and the Pediatric Lung Injury and Sepsis Investigators (PALISI) Network
Published: June 2020

Objectives:

We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries.

Design:

Cross-sectional survey.

Setting:

PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil.

Subjects:

Pediatric intensivists.

Interventions:

None.

Measurements and Main Results:

We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped ses. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5–4.0 d] to 9.5 d [95% CI, 8.5–10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries.

Conclusions:

Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
Postauricular Masses
Authors: Tasli Hamdi , Gokgoz Mert Cemal , Karakoc Omer
Published: June 2020

Objective:

The postauricular region (PR) is an anatomic area that has been neglected until now, due to the fact that the significant cosmetic changes and features of this region are often overlooked. There are limited and inconsistent data about postauricular masses in the literature and the definition of the PR and its borders remain unclear. The aim of the present study was to define the PR and evaluate benign and malignant masses that may arise in the PR.

Methods:

Fifty-two patients were enrolled in the study. The patients were evaluated retrospectively in terms of demographic data, including age, gender, operative method, lesion side and size, diagnostic tools, and histopathologic diagnosis of the masses.

Results:

The masses were categorized into 4 groups according to the etiology; neoplastic (n: 15, 28.8%), inflammatory (n: 13, 25%), congenital (n: 22, 42.3%) and traumatic (n: 2, 3.8%). Of the neoplastic masses, 6 (11.5%) were nonmelanoma skin cancer, comprising 4 (7.6%) basal cell carcinomas and 2 (3.8%) squamous cell carcinomas. A total of 9 (17.3%) neoplastic masses were benign, comprising 3 (5.7%) lipomas, 3 (5.7%) temporal bone osteomas, 2 (3.8%) nevi, and 1 (1.9%) plexiform neurofibroma. Of the 13 (25%) inflammatory masses, 12 (23%) were lymph nodes and 1 (1.9%) was pilonidal sinus. There were 22 (42.3%) congenital masses comprising 15 (28.8%) epidermal cysts, 4 (7.6%) dermoid cysts, and 3 (5.7%) hemangiomas. The 2 (3.8%) patients with traumatic lesion were both keloid patients.

Conclusion:

The PR does not attract attention from the cosmetic point of view but many benign and malignant masses can be found in this region. Any masses detected in this area should be treated to prevent further growth.
One-Stage Reconstruction of the Large Lower Nose Defect Involving 2 Subunits With Lateral Nasal Artery Pedicle Nasolabial Flap
Authors: Jiang Banghong , Zhang Li , Xu Jing , Zhang Leiming , Liu Hongwei
Published: June 2020

Background:

Large nose defect reconstructions involving the tip and alar subunits are still difficult to achieve in one stage. This study aimed to investigate the size of the nasal tip and alae, observe the distribution patterns of the lateral nasal artery and present our clinical experience with the lateral nasal artery pedicle nasolabial (LNAPN) flap.

Methods:

From June 2019 to January 2020, lower nose parameters from 60 subjects were measured by a 3-dimensional scan, and the cranial digital subtraction angiogram results of 20 patents without vascular malformation were retrospectively analyzed. The case series consisted of four patients with nasal tip and alar defects who underwent surgery with LNAPN flaps from December 2018 to June 2019. Outcomes and complications were followed-up at 6 to 12 months.

Results:

For the 3-dimensional scan study, the mean area of the 2 subunits involving the tip and alae was 7.986 ± 1.728 cm2. In the digital subtraction angiogram data, the lateral nasal artery was identified among all facial arteries and had a mean diameter of 1.0 ± 0.20 mm. Sixteen people (80%) had a rich connection between the lateral nasal artery and the transverse facial artery. All cases revealed satisfactory aesthetic outcomes by reconstruction of large defects in one stage. The largest flap of 4.2 cm × 3.0 cm in our study showed complete healing.

Conclusions:

The LNAPN flap represents a feasible, flexible, efficient, and easily mastered reconstructive method for large nose defects involving the tip and alar subunits.
Cleft Palate Repair: A New Maxillary Nerve Block Approach
Authors: Moggi Luis E. , Ventorutti Tatyana , Bennun Ricardo D.
Published: June 2020

Objective:

To introduce a different approach for maxillary nerve block (MNB), in cleft palate repair. To reduce the use of opioids during surgery and to prevent frequent respiratory complications by means of an adequate intra and postoperative pain relief.

Patients and Methods:

A prospective clinical trial was planned, to collect scientific evidences between 2 groups of patients with primary cleft palate, receiving surgery in 2 Pediatric centers of Buenos Aires, utilizing a different protocol.

Sixty patients undergoing primary cleft palate repair in both hospitals, from January 2017 to July 2018, by senior surgeons and the same expert anesthesiologists’ team, were included.

Syndromic and secondary cases, and patients whose parents rejected to participate of this study were excluded. The first group called Hospital A included 45 children, the second group identified as Hospital B was formed by 15 patients.

A combination of general whit local anesthesia and a bilateral regional MNB, was used in all the patients of the Hospital A. Utilizing an aspirating syringe, children received 0.15 ml/kg of lidocaine clorhidrate 2% with epinephrine 1:50.000, under direct vision through the spheno palatine holes, just before surgery. A traditional general anesthesia procedure plus local anesthesia, was utilized in all the patients treated at the Hospital B Medial blood pressure and cardiac frequency parameters were tested during induction, along the surgical procedure and in the immediate post op, to detect any sign of pain (12). After surgery, patient reactivity, airway depression symptoms, time of initial feeding and discharge time, were also monitored (13).

This study was approved by the Hospitals Ethics Committees of both hospitals, and is in accordance with the 1975 Helsinki Declaration, as amended in 1983. The parents have signed an informed consent form for all the patients included.

Results:

Patients of both groups did not show any significant variant in the monitored parameters to detect signals of pain, along the surgery. The rest of controls during and after surgery showed significant differences in favor of the patients of Hospital A.

Conclusions:

Bilateral regional MNB, under direct vision trough the spheno palatine holes results an effective, easy, and safe method for pain relief during and after primary cleft palate repair surgeries.

The combination of slight general anesthesia with local anesthesia and regional blocks, results a good option to reduce opioids utilization, to prevent neurotoxicity, respiratory depression, sickness, and vomiting facilitating early feeding and patient discharge.
Evaluation of Hyoid Position and Retroglossal Airway After Mandibular Alveolar Archwise Distraction Osteogenesis
Authors: Acar Yasemin Bahar , Yöndem Cihan , Erverdi Ahmet Nejat , Bakkalbaşi Banu Çakirer
Published: June 2020

The interaction between form and function in the craniofacial region is a well-accepted fact in orthodontics. The aim of the present study is to objectively evaluate if mandibular sagittal symphyseal distraction causes an increase in the retroglossal airway size and hyoid position in a retrospective clinical study. The pretreatment (T0) and 3 months post-distraction (T1) cone-beam computed tomography images of 12 patients (mean age 17.1 years) were retrieved. The retroglossal airway volume and hyoid-mandibular plane distance, hyoid-C3 distance, sella-nasion-B point angle angle, lower incisor to mandibular plane, and Mandibular plane angles were measured using 3D medical imaging software. The average amount of distraction at the superior border of the bony transport segment was 6.2 mm and 4.4 mm at the inferior border. The changes in retroglossal airway volume (2943.2 mm3), incisor to mandibular plane (6.5°), and mandibular plane (2.1°) were significant. The changes in hyoid-mandibular plane distance and hyoid-C3 distances were not significant. However, a downward repositioning in Hyoid position was observed along with the mandibular clockwise rotation. This study showed that symphyseal dentoalveolar distraction osteogenesis, as a complementary to orthodontic therapy, can affect the form and size of the pharynx. Therefore, the airway size should be one of the diagnostic and decisive factors for an ideal treatment planning.
Lip Synechia Resulting From Toxic Epidermal Necrolysis: A Rare Condition
Authors: Mendes Bruno Coelho , Santos Anderson Maikon de Souza , Cervantes Lara Cristina da Cunha , Pereira Rodrigo dos Santos , Hochuli-Vieira Eduardo , Bonardi João Paulo
Published: June 2020

Toxic epidermal necrolyses represent a severe epidermolytic reaction characterized by cutaneous erythema and target lesions affecting >30% of the body surface, skin, and mucous membranes. Ulcerative lesions on the labial mucosa may evolve during healing, resulting in rare complications, such as lip adhesions. This report shows the successful treatment of a lip synechia resulting from the healing of mucosal lesions in a patient with toxic epidermal necrolysis caused by the use of Lamotrigine and Ibuprofen. Although the treatment of the presented lip synechia was simple, this sequela can be avoided by measures such as hydration, hygiene and lip lubrication.
Broad, Recurrent Nasal Dermoid Cyst: A Challenging Task
Authors: Kuzu Selçuk
Published: June 2020

Nasal dermoid sinus cyst is a rare congenital midline anomaly. The embryological origin is different from the dermoid cysts seen in other parts of the face. Nasal dermoid sinus cysts constitute 1% to 3% of all dermoid cysts and 11% to 12% of head and neck dermoid cysts. While most lesions are detected in the first 3 years, in some cases they may not be noticed until later years. Delay in diagnosis increases recurrent infections, airway obstruction and intracranial complications. The authors present a 34-year-old patient with a broad nasal dermoid cyst who had previously undergone external rhinoplasty for a nasal dermoid cyst but relapsed after 5 months.
Intraosseous Hemangioma of Nasal Bone: Unusual Cause of Epiphora
Authors: Choi Jung Sik , Kim Seong Ae , Kim Yu Il. , Lee Jung Ho
Published: June 2020

Intraosseous hemangioma is very rare, accounting for <1% of bone tumors. Nasal bone origin of it is even rarer. A 63-year-old female patient visited our clinic with a complaint of epiphora. On physical examination, about 2-cm-sized nontender and fixed mass was palpated along the left nasomaxillary suture area. Preoperative magnetic resonance imaging findings were consistent with intraosseous hemangioma originating from the nasal bone. Epiphora was thought to be developed due to the mass effect and a marginal resection of the mass was performed. The defect was reconstructed with a septal cartilage and porous polyethylene implant (Synpor). Postoperatively, epiphora subsided and there has been no sign of recurrence or facial deformity during 6 months of follow-up.
The Effect of Xinmailong Infusion on Sepsis-Induced Myocardial Dysfunction: a Pragmatic Randomized Controlled Trial
Authors: He Jianzhuo , Zhao Xujie , Lin Xinfeng , Yang Zhixu , Ma Mingyuan , Ma Li , Liang Qun , Li Lan , Ye Yong , Wen Zehuai , Zhang Zhanlin , Zhang Minzhou , Guo Liheng
Published: June 2020

Sepsis-induced myocardial dysfunction (SIMD) contributes significantly to cardiovascular dysfunction during septic shock. We aimed to evaluate the potential role of Xinmailong injection (XMLI), a polypeptide medicine extracted from Periplaneta americana, in reversing the progression of myocardial damage to SIMD in sepsis patients. This was a multicenter, randomized, double-blind, parallel-group trial. We recruited all patients consecutively admitted to intensive care units (ICUs) who were aged 18 to 85 years old and met the sepsis 3.0 criteria. The primary outcome measure was the incidence of sepsis-induced myocardial dysfunction while in the ICU. Of the 192 patients, 96 were assigned to the treatment group, and 96 to the control group. Subsequently, 41 patients [41/96 (42.7%)] in the XMLI group and 61 patients in the placebo group [61/96 (63.5%)] were confirmed to have diastolic dysfunction on the fifth day (D5). The incidence of diastolic SIMD was significantly different between the two groups (P = 0.004). There were 36 deaths in the two groups during the 28-day follow-up, with a general mortality rate of 18.8% (36/192). The 28-day mortality rates were not significantly different between the groups (P = 0.45). However, the brain natriuretic peptide (BNP) plasma concentration trends on D0, D2, and D5 significantly differed between the two groups (P = 0.049). In septic patients, XMLI decreased the occurrence rate of diastolic SIMD more effectively than the placebo. The improvement in serum BNP concentration was also greater in the XMLI group. XMLI may, therefore, effectively and safely improve cardiac function in patients with sepsis.
Assessment and management of women with heavy menstrual bleeding in Kenya: a best practice implementation project
Authors: Akumu Lydia A. , Ratemo Stanley N. , Owende Philomena
Published: June 2020

Aim:

The aim of this evidence implementation project is to make a contribution to promoting evidence-based practice in the assessment and management of women with heavy menstrual bleeding (HMB) attending the gynaecology outpatient clinic at Kenyatta National Hospital (KNH) and thereby improve patient outcomes and resource utilization.

Methods:

The evidence implementation project was carried out at the gynaecology outpatient clinic of the largest referral facility in Kenya. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool were used. A baseline audit was conducted using a sample of 40 patient files; this was followed by interventions such as trainings, developing of visual tools and updating of protocols. A follow-up audit was then conducted 4 months post intervention.

Results:

Baseline audit results demonstrated varying results in each of the nine criteria selected. Four of the criteria recorded less than 51% compliance, with two of these recording 0% compliance. Postintervention results showed a remarkable increase in most of the audit criteria selected, with eight of these having compliance levels of 90% or more.

Conclusion:

The implementation project served the dual purpose of enlightening health care workers on best practices and educating patients on what they need to know about their condition. This led to an overall improvement in the management of HMB.
Far-red pentamethine cyanine dyes as fluorescent probes for the detection of serum albumins
Authors: Aristova D. , Volynets G. , Chernii S. , Losytskyy M. , Balanda A. , Slominskii Yu. , Mokhir A. , Yarmoluk S. , Kovalska V.
Published: June 2020

Benzothiazole based cyanine dyes with bridged groups in the pentamethine chain were studied as potential far-red fluorescent probes for protein detection. Spectral-luminescent properties were characterized for unbound dyes and in the presence of serum albumins (bovine (BSA), human (HSA), equine (ESA)), and globular proteins (β-lactoglobulin, ovalbumin). We have observed that the addition of albumins leads to a significant increase in dyes fluorescence intensity. However, the fluorescent response of dyes in the presence of other globular proteins was notably lower. The value of fluorescence quantum yield for dye bearing a sulfonate group complexed with HSA amounted to 42% compared with 0.2% for the free dye. The detection limit of HSA by this dye was greater than 0.004 mg ml
−1
which indicates the high sensitivity of dye to low HSA concentrations. Modelling of structure of the dyes complexes with albumin molecules was performed by molecular docking. According to these data, dyes could bind to up to five sites on the HSA molecule; the most preferable are the haemin-binding site in subdomain IB and the dye-binding site in the pocket between subdomains IA, IIA and IIIA. This work confirms that pentamethine cyanine dyes could be proposed as powerful far-red fluorescent probes applicable for highly sensitive detection of albumins.
New azobenzene liquid crystal with dihydropyrazole heterocycle and photoisomerization studies
Authors: Wang Xiaoxuan , Li Zhaoxia , Zhao Haiying , Chen Shufeng
Published: June 2020

New azobenzene derivatives with dihydropyrazole heterocycle have been prepared and characterized. According to thermal polarizing microscopy and differential scanning calorimetry studies, the compounds consisting of four linearly linked rings and a long alkoxy chain on the azobenzene side (
3a-8
and
3a-14
) displayed no liquid crystal properties. When the length of mesogenic unit increased to five rings, except for compound
5a-8
, all compounds from
5a-10
to
5a-16
containing a long chain of 10–16 carbon atoms on the side of ester group displayed liquid crystalline properties, and the mesogenic domain gradually narrowed with increase of the chain length. However, in the case of the molecule with long alkoxy chains on both sides, only
5c-16
with a long chain of 16 carbon atoms exhibited liquid crystal behaviour. In addition, these azo compounds underwent isomerization from E to Z under ultraviolet irradiation and then thermal back relaxation slowly in the dark, which can be recycled many times.
Why chimpanzees carry dead infants: an empirical assessment of existing hypotheses
Authors: Lonsdorf Elizabeth V. , Wilson Michael L. , Boehm Emily , Delaney-Soesman Josephine , Grebey Tessa , Murray Carson , Wellens Kaitlin , Pusey Anne E.
Published: June 2020

The study of non-human primate thanatology has expanded dramatically in recent years as scientists seek to understand the evolutionary roots of human death concepts and practices. However, observations of how conspecifics respond to dead individuals are rare and highly variable. Mothers of several species of primate have been reported to carry and continue to interact with dead infants. Such interactions have been proposed to be related to maternal condition, attachment, environmental conditions or reflect a lack of awareness that the infant has died. Here, we tested these hypotheses using a dataset of cases of infant corpse carrying by chimpanzees in Gombe National Park, Tanzania (n= 33), the largest dataset of such cases in chimpanzees. We found that mothers carried infant corpses at high rates, despite behavioural evidence that they recognize that death has occurred. Median duration of carriage was 1.83 days (interquartile range = 1.03–3.59). Using an information theoretic approach, we found no support for any of the leading hypotheses for duration of continued carriage. We interpret these data in the context of recent discussions regarding what non-human primates understand about death.
Viability of slow-roll inflation in light of the non-zero
k
min
measured in the cosmic microwave background power spectrum
Authors: Liu Jingwei , Melia Fulvio
Published: June 2020

Slow-roll inflation may simultaneously solve the horizon problem and generate a near scale-free fluctuation spectrum
P
(
k
). These two processes are intimately connected via the initiation and duration of the inflationary phase. But a recent study based on the latest
Planck
release suggests that
P
(
k
) has a hard cut-off,

k

min

≠
0

, inconsistent with this conventional picture. Here, we demonstrate quantitatively that most—perhaps all—slow-roll inflationary models fail to accommodate this minimum cut-off. We show that the small parameter
ϵ
must be

≳
0.9

throughout the inflationary period to comply with the data, seriously violating the slow-roll approximation. Models with such an
ϵ
predict extremely red spectral indices, at odds with the measured value. We also consider extensions to the basic picture (suggested by several earlier workers) by adding a kinetic-dominated or radiation-dominated phase preceding the slow-roll expansion. Our approach differs from previously published treatments principally because we require these modifications not only to fit the measured fluctuation spectrum but also simultaneously to fix the horizon problem. We show, however, that even such measures preclude a joint resolution of the horizon problem and the missing correlations at large angles.
Stereotypic Neutralizing VHClonotypes Against SARS-CoV-2 RBD in COVID-19 Patients and the Healthy Population
Authors: Kim Sang Il , Noh Jinsung , Kim Sujeong , Choi Younggeun , Yoo Duck Kyun , Lee Yonghee , Lee Hyunho , Jung Jongtak , Kang Chang Kyung , Song Kyoung-Ho , Choe Pyoeng Gyun , Kim Hong Bin , Kim Eu Suk , Kim Nam-Joong , Seong Moon-Woo , Park Wan Beom , Oh Myoung-don , Kwon Sunghoon , Chung Junho
Published: June 2020

In six of seven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients, VHclonotypes, encoded by either immunoglobin heavy variable (IGHV)3-53 or IGHV3-66 and immunoglobin heavy joining (IGHJ)6, were identified in IgG1, IgA1, and IgA2subtypes, with minimal mutations, and could be paired with diverse light chains, resulting in binding to the SARS-CoV-2 receptor-binding domain (RBD). Because most human antibodies against the RBD neutralized the virus by inhibiting host cell entry, we selected one of these clonotypes and demonstrated that it could potently inhibit viral replication. Interestingly, these VHclonotypes pre-existed in six of 10 healthy individuals, predominantly as IgM isotypes, which could explain the expeditious and stereotypic development of these clonotypes among SARS-CoV-2 patients.
Neurotensin receptor 2 is induced in astrocytes and brain endothelial cells in relation to status epilepticus and neuroinflammation following pilocarpine administration in rats
Authors: Grigorios Kyriatzis , Anne Bernard , Angélique Bôle , Guillaume Pflieger , Petros Chalas , Maxime Masse , Pascaline Lécorché , Guillaume Jacquot , Lotfi Ferhat , Michel Khrestchatisky
Published: June 2020

Neurotensin (NT) acts as a primary neurotransmitter and neuromodulator in the CNS and has been involved in a number of CNS pathologies including epilepsy. NT mediates its central and peripheral effects by interacting with the NTSR1, NTSR2 and NTSR3 receptor subtypes. To date, little is known about the precise expression of the NT receptors in brain neural cells and their regulation in pathology. In the present work, we studied expression of the NTSR2 protein in the rat hippocampus using a model of temporal lobe epilepsy induced by pilocarpine and questioned whether NTSR2 was modulated in conditions of neuro-inflammation. This model is characterized by a rapid and intense inflammatory reaction with a pattern of reactive gliosis in the hippocampus. We show that NTSR2 protein is expressed in hippocampal astrocytes and its expression increases together with astrocyte reactivity following induction of status epilepticus. NTSR2 immunoreactivity is also increased in perivascular astrocytes and their end-feet and is apparent in endothelial cells following induction of status epilepticus. Proinflammatory factors such as IL1β and LPS induced NTSR2 in astrocytes, but also in microgliain vitro. Glial NTSR2 expression showed characteristic immediate early gene response under inflammatory conditions. Treating inflamed glial cells with a vectorized NT analogue decreased NTSR2 expression as well as astrocytic and microglial reactivity. Together, these results suggest that NTSR2 is implicated in astroglial and gliovascular inflammation and that targeting the NTSR2 receptor may open new avenues in the regulation of neuroinflammation in CNS diseases.

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Identifying Modules of Cooperating Cancer Drivers
Authors: Klein Michael I. , Cannataro Vincent L. , Townsend Jeffrey P. , Newman Scott , Stern David F. , Zhao Hongyu
Published: June 2020

Abstract

Identifying cooperating modules of driver alterations can provide biological insights to cancer causation and would advance the development of effective personalized treatments. We present Cancer Rule-Set Optimization (CRSO) for inferring the combinations of alterations that cooperate to drive tumor formation in individual patients. Application to 19 TCGA cancer types found a mean of 11 core driver combinations per cancer, comprising 2-6 alterations per combination, and accounting for a mean of 70% of samples per cancer. CRSO departs from methods based on statistical cooccurrence, which we demonstrate is a suboptimal criterion for investigating driver cooperation. CRSO identified well-studied driver combinations that were not detected by other approaches and nominated novel combinations that correlate with clinical outcomes in multiple cancer types. Novel synergies were identified inNRAS-mutant melanomas that may be therapeutically relevant. Core driver combinations involvingNFE2L2mutations were identified in four cancer types, supporting the therapeutic potential of NRF2 pathway inhibition. CRSO is available athttps://github.com/mikekleinsgit/CRSO/.