bluuebunny/crossref_metadata_2025 huggingface dataset:
Brexpiprazole as Adjunctive Treatment for Major Depressive Disorder Following Treatment Failure With at Least One Antidepressant in the Current Episode: a Systematic Review and Meta-Analysis
Authors: Kishi Taro , Sakuma Kenji , Nomura Ikuo , Matsuda Yuki , Mishima Kazuo , Iwata Nakao
Published: July 2019

Background

This systematic review and meta-analysis included double-blind, randomized, placebo-controlled trials of brexpiprazole adjunctive treatment (0.5–3 mg/d) for major depressive disorder where antidepressant treatment had failed.

Methods

The outcomes were the response rate (primary), remission rate (secondary), Montgomery Åsberg Depression Rating Scale score (secondary), Sheehan Disability Scale scores (secondary), Clinical Global Impression–Improvement/Severity scores, discontinuation rate, and individual adverse events. A subgroup meta-analysis of the data at week 6 compared outcomes by dose >2 mg/d or ≤2 mg/d (2 mg/d is the recommended dose).

Results

We identified 9 studies (n = 3391). Compared with placebo, brexpiprazole (any dose) was superior for response rate (risk ratio [RR] = 0.93, 95% confidence interval [95% CI] = 0.89−0.97, number needed to treat = 17), remission rate (RR = 0.95, 95% CI = 0.93−0.98, number needed to treat = 25), Montgomery Åsberg Depression Rating Scale score (standardized mean difference = −0.20, 95% CI = −0.29, −0.11), Sheehan Disability Scale score (standardized mean difference = −0.12, 95% CI = −0.21, −0.04), and Clinical Global Impression–Improvement/Severity scores but was associated with a higher discontinuation rate, akathisia, insomnia, restlessness, somnolence, and weight increase. Doses >2 mg/d had a significantly higher RR for response rate than ≤2 mg/d (0.96 vs 0.89); moreover, compared with placebo, doses >2 mg/d were associated with higher incidences of akathisia (RR = 4.58) and somnolence (RR = 7.56) as well as were marginally associated with a higher incidence of weight increase (RR = 3.14, P = .06). Compared with placebo, doses ≤2 mg/d were associated with higher incidences of akathisia (RR = 2.28) and weight increase (RR = 4.50).

Conclusions

Brexpiprazole adjunctive treatment is effective for major depressive disorder when antidepressant treatment fails. At 6 weeks, doses ≤2 mg/d presented a better risk/benefit balance than >2 mg/d.
A patient and family reporting system for perceived ambulatory note mistakes: experience at 3 U.S. healthcare centers
Authors: Bourgeois Fabienne C , Fossa Alan , Gerard Macda , Davis Marion E , Taylor Yhenneko J , Connor Crystal D , Vaden Tracela , McWilliams Andrew , Spencer Melanie D , Folcarelli Patricia , Bell Sigall K
Published: July 2019

Objective

The study sought to test a patient and family online reporting system for perceived ambulatory visit note inaccuracies.

Materials and Methods

We implemented a patient and family electronic reporting system at 3 U.S. healthcare centers: a northeast urban academic adult medical center (AD), a northeast urban academic pediatric medical center (PED), and a southeast nonprofit hospital network (NET). Patients and families reported potential documentation inaccuracies after reading primary care and subspecialty visit notes. Results were characterized using descriptive statistics and coded for clinical relevance.

Results

We received 1440 patient and family reports (780 AD, 402 PED, and 258 NET), and 27% of the reports identified a potential inaccuracy (25% AD, 35% PED, 28% NET). Among these, patients and families indicated that the potential inaccuracy was important or very important in 58% of reports (55% AD, 55% PED, 71% NET). The most common types of potential inaccuracies included description of symptoms (21%), past medical problems (21%), medications (18%), and important information that was missing (15%). Most patient- and family-reported inaccuracies resulted in a change to care or to the medical record (55% AD, 67% PED, data not available at NET).

Discussion

About one-quarter of patients and families using an online reporting system identified potential documentation inaccuracies in visit notes and more than half were considered important by patients and clinicians, underscoring the potential role of patients and families as ambulatory safety partners.

Conclusions

Partnering with patients and families to obtain reports on inaccuracies in visit notes may contribute to safer care. Mechanisms to encourage greater use of patient and family reporting systems are needed.
A Systematic Review of Solid-Phase Microextraction Applications in the Forensic Context
Authors: De Giovanni Nadia , Marchetti Daniela
Published: July 2019

Since the introduction in 1990, the solid-phase microextraction (SPME) technology has brought significant progress in many fields of forensic sciences due to the versatility of this fast and solventless alternative to conventional extraction techniques.

A systematic review about SPME applications in forensic context from January 1995 to June 2018 was carried out according to systematic review guidelines. The majority of the reviewed articles (40/133) aimed to identify drugs (cannabinoids, cocaine, opiates, amphetamines, simultaneous detection of different drugs of abuse, prescribed drugs); 29 of the 133 articles focused on the investigation of fatalities; 28 of the 133 papers used headspace SPME technique for the identification of markers of chronic alcohol abuse. Sixteen papers involved this technique for the isolation of volatile organic compounds for the human odor profile and 20 concerned forensic applications regarding living people.

Solid-phase microextraction was preferably employed in the headspace mode and many kinds of fibers were employed, although polydimethylsiloxane was the most adaptable to many forensic realities. Gas chromatography/mass spectrometry was more frequently used, probably for the well-established coupling with SPME. Most of the papers validated their method to harmonize the scientific approaches of procedures development.

Good outcomes are reported on biological material collected from living people as well as on cadaveric samples. The results obtained by most of the studies about alcohol biomarkers on scalp hair have been adopted by the “Society of Hair Testing” to demonstrate abstinence over a pre-defined time period and to assess chronic excessive alcohol consumption.
Cameras Everywhere Revisited: How Digital Technologies and Social Media Aid and Inhibit Human Rights Documentation and Advocacy
Authors: Gregory Sam
Published: July 2019

Pessimism currently prevails around human rights globally, as well as about the impact of digital technology and social media in supporting rights. However, there have been key successes in the use of these tools for documentation and advocacy in the past decade, including greater participation, more documentation, and growth of new fields around citizen evidence and fact-finding. Governments and others antagonistic to human rights have caught up in terms of weaponizing the affordances of the internet and pushing back on rights actors. Key challenges to be grappled with are consistent with ones that have existed for a decade but are exacerbated now—how to protect and enhance safety of vulnerable people and provide agency over visibility and anonymity; how to ensure and improve trust and credibility of human rights documentation and advocacy campaigning; and how to identify and use new strategies that optimize for a climate of volume of media, declining trust in traditional sources, and active strategies of distraction and misinformation. All of these activities take place primarily within a set of platforms that are governed by commercial imperatives and attention-based algorithms, and that increasingly use unaccountable content moderation processes driven by artificial intelligence. The article argues for a pragmatic approach to harm reduction within the platforms and tools that are used by a diverse range of human rights defenders, and for a proactive engagement on ensuring that an inclusive human rights perspective is centred in responses to new challenges at a global level within a multipolar world as well as specific areas of challenge and opportunity such as fake news and authenticity, deepfakes, use of artificial intelligence to find and make sense of information, virtual reality, and how we ensure effective solidarity activism. Solutions and usages in these areas must avoid causing inadvertent as well as deliberate harms to already marginalized people.
Dually hemimorphic semi-Nelson algebras
Authors: Cornejo Juan Manuel , San MartÍn HernÁn Javier
Published: July 2019

Extending the relation between semi-Heyting algebras and semi-Nelson algebras to dually hemimorphic semi-Heyting algebras, we introduce and study the variety of dually hemimorphic semi-Nelson algebras and some of its subvarieties. In particular, we prove that the category of dually hemimorphic semi-Heyting algebras is equivalent to the category of dually hemimorphic centered semi-Nelson algebras. We also study the lattice of congruences of a dually hemimorphic semi-Nelson algebra through some of its deductive systems.
Family-Based Consent to Organ Transplantation: A Cross-Cultural Exploration
Authors: Cherry Mark J , Fan Ruiping , Evans Kelly Kate
Published: July 2019

This special thematic issue of The Journal of Medicine and Philosophy brings together a cross-cultural set of scholars from Asia, Europe, and North America critically to explore foundational questions of familial authority and the implications of such findings for organ procurement policies designed to increase access to transplantation. The substantial disparity between the available supply of human organs and demand for organ transplantation creates significant pressure to manipulate public policy to increase organ procurement. As the articles in this issue explore, however, even if well intentioned, the desire to maximize organ procurement does not justify undermining foundational elements of human flourishing, such as the family. While defending at times quite different understandings of autonomy, informed consent, and familial authority, each author makes clear that a principled appreciation of the family is necessary. Otherwise, health care practice will treat the family in a cynical and instrumental fashion unlikely to support social or individual good.
Human Being, Bodily Being: Phenomenology from Classical India, by Chakravarthi Ram-Prasad
Authors: Prueitt Catherine
Published: July 2019

In the matter of the body, even comparative language—the very use of English today—is soaked through and through with the Cartesian version of the intuition of dualism: the idea that we are fundamentally a mind and a body that must be either related ingeniously, or else reduced to one another. Instead, by deliberately looking at genres that pertain to other aspects of being human, I seek to go deeper into texts that simply start elsewhere than with intuitions of dualism, even while being engrossed in the category of the experiential ‘body’ (in all its translational variety in Sanskrit and Pali). (Ram-Prasad 2018, p. 11)
Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management
Authors: Pastick Katelyn A , Nalintya Elizabeth , Tugume Lillian , Ssebambulidde Kenneth , Stephens Nicole , Evans Emily E , Ndyetukira Jane Frances , Nuwagira Edwin , Skipper Caleb , Muzoora Conrad , Meya David B , Rhein Joshua , Boulware David R , Rajasingham Radha
Published: July 2019

Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7–1.0 mg/kg). Five were exposed to 200–800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n = 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.
New constraints on red-spiral galaxies from their kinematics in clusters of galaxies
Authors: Hamabata Akinari , Oogi Taira , Oguri Masamune , Nishimichi Takahiro , Nagashima Masahiro
Published: July 2019

The distributions of the pairwise line-of-sight velocity between galaxies and their host clusters are segregated according to the galaxy’s colour and morphology. We investigate the velocity distribution of red-spiral galaxies, which represents a rare population within galaxy clusters. We find that the probability distribution function of the pairwise line-of-sight velocity vlos between red-spiral galaxies and galaxy clusters has a dip at vlos = 0, which is a very odd feature, at 93 per cent confidence level. To understand its origin, we construct a model of the phase-space distribution of galaxies surrounding galaxy clusters in three-dimensional space by using cosmological N-body simulations. We adopt a two component model that consists of the infall component, which corresponds to galaxies that are now falling into galaxy clusters, and the splashback component, which corresponds to galaxies that are on their first (or more) orbit after falling into galaxy clusters. We find that we can reproduce the distribution of the line-of-sight velocity of red-spiral galaxies with the dip with a very simple assumption that red-spiral galaxies reside predominantly in the infall component, regardless of the choice of the functional form of their spatial distribution. Our results constrain the quenching time-scale of red-spiral galaxies to a few Gyr, and the radius where the morphological transformation is effective as $r \sim 0.2 \, h^{-1 } \, \rm {Mpc}$.
Comparing Multiclass, Binary, and Hierarchical Machine Learning Classification schemes for variable stars
Authors: Hosenie Zafiirah , Lyon Robert J , Stappers Benjamin W , Mootoovaloo Arrykrishna
Published: July 2019

Upcoming synoptic surveys are set to generate an unprecedented amount of data. This requires an automatic framework that can quickly and efficiently provide classification labels for several new object classification challenges. Using data describing 11 types of variable stars from the Catalina Real-Time Transient Survey (CRTS), we illustrate how to capture the most important information from computed features and describe detailed methods of how to robustly use information theory for feature selection and evaluation. We apply three machine learning algorithms and demonstrate how to optimize these classifiers via cross-validation techniques. For the CRTS data set, we find that the random forest classifier performs best in terms of balanced accuracy and geometric means. We demonstrate substantially improved classification results by converting the multiclass problem into a binary classification task, achieving a balanced-accuracy rate of ∼99 per cent for the classification of δ Scuti and anomalous Cepheids. Additionally, we describe how classification performance can be improved via converting a ‘flat multiclass’ problem into a hierarchical taxonomy. We develop a new hierarchical structure and propose a new set of classification features, enabling the accurate identification of subtypes of Cepheids, RR Lyrae, and eclipsing binary stars in CRTS data.
Testing a quintessence model with Yukawa interaction from cosmological observations and N-body simulations
Authors: An Rui , Costa André A , Xiao Linfeng , Zhang Jiajun , Wang Bin
Published: July 2019

We consider a quintessence model with Yukawa interaction between dark energy and dark matter and constrain this model by employing the recent cosmological data including the updated cosmic microwave background (CMB) measurements from Planck 2015, the weak gravitational lensing measurements from Kilo Degree Survey (KiDS), and redshift-space distortions. We find that an interaction in the dark sector is compatible with observations. The updated Planck data can significantly improve the constraints compared with the previous results from Planck 2013, while the KiDS data have less constraining power than Planck. The Yukawa interaction model is found to be moderately favoured by Planck and able to alleviate the discordance between weak lensing measurements and CMB measurements as previously inferred from the standard Lambda cold dark matter model. N-body simulations for Yukawa interaction model is also performed. We find that using the halo density profile is plausible to improve the constraints significantly in the future.
An unusual transient following the short GRB 071227
Authors: Eyles R A J , O’Brien P T , Wiersema K , Starling R L C , Gompertz B P , Lamb G P , Lyman J D , Levan A J , Rosswog S , Tanvir N R
Published: July 2019

We present X-ray and optical observations of the short duration gamma-ray burst GRB 071227 and its host at z = 0.381, obtained using Swift, Gemini South, and the Very Large Telescope. We identify a short-lived and moderately bright optical transient, with flux significantly in excess of that expected from a simple extrapolation of the X-ray spectrum at 0.2–0.3 d after burst. We fit the SED with afterglow models allowing for high extinction and thermal emission models that approximate a kilonova to assess the excess’ origins. While some kilonova contribution is plausible, it is not favoured due to the low temperature and high luminosity required, implying superluminal expansion and a large ejecta mass of ∼0.1 M$\odot$. We find, instead, that the transient is broadly consistent with power-law spectra with additional dust extinction of E(B − V) ∼ 0.4 mag, although a possibly thermal excess remains in the z band. We investigate the host, a spiral galaxy with an edge-on orientation, resolving its spectrum along its major axis to construct the galaxy rotation curve and analyse the star formation and chemical properties. The integrated host emission shows evidence for high extinction, consistent with the afterglow findings. The metallicity and extinction are consistent with previous studies of this host and indicate the galaxy is a typical, but dusty, late-type SGRB host.
Nearly coeval intermediate-age Milky Way star clusters at very different dynamics evolutionary stages
Authors: Piatti Andrés E , Angelo Mateus S , Dias Wilton S
Published: July 2019

We report astrophysical properties of 12 Milky Way open clusters located beyond a 2 kpc circle around the Sun by using deep optical photometry. We estimated their age and metallicities on the basis of a maximum likelihood approach using astrometric members determined from Gaia DR2 data. The studied clusters turned out to be of intermediate-age (0.8–4.0 Gyr), with metallicities spanning the range [Fe/H] ∼ −0.5–+0.1 dex, and distributed within the general observed trend of the Milky Way disc radial and perpendicular metallicity gradients. As far as we are aware, these are the first metal abundance estimates derived for these clusters so far. From the constructed stellar density radial profiles and cluster mass functions we obtained a variety of structural and internal dynamics evolution parameters. They show that while the innermost cluster regions would seem to be mainly shaped according to the respective internal dynamics evolutionary stages, the outermost ones would seem to be slightly more sensitive to the Milky Way tidal field. The nearly coeval studied clusters are experiencing different levels of two-body relaxation following star evaporation; those at more advanced stages being more compact objects. Likewise, we found that the more important the Milky way tides, the larger the Jacobi volume occupied by the clusters, irrespective of their actual sizes and internal dynamics evolutionary stages.
Thirty-Day Hospital Readmission and Surgical Complication Rates for Shunting in Normal Pressure Hydrocephalus: A Large National Database Analysis
Authors: Nadel Jeffrey L , Wilkinson D Andrew , Linzey Joseph R , Maher Cormac O , Kotagal Vikas , Heth Jason A
Published: July 2019

BACKGROUND

Research on age-related complications secondary to shunts in normal pressure hydrocephalus (NPH) is primarily limited to single-center studies and small cohorts.

OBJECTIVE

To determine the rates of hospital readmission and surgical complications, and factors that predict them, following shunt surgery for NPH in a large healthcare network.

METHODS

Surgical procedures, complications, and readmissions for adults undergoing ventricular shunting for NPH were determined using de-identified claims from a privately insured United States healthcare network in years 2007-2014. Univariate and multivariate statistics were used to determine factors that predict poor surgical outcomes. The primary outcome variable was surgical complications or readmissions (composite variable for any major perioperative complication or 30-d readmission).

RESULTS

The 30-d readmission rate for 974 patients with NPH who underwent ventricular shunting was 7.29%; the most common reasons for readmission were shunt-related complications, infection, hemorrhage, altered mental status, and cardiopulmonary and musculoskeletal problems. The perioperative complication rate was 21.15%, including intraparenchymal hemorrhage (5.85%) and extra-axial (subdural or epidural) hematoma (5.54%). The overall rate of having a surgical complication or 30-d readmission was 25.15%. Age did not predict surgical complication or 30-d readmission. Preoperative comorbidities independently associated with poor outcome were myocardial infarction within 1 yr (OR = 3.984, 95% CI = 1.105-14.368); existing cerebrovascular disease (odds ratio [OR] = 2.206, 95% CI = 1.544-3.152); and moderate/severe renal disease (OR = 2.000, 95% CI = 1.155-3.464).

CONCLUSION

The rate of complications or readmission within 30 d of ventricular shunting for NPH is 25.15%. Preoperative comorbidities of myocardial infarction within 1 yr, cerebrovascular disease, and moderate/severe renal disease are independent risk factors for poor outcome.
Reform and Consolidation: A New Perspective on Commons Select Committees 1960–1980
Authors: Aylett Philip
Published: July 2019

The ‘departmental’ select committees of the Commons established from 1979 onwards are often represented as a radical and distinctive departure in the history of parliamentary scrutiny, and a clear improvement on the arrangements of previous decades. The article argues that this view needs to be revised, in light of a substantial shift in thinking about select committee scrutiny from the 1960s. Whereas select committees in 1960 were seen as primarily restricted to financial matters, politicians and others later began successfully to promote committee interventions in wider questions of policy and administration. The introduction of departmental committees should therefore be seen as part of a broader long-term process of committee development.
Toward the design of efficient transglycosidases: the case of the GH1 of Thermus thermophilus
Authors: David Benoit , Arnaud Philippe , Tellier Charles , Sanejouand Yves-Henri
Published: July 2019

Using the information available in the sequences of well-characterized transglycosidases found in plants, mutations were introduced in the glycoside hydrolase of the bacterium Thermus thermophilus, with the aim of turning it into an efficient transglycosidase. All mutants happen to have fair catalytic efficiencies, being at worst 25 times less efficient than the wild type. Noteworthy, W120F, one of our high transglycosylation yield (≈ 50%) mutants, is only two times less efficient than the wild type. Interestingly, while in the wild type the sidechain of the acid–base is only found able to sample a pair of equivalent conformations during 0.5-μs-long molecular dynamics simulations, its flexibility is much higher in the case of the high transglycosylation yield mutants. Our results thus suggest that engineering the flexibility of the acid–base of a retaining glycoside hydrolase could be a general way to turn it into an efficient transglycosidase.
(Not) Like Aeneas: Allusions to the Aeneid in Laʒamon’s Brut
Authors: Burek Jacqueline M
Published: July 2019

This article argues that the well-known extended similes in the Arthurian section of Laʒamon’s Brut allude to Vergil’s Aeneid. Most scholars agree that these similes were influenced by the extended similes of Latin epic, but few have claimed that these similes can be traced back to a definitive Latin source, or that this influence is anything other than stylistic in nature. In contrast, this article argues that Laʒamon’s similes allude to the Aeneid’s plot and characters as part of a broader commentary on Arthur’s kingship. Although Laʒamon does not quote specific words or phrases from the Aeneid, he replicates the style, content, and narrative function of Vergil’s epic similes to set up a subtle contrast between British history and Roman history. But while Vergil emphasizes Rome’s ascendance, Laʒamon emphasizes the Britons’ downfall; and whereas Vergil depicts Aeneas as a ruler who prioritizes the welfare of his people, Laʒamon depicts Arthur as a king whose self-centred individualism leads to his people’s downfall. Laʒamon’s allusions to the Aeneid highlight classical epic’s dual function in the Brut: stylistic model and source of political and ethical ideas. Moreover, they reveal how Laʒamon uses epic as a tool for interpreting history.
Between ‘Scientization’ and a ‘Participatory Turn’. Tracing shifts in the governance of policy advice
Authors: Krick Eva , Christensen Johan , Holst Cathrine
Published: July 2019

This study traces the claims of a ‘scientization’ and a ‘participatory turn’ in modern governance within the system of temporary policy advisory committees in Norway. It analyzes whether there is evidence of the two claims in these key governance institutions and to what extent these shifts are compatible with each other. As expressions of a participatory turn, a growing emphasis on citizen involvement and transparency in the committee system is searched for. A growing relevance of researchers and of science-based claims in the committees’ reports are taken as indicators of scientization. The longitudinal study shows an overall shift both towards science- and expertise-based governance and towards an increasing openness and public engagement, as well as some variation between policy fields.
Doxorubicin Exposure Affects Oocyte Meiotic Maturation through DNA Damage-Induced Meiotic Arrest
Authors: Ding Zhi-Ming , Zhang Shou-Xin , Jiao Xiao-Fei , Hua Li-Ping , Ahmad Muhammad Jamil , Wu Di , Chen Fan , Wang Yong-Shang , Zhang Xi-Yu , Meng Fei , Duan Ze-Qun , Miao Yi-Liang , Huo Li-Jun
Published: July 2019

Developments in chemotherapeutics have enhanced the survival rate of cancer patients, however, adverse effects of chemotherapeutics on ovarian functions causes the fertility loss in young female cancer patients. Doxorubicin (DOX), as an anthracycline antitumor antibiotic, is extensively used to cure various malignancies. Recent studies have suggested that DOX can cause ovarian damage and affect the oocyte maturation, nevertheless the mechanism by which DOX on oocytes meiosis is poorly understood. In this study, we explored the mechanism for DOX-induced oocytes meiotic failure in vitro at human relevant exposure levels and time periods. Results described that DOX (100 nM) can interrupt the mouse oocytes meiotic maturation directly with reduced first polar body extrusion. Cell cycle analysis showed that most oocytes were arrested at metaphase I (MI) stage. However, DOX treatment had no effect on spindle structure but chromosomal misalignment. We observed that kinetochore-microtubule structure was affected and the spindle assemble checkpoint was provoked after DOX treatment. Moreover, severe DNA damage was found in DOX-treated oocytes indicated by the positive γ-H2A.X foci signal, which then may trigger oocytes early apoptosis. Besides, metaphase II oocytes with disorganized spindle morphologies and misaligned chromosomes were observed after DOX treatment. In conclusion, DOX have the potential to disrupt oocyte meiotic maturation through DNA damage induced meiotic arrest mediated by spindle assemble checkpoint activation. These findings can contribute to design the new therapies to alleviate DNA damage to preserve fertility for young female cancer patients with chemotherapeutics.
The Prevalence and Case-Fatality Rates of Post-Neonatal Tetanus in a Population of Hospitalized Nigerian Children: An 8-Year Retrospective Review
Authors: Okike Clifford Onuorah , Muoneke Uzoamaka Vivian , Uwaezuoke Samuel Nkachukwu , Mbagwu Emmanuel Nkemjika , Onyeka-Okite Ezinne
Published: July 2019

Background

Although tetanus is a vaccine-preventable disease, reports indicate that it remains a significant cause of morbidity and mortality in both neonatal and post-neonatal periods especially in most developing countries.

Aim

This study aimed to determine the prevalence and case fatality rates of post-neonatal tetanus among children managed at the Federal Medical Centre Asaba, Delta State, Nigeria over 8 years.

Method

The study was a retrospective review of the records of the children above 1 month of age admitted into Federal Medical Centre, Asaba, with a clinical diagnosis of tetanus from January 2008 to May 2016. Data analysis was conducted on descriptive and inferential statistics using Statistical Package for Social Sciences version 22.0. Mean, standard deviation and other relevant parameters were calculated. Level of significance was set at p < 0.05.

Results

During the study period, 32 out of 3693 admitted Paediatric patients had post-neonatal tetanus: giving a prevalence rate of 0.9%. The male : female ratio was 1.9 : 1 and patients’ ages ranged from 2 to 15 years with a mean age 8.9 ± 3.1 years. Twenty-nine percent of them had complete immunization during infancy, but none had booster doses. Also, 60.9% of them presented with lower limb injuries as the portal of entry. Over 17.4% of the patients had very severe tetanus. Of the 32 patients studied, 62.5% resided in the neighbouring rural communities, while 50.0% were admitted for ≤10 days. The calculated case fatality rate was 50%.

Conclusion

The prevalence and case fatality rates of post-neonatal tetanus are still relatively high in this clime. Given the prevalent nature of the disease in children aged 5 years and above, there is a need to include the booster doses of tetanus toxoid in the country’s National Programme on Immunization schedule.
Pathogenesis and complications of chronic eye rubbing in ocular allergy
Authors: Ben-Eli Hadas , Erdinest Nir , Solomon Abraham
Published: July 2019

Purpose of review

To review the updated literature regarding eye rubbing complications and its association with ocular allergy disorders.

Recent findings

Atopy and ocular allergy disorders, mainly vernal keratoconjunctivitis (VKC), are strongly associated with rubbing-related complications, most probably via itching and watery eye sensations that trigger the habit of chronic eye rubbing. Vigorous and prolonged rubbing may lead to establishment of corneal remodeling and ectatic disorders, such as keratoconus. Keratoconus development in rubbed eyes can be caused by mechanical mechanisms of corneal thinning and its loss of rigidity, by elevated temperature of the epithelium during rubbing, by increased intraocular pressure (IOP) because of distending forces, and by inflammatory molecules that may serve as a causal mediator between eye rubbing and keratoconus. Other eye rubbing complications include acute hydrops and perforation, IOP spikes, iris prolapse and iridoschisis rupture of lens capsule and IOL dislocation, and even posterior segment disorders, such as glaucomatous optic neuropathy, retinal detachment and extrusion of implanted silicone oil in the eye.

Chronic eye rubbing in allergic eye diseases can lead to progression of keratoconus, and to other rare anterior and posterior segment complications. Strategies eliminating eye rubbing and its consequences are vital, mainly among at-risk populations, such as young children and individuals with allergic ocular disorders or corneal transplants.
Effect of Kidney Disease on Hemiarthroplasty Outcomes After Femoral Neck Fractures
Authors: Hsiue Peter P. , Seo Lauren J. , Sanaiha Yas , Chen Clark J. , Khoshbin Amir , Stavrakis Alexandra I.
Published: July 2019

Objective:

To compare the outcomes of patients with predialysis chronic kidney disease (CKD) or end-stage renal disease (ESRD) with the outcomes of patients with no kidney disease after hemiarthroplasty (HA) for femoral neck fractures (FNF).

Design:

Retrospective review utilizing the Nationwide Readmissions Database.

Setting:

National database incorporating inpatient data from 22 states.

Patients:

Using the Nationwide Readmissions Database, 214,399 patients who underwent HA after FNF between 2010 and 2014 were identified and divided into 3 groups using ICD-9 diagnosis codes: no kidney disease (n = 176,300, 82%), predialysis CKD (n = 34,400, 16%), and ESRD (n = 3,698, 2%).

Intervention:

HA for FNF.

Main Outcome Measurement:

Mortality, blood transfusion, and postoperative complications during index hospitalization. Hospital readmission, postoperative dislocation, periprosthetic fracture, and revision surgery within 90 days of surgery.

Results:

Compared to patients with no kidney disease, ESRD patients had an increased risk of mortality [odds ratio (OR) = 3.76, 95% confidence interval (CI), 2.95–4.78], blood transfusion (OR = 2.35, 95% CI, 2.08–2.64), and postoperative complications (OR = 1.64, 95% CI, 1.45–1.86) during the index hospitalization as well as an increased risk of 90-day hospital readmission (OR = 3.09, 95% CI, 2.72–3.50). Interestingly, even patients with predialysis CKD had an increased risk of mortality (OR = 1.80, 95% CI, 1.59–2.05), blood transfusion (OR = 1.66, 95% CI, 1.59–1.75), and postoperative complications (OR = 2.37, 95% CI, 2.25–2.50) during the index hospitalization as well as an increased risk of 90-day hospital readmission (OR = 1.43, 95% CI, 1.37–1.51).

Conclusions:

This retrospective cohort study demonstrates that both ESRD and CKD patients have worse outcomes compared to patients with no kidney disease after HA for FNF.

Level of Evidence:

Prognostic Level III. See instructions for authors for a complete description of levels of evidence.
A Prospective, Psychometric Validation of National Institutes of Health Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Upper Extremity Computer Adaptive Testing in Cervical Spine Patients
Authors: Iyer Sravisht , Koltsov Jayme C.B. , Steinhaus Michael , Ross Thomas , Stein Daniel , Yang Jingyan , LaFage Virginie , Albert Todd , Kim Han Jo
Published: July 2019

Study Design.

Prospective Cohort Study

Objective.

The aim of this study was to validate the Patient Reported Outcomes Measurement Information System (PROMIS) against existing patient-reported outcomes in the cervical spine.

Summary of Background Data.

Current patient-reported outcomes in cervical spine have substantial limitations. PROMIS offers the potential for improved psychometric properties with reduced questionnaire burden.

Methods.

Adult patients undergoing cervical spine surgery at a single institution between 2016 and 2018 were prospectively enrolled. Patients completed questionnaires (36-Item Short Form Health Survey [SF-36], Neck Disability Index (NDI), Visual Analog Scale arm/neck, and PROMIS pain Interference [PI], physical Function [PF], and Upper Extremity [UE]) preoperatively and at 6 months postoperatively. Demographic data, diagnosis, and procedural data were recorded. Validation of the instruments was completed with a Rasch Model as well as measurement of coverage, efficiency, test–retest reliability, responsiveness, and convergent validity.

Results.

Of 197 patients who completed the preoperative survey, 164 were eligible for 6-month follow-up and 139 completed 6-month postoperative surveys. The most common diagnoses were radiculopathy (37.6%), myeloradiculopathy (30.5%), and myelopathy (28.4%). All studied instruments had acceptable fit to a Rasch model. PROMIS computer adaptive testings (CATs) demonstrated improved average time to completion for PI (39 seconds), PF (47 seconds), and UE (54  seconds), compared to NDI (117 s) and SF-36 PCS (175 seconds). Responsiveness for PROMIS CATs was similar to NDI and SF-36, test–retest reliability was lower for PI (intraclass correlation: 0.68), PF (0.70), and UE (0.59), compared to NDI (0.86) and PCS (0.85). For convergent validity, PI was strongly correlated to NDI and PF to SF-36 PCS. There were no significant floor or ceiling effects for the PROMIS domains, although UE had preoperative clustering (n = 18) at a high score (56.4) and PI had postoperative clustering (n = 27) at a low score (38.7).

Conclusion.

PROMIS CATs demonstrate several advantages, including efficiency and responsiveness, while demonstrating good convergent validity with legacy instruments. Nevertheless, CATs had lower test–retest reliability and had significant clustering at higher levels of function for the PI and UE CATs. These limitations must be considered before broad adoption of CATs in cervical spine patients.

Level of Evidence: 3
What Factors Influence Delayed Referral to Spinal Surgeon in Adolescent Idiopathic Scoliosis?
Authors: Kenner Peter , McGrath Stephen , Woodland Peter
Published: July 2019

Study Design.

Retrospective review with qualitative phone interview.

Objective.

This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS.

Methods.

A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral.

Results.

Mean Cobb angle at first specialist review was 49.5° ± 14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic.

Conclusion.

In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics.

Level of Evidence: 4
Minimally Invasive Posterior Cervical Foraminotomy as an Alternative to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy
Authors: Sahai Nikhil , Changoor Stuart , Dunn Conor J. , Sinha Kumar , Hwang Ki Soo , Faloon Michael , Emami Arash
Published: July 2019

Study Design.

Systematic review and meta-analysis.

Objective.

The aim of this study was to evaluate clinical outcomes, complications, and reoperations of minimally invasive posterior cervical foraminotomy (MI-PCF) for unilateral cervical radiculopathy without myelopathy, in comparison to anterior cervical decompression and fusion (ACDF).

Summary of Background Data.

ACDF is a standard treatment for cervical radiculopathy secondary to lateral disc herniation or foraminal stenosis. Recent studies have suggested MI-PCF to be an effective alternative to ACDF. However, concern for reoperation and whether similar improvements in clinical outcomes can be achieved has led to a debate in the literature.

Methods.

We comprehensively searched PubMed, CINAHL Plus, and SCOPUS utilizing terms related to MI-PCF. Two independent reviewers assessed potential studies and extracted data on clinical outcome scores (neck disability index [NDI], visual analog scale [VAS]-neck, and VAS-arm), reoperation proportion, and complications. Studies included were on noncentral cervical pathology, published in the last 10 years, had a sample size of >10 patients, and reported data on minimally invasive techniques for posterior cervical foraminotomy. Heterogeneity and publication bias analyses were performed. The pooled proportions of each outcome were compared to those of ACDF obtained from two previously published studies.

Results.

Fourteen studies were included with data of 1216 patients. The study population was 61.8% male, with a mean age of 51.57 years, and a mean follow-up of 30 months. MI-PCF resulted in a significantly greater improvement in VAS-arm scores compared to ACDF, and similar improvements in VAS-neck and NDI scores. Proportions of complications and reoperations were similar between the two cohorts. The most common complications were transient neuropraxia, wound-related, and durotomy.

Conclusion.

Our findings suggest that MI-PCF may be utilized as a safe and effective alternative to ACDF in patients with unilateral cervical radiculopathy without myelopathy, without concern for increased reoperations or complications.

Level of Evidence: 3
Disc Wedge and Vertebral Body Tilt Angle Below Lower Instrumented Vertebra After Posterior Correction and Fusion in Patients With a Structural Thoracolumbar/Lumbar Curve
Authors: Cho Jae Hwan , Lee Choon Sung , Lee Dong-Ho , Hwang Chang Ju , Park Jae-Woo , Jung Hyung Seo , Park Kun-Bo
Published: July 2019

Study Design.

A retrospective cohort study.

Objective.

The purpose of this study was to evaluate the stability of remained lumbar curve by the review of serial changes in L3/L4 disc wedge and L4 body tilt angle in patients with idiopathic scoliosis who underwent posterior-only fusion to L3 lower instrumented vertebra (LIV) for the correction of structural thoracolumbar/lumbar (TL/L) curve for a minimum 5-year follow-up.

Summary of Background Data.

There has been some debate in the selection of L3 or L4 as the LIV for the correction of structural TL/L curve. However, there is a limited information about the changes in disc wedge or vertebral body tilt angles below the L3 LIV.

Methods.

Forty-seven patients were included (mean age 16 yr 7 mo, follow-up 8 yr 2 mo). The Cobb angle of the TL/L curve, L3/L4 disc wedge angle, L4 tilt angle, trunk shift (TS), and apical vertebral translation (AVT) were compared preoperatively and at postoperative 5 days, 1 month, 6 months, 2 years, and final follow-up.

Results.

At postoperative 5 days, Cobb angle of the TL/L curve, L4 tilt angle, and AVT were improved, except TS and L3/L4 disc wedge angle. The L3/L4 disc wedge and L4 tilt angle were most increased at postoperative 6 months and decreased thereafter. L4 tilt angle, AVT, and TS were improved during postoperative follow-up, except L3/L4 disc wedge angle. Finally, Cobb angle of the TL/L curve (11.8° ± 5.1°, P < 0.001), L4 tilt angle (7.6° ± 4.0°, P < 0.001), AVT (19.2 ± 9.3 mm, P < 0.001), and TS (−5.0 ± 10.0 mm, P = 0.041) were improved; however, L3/L4 disc wedge angle (3.3° ± 2.3°, P = 0.442) was not improved compared to the preoperative evaluation.

Conclusion.

When LIV was selected as the L3, the correction of TL/L curve was maintained in a minimum 5-year follow-up with the improvement of L4 tilt angle, AVT, and TS; however, L3/L4 disc wedge angle may remain.

Level of Evidence: 3
Competing Mortality in Patients With Neuroendocrine Tumors
Authors: Low Soon Khai , Giannis Dimitrios , Bahaie Nourelhoda Sami , Trong Bao Long Hoang , Moris Dimitrios , Huy Nguyen Tien
Published: July 2019

Objectives:

Patients with neuroendocrine tumors (NETs) are at increased risk of mortality from competing causes in light of the improvement in overall survival over recent decades. The purpose of this study was to explore the competing causes of deaths and the risk factors associated with competing mortality.

Materials and Methods:

The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with NETs between 1973 and 2015. Risk of competing mortality was estimated by the standardized mortality ratios (SMRs) and by using the Fine and Gray multivariate regression model.

Results:

Of the 29,981 NET patients, 42.5% of the deaths that occurred during follow-up were attributed to competing causes (83.9% from noncancer causes and 16.1% from second primary neoplasms). Overall SMR of competing mortality was 2.50 (95% confidence interval [CI]: 2.43-2.56). The SMR of noncancer causes was 2.65 (95% CI: 2.58-2.73), with the highest risk present within the first year of diagnosis. The SMR of second primary neoplasms was 1.91 (95% CI: 1.79-2.04), with the highest risk observed after 10-year postdiagnosis. A drastic rise in competing mortality was observed in the last decade between 2005 and 2015. Advanced age, black race, small intestinal and gastric NETs, and surgery were significantly associated with competing mortality. Female, pancreatic and recto-anal NETs, distant and regional spread, chemotherapy and radiotherapy were significantly associated with lower competing mortality.

Conclusions:

Competing mortality plays an increasingly significant role over the years and may hamper efforts made to improve survival outcomes in NET patients.
Patient-Reported Psychological Distress After Spontaneous Coronary Artery Dissection
Authors: Edwards Katharine S. , Vaca Kelsey C. , Naderi Sahar , Tremmel Jennifer A.
Published: July 2019

Purpose:

High rates of depression and anxiety are reported among patients who have experienced spontaneous coronary artery dissection (SCAD) but the incidence of post-traumatic stress disorder (PTSD) is unknown. The purpose of this study was to investigate symptoms of PTSD in women who have experienced SCAD.

Methods:

This cross-sectional pilot study included 14 female SCAD patients, mean age of 51 yr, who responded to standardized psychosocial questionnaires at a median of 35 mo post-SCAD. Patients were identified by cardiologists as having had a SCAD event and were concurrently invited to participate in a psychosocial group for SCAD survivors.

Results:

Participants reported current symptoms of stress (93%), insomnia (57%), anxiety (71%), depression (36%), and PTSD (43%). Eight of the 11 women who reported having a mental health history (72.7%) indicated that their symptoms were related to having experienced SCAD. Health-related quality of life and social support were comparable with other all-female cardiac samples. Patterns of perceived control were more similar to those of patients with cancer than other cardiac patients in that SCAD patients ranked “chance” as more likely than “self-control” to impact medical outcomes.

Conclusions:

The prevalence of PTSD symptoms in this first-known assessment of post-traumatic stress among SCAD patients is concerning. The unexpected nature of SCAD and lack of known treatment options may play a role in patient distress. Future research is needed to accurately estimate rates of PTSD after SCAD and assess the benefits of treatment.