bluuebunny/crossref_metadata_2025 huggingface dataset:
The Gutturals in North Argobba: An Etymological Evaluation
Authors: Bulakh Maria
Published: September 2022

North Argobba is a South Ethio-Semitic idiom used by Argobba communities in the villages of Shonke and T’ollaha (Oromiya zone of Amhara region of Ethiopia). One of the most striking features of North Argobba is the presence of the gutturals ʔ, ʕ, h and ḥ as distinct phonemes. While the importance of this feature has been recognized by the linguists, it is also been observed that not all examples of gutturals are etymologically correct. The present work provides a systematic evaluation of the sources for the North Argobba guttural phonemes ʔ, ʕ, h, ḥ. It demonstrates that these phonemes are reflexes of Proto-Ethio-Semitic gutturals with the same value, although the original picture is to some extent blurred by various phonological processes. The data of North Argobba are thus of considerable value for the phonological reconstruction of the Proto-Ethio-Semitic roots.
The Voluntary Sterilisation Act: Best Interests, Caregivers, and Disability Rights
Authors: Chua Hillary
Published: September 2022

How can caregivers’ interests be balanced with disability rights in decisions about whether to sterilise an intellectually disabled person? This question is considered in the context of Singapore, a commonwealth country that lacks a test case. Singapore has a lesser-known history of eugenics, and has struck an uneasy compromise between communitarian values and obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in recent years. This article provides an overview of Singaporean law under the Voluntary Sterilisation Act 1974 and the Mental Capacity Act 2008, and compares this with the law in Canada, England and Wales, and Australia. This article also situates the CRPD in the context of Singapore’s dualist view of international law and communitarian approach to disability policy. It argues that CRPD rights to bodily integrity can be presumptively upheld in best interests determinations on sterilisation, while caregivers’ interests can be accommodated in a relational understanding of best interests. A decisional framework along these lines is proposed.
Betaine consumption as a new clinical approach to treatment and prophylaxis of folate-related pathologies
Authors: Yeroshkina Krystyna , Rossokha Zoia , Fishchuk Liliya , Gorovenko Nataliia
Published: September 2022

The most important pathway in the development of folate-related pathologies is an increase in the level of homocysteine (HC). HC, a cytotoxic and neurotoxic amino acid (when its level is ≥12 μmol/L), is 1 of the most widely studied compounds in cardiology, neurobiology, oncology, and embryology for the last 20 years. Given its toxicity, the processes of endogenous detoxification of HC are of particular interest to medicine. To date, the most studied pathway is that of remethylation (the conversion of HC to methionine), with the participation of B12- and B9-dependent methionine synthase. Less studied is remethylation with the participation of the choline derivatives betaine and betaine-HC-S-methyltransferase (BHMT). Therefore, the aim of this review was to conduct a theoretical analysis of available information regarding the contribution of betaine metabolism, its enzyme, and its genetic polymorphism to folate metabolism disturbances, and the development of folate-related pathologies. This review emphasizes the potential clinical significance of 2 factors that can influence the remethylation reaction of HC: the use of betaine and identifying the BHMT gene variants and their impact on the risk for developing certain folate-related pathologies, and treatment options. Moreover, with a high level of methylation of the BHMT gene and in the presence of its low-function variants (eg, rs3733890), it is necessary to use betaine as an additional methyl donor, especially during folate therapy. More clinical research is needed to identify the effects of the different BHMT gene variants on the individual risk for folate-related pathologies to better assess the clinical significance, the need for genetic testing, and betaine consumption.
Multiple endocrine neoplasia type 1 with suspicion of Zollinger Ellison syndrome in a family with history of renal stones and hypercalcemia in a limited resource setting: a case report
Authors: Hussain Kamran , Nahar Jebun , Abbas Fakhar , Nawar Jasir , Anand Ayush
Published: September 2022

Multiple endocrine neoplasia type 1 (MEN 1) syndrome is a rare autosomal dominant endocrine tumour syndrome, which can be diagnosed clinically based on family history and the existence of MEN 1-associated tumours or molecularly based on genetic testing. We described the case of a Hispanic 55-year-old male presenting with dysphagia, chest pain and diarrhoea for three months with a family history of hypercalcaemia and nephrolithiasis in first-degree relatives. Primary hyperparathyroidism was suggested by hypercalcaemia, elevated parathyroid hormone level, hypercalciuria, nephrolithiasis on abdominal computed tomography scan and enlarged parathyroid gland on computed tomography pulmonary angiogram. Also, patient had hypergastrinemia and a hypodense lesion in the pancreas on computed tomography scan of abdomen. These findings suggested MEN 1 syndrome with high suspicion of associated Zollinger Ellison syndrome. Our case highlights the importance of family history and high clinical suspicion in patients presenting with primary hyperparathyroidism and hypergastrinemia.
Enterococcus hirae bacteremia associated with perinephric collection and renal abscesses in a diabetic woman
Authors: Chang Chee Yik , Jayabalan Mogeshwari , Gan Yi Lung , Radhakrishnan Anuradha P , Ong Edmund L C
Published: September 2022

Enterococcus hirae infection accounts for about 1% of all enterococcal infections. This number is likely to be underestimated because of inadequate identification. Human infection due to E. hirae is rarely reported. We present the case of a young woman with diabetes mellitus who developed symptoms of pyelonephritis and diabetic ketoacidosis. Renal computed tomography scan revealed the presence of subcapsular perinephric collection and renal abscesses. Her blood culture yielded E. hirae. Our patient was successfully treated with antimicrobials based on the susceptibility result. To our knowledge, this is the first reported case of perinephric collection and renal abscesses associated with E. hirae bacteremia.
Buprenorphine Initiation in the Era of High-Potency Synthetic Opioids: A Call for Community-Based Participatory Research to Help Learning Health Systems Provide Precision Medicine for Opioid Use Disorder
Authors: Fiellin David A.
Published: September 2022

High-potency synthetic opioids and adulterants have saturated the US opioid supply, heightening risk to people who use drugs and creating challenges to buprenorphine initiation. As buprenorphine is an essential component of a response to the opioid crisis, a robust evidence base is urgently needed. Rapid research, in partnership with people who use drugs and using community-based participatory research practices to ensure trust, shared goals, and an absence of adverse consequences, should be conducted to help identify the factors associated with successful and failed inductions. Among factors to be considered include detailed assessment of substances used, amount of substances used, time between last use and buprenorphine induction, withdrawal severity at time of buprenorphine induction, dose of buprenorphine, impact of buprenorphine on withdrawal severity, and perhaps even genotypic information. Successful conduct of these efforts in learning health systems can help us move toward precision medicine for opioid use disorder.
Using the Generalized Synthetic Control Method to Estimate the Impact of Extreme Weather Events on Population Health
Authors: Sheridan Paige , McElroy Sara , Casey Joan , Benmarhnia Tarik
Published: September 2022

Background:

Traditional epidemiologic approaches such as time-series or case–crossover designs are often used to estimate the effects of extreme weather events but can be limited by unmeasured confounding. Quasi-experimental methods are a family of methods that leverage natural experiments to adjust for unmeasured confounding indirectly. The recently developed generalized synthetic control method that exploits the timing of an exposure is well suited to estimate the impact of acute environmental events on health outcomes. To demonstrate how this method can be used to study extreme weather events, we examined the impact of the 20–26 October 2007 Southern California wildfire storm on respiratory hospitalizations.

Methods:

We used generalized synthetic control to compare the average number of ZIP code-level respiratory hospitalizations during the wildfire storm between ZIP codes that were classified as exposed versus unexposed to wildfire smoke. We considered wildfire exposure eligibility for each ZIP code using fire perimeters and satellite-based smoke plume data. We retrieved respiratory hospitalization discharge data from the Office of Statewide Health Planning and Development. R code to implement the generalized synthetic control method is included for reproducibility.

Results:

The analysis included 172 exposed and 578 unexposed ZIP codes. We estimated that the average effect of the wildfire storm among the exposed ZIP codes was an 18% (95% confidence interval: 10% to 29%) increase in respiratory hospitalizations.

Conclusions:

We illustrate the use of generalized synthetic control to leverage natural experiments to quantify the health impacts of extreme weather events when traditional approaches are unavailable or limited by assumptions.
CLINICAL AND STRUCTURAL IMPACT OF SUBMACULAR FLUID AFTER PNEUMATIC RETINOPEXY REPAIR FOR RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Carrera William M. , Peng Michelle Y. , Reddy Manisha , Chen Judy J. , Johnson Robert N. , Jumper J. Michael , McDonald H. Richard , Agarwal Anita
Published: September 2022

Purpose:

To assess the impact of submacular fluid (SMF) after pneumatic retinopexy for primary rhegmatogenous retinal detachment repair.

Methods:

Retrospective review of consecutive patients treated with pneumatic retinopexy for primary rhegmatogenous retinal detachment repair. 387 eyes (374 patients) were included, of which 166 underwent optical coherence tomography imaging after successful pneumatic retinopexy. Foveal-centered optical coherence tomography scans were reviewed.

Results:

SMF occurred in 59 eyes (35.5%) and was associated with macular detachment (P ≤ 0.001) and phakic lens status (P = 0.007). Submacular fluid resolved over an average of 9.39 months and was associated with worse preprocedure best-corrected visual acuity and delayed visual recovery. The mean final best-corrected visual acuity was 0.277 logarithm of the minimum angle of resolution (20/40) in eyes with SMF and 0.162 logarithm of the minimum angle of resolution (20/30) in those without SMF (P < 0.001). Submacular fluid was associated with discontinuity of the interdigitation zone (P = 0.003), ellipsoid zone (P = 0.005), and external limiting membrane (P ≤ 0.001) after SMF resolution. Ellipsoid zone discontinuity was associated with worse visual prognosis (P = 0.009).

Conclusion:

Trace SMF detected by optical coherence tomography is common after successful pneumatic retinopexy and resulted in delayed visual recovery and increased rates of outer retinal discontinuity after SMF resorption, although the final difference in best-corrected visual acuity in those with and without SMF was minimal.
Ocular manifestations of rheumatoid arthritis
Authors: Reddy Amit K. , Kolfenbach Jason R. , Palestine Alan G.
Published: September 2022

Purpose of review

This article summarizes the pathophysiology of rheumatoid arthritis and common ocular manifestations that it is associated with: keratoconjunctivitis sicca, episcleritis, scleritis, and peripheral ulcerative keratitis.

Recent findings

Newer biologic agents are being used to effectively treat rheumatoid arthritis and its ocular manifestations.

The eye is a frequent extra-articular site of inflammation in patients with rheumatoid arthritis. Ocular involvement can range from more benign conditions such as keratoconjunctivitis sicca and episcleritis, to potentially vision and globe-threatening diseases like scleritis and peripheral ulcerative keratitis. Clinicians should be aware of these ophthalmic manifestations and the various treatment options that are available. Coordination between ophthalmology and rheumatology is helpful in the treatment of these patients.
Efferent neuro-ophthalmic complications of coronavirus disease 2019
Authors: Dinkin Marc , Sathi Swetha
Published: September 2022

Purpose of review

We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus.

Recent findings

Efferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described.

Observed neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.
Severe bleeding diathesis as onset of light-chain amyloidosis: combined excessive fibrinolysis and acquired von Willebrand disease in a young patient
Authors: Pardos-Gea José , Cortina Vicente , Marques-Soares Joana Rita , Martínez Fernanda , Gironella Merche
Published: September 2022

Our report shows a case of primary light-chain amyloidosis in a young patient that reflects the potential severity of bleeding diathesis associated with this plasma cell dyscrasia and the difficulty of diagnosis when only hemorrhagic manifestations are present at the onset of disease. The patient presented with recurrent and severe muscular bleeding secondary to associated acquired von Willebrand disease and fibrinolysis dysfunction. Treatment with bortezomib-cyclophosphamide and sequential hematopoietic stem cell transplantation solved coagulation alterations. On the basis of our case, we review previous reports and discuss the potential mechanism of dysfunction of coagulation in light-chain amyloidosis.
Higher serum infliximab concentrations during induction predict short-term endoscopic response in patients with inflammatory bowel disease
Authors: Eberl Anja , Qadri Sami , Saavalainen Päivi , Sipponen Taina
Published: September 2022

Objective

Measuring of serum infliximab (IFX) induction concentrations might reduce primary non-response rates in inflammatory bowel diseases (IBD), but optimal target concentrations are unclear. We investigated whether IFX induction concentrations predict short-term endoscopic response at week 12 or treatment persistence at week 52.

Methods

Sixty-nine IBD patients (Crohn’s disease, n=24; ulcerative colitis, n=45) received standard IFX induction of 5 mg/kg bodyweight at weeks 0, 2, and 6. Responders continued maintenance therapy and underwent follow-up until week 52 or treatment discontinuation. We measured IFX concentrations at weeks 2, 6, and 12, and evaluated treatment response around week 12 with endoscopy or with clinical scores and fecal calprotectin. Using the receiver operating characteristic analysis, we determined optimal IFX concentration thresholds associated with treatment response. We further compared IFX induction concentrations between patients persisting on IFX at week 52 and patients discontinuing treatment due to insufficient response.

Results

Responders (74%, 51 out of 69 patients) had significantly higher median IFX concentrations than non-responders at weeks 6 (25.06 vs. 19.68 µg/ml; P = 0.04) and 12 (18.03 vs. 10.02 µg/ml; P = 0.03), but not at week 2 (33.12 vs. 34.20 µg/ml; P = 0.97). Optimal IFX concentration thresholds for induction response were 21.33 and 5.13 µg/ml at weeks 6 and 12, respectively. Fifty-three patients continued IFX maintenance therapy until week 52. Induction concentrations failed to predict persistence on IFX therapy at week 52.

Conclusion

Higher IFX induction concentrations predict endoscopic short-term response. However, induction concentrations failed to predict long-term persistence on IFX treatment.
Cardiac involvement in Wilson’s disease: a retrospective cohort study
Authors: Wang Chunya , Gao Hai , Sun Jie , Wang Limin , Li Weijie , Zu Xiaolin , Cheng Peili , Wei Shizhang , Zhao Pan
Published: September 2022

Background and objectives

Wilson’s disease (WD) is an inherited disorder with perturbations in copper metabolism and can cause multiorgan damage. This study aims to explore cardiac findings mainly based on electrocardiography (ECG) in WD patients.

Methods

We retrospectively enrolled adult patients who were diagnosed with WD between January 2011 and December 2020. Demographic and clinical data were collected and reevaluated.

Results

A total of 126 patients were included. There were 71 men and 55 women. The mean age was 27.2 years. Ninety-nine had hepatic presentation as the initial symptom and 27 had neuropsychiatric presentation as the initial symptom. Thirty-seven patients (29.4%) had cardiac manifestations. Of these patients, nine presented apparent cardiac symptoms (three with discontinuous chest tightness, three with dizziness, two with palpitation and one with atypical chest pain) and 28 had asymptomatic electrocardiography (ECG) abnormalities. Among the nine patients, four had second- or third-degree atrioventricular block, three had ST-segment change and two had ventricular tachycardia. ECG abnormalities in the 28 patients included increase in the width of the QRS complex in 8, atrial premature beats in 8, T-wave inversion in 5, P-wave inversion in 2, sinus bradycardia in 2, ST-segment change in 2, and coexistence of sinus bradycardia and T-wave inversion in 1. No statistical difference (P = 0.32) existed in the occurrence of ECG abnormalities between patients with hepatic presentation (27/99) and those with neuropsychiatric presentation (10/27).

Conclusion

Cardiac involvement is not rare in adult WD patients. We suggest that cardiac evaluation should be routinely performed in the population.
Effect of altered gut microbiota on visceral hypersensitivity of postinfectious irritable bowel syndrome mice
Authors: Cheng Fangli , Fan Zhenzhen , Lin Chenhong , Zhu Yubin , He Huiqin , Dai Ning , Du Lijun
Published: September 2022

Objective

Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized with visceral hypersensitivity. Previous studies indicated gut microbiota alteration associated short-chain fatty acids (SCFAs) dysregulation is associated with IBS development. The aim of the study is to explore the potential role of microbiota dysbiosis mediated visceral hypersensitivity in postinfectious-IBS (PI-IBS) mouse model.

Methods

Four-week-old NIH mice were randomly allocated into four groups: control mice, PI-IBS mice, PI-IBS mice co-housing with normal mice, and PI-IBS mice were administrated with a cocktail of antibiotics. Trichinella spiralis infection established PI-IBS mouse model. Microbiota in cecal contents and feces were analyzed by 16S rDNA sequencing. SCFAs were detected by gas chromatography. 5-hydroxytryptamine (5-HT) was evaluated by ELISA, and N-methyl-D-aspartate receptors (NMDARs) were examined by western blot. Visceral sensitivity was determined by abdominal withdrawal reflex in response to colorectal distention.

Results

Increased SCFAs were observed in cecal contents and feces in PI-IBS mice accompanied with higher 5-HT and NMDAR subunits expressions in ileum and colon. Visceral hypersensitivity was observed in PI-IBS mice compared to control mice. When administrated with antibiotics cocktails and co-housing with normal mice, PI-IBS mice showed decreased SCFAs, 5-HT, NMDAR subunits expressions, and improved visceral hypersensitivity.

Conclusion

Gut microbiota alteration induced increased SCFAs, 5-HT and NMDAR subunits expressions were associated with visceral hypersensitivity in PI-IBS mice. The critical role of gut microbiota in improving visceral hypersensitivity was further identified by treatment of antibiotics cocktail and co-housing.
Stereotactic body radiotherapy versus radiofrequency ablation as initial treatment of small hepatocellular carcinoma
Authors: Shin Hwang Sik , Hwan Lee Sae , Jun Baek Gyu , Kim Hong Soo , Kang Seong Hee , Park Ji Young , Choi Soo In , Cheon Gab Jin , Kim Young Don , Yoo Jeong-Ju , Kim Sang Gyune , Kim Young Seok , Jeong Soung Won , Jang Jae Young , Suk Ki Tae , Kim Dong Joon , Jo In Young , Won Yong Kyun
Published: September 2022

Background/Aim

Stereotactic body radiotherapy (SBRT) may be an alternative treatment for patients with small (≤3 cm) hepatocellular carcinomas (HCCs) who were not indicated for resection or local ablation therapy. This study compared the therapeutic effects of radiofrequency ablation (RFA) and SBRT in patients with small (≤3 cm) HCCs.

Methods

Data of HCC patients who underwent SBRT or RFA as an initial treatment at four tertiary referral hospitals between March 2011 and February 2017 were reviewed. The patient inclusion criteria were a single nodule measuring ≤3 cm in size and not suitable for resection.

Results

SBRT and RFA were performed for 72 (SBRT group) and 134 (RFA group) patients, respectively. The 1-, 3-, and 5-year overall survival (OS) rates were 97.0%, 80.3%, and 80.3%, respectively, in the SBRT group compared with 98.5%, 83.9%, and 80.8%, respectively, in the RFA group, with no significant differences between the groups (P = 0.81). The estimated five-year local control (LC) rate was 68.1% in the SBRT group and 73.1% in the RFA group (P = 0.81). In the SBRT group analysis, both SBRT alone (n = 34) and SBRT combined with transarterial chemoembolization (n = 38) showed no difference with RFA in OS (P = 0.72 and P = 0.90) or LC rate (P = 0.95 and P = 0.68), respectively.

Conclusion

SBRT is an effective and safe treatment method for small HCCs, with survival and tumor recurrence rates similar to those of RFA.
Can albumin reduce the mortality of patients with cirrhosis and ascites? A meta-analysis of randomized controlled trials
Authors: Xu Taichuan , Liu Wanjiang , Huang Ruizhen
Published: September 2022

Background

Albumin therapy in patients with decompensated liver cirrhosis has always been a controversial issue. This study aimed to investigate the efficacy and safety of albumin in reducing mortality and controlling complications in patients with liver cirrhosis and provide a reference for relevant decision-making.

Methods

Databases such as PubMed, EMBASE, and Web of Science were searched to collect eligible articles published before January 2022, which were analyzed by Revman 5.3.

Results

A total of 10 randomized controlled trials (2040 patients) were included. Based on the meta-analysis results, no significant difference in mortality was shown between the albumin administration group and the control group (HR = 1.01; 95% CI, 0.97–1.05; P = 0.62). Subgroup analysis showed that albumin administration had no significant short-term or long-term survival benefits in patients with decompensated liver cirrhosis and increased the risk of pulmonary edema adverse reactions (RR = 3.14; 95% CI, 1.48–6.65; P = 0.003). Subgroup analysis based on albumin administration time showed that short-term (HR = 0.93; 95% CI, 0.76–1.13; P = 0.47) or long-term (HR = 0.97; 95% CI: 0.87–1.08; P = 0.58) administration of albumin could not significantly reduce the mortality of patients with decompensated liver cirrhosis. In contrast, albumin administration could significantly reduce the recurrence rate of ascites (RR = 0.56; 95% CI, 0.46–0.68; P = 0.000).

Conclusion

Short-term(<1 month) or long-term (>1 month) administration of albumin can not significantly reduce the mortality of patients with decompensated liver cirrhosis, and a large amount of albumin infusion will increase the risk of pulmonary edema.
Is technetium-99m dimercaptosuccinic acid renal scintigraphy available for predicting vesicoureteral reflux in children with first febrile urinary tract infection under the age of 24 months?
Authors: Yang Wei , Jiao Qinghan , Wang Haiyan , Chen Weizhen , Yao Hongxiang
Published: September 2022

Objective

Vesicoureteral reflux (VUR) is a common complication after urinary tract infection (UTI) and can lead to irreversible renal scar. Voiding cystourethrogram is the most reliable technology to detect VUR and its severity, but it is restricted in children’s examinations for various shortcomings. This study aimed to evaluate and compare the efficiency of Tc-99m DMSA renal scintigraphy and conventional ultrasonography (USG) in predicting VUR with the gold standard of cystourethrogram results.

Methods

This retrospective study consisted of 285 first febrile UTI children under the age of 24 months who completed inflammatory indicator examinations, USG, Tc-99m DMSA renal scintigraphy and underwent cystourethrography after controlling infection with prophylactic antibiotics. The efficiency of Tc-99m DMSA renal scintigraphy and USG in predicting VUR was calculated and compared.

Results

Abnormal USG (40.23% vs. 21.72%, P = 0.001) and Tc-99m DMSA renal scintigraphy results (87.36% vs. 71.72%, P = 0.004) were more common in VUR children. The sensitivity of USG in predicting VUR was only 40.23%, whereas the sensitivity and negative predictive value of Tc-99m DMSA renal scintigraphy reached 87.63 and 83.58%, respectively. Tc-99m DMSA renal scintigraphy had a higher efficacy than USG in predicting high-grade reflux kidneys (73.87% vs. 33.33%; P < 0.001), but there was no significant difference in predicting low-grade reflux kidneys (P = 0.703).

Conclusion

Tc-99m DMSA renal scintigraphy had a significant higher efficiency in predicting VUR (a common cause of renal scarring, detected on DMSA) in first febrile urinary tract infection children under the age of 24 months as compared with USG, especially in high-grade reflux.
Diet and carcinogenesis of gastric cancer
Authors: Maddineni Gautam , Xie Jesse J. , Brahmbhatt Bhaumik , Mutha Pritesh
Published: September 2022

Purpose of review

Several recent studies have corroborated a strong association between diet and gastric cancer risk; investigators have also identified dietary factors that protect against gastric cancer. This review summarizes the literature on this topic and guides future research directions.

Recent findings

High-salt intake disrupts the gastric mucosal defense barrier, promoting Helicobacter pylori colonization and penetration of other carcinogenic compounds. Processed foods, processed meats, red meat, alcohol, foods with high dietary fat, and dietary cholesterol increase the risk of gastric carcinogenesis. On the other hand, increased consumption of fruits, vegetables, whole grains, nuts, and a low-salt diet may offer a protective effect.

Despite decreases in gastric cancer incidence because of increased identification and treatment of H. pylori, gastric cancer remains one of the most common cancers worldwide with a high mortality rate. This disturbing statistic highlights the importance of reducing and eliminating other risk factors for gastric cancer. There is a strong body of evidence that alcohol, processed foods, high salt intake, high fat intake, and foods with animal products (meats, eggs, and dairy) increase the risk of gastric cancer. A diet that is high in whole grains, fruits, vegetables, nuts and is low in salt may reduce the risk of gastric cancer.
Evaluation and management of paediatric vertigo
Authors: Peterson Joseph D. , Brodsky Jacob R.
Published: September 2022

Purpose of review

This review summarizes the most current information on cause, evaluation and treatment of dizziness in children.

Recent findings

There has been an increased understanding of the multifactorial cause of dizziness in the paediatric population. Quantitative vestibular testing is increasingly used and valuable as a diagnostic adjunct. Vestibular rehabilitation, migraine hygiene, psychological therapies, pharmaceuticals and/or surgery can be used as well tolerated and effective treatments for vertigo in children and adolescents when tailored to cause.

Paediatric vertigo can be effectively evaluated through careful history taking and physical examination along with adjunctive tests, such as vestibular testing and audiometry, when appropriate. Options for treatment of vestibular disorders in children and adolescents have greatly expanded in recent years allowing for the effective management of nearly all cases of paediatric vertigo, though a multimodal and/or multidisciplinary approach is often needed.
Updates in paediatric cholesteatoma
Authors: Orobello Nick , Harrington Chloe , Reilly Brian K.
Published: September 2022

Purpose of review

The management of paediatric patients with cholesteatoma is complex, as the disease process is more aggressive in children than adults. New technologies and practice adaptations currently help optimize the surgical management and monitoring of these challenging patients.

Recent findings

Several options of surgical management are available and are associated with equal if not improved outcomes. Technologic advancements in endoscopic ear surgery, the discovery of chemical-assisted dissection of cholesteatoma and advanced imaging protocols have enabled surgeons to better care for patients with this complex disease process.

The advances in endoscopic ear surgery, the discovery of Mesna as a chemically assisted dissection agent to improve recidivism rates and the use of specific diffusion-weighted MRI protocols enable the otologic surgeon to better care for these paediatric patients.
Impact of high-dose glucocorticoid on endothelial damage after liver resection – a double-blinded randomized substudy
Authors: Pitter Sandra E L T , Steinthorsdottir Kristin J , Johansson Pär I , Nørgaard Peter , Schultz Nicolai , Kehlet Henrik , Aasvang Eske K
Published: September 2022

Objectives

Postoperative endothelial damage potentially results in increased vascular leakage, tissue edema and subsequent complications. The preventive effect of glucocorticoids on endothelial damage after surgery is sparsely described, including the relation between endothelial damage and the postoperative inflammatory response. Thus, we aimed to assess the preventive effect of high-dose glucocorticoids on postoperative endothelial damage, and the association between endothelial damage and inflammation after surgery.

Methods

This was a predefined substudy of a randomized double-blinded clinical trial of methylprednisolone 10 mg/kg (high dose) vs. dexamethasone 8 mg (low dose) in patients undergoing liver resection at Rigshospitalet, Copenhagen. In total 25 patients undergoing major liver resection (11 in the high-dose group and 14 in the low-dose group) were included. The primary outcome was changed in five endothelial biomarkers and the secondary outcome was changes in inflammation [C-reactive protein (CRP)] for the first three postoperative days.

Results

No statistically significant difference was found for any endothelial biomarkers postoperatively between the two groups (P > 0.15, for all). High-dose glucocorticoids significantly reduced CRP on day 3 compared to low-dose glucocorticoids [median difference on a postoperative day 3, 59.6 g/L, (84.2; 27.1), P < 0.002]. No significant correlation between endothelial damage and CRP levels was seen.

Conclusions

No significant effect of high- vs. low-dose glucocorticoids on development in endothelial biomarkers after major liver resection was observed. High-dose glucocorticoids reduce the inflammatory response though without correlation to endothelial damage. Future studies should assess the clinical impact of increased endothelial biomarkers for clinical perioperative outcomes.
Equipping Nurses to Lead Evidence-Based Practice
Authors: Galuska Lee , Loos Nancy , Kawar Lina Najib , Thomas Bindu , Gallagher-Ford Lynn
Published: September 2022

OBJECTIVE

The aim of this study was to describe the evidence-based practice (EBP) attributes among California nurse leaders who are members of a professional nursing organization.

BACKGROUND

Nurse leaders are pivotal for successful EBP implementation. The Association of California Nurse Leaders' (ACNL) mission to equip nurses to lead self, others, and systems propelled them to conduct a study of members' EBP beliefs, knowledge, competencies, and implementation.

METHODS

Evidence-based practice attributes of California nurse leaders were measured using valid and reliable scales via an anonymous, electronic survey.

RESULTS

Although ahead in the subjective EBP scales, California nurse leaders' perceptions of organizational EBP culture were comparable with those of a similar national sample. Scores still indicated opportunities for improvement.

CONCLUSIONS

Nurse leaders must be prepared to lead EBP in their organizations. Professional organizations such as ACNL have an opportunity to help leaders by conducting research and assessing and meeting their members' learning needs.
The Story of the Magee Equations: The Ultimate in Applied Immunohistochemistry
Authors: Bhargava Rohit , Dabbs David J.
Published: September 2022

Magee equations (MEs) are a set of multivariable models that were developed to estimate the actual Oncotype DX (ODX) recurrence score in invasive breast cancer. The equations were derived from standard histopathologic factors and semiquantitative immunohistochemical scores of routinely used biomarkers. The 3 equations use slightly different parameters but provide similar results. ME1 uses Nottingham score, tumor size, and semiquantitative results for estrogen receptor (ER), progesterone receptor, HER2, and Ki-67. ME2 is similar to ME1 but does not require Ki-67. ME3 includes only semiquantitative immunohistochemical expression levels for ER, progesterone receptor, HER2, and Ki-67. Several studies have validated the clinical usefulness of MEs in routine clinical practice. The new cut-off for ODX recurrence score, as reported in the Trial Assigning IndividuaLized Options for Treatment trial, necessitated the development of Magee Decision Algorithm (MDA). MEs, along with mitotic activity score can now be used algorithmically to safely forgo ODX testing. MDA can be used to triage cases for molecular testing and has the potential to save an estimated $300,000 per 100 clinical requests. Another potential use of MEs is in the neoadjuvant setting to appropriately select patients for chemotherapy. Both single and multi-institutional studies have shown that the rate of pathologic complete response (pCR) to neoadjuvant chemotherapy in ER+/HER2-negative patients can be predicted by ME3 scores. The estimated pCR rates are 0%, <5%, 14%, and 35 to 40% for ME3 score <18, 18 to 25, >25 to <31, and 31 or higher, respectively. This information is similar to or better than currently available molecular tests. MEs and MDA provide valuable information in a time-efficient manner and are available free of cost for anyone to use. The latter is certainly important for institutions in resource-poor settings but is also valuable for large institutions and integrated health systems.
The Effectiveness of Exercises with Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study
Authors: Tiryaki Pelin , Çelik Derya , Bilsel Kerem , Erşen Ali
Published: September 2022

Objective

To investigate the effectiveness of a rehabilitation program with electromyographic biofeedback (EMG-BF) compared to the control group on patients with massive rotator cuff (RC) tear.

Design

Forty-six adults with massive RC tears, randomly assigned to two groups (23 EMG-BF group vs. 23 Control group). The EMG-BF group (experimental group) performed the exercises under the guidance of EMG-BF, unlike the control group. All patients underwent a 45-minute training session a day, three times a week over a 6-week duration, and followed up until 1-year. The outcome measures were American Shoulder and Elbow (ASES) score, shoulder flexion strength, shoulder range of motion (ROM), numeric pain rating scale (NPRS), and Global Rating of Change Scale (GRCS).

Results

Compared with the control group, the EMG-BF group demonstrated a significant change in shoulder flexion strength and patient satisfaction from baseline to 6 weeks (post-training) and from baseline to 12-month follow-up (F = 4.671, P = 0.005). There were significant improvements in within groups statistics for ASES score, shoulder flexion strength, shoulder ROM, and NPRS in both groups (p < 0.05).

Conclusion

The results demonstrate that deltoid focused structured rehabilitation program combined with EMG-BF can be used to increase shoulder flexion strength and patient satisfaction in conservative treatment of massive RC tear.
Longitudinal Cadaver-Based Training Curriculum for Musculoskeletal Ultrasound-Guided Procedures Among Physical Medicine & Rehabilitation Residents
Authors: Swenson Theodora L. , Roehmer Christian , Tran Richard T. , Schaaf Stephen
Published: September 2022

Musculoskeletal ultrasound has become a fundamental diagnostic and treatment tool in the field of physical medicine and rehabilitation (PM&R). However, there is no standardized curriculum for teaching and practicing musculoskeletal ultrasound during PM&R residency. The objective of this study is to describe a longitudinal curriculum using unembalmed fresh frozen cadavers to teach PM&R residents ultrasound-guided procedures. This protocol can help guide residents to begin learning how to independently identify important musculoskeletal structures and perform some of the most common musculoskeletal procedures relevant to clinical practice. Residents performed a procedure on average 6.99 times per block, and residents’ self-reported confidence in various aspects of ultrasound practice significantly improved after this curriculum (P < 0.005). Hence, a cadaver-based training curriculum may be a worthwhile tool for preparing PM&R residents to perform musculoskeletal ultrasound-guided procedures in the clinical setting.
Quantitative MRI for Evaluation of Musculoskeletal Disease
Authors: Eck Brendan L. , Yang Mingrui , Elias John J. , Winalski Carl S. , Altahawi Faysal , Subhas Naveen , Li Xiaojuan
Published: September 2022

Magnetic resonance imaging (MRI) is a valuable tool for evaluating musculoskeletal disease as it offers a range of image contrasts that are sensitive to underlying tissue biochemical composition and microstructure. Although MRI has the ability to provide high-resolution, information-rich images suitable for musculoskeletal applications, most MRI utilization remains in qualitative evaluation. Quantitative MRI (qMRI) provides additional value beyond qualitative assessment via objective metrics that can support disease characterization, disease progression monitoring, or therapy response. In this review, musculoskeletal qMRI techniques are summarized with a focus on techniques developed for osteoarthritis evaluation. Cartilage compositional MRI methods are described with a detailed discussion on relaxometric mapping (T2, T2*, T1ρ) without contrast agents. Methods to assess inflammation are described, including perfusion imaging, volume and signal changes, contrast-enhanced T1 mapping, and semiquantitative scoring systems. Quantitative characterization of structure and function by bone shape modeling and joint kinematics are described. Muscle evaluation by qMRI is discussed, including size (area, volume), relaxometric mapping (T1, T2, T1ρ), fat fraction quantification, diffusion imaging, and metabolic assessment by 31P-MR and creatine chemical exchange saturation transfer. Other notable technologies to support qMRI in musculoskeletal evaluation are described, including magnetic resonance fingerprinting, ultrashort echo time imaging, ultrahigh-field MRI, and hybrid MRI-positron emission tomography. Challenges for adopting and using qMRI in musculoskeletal evaluation are discussed, including the need for metal artifact suppression and qMRI standardization.
Persistent Cranial Defects After Endoscopic Sagittal Synostosis Surgery
Authors: Wu Robin T. , Menard Robert M.
Published: September 2022

Introduction:

Incomplete cranial ossification is a rare complication of calvarial-vault remodeling for sagittal synostosis often requiring reoperation. Studies show an incidence ranging from 0.5% to 18%.

Methods:

Infants with sagittal synostosis who underwent endoscopic sagittal synostectomy and barrel stave osteotomies with postoperative orthotic helmeting between 2003 and 2021 were included with minimum follow-up until the completion of helmeting.

Results:

Of 90 patients, 86 met inclusion; 3 had defects (3.5%). Patients with and without cranial defects had no difference in age of surgery (113 versus 131 d), duration helmeting (6.6 versus 7.0 mo), or perioperative/postoperative complications. Two underwent reoperation for recurrence. Patients with cranial defects manifested the evidence of developmental concerns more than patients without (100% versus 16.9%).

The average cranial defect size was 19.33 cm2 and age at surgery 4.29 years. All were managed with cranial particulate bone grafting with addition of bone matrix and SonicWeld plate. The first had 6×6 cm posterior defect requiring cranioplasty at 4.86 years with excellent healing. The second had a 3×6 cm posterior and 1×1 cm anterior defect, underwent cranioplasty at 4.14 years with persistent 4×6 defect, requiring repeat cranioplasty at 5.3 years. The third had a 3×5 cm posterior defect and underwent cranioplasty at 3.88 years with continued defect, planning for repeat intervention.

Conclusions:

This is the largest documented series of reoperations for incomplete ossification after endoscopic sagittal synostectomy with postoperative helmet treatment. The authors report a 3.5% rate of cranial defects, managed with bone grafting, bone matrix, and absorbable plates. Patients with poor ossification may have a propensity toward developmental concerns.
Tests to uncover and assess breathlessness: a proposed framework
Authors: Ekström Magnus
Published: September 2022

Purpose of Review

Breathlessness is a common, distressing, and limiting symptom that many people avoid by reducing their activity. This review discusses exertional tests that can be used for uncovering and assessing breathlessness depending on the person's severity of illness, function, the setting, and aim of the assessment.

Recent Findings

Standardized exertional tests are useful to uncover ‘hidden’ breathlessness earlier in people who may have adapted their physical activity to limit their breathing discomfort. In ‘more fit’ ambulatory people and outpatients, cardiopulmonary exercise testing is the gold standard for assessing symptom severity, underlying conditions, and mechanisms and treatment effects. Among field tests, the 6-min walk test is not useful for assessing breathlessness. Instead, the 3-min step test and walk test are validated for measuring breathlessness change in chronic obstructive pulmonary disease. In people with more severe illness (who are most often not breathless at rest), reported tests include upper limb exercise or counting numbers aloud, but a valid and useful test for this population is lacking.

A framework for selecting the most appropriate test to assess breathlessness validly is proposed, and research needs are identified.
Mini Nutritional Assessment Score and Visceral Proteins as Potential Predictors of Pressure Injuries in Home Care Patients With Stroke
Authors: Yurt Nur Simsek , Cubukcu Mahcube
Published: September 2022

This study aimed to determine the presence of pressure injuries and their severity based on Mini Nutritional Assessment (MNA) score and visceral protein levels in stroke patients receiving home care services. A case-control study was conducted in a case group with pressure injury (n = 54) and in a control group with no pressure injury (n = 54). The MNA scores and serum albumin and prealbumin values were significantly lower in the case group than in the control group (P < .001). There were also significant differences according to the pressure injury stages. Lower MNA score and low levels of serum albumin and prealbumin are associated with the presence of pressure injuries and increased severity of pressure injuries.
Tnpo3 enables EBF1 function in conditions of antagonistic Notch signaling
Authors: Bayer Marc , Boller Sören , Ramamoothy Senthilkumar , Zolotarev Nikolay , Cauchy Pierre , Iwanami Norimasa , Mittler Gerhard , Boehm Thomas , Grosschedl Rudolf
Published: September 2022

Transcription factor EBF1 (early B cell factor 1) acts as a key regulator of B cell specification. The transcriptional network in which EBF1 operates has been extensively studied; however, the regulation of EBF1 function remains poorly defined. By mass spectrometric analysis of proteins associated with endogenous EBF1 in pro-B cells, we identified the nuclear import receptor Transportin-3 (Tnpo3) and found that it interacts with the immunoglobulin-like fold domain of EBF1. We delineated glutamic acid 271 of EBF1 as a critical residue for the association with Tnpo3. EBF1E271A showed normal nuclear localization; however, it had an impaired B cell programming ability in conditions of Notch signaling, as determined by retroviral transduction of Ebf1−/− progenitors. By RNA-seq analysis of EBF1E271A-expressing progenitors, we found an up-regulation of T lineage determinants and down-regulation of early B genes, although similar chromatin binding of EBF1E271A and EBF1wt was detected in pro-B cells expressing activated Notch1. B lineage-specific inactivation of Tnpo3 in mice resulted in a block of early B cell differentiation, accompanied by a down-regulation of B lineage genes and up-regulation of T and NK lineage genes. Taken together, our observations suggest that Tnpo3 ensures B cell programming by EBF1 in nonpermissive conditions.
Intermolecular hydrogen bonding in N-methyl-N′-(pyridin-2-yl)benzene-1,2-diamine
Authors: Collis Gavin , Bilyk Alex , Kazanori Ueno , Forsyth Craig M.
Published: September 2022

The structure of N-methyl-N′-(pyridin-2-yl)benzene-1,2-diamine, C12H13N3, at 123 K has orthorhombic (Pna21) symmetry. The title compound displays an unexpected proton-splitting pattern when studied by 1H NMR spectroscopy. The X-ray crystallography analysis determined this to be caused by strong dual N—H...N hydrogen bonding.
Synthesis and structure of clozapine N-oxide hemi(hydrochloride): an infinite hydrogen-bonded poly[n]catenane
Authors: Peet Phillip L. van der , Joyce Rohan D. , Ott Holger , Marcuccio Sebastian M. , White Jonathan M. , Williams Spencer J.
Published: September 2022

The structure of the title compound, 2C18H19ClN4O·HCl or (CNO)2·HCl (C36H39Cl3N8O2), at 100 K has tetragonal (I4/m) symmetry. The dihedral angle between the benzene rings of the fused ring system of the CNO molecule is 40.08 (6)° and the equivalent angle between the seven-membered ring and its pendant N-oxide ring is 31.14 (7)°. The structure contains a very strong, symmetrical O—H...O hydrogen bond [O...O = 2.434 (2) Å] between two equivalent R
3N+—O− moieties, which share a proton lying on a crystallographic twofold rotation axis. These units then form a (CNO)4·(HCl)2 ring by way of two equivalent N—H...Cl hydrogen bonds (Cl− site symmetry m). These rings are catenated into infinite chains propagating along the c-axis direction by way of shape complementarity and directional C—H...N and C—H...π interactions.