bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudodiagnosis of Pseudoseizure
Authors: Croskerry Pat
Published: June 2020

In this case, a 35-year-old male is brought to a community hospital emergency department by ambulance having suffered an apparent seizure in the street. He is well known to the nurses and physician who see him. He has had several visits for seizures, and he has a history of depression. He has had electroencephalography studies and a computed tomography scan of his head in the past and has had assessments by both neurology and psychiatry. While he is in the department, he has an atypical seizure. There is a consensus among the ED staff that his seizures may be factitious. After a period of observation, he is discharged. Approximately 6 months later, the physician hears that the patient has died and tracks down his autopsy report, which had a surprising finding.
An Instable Inadvertence
Authors: Croskerry Pat
Published: June 2020

A 35-year-old male presents to the emergency department with an injury to his wrist that resulted from a fall while skating. On reviewing the patient’s X-rays, the emergency physician becomes concerned about the possibility of a fracture of the radius. His selective attention results in his inadvertently missing an associated ligamentous injury which the radiologist does pick up. The patient proves to have two very significant injuries from the fall.
A Laconic Lad
Authors: Croskerry Pat
Published: June 2020

This case describes the clinical course of a young boy through an ophthalmology clinic and two hospital emergency departments. A variety of contributory factors led to his initial misdiagnosis and provide a good illustration of James Reason’s classic Swiss cheese model for the trajectory of an error through the system. Numerous cognitive biases and other cognitive failures occur along the way, including the classic déformation professionnelle. The case raises several important considerations about clinical decision making generally, especially the common confusion regarding correlation and causation.
The Misunderstood Matelot
Authors: Croskerry Pat
Published: June 2020

This case describes a pleasant, elderly naval veteran who presents to the emergency department on several occasions with some troubling symptoms that are of concern to his family. A consensus develops among his physicians that he is showing signs of dementia, probably due to organicity caused by a lifetime of drinking alcohol. Although he may have incurred some damage to his liver–brain axis through drinking alcohol, the true cause of his recent deterioration lies elsewhere.
A Rake’s Progress
Authors: Croskerry Pat
Published: June 2020

This case discusses a middle-aged male who experiences abdominal pain and loss of consciousness at a mall. His wife believes he is having a heart attack and rushes him to a nearby emergency department. He is also experiencing some left shoulder pain and diaphoresis, which is misinterpreted at triage. This communication error leads to him being misassigned to a cardiac area. Eventually, the correct diagnosis is made, and the patient makes an uneventful recovery.
Bungled Bullae
Authors: Croskerry Pat
Published: June 2020

In this case, an elderly male with a history of chronic obstructive pulmonary disease presents to the emergency department of a teaching hospital with an acute exacerbation of his lung disease. He is initially treated for what appears to the emergency physician to be a significant pneumothorax, a diagnosis confirmed by a radiologist. However, the insertion of a Heimlich valve considerably worsens the patient’s condition. The diagnostic error is subsequently discovered.
Alternate Alternatives
Authors: Croskerry Pat
Published: June 2020

In this case, an elderly female presents to the emergency department with a complaint of low back pain for the past few months. She has been receiving treatment from a chiropractor for misalignment of her spine but believes she is not improving. She is seen by an emergency physician, who finds an essentially normal exam. Specifically, she has no neurological findings and a completely normal musculoskeletal exam. Urinalysis shows clear signs of a urinary tract infection. She is started on an antibiotic, and at follow-up her back pain has resolved and her urinalysis is normal. The case provides an opportunity to review complementary and alternative medicine and its pitfalls.
Notable Near Miss
Authors: Croskerry Pat
Published: June 2020

In this case, a 70-year-old female presents to the emergency department (ED) of a community hospital with facial swelling and rash. She was seen at her family doctor’s office 4 days earlier, when she was diagnosed with herpes zoster and started on medication. She complains of headache, blurred vision, severe pain in her scalp, and swelling around her eye. Attention is initially focused on her skin infection and the appropriate antibiotic treatment. She has two further visits to the same ED before a complication of her infection is noted, requiring referral for ophthalmological assessment.
Missed It
Authors: Croskerry Pat
Published: June 2020

In this case, a middle-aged male presents in the early hours of the morning to the emergency department (ED) of a teaching hospital. His chief complaint is shortness of breath. His history is significant for chronic obstructive pulmonary disease (COPD), and he is diagnosed as having exacerbation of COPD. The ED physician calls a medical intern to do the admission, and the patient is taken to the floor. The patient does not settle, and the intern is called back to the floor twice. The second time the intern is called back, the patient deteriorates further and has a cardiac arrest from which he cannot be resuscitated. His true diagnosis is revealed at an autopsy later that day.
Prevention of Postpartum Disorders
Authors: Mittal Leena P.
Published: June 2020

This chapter on prevention of postpartum disorders reviews the factors that can decrease the risks of developing a postpartum psychiatric disorder. The primary risk for postpartum or perinatal depression is a personal history of depression during or after a previous pregnancy. Maintenance during pregnancy of treatment for a pre-existing mental health disorder is essential. Building support networks is also important. Ensuring good health practices during the postpartum such as getting adequate exercise, eating well, and exposure to light can all be helpful. Sleep is an important component in reducing risks. Working with a partner who can help with some overnight bottle feeding can also be very beneficial.
Who’s Doing the Twist?
Authors: Hari Shilpa , Kaplan Dana , Barata Isabel A.
Published: June 2020

Fractures are common accidental and nonaccidental injuries. It is the job of the physician to be able to gather the necessary historical information, place the injury in developmental context, and identify and recognize abusive injury patterns. It is important to consider the age and development of the child paired with the history, location, type, and mechanism of the injury. Further workup may be needed in cases of suspected child maltreatment with physical abuse to look within and beyond the skeletal system for additional injuries such as neurologic and gastroenterological in nature. It is imperative to consider insufficient nutrition and genetic causes as differential diagnoses for fractures.
The Neverending Ouch
Authors: Hughes Julianne , Barata Isabel A.
Published: June 2020

Chronic pain is defined as pain that is either persistent (ongoing) or recurrent (episodic) and is thought to be multifactorial, involving biological, psychological, and sociocultural factors. Generally, pain is considered chronic when the pain itself or recurrent episodes of pain persist greater than 3 to 6 months. Assessing children’s pain can be challenging, and validated tools should be used such as the Wong-Baker FACES Pain Rating Scale or the OUCHER Pain Scale (younger children) and verbal numerical scales (older children). Following assessment, treatment can be initiated based on the severity, nature, and presumed etiology of the pain. Management of acute or chronic pain episodes should follow evidence-based recommendations, which include both pharmacological and nonpharmacological principle. A stepwise escalation in pain medication may be required to adequately control the patient’s pain.
Has the spirit of Basaglia affected Polish psychiatry?
Authors: Moskalewicz Jacek , Herczyńska Grażyna , Prot-Klinger Katarzyna
Published: June 2020

The anti-psychiatry movement emerged in Poland in the 1960s, demanding changes in a system based on huge psychiatric hospitals. Nevertheless, large hospitals did not vanish. Even today, they provide three quarters of the beds and serve two thirds of all patients hospitalized within the psychiatric care system. To understand better the slow pace of the Polish reforms, a theory of diffusion of innovations has been applied. Written sources such as journals, private letters, and statistical archives have been reviewed. In addition, seven non-structured interviews were carried out with mental health workers who could remember reform efforts from the 1970s. A critical opinion of the Italian reform prevailed in Poland, based on second-hand sources and rumours. These described the Italian experiences as an irresponsible reform carried out with disregard of patients’ interests. Blaming Basaglia for irresponsible reforms provided a moral legitimacy for the slow pace of reforms in Poland.
Making sense of Basaglia
Authors: Burns Tom , Foot John
Published: June 2020

The symposium in Oxford, in September 2018, heard 18 papers from 14 countries exploring the international reception of Basaglia and the Italian reforms. In the ensuing discussions, a number of issues arose which are addressed in this chapter. There were three striking omissions in Basaglian writing—primary care, gender, and the role of specialist services. Several thorny questions kept recurring. Was Basaglia an anti-psychiatrist? Was he a Marxist? Was the movement too ideological? What was the source of resistance from North European psychiatry? What explains the North/South implementation divide in Italy? In addition, differences in understanding two key concepts were explored. What is meant by a therapeutic community? What exactly is a mental hospital? These issues are explored in this final chapter in the hope that they will stimulate further research into a richer understanding of a man and movement whose international impact is undeniable but often misunderstood.
Is Fornax 4 the nuclear star cluster of the Fornax dwarf spheroidal galaxy?
Authors: Martocchia S , Dalessandro E , Salaris M , Larsen S , Rejkuba M
Published: June 2020

Fornax 4 is the most distinctive globular cluster in the Fornax dwarf spheroidal. Located close to the centre of the galaxy, more metal-rich and potentially younger than its four companions (namely, Fornax clusters number 1, 2, 3, and 5), it has been suggested to have experienced a different formation than the other clusters in the galaxy. Here, we use Hubble Space Telescope/WFC3 photometry to characterize the stellar population content of this system and shed new light on its nature. By means of a detailed comparison of synthetic horizontal branch and red giant branch with the observed colour–magnitude diagrams, we find that this system likely hosts stellar sub-populations characterized by a significant iron spread up to Δ[Fe/H] ∼ 0.4 dex and possibly by also some degree of He abundance variations ΔY ∼ 0.03. We argue that this purely observational evidence, combined with the other peculiarities characterizing this system, supports the possibility that Fornax 4 is the nuclear star cluster of the Fornax dwarf spheroidal galaxy. A spectroscopic follow-up for a large number of resolved member stars is needed to confirm this interesting result and to study in detail the formation and early evolution of this system and more in general the process of galaxy nucleation.
What determines the maximum stellar surface density of galaxies?
Authors: Ling Chih-Teng , Hashimoto Tetsuya , Goto Tomotsugu , Lu Ting-Yi , On Alvina Y L , Santos Daryl Joe D , Hsiao Tiger Y-Y , Ho Simon C-C
Published: June 2020

Observationally, it has been reported that the densest stellar system in the Universe does not exceed a maximum stellar surface density, $\Sigma ^{\max }_{*}$ = $3\times 10^5\, {\rm M}_{\odot }\,{\rm pc}^{-2}$, throughout a wide physical scale ranging from star cluster to galaxy. This suggests that there exists a fundamental physics that regulates the star formation and stellar density. However, factors that determine this maximum limit are not clear. In this study, we show that $\Sigma ^{\max }_{*}$ of galaxies is not a constant as previous work reported, but actually it depends on the stellar mass. We select galaxy sample from the Sloan Digital Sky Survey Data Release 12 at z = 0.01–0.5. In contrast to a constant maximum predicted by theoretical models, $\Sigma ^{\max }_{*}$ strongly depends on stellar mass, especially for less massive galaxies with $\text{$\sim$}10^{10}\, {\rm M}_{\odot }$. We also found that a majority of high-Σ* galaxies show red colours and low star formation rates. These galaxies probably reach the $\Sigma ^{\max }_{*}$ as a consequence of the galaxy evolution from blue star forming to red quiescent by quenching star formation. One possible explanation of the stellar-mass dependence of $\Sigma ^{\max }_{*}$ is a mass-dependent efficiency of stellar feedback. The stellar feedback could be relatively more efficient in a shallower gravitational potential, which terminates star formation quickly before the stellar system reaches a high stellar density.
Testing the cosmic curvature at high redshifts: the combination of LSST strong lensing systems and quasars as new standard candles
Authors: Liu Tonghua , Cao Shuo , Zhang Jia , Biesiada Marek , Liu Yuting , Lian Yujie
Published: June 2020

The cosmic curvature, a fundamental parameter for cosmology could hold deep clues to inflation and cosmic origins. We propose an improved model-independent method to constrain the cosmic curvature by combining the constructed Hubble diagram of high-redshift quasars with galactic-scale strong lensing systems expected to be seen by the forthcoming Large Synoptic Survey Telescope survey. More specifically, the most recent quasar data are used as a new type of standard candles in the range 0.036 < z < 5.100, whose luminosity distances can be directly derived from the non-linear relation between X-ray and UV luminosities. Compared with other methods, the proposed one involving the quasar data achieves constraints with higher precision (ΔΩk ∼ 10−2) at high redshifts (z ∼ 5.0). We also investigate the influence of lens mass distribution in the framework of three types of lens models extensively used in strong lensing studies (SIS model, power-law spherical model, and extended power-law lens model), finding the strong correlation between the cosmic curvature and the lens model parameters. When the power-law mass density profile is assumed, the most stringent constraint on the cosmic curvature Ωk can be obtained. Therefore, the issue of mass density profile in the early-type galaxies is still a critical one that needs to be investigated further.
Progenitors of early-time interacting supernovae
Authors: Boian Ioana , Groh Jose H
Published: June 2020

We compute an extensive set of early-time spectra of supernovae interacting with circumstellar material using the radiative transfer code cmfgen. Our models are applicable to events observed from 1 to a few days after explosion. Using these models, we constrain the progenitor and explosion properties of a sample of 17 observed interacting supernovae at early times. Because massive stars have strong mass-loss, these spectra provide valuable information about supernova progenitors, such as mass-loss rates, wind velocities, and surface abundances. We show that these events span a wide range of explosion and progenitor properties, exhibiting supernova luminosities in the 108 to 1012 L⊙ range, temperatures from 10 000 to 60 000 K, progenitor mass-loss rates from a few 10−4 up to 1 M⊙ yr−1, wind velocities from 100 to 800 km s−1, and surface abundances from solar-like to H-depleted. Our results suggest that many progenitors of supernovae interacting with circumstellar material have significantly increased mass-loss before explosion compared to what massive stars show during the rest of their lifetimes. We also infer a lack of correlation between surface abundances and mass-loss rates. This may point to the pre-explosion mass-loss mechanism being independent of stellar mass. We find that the majority of these events have CNO-processed surface abundances. In the single star scenario this points to a preference towards high-mass RSGs as progenitors of interacting SNe, while binary evolution could impact this conclusion. Our models are publicly available and readily applicable to analyse results from ongoing and future large-scale surveys such as the Zwicky Transient Factory.
Inertial oscillation modes of an inclined dipolar magnetosphere as a source of band-limited noise in X-ray pulsars
Authors: Abolmasov Pavel , Biryukov Anton
Published: June 2020

Magnetic fields of strongly magnetized stars can trap conducting matter due to frozen-in condition. In the force-free regime, the motion of the matter along the field lines may be considered in the ‘bead on a wire’ approximation. Such a motion, if gravity and centrifugal forces are taken into account, has equilibrium points, some of which are stable. In most cases, stability is possible in about several per cent of the possible locations. Corresponding oscillation frequencies span the range from zero to $\sqrt{3}$ of the spin frequency. We suggest that this variability mode may be excited in some X-ray pulsars during the outbursts and create the peaked broad-band noise component near the break frequency in the power density spectrum, as well as produce some of the quasi-periodic oscillation features in this frequency range. Existence of this variability does not require any changes in mass accretion rate and involves only a small amount of matter infiltrating from the disc and magnetic flow due to interchange instabilities.
Human chorionic gonadotropin improves endometrial receptivity by increasing the expression of homeobox A10
Authors: Zhu Mengchen , Yi Shanling , Huang Xiaomin , Meng Junan , Sun Haixiang , Zhou Jianjun
Published: June 2020

Homeobox A10 (HOXA10) is a characterized marker of endometrial receptivity. The mechanism by which hCG intrauterine infusion promotes embryo implantation is still unclear. This study seeks to investigate whether hCG improves endometrial receptivity by increasing expression of HOXA10. HOXA10 expression with human chorionic gonadotropin stimulation was analyzed in vitro and in vivo. Our results demonstrate that HOXA10 was decreased in the endometria of recurrent implantation failure patients compared to that in the healthy control fertile group, also we observed that hCG intrauterine infusion increased endometrial HOXA10 expression. HOXA10, blastocyst-like spheroid expansion area was increased, whereas DNA (cytosine-5-)-methyltransferase 1 was decreased when human endometrial stromal cells (hESCs) were treated with 0.2 IU/ml of hCG for 48 h. HOXA10 promoter methylation was also reduced after hCG treatment. Collagen XV (ColXV) can repress the expression of DNA (cytosine-5-)-methyltransferase 1, and hCG treatment increased the expression of ColXV. However, when the hESCs were treated with LH/hCG receptor small interfering RNA to knock down LH/hCG receptor, hCG treatment failed to repress DNA (cytosine-5-)-methyltransferase 1 expression or to increase ColXV expression. Our findings suggest that hCG may promote embryo implantation by increasing the expression of HOXA10.
Perspectives of Patients on Outpatient Parenteral Antimicrobial Therapy: Experiences and Adherence
Authors: Hamad Yasir , Dodda Sai , Frank Allison , Beggs Joe , Sleckman Christopher , Kleinschmidt Glen , Lane Michael A , Burnett Yvonne
Published: June 2020

Background

Nonadherence to medication is a burden to the US health care system and is associated with poor clinical outcomes. Data on outpatient parenteral antimicrobial therapy (OPAT) treatment plan adherence are lacking. The purpose of this study is to determine the rate of nonadherence and factors associated with it.

Methods

We surveyed patients discharged from a tertiary hospital on OPAT between February and August 2019 about their baseline characteristics, OPAT regimen, adherence, and experience with OPAT.

Results

Sixty-five patients responded to the survey. The median age was 62 years, and 56% were male. The rate of reported nonadherence to intravenous (IV) antibiotics was 10%. Factors associated with nonadherence to IV antibiotics included younger age, household income of <$20 000, and lack of time for administering IV antibiotics (30 vs 64 years, P < .01; 83% vs 20%, P < .01, and 33% vs 4%, P = .04, in the nonadherent vs adherent groups, respectively), while less frequent administration (once or twice daily) and having friend or family support during IV antibiotic administration were associated with better adherence (17% vs 76%, P < .01, and 17% vs 66%, P = .03, in the nonadherent vs adherent groups, respectively). Most patients attended their infectious diseases clinic visits (n = 44, 71%), and the most commonly cited reasons for missing an appointment were lacking transportation (n = 12, 60%), not feeling well (n = 8, 40%), and being unaware of the appointment (n = 6, 30%).

Conclusions

Less frequent antibiotic dosing and better social support were associated with improved adherence to OPAT. In contrast, younger age, lower income, and lack of time were associated with nonadherence.
Corticosteroid discontinuation, complete clinical response and remission in juvenile dermatomyositis
Authors: Kishi Takayuki , Warren-Hicks William , Bayat Nastaran , Targoff Ira N , Huber Adam M , Ward Michael M , Rider Lisa G ,   with the Childhood Myositis Heterogeneity Study Group
Published: June 2020

Objective

A North American registry of JDM patients was examined for frequency of and factors associated with corticosteroid discontinuation, complete clinical response and remission.

Methods

We evaluated probability of achieving final corticosteroid discontinuation, complete clinical response and remission in 307 JDM patients by Weibull time-to-event modelling; conditional probability of complete clinical response and remission using Bayesian network modelling; and significant predictors with multivariable Markov chain Monte-Carlo Weibull extension models.

Results

The probability of corticosteroid discontinuation was 56%, complete clinical response 38% and remission 30% by 60 months after initial treatment in 105 patients. The probability of remission was conditional on corticosteroid discontinuation and complete clinical response. Photosensitivity, contractures and a longer time to complete clinical response were predictive of the time to final corticosteroid discontinuation. Anti-MJ (NXP2) autoantibodies and a Northwest residential geoclimatic zone were predictive of shorter time to complete clinical response, while dysphonia, contractures, an increase in medications within 24 months and a longer time to corticosteroid discontinuation were associated with longer time to complete clinical response. Anti-p155/140 (TIF1) autoantibodies, an increase in medications within 12–24 months, or longer times to corticosteroid discontinuation and complete clinical response were associated with longer time to remission.

Conclusion

JDM patients achieve favourable outcomes, including corticosteroid discontinuation, complete clinical response and remission, although timelines for these may be several years based on time-dependent analyses. These outcomes are inter-related and strong predictors of each other. Selected clinical features and myositis autoantibodies are additionally associated with these outcomes.
A White Matter Connection of Schizophrenia and Alzheimer’s Disease
Authors: Kochunov Peter , Zavaliangos-Petropulu Artemis , Jahanshad Neda , Thompson Paul M , Ryan Meghann C , Chiappelli Joshua , Chen Shuo , Du Xiaoming , Hatch Kathryn , Adhikari Bhim , Sampath Hemalatha , Hare Stephanie , Kvarta Mark , Goldwaser Eric , Yang Fude , Olvera Rene L , Fox Peter T , Curran Joanne E , Blangero John , Glahn David C , Tan Yunlong , Hong L Elliot
Published: June 2020

Schizophrenia (SZ) is a severe psychiatric illness associated with an elevated risk for developing Alzheimer’s disease (AD). Both SZ and AD have white matter abnormalities and cognitive deficits as core disease features. We hypothesized that aging in SZ patients may be associated with the development of cerebral white matter deficit patterns similar to those observed in AD. We identified and replicated aging-related increases in the similarity between white matter deficit patterns in patients with SZ and AD. The white matter “regional vulnerability index” (RVI) for AD was significantly higher in SZ patients compared with healthy controls in both the independent discovery (Cohen’s d = 0.44, P = 1·10–5, N = 173 patients/230 control) and replication (Cohen’s d = 0.78, P = 9·10–7, N = 122 patients/64 controls) samples. The degree of overlap with the AD deficit pattern was significantly correlated with age in patients (r = .21 and .29, P < .01 in discovery and replication cohorts, respectively) but not in controls. Elevated RVI-AD was significantly associated with cognitive measures in both SZ and AD. Disease and cognitive specificities were also tested in patients with mild cognitive impairment and showed intermediate overlap. SZ and AD have diverse etiologies and clinical courses; our findings suggest that white matter deficits may represent a key intersecting point for these 2 otherwise distinct diseases. Identifying mechanisms underlying this white matter deficit pattern may yield preventative and treatment targets for cognitive deficits in both SZ and AD patients.
Explaining the exceptional 4270 m high elevation limit of an evergreen oak in the south-eastern Himalayas
Authors: Yang Yang , Sun Hang , Körner Christian
Published: June 2020

Unlike the well-understood alpine treeline, the upper range limits of tree taxa that do not reach the alpine treeline are largely unexplained. In this study, we explored the causes of the exceptionally high elevation (4270 m) occurrence of broad-leaved evergreen oaks (Quercus pannosa) in the south-eastern Himalayas. We assessed the course of freezing resistance of buds and leaves from winter to summer at the upper elevational limit of this oak species. Linked to leaf phenology, we analyzed freezing resistance and assessed minimum crown temperature for the past 65 years. We also examined potential carbon limitation at the range limit of this species. Last season buds and leaves operated at a safety margin of 5.5 and 11 K in mid-winter. Once fully dehardened early in July, last season foliage is damaged at −5.9 and new foliage at −4.6 °C. Bud break is timed for late June to early July when low temperature extremes historically were never below −3.0 °C. The monsoon regime ensures a long remaining season (149 days), thus compensating for the late onset of shoot growth. Compared with a site at 3450 m, specific leaf area is reduced, foliar non-structural carbohydrate concentrations are similar and the δ13C signal is higher, jointly suggesting that carbon limitation is unlikely at the range limit of this species. We also show that these oaks enter the growing season with fully intact (not embolized) xylem. We conclude that the interaction between phenology and freezing tolerance results in safe flushing, while still facilitating shoot maturation before winter. These factors jointly determine the upper range limit of this oak species. Our study illuminates an exceptional case of broad-leaved evergreen tree performance near the treeline, and by exploring a suite of traits, we can underpin the central role of flushing phenology in such a stressful environment.
The Globodera pallida Effector GpPDI1 Is a Functional Thioredoxin and Triggers Defense-Related Cell Death Independent of Its Enzymatic Activity
Authors: Gross Rachel , Zhang Shan , Wei Lihui , Caplan Allan , Kuhl Joseph , Dandurand Louise-Marie , Wang Xiaofang , Xiao Fangming
Published: June 2020

The plant-parasitic nematode Globodera pallida is an obligate biotroph that only reproduces on select species in the Solanum family. The establishment of the feeding site, the syncytium, involves secretion of effectors into the plant cell to combat the plant defense response and facilitate transformation of root cells into the syncytium. Despite the important predicted roles of effectors in the plant−pathogen interactions, the functionality of G. pallida effectors is largely unknown. In this study, we identified and characterized a G. pallida effector protein disulfide isomerase (GpPDI1). GpPDI1 contains two thioredoxin domains that function together to reduce disulfide bonds, as manifested by the nullification of enzymatic activity when either domain is absent. The transcript of GpPDI1 is localized in the dorsal gland of the nematode during the J2 stage. In addition, GpPDI1 can trigger defense-related cell death in Nicotiana benthamiana and tomato (Solanum lycopersicum) leaf tissue and localizes in the plant host cell’s cytoplasm and nucleus when transiently expressed in plant cells. Significantly, the ability of elicitation of cell death is not dependent on the enzymatic activity of GpPDI1 or correlated with the subcellular distribution of GpPDI1, suggesting that a nondisulfide reducing function or structural feature of GpPDI1 is responsible for the recognition by the host immune system to elicit cell death.
Risk of Miscarriage Following Amniocentesis or Chorionic Villus Sampling: Systematic Review of Literature and Updated Meta-analysis
Authors: Salomon L. J. , Sotiriadis A. , Wulff C. B. , Odibo A. , Akolekar R.
Published: June 2020

(Abstracted from Ultrasound Obstet Gynecol 2019;54:442–451)

Evidence suggests that the risk of miscarriage after invasive prenatal testing is much lower than that cited by professional bodies. Since the last reported systematic review of this risk in 2015, more large studies have been conducted, and advances in equipment and techniques have been made.
Race, Social Status, and Depressive Symptoms
Authors: Aroke Edwin N. , Jackson Pamela , Overstreet Demario S. , Penn Terence M. , Rumble Deanna D. , Kehrer Caroline V. , Michl Ava N. , Hasan Fariha N. , Sims Andrew M. , Quinn Tammie , Long D. Leann , Goodin Burel R.
Published: June 2020

Background:

Chronic low back pain (cLBP) is the leading cause of disability, with a significant societal cost. It disproportionately affects non-Hispanic blacks and individuals of lower socioeconomic status. The biopsychosocial framework has been used to study and manage cLBP, yet disparities persist.

Objective:

The objective of this study was to assess whether self-identified race moderated the relationship between perceived social status and cLBP outcomes (pain interference and pain severity) and investigate whether race moderated the indirect relationship between perceived social status and pain outcomes via depressive symptoms.

Methods:

Fifty-seven blacks and 48 whites with cLBP were recruited as part of a large ongoing study. Depressive symptoms, objective and subjective measures of socioeconomic status, and pain outcomes were measured. Hayes’ moderated mediation model was used to estimate conditional direct and indirect relationship between these variables.

Result:

On average black participants reported significantly more pain interference (4.12 [SD=2.65] vs. 2.95 [SD=2.13]) and severity (5.57 [SD=2.27] vs. 3.99 [SD=1.99]) than white participants, (P<0.05). Race moderated the association between perceived social status and pain interference: higher social status decreases pain interference for white participants, but that trend was not observed in black participants. Moreover, race moderated association of perceived social status with depressive symptoms (P<0.001); which mediates the effects of perceived social status on pain outcomes.

Conclusion:

Higher perceived social status is associated with less severe depressive symptoms, which in turn is associated with less pain severity and less pain interference for whites but not for blacks with cLBP.
Impaired School Functioning in Children With Chronic Pain
Authors: Groenewald Cornelius B. , Tham See Wan , Palermo Tonya M.
Published: June 2020

Objective:

The purpose of this study was to determine the association between presence of chronic pain and school functioning among school-aged children (6 to 17 y) using the most recent United States national data.

Materials and Methods:

Secondary data analyses of the 2016-2017 National Survey of Children’s Health. Parents (n=48,254) reported on whether their child had chronic pain over the past 12 months. Parents also reported on school functioning including (1) engagement with school, (2) number of school days missed, (3) problems at school, (4) repeating a grade, and (5) diagnosis of a learning disability. Children with chronic pain were compared with children without chronic pain using multivariate logistic regression models. We also stratified analysis according to age and sex.

Results:

In multivariate analyses, children with pain were more likely to have low school engagement (adjusted odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.0-1.9), be chronically absent (OR: 4.2, 95% CI: 3.0-5.8), have school-related problems (OR: 1.9, 95% CI: 1.5-2.3), repeat a grade (OR: 1.4, 95% CI: 1.0-2.0), and be diagnosed with a learning disability (OR: 1.6, 95% CI: 1.1-2.5). In stratified analyses, associations between chronic pain and school measures were strongest among adolescents (15 to 17 y of age) and males.

Discussion:

This study extends evidence linking chronic pain status to poorer school functioning in a large, national sample. Poor school functioning is a pressing public concern affecting children with chronic pain. Health care providers, educators, policymakers, and families should work together to ensure that needs are met for this vulnerable population.
Ovarian cancer risk in relation to blood lipid levels and hyperlipidemia: a systematic review and meta-analysis of observational epidemiologic studies
Authors: Zhang Dongyu , Xi Yuzhi , Feng Yilin
Published: June 2020

Epidemiologic evidence regarding association of ovarian cancer risk with blood lipid level and hyperlipidemia is inconsistent. We aimed to synthesize available epidemiologic studies to disentangle associations of cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and hyperlipidemia with ovarian cancer risk. We searched PubMed, EMBASE, and Web of Science for eligible studies. A random-effects model was applied for synthesis. Heterogeneity was evaluated by a Chi-squared test for the Cochran Q statistic and the I-squared value. Subgroup analysis was conducted by design, study locale, and ovarian cancer case number. Sensitivity analysis was conducted for studies adjusting for certain covariates or with superior quality. To explore the potential dose–response relationship, we further synthesized effect measures of moderate levels of cholesterol, triglycerides, HDL-C, and LDL-C. Twelve studies (five cohort and seven case-control studies) were included. In primary meta-analysis, the synthesized risk ratio (RRpool) and 95% confidence interval (CI) suggested that high cholesterol was associated with an increased ovarian cancer risk (RRpool 1.22, 95% CI 1.01–1.48, Cochran P value: 0.40, I2: 0.5%). High HDL-C was associated with a lower ovarian cancer risk (RRpool 0.61, 95% CI 0.40–0.94, Cochran P value: 0.06, I2: 63.7%). We obtained nonsignificant associations for other exposures. Subgroup and sensitivity analyses yielded consistent results as the primary analysis. Only cholesterol showed marginally significant association in synthesis using moderate exposure levels (RRpool 1.18, 95% CI 0.99–1.42, Cochran P value: 0.51, I2: 0.0%). Our study suggests that high blood cholesterol is associated with an increased ovarian cancer risk, whereas the etiological significance of other exposures deserves more investigations.
Drug-specific and dosage effects of statins and the risk of cancer: a population-based cohort study in South Korea
Authors: Oh Tak Kyu , Song In-Ae
Published: June 2020

This study aimed to investigate whether the drug-specific and dosage effects of statin use were associated with a lower risk of cancer in adults in South Korea. We evaluated the adult population registered in the 2010 sample cohort database of South Korea. Subjects were divided into the statin group (those who had been prescribed continuous oral statin over 1 year) and the control group (those who had never been prescribed statin from 2010 to 2016). In total, 687 396 individuals were included in the analysis [statin group, 53 592 (7.8%); control group, 633 804 (92.2%)]. In a multivariable Cox model, the hazard of cancer in the statin group was 5% lower than that in the control group [hazard ratio, 0.95; 95% confidence interval (CI), 0.91–0.98; P = 0.004]. Additionally, the hazard of cancer in patients receiving moderate- and high-intensity daily dosages of statin were 5% (hazard ratio, 0.95; 95% CI, 0.91–0.98; P = 0.005) and 9% (hazard ratio, 0.91; 95% CI, 0.83–0.99; P = 0.042) lower than that of the control group, respectively. The hazard of cancer in patients receiving atorvastatin was 6% (hazard ratio, 0.94; 95% CI, 0.90–0.98; P = 0.005) lower than that in the control group, while other types of statins showed no significant associations (all P > 0.05). Statin use was associated with a lower risk of cancer in South Korea. This association was stronger in patients receiving moderate and high daily dosages of statin and in patients receiving atorvastatin.
Syndemic theory, structural violence and HIV among African–Americans
Authors: Godley Bria A. , Adimora Adaora A.
Published: June 2020

Purpose of review

This paper will review recent use of syndemic frameworks in HIV research among African–Americans.

Recent findings

Researchers have used syndemic theory in diverse African–American study populations, including MSM, cis-women, trans-women, heterosexual men and adolescents. These studies have evaluated the associations between syndemic conditions and a variety of outcomes, such as sexual behaviours, HIV and other sexually transmitted infections, HIV testing, adherence to antiretroviral therapy, HIV suppression and preexposure prophylaxis use. The most frequently evaluated syndemic conditions have been depression, substance use and personal experience of abuse or violence; a few studies have included experience of incarceration and unstable housing.

These studies have yielded valuable insights into links between HIV-related outcomes and mental health, experience of violence and abuse, and substance use. But a key feature – and major utility – of the syndemics framework is its potential for examining not only synergistic individual-level risk factors but also the interactions with economic, political and social systems that influence these individual-level factors and thereby shape the HIV epidemic among African–Americans. Research that takes these systems into account is needed to inform policy changes that can help end the HIV epidemic in this population.
Changes in Behavior with Increasing Pregnancy Attempt Time
Authors: Wise Lauren A. , Wesselink Amelia K. , Hatch Elizabeth E. , Weuve Jennifer , Murray Eleanor J. , Wang Tanran R. , Mikkelsen Ellen M. , Sørensen Henrik Toft , Rothman Kenneth J.
Published: June 2020

Background:

The extent to which couples change their behaviors with increasing pregnancy attempt time is not well documented.

Methods:

We examined change in selected behaviors over pregnancy attempt time in a North American preconception cohort study. Eligible females were ages 21–45 years and not using fertility treatment. Participants completed baseline and bimonthly follow-up questionnaires for up to 12 months or until pregnancy.

Results:

Among 3,339 females attempting pregnancy for 0–1 cycles at enrollment, 250 contributed 12 months of follow-up without conceiving. Comparing behaviors at 12 months versus baseline, weighted for loss-to-follow-up, we observed small-to-moderate reductions in mean caffeine intake (−19.5 mg/day, CI = −32.7, −6.37), alcohol intake (−0.85 drinks/week, CI = −1.28, −0.43), marijuana use (−3.89 percentage points, CI = −7.33, 0.46), and vigorous exercise (−0.68 hours/week, CI = −1.05, −0.31), and a large increase in activities to improve conception chances (e.g., ovulation testing) (21.7 percentage points, CI = 14.8, 28.6). There was little change in mean cigarette smoking (−0.27 percentage points, CI = −1.58, 1.04), perceived stress scale score (−0.04 units, CI = −0.77, 0.69), or other factors (e.g., sugar-sweetened soda intake, moderate exercise, intercourse frequency, and multivitamin use), but some heterogeneity within subgroups (e.g., 31% increased and 32% decreased their perceived stress scores by ≥2 units; 14% reduced their smoking but none increased their smoking by ≥5 cigarettes/day).

Conclusions:

Although many behaviors changed with increasing pregnancy attempt time, mean changes tended to be modest for most variables. The largest differences were observed for the use of caffeine, alcohol, and marijuana, and methods to improve conception chances.
Updates in uterine artery embolization for leiomyomas
Authors: Kim Annie , Arabkhazaeli Moona , Ulrich Amanda , Lerner Veronica , Shin Ja Hyun
Published: June 2020

Purpose of review

Uterine leiomyomas are a common condition estimated to affect 70–80% of reproductive-aged women. An evolving body of evidence continues to guide our understanding of various surgical and interventional treatment options, such as uterine artery embolization (UAE). This article provides an updated review of novel findings regarding UAE.

Recent findings

Despite an abundance of observational studies and several small randomized controlled trials, large scale long-term comparative efficacy studies are lacking. Although short-term outcomes continue to be favorable, recent trials show reoperation rate of up to 35% in 10 years and may raise some concerns regarding ovarian reserve, fertility and pregnancy outcomes.

UAE remains a safe and effective alternative to surgery in the management of leiomyomas. A deeper investigation into understanding this treatment's optimal use in various patient populations is needed.
Association Between Structure-function Characteristics and Visual Field Outcomes in Glaucoma Subjects With Intraocular Pressure Reduction After Trabeculectomy
Authors: Kadziauskienė Aistė , Chua Jacqueline , Baskaran Mani , Yow Ai Ping , Tan Bingyao , Sng Chelvin , Ašoklis Rimvydas , Lesinskas Eugenijus , Crowston Jonathan , Schmetterer Leopold , Wong Damon Wing Kee
Published: June 2020

Precis:

Improvements in post-trabeculectomy visual field (VF) outcomes were found to be significantly associated with preoperative nerve fiber layer thickness parameters extracted from the sectorized structure-function relationship, baseline VF, and severity of glaucoma.

Objective:

To determine whether the preoperative structure-function relationship helps to predict visual outcomes at 1-year post-trabeculectomy.

Patients and Methods:

In total, 91 eyes from 87 participants who successfully underwent trabeculectomy were included in our study. All eyes received optical coherence tomography imaging and VF assessment using 30-2 standard automated perimetry preoperatively at baseline and postoperatively 1 year after trabeculectomy. The linear mixed-model analysis was used to assess the association of structure and function at baseline, and multivariate analysis to investigate factors associated with postoperative VF outcomes.

Results:

Results from multivariate and univariate analysis for VF 1 year after trabeculectomy showed that a positive preoperative retinal nerve fiber layer thickness deviation from the structure-function model was found to be significantly associated with improved postoperative VF outcomes [β=0.06 dB/μm; 95% confidence interval (CI), 0.03-0.09]. Other significant factors included baseline VF MD (β=−0.18; 95% CI, −0.23 to −0.13) and the presence of severe glaucoma (β=−1.69; 95% CI, −2.80 to −0.57). Intraocular pressure was positively associated with improved VF outcomes only in univariate analysis (β=0.06; 95% CI, 0.01-0.11).

Conclusions and Relevance:

Characteristics derived from the baseline structure-function relationship were found to be strongly associated with postoperative VF outcomes. These findings suggest that the structure-function relationship could potentially have a role in predicting VF progression after trabeculectomy.
Bilateral Secondary Angle Closure During Daratumumab Infusion: A Case Report and Review of the Literature
Authors: Edwards Rebecca G. , Vanderhoof Shawna , Palestine Alan , Seibold Leonard K.
Published: June 2020

Daratumumab is an anti-CD38 monoclonal antibody approved for use in multiple myeloma in 2015 and under investigation for use in light-chain amyloidosis. We report a case of a patient with amyloidosis who developed bilateral, acute secondary angle closure during an infusion of daratumumab. Ultrasound biomicroscopy obtained 3 days after the onset of her symptoms demonstrated the cause to be bilateral choroidal effusions. Taken together with several previous case reports, the evidence suggests that, like topiramate, daratumumab is associated with the idiosyncratic reaction of choroidal effusions, resulting in a spectrum of clinical outcomes from myopic shift to acute angle closure. The treating oncologist and eye care provider should be aware of these adverse outcomes in any patient undergoing treatment with this medication, as swift recognition and intervention may be vision-saving.
Difficult Balance Between Multidrug-Resistant Cytomegalovirus Infection and Graft-Versus-Host Disease in an Allogeneic Hematopoietic Stem Cell Transplant Recipient
Authors: Rhee Yoona , Santos Carlos A.Q. , Lurain Nell , Marinovic Debra A. , Prockop Susan E. , Varma Ankur , Papanicolaou Genovefa , Ustun Celalettin , Nathan Sunita
Published: June 2020

We present a case of multidrug-resistant cytomegalovirus (CMV) infection in an allogeneic hematopoietic stem cell transplant recipient with graft-versus-host disease. We demonstrate evolving viral mutations with documented resistance to first-line CMV DNA polymerase inhibitors and letermovir. Leflunomide and compassionate use investigational third-party CMV-specific cytotoxic T-cell lymphocyte infusions led to reductions in CMV viremia; however, the patient succumbed to respiratory failure. This article highlights the difficult balance between immunosuppression for graft-versus-host disease therapy and refractory CMV treatment, with a review of CMV antiviral therapy.
Practical applications of nutritional scores
Authors: Mendes Rosa , Bento Luís
Published: June 2020

Purpose of review

Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.

The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU.

Recent findings

Critically ill patient staying for more than 24–48 h in the ICU, if unable to eat, should be considered at risk for malnutrition. Several nutritional tools have been proposed but not all are validated to screening those patients. The limitations of existing screening tools are described.

Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.