bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Justice in Rabbinic Judaism
Authors: Novick Tzvi
Published: November 2019

The category of social justice can be understood to encompass both protection of the vulnerable from abuse and support for the poor (charity). The chapter surveys aspects of social justice, conceived in these broad terms, in the classical rabbinic corpus (c. second to sixth centuriesce). After reviewing methodological challenges, important contributions, and scholarly lacunae, the chapter turns to the conceptualization of charity in rabbinic literature, and the light that rabbinic literature sheds on charity practices in Jewish late antiquity. The final section examines rabbinic interpretation of biblical verses mandating protection of the vulnerable from abuse, with particular attention to the liminal status of such provisions between law and ethics.
Priestly Law
Authors: Achenbach Reinhard
Published: November 2019

The chapter presents a short history of research on the Priestly Code, Holiness Code, and priestly law from pre-exilic and post-exilic times in the composition of the Pentateuch. It then describes developments of priestly law in the Covenant Code, Deuteronomy, the priestly description of the Tabernacle in Exodus 25–31, the orders of priests and Levites, the consecration and inauguration of the High Priest, and the development of priestly institutions according to the accounts of Leviticus and Numbers and the priestly Torot on festivals and on purity. Section 12.3 presents a survey on present perspectives in scholarly research on priestly law.
Determining the Date of Biblical Legal Texts
Authors: Barmash Pamela
Published: November 2019

Determining the date of the legal texts of the Bible is fundamental to the study of biblical law because scholars seek to illuminate the interrelationship between law and the historical development of ancient Israel. Employing a pattern of evolving socio-economic institutions as a means of securing a chronological framework is faulty because a specific legal issue may have been addressed during a wide range of Israelite history. Charting the development of a single institution as a means of dating legal texts that lack an explicit chronological reference assumes a linear process without deviations. It is important to note that although we might assume that legal texts mirror reality, they might express an ideal divorced from reality or an ideology articulated in one time period that is adopted in another. By contrast, using linguistic criteria to determine dating is a more rigorous approach. This method can assign a text to a broad chronological era. It can mark out a chronology between texts from different linguistic strata, but it cannot ascertain a relative chronology between texts from the same linguistic stratum. For a relative chronology to be ascertained, a method to determine whether one text is alluding to another must be employed. Identification of an allusion must be based on shared language that is distinctive and rare.
Purity and Sancta Desecration in Ritual Law
Authors: Feder Yitzhaq
Published: November 2019

This essay applies Emile Durkheim’s category of “repressive law” to the laws dealing with purity and sancta desecration in the Hebrew Bible. Specifically, this chapter seeks to develop Durkheim’s insight by viewing these laws as an expression of the “collective conscience.” More broadly, it is shown how the biblical materials, when viewed in the light of contemporary legal theory, can offer a fascinating historical perspective for reflection on the relation between morality and law and their psychological and sociological foundations. As a test case, the final section of the paper brings these ancient texts to bear on the debate in modern legal theory regarding retribution.
Social Justice
Authors: Gane Roy E.
Published: November 2019

This chapter surveys biblical laws relevant to social power and the distribution of resources and addresses challenges of assessing the legislation and finding potential for the application of its principles within the modern world. The goal of social justice in biblical law is not to overturn the existing social order but to preserve pre-existing privileges of individuals within their respective socioeconomic statuses. Thus, laws protect and aid persons who are socially, legally, and/or economically vulnerable (e.g. poor, widows, fatherless, and resident aliens), and remedy problems of those who are already suffering from loss of their status (e.g. debt slaves). Biblical law fosters a society in which people enjoy fair representation and have access to resources with which to independently support themselves. Social justice is based on ethical values that must be taught, encouraged, and accepted as part of the collective world view; it is not enough to legislate and enforce them.
Temporal Processing
Authors: Mani Inderjeet
Published: November 2019

This chapter introduces approaches to the processing of time-related constructs in natural language. It covers information extraction systems that can interpret time expressions and create a chronology of events in a narrative, as well as systems that can generate such expressions and render an ordering of events in a fluent discourse. Annotation schemes for marking up time expressions and temporal orderings are introduced, along with automatic methods for computing such annotations. The representation of annotated temporal relations in the interval calculus is described, as is the problem of inferring a consistent set of temporal relations for a narrative. The accuracy of humans and machine annotation is examined, and a question-answering application is discussed.
A Quantitative Theory of Political Transitions
Authors: Buchheim Lukas , Ulbricht Robert
Published: November 2019

We develop a quantitative theory of repeated political transitions driven by revolts and reforms. In the model, the beliefs of disenfranchised citizens play a key role in determining revolutionary pressure, which in interaction with preemptive reforms determine regime dynamics. We study the quantitative implications of the model by fitting it to data on the universe of political regimes existing between 1946 and 2010. The estimated model generates a process of political transitions that looks remarkably close to the data, replicating the empirical shape of transition hazards, the frequency of revolts relative to reforms, the distribution of newly established regime types after revolts and reforms, and the unconditional distribution over regime types.
Hydroxychloroquine is associated with a lower risk of polyautoimmunity: data from the RELESSER Registry
Authors: Mena-Vázquez Natalia , Fernández-Nebro Antonio , Pego-Reigosa José María , Galindo María , Melissa-Anzola Ana , Uriarte-Isacelay Esther , Olivé-Marqués Alejandro , Aurrecoechea Elena , Freire Mercedes , Tomero Eva , García-Villanueva María Jesús , Stoye Claudia , Salas-Heredia Esteban , Bernal-Vidal Jose Antonio , Salgado Eva , Blanco Ricardo , Javier Novoa Francisco , Ibáñez-Barcelo Mónica , Torrente-Segarra Vicente , Narvaez Javier , Calvet Joan , Moriano Morales Clara , Ramon Vazquez-Rodriguez Tomas , Garcia de la Peña Paloma , Bohórquez Cristina , Andreu-Sánchez José Luis , Cobo-Ibañez Tatiana , Bonilla Gema , Lozano-Rivas Nuria , Montilla Carlos , Toyos Francisco Javier , De la Fuente Jose Luis Marenco , Expósito Lorena , Ruiz-Lucea María Esther , Vals Elia , Manero-Ruiz Javier , Bernal-Vidal Jose A , Rua-Figueroa Iñigo
Published: November 2019

Objectives

This article estimates the frequency of polyautoimmunity and associated factors in a large retrospective cohort of patients with SLE.

Methods

RELESSER (Spanish Society of Rheumatology Lupus Registry) is a nationwide multicentre, hospital-based registry of SLE patients. This is a cross-sectional study. The main variable was polyautoimmunity, which was defined as the co-occurrence of SLE and another autoimmune disease, such as autoimmune thyroiditis, RA, scleroderma, inflammatory myopathy and MCTD. We also recorded the presence of multiple autoimmune syndrome, secondary SS, secondary APS and a family history of autoimmune disease. Multiple logistic regression analysis was performed to investigate possible risk factors for polyautoimmunity.

Results

Of the 3679 patients who fulfilled the criteria for SLE, 502 (13.6%) had polyautoimmunity. The most frequent types were autoimmune thyroiditis (7.9%), other systemic autoimmune diseases (6.2%), secondary SS (14.1%) and secondary APS (13.7%). Multiple autoimmune syndrome accounted for 10.2% of all cases of polyautoimmunity. A family history was recorded in 11.8%. According to the multivariate analysis, the factors associated with polyautoimmunity were female sex [odds ratio (95% CI), 1.72 (1.07, 2.72)], RP [1.63 (1.29, 2.05)], interstitial lung disease [3.35 (1.84, 6.01)], Jaccoud arthropathy [1.92 (1.40, 2.63)], anti-Ro/SSA and/or anti-La/SSB autoantibodies [2.03 (1.55, 2.67)], anti-RNP antibodies [1.48 (1.16, 1.90)], MTX [1.67 (1.26, 2.18)] and antimalarial drugs [0.50 (0.38, 0.67)].

Conclusion

Patients with SLE frequently present polyautoimmunity. We observed clinical and analytical characteristics associated with polyautoimmunity. Our finding that antimalarial drugs protected against polyautoimmunity should be verified in future studies.
EEG connectivity across sleep cycles and age
Authors: Bouchard Maude , Lina Jean-Marc , Gaudreault Pierre-Olivier , Dubé Jonathan , Gosselin Nadia , Carrier Julie
Published: November 2019

Study Objectives

In young adults, sleep is associated with important changes in cerebral connectivity during the first cycle of non-rapid eye movement (NREM) sleep. Our study aimed to evaluate how electroencephalography (EEG) connectivity during sleep differs between young and older individuals, and across the sleep cycles.

Methods

We used imaginary coherence to estimate EEG connectivity during NREM and rapid eye movement (REM) sleep in 30 young (14 women; 20–30 years) and 29 older (18 women; 50–70 years) individuals. We also explored the association between coherence and cognitive measures.

Results

Older individuals showed lower EEG connectivity in stage N2 but higher connectivity in REM and stage N3 compared to the younger cohort. Age-related differences in N3 were driven by the first sleep cycle. EEG connectivity was lower in REM than N3, especially in younger individuals. Exploratory analyses, controlling for the effects of age, indicated that higher EEG connectivity in delta during N2 was associated with higher processing speed, whereas, during REM sleep, lower EEG connectivity in delta and sigma was associated with higher verbal memory performance and a higher global averaged intelligence quotient score.

Conclusion

Our results indicated that age modifies sleep EEG connectivity but the direction and the magnitude of these effects differ between sleep stages and cycles. Results in N3 and REM point to a reduced ability of the older brains to disconnect as compared to the younger ones. Our results also support the notion that cerebral functional connectivity during sleep may be associated with cognitive functions.
Personal Faith and Professional Ethics: Best Practice with the Families of Sexual and Gender Minority Youths
Authors: Okrey Anderson Sloan , McGuire Jenifer K
Published: November 2019

Religious mental health practitioners who hold traditional views of gender and sexuality may face moral and ethical dilemmas when working with sexual and gender minority (SGM) clients. Typical responses to this dilemma include selective positioning, values-based referrals, and attempted objectivity. Grounded in social work ethics and values, this article examines the evidence base, viability, and repercussions of these approaches. This article demonstrates the importance of cultural competence and affirmative therapeutic practices for religious mental health practitioners, whether or not they expect to work with gender and sexual minority clients or their families. In addition, the author tackles the difficult issue of providing ethical, evidence-based therapeutic services for religiously conservative parents of SGM children and adolescents. SGM people exist in every community, in every faith, and in every kind of family. The ethical treatment of SGM clients is relevant to all mental health practitioners, regardless of personal values or the type of practice they maintain.
Inhibition of cyclin‐dependent kinase 5 activity alleviates diabetes‐related cognitive deficits
Authors: Liu Wei , Zhou Yi , Liang Rui , Zhang Yue
Published: November 2019

Cognitive deficit is a prevalent and underestimated complication of diabetes, and the underlying cellular and molecular mechanisms are not well understood. Aberrant activity of cyclin‐dependent kinase (Cdk)5 is implicated in a number of neurodegenerative diseases. The present study examined the role of Cdk5 in the progression of diabetes‐related cognitive deficits. We showed that the Cdk5 protein expression and kinase activity were significantly increased in diabetic mice at 16 wk. In primary cultured hippocampal neurons exposed to 30 mM glucose, Cdk5 protein and kinase activity were also elevated in a time‐dependent manner. Moreover, the high glucose exposure led to an aberrant Cdk5 activation due to its activator p25 that was cleaved from p35 by calpain. Both in diabetic mice and in cultured hippocampal neurons exposed to high glucose, inhibition of Cdk5 activity with roscovitine (Ros) or short hairpin RNA (shRNA) decreased the protein levels of cleaved caspase‐3 and the ratio of Bax and Bcl‐2. The apoptotic rate detected by TUNEL in vivo or Annexin V and propidium iodide staining for flow cytometry in vitro also had obvious reduction. In addition, high glucose exposure resulted in the increase of phosphorylated (phospho)‐MAPK kinase (MKK)6, phospho‐p38, and c‐Jun, which were rescued by Ros or Cdk5 shRNA. It is more important that the cognitive deficits of diabetic mice were also effectively alleviated by Ros. These results indicate that aberrant Cdk5 activity triggered hippocampal neuron apoptosis by activating MKK6/p38 MAPK cascade in hyperglycemia. Inhibition of Cdk5 overactivation attenuates neuronal apoptosis and cognitive deficits and contributes to the relief of diabetic neurotoxicity in the brain.—Liu, W., Zhou, Y., Liang, R., Zhang, Y. Inhibition of cyclin‐dependent kinase 5 activity alleviates diabetes‐related cognitive deficits. FASEB J. 33, 14506‐14515 (2019). www.fasebj.org
Neural precursor cell‐expressed, developmentally down‐regulated 4 (NEDD4) regulates hydrogen peroxide‐induced cell proliferation and death through inhibition of Hippo signaling
Authors: Jeon Seon‐Ae , Kim Dong Wook , Cho Je‐Yoel
Published: November 2019

E3 ubiquitin ligases are involved in the regulation of oxidative stress‐induced cell death. In this study, we investigated the role of neural precursor cell‐expressed, developmentally down‐regulated protein 4 (NEDD4) in regulation of hydrogen peroxide (H2O2)‐induced cell proliferation and apoptosis in human bone marrow‐derived stem cells (hBMSCs). Cell proliferation was increased in low doses of H2O2 (10‐4 to 10‐2 μM), whereas sublethal concentrations of H2O2 (>200 μM) induced apoptosis. A chromatin immunoprecipitation assay identified that recruitment of NF‐κB onto the promoter region of NEDD4 mediated H2O2‐induced NEDD4 expression. The increase of NEDD4 expression by H2O2 induced translocation of yes‐associated protein (YAP) into the nucleus by decreasing the stability of large tumor suppressor kinase (LATS). Thus, the phosphorylation of serine 127 residue of YAP by LATS upstream kinase is decreased and thereby increased the transcriptional activity of YAP. The mRNA expression levels of catalase and manganese superoxide dismutase, which are well‐known targets of YAP, were increased by H2O2 treatment but down‐regulated by NEDD4 silencing using a specific small interfering RNA targeting NEDD4 (siNEDD4). H2O2‐induced scavenging capacity of reactive oxygen species was also decreased by siNEDD4 in hBMSCs. Finally, hBMSC differentiation into osteoblast was decreased by siNEDD4 but reverted by reintroduction of the S127A mutant construction of YAP. Taken together, these results indicate that NEDD4 regulates H2O2‐induced alteration of cell status through regulation of the Hippo signaling pathway.—Jeon, S.‐A., Kim, D.W., Cho, J.‐Y. Neural precursor cell‐expressed, developmentally down‐regulated 4 (NEDD4) regulates hydrogen peroxide‐induced cell proliferation and death through inhibition of Hippo signaling. FASEB J. 33, 14772‐14783 (2019). www.fasebj.org
Facial Pain and Temporomandibular Joint Dysfunction Secondary to Acromegaly: Treatment With Manual Therapy, Neuromuscular Reeducation—A Case Report
Authors: Wechsler Stephen
Published: November 2019

Background and Purpose:

Acromegaly is a disorder typically caused by a benign pituitary adenoma resulting in hypersecretion of growth hormone. Common sequelae, including musculoskeletal changes and arthropathies, can result in facial pain and temporomandibular disorder (TMD) that persist beyond primary treatment. Because of the unique etiology of facial pain and TMD in cases of acromegaly, the generalizability of established physical therapy (PT) literature for treatment of TMD cannot be assumed. The purpose of this case report was to illustrate an example of multimodal PT as a treatment strategy for facial pain and TMD secondary to acromegaly following treatment of benign pituitary macroadenoma.

Case Description:

A 48-year-old male patient with a history significant for benign pituitary macroadenoma presented with facial pain and TMD secondary to acromegaly. Patient-reported outcomes of pain, function, and quality of life were assessed using the Gothenburg Trismus Questionnaire (GTQ) at baseline, eighth PT visit, and 8 weeks following course of PT. Quantity and quality of jaw mobility were assessed at baseline and postintervention using standard goniometric measurements and observation. A total of 9 PT sessions were delivered over 3 months consisting of manual therapy, relaxation techniques, neuromuscular reeducation, and therapeutic exercise.

Outcomes:

After 8 PT visits, the patient's GTQ score decreased from 81% to 67.6%, with a corresponding decrease in pain and improved symmetry of jaw mobility. Eight weeks following the last PT visit, the patient's GTQ score further decreased from 67.6% to 61.3%.

Discussion:

Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment of benign pituitary macroadenoma.
Subsequent Pregnancy Outcomes After Failed Vacuum-Assisted Delivery
Authors: Levin Gabriel , Elami-Suzin Matan , Elchalal Uriel , Ezra Yossef , Mankuta David , Lewkowicz Aya , Yagel Simcha , Rottenstreich Amihai
Published: November 2019

OBJECTIVE:

To examine trial of labor after cesarean delivery (TOLAC) success rates and its associated factors among women with a previous failed vacuum-assisted vaginal delivery.

METHODS:

We conducted a retrospective cohort study. The study group comprised all women with a prior failed vacuum-assisted vaginal delivery who subsequently delivered from 2008 to 2017 at a university hospital.

RESULTS:

Overall, 166 women with prior history of failed vacuum-assisted vaginal delivery delivered during the study period, with a median interdelivery interval of 28 (21–36) months. Of them, 53 (32%) had an elective repeat cesarean delivery, and 113 (68%) had a TOLAC. Although there were small statistical differences in the predelivery characteristics of the two groups, there were not clinically significant differences. Of the 113 women who underwent TOLAC in the subsequent pregnancy, the overall success rate was 67%. Neonatal 1- and 5-minute Apgar scores were lower among neonates born to women who experienced a failed TOLAC attempt compared with those who underwent successful TOLAC: 1-minute Apgar score less than 7 (6 [16%] vs 2 [3%], odds ratio [OR] 7.16, 95% CI 1.36–37.45, P=.01), 5-minute Apgar score less than 8 (3 [8%] vs 0 [0%], OR 15.5, 95% CI 1.78–308.7, P=.03). No events of obstetric anal sphincter injury, postpartum hemorrhage and uterine rupture were encountered among women who underwent TOLAC.

CONCLUSION:

Trial of labor after cesarean delivery in women with a previous failed vacuum-assisted vaginal delivery appears to be associated with an acceptable success rate. These data should improve patient counseling and provide reassurance for those who wish to deliver vaginally after a previous failed vacuum-assisted vaginal delivery.
Ibuprofen and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy
Authors: Penfield Christina A. , McNulty Jennifer A. , Oakes Megan C. , Nageotte Michael P.
Published: November 2019

OBJECTIVE:

To evaluate the effect of ibuprofen on blood pressure in women with a diagnosis of hypertensive disorders of pregnancy and mild hypertension during the immediate postpartum period.

METHODS:

In this double-blind controlled trial, we randomly assigned women with a diagnosis of hypertensive disorders of pregnancy and mild hypertension to receive a postpartum analgesic regimen with either ibuprofen or acetaminophen. The primary outcome was average mean arterial pressure during the postpartum hospital stay. Prespecified secondary outcomes included use of breakthrough opioid pain medications, length of hospital stay, and postpartum diuresis, defined as urine output of at least 200 mL/hour for 4 hours. A sample size of 56 participants was needed to detect a difference of 6 mm Hg in average mean arterial pressure between the study groups.

RESULTS:

From January 17, 2017, to February 24, 2018, 61 participants were randomized and completed the trial, 31 participants in the ibuprofen group and 30 in the control group. Baseline characteristics were similar between groups. Postpartum average arterial pressure did not differ between study groups (93±8 mm Hg for those in the ibuprofen group vs 93±7 mm Hg in the control group, P=.93). Breakthrough opioid medications were requested by 24% of the participants in the ibuprofen group compared with 30% in the control group (P=.62). The ibuprofen group did not have a longer length of stay (48 hours vs 43 hours in the control group) or decreased rate of postpartum diuresis (61% in ibuprofen group vs 77% in the control group, P=.2).

CONCLUSION:

In women with hypertensive disorders of pregnancy and mild hypertension, ibuprofen did not increase postpartum blood pressure compared with women not receiving nonsteroidal antiinflammatory drugs.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov NCT03011567.
Novel Use of Three-Dimensional Ultrasonography to Locate a Retained Needle in the Vaginal Wall
Authors: Wong Halei , Dwarica Denicia , Quiroz Lieschen
Published: November 2019

BACKGROUND:

The occurrence of retained surgical instruments in vaginal surgery, although low, carries unique complications. Appropriate imaging to find retained surgical instruments allows for timely diagnosis and retrieval of the vaginal foreign body.

CASE:

The patient is a 33-year-old woman with recurrent cervical cancer who was undergoing radiation therapy. During interstitial implantation, a reverse cutting needle was broken into the anterior vaginal wall. Three-dimensional endoluminal ultrasonography allowed for timely retrieval with minimal surgical exploration in the operating room.

CONCLUSION:

Intraoperative three-dimensional endoluminal ultrasonography allows for accurate visualization and mapping of a vaginal foreign body. This highlights an innovative and highly useful feature of this imaging technique.
Maternal and Infant Health Care Costs Related to Preeclampsia
Authors: Hao Jing , Hassen Dina , Hao Qiang , Graham Jove , Paglia Michael J. , Brown Jason , Cooper Matthew , Schlieder Victoria , Snyder Susan R.
Published: November 2019

OBJECTIVE:

To provide U.S. case-based preeclampsia health care cost estimates for mothers and infants from a U.S. payer perspective, with comparisons with both uncomplicated and hypertensive pregnancies.

METHODS:

Electronic health record and billing data from a large regional integrated health care system in Pennsylvania were used to identify mother–singleton infant pairs with deliveries between 2010 and 2015. Data on clinical care and costs using actual payment amounts were compiled from 20 weeks of gestation to 6 weeks postdelivery for mothers and birth to 12 months for infants. Three defined pregnancy study cohorts, uncomplicated, hypertension and preeclampsia, were matched using a 1:1:1 ratio on the basis of maternal age, parity, body mass index, and comorbidities. Costs per pregnancy were calculated in 2015 dollars and preeclampsia incremental costs estimated by subtracting the average cost of the matched cohorts.

RESULTS:

The final study population included 712 matched mother–infant pairs in each cohort. The mean combined maternal and infant medical care costs in the preeclampsia cohort of $41,790 were significantly higher than those for the uncomplicated cohort of $13,187 (P<.001) and hypertension cohort of $24,182 (P<.001), and were largely driven by differences in the infant costs. The mean infant cost in the preeclampsia cohort were $28,898, in the uncomplicated cohort $3,669 and $12,648 in the hypertension cohort (P<.001). Mothers with preeclampsia delivered 3 weeks earlier (median 36.5 weeks of gestation) than women in the uncomplicated cohort and more than 2 weeks earlier than women in the hypertension cohort. A significantly larger percentage of women with preeclampsia and their infants experienced adverse events (13.9% for mothers and 14.6% for infants) compared with unaffected women (4.1% and 0.7%) and those with hypertension (9.4% and 4.8%), respectively (P<.001).

CONCLUSION:

The economic burden of preeclampsia health care is significant with the main cost drivers being infant health care costs associated with lower gestational age at birth and greater adverse outcomes.

FUNDING SOURCE:

This study is funded by Progenity, Inc.
Combination Antiretroviral Therapy and Hypertensive Disorders of Pregnancy
Authors: Saums Michele K. , King Caroline C. , Adams Jenna C. , Sheth Anandi N. , Badell Martina L. , Young Marisa , Yee Lynn M. , Chadwick Ellen G. , Jamieson Denise J. , Haddad Lisa B.
Published: November 2019

OBJECTIVE:

To compare the incidence of hypertensive disorders of pregnancy among women living with human immunodeficiency virus (HIV) on combination antiretroviral therapy (ART) to women without HIV, and to evaluate the association of hypertensive disorders of pregnancy with ART regimens or timing of ART initiation.

METHODS:

We conducted a retrospective cohort study among two overlapping pregnancy cohorts using preexisting databases at a single tertiary care hospital: all pregnant women who delivered during years 2016–2018 (cohort 1) and all women living with HIV who delivered during years 2011–2018 (cohort 2). The primary outcome for both cohorts was any hypertensive disorder of pregnancy; gestational hypertension and preeclampsia were also examined separately. The primary exposure variables were HIV status for cohort 1 and ART regimen (integrase strand transfer inhibitor–containing, protease inhibitor–containing, or non-nucleoside reverse transcriptase inhibitor–containing) for cohort 2. For estimation of risk ratios (RRs), we used a modified Poisson regression with robust error variances. Multivariate models among the women living with HIV in cohort 2 were tested for a statistical interaction between ART regimen and timing of initiation.

RESULTS:

In cohort 1, among 80 women living with HIV compared with 3,464 women without HIV, there was no difference in the risk of hypertensive disorders of pregnancy (29% in women living with HIV vs 30% in women without HIV, adjusted RR 0.9, 95% CI 0.6–1.3). In cohort 2, among 265 women living with HIV, integrase strand transfer inhibitor–containing regimens were associated with an increased risk for any hypertensive disorder of pregnancy (25% among integrase strand transfer inhibitor vs 10% among protease inhibitor, adjusted RR 2.8, 95% CI 1.5–5.1) and gestational hypertension (20% among integrase strand transfer inhibitor vs 8% among protease inhibitor, adjusted RR 2.8, 95% CI 1.3–5.9) compared with protease inhibitor–containing regimens. Timing of ART initiation was not associated with hypertensive disorders of pregnancy, nor did it significantly alter the associations between ART regimen and hypertensive disorders of pregnancy outcomes.

CONCLUSION:

Overall the risk of hypertensive disorders of pregnancy was similar among women living with HIV on ART and women without HIV. With greater integrase strand transfer inhibitor use, the greater frequency of hypertensive disorders of pregnancy with these regimens compared with protease inhibitor–containing regimens warrants future evaluation using cohorts with greater sample size.
A Useful Model for Predicting Intraoperative Blood Loss in Metastatic Spine Tumor Surgery
Authors: Gao Xin , Fan Tianqi , He Shaohui , Wan Wei , Zhao Chenglong , Wang Dongsheng , Tang Liang , Lou Yan , Li Zhenxi , Liu Tielong , Xiao Jianru
Published: November 2019

Study Design:

A retrospective study was performed.

Objective:

As predictors of intraoperative blood loss have not yet been well defined, the objective of the present study is to develop a model to predict the amount of intraoperative blood loss in metastatic spine tumor surgery.

Summary of Background Data:

Massive blood loss is a huge challenge in metastatic spine tumor surgery. Misjudgment of intraoperative blood loss in preoperative planning may result in disastrous consequences.

Materials and Methods:

Enrolled in this retrospective analysis were 392 patients who received 423 surgeries of vertebrectomy and reconstruction in our hospital between 2011 and 2017. Risk factors for high-volume blood loss were identified by univariate and multivariate linear regression. The optimal regression model was selected to predict the amount of intraoperative blood loss. Correlation analysis between predicted and actual blood loss in the test cohort was performed to verify the performance of the new model.

Results:

The overall mean blood loss was 1756±1218 mL, with spinal metastases from thyroid cancer most prominent, followed by renal cancer. The model was developed based on 5 independent risk factors influencing intraoperative blood loss: primary tumor, tumor site, level of instrumentation, level of vertebrectomy, and resection method. In the test cohort, the correlation coefficient (r) between predicted and actual blood loss was 0.606.

Conclusions:

This study presented a relatively reliable method to predict the amount of intraoperative blood loss in metastatic spine tumor surgery, which may help surgeons address blood loss–related issues in preoperative planning.
The Impact of Preventative Multimodal Analgesia on Postoperative Opioid Requirement and Pain Control in Patients Undergoing Lumbar Fusions
Authors: Rajpal Sharad , Hobbs Steven L. , Nelson E. Lee , Villavicencio Alan , Zielenski Christopher , Beasley Kara , Kantha Vinod , Mesenbrink Jaime , Burneikiene Sigita
Published: November 2019

Study Design:

A prospective observational study with a historical reference group.

Objectives:

The main objectives of this study were to determine the impact of preventative multimodal analgesia (PMA) on postoperative opioid requirements and analgesic effectiveness in patients undergoing lumbar fusion surgery.

Summary of Background Data:

PMA addresses the multiple pathways of acute and chronic pain by interfering with peripheral and central sensitization and should provide a way to achieve safer and more effective pain management with reduced opioid medication use.

Materials and Methods:

This study compared postoperative opioid requirement and analgesic effect in a total of 101 patients undergoing elective, 1-level or 2-level transforaminal lumbar interbody fusion surgeries for symptomatic lumbar degenerative disk disease. The PMA patient group included 51 consecutive patients who received 1000 mg of acetaminophen, 300–900 mg of gabapentin, and 200–400 mg of celecoxib 1 hour before their index procedure. The reference group included 50 patients who received 15 mg of morphine-equivalent dose (MED) preoperatively.

Multiple linear regression was used to evaluate the effect of PMA on postoperative pain and MED over 4 postoperative days, while controlling for all variables likely to influence these outcomes, including age, sex, baseline opioid use, duration of surgery, postoperative intrathecal morphine use and the administration of muscle relaxants and anticonvulsants.

Results:

The differences in opioid requirement and postoperative pain scores were statistically significant on all 4 postoperative days. The effect size varied from −0.54 to −0.99 (34.8%–54.2% MED reduction) for the postoperative opioid requirement and from −0.59 to −1.16 (28.9%–37.3% visual analog scale reduction) for postoperative pain indicating that these measures were reduced by about ½ to 1 SD in the PMA patient group.

Conclusions:

PMA is a highly effective and safe method for postoperative pain management in patients undergoing elective lumbar fusion surgeries by improving pain control and reducing opioid requirement.

Level of Evidence:

Level III.
Dorsal Intercarpal Ligament Preserving Arthrotomy and Capsulodesis for Scapholunate Dissociation
Authors: Omokawa Shohei , Ono Hiroshi , Suzuki Daisuke , Shimizu Takamasa , Kawamura Kenji , Tanaka Yasuhito
Published: November 2019

Carpal instability secondary to scapholunate (SL) ligament tears can lead to a significant disability of the wrist. Different surgical procedures have been proposed to treat SL instability. A variety of dorsal capsulodesis techniques tethering the scaphoid have been used in patients with SL dissociation. We report a novel technique of modified dorsal intercarpal ligament (DICL) capsulodesis for the treatment of SL dissociation. The surgical indication for this procedure is complete SL ligament tear with a reducible carpal malalignment and no secondary osteoarthritis. This procedure is indicated when the remnant of torn ligament in the dorsal SL interosseous space is available for repair. First, carpal malalignment is corrected and the scaphoid and the lunate are temporarily fixed with a transosseous screw or Kirschner wires. Using a dorsal approach, the DICL is then exposed, which originates from the triquetrum and attaches to the scaphoid, trapezium, and trapezoid. The distal and proximal borders of the ligament are identified and elevated without detaching the attachment sites. The DICL is transferred proximally to reinforce the dorsal SL interosseous ligament. The wrist joint is immobilized for 3 weeks postoperatively, and dart-throwing motion is permitted until temporary SL fixation is removed at 2 to 3 months after surgery. A wrist brace is recommended until 3 to 6 months after the first surgery depending on the patient’s occupation and sports activity.
Comparing Late-line Treatment Sequence of Regorafenib and Reduced-intensity FOLFOXIRI for Refractory Metastatic Colorectal Cancer
Authors: Tai Cheng-Chun , Chen Wei-Shone , Jiang Jeng-Kai , Yang Shung-Haur , Wang Huann-Sheng , Chang Shih-Ching , Lan Yuan-Tzu , Lin Chun-Chi , Lin Hung-Hsin , Huang Sheng-Chieh , Cheng Hou-Hsuan , Chao Yee , Teng Hao-Wei
Published: November 2019

Background:

Both regorafenib and reduced-intensity FOLFOXIRI (riFOLFOXIRI) prolong survival in patients with metastatic colorectal cancer (mCRC). However, the sequence in which they should be administrated first in late-line treatment for refractory mCRC remains unclear.

Patients and Methods:

This study was a single-center retrospective cohort study that reviewed data from patients at Taipei Veterans General Hospital, Taiwan, with mCRC refractory to fluorouracil, irinotecan, oxaliplatin, cetuximab (wild-type RAS), and bevacizumab. Patients were divided into 2 groups: a regorafenib-first group and a riFOLFOXIRI-first group. The Kaplan-Meier method and log-rank test were used to analyze survival, and a Cox proportional hazards model was used for univariate, multivariate, and subgroup analyses.

Results:

A total of 136 and 55 patients followed a regorafenib-first or riFOLFOXIRI-first treatment strategy, respectively. At baseline, patient characteristics were similar between the groups, except for younger age in the riFOLFOXIRI-first group. The regorafenib-first group had better overall survival (13.8 vs. 10.7 mo, P=0.038), whereas patients in the riFOLFOXIRI-first group had a better partial response rate (P=0.005) but a higher rate of discontinuation due to adverse effects (P=0.004) and cross-over to regorafenib (P<0.001). Thus, no significant difference was observed in progression-free survival (regorafenib-first strategy: 3.17 mo; riFOLFOXIRI-first strategy: 4.97 mo; P=0.624). Regorafenib-first strategy, sex, and pathology were identified as independent prognostic factors. Subgroup analysis indicated that younger age, better performance status, stage IV disease, and mutant RAS gene favored the regorafenib-first strategy.

Conclusion:

Treatment with regorafenib-first followed by riFOLFOXIRI resulted in better overall survival when given as late-line treatment for patients with refractory mCRC.
Multifocal Epithelioid Hemangioma of the Penis in a 4-Year-Old Child: A Case Report
Authors: Murshed Khaled , Farghaly Hanan
Published: November 2019

Epithelioid hemangioma (EH) is a rare benign vascular tumor which has wide morphological spectrum. In its typical forms, it is characterized histologically by lobular proliferation of vascular spaces lined by plump endothelial cells with variable inflammatory cell infiltrate in the background. They usually occur in middle-aged women and have predilection for the head and neck site, especially postauricular region. In this study, we report a case of a 4-year-old boy who presented with 2 red-raised skin lesions on the penis. Histopathologic examination revealed a dermal lesion composed of vascular spaces lined by epithelioid endothelial cells. The cells are bland with hobnail protrusions into the lumen. There is no cytological atypia or mitotic activity. The stroma is fibrotic with scant inflammatory cells. By immunoperoxidase stains, the tumor cells are positive with the vascular markers CD31 and CD34 but negative with the epithelial marker cytokeratin AE1/AE3. The diagnosis of multifocal EH was rendered. To the best of our knowledge, this is the first reported case in the English literature of multifocal EH developing in a child's penis.
Evaluating the Sensitivity of PM2.5–Mortality Associations to the Spatial and Temporal Scale of Exposure Assessment
Authors: Crouse Dan L. , Erickson Anders C. , Christidis Tanya , Pinault Lauren , van Donkelaar Aaron , Li Chi , Meng Jun , Martin Randall V. , Tjepkema Michael , Hystad Perry , Burnett Rick , Pappin Amanda , Brauer Michael , Weichenthal Scott
Published: November 2019

Background:

The temporal and spatial scales of exposure assessment may influence observed associations between fine particulate air pollution (PM2.5) and mortality, but few studies have systematically examined this question.

Methods:

We followed 2.4 million adults in the 2001 Canadian Census Health and Environment Cohort for nonaccidental and cause-specific mortality between 2001 and 2011. We assigned PM2.5 exposures to residential locations using satellite-based estimates and compared three different temporal moving averages (1, 3, and 8 years) and three spatial scales (1, 5, and 10 km) of exposure assignment. In addition, we examined different spatial scales based on age, employment status, and urban/rural location, and adjustment for O3, NO2, or their combined oxidant capacity (Ox).

Results:

In general, longer moving averages resulted in stronger associations between PM2.5 and mortality. For nonaccidental mortality, we observed a hazard ratio of 1.11 (95% CI = 1.08, 1.13) for the 1-year moving average compared with 1.23 (95% CI = 1.20, 1.27) for the 8-year moving average. Respiratory and lung cancer mortality were most sensitive to the spatial scale of exposure assessment with stronger associations observed at smaller spatial scales. Adjustment for oxidant gases attenuated associations between PM2.5 and cardiovascular mortality and strengthened associations with lung cancer. Despite these variations, PM2.5 was associated with increased mortality in nearly all of the models examined.

Conclusions:

These findings support a relationship between outdoor PM2.5 and mortality at low concentrations and highlight the importance of longer-exposure windows, more spatially resolved exposure metrics, and adjustment for oxidant gases in characterizing this relationship.
The Ethics of Facial Allotransplantation: A Systematic Review
Authors: Liu Xiangxia , Langsdon Sarah , Holloway Wesley , Xu Shuqia , Tang Qing , Xu Yangbin , Velamuri Sai Ram , Hickerson William
Published: November 2019

Background:

Currently, there are more than 40 cases of facial allotransplantation performed by 13 different groups in 10 countries. Although it has become a potential option to reconstruct and restore the function and appearance of severely facially disfigured individuals, the ethical concerns of facial allotransplantation remain unsolved. We conducted a systematic review to better understand the ethical concerns on facial allotransplantation and the changing trends of the ethical debate over time.

Methods:

A systematic review of 3 databases was performed to identify articles related to ethical topics on facial allotransplantation. The inclusion criteria were peer-reviewed articles written since 1995 on the topics of ethics and facial allotransplantation in English, French, and Chinese languages. The ethical concerns extracted from the included articles were categorized into 4 core principles of ethics: autonomy, beneficence, nonmaleficence, and justice. The different themes under these 4 principles were extracted and subgrouped. The positions of the included articles were collected. Joinpoint regression was applied to compare the frequency of themes and positions by publication year. We presented the main topics on ethical concerns and the changing trends in ethical themes and principles of facial allotransplantation.

Results:

There were 889 articles identified initially. After excluding 265 duplicated articles, 624 articles were included for title/abstract review process, and 148 articles were included in final data analysis. The publication year was from 2002 to 2018 with 136 articles in English, 11 in French, and 1 in Chinese. The most addressed principle was nonmaleficence (117/148, 79.1%), followed by beneficence (116/148, 78.4%), justice (103/148, 69.6%), and autonomy (86/148, 58.1%). The themes on immunosuppression/rejection, quality of life, and identity were the top 3 addressed ethical concerns. Twelve of 13 most addressed ethical themes demonstrated a decreasing trend after 2004. The themes of identity under beneficence showed a significant decrease after 2004. Ethical concerns on the cost/financial topic were the only one showing consistently increase trends from 2002 to 2018. There was a significant increase of the papers in favor of facial allotransplantation procedure comparing to those were against or neutral before and after 2008.

Conclusions:

More and more articles support facial allotransplantation as a feasible option to reconstruct and restore the function and appearance of severely facially disfigured individuals. The requirement of life-long immunosuppression therapy, quality of life, and identity center the ethical debates. Supported by favorable short-term results, 12 of 13 most addressed ethical concerns have trended down. The theme of cost/financial topic becomes more frequently addressed in recent years.
Low-Volume High-Intensity Aerobic Interval Training Is an Efficient Method to Improve Cardiorespiratory Fitness After Myocardial Infarction
Authors: Jayo-Montoya Jon Ander , Maldonado-Martín Sara , Aispuru G. Rodrigo , Gorostegi-Anduaga Ilargi , Gallardo-Lobo Rodrigo , Matajira-Chia Tatiana , Villar-Zabala Beatriz , Blanco-Guzmán Sonia
Published: November 2019

Purpose:

To analyze the changes in cardiorespiratory fitness (CRF) and body composition following 2 different (low-volume vs high-volume) high-intensity aerobic interval training (HIIT) programs with Mediterranean diet (Mediet) recommendations in individuals after myocardial infarction (MI) and compared with an attention control group (AC).

Methods:

Body composition and CRF were assessed before and after a 16-wk intervention in 70 participants (58.4 ± 8.5 yr) diagnosed with MI. All participants received Mediet recommendations and were randomly assigned to the AC group (physical activity recommendations, n = 14) or one of the 2 supervised aerobic exercise groups (2 d/wk training): high-volume (40 min) HIIT (n = 28) and low-volume (20 min) HIIT (n = 28).

Results:

Following the intervention, no significant changes were seen in the AC group and no differences between HIIT groups were found in any of the studied variables. Only HIIT groups showed reductions in waist circumference (low-volume HIIT, Δ = −4%, P < .05; high-volume HIIT, Δ = −2%, P < .001) and improvements in CRF (low-volume HIIT, Δ = 15%, P < .01; high-volume HIIT, Δ = 22%; P < .001) with significant between-group differences (attention control vs HIIT groups).

Conclusions:

Results suggest that a 16-wk intervention (2 d/wk) of different HIIT volumes with Mediet recommendations could equally improve CRF and waist circumference after MI. Low-volume HIIT may be a potent and time-efficient exercise training strategy to improve functional capacity.
Visual Outcomes of Patients With Retrobulbar Hemorrhage Undergoing Lateral Canthotomy and Cantholysis
Authors: Bailey Lucy A. , van Brummen Alexandra J. , Ghergherehchi Layla M. , Chuang Alice Z. , Richani Karina , Phillips Margaret E.
Published: November 2019

Patients with orbital compartment syndrome may see visual recovery after lateral canthotomy and cantholysis, even if performed outside of the previously accepted 3-hour window.

Purpose:

Evaluate visual outcomes in relation to time from injury to intervention in patients who undergo lateral canthotomy with cantholysis (LCC) for retrobulbar hemorrhage (RBH).

Methods:

Retrospective study of patients with orbital compartment syndrome (OCS) secondary to RBH who underwent LCC. OCS due to RBH was defined by a combination of decreased vision, proptosis, resistance to retropulsion, increased intraocular pressure, and relative afferent pupillary defect. Time from injury to intervention and change in visual acuity were calculated, with regression analysis identifying predictors of vision recovery.

Results:

Fifteen participants were included. Three (20%) participants presented with no light perception, 7 (47%) with count fingers (CF) to light perception, and 5 (33%) with better than count fingers vision. All 5 participants who had LCC within 3 hours (twice the standard 90 minutes) gained some vision, and 6 of 10 participants who had LCC after 3 hours recovered some vision. The latest intervention with visual acuity improvement was performed 9 hours postinjury. Of 3 participants who presented with no light perception vision, 1 regained vision to 20/40 (intervention 1.7 hours postinjury), and 2 did not regain any vision (interventions at 5 and 8.7 hours postinjury). Duration from injury to intervention was associated with decreased amount of vision recovery (P = 0.03).

Conclusions:

Increased time to intervention with LCC was associated with less vision recovery after OCS from RBH. However, over half of participants with intervention more than 90 minutes after injury still showed visual acuity improvement. The authors recommend LCC in all patients who present with OCS regardless of the time since injury.