bluuebunny/crossref_metadata_2025 huggingface dataset:
I Have an Owie!!!
Authors: Feinberg Evan , McGuire Melissa A.
Published: June 2020

Acute pain in the pediatric patient population is a frequently encountered clinical issue and presenting symptom. Prompt attention to, assessment of, and management of a pediatric patient’s pain are critical in order to enable providers to carry out the necessary diagnostic evaluation and enact the appropriate therapeutic interventions in a timely fashion. This also allows for rapport building between the provider and patients and engenders more trust, compassion, and benevolent care. The pediatric population is unique, both physiologically and developmentally, and therefore, approaches to management of acute pain in these patients must be unique as well. This chapter addresses and discusses assessment of acute pain, including pain scores, and modalities for control of acute pain in pediatric patients.
Franco Basaglia
Authors: Foot John
Published: June 2020

This chapter looks at the life and times of the psychiatrist Franco Basaglia (1924–1980) from a series of points of view. It analyses the importance of his experiences as Director of Psychiatric Hospitals in Gorizia (1961–1968) and Trieste (1971–1978), and the legacy of the law (1978) which carries his name. The chapter also looks at the connections between Basaglia’s life and his work as a radical and critical psychiatrist, and at the way in which certain sources—above all, those linked to Basaglia’s personal descriptions of his life—have been used to tell this story, creating a circularity of sources and a tendency towards a ‘Basagliacentric’ account of the movement itself. The chapter ends with a reflection of the global impact of the Basaglia law and movement, and the different messages emerging from the 1960s and 1970s for the world of psychiatrists and patients.
A spectre for some, a Mecca for others
Authors: Blok Gemma
Published: June 2020

In the Netherlands, Basaglia’s ideas met with great interest. His work was translated, discussed by leading psychiatrists, and, in the early 1980s, Italy became a Mecca for those who wanted to reform psychiatry. Journalists, psychiatrists, policy makers, and members of the client movement travelled to Italy to see how Basaglia’s ideology was working out. Italian democratic psychiatry inspired a radicalization of the Dutch anti-psychiatric movement. Some reformers founded Shelters for psychiatric runaways; others introduced new methods for rehabilitating chronic patients. In 1987, it was even decided, partly inspired by Italian examples, that the largest and oldest Dutch psychiatric hospital in Santpoort, near Amsterdam, would be closed. In general, however, the reduction in inpatient capacity was slow to happen in the Netherlands. The Italian experiments served as an inspiration for some, but also as a warning sign for others to avoid the ‘Italian mistake’ of changing things too radically, and too fast.
Basaglia in France
Authors: Henckes Nicolas , Lovell Anne M.
Published: June 2020

This chapter assesses Franco Basaglia’s enduring influence in France by focusing on the circulation of concepts and practices and their effects on French mental health policies and scattered experimentation. Despite similar origins, Basaglia’s early work contrasts with the Second World War movement of French psychiatric reformers to humanize the asylum, including through ‘psychothérapie institutionnelle’ and the subsequent development of a sectorization policy. The chapter then examines the extent to which Basaglia’s ideas took ground in France through the efforts of a small network of psychiatric practitioners and intellectuals, within roughly three periods: 1960–1980, 1980–2000, and 2000 to the present. In conclusion, the chapter asks what might explain the French paradox: the early receptivity to Basaglia’s politically-oriented, community-based, anti-institutional practice, on the one hand; and a tenacious hospital-centric psychiatric system and increased use of constraints and high-security confinement, on the other.
Structure of the self-gravitating accretion discs in the presence of outflow
Authors: Ghanbarnejad Hanifeh , Ghasemnezhad Maryam
Published: June 2020

Numerical simulations of self-gravitating accretion discs have shown that the evolution of such systems depends strongly on the rate at which it cools. In this work, we study the vertical structure of the self-gravitating accretion discs and also investigate the effect of the cooling rate on the latitudinal structure of such accretion discs. In the spherical coordinates, we write the hydrodynamics equations and simplify the basic equations based on the assumptions of axisymmetric and steady state. We use the self-similar method for solving the equations in the radial direction and we find proper boundary conditions. We find inflow–outflow solutions by considering the meridional component of the velocity field. In order to formulate the cooling term in energy equation, we introduce the new parameter β as a free constant that is the cooling time-scale in units of the dynamical time-scale. Our numerical solutions show that the thickness of the disc decreases with smaller β (or increasing the cooling term in energy equation) and it makes the disc colder and outflows form in the regions with lower latitude. So by increasing the cooling rate in the disc, the regions which belong to inflow decrease.
The initial evolution of millisecond magnetars: an analytical solution
Authors: Çıkıntoğlu S , Şaşmaz Muş S , Ekşi K Yavuz
Published: June 2020

Millisecond magnetars are often invoked as the central engine of some gamma-ray bursts (GRBs), specifically the ones showing a plateau phase. We argue that an apparent plateau phase may not be realized if the magnetic field of the nascent magnetar is in a transient rapid decay stage. Some GRBs that lack a clear plateau phase may also be hosting millisecond magnetars. We present an approximate analytical solution of the coupled set of equations describing the evolution of the angular velocity and the inclination angle between rotation and magnetic axes of a neutron star in the presence of a corotating plasma. We also show how the solution can be generalized to the case of evolving magnetic fields. We determine the evolution of the spin period, inclination angle, magnetic dipole moment, and braking index of six putative magnetars associated with GRB 091018, GRB 070318, GRB 080430, GRB 090618, GRB 110715A, and GRB 140206A through fitting, via Bayesian analysis, the X-ray afterglow light curves by using our recent model. We find that within the first day following the formation of the millisecond magnetar, the inclination angle aligns rapidly, the magnetic dipole moment may decay by a few times, and the braking index varies by an order of magnitude.
MerTK inhibition decreases immune suppressive glioblastoma-associated macrophages and neoangiogenesis in glioblastoma microenvironment
Authors: Su Yu-Ting , Butler Madison , Zhang Meili , Zhang Wei , Song Hua , Hwang Lee , Tran Andy D , Bash Ryan E , Schorzman Allison N , Pang Ying , Yu Guangyang , Zamboni William C , Wang Xiaodong , Frye Stephen V , Miller Christopher Ryan , Maric Dragan , Terabe Masaki , Gilbert Mark R , Earp III Henry Shelton , Wu Jing
Published: June 2020

Background

Glioblastoma-associated macrophages and microglia (GAMs) are the predominant immune cells in the tumor microenvironment. Activation of MerTK, a receptor tyrosine kinase, polarizes GAMs to an immunosuppressive phenotype, promoting tumor growth. Here, the role of MerTK inhibition in the glioblastoma microenvironment is investigated in vitro and in vivo.

Methods

Effects of MRX-2843 in glioblastoma microenvironment regulation were determined in vitro by cell viability, cytokine array, in vitro tube formation, Western blotting, and wound healing assays. A syngeneic GL261 orthotopic glioblastoma mouse model was used to evaluate the survival benefit of MRX-2843 treatment. Multiplex fluorescent immunohistochemistry was used to evaluate the expression of CD206, an anti-inflammatory marker on GAMs, and angiogenesis in murine brain tumor tissues.

Results

MRX-2843 inhibited cell growth and induced apoptosis in human glioblastoma cells and decreased protein expression of phosphorylated MerTK, AKT, and ERK, which are essential for cell survival signaling. Interleukin-8 and C-C motif chemokine ligand 2, the pro-glioma and pro-angiogenic cytokines, were decreased by MRX-2843. Decreased vascular formation and numbers of immunosuppressive (CD206+) GAMs were observed following MRX-2843 treatment in vivo, suggesting that in addition to alleviating immunosuppression, MRX-2843 also inhibits neoangiogenesis in the glioma microenvironment. These results were supported by a prolonged survival in the syngeneic mouse orthotopic GL261 glioblastoma model following MRX-2843 treatment.

Conclusion

Our findings suggest that MRX-2843 has a therapeutic benefit via promoting GAM polarization away from immunosuppressive condition, inhibiting neoangiogenesis in the glioblastoma microenvironment and inducing tumor cell death.
New timing measurement results of 16 pulsars
Authors: Liu Jie , Yan Zhen , Shen Zhi-Qiang , Huang Zhi-Peng , Zhao Ru-Shuang , Wu Ya-Jun , Yuan Jian-Ping , Wu Xin-Ji
Published: June 2020

A pulsar’s position, proper motion, and parallax are important parameters in timing equations. It is challenging to fit astrometric parameters accurately through pulsar timing, especially for pulsars that show irregular timing properties. With the fast development of related techniques, it is possible to measure astrometric parameters of more and more pulsars in a model-independent manner with very-long-baseline interferometry (VLBI). In this work we select 16 normal pulsars, whose parallax and proper motion have not been successfully fitted with timing observations or show obvious differences from the corresponding latest VLBI solutions, and do further studies on their timing properties. After updating the astrometric parameters in pulsar ephemerides with the latest VLBI measurements, we derive the latest rotation solutions of these pulsars with observation data in the S and C bands obtained from the Shanghai Tian Ma Radio Telescope. Compared with the spin frequency ν inferred from previous rotation solutions, the newly fitted ν show differences larger than 10−9 Hz for most pulsars. The contribution of the Shklovsky effect to the period derivative $\dot{P}$ can be properly removed by taking advantage of the accurate proper motion and distance of target pulsars measured by VLBI astrometry. This further leads to a precise estimate of the intrinsic characteristic age τc. The differences between the newly measured τc and corresponding previous results are as large as 2% for some pulsars. VLBI astrometric parameter solutions also lead to better measurements of timing irregularities. For PSR B0154+61, the glitch epoch (MJD 58279.5) measured with a previous ephemeris is about 13 d later than the result (MJD 58266.4) obtained with VLBI astrometric parameter solutions.
Electroencephalography During Nociceptive Stimulation in Chronic Pain Patients: A Systematic Review
Authors: Lenoir Dorine , Willaert Ward , Coppieters Iris , Malfliet Anneleen , Ickmans Kelly , Nijs Jo , Vonck Kristl , Meeus Mira , Cagnie Barbara
Published: June 2020

Background

With its high temporal resolution, electroencephalography (EEG), a technique that records electrical activity of cortical neuronal cells, is a potentially suitable technique to investigate human somatosensory processing. By using EEG, the processing of (nociceptive) stimuli can be investigated, along with the functionality of the nociceptive pathway. Therefore, it can be applied in chronic pain patients to objectify whether changes have occurred in nociceptive processing. Typically, so-called event-related potential (ERP) recordings are used, where EEG signals are recorded in response to specific stimuli and characterized by latency and amplitude.

Objective

To summarize whether differences in somatosensory processing occur between chronic pain patients and healthy controls, measured with ERPs, and determine whether this response is related to the subjective pain intensity.

Design

Systematic review.

Setting and Methods

PubMed, Web of Science, and Embase were consulted, and 18 case–control studies were finally included.

Subjects

The chronic pain patients suffered from tension-type headache, back pain, migraine, fibromyalgia, carpal tunnel syndrome, prostatitis, or complex regional pain syndrome.

Results

Chronic neuropathic pain patients showed increased latencies of the N2 and P2 components, along with a decreased amplitude of the N2-P2 complex, which was also obtained in FM patients with small fiber dysfunction. The latter also showed a decreased amplitude of the N2-P3 and N1-P1 complex. For the other chronic pain patients, the latencies and the amplitudes of the ERP components did not seem to differ from healthy controls. One paper indicated that the N2-P3 peak-to-peak amplitude correlates with the subjective experience of the stimulus.

Conclusions

Differences in ERPs with healthy controls can mostly be found in chronic pain populations that suffer from neuropathic pain or where fiber dysfunction is present. In chronic pain populations with other etiological mechanisms, limited differences were found or agreed upon across studies.
The Associations Between CYP2D6*10 C188T Polymorphism and Pharmacokinetics and Clinical Outcomes of Tramadol: A Systematic Review and Meta-analysis
Authors: Wen Qing-Hua , Zhang Zheng , Cai Wen-Ke , Lin Xiao-Qian , He Gong-Hao
Published: June 2020

Background

Tramadol is one of the most extensively used centrally acting synthetic opioid analgesics. Recently, a number of studies have explored the associations of the CYP2D6*10 C188T polymorphism with pharmacokinetic and clinical outcomes of tramadol. However, the results of these previous reports remain controversial. Therefore, a meta-analysis was needed to reach a consensus.

Methods

PubMed, EMBASE, and the Cochrane Library were searched to identify eligible studies that explored the influence of the CYP2D6*10 C188T polymorphism on clinical outcomes of tramadol through April 2019. Articles meeting the inclusion criteria were comprehensively reviewed by two independent evaluators. A meta-analysis was performed using Review Manager 5.3.

Results

A total of nine studies involving 809 related subjects were included in this meta-analysis. Significant associations were found between CYP2D6*10 C188T mutation and longer serum tramadol half-lives, larger AUC0-∞, and the slower clearance rate of tramadol. In addition, we also found that CYP2D6*10 C188T had effects on the pharmacokinetic parameters of the metabolite of tramadol, O-desmethyltramadol, by sensitive analysis. Furthermore, CYP2D6*10 C188T polymorphism was associated with higher visual analog scale score, loading dose, and total consumption of tramadol. There was no significant association between CYP2D6*10 C188T polymorphism and postoperative nausea and vomiting.

Conclusions

CYP2D6*10 C188T polymorphism had a significant influence on tramadol pharmacokinetics and analgesic effect, but there was insufficient evidence to demonstrate that this polymorphism was associated with incidence of nausea and vomiting.
Using a Narrative Practice Approach to Understand In-Depth Experiences of Individuals Coping with Chronic Pain
Authors: Lew Yuen Foong Henry , Xin Xiao Hui
Published: June 2020

Objective

Current psychological interventions to enhance management of chronic pain report small to moderate effects. There is a need to explore the experiences and coping of individuals with chronic pain in depth and expand beyond current knowledge paradigms to enhance psychological interventions. The current literature recommends narrative practice as a qualitative approach in a group to facilitate sharing of knowledge on coping with chronic pain. Therefore, we conducted group sessions incorporating narrative practice to explore the experiences of individuals coping with chronic pain.

Design

We explored the experiences of 11 individuals coping with chronic pain from two group sessions that incorporated narrative practice. Themes emerging from participants’ sharing were triangulated from interview transcripts, field notes, and participants’ response worksheets. Data analysis adopted thematic analysis and narrative practice approaches.

Results

Themes on coping found include “refocusing,” “distraction,” “inspiration and perspective taking,” and “acknowledgement of skills, knowledge, and attitude.” “Distraction” and “refocusing” complimented one another. This provided a new perspective, in contrast to current research that views both as mutually exclusive. Social environmental factors were found to help participants share existing coping methods of “connection,” “deepen perspective,” “inspiration and perspective taking,” and “acknowledgement of skill, knowledge and attitude.” The possible relationships between the themes also provided support to the theoretical foundations of Acceptance and Commitment Therapy. Results suggest that adopting a narrative practice sequence helped individuals to acknowledge chronic pain experiences and facilitated their identification of ways to cope.

Conclusions

Narrative practice identified themes of coping that can inform clinical practice. Narrative practice is indicated as a feasible and acceptable research and clinical approach for individuals with chronic pain.
ESTIMATION OF HUMAN DOSE OF 188/186RE-HEDP COCKTAIL BASED ON OLINDA/EXM AND DISTRIBUTION DATA IN RATS
Authors: Pourhabib Zahra , Ranjbar Hassan , Bahrami Samani Ali
Published: June 2020

188Re and 186Re are two applicable rhenium medical radioisotopes with complementary features that make them beneficial for different sizes of tumours. The aim of this study is to investigate 188/186Re-HEDP efficacy as a cocktail by calculating absorbed radiation dose in human organs based on biodistribution data obtained by injecting it to normal rats. Three rats were sacrificed at different time intervals and the percentage of injected dose per gram of each organ was measured by direct counting from rat data. By calculating accumulated activities in each organ and extrapolating rat data to human data by the radiation dose assessment resource method and by using OLINDA/EXM software, the injected dose in various human organs was obtained. The calculated absorbed dose showed that the 188/186Re-HEDP has noticeable properties that can be more helpful in comparison with using each of the rhenium radioisotopes separately.
Using low-moisture molasses-based blocks to supplement Ca salts of soybean oil to forage-fed beef cows
Authors: Brandão Alice Poggi , Cooke Reinaldo F , Schubach Kelsey M , Colombo Eduardo A , Scatolin Giovanna N , Rett Bruna , Jump Donald B , Pohler Ky G
Published: June 2020

This experiment compared plasma fatty acid (FA) profile of forage-fed beef cows receiving a molasses-based supplement enriched with Ca salts of soybean oil [CSSO; 24.7% of dry matter (DM)] via a self-fed low-moisture block (LMB) or hand-fed granular concentrate daily (CONC). Thirty-six nonlactating, nonpregnant, multiparous beef cows were blocked by age (three blocks), ranked within blocks by body weight (BW) and body condition score (BCS), and allocated to 1 of three drylot pens (27 × 10 m) per block. Nine pens with four cows each were enrolled in a replicated 3 × 2 Latin square design with two periods of 42 d, and a 21-d washout interval. On day 0, pens within each block were randomly assigned to receive one of the three treatments, in a manner that pens did not receive the same treatment in both periods (total n = 6 pens per treatment). Cows received hay (Cynodon dactylon), water, and a mineral–vitamin mix for ad libitum consumption during the study. Hay intake was recorded daily from days 0 to 42, and LMB intake was recorded from days 14 to 42 to allow cows to adapt to supplement with minimal interference from days 0 to 13. The CONC was offered at 0.420 kg/cow daily (DM basis) from days 0 to 13 and then adjusted (days 14 to 42) to match LMB intake. Cow BW and BCS were recorded, and blood samples were collected on days 0, 14, 28, and 42. Average LMB intake during the initial 13 d was 0.846 ± 0.107 kg/cow daily (DM basis). Supplement DM intake did not differ (P = 0.39) between LMB and CONC cows from days 14 to 42 as designed (0.570 vs. 0.583 kg/d, respectively; SEM = 0.011), despite a greater variation in daily intake of LMB vs. CONC (treatment × day interaction; P < 0.01). No treatments effects were noted (P ≥ 0.40) for hay intake, BCS, and BW. Treatment × day interactions were detected (P ≤ 0.01) for plasma concentrations of ω-6 polyunsaturated FA and total FA. On day 0, plasma FA profile did not differ (P ≥ 0.20) between treatments. From days 14 to 42, plasma concentrations of linoleic acid, ω-6 polyunsaturated FA, and total FA were greater (P < 0.01) in CONC and LMB vs. NOSUPP cows. Plasma concentrations of these FA were also greater (P ≤ 0.03) in LMB vs. CONC cows on day 14, but did not differ (P ≥ 0.35) on days 28 and 42. These results indicate that CSSO inclusion into LMB resulted in similar incorporation of ω-6 polyunsaturated and total FA in the circulation compared with CONC offered at the same daily rate. Hence, the use of self-fed LMB appears to be a valid strategy to provide CSSO to forage-fed beef cattle with reduced labor needs.
Race, Archival Silences, and a Black Footballer Between the Wars
Authors: Johnes Martin
Published: June 2020

The relative absence of colour in archival sources has led the British historiography of race to concentrate too much on the reactions of white Britons and not enough on black experiences. With some notable exceptions, this has created an analytical emphasis on racism and discrimination rather than the agency of black men and women to resist prejudices and live meaningful lives. This article explores the life of Welsh footballer Eddie Parris in order to investigate the working-class black experience in interwar Britain. It acts as a reminder of the importance of thinking of people of colour in early-twentieth-century Britain as individuals rather than just as a racialized category. Nonetheless, notions of racial difference were so pervasive that race was never irrelevant for their lives. The task for the historian is to acknowledge and investigate the impact of these ideas without letting them push aside the actual people within them.
α-Linolenic and γ-linolenic acids exercise differential antitumor effects on HT-29 human colorectal cancer cells
Authors: González-Fernández María José , Ortea Ignacio , Guil-Guerrero José Luis
Published: June 2020

α-Linolenic acid (ALA, 18:3n-3) and γ-gamma linolenic acid (GLA, 18:3n-6) are polyunsaturated fatty acids (PUFA) that improve the human health. The present study focused on testing the in vitro antitumor actions of pure ALA and GLA on the HT-29 human colorectal cancer cell line. Cell viability was checked by MTT ((3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) test, cell membrane damage by the lactate dehydrogenase assay, apoptosis was tested by both caspase-3 activity trial and transmission electron microscopy images, and protein composition was analyzed by quantitative proteomics analysis. MTT test revealed IC50 values of 230 and 255 μM for ALA and GLA, respectively, at 72 h. After 24 h of incubation, both ALA and GLA induced apoptosis on HT-29 colorectal cancer cells according to the caspase-3 assay and microscopy images. SWATH/MS analysis evidenced that ALA significantly affected the mitochondrial protein import pathway and the citric acid cycle pathway, while GLA did not significantly affect any particular pathway. In summary, both ALA and GLA showed concentration-dependent inhibitory effects on HT-29 cells viability and induced cell death by apoptosis. ALA significantly affected cellular pathways, while GLA does not have specific actions on either pathway. Both n-3 and n-6 C18 PUFA are bioactive food components useful in the colorectal cancer prevention.
Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial
Authors: Winer Rachel L. , Lin John , Tiro Jasmin A. , Miglioretti Diana L. , Beatty Tara , Gao Hongyuan , Kimbel Kilian , Thayer Chris , Buist Diana S. M.
Published: June 2020

(Abstracted from JAMA Network Open 2019;2(11):e1914729)

Greater than 50% of the 12,000 cases of cervical cancer diagnosed annually in the United States are in underscreened women. The US Preventative Task Force issued updated cervical cancer screening guidelines in 2018, suggesting the addition of primary human papillomavirus (HPV)–only screening to Papanicolaou testing alone and Papanicolaou and HPV cotesting for women aged 30 to 65 years.
Practice Modification for Pandemics
Authors: Duzyj Christina M. , Thornburg Loralei L. , Han Christina S.
Published: June 2020

This review highlights proposed pandemic-adjusted modifications in obstetric care, with discussion of risks and benefits based on available evidence. We suggest best practices for balancing community-mitigation efforts with appropriate care of obstetric patients.
Syndemics of HIV with mental illness and other noncommunicable diseases: a research agenda to address the gap between syndemic theory and current research practice
Authors: Bhardwaj Anvita , Kohrt Brandon A.
Published: June 2020

Purpose of review

The aim of this article is to summarize the status of syndemic research on HIV and noncommunicable diseases (NCDs) to identify opportunities for improving research to benefit prevention and treatment of NCDs among persons living with HIV.

Recent findings

The majority of research on syndemics of HIV and NCDs has been conducted in the United States, with few studies in low and middle-income countries. The substance abuse, violence, and AIDS syndemic model was used by a quarter of the studies, however, most other studies failed to outline a syndemic model for interpreting their findings. Mental illnesses were the dominant NCD (15 out of 16 studies), and only one study explored physical health NCDs.

Recent studies referring to syndemics of HIV and NCDs often do not meet criteria for a syndemic framework. Future research needs to assure minimum criteria are met: articulation of two or more health conditions, descriptions of social/geographic context that impact the relationship among these conditions, a syndemic model with proposed mechanisms for interaction in the particular social/geographic context, and a population or context without the observed syndemic. Expanding the current syndemic research beyond the United States context and beyond mental illness also would enrich the field.
Ten years of the Helsinki Declaration on patient safety in anaesthesiology
Authors: Preckel Benedikt , Staender Sven , Arnal Daniel , Brattebø Guttorm , Feldman Jeffrey M. , Ffrench-O’Carroll Robert , Fuchs-Buder Thomas , Goldhaber-Fiebert Sara N. , Haller Guy , Haugen Arvid S. , Hendrickx Jan F.A. , Kalkman Cor J. , Meybohm Patrick , Neuhaus Christopher , Østergaard Doris , Plunkett Adrian , Schüler Hans U. , Smith Andrew F. , Struys Michel M.R.F. , Subbe Christian P. , Wacker Johannes , Welch John , Whitaker David K. , Zacharowski Kai , Mellin-Olsen Jannicke
Published: June 2020

Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the ‘Helsinki Declaration on Patient Safety in Anaesthesiology’. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.
Pubertal Development: What’s Normal/What’s Not
Authors: SMITH COLBY E. , BIRO FRANK M.
Published: June 2020

Onset of puberty, as defined by breast stage 2, appears to be starting at younger ages since the 1940s. There is an ongoing controversy regarding what is normative, as well as what is normal, and the evaluation that is deemed necessary for girls maturing before 8 years of age. There are potential implications of earlier pubertal timing, including psychosocial consequences during adolescence, as well as longer term risks, such as breast cancer and cardiometabolic risks. There are additional consequences derived from slower pubertal tempo, for age of menarche has not decreased as much as age of breast development; these include longer interval between sexual initiation and intentional childbearing, as well as a broadened window of susceptibility to endocrine-related cancers.
Artificial intelligence in cornea, refractive, and cataract surgery
Authors: Siddiqui Aazim A. , Ladas John G. , Lee Jimmy K.
Published: June 2020

Purpose of review

The subject of artificial intelligence has recently been responsible for the advancement of many industries including aspects of medicine and many of its subspecialties. Within ophthalmology, artificial intelligence technology has found ways of improving the diagnostic and therapeutic processes in cornea, glaucoma, retina, and cataract surgery. As demands on the modern ophthalmologist grow, artificial intelligence can be utilized to help address increased demands of modern medicine and ophthalmology by adding to the physician's clinical and surgical acumen. The purpose of this review is to highlight the integration of artificial intelligence into ophthalmology in recent years in the areas of cornea, refractive, and cataract surgery.

Recent findings

Within the realms of cornea, refractive, and cataract surgery, artificial intelligence has played a major role in identifying ways of improving diagnostic detection. In keratoconus, artificial intelligence algorithms may help with the early detection of keratoconus and other ectatic disorders. In cataract surgery, artificial intelligence may help improve the performance of intraocular lens (IOL) calculation formulas. Further, with its potential integration into automated refraction devices, artificial intelligence can help provide an improved framework for IOL formula optimization that is more accurate and customized to a specific cataract surgeon.

The future of artificial intelligence in ophthalmology is a promising prospect. With continued advancement of mathematical and computational algorithms, corneal disease processes can be diagnosed sooner and IOL calculations can be made more accurate.
Meropenem-Induced Resistant Hypokalemia
Authors: Glover Jennifer Anne , Alam Farjana , Avasthi Salil , Avasthi Deepti
Published: June 2020

Meropenem is a β-lactam antibiotic from the carbapenem class that has been one of the most effective drugs in treating some of the most serious infections in hospitalized patients. Because of its unique β-lactam structure, it has a wide spectrum of activity against some of the most resistant bugs especially penicillinase-producing gram-positive bacteria, gram-negative bacteria, and anaerobes. Common adverse effects that have been well documented with meropenem include nausea, vomiting, diarrhea, and in rare cases skin rashes from hypersensitivity reactions. Hypokalemia is not a known adverse effect of meropenem use. In this case report, we discuss a patient who developed resistant hypokalemia while getting treatment with meropenem for a severe right upper arm infectious myositis. This effect of meropenem was noted to be secondary to impaired potassium absorption in renal tubules, which was found be reversible after discontinuation of the drug.
“This is not a Drill—Evacuate the Building Now!”
Authors: Burnett Ann Lacy , McGuire Koren
Published: June 2020

This article describes an actual disaster that took place at an outpatient surgical center. Reported are the context of the disaster, the potential dangers, the unprepared reactions of the staff, and the following leadership shown by the staff nurses and clinical nurse specialist in response to the disaster. Described is the didactic education they created, with a tabletop evacuation drill and a hands-on exercise presented to the whole multidisciplinary staff. Participants were given a pre- and posteducation survey to assess the effectiveness of the training. Results showed that staff felt far more confident and prepared to deal with a disaster and evacuation after the didactic education combined with the hands-on exercises. Our findings suggest that a training that uses minimal time, space, and resources can significantly improve confidence and preparedness in staff. Also identified was the need for changes in our existing policy to be modeled on logistics that correspond with an actual disaster and evacuation.
In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with and without prior coronary artery bypass graft
Authors: Liu Mei-Jun , Chen Chao-Feng , Gao Xiao-Fei , Liu Xiao-Hua , Xu Yi-Zhou
Published: June 2020

The clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in prior coronary artery bypass graft (pCABG) patients have been investigated; however, the results are inconsistent.

The present meta-analysis compared the clinical outcomes of CTO PCI in patients with and without prior CABG (nCABG). The endpoints included technical success, procedural success, all-cause mortality, myocardial infarction (MI), major bleeding, coronary perforation, pericardial tamponade, emergency CABG, and vascular access complication.

A total of 7 studies comprising of 11099 patients were included in this meta-analysis. The results showed that compared to nCABG patents, pCABG patients were associated with lower technical success (82.3% versus 87.8%; OR, 0.60; 95% CI, 0.53–0.68; P < .00001; I
2 = 0%) and procedural success (80.4% versus 86.2%; OR, 0.61; 95% CI, 0.53–0.70; P < .00001; I
2 = 10%); a higher risk of all-cause mortality (OR, 2.95; 95% CI, 1.56–5.57; P = 0.0008; I
2 = 0%), MI (OR, 2.30; 95% CI, 1.40–3.80; P = .001; I
2 = 5%), and coronary perforation (OR, 2.16; 95% CI, 1.51–3.08; P < 0.0001; I
2 = 52%). On the other hand, the risk of pericardial tamponade (OR, 0.42; 95% CI, 0.15–1.18; P = .10; I
2 = 21%), major bleeding (OR, 1.51; 95% CI, 0.90–2.53; P = .11; I
2 = 0%), vascular access complication (OR, 1.50; 95% CI, 0.93–2.41; P = .10; I
2 = 0%), and emergency CABG (OR, 0.99; 95% CI, 0.25–3.91; P = .99; I
2 = 0%) was similar in both groups.

Compared to nCABG patients, pCABG patients had lower CTO PCI success rates, higher rates of in-hospital mortality, MI, and coronary perforation, and similar risk of pericardial tamponade and vascular complication rates.
Type II enteropathy-associated T cell lymphoma in the duodenum
Authors: Liu Zhicheng , He Liang , Jiao Yan , Wang Helei , Suo Jian
Published: June 2020

Introduction:

Enteropathy-associated T-cell lymphoma (EATL) is a very rare form of lymphoma in the gastrointestinal tract. The proximal jejunum and ileum are the most common sites of EATL, whereas EATL rarely arises in the duodenum, and EATL involving metastasis of the bilateral ovaries is even rarer.

Patient concerns:

A 43-year-old female suffered from upper abdominal pain and weight loss for 3 months.

Diagnosis:

Type II EATL.

Interventions:

The patient was initially treated with chemotherapies, including 4 cycles of the CHOP-E and 2 cycles of the DHAP+ chidamide chemotherapy regimens. However, the patient did not respond well to chemotherapy. Surgical treatment of the duodenal obstruction, with perforation of small intestine and the duodenum, was performed successively.

Outcomes:

The patient died of septic shock only 1 day after the surgery for the second perforation. Her overall survival was 11 months from the time of initial diagnosis.

Conclusion:

This case suggests that EALT is highly invasive and its clinical course is very aggressive. Intestinal perforation, intestinal obstruction, or involvement of extraintestinal organs may occur in EALT patients. Additionally, EALT patients respond poorly to chemotherapy and have an extremely unfavorable prognosis.
Utilization of virtual low-keV monoenergetic images generated using dual-layer spectral detector computed tomography for the assessment of peritoneal seeding from ovarian cancer
Authors: Kim Taek Min , Kim Sang Youn , Cho Jeong Yeon , Kim Seung Hyup , Moon Min Hoan
Published: June 2020

This study aimed to compare the quality of virtual low-keV monoenergetic images vs conventional images reconstructed from dual-layer spectral detector computed tomography (SDCT) for the detection of peritoneal implants of ovarian cancer.

Fifty ovarian cancer patients who underwent abdominopelvic SDCT scans were included in this retrospective study. Virtual monoenergetic images at 40 (VMI40) and 50 keV (VMI50), and two conventional images were reconstructed using filtered back projection (FBP) and iterative model reconstruction (IMR) protocols. The mean attenuation of the peritoneal implant, signal-to-noise ratio (SNR), contrast-to-noise ratio relative to ascites (CNRA) and adjacent reference tissues (e.g., bowel wall, hepatic, or splenic parenchyma [CNRB]) were calculated and compared using paired t tests. Qualitative image analysis regarding overall image quality, image noise, image blurring, lesion conspicuity, was performed by two radiologists. A subgroup analysis according to the peritoneal implant region was also conducted.

VMI40 yielded significantly higher mean attenuation (183.35) of SNR and CNR values (SNR 11.69, CNRA 7.39, CNRB 2.68), compared to VMI50, IR, and FBP images (P < .001). The mean attenuation (129.65), SNR and CNR values (SNR 9.37, CNRA 5.72, CNRB 2.02) of VMI50 were also significantly higher than those of IR and FBP images (P < .001). In the subgroup analysis, all values were significantly higher on VMI40 regardless of the peritoneal implant region (P < .05). In both readers, overall image quality and image blurring showed highest score in VMI50, while image noise and lesion conspicuity showed best score in IMR and VMI40 respectively. Inter-reader agreements are moderate to almost perfect in every parameter.

The low-keV VMIs improved both quantitative assessment and lesion conspicuity of peritoneal implants from ovarian cancer compared to conventional images.
Investigation on the status of oral intake management measures during labor in China
Authors: Huang Chuan-Ya , Luo Bi-Ru , Hu Juan
Published: June 2020

The World Health Organization recommended that the oral intake of low-risk pregnant women during labor should not be restricted. Hospitals in different countries take different measures to manage the intake during labor, but it is not clear about the current situation of oral intake management measures in the hospital during labor in China. Thus, the objective of this study was to investigate the current situation of oral intake management measures during labor in China, so as not only provide references for developing appropriate midwifery technology training and formulating relevant policies, but also provide a basis for exploring and implementing better oral intake management measures in the future.

A cross-sectional survey was conducted. From December 2017 to November 2018, the oral intake management measures of 1213 hospitals in 22 provinces, cities, and autonomous regions in China were investigated by a self-designed questionnaire. χ
2 test was used for statistical analysis.

Different hospitals in China have adopted different oral intake management measures. Among the 1213 hospitals, 939(77.4%) hospitals took measures to allow pregnant women to bring the easily digestible food, 813(67.0%) hospitals took measures to allow pregnant women to eat what she wanted to eat. Few hospitals provide pregnant women with oral nutrition solution or provide a suitable diet for pregnant women. Thirty-four (2.8%) hospitals still restrict pregnant women's fluid intake.

Oral intake management measures that are more suitable for Chinese pregnant women should be explored to better ensure the women energy needs and they safely go through childbirth.
The association between mastication and mild cognitive impairment in Korean adults
Authors: Kim Mi-Sun , Oh Bumjo , Yoo Ji Won , Han Dong-Hun
Published: June 2020

Currently, a few of studies revealed that there is an association between mastication and cognitive impairment. There is no study of Korean adult representative samples in relation to mastication and cognitive decline. This study was to investigate the relationship between mastication and mild cognitive impairment in Korean adults.

A population-based cross-sectional study was conducted in which a total of 7029 subjects (2987 men and 4042 women) over 45 years old were surveyed from the Korea Longitudinal Study on Aging (KLoSA), Round 5th survey. Logistic regression analysis was performed for the study data controlling for confounding factors such as age, gender, education, income, smoking, drinking, exercise, wearing denture, and the number of chronic diseases.

Decreased chewing function is associated with mild cognitive impairment (odds ratio [OR] = 3.24, 95% confidence interval [CI] = 2.67–3.93) after controlling for confounding variables. In the participants who did not wear dentures, the reduction of chewing function was strongly correlated with mild cognitive impairment (OR = 3.97, 95% CI = 3.11–5.08).

Mastication was associated with mild cognitive impairment. To prevent cognitive decline, health specialists should pay more attention to the decline of the mastication in people without dentures.
Endoscopic management of pancreaticopleural fistula in a pediatric patient
Authors: Yang Jing , Lu Lei , Jin Hang-bin , Yang Jian-feng , Zhang Xiao-feng
Published: June 2020

Introduction:

Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disorders. As the clinical presentations of PPF are often deceptive, it can cause a delay in the timely diagnosis and proper treatment. PPF is extremely uncommon in pediatric patients, and diagnostic and management strategies for PPF among pediatric patients are scanty.

Patient concerns:

A 12-year-old girl presented with cough and dyspnea owing to massive right-side pleural effusion confirmed by Chest X-ray. Biochemical examination of pleural effusion revealed a significant elevation of amylase level. Imaging modalities showed dilated pancreatic duct and fistulous tract connecting pancreatic duct and right thorax.

Diagnosis:

Chronic pancreatitis with PPF was diagnosed.

Interventions:

Medical therapy was initially attempted for 2 weeks. Endoscopic therapy with naso-pancreatic drainage tube placement was then performed without any complications after failed medical therapy.

Outcomes:

The patient has remained healthy and symptom-free during 2 years of follow-up.

Conclusion:

When pediatric patients presented with recurrent pleural effusion with unknown etiology, PPF should be taken into consideration. Pleural effusion amylase level is the most important laboratory test and magnetic resonance cholangiopancreatography is recommended to visualize the fistula. Optimal management of PPF should be based on pancreatic duct morphology.
How to advise patients on the risk of chronic proton pump inhibitor therapy
Authors: Moayyedi Paul
Published: June 2020

Purpose of review

Proton pump inhibitors (PPIs) are widely prescribed and have excellent short-term tolerability. Administrative database studies have highlighted that many diseases are associated with PPI therapy including pneumonia, fracture, cardiovascular disease, and all-cause mortality. This review therefore reviews the evidence of the risks and benefits of these drugs.

Recent findings

There is high-to-moderate quality evidence that PPIs are effective at treating many acid-related disorders. Recent randomized trials have suggested that the associations between PPIs and various diseases are likely to be related to bias and residual confounding and these drugs appear to be safe apart from a possible increased risk of enteric infections.

PPIs should be used at the lowest dose and for the shortest duration possible. They are still relatively well-tolerated drugs but should only be prescribed for proven indications.
Neighborhood-Level Chronic Disease Surveillance: Utility of Primary Care Electronic Health Records and Emergency Department Claims Data
Authors: Chan Pui Ying , Perlman Sharon E. , Lee David C. , Smolen Jenny R. , Lim Sungwoo
Published: June 2020

Context:

Disease burden may vary substantively across neighborhoods in an urban setting. Yet, data available for monitoring chronic conditions at the neighborhood level are scarce. Large health care data sets have potential to complement population health surveillance. Few studies have examined the utility of health care data for neighborhood-level surveillance.

Objective:

We examined the use of primary care electronic health records (EHRs) and emergency department (ED) claims for identifying neighborhoods with higher chronic disease burden and neighborhood-level prevalence estimation.

Design:

Comparison of hypertension and diabetes estimates from EHRs and ED claims with survey-based estimates.

Setting:

Forty-two United Hospital Fund neighborhoods in New York City.

Participants:

The EHR sample comprised 708 452 patients from the Hub Population Health System (the Hub) in 2015, and the ED claim sample comprised 1 567 870 patients from the Statewide Planning and Research Cooperative System in 2015. We derived survey-based estimates from 2012 to 2016 Community Health Survey (n = 44 189).

Main Outcome Measure:

We calculated hypertension and diabetes prevalence estimates by neighborhood from each data source. We obtained Pearson correlation and absolute difference between EHR-based or claims-based estimates and survey-based estimates.

Results:

Both EHR-based and claims-based estimates correlated strongly with survey-based estimates for hypertension (0.91 and 0.72, respectively) and diabetes (0.83 and 0.82, respectively) and identified similar neighborhoods of higher burden. For hypertension, 10 and 17 neighborhoods from the EHRs and ED claims, respectively, had an absolute difference of more than 5 percentage points from the survey-based estimate. For diabetes, 15 and 4 neighborhoods from the EHRs and ED claims, respectively, differed from the survey-based estimate by more than 5 percentage points.

Conclusions:

Both EHRs and ED claims data are useful for identifying neighborhoods with greater disease burden and have potential for monitoring chronic conditions at the neighborhood level.