bluuebunny/crossref_metadata_2025 huggingface dataset:
Modifiable and other risk factors for rheumatoid arthritis: A basis for prevention and better therapy
Authors: Klareskog Lars , Alfredsson Lars
Published: September 2020

Rheumatoid arthritis (RA) is a heterogeneous disease, consisting of distinct subsets with partly distinct aetiologies and risk factors. Such risk factors are environmental, including lifestyle mediated and genetic, and these factors must always be considered in the context of stochastic (i.e. chance) factors. As RA is a disease where immune reactions often precede symptoms, and where symptoms that do not involve joint inflammation such as joint pain, bone loss, and fatigue may precede arthritis, and where severe symptoms and comorbidities may follow after the first episode of joint inflammation, we also have to consider risk factors during these different phases of disease development. This chapter focuses on environmental, including lifestyle, factors, and on when and how during disease development such factors are active. The chapter also describes pathogenic mechanisms that may be triggered by such risk factors. Particular emphasis is on recognition of modifiable environmental/lifestyle factors as such knowledge can be used in primary as well as secondary prevention and also to improve effects of current pharmacological treatments.
Genetics and epigenetics of rheumatoid arthritis
Authors: Barton Anne
Published: September 2020

Rheumatoid arthritis (RA) is known to have a genetic component: the evidence comes from twin and family studies as well as genetic studies themselves. Family studies consistently confirm that first degree relatives of patients with RA are at increased risk of developing the condition, supporting a genetic component. The most robust data comes from the Icelandic genealogical database. This chapter covers the basics of genetic studies in RA, designing the genetic study, RA-specific results and insights that can be gained from these. Detailed analyses of selected genetic regions are discussed, alongside genes that may indicate severity. Genetic factors associated with treatment response are also considered. Finally, the role of epigenetics is covered.
Dendritic cells and T cells in rheumatoid arthritis
Authors: Law Soi-Cheng , Wehr Pascale , Purvis Harriet , Thomas Ranjeny
Published: September 2020

Dendritic cells (DCs) are specialized antigen-presenting cells which link the innate and adaptive immune responses, activating and priming effector CD4+ T cells, cross-presenting antigen to CD8+ T cells, and promoting B-cell antibody production. DCs also play important roles in the maintenance of immune tolerance. DCs and T cells underpin the basis of the autoimmune response in rheumatoid arthritis. In this chapter we describe the function of DCs and the response of T cells in rheumatoid arthritis pathogenesis, introduce the DC and T-cell players and their function in the immune system, then review the evidence for their involvement in the pathogenesis of rheumatoid arthritis (RA), particularly through the presentation of antigen that triggers the differentiation of autoreactive T cells, as well as innate immune effector functions. Finally, the emerging prospects for DC targeting for immunotherapy are covered.
Comorbidity in rheumatoid arthritis
Authors: Hyrich Kimme , Skeoch Sarah
Published: September 2020

A high prevalence of comorbidity is observed in patients with rheumatoid arthritis (RA) and the presence and type of comorbidity has a significant impact on mortality and quality of life in RA. Comorbidity also has an impact on treatment decisions and recognizing and managing comorbidities is an important aspect in the care of patients with RA. Some comorbidities occur as a direct result of RA or the treatments used, while others can be unrelated but have an effect on treatment and outcomes. In this chapter we describe the burden of comorbidity and the prevalence, risk factors, and management of important comorbidities seen in RA.
Ultrasound in rheumatoid arthritis
Authors: Filer Andrew , D’Agostino Maria Antonietta , Sahbudin Ilfita
Published: September 2020

Ultrasound in increasingly used in rheumatology practice in the assessment of inflammatory patient, including facilitating early diagnosis of rheumatoid arthritis (RA), predicting its outcome, measuring structural damage, and monitoring its progression. This imaging modality can visualize both inflammatory and structural changes in patients with unclassified arthritis and RA, as well as other inflammatory arthritides such as psoriatic arthritis (PsA), spondyloarthropathy (SpA), and crystal arthritis. This chapter aims to provide an overview of the recent advances of this technique for in the assessment of RA. Firstly, the principles which underpin the physics of ultrasound are summarized, followed by the musculoskeletal pathologies which are amenable to ultrasound examination. In addition, it also highlights the role of ultrasound in procedures (e.g. ultrasound-guided biopsy and ultrasound-guided injection).
Physical activity and exercise
Authors: Bearne Lindsay M. , Opava Christina H.
Published: September 2020

This chapter provides an overview of the role of physical activity and exercise in the management of people with rheumatoid arthritis (RA). It defines the concepts of physical activity, exercise, and sedentary behaviour and considers how these are measured objectively and subjectively in research studies and clinical practice. The symptoms and disabilities targeted by appropriately prescribed interventions are discussed and the growing evidence base for the effects of exercise in people with RA is highlighted. The recommendations and guidelines for health-enhancing physical activity and exercise prescription are reviewed and the factors that influence adherence to these are acknowledged. Suggestions of how clinicians may adapt their management approach to facilitate the uptake and maintenance of health-enhancing physical activity and exercise are considered.
Foot health
Authors: Siddle Heidi J. , Redmond Anthony C.
Published: September 2020

This chapter discusses and emphasizes the effects that a complex multisystem disease such as rheumatoid arthritis (RA) has on a weight-bearing structure. The foot is frequently described by people with RA as ‘the first to be affected but the last to be treated’. An overview of subjective and objective assessment tools, including clinical and imaging modalities is reviewed. This chapter encourages the clinician to ask the important question, ‘Have you had any problems with your feet recently?’ and provides a simple assessment approach and knowledge of further assessment strategies to ensure that the foot is adequately assessed to avoid long-term complications. The relevant non-surgical foot health management strategies have been highlighted for people with RA who frequently present with both inflammatory and mechanical disease in their feet, with the aim of minimizing the impact on the foot and ankle.
B-cell therapies
Authors: Yusof Md Yuzaiful Md , Vital Edward M. , Buch Maya H.
Published: September 2020

The development of B-cell therapies represents a major advance in the treatment of rheumatoid arthritis (RA). The two most evaluated strategies for B-cell inhibition are B-cell depletion and inhibition of B-cell survival factors (BAFF). Rituximab depletes B cells by targeting CD20, although the depth, duration of depletion, and clinical response may vary between patients. Rituximab is licensed for patients with severe active RA who have an inadequate response or intolerance to ≥1 tumour necrosis factor inhibitors. Postmarketing use has not revealed notable additional safety signals, although lower than normal immunoglobulin levels may develop in some patients after several courses and particularly with other risk factors, increase risk of infection. Rarely, cases of progressive multifocal leukoencephalopathy have been reported (3/100 000) although no proven causal association has yet been shown. BAFF inhibition is a promising alternative strategy through B- and non-B-cell independent mechanisms and several ongoing trials are addressing these approaches.
Biosimilars
Authors: Strand Vibeke , Kaine Jeffrey , Isaacs John
Published: September 2020

Biologic therapy for treatment of rheumatoid arthritis (RA) has evolved considerably over the past 20 years. Biosimilar development continues to accelerate at a frenetic pace worldwide. Initial regulatory efforts were developed within the EU and subsequent guidelines have now evolved in over 20 countries. Biosimilars by definition are highly similar, with ‘comparable quality, safety, and efficacy’ (EMA) and ‘no clinically meaningful differences in safety, purity, and potency’ (FDA) to the reference product. Development and manufacturing are based on reverse engineering of the reference product as only the primary amino acid sequence is known. Testing of primary, secondary, tertiary, and quaternary structure, binding pharmacokinetics, and stability is required. Characterization of post-translational modifications and biologic function, pharmacokinetics, evaluation of immunogenicity, and at least one comparative efficacy clinical trial are major requirements for regulatory approval. Clinical trials to assess biosimilarity are required in only one clinical indication and may be extrapolated to other indications for which the reference product is approved. Both single and multiple switching trials (between biosimilar and reference product) have yielded consistent results across numerous patient populations and diseases, with no evidence of detrimental outcomes. Two prospective large observational series (Danbio and Nor-Switch) have similarly assessed non-medical switching. Several open-label switching studies have revealed equivalent efficacy, safety, and discontinuation rates but real-world studies have raised concerns about potential nocebo responses.
The use of JAK inhibitors in the treatment of rheumatoid arthritis
Authors: Bechman Katie , Galloway James , Taylor Peter C.
Published: September 2020

Low molecular weight, orally available, ‘small molecules’ which target and inhibit components of the Janus family tyrosine kinase (JAK) enzyme inflammatory signalling cascade have been lately considered as an important alternative to biologic therapies for rheumatoid arthritis (RA). JAK signalling is used by a number of pro-inflammatory cytokines known to be involved in RA pathogenesis, notably IL-6. Therefore, several JAK inhibitors with variable degrees of selectivity and specificity for the JAK enzymes have been investigated in treatment of RA. To date, two JAK inhibitors, tofacitinib and baricitinib, have been approved for treatment of RA in certain regions. This chapter discusses the safety, efficacy, trials, and future directions of these two JAK inhibitors.
Prevention of rheumatoid arthritis
Authors: Huizinga Tom W.J. , Mil Annette van der Helm-van , Cope Andrew
Published: September 2020

The field of rheumatology has made major contributions to medicine through the identification of cellular and molecular targets. Moreover, early treatment is associated with improved outcomes of rheumatoid arthritis (RA). This observation led to the assumption that a window of opportunity exists, in which the disease is most susceptible to disease-modifying treatment. Although this window of opportunity has yet to be precisely defined significant progress has been achieved in this area. This includes the recognition of an at-risk state, characterized by disease specific autoantibodies in serum and inflammatory joint pain. This chapter describes the current state-of-the-art of RA prevention highlighting the importance of risk stratification. At this moment the best starting position for preventive studies is inclusion of patients at high risk of developing RA, such as those subjects who fulfil the European League Against Rheumatism (EULAR) definition of arthralgia at risk for RA.
Clinical recommendations
Authors: Aga Anna-Birgitte , Haavardsholm Espen A. , Uhlig Till , Kvien Tore K.
Published: September 2020

This chapter will review the most important recommendations that are relevant for evidence-based clinical practice. The main focus will be on recommendations that are specific to rheumatoid arthritis (RA) but some recommendation on special topics (e.g. biosimilars) will also be addressed. The literature to support evidence-based medicine is enormous, but the scientific quality may differ across studies. Recommendations based on systematic literature research may support evidence-based practice. Both the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have published several important evidence-based recommendations. Further, task forces independent of these organizations have also presented important recommendations to support best practice. New treatment strategies have also improved RA care to an extent where remission has become an achievable goal for the majority of patients with RA. Important principles in the new treatment strategies are ‘window of opportunity’ which imply early initiation of disease-modifying antirheumatic drugs (DMARDs) before the onset of damage, and further ‘treat-to-target’ which is a strategy for follow-up with focus on reaching a predefined target, and where DMARD treatment is adjusted if the target is not achieved. Patients with early disease are monitored with ‘tight controls’, and with use of composite disease activity measures that includes joint counts.
Voluntary patient registries
Authors: Greenberg Jeff , Patel Sheetal
Published: September 2020

With the number of approved drugs now available for the treatment of rheumatoid arthritis, there is an ever-increasing need for real-world, objective data to shed light on the comparative effectiveness and comparative safety of newly approved drugs versus other standard of care older medications. This chapter will provide an overview of voluntary rheumatoid arthritis (RA) registries that currently recruit patients and actively publish research findings. It will also highlight some of the key clinical insights derived from these voluntary registries. Voluntary registries have their own strengths and limitations compared to population-based registries. Unlike pharmaceutical sponsored clinical trials, the majority of these voluntary registries do not exclude patients based on comorbidities. Additionally, clinical trials are not always feasible on a large scale and have limited duration. Observational registries do not typically have these limitations.
Anaesthesia for Caesarean section: Regional anaesthesia
Authors: Harries Sarah , Collis Rachel
Published: September 2020

Regional anaesthesia is the technique of choice for CS, provided no contra-indications exist. The relationship between increased use of regional techniques and decreased maternal mortality is well recognized, with evidence suggesting it to be 16 times safer than GA. The use of three commonly practised techniques; epidural top-up, spinal, and combined spinal–epidural anaesthesia are described in detail in this chapter. Pain during CS surgery is the most common complaint and litigation made against obstetric anaesthetists. The importance and conduct of thorough block assessment prior to commencement of surgery and its documentation is emphasized with a ‘top tips’ list. Management of a failed block is described for all three techniques, together with strategies to treat common intra-operative complications e.g. hypotension and respiratory difficulty.
Anaesthesia for Caesarean section: General anaesthesia
Authors: Morris Stephen , Jones Rhidian
Published: September 2020

There will always be the need to give GA to pregnant womrn, and it is paramount that the obstetric anaesthetist is well prepared to perform a GA quickly and safely. This chapter reviews the current evidence, drugs, and conduct of GA for CS, with emphasis on exemplary communication within the delivery suite team and meticulous airway assessment to identify features suggestive of additional anticipated difficulty. A helpful ‘pre-induction’ checklist illustrates the need for team-based communication in preparation and planning to mitigate against complications following induction. The latest guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society on the management of failed intubation and ventilation have been included. The chapter also includes up-to-date information on accidental awareness in obstetric surgery from NAP4, and the steps to avoid and manage aspiration if it occurs.
The sick and septic mother
Authors: Lloyd Lucy de , Bell Sarah
Published: September 2020

Sepsis is a leading overall cause of direct and indirect maternal death in the UK. Successive recent confidential enquires have highlighted the importance of early recognition of sepsis markers, prompt initiation of treatment, and continuing monitoring to recognize further deterioration. The obstetric anaesthetist is key in leading the team in the management of any sick pregnant woman who presents to labour ward or the emergency department. This chapter includes sections on the assessment and identification of the septic mother, with a list of sepsis ‘red flag’ symptoms and signs, where immediate escalation in treatment is required. The sources and causes of sepsis are described. Management of sepsis on labour ward and transfer, if necessary, of the critically ill mother and management within critical care facilities are explained.
The collapsed parturient
Authors: Collis Rachel
Published: September 2020

This chapter covers a wide spectrum of causes for collapse on the labour ward or in the emergency department, for the first steps in management. The latest guidance on the management of cardiac arrest which the obstetric anaesthetist will be required to immediately attend and initiate in a pregnant woman is described in detail, with the steps needed to progress to perimortem caesarean delivery if resuscitation is not immediately effective. The serious complications of regional anaesthesia; high blocks, total spinals, and local anaesthesia toxicity are emphasized. Anaphylaxis, magnesium toxicity, and management of trauma in the obstetric patient are also outlined.
Anaesthesia for non-obstetric surgery
Authors: Garry Martin
Published: September 2020

It is not uncommon for a woman to require urgent or emergency surgery for many differing co-incidental reasons during pregnancy. It invariably causes a degree of concern to both the woman and the responsible anaesthetist, particularly if general anaesthesia is necessary, as surgery can precipitate onset of premature labour and fetal loss. This chapter highlights the anaesthesia and surgical issues for the pregnant woman, recommendations for fetal monitoring and the effect of anaesthesia drugs on the developing fetus. An anaesthetic management plan is set out based on the pregnancy trimester, with postpartum considerations highlighted.
Neonatal resuscitation
Authors: Hayward Angela
Published: September 2020

It is not always possible to predict if a neonatal team is required at delivery, therefore it is vital that personnel who are present are able to provide prompt and effective basic newborn resuscitation, whilst additional help is requested. Resuscitating a baby at birth is different from all other age groups, due to the unique physiological adaptations that occur at that time. This chapter summarizes the steps required to initiate immediate neonatal resuscitation according to the Neonatal Life Support algorithm, advanced airway management with appropriate endotracheal sizing based on gestational age, the rationale for resuscitation with air vs 100% oxygen, and provision of circulatory support.
Contingent Objects, Contingent Propositions, and Essentialism
Authors: Werner Jonas
Published: September 2020

Trevor Teitel (2017) has recently argued that combining the assumption that modality reduces to essence with the assumption that possibly some objects contingently exist leads to problems if one wishes to uphold that the logic of metaphysical modality is S5. In this paper I will argue that there is a way for the essentialist to evade the problem described by Teitel. The proposed solution crucially involves the assumption that some propositions possibly fail to exist. I will show how this assumption affords a motivated contingentist response to Teitel’s argument.
Pooling of Upper Respiratory Specimens Using a SARS-CoV-2 Real-time RT-PCR Assay Authorized for Emergency Use in Low-Prevalence Populations for High-Throughput Testing
Authors: Borillo Gwynngelle A , Kagan Ron M , Baumann Russell E , Fainstein Boris M , Umaru Lamela , Li Hai-Rong , Kaufman Harvey W , Clarke Nigel J , Marlowe Elizabeth M
Published: September 2020

Background

Nucleic acid amplification testing is a critical tool for addressing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Specimen pooling can increase throughput and conserve testing resources but requires validation to ensure that reduced sensitivity does not increase the false-negative rate. We evaluated the performance of a real-time reverse transcription polymerase chain reaction (RT-PCR) test authorized by the US Food and Drug Administration (FDA) for emergency use for pooled testing of upper respiratory specimens.

Methods

Positive specimens were selected from 3 prevalence groups, 1%–3%, >3%–6%, and >6%–10%. Positive percent agreement (PPA) was assessed by pooling single-positive specimens with 3 negative specimens; performance was assessed using Passing-Bablok regression. Additionally, we assessed the distributions of RT-PCR cycle threshold (Ct) values for 3091 positive specimens.

Results

PPA was 100% for the 101 pooled specimens. There was a linear relationship between Ct values for pooled and single-tested specimens (r = 0.96–0.99; slope ≈ 1). The mean pooled Ct shifts at 40 cycles were 2.38 and 1.90, respectively, for the N1 and N3 targets. The median Cts for 3091 positive specimens were 25.9 (N1) and 24.7 (N3). The percentage of positive specimens with Cts between 40 and the shifted Ct was 1.42% (N1) and 0.0% (N3).

Conclusions

Pooled and individual testing of specimens positive for SARS-CoV-2 demonstrated 100% agreement, which demonstrates the viability of pooled specimens for SARS-COV-2 testing using a dual-target RT-PCR system. Pooled specimen testing can help increase testing capacity for SARS-CoV-2 with a low risk of false-negative results.
Bank Cleanups, Capitalization, and Lending: Evidence from India
Authors: Chopra Yakshup , Subramanian Krishnamurthy , Tantri Prasanna L
Published: September 2020

We examine the Indian bank asset quality review, which doubled the declared loan delinquency rate. Relative economic stability during the exercise and the absence of a capital backstop together make it unique. We find that the expected reduction in information asymmetry does not automatically lead to the recapitalization of banks by markets. The consequent undercapitalization leads to underinvestment and risk-shifting through zombie lending. The impact flows to the real economy through borrowers, including shadow banks, and adversely impacts growth. These findings show that bank cleanup exercises not accompanied by policies aimed at recapitalization may be insufficient even during normal times.
Humans’ pupillary contagion extends to cats and dogs
Authors: Axelsson Emma L , Fawcett Christine
Published: September 2020

When viewing pupil sizes change, our own pupil sizes change, a phenomenon known as pupillary contagion. This involuntary response is reliable between humans but can be affected by familiarity and empathy. We investigated whether the pupillary contagion response occurs for humans viewing familiar species—cats and dogs—and whether it is modulated by preferences for particular species. Pupil sizes were measured while viewing cat, dog and human images with small, medium and large pupils. Trait empathy, cat and dog affiliation and experience were subsequently measured. There was an image pupil size effect, but this did not vary by species. There was greater pupil size change to cats and dogs than to humans, but this might have been due to the varying size and appearance of the cats and dogs. Greater dog affiliation was also associated with smaller overall pupil size change to dogs and larger change to humans, but this did not interact with image pupil size. Dog affiliation might be associated with less arousal to dog images. In sum, pupillary contagion responses indicate a spontaneous transfer of information about internal states and the findings suggest that humans are sensitive to this across species, regardless of individual preference.
Evaluation of the Situation, Background, Assessment, and Recommendation Handover Tool in Improving Communication and Satisfaction Among Jordanian Nurses Working in Intensive Care Units
Authors: Dalky Heyam Fawaz , Al-Jaradeen Rawan Salem , AbuAlRrub Raeda Fawzi
Published: September 2020

Background

The SBAR (situation, background, assessment, and recommendation) is a standardized handover tool that has been utilized in health care settings. It has positive impacts on staff communication and patient quality of care. In Jordan, few reports are available about handover tools' impacts.

Purpose

To evaluate the implementation of the SBAR among nurses in intensive care units (ICUs) in Jordan.

Methods

A pretest–posttest quasi-experimental design was used. A convenience sample of 71 ICU nurses participated. The 43-item ICU physician-nurse questionnaire was used to measure SBAR effectiveness as measured by the following subscales: general relationship and communication, teamwork and leadership, and job satisfaction.

Results

There was a significant improvement in posttest knowledge scores and in “general relationships and communication” and “satisfaction” scores. There was a significant improvement in both “general relationships and communication” and “satisfaction” posttest scores compared with their pretest scores (t = 16.709, 2.656; P < .001, P < .01) consecutively.

Conclusions

This study revealed a strong indicator to encourage the SBAR utilization among nurses in health care settings. The SBAR has a positive impact on enhancing communication between nurses and increasing their job satisfaction. Thus, the utilization of such a standardized tool that maintains and assures good communication relationships shall increase level of satisfaction. Future studies are recommended to provide further evidence on its feasibility and efficacy as compared with traditional handover tools and among different health care contexts.
Reduction of Postoperative Infections Through Routine Preoperative Universal Decolonization of Advanced Heart Failure Patients With Chlorhexidine and Mupirocin Before Left Ventricular Assist Device Implantation
Authors: George Susan , Leasure A. Renee , McGovern Angela , Horstmanshof Douglas A.
Published: September 2020

Background

Left ventricular assist devices (LVADs) are increasingly being used in patients with advanced heart failure as bridge to transplant, bridge to decision, or destination therapy. Infections are a major complication associated with LVADs. Staphylococcus aureus is one of the common causative organisms associated with LVAD infections. Methicillin resistant staphylococcus aureus (MRSA)-colonized patients are at an increased risk for developing MRSA-associated infections. Various studies have demonstrated decolonization of skin with topical chlorhexidine and nares with 2% intranasal mupirocin ointment is effective in reducing MRSA-associated infections.

Objective

The objective of this observational study was to examine the impact of a universal decolonization protocol using topical chlorhexidine and intranasal mupirocin ointment for 5 days before LVAD implantation on postoperative infections (30, 60, and 90 days) and 30-day infection-related rehospitalization.

Methods

A preoperative universal decolonization with 4% chlorhexidine daily whole-body bath and 2% intranasal mupirocin ointment twice a day for 5 days was implemented for patients undergoing elective LVAD implantation. Using an observational study design, we included a convenience sample of 84 subjects who were established patients in an accredited advanced heart failure program. Thirty-seven patients served in the standard protocol group, and 47 in the universal decolonization protocol group participated in the observational study.

Results

In the standard protocol group, there were 4 MRSA infections with none in the universal decolonization group (χ2= 5.34,P= .03). In total, there were 8 surgical site infections in the standard protocol group and 1 in the universal decolonization group (χ2= 5.95,P= .01).

Conclusion

A 5-day universal decolonization protocol before LVAD implantation was effective in reducing total infections as well as MRSA-specific infections.
A UNILATERAL FOVEAL VITELLIFORM LESION IN A CHOROIDEREMIA CARRIER
Authors: Torm Marie E. W. , Eckmann-Hansen Christina , Christensen Søren K. , Larsen Michael
Published: September 2020

Purpose:

To describe a unilateral foveal vitelliform lesion associated with subnormal visual acuity in a choroideremia carrier.

Methods:

A retrospective case report, assessment of the best-corrected visual acuity, fundus photography, wide-angle scanning laser ophthalmoscopy, optical coherence tomography, and microperimetry.

Results:

A 37-year-old woman with a pathogenic 907C>T mutation in the choroideremia gene encoding Rab escort protein-1 presented with blurred vision in her left eye.

The Snellen best-corrected visual acuity was 20/20 in the right eye and 20/32 in the left eye, a unilateral decrease because it was 20/20 in both eyes at the most recent examination nine years earlier. In the left eye, a large vitelliform lesion with a diameter of 1,300 µm had developed in the fovea, whereas in the right eye, a smaller similar lesion was seen close to the fovea. Both eyes showed classical radial patterns of multiple bright fundus patches with associated autofluorescence defects and focal drusenoid lesions of the outer retina.

Conclusion:

With its large size and foveal location the vitelliform lesion in this patient's left eye is an unusual manifestation in an otherwise common Rab escort protein-1 mutation carrier state, and its unilaterality fits the assumption of random X-chromosome inactivation.
A Case of Vasculitis-Like Skin Eruption Associated With COVID-19
Authors: Geremia Nicholas , De Vito Andrea , Gunnella Susanna , Fiore Vito , Princic Elija , Panu Napodano Catello , Madeddu Giordano , Babudieri Sergio
Published: September 2020

Since the start of the SARS-CoV-2 outbreak, more than 4 million cases have been reported with almost 300,000 deaths. Commonly, the virus involves the respiratory system causing fever, cough, and dyspnea. On the contrary, cutaneous involvement has been infrequently reported. We described the case of a 72-year-old woman without a history of dermatologic diseases with COVID-19 who developed vasculitis-like skin eruptions. Because she has not received any treatment for COVID-19, we suggest that the dermatologic clinical picture was related to SARS-CoV-2.
Diabetes, insulin resistance, and asthma: a review of potential links
Authors: Wu Tianshi David
Published: September 2020

Purpose of review

Disorders of glucose metabolism, including insulin resistance, prediabetes, and diabetes, have been identified as risk factors for worsened asthma. This review summarizes emerging evidence for their role as modifiable risk factors in asthma, including the potential benefit of diabetes medications on asthma outcomes.

Recent findings

Experimental studies show that hyperinsulinemia associated with insulin resistance is associated with airway smooth muscle proliferation and promotes contractility. Epidemiologic studies have identified a higher prevalence of glycemic dysfunction among those with severe and uncontrolled asthma, and longitudinal studies have associated prediabetes and diabetes with higher risk of asthma exacerbations. The potential benefits of thiazolidinediones (TZDs), glucagon-like peptide-1 agonists, and metformin being investigated in asthma, but thus far interventional studies of TZDs have reported null results. On the contrary, observational studies have inconsistently controlled for relevant confounders which leaves conclusions vulnerable to misattribution of relationships due to corelated metabolic disorders, including dyslipidemia.

Developing evidence suggests that disorders of glucose metabolism may be associated with worsening asthma. However, these conditions arise within a network of obesity-related metabolic diseases that may themselves worsen asthma. Few interventional trials have not identified a benefit, but data have been limited. Additional research is needed to define the potential independent impact of disorders of glucose metabolism in asthma.
Psychiatric Morbidity and Personality Characteristics of Detained Adolescents With Delinquent Behavior
Authors: Nasreldin Mohamed , Gohar Sherif M. , Abdel Samie Mai , Madbouly Nagwan
Published: September 2020

The current study was undertaken with the aim of assessing the psychopathological symptoms, personality profile, and hostility in detained adolescents with delinquent behavior. A cross-sectional analytical study was carried out on 50 admitted adolescent delinquents in correctional institutes in the Greater Cairo region of Egypt. Results for delinquent adolescents were compared with age-equivalent adolescents with no history of delinquency. Both groups were subjected to the Adolescent and Adult Psychological State Inventory, Eysenck Personality Questionnaire, Locus of Control scale, and the Hostility and Direction of Hostility Questionnaire (HDHQ). Results concluded that adolescents with delinquent behavior displayed increased rates of psychiatric disorders over the comparative group. Significantly higher scores on the psychoticism, neuroticism, extraversion, and psychopathic deviation subscales and the Locus of Control scale were evident among the adolescent delinquent group compared with their nondelinquent peers. The delinquent group obtained, in general, higher overall scores on the HDHQ questionnaire when compared with the nondelinquent adolescents, while also obtaining higher scores on the paranoid hostility subscale of HDHQ. Acting out hostility scores correlated positively with neuroticism and psychoticism in delinquents. Psychiatric morbidity, extraversion, neuroticism, psychoticism, and increased hostility were found to contribute as major psychosocial factors underlying the psychopathology in detained juvenile delinquents.
Telehealth and the Community SMI Population
Authors: Talley Rachel M. , Brunette Mary F. , Adler David A. , Dixon Lisa B. , Berlant Jeffrey , Erlich Matthew D. , Goldman Beth , First Michael B. , Koh Steve , Oslin David W. , Siris Samuel G.
Published: September 2020

The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.
Quality and Safety in Healthcare, Part LXXII
Authors: Harolds Jay A.
Published: September 2020

Healthcare credentialing is the methodology used by an organization to obtain and validate a practitioner’s credentials, typically to participate in patient care. Privileging is the process by which the designated individuals in the healthcare organization evaluate the credentials, as well as the performance of the individual to determine that the provider is worthy to have certain privileges in the institution to contribute to the care of patients. The healthcare institution must have appropriate processes to ensure that providers continue to give excellent care in order to maintain privileges. There must also be procedures in place for remediation and revocation of privileges when necessary, as well as an appeals procedure. In addition, there should be provisions for privileging of temporary workers and for privileging in emergency situations.
18F-FDG PET/CT Findings in a Patient With Neurosarcoidosis
Authors: Chen Xueqi , Chen Guoqian , Fu Zhanli , Li Qian
Published: September 2020

A 58-year-old woman experienced 4 months of headache, fatigue, and depression, as well as 1 week of confusion and hallucinations. 18F-FDG PET/CT showed numerous hypermetabolic lesions in the pituitary gland and stalk, dura mater, glossopharyngeal nerve, and cauda equina, as well as in cervical and mediastinal lymph nodes. Surgical biopsy of the mediastinal lymph node confirmed the diagnosis of sarcoidosis. The follow-up 18F-FDG PET/CT, performed at the eighth month after the treatment of glucocorticoids and immunosuppressive agents, demonstrated complete remission of the previous hypermetabolic lesions.
Dysautonomia Is Linked to Striatal Dopamine Deficits and Regional Cerebral Perfusion in Early Parkinson Disease
Authors: Shin Hae-Won , Chung Seok Jong , Lee Sangwon , Cha Jungho , Sohn Young H. , Yun Mijin , Lee Phil Hyu
Published: September 2020

Purpose

The aim of this study was to investigate the association between autonomic dysfunction and striatal dopamine depletion or metabolic changes in de novo Parkinson disease (PD).

Methods

Based on the Composite Autonomic Severity Score (CASS), patients with de novo PD were classified into PD with (PD-AUT+) and without autonomic dysfunction (PD-AUT−) groups. We compared the dopamine transporter (DAT) availability in the striatum by quantitatively measuring18F-FP-CIT PET between both groups. We also assessed the association between DAT availability and the CASS. In addition, we compared regional uptake in early-phase images of18F-FP-CIT PET as well as cortical thickness between the PD-AUT+ and PD-AUT− groups.

Results

The PD-AUT+ group had significantly lower DAT availability in all striatal subregions than did the PD-AUT− group. The total CASS was significantly correlated with DAT availability in all striatal subregions. In addition, the subscores of the adrenergic component were correlated with DAT availability in all striatal subregions. The subscores of the cardiovagal component were negatively correlated with DAT availability in the caudate and ventral striatum. In early-phase18F-FP-CIT PET, the PD-AUT+ group exhibited decreased regional perfusion in the parieto-occipital areas and increased regional perfusion in the pallidothalamic, pontocerebellar, inferior frontal, and primary motor areas compared with the PD-AUT− group. There were no regions of different cortical thickness between the PD groups.

Conclusions

The present study revealed that autonomic dysfunction is closely linked to striatal dopamine depletion and prominent PD-related perfusion patterns in de novo PD, suggesting a greater pathological burden in patients with dysautonomia.
Peptide Receptor Radionuclide Therapy in Patients With Differentiated Thyroid Cancer
Authors: Lee Dong Yun , Kim Yong-il
Published: September 2020

Purpose

As patients with progressive medullary thyroid cancer (MTC) and radioiodine-refractory metastatic differentiated nonmedullary thyroid cancer (DTC) have poor prognoses and present therapeutic challenges, peptide receptor radionuclide therapy (PRRT) targeting the somatostatin receptor provides a promising option. This meta-analysis evaluated the therapeutic effects and outcomes of PRRT in differentiated thyroid cancer.

PATIENTS AND METHODS

PUBMED, EMBASE, CINAHL, SCOPUS, and COCHRANE were systematically searched using appropriate key words. The primary therapeutic effect was the radiological response after PRRT, and the objective response rate (ORR) and disease control rate (DCR) were identified in MTC and DTC, respectively. The outcome of serious adverse events (grade 3 or 4), additional therapeutic effects of 18F-FDG PET/CT and biochemical (calcitonin and thyroglobulin) responses, and radionuclides for PRRT were assessed as subgroup analyses. The parameters were generated as pooled proportions.

Results

Eleven articles with 165 patients were included (98 patients with MTC and 67 patients with DTC). PRRT achieved pooled proportions of ORR in 8.53% to 15.61%, DCR in 53.95% to 59.99%, and serious adverse events in 2.79% to 2.82% in MTC and DTC patients. 18F-FDG PET/CT and biochemical responses revealed similar results as the radiological response. 177Lu-based PRRT (ORR, 11.48%–24.52%; DCR, 61.47%–67.26%) showed better therapeutic effects than 90Y-based PRRT (ORR, 6.98%–13.82%; DCR, 50.86%–57.29%).

Conclusions

This meta-analysis suggests that PRRT could be a potential and safe strategy for MTC and DTC. In particular, PRRT with 177Lu exhibited improved therapeutic effects relative to PRRT with 90Y.
18F-NaF Uptake in Breast Cancer
Authors: Liu Huipan , Liu Lin , Fu Wenhui , Chen Yue
Published: September 2020

A 55-year-old woman with back pain underwent 18F-NaF PET/CT study to evaluate bone metastases from newly diagnosed breast cancer. Multiple foci of increased tracer uptake indicating osteoblastic metastases were noted in cervical and thoracic vertebrae. Unexpectedly, breast cancer also revealed increased NaF activity.
Adrenal and Bone Metastases as the Initial Presentation of Endometrial Carcinoma Diagnosed by 18F-FDG PET/CT
Authors: Su Minggang , Sun Jiangming , Fan Qiuping , Tian Rong
Published: September 2020

Adrenal and bone metastases as the initial presentation of endometrial carcinoma are rare. We report a case of endometrial carcinoma in a 47-year-old woman with initial manifestation as right chest wall pain, which was suspected as adrenal cortical carcinoma with rib metastasis after diagnostic CT scan. However, uterine and pelvic bone lesions were revealed by staging FDG PET/CT. Eventually, endometrial carcinoma with adrenal and bone metastases was confirmed pathologically.
Is It Time to Introduce PET/CT in Rectal Cancer Guidelines?
Authors: Maffione Anna Margherita , Montesi Giampaolo , Caroli Paola , Colletti Patrick M. , Rubello Domenico , Matteucci Federica
Published: September 2020

At the moment, international guidelines for rectal cancer suggest to consider 18F-FDG PET/CT scan in a few conditions: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma with potentially curable M1 disease; (2) in the recurrence workup for serial carcinoembryonic antigen level elevation; (3) in the recurrence workup with metachronous metastases documented by CT, MRI, or biopsy; (4) in case of strong contraindication to IV contrast agent administration; and (5) to evaluate an equivocal finding on a contrast-enhanced CT or MRI. PET/CT is not indicated in the follow-up or surveillance of rectal cancer. On the other hand, an attentive evaluation of the literature shows that PET/CT may also be used in some circumstances with significant levels of diagnostic accuracy. This review article aims to emphasize differences between current international guidelines and scientific literature in the role of PET/CT in rectal cancer.
18F-FDG Uptake in a Mesonephric Carcinoma
Authors: Luong Thien Vinh , Lindegaard Jacob Christian , Donskov Frede , Mejlgaard Else , Bouchelouche Kirsten
Published: September 2020

We present the case of a 39-year-old woman with vaginal bleeding and abdominal pain. An 18F-FDG PET/CT showed high 18F-FDG uptake in a tumor in the pouch of Douglas, in 3 lymph nodes in the pelvis, and in the left tuber ischiadicum. Biopsies revealed a mesonephric carcinoma with metastases. Six series of empiric chemotherapy with carboplatin, paclitaxel, and bevacizumab were not sufficient to treat the cancer, and checkpoint immunotherapy with nivolumab and ipilimumab was initialized.
Ureteral Metastasis From Prostate Cancer
Authors: Chaussé Guillaume , Skinnider Brian , Crook Juanita , Black Peter , Abikhzer Gad , Probst Stephan
Published: September 2020

A 72-year-old man with a history of prostate adenocarcinoma initially managed by radical prostatectomy and salvage radiation therapy underwent resection of a left vas deferens recurrence identified on PSMA PET. Despite an initial response, PSA failed to fall below 3.5 ng/L, prompting re-evaluation with PSMA PET/CT: a left distal hydroureter with presumed physiologic urine activity remains despite diuretic administration. Upon scrutiny of the prior PSMA PET/CT and diagnostic CTs, the distal ureteral uptake matched a subtle circumferential area of enhancing mild ureteral thickening. Pathological review after left uretectomy confirmed metastatic prostate cancer.
18F-FDG PET/CT in Hodgkin Lymphoma With Unsuspected COVID-19
Authors: Boulvard Chollet Xavier L.E. , Romero Robles Leonardo G. , Garrastachu Puy , Cabrera Villegas Antonio , Albornoz Almada M. Clara , Colletti Patrick M. , Rubello Domenico , Ramírez Lasanta Rafael , Delgado Bolton Roberto C.
Published: September 2020

We present an asymptomatic 70-year-old man referred for an 18F-FDG PET/CT for initial staging of a Hodgkin lymphoma. 18F-FDG PET/CT showed bilateral cervical lymphadenopathy (stage II). Incidentally, the CT demonstrated bilateral ground-glass opacities with low-grade 18F-FDG activity. CT findings were suspicious for COVID-19 pneumonitis. The COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) examination result was negative. Given the high clinical suspicion for COVID-19, the patient was isolated and repeat RT-PCR was positive at 72 hours. RT-PCR may be falsely negative in early COVID-19 disease, even with positive CT findings.
Three Cases of Diffuse, Intense Stomach Uptake on DOTATATE PET
Authors: Auerbach Martin S. , Pisegna Joseph R. , Kim Stephen , Yu Run
Published: September 2020

Incidental tracer uptake on DOTATATE PET is increasingly encountered in clinical practice. We describe 3 patients with suspected or known neuroendocrine tumor who were found to have diffuse and intense stomach uptake on DOTATATE PET. All patients underwent esophagogastroduodenoscopy and/or endoscopic ultrasound; the cause of the stomach uptake was attributed to proton-pump inhibitor use, chronic gastritis, and gastrinoma, respectively. These 3 cases highlight that diffuse and intense stomach DOTATATE uptake can be a benign finding probably attributed to proton-pump inhibitor use, chronic gastritis, or gastrinoma.
Hepatic Schwannoma on 18F-FDG PET/CT
Authors: Liu Yachao , Xu Baixuan
Published: September 2020

Schwannoma is a slow-growing benign tumor, which originates from Schwann cells and is usually asymptomatic. The most common sites of schwannomas are the head, neck, and extremities. However, a schwannoma located in the liver is extremely rare. Here, we report a 53-year-old woman with a hepatic lesion accidentally found by ultrasound. It was highly suggestive of hepatic cholangiocarcinoma by MRI. 18F-FDG PET/CT could not exclude hepatic malignant tumor due to its high metabolism. Finally, it was confirmed as hepatic schwannoma by postoperative pathology.
Multifocal Interdigitating Dendritic Cell Sarcoma Demonstrated on FDG PET/CT Imaging
Authors: Bai Xia , Wang Xiangcheng , Wang Xuemei
Published: September 2020

Interdigitating dendritic cell sarcoma is a very rare malignancy that more commonly occurs in one anatomic location. Surgical resection of the lesion is the mainstay of the therapy. Multiple lesions at different locations are less common at the presentation. We report FDG PET/CT findings of multifocal interdigitating dendritic cell sarcoma in a 30-year-old woman.