bluuebunny/crossref_metadata_2025 huggingface dataset:
29 Art. 80 GG: Issuance of Executive Orders
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the relevant provisions of Art. 80 of the Grundgesetz (GG) with regard to the issuance of executive orders. Under the Grundgesetz, only the federal government, a federal minister, or state governments may create executive orders, and only to the extent that they are expressly authorised to do so by a parliamentary law. The chapter first examines the Federal Constitutional Court's jurisprudence concerning the scope of Art. 80 GG, focussing on the delegation of law-making power to the executive in the form of authorisation to promulgate executive orders. It then considers the specificity of the delegation of powers, with emphasis on the four formulas developed by the Court: foreseeability formula, autonomous decision formula, program formula and clarity formula. It also analyses the requirement of citation for authorities which create an executive order, the procedure for issuing executive orders, and executive orders which require consent by the Bundesrat.
32 Art. 103 GG: Right to a Lawful Hearing, Ban on Retroactive Punishment, and Ban on Multiple Punishments for the Same Crime
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses three separate fundamental rights that are guaranteed in Art. 103 of the Grundgesetz (GG): the right to a hearing before a court, the ban on retroactive punishment and the requirement of specificity in criminal laws, and the ban on multiple punishments for the same crime. It first examines the Federal Constitutional Court's jurisprudence concerning the function and significance of the right to a hearing and the direct applicability of Art. 103 before explaining the Court's position on the timing of the hearing and the right to a hearing in relation to the procedural rules of preclusion. It also analyses the Court's decisions in cases relating to the requirement of specificity in criminal laws and the prohibition of retroactivity, including those that deal with Sit-In Protest and preventive detention.
The Troubled Friendship of Clemens Brentano and Rahel Levin in the Shadow of the Christlich-deutsche Tischgesellschaft*
Authors: Hertz Deborah
Published: July 2019

This article reconstructs the friendship between the Romantic author Clemens Brentano and the Jewish salonnière Rahel Levin, and explores her motivations for maintaining a friendship with him in spite of his public and private attacks on contemporary Jews, including her. Through analysis of his 1811 speech at the Christlich-deutsche Tischgesellschaft and the letters they exchanged, the article shows how limited Levin’s options were for balancing her identity as a Jew with her social and intellectual ambitions.
The interface with community services
Authors: Morton Christopher , Norman-Nott Arabella
Published: July 2019

The interface between inpatient and community services requires special attention in order to provide safe and high-quality care to patients who are significantly unwell, pose significant risks, and are transitioning between teams. This chapter provides an outline of how community services work to provide care for patients with mental health problems both in the community and in hospital. The authors describe their experience working within an adapted flexible assertive community treatment (FACT) model of care, alongside the Care Programme Approach for supporting service users and carers during their journey through services. The contribution of a community partnership between mental health services and the voluntary sector organizations is also described, with a focus on the support it provides to patients in delivering timely and safe discharge from the acute inpatient ward.
Rehabilitation wards
Authors: Dauncey Karen , Patterson Janet
Published: July 2019

This chapter describes, from the authors’ own experience and practice, the workings of a modern rehabilitation ward in an English hospital. It includes some of the authors’ guiding principles, and how some aspects of rehabilitation practice are necessarily different from those in an acute ward. The components, skills, and interventions provided by the team are considered, along with ways in which the care and treatment can be evaluated. A rehabilitation ward is part of a wide range and network of provision for people with severe mental illness and the authors believe that all mental health services in the UK should have rehabilitation provision as a core requirement at district level.
Accreditation of inpatient mental health services
Authors: Chaplin Rob
Published: July 2019

This chapter outlines how a programme of accreditation can help improve the standards of care on inpatient units by describing the Accreditation for Inpatient Mental Health Services (AIMS). The development of and need for accreditation are outlined with evidence of how accreditation adds value to the process of audit. There is a discussion of how data obtained from national audits of inpatient care and accreditation have been used to describe the quality of inpatient mental health services. There follows a report of the local use of the accreditation programme for an acute mental health inpatient ward for men in Oxford. Finally, some key standards are provided in order to describe what a high-quality inpatient unit may look like.
Oxford Handbook of Psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This fourth edition of what has become an indispensable pocket guide to general psychiatry and the subspecialties continues to provide portable reassurance to health professionals at all levels of experience when dealing with psychiatric issues. As well as a comprehensive overview of the common presentations in psychiatry, this handbook includes practical guidance on the principles of management for individual conditions. Subspecialties, including old age psychiatry, substance misuse, child and adolescent psychiatry, forensic psychiatry, intellectual disability, liaison psychiatry, and psychotherapy are covered in separate chapters, as are overarching considerations such as legal issues, cultural context, and therapeutics. As in previous editions, the handbook is indexed alphabetically, by ICD-10/DSM-5 codes, and by acute presentations for quick access to topics. The text is peppered with clinical observations, guidance, and commentary, reflecting the authors’ own experiences of working in psychiatry. This new edition has been thoroughly revised and updated to include the latest clinical guidelines, new licensed drug indications, changes to the legislature impacting on psychiatric practice across the United Kingdom and Ireland, the new DSM-5 classification system, and the anticipated ICD-11 changes to diagnostic coding.
Thinking about psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter introduces ways of thinking about psychiatry, from investigating the question ‘what is disease’ to techniques for diagnosis and treatment and overarching themes of the role of the psychiatrist. With a brief history and a discussion of potential future directions of the discipline, this chapter provides an overview and rationale for the subsequent content.
Neuropsychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers neuropsychiatry in the medical sense (behavioural neurology and neuropsychiatry). Starting with the psychiatric presentations of organic illness and neurological examinations and investigations in psychiatry, it covers movement disorders, neurodevelopmental disorders, epilepsy, Parkinson’s disease and other related syndromes, and the psychiatric effects of central nervous system infections and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Outlining both the aetiology and treatment for dementia and Alzheimer’s disease, other specific neurodegenerative conditions are also featured.
Depressive illness
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers depression. After a historical perspective, it describes the symptoms, caseness, and clinical presentations to aid in diagnosis. Epidemiology and aetiology of the disease are both covered, and specific investigations for diagnosis are outlined. The course and prognosis are discussed, and management principles are covered. Both inpatient and outpatient treatment are covered. Treatment methods for depression both with and without psychotic features are defined, and treatment-resistant depression management is also discussed. Antidepressants, including schedules for swapping or stopping drugs, are covered, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs), as well as assorted other pharmaceutical interventions. Electroconvulsive therapy (ECT) is covered in detail.
Eating and impulse-control disorders
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers eating disorders. For anorexia nervosa, an overview, the physical consequences, methods of assessment, and in- and outpatient management are discussed. Similarly, the definitions and management for bulimia are also described, with a brief overview of binge eating disorder. Impulse-control disorders are subsequently defined, from pyromania, kleptomania, and intermittent explosive disorder to gambling and trichotillomania. Newer addictive disorders, such as gaming disorder, are also covered.
Personality disorders
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers personality disorders, using the framework of defining a ‘normal’ personality to classify different disorders. Psychopathy and severe personality disorder are defined, including assessment, diagnosis, and aetiology of these disorders. The relationship between personality disorders and other mental health conditions are discussed, and assessment is also described. Management is described, from general aspects to specific pharmacological treatments and psychotherapy.
Old age psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter covers old age psychiatry, including both psychiatric illnesses in older people and specific aspects of illness with regard to the elderly, from neuroses and psychoses to mood disorders. New disorders owing to specific old age-related issues, such as bereavement, isolation, and the changing physiology of the brain, are covered, as well as pre-existing illnesses in the ageing patient. The increasing recognition of elder abuse is defined, and responses outlined. End of life considerations, such as power of attorney and advanced directives, are included.
Liaison psychiatry
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter concerns liaison psychiatry and the assessment and management of psychiatric and psychological illnesses in the general medical population. It covers the 12 most common referral types, assessment of depressive and anxiety symptoms, psychotic symptoms and confusion, depression in physical illness, delirium, and management after self-harm. Focusing on capacity and consent, as well as differential diagnoses and potential management principles for medically unexplained symptoms, it covers the basis of working as a psychiatrist in a hospital.
Difficult and urgent situations
Authors: Semple David , Smyth Roger
Published: July 2019

Covering difficult and emergency situations encountered in psychiatric practice, this chapter informs the reader how to deal with crisis situations. It includes suggestions for dealing with patients responding to paranoid delusions, antisocial or borderline traits, the depressed person, and those experiencing acute stress. A multidisciplinary approach to suicide attempts in hospital is detailed. Severe behavioural disturbance and guidelines for rapid tranquillization (RT) are also covered. Issues of child protection and how to deal with patients who are manipulative or act against medical advice, and common clinical scenarios are all discussed.
ICD-10/DSM-5 index
Authors: Semple David , Smyth Roger
Published: July 2019

This chapter is an index of ICD-10 and DSM-5 category codes and their relation to other information within this book.
Screening
Authors: Raffle Angela E. , Mackie Anne , Gray J. A. Muir
Published: July 2019

Muir Gray, Anne Mackie and Angela Raffle have been at the forefront of achieving improvements in UK screening over recent years, and they bring a wealth of experience to this non-technical introductory guide covering all aspects of screening. As USA expert Gilbert Welch describes it, this book is “A readable yet encyclopaedic guide to screening: its history, its key design elements, its implementation and policy challenges… A must read for clinicians, managers, and policy makers who would like to assist Raffle Mackie and Gray in achieving their goal: ‘to sort out the mess’.” The first four chapters deal with concepts, methods and evidence, explaining what screening is and how it is evaluated. Chapters five to eight describe practical aspects, for example how to make policy, and how to deliver screening to a high standard. The book includes numerous examples and real-life case histories, giving important reminders of the need to be vigilant for the hidden influence of commercial incentives and ‘bad science’ if we are to achieve best value health and healthcare. A comprehensive glossary makes medical terms accessible to all, and each chapter concludes with a summary and self-test questions. Reference is made to the UK National Health Service, a leader in screening, but the book is internationally relevant because the principles of good screening apply in any setting. The controversies, paradoxes, uncertainties, and ethical dilemmas of screening are explained in a balanced way.
What screening is, and is not
Authors: Raffle Angela E. , Mackie Anne , Gray J. A. Muir
Published: July 2019

This chapter reviews the different ways in which the term ‘screening’ has been and is used, and defines the meaning used throughout the rest of the book. Growth of screening programmes in the twentieth century led to a range of activities which vary widely in purpose and process, from bloodspot tests in newborn babies, through to whole body scans for the wealthy worried well. This chapter explains the different kinds of testing done on healthy people, and how these differ from diagnostic tests for solving problems that patients bring to clinicians. It explains where screening fits in the pathway of disease development. It describes the basic system that makes up a screening programme as opposed to just a screening test. It explains, using infant phenylketonuria as a case history, why screening needs to be delivered as a proper programme if it is to successfully achieve risk reduction. We describe the variation in screening delivery across different countries and emphasise that this book focuses on systematic screening programmes, aimed at risk reduction for the screened individual, based on sound evidence that harm, benefit and affordability are well balanced, and delivered to pre-agreed policy and standards.
Formation of Second Generation Stars in Globular Clusters
Authors: Calura F , D’Ercole A , Vesperini E , Vanzella E , Sollima A
Published: July 2019

By means of grid-based, 3D hydrodynamical simulations we study the formation of second generation (SG) stars in a young globular cluster (GC) of mass 107 M⊙, the possible progenitor of an old GC with a present mass ∼ (1 − 5) 106 M⊙. The cluster accretes external gas as its first generation (FG) asymptotic giant branch (AGB) stars release their ejecta and SG stars form. We consider two models characterised by different densities of the external gas. In both cases, we find that a very compact SG subsystem with central density >105 M⊙/pc3 forms in the innermost regions of the cluster. The low-density model forms a population of extreme SG stars with high helium enhancement, followed by the formation of another SG group out of a mix of pristine gas and AGB ejecta and characterised by a modest helium enhancement. On the other hand, the high-density model forms in prevalence SG stars with modest helium enhancement. Our simulations illustrate the dynamical processes governing the formation of SG populations in GCs and shed light on the structural properties emerging at the end of this phase. The newly born SG groups have different concentrations, with more extreme SG stars more centrally concentrated than those with less extreme chemical abundances. The very high density of the SG subsystems implies that SG massive stars, if formed, might suffer frequent close encounters, collisions and gas stripping, thus possibly contributing further gas to the SG formation.
The supernova-regulated ISM – VI. Magnetic effects on the structure of the interstellar medium
Authors: Evirgen C C , Gent F A , Shukurov A , Fletcher A , Bushby P J
Published: July 2019

We explore the effect of magnetic fields on the vertical distribution and multiphase structure of the supernova-driven interstellar medium in simulations that admit dynamo action. As the magnetic field is amplified to become dynamically significant, gas becomes cooler and its distribution in the disc becomes more homogeneous. We attribute this to magnetic quenching of vertical velocity, which leads to a decrease in the cooling length of hot gas. A non-monotonic vertical distribution of the large-scale magnetic field strength, with the maximum at |z| ≈ 300 pc causes a downward pressure gradient below the maximum which acts against outflow driven by SN explosions, while it provides pressure support above the maximum.
Linking long- and short-term emission variability in pulsars
Authors: Brook P R , Karastergiou A , Johnston S
Published: July 2019

It is now known that the emission from radio pulsars can vary over a wide range of time-scales, from fractions of seconds to decades. However, it is not yet known if long- and short-term emission variability are caused by the same physical processes. It has been observed that long-term emission variability is often correlated with rotational changes in the pulsar. We do not yet know if the same is true of short-term emission variability, as the rotational changes involved cannot be directly measured over such short time-scales. To remedy this, we propose a continuous pulsar monitoring technique that permits the statistical detection of any rotational changes in nulling and mode-changing pulsars with certain properties. Using a simulation, we explore the range of pulsar properties over which such an experiment would be possible.
Vitamin C protects carboplatin-exposed oocytes from meiotic failure
Authors: Zhou Changyin , Zhang Xue , Zhang Yuwei , ShiYang Xiayan , Li Yu , Shi Xiaoyan , Xiong Bo
Published: July 2019

CBP (carboplatin) is a second-generation chemotherapeutic drug of platinum compound commonly applied in the treatment of sarcomas and germ cell tumours. Although it is developed to replace cisplatin, which has been proven to have a variety of side effects during cancer treatment, CBP still exhibits a certain degree of toxicity including neurotoxicity, nephrotoxicity, hematotoxicity and myelosuppression. However, the underlying mechanisms regarding how CBP influences the female reproductive system especially oocyte quality have not yet been fully determined. Here, we report that CBP exposure led to the oocyte meiotic defects by impairing the dynamics of the meiotic apparatus, leading to a remarkably aberrant spindle organisation, actin polymerisation and mitochondrial integrity. Additionally, CBP exposure caused compromised sperm binding and fertilisation potential of oocytes by due to an abnormal distribution of cortical granules and its component ovastacin. More importantly, we demonstrated that vitamin C supplementation prevented meiotic failure induced by CBP exposure and inhibited the increase in ROS levels, DNA damage accumulation and apoptotic incidence. Taken together, our findings demonstrate the toxic effects of CBP exposure on oocyte development and provide a potential effective way to improve the quality of CBP-exposed oocytes in vitro.
PUB4, a CERK1-Interacting Ubiquitin Ligase, Positively Regulates MAMP-Triggered Immunity in Arabidopsis
Authors: Desaki Yoshitake , Takahashi Shohei , Sato Kenta , Maeda Kanako , Matsui Saki , Yoshimi Ikuya , Miura Takaki , Jumonji Jun-Ichi , Takeda Jun , Yashima Kohei , Kohari Masaki , Suenaga Takayoshi , Terada Hayato , Narisawa Tomoko , Shimizu Takeo , Yumoto Emi , Miyamoto Koji , Narusaka Mari , Narusaka Yoshihiro , Kaku Hanae , Shibuya Naoto
Published: July 2019

Lysin motif (LysM) receptor-like kinase CERK1 is a co-receptor essential for plant immune responses against carbohydrate microbe-associated molecular patterns (MAMPs). Concerning the immediate downstream signaling components of CERK1, receptor-like cytoplasmic kinases such as PBL27 and other RLCK VII members have been reported to regulate immune responses positively. In this study, we report that a novel CERK1-interacting E3 ubiquitin ligase, PUB4, is also involved in the regulation of MAMP-triggered immune responses. Knockout of PUB4 resulted in the alteration of chitin-induced defense responses, indicating that PUB4 positively regulates reactive oxygen species generation and callose deposition but negatively regulates MAPK activation and defense gene expression. On the other hand, detailed analyses of a double knockout mutant of pub4 and sid2, a mutant of salicylic acid (SA) synthesis pathway, showed that the contradictory phenotype of the pub4 mutant was actually caused by abnormal accumulation of SA in this mutant and that PUB4 is a positive regulator of immune responses. The present and recent findings on the role of PUB4 indicate that PUB4 is a unique E3 ubiquitin ligase involved in the regulation of both plant immunity and growth/development.
Cardiovascular autonomic dysfunction, altered sleep architecture, and muscle overactivity during nocturnal sleep in pediatric patients with narcolepsy type 1
Authors: Vandi Stefano , Rodolfi Sara , Pizza Fabio , Moresco Monica , Antelmi Elena , Ferri Raffaele , Mignot Emmanuel , Plazzi Giuseppe , Silvani Alessandro
Published: July 2019

Study Objectives

Arterial blood pressure (ABP) decreases during sleep compared with wakefulness and this change is blunted in mouse models of and adult patients with narcolepsy type 1 (NT1). We tested whether: (1) pediatric patients with NT1 have similar cardiovascular autonomic abnormalities during nocturnal sleep; and (2) these abnormalities can be linked to hypocretin-1 cerebrospinal fluid concentration (CSF HCRT-1), sleep architecture, or muscle activity.

Methods

Laboratory polysomnographic studies were performed in 27 consecutive drug-naïve NT1 children or adolescents and in 19 matched controls. Nocturnal sleep architecture and submentalis (SM), tibialis anterior (TA), and hand extensor (HE) electromyographic (EMG) activity were analyzed. Cardiovascular autonomic function was assessed through the analysis of pulse transit time (PTT) and heart period (HP).

Results

PTT showed reduced lengthening during total sleep and REM sleep compared with nocturnal wakefulness in NT1 patients than in controls, whereas HP did not. NT1 patients had altered sleep architecture, higher SM EMG during REM sleep, and higher TA and HE EMG during N1–N3 and REM sleep when compared with controls. PTT alterations found in NT1 patients were more severe in subjects with lower CSF HRCT-1, but did not cluster or correlate with sleep architecture alterations or muscle overactivity during sleep.

Conclusion

Our results suggest that pediatric NT1 patients close to disease onset have impaired capability to modulate ABP as a function of nocturnal wake–sleep transitions, possibly as a direct consequence of hypocretin neuron loss. The relevance of this finding for cardiovascular risk later in life remains to be determined.
The first metriorhynchoid crocodyliform from the Aalenian (Middle Jurassic) of Germany, with implications for the evolution of Metriorhynchoidea
Authors: Aiglstorfer Manuela , Havlik Philipe , Herrera Yanina
Published: July 2019

Thalattosuchia, a clade of Mesozoic aquatic crocodyliforms, were the only archosaurs that ever became fully adapted to marine ecosystems. They are represented by two clades, the semiaquatic teleosauroids and the metriorhynchoids, which include fully pelagic forms. So far, little is known on the early evolutionary history of Metriorhynchoidea and data are sparse, especially from the early Middle Jurassic. Opisuchus meieri gen. et sp. nov. a metriorhynchoid crocodyliform from the early Aalenian (early Middle Jurassic) of southern Germany, is described here. It is one of the most complete specimens of a non-metriorhynchid metriorhynchoid, and the best-preserved thalattosuchian described from the Aalenian. The new taxon is represented by a nearly complete skull, which has a unique combination of characters distinguishing it from other species of Metriorhynchoidea. It displays a mosaic of plesiomorphic and apomorphic morphological features that sheds new light on early metriorhynchoid evolution. This taxon is an important puzzle piece, which will help to better track the mosaic character distribution in Thalattosuchia.
Making OTC Oral Contraceptives Available for All Women
Authors: Haracz Julie Michelle
Published: July 2019

Sensible legislation has been introduced. It's time to pass it.
Time Extended for Use of Image-Guided Intravenous Alteplase After Stroke
Authors: Potera Carol
Published: July 2019

Patients benefit from treatment up to nine hours.
The Changing Landscape of Simulation-Based Education
Authors: Morse CatherineJean , Fey Mary , Kardong-Edgren Suzie , Mullen Ann , Barlow Melanie , Barwick Stephanie
Published: July 2019

Once considered solely as an educational tool in undergraduate education, simulation-based education (SBE) now has many uses. SBE is now embedded in both graduate and undergraduate nursing education programs and has become increasingly accepted practice in hospital orientation and transition-to-practice programs. Newer applications include ongoing professional education, just-in-time training, teamwork development, and systems testing. This article highlights the changing landscape of SBE and describes elements critical to its successful use, including facilitator competencies, the necessity of providing a psychologically safe environment to enable learning, and the importance of addressing other safety concerns, such as the possibility of accidentally introducing simulated equipment and medications into real patient care.
Higher Prevalence of Sexual Assault Among Transgender and Nonbinary Adolescent Students
Authors: Rosenberg Karen
Published: July 2019

According to this study:

Transgender and gender nonbinary adolescents experience high rates of sexual assault in school.

The risk of assault is higher in schools that restrict students from using restrooms and locker rooms that align with their gender identity.
Uterine Cancer Rates Rising, Racial Disparities Found
Authors: Rosenberg Karen
Published: July 2019

According to this study:

Uterine cancer incidence rates, including for aggressive nonendometrioid subtypes and corrected for hysterectomy prevalence, have been rising significantly in the United States.

Higher incidence of nonendometrioid cancers and poorer survival rates among non-Hispanic black women indicate profound racial differences and disparities.
A New Era in Pediatric Hospice Care for Military Families
Authors: Smith Marsha G. Wilson , LaFond Deborah A. , Keim-Malpass Jessica , Lindley Lisa C. , Matzo Marianne
Published: July 2019

This series on palliative care is developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; https://advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research.
Difficult Conversations
Authors: Arroyo Vanessa
Published: July 2019

With time running out, a nurse makes sure a family answers a crucial question.
Optimal Arterial Blood Oxygen Tension in the Early Postresuscitation Phase of Extracorporeal Cardiopulmonary Resuscitation: A 15-Year Retrospective Observational Study*
Authors: Chang Wei-Tien , Wang Chih-Hung , Lai Chien-Heng , Yu Hsi-Yu , Chou Nai-Kuan , Wang Chih-Hsien , Huang Shu-Chien , Tsai Pi-Ru , Chou Fang-Ju , Tsai Min-Shan , Huang Chien-Hua , Ko Wen-Je , Chen Wen-Jone , Chen Yih-Sharng
Published: July 2019

Objectives:

Hyperoxia could lead to a worse outcome after cardiac arrest. Few studies have investigated the impact of oxygenation status on patient outcomes following extracorporeal cardiopulmonary resuscitation. We sought to delineate the association between oxygenation status and neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation.

Design:

Retrospective analysis of a prospective extracorporeal cardiopulmonary resuscitation registry database.

Setting:

An academic tertiary care hospital.

Patients:

Patients receiving extracorporeal cardiopulmonary resuscitation between 2000 and 2014.

Interventions:

None.

Measurements and Main Results:

A total of 291 patients were included, and 80.1% were male. Their mean age was 56.0 years. The arterial blood gas data employed in the primary analysis were recorded from the first sample over the first 24 hours in the ICUs after return of spontaneous circulation. The mean Pao
2 after initiation of venoarterial extracorporeal membrane oxygenation was 178.0 mm Hg, and the mean Pao
2/Fio
2 ratio was 322.0. Only 88 patients (30.2%) demonstrated favorable neurologic status at hospital discharge. Multivariate logistic regression analysis indicated that Pao
2 between 77 and 220 mm Hg (odds ratio, 2.29; 95% CI, 1.01–5.22; p = 0.05) and Pao
2/Fio
2 ratio between 314 and 788 (odds ratio, 5.09; 95% CI, 2.13–12.14; p < 0.001) were both positively associated with favorable neurologic outcomes.

Conclusions:

Oxygenation status during extracorporeal membrane oxygenation affects neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. The Pao
2 range of 77 to 220 mm Hg, which is slightly narrower than previously defined, seems optimal. The Pao
2/Fio
2 ratio was also associated with outcomes in our analysis, indicating that both Pao
2 and the Pao
2/Fio
2 ratio should be closely monitored during the early postcardiac arrest phase for postextracorporeal cardiopulmonary resuscitation patients.
Antihypertensive and Vasodilatory Effects of Qingda Granules by Suppression of Calcium Influx and the AKT Pathway
Authors: Huang Yue , Wu Xiangyan , Wu Meizhu , Chu Jianfeng , Yu Na , Shen Aling , Shen Zhiqing , Chen Youqin , Peng Jun
Published: July 2019

The Qingda granule (QDG) formulation was simplified from the Qingxuan Jiangya Decoction, which has been used in China to treat hypertension for decades. However, the molecular mechanisms of QDG in antihypertension remain largely unknown. Therefore, we evaluated the therapeutic efficacy of QDG against elevated blood pressure and explored its underlying mechanism. QDG treatment decreased elevated blood pressure and increased the vascular elasticity of thoracic aortic rings to KCl stimulation in spontaneously hypertensive rats. QDG treatment increased the relaxation of isolated thoracic aortic rings precontracted with norepinephrine (NE) or KCl in an endothelium-independent manner, which was attenuated by treatment with verapamil, but not by treatment with TEA, 4-AP, Gli, or BaCl2. Moreover, QDG pretreatment attenuated the CaCl2-induced constriction of isolated thoracic aortic rings in K+- or NE-containing Ca2+-free solutions. In addition, QDG pretreatment significantly inhibited the influx of Ca2+ in A7r5 cells induced by a K+- or NE-containing Ca2+ solution and decreased the levels of p-AKT but had no effect on levels of total AKT protein in isolated thoracic aortic rings. Considering these results, QDG treatment attenuated elevated blood pressure and promoted the vasorelaxation of thoracic aortic rings by inhibiting the influx of Ca2+ and activating the AKT pathway.
Xanthoangelol Prevents Ox-LDL–Induced Endothelial Cell Injury by Activating Nrf2/ARE Signaling
Authors: Yan Rui , Yan Jifeng , Chen Xiaozhen , Yu Yunfu , Sun Tao
Published: July 2019

Objective:

Atherosclerosis (AS) contributes to the development of several cardiovascular diseases such as myocardial infarction and stroke. Oxidized low-density lipoprotein (Ox-LDL)–induced endothelial cell injury plays a key role in the pathogenesis of AS. Thus, this study was conducted to examine the effects of a naturally occurring flavonoid compound, xanthoangelol (XAG), on Ox-LDL–induced cell injury.

Materials and Methods:

Human umbilical vein endothelial cells (HUVECs) were used as the in vitro cell model. The number of viable cells was determined using CCK-8 assay. Cell apoptosis was detected using Hoechst staining. Percentage of apoptotic cells was quantified by flow cytometry. The cellular levels of malondialdehyde (MDA), superoxide dismutase, catalase (CAT), and glutathione peroxidase were determined using enzyme-linked immunosorbent assays. The cellular reactive oxygen species level was detected by flow cytometry after fluorescence staining. The mRNA expression levels of nuclear factor-E2–related factor-2 (Nrf2), heme oxygenase-1 (HO-1), and NQO-1 were determined using quantitative real-time polymerase chain reaction assay. The protein levels of cleaved caspase-3, cleaved poly ADP-ribose polymerase, Bax, Bcl-2, Nrf2, Keap1, HO-1, and NQO-1 were measured by using Western blot assay. The HUVECs were transfected with Nrf2 siRNA to reduce the expression of Nrf2.

Results:

XAG could effectively protect against Ox-LDL–stimulated cell death in HUVECs. These cytoprotective effects were due to its anti-apoptotic and anti-oxidant activities, as supported by the increase of SOD, CAT, and glutathione peroxidase activities, and the decrease of MDA and reactive oxygen species levels in injured HUVECs induced by Ox-LDL. Moreover, the results showed that XAG activated Nrf2/ARE signaling in a dose-dependent manner. Importantly, blockade of Nrf2 signaling using siRNA or specific inhibitor notably abolished the cytoprotective activities of XAG.

Conclusions:

These data suggest that XAG cytoprotects against Ox-LDL–induced cell injury through activating Nrf2/ARE–mediated antioxidative stress. Cumulatively, these findings show that EX has the potential to prevent and treat AS.
The female adolescent breast: disorders of development
Authors: Khaja Anam , DeSilva Nirupama
Published: July 2019

Purpose of review

This article will provide an overview on female breast development and focus on common abnormalities of growth, the emerging role of breast self-awareness, and discuss trends in the evaluation and treatment of the breast masses and disorders most often encountered in the female adolescent population.

Recent findings

Although the embryology of breast development is unchanged, data are emerging on the role of environmental factors on the timing of puberty and thelarche. As breast development occurs, the role of breast self-awareness is also a new trend that allows teens to be cognizant of changes in their own breast and to become more comfortable with their own anatomy. Finally, when breast treatments are needed or desired, the timing of breast treatments is a subject that must be individualized.

There are numerous conditions that can result from disruption of normal breast development. These resultant breast disorders are generally benign but can still cause emotional distress to both the patient and family. It is thus imperative that healthcare providers be educated on breast development, the common breast masses that occur in the adolescent population and be prepared to discuss breast self-awareness and shared decision-making in this population.
Evaluation of Current Perioperative Antimicrobial Regimens for the Prevention of Surgical Site Infections in Breast Implant-based Reconstructive Surgeries
Authors: Viola George M. , Rolston Kenneth V. , Butler Charles , Selber Jesse , Reece Gregory , Clemens Mark , Villa Mark , Raad Issam I. , Baumann Donald
Published: July 2019

Background:

Several steps to reduce the rate of postoperative surgical site infections (SSIs) have been implemented. The use of prophylactic antimicrobials targeting patient’s microbial flora has been associated with a decrease in postoperative infections. We evaluated the relationship between perioperative antimicrobials, baseline microbial flora, and occurrence of SSIs.

Methods:

We prospectively enrolled 241 patients scheduled to receive a postmastectomy implant-based reconstructive procedure between September 2015 and January 2018. Axillary swab cultures were obtained preoperatively, and all recovered bacteria were identified. Surgeons were blinded to these results. The use of prophylactic perioperative antimicrobials was defined as concordant if the baseline axillary flora were susceptible to the given antibiotic and discordant if not. As Staphylococcus species are the most common pathogen causative for breast implant-related infections, patients colonized with these organisms were analyzed in detail. All patients were followed up for at least 6 months postoperatively and evaluated for SSIs.

Results:

A total of 238 patients (99%) received both perioperative and postoperative oral antimicrobials. The most common preoperative staphylococci axillary flora recovered were methicillin-sensitive coagulase-negative Staphylococcus (67%), methicillin-resistant coagulase-negative Staphylococcus (35%), with only 1 case of methicillin-sensitive Staphylococcus aureus (0.4%). Thirty-three patients (14%) developed an SSI. Of those with a positive Staphylococcus culture, only 54% received a concordant antimicrobial regimen, but this was not associated with an increased risk for infection (P > 0.72).

Conclusions:

The use of perioperative antimicrobials whether concordant or discordant with the preoperative axillary microbial flora, specifically Staphylococci species, did not provide a significant impact on the risk of SSI.
ABSENCE OF MACULAR DEGENERATION IN A PATIENT WITH ACERULOPLASMINEMIA
Authors: Ronquillo Cecinio C. , Sauer Lydia , Morgan Denise , Heckzo Josh B. , Creel Donnell J. , Mamalis Nick , DeAngelis Margaret M. , Hagemann Gregory S. , Bernstein Paul S.
Published: July 2019

Purpose:

To describe the clinical, histological, electrophysiologic, and multimodal imaging findings in a 76-year-old patient with aceruloplasminemia with low genetic risk of age-related macular degeneration (AMD).

Methods:

Clinical examination as well as multimodal imaging including fundus photography, optical coherence tomography, fluorescence lifetime imaging ophthalmoscopy imaging, and full-field and multifocal electroretinography were performed on one patient with aceruloplasminemia. The ceruloplasmin gene was sequenced to confirm a known mutation. Single nucleotide polymorphism genotyping of known AMD risk alleles was performed to characterize the AMD risk profile of the patient. Prussian blue staining in postmortem retinal sections was used to confirm iron accumulation.

Results:

A homozygous mutation in the ceruloplasmin gene was detected at position c.395-1 G>A. The clinical assessment and imaging of the patient did not show any findings of AMD. Fundus examination revealed yellow flecks in the midperiphery with notable absence of macular drusen or geographic atrophy. Genotyping for AMD risk alleles revealed a low AMD risk profile. Histopathologic analysis confirms iron accumulation in retinal pigment epithelial cells.

Conclusion:

In contrast to a previous report, these findings suggest that neither aceruloplasminemia nor iron accumulation was sufficient to cause AMD in this patient.
ACUTE SYPHILITIC POSTERIOR PLACOID CHORIORETINITIS: MULTIMODAL IMAGING AND ELECTROPHYSIOLOGIC FINDINGS BEFORE AND AFTER TREATMENT
Authors: Wong Wendy , Naing Thet , Bhargava Mayuri , Chee Caroline , Lingam Gopal , Holder Graham E.
Published: July 2019

Purpose:

To describe the clinical course of acute syphilitic posterior placoid chorioretinitis (ASPPC) in the preplacoid stage, placoid stage, and after treatment with penicillin.

Method:

A retrospective case report of serial multimodal imaging and electrophysiology studies of a patient with ASPPC, with 18 months of follow-up.

Results:

A 47-year-old man presented with bilateral panuveitis. The patient defaulted follow-up and returned when his vision deteriorated. Tests for neurosyphilis and retroviral disease were positive, and treatment was initiated. The earliest change on serial optical coherence tomography was loss of the signal from the reflective band corresponding to the ellipsoid zone. In the placoid stage, there was nodular thickening of the retinal pigment epithelium. The ellipsoid zone signals reappeared after treatment. Fundus fluorescein angiogram at presentation showed peripapillary vasculitis and disk leakage; indocyanine green angiography revealed multiple hypofluorescent spots in the peripapillary region and posterior pole that was not visible clinically. The angiographic abnormalities resolved after treatment. Electrophysiology demonstrated bilateral maculopathy and reduction of both a- and b-waves from dark-adapted and light-adapted responses at presentation. The b-waves (inner retina) recovered partially with treatment.

Conclusion:

To the best of our knowledge, this is the first case report of the multimodal imaging and electrophysiology findings in a patient with acute syphilitic posterior placoid chorioretinitis, before the development of the classic placoid lesion. Improvement of structural and functional pathology after systemic treatment is demonstrated.
The role of the small intestine in modulating metabolism and inflammation in atherosclerosis and cancer
Authors: Mukherjee Pallavi , Chattopadhyay Arnab , Fogelman Alan M.
Published: July 2019

Purpose of review

To discuss recent findings on the importance of the small intestine in modulating metabolism and inflammation in atherosclerosis and cancer.

Recent findings

Integrin β7+ natural gut intraepithelial T cells modulated metabolism and accelerated atherosclerosis in mice. Reducing the generation of lysophospholipids in the small intestine mimicked bariatric surgery and improved diabetes. Enterocyte-specific knockdown of stearoyl-CoA desaturase-1 significantly improved dyslipidemia in LDL receptor null (Ldlr

−/−
) mice fed a Western diet. Adding a concentrate of tomatoes transgenic for the apolipoprotein A-I mimetic peptide 6F to the chow of wild-type mice altered lipid metabolism in the small intestine, preserved Notch signaling and reduced tumor burden in mouse models. The phospholipid-remodeling enzyme Lpcat3 regulated intestinal stem cells and progenitor cells by stimulating cholesterol biosynthesis; increasing cholesterol in the diet or through genetic manipulation promoted tumorigenesis in Apcmin+ mice.

The small intestine is important for regulating metabolism and inflammation in animal models of both atherosclerosis and cancer.
Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database
Authors: Jodeh Diana S. , Nguyen Anh Thy H. , Rottgers S. Alex
Published: July 2019

Background:

Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes.

Methods:

Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery.

Results:

Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63).

Conclusions:

Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Predictors for Prolonged Drainage following Tissue Expander–Based Breast Reconstruction
Authors: Lee Kyeong-Tae , Hong Seung Heon , Jeon Byung-Joon , Pyon Jai Kyong , Mun Goo-Hyun , Bang Sa Ik
Published: July 2019

Background:

A closed-suction drain is usually inserted during tissue expander–based breast reconstruction. Prolonged duration of drain retention can disturb patients’ daily lives and affect overall sociomedical costs. This study aimed to investigate factors that may influence the drainage and to identify predictors of unusually prolonged drain duration.

Methods:

Patients who underwent delayed-immediate, two-stage breast reconstruction using a tissue expander between January of 2013 and July of 2017 were reviewed. Prolonged drain duration was defined as drain duration for longer than the 75th percentile of that for the entire cohort. Effects of patient- and operation-related variables on drainage and prolonged drain duration were evaluated.

Results:

A total of 1056 cases (1002 patients) were analyzed. The median drain duration was 10 days. Drain placement for more than 12 postoperative days was observed in 256 cases (24.2 percent), classified as prolonged drain duration. Multivariate analyses demonstrated that old age, high body mass index, neoadjuvant chemotherapy, insertion of large Siltex textured tissue expanders, and greater volume of initial inflation were independent risk factors of prolonged drain duration. The size and texture of the tissue expanders and initial inflation volume retained their influence, regardless of mastectomy specimen weight. Use of acellular dermal matrix had contradictory effects according to breast size, being protective against prolonged drain duration in cases with mastectomy specimen weight greater than 400 g, and being a significant predictor for it in cases with mastectomy specimen weight less than or equal to 400 g.

Conclusion:

Several factors, including reconstructive operation-related factors, might influence drain duration following tissue expander–based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.