bluuebunny/crossref_metadata_2025 huggingface dataset:
A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States
Authors: Kase Samuel M. , Waldman Elisha D. , Weintraub Andrea S.
Published: February 2018

Objective

Compassion fatigue (CF) is secondary traumatic distress experienced by providers from contact with patients' suffering. Burnout (BO) is job-related distress resulting from uncontrollable workplace factors that manifest in career dissatisfaction. Compassion satisfaction (CS) is emotional fulfillment derived from caring for others. The literature on BO in healthcare providers is extensive, whereas CF and CS have not been comprehensively studied. Because of ongoing exposure to patient and family distress, pediatric palliative care (PPC) providers may be at particular risk for CF. We conducted a cross-sectional pilot study of CF, BO, and CS among PPC providers across the United States.

Method

The Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of professional and personal characteristics were distributed electronically and anonymously to PPC physicians and nurses. Logistic and linear regression models for CF, BO, and CS as a function of potential risk factors were constructed.

Results

The survey response rate was 39%, primarily consisting of female, Caucasian providers. The prevalence of CF, BO, and CS was 18%, 12%, and 25%, respectively. Distress about a “clinical situation,” physical exhaustion, and personal loss were identified as significant determinants of CF. Distress about “coworkers,” emotional depletion, social isolation, and “recent involvement in a clinical situation in which life-prolonging activities were not introduced” were significant determinants of BO. Physical exhaustion, personal history of trauma, “recent involvement in a clinical situation in which life-prolonging activities were not introduced,” and not discussing distressing issues were significant predictors of lower CS scores.

Significance of results

CF and BO directly influence the well-being and professional performance of PPC providers. To provide effective compassionate care to patients, PPC providers must be attentive to predictors of these phenomena. Further work is needed to explore additional causes of CF, BO, and CS in PPC providers as well as potential interventions.
The Voice of AGU’s Editors
Authors: Hanson Brooks
Published: February 2018

AGU’s journal and book editors share their perspectives on current science, trends, conferences, debates, and more.
Tiny Particles with Big Impact on Global Climate
Authors: Shrivastava Manishkumar
Published: February 2018

A recent paper in Reviews of Geophysics suggests that new understandings of secondary organic aerosol may require a rethinking of atmospheric chemistry-climate models.
Mesmerized by Gracefully Gliding Albatrosses
Authors: ten Brink Uri
Published: February 2018

Despite avian distractions and dreadful weather, a research cruise to map the seafloor off Alaska revealed new insights into the Queen Charlotte Fault.
Small Streams Make Big Contribution to Carbon Cycle
Authors: Marx Anne , van Geldern Robert , Barth Johannes
Published: February 2018

A recent paper in Reviews of Geophysics discussed the carbon dynamics of headwater streams.
Peering into the Cracks
Authors: Eppes Martha , Keanini Russell
Published: February 2018

A recent article in Reviews of Geophysics combined mathematical modeling, fracture mechanics theory and engineering research data to provide new insights into a critical geological process.
Caught on Camera: Volcanic Bombs in Flight
Authors: Taddeucci Jacopo
Published: February 2018

A recent paper in Reviews of Geophysics revealed new insights into the flight patterns of solid and molten debris flung out of volcanos during explosive eruptions.
Introducing a New Editor in Chief for GeoHealth
Authors: Filippelli Gabriel
Published: February 2018

Find out how the person in charge of AGU’s newest journal became interested in geohealth and his vision for the journal over the coming years.
Working Towards a Sustainable Future
Authors: Pandey Vishnu , Salam P. , Shrestha Sangam , Anal Anil
Published: February 2018

A new book on the water-energy-food nexus contributes to the global debate about this concept in both principle and practice.
New Style for AGU Journals and Books
Authors: Hanson Brooks
Published: February 2018

A major standardization of reference and grammatical styles will be rolled out across AGU publications from September 2017.
In Pursuit of Flash Flood Data
Authors: Gourley Jonathan
Published: February 2018

How remote sensing of streams provides valuable data for the characterization, prediction, and warning of impending flash floods.
New Findings from Old Data
Authors: Liemohn Mike
Published: February 2018

Recalibrated and reanalyzed data from the Voyager flybys of Jupiter 40 years ago, presented in a series of papers in JGR: Space Physics, show the value of archival data.
AGU Provides Open Citations and Content Sharing
Authors: Hanson Brooks
Published: February 2018

AGU joins new initiatives to make scientific research more transparent and accessible.
“Do You Expect Me to Just Give Away My Data?”
Authors: Brewer Peter
Published: February 2018

The Editor-in-Chief of JGR: Oceans explains why the new AGU data policy is important for the rigor and long-term security of scientific research.
Connecting People and Papers
Authors: Wooden Paige
Published: February 2018

The ORCID initiative to assign unique identifiers to researchers has had good uptake among authors in AGU journals, giving them additional recognition and credit for their work.
Enabling Findable, Accessible, Interoperable, and Reusable Data
Authors: Stall Shelley
Published: February 2018

AGU is convening a partnership in the Earth and space science community to develop the standards to connect researchers, publishers, and data repositories.
Hot Water, Cold Ice
Authors: Hubbard Bryn
Published: February 2018

Despite careful planning, there can be many uncertainties and unknowns about doing field research in remote locations.
AGU Marks Peer Review Week
Authors: Hanson Brooks , Lunn Jenny
Published: February 2018

AGU is committed to assessing and improving the peer review process through various new and recent initiatives.
Water World: Sea Level Rise, Coastal Floods, and Storm Surges
Authors: Hagen Scott , van der Pluijm Ben
Published: February 2018

A special issue of Earth’s Future examines the impacts of sea level rise on coastal areas and showcases a paradigm shift in the modeling of these dynamic systems.
Annotation Tool Facilitates Peer Review
Authors: Hanson Brooks , Panning Jeanette , Townsend Randy , Wooden Paige
Published: February 2018

AGU journals will incorporate open source software to facilitate dialog among reviewers, editors and authors during peer review.
Cassini’s Legacy in Print
Authors: Lunn Jenny , Liemohn Mike , Moldwin Mark , Turtle Elizabeth
Published: February 2018

With over 750 papers published in AGU journals based on Cassini-Huygens mission data, three editors select some of the most noteworthy.
Is Living Near a Farm Bad for Your Health?
Authors: Ceccarelli Daniela , Smit Lidwien
Published: February 2018

A recent commentary in GeoHealth highlighted the health risks for people living close to large-scale livestock farms.
Choosing a Lunar Landing Site
Authors: Fassett Caleb
Published: February 2018

A recent article in JGR: Planets described the geological characteristics of two candidate sites for the upcoming Chinese mission to the Moon.
Stories in the Soil
Authors: Papanicolaou Thanos
Published: February 2018

A series of field experiments in the U.S. Midwest is investigating how past, present, and future human activities and climate affect the health of soil.
Tropical Teleconnections
Authors: Stan Cristiana
Published: February 2018

A recent article in Reviews of Geophysics explored how regional climate and weather is interconnected across space and time.
A Wake-up Call from the Sun
Authors: Hapgood Michael
Published: February 2018

A sudden burst of activity from the Sun in early September 2017 caused a wide range of space weather effects at Earth.
The Spaces In Between
Authors: Hunt Allen , Sahimi Muhammad
Published: February 2018

A recent paper in Reviews of Geophysics explored the characteristics of porous media, described advances in percolation theory and its various applications across the geosciences.
Ethics Crucial for the Future of the Geosciences
Authors: Gundersen Linda
Published: February 2018

A new AGU Special Publication provides a policy and practice overview of where we are and where we need to be regarding scientific integrity and ethics in the geosciences.
The Gravity of Geophysics
Authors: Van Camp Michel , de Viron Olivier , Watlet Arnaud , Meurers Bruno , Francis Olivier , Caudron Corentin
Published: February 2018

A recent article in Reviews of Geophysics examined terrestrial techniques for measuring changes in gravity over time and their application to the geosciences.
Future Looks Drier as Drylands Continue to Expand
Authors: Huang Jianping , Fu Congbin
Published: February 2018

A recent article in Reviews of Geophysics examined the areas of land globally that are classified as drylands and the impact of their growth on human communities.
A Rover’s Eye View of Moving Martian Dunes
Authors: Rogers A. , Ehlmann Bethany
Published: February 2018

A new special issue of JGR: Planets presents findings on sand motion, morphology, and mineralogy from the Curiosity rover’s traverse of the active Bagnold dune field in Gale crater.
An “Old School” Approach and a Community Effort
Authors: Moldwin Mark
Published: February 2018

The outgoing Editor in Chief of Reviews of Geophysics expresses thanks and appreciation to all those who contributed to the success of the journal over the past eight years.
Introducing the New Editor in Chief for Reviews of Geophysics
Authors: Florindo Fabio
Published: February 2018

Find out about the person taking the helm of AGU’s highest-impact journal and his vision for the coming years.
Introducing the New Editor in Chief for G-Cubed
Authors: Faccenna Claudio
Published: February 2018

Find out who is taking over at Geochemistry, Geophysics, Geosystems, AGU’s premier interdisciplinary journal, and his vision for the coming years.
Thirty Years of GBC in a Changing World
Authors: Trumbore Susan
Published: February 2018

The outgoing Editor in Chief of Global Biogeochemical Cycles reflects on how research topics published in the journal have adapted and developed since its launch three decades ago.
2000 Manuscripts Under the G
Authors: Becker Thorsten
Published: February 2018

The outgoing Editor in Chief of Geochemistry, Geophysics, Geosystems reflects on almost a decade with the journal and expresses appreciation for all those who contributed to its success.
AGU Editor Picks for 2017 Fall Meeting, Part I
Authors: Lunn Jenny
Published: February 2018

AGU's journal editors give their recommendations for some of the most interesting paper, panel, and poster sessions coming up at this year’s meeting.
AGU Editor Picks for 2017 Fall Meeting, Part II
Authors: Lunn Jenny
Published: February 2018

AGU's journal editors give their recommendations for some of the most interesting paper, panel, and poster sessions coming up at this year’s meeting.
Examining our Eyes in the Sky
Authors: Verhoelst Tijl
Published: February 2018

A recent paper in Reviews of Geophysics explored the challenges of validating data collected from Earth observation satellites.
Probability Analysis Improves Hazard Assessment
Authors: Grezio Anita
Published: February 2018

A recent paper in Reviews of Geophysics describes a probabilistic method for evaluating tsunami location, size, and risk to human populations.
Bioenergy’s Impacts on the Landscape
Authors: Qin Zhangcai , Mishra Umakant , Hastings Astley
Published: February 2018

The editors of a new book describe how bioenergy production impacts the landscape, environmental processes, and climate.
Spills, Sediment, and Shoreline Contamination
Authors: Clement T.
Published: February 2018

A recent paper in Reviews of Geophysics describes the formation and behavior of oil-sediment residues in marine and coastal environments following an oil spill.
Pedotransfer Functions Bring New Life to Earth System Modeling
Authors: Van Looy Kris , Vereecken Harry
Published: February 2018

A recent paper in Reviews of Geophysics describes how currently available soil information furthers our understanding of soil processes and their integration in Earth system modeling.
Modeling Megathrust Zones
Authors: Govers Rob
Published: February 2018

A recent paper in Review of Geophysics built a unifying model to predict the surface characteristics of large earthquakes.
Airborne Fireball
Authors: Liemohn Mike
Published: February 2018

A surprise sighting of a meteor in the sky above southeast Michigan.
Erasing a Billion Years of Geologic Time Across the Globe
Authors: Joel Lucas
Published: February 2018

The Great Unconformity—a huge time gap in the rock record—may have been triggered by the uplift of an ancient supercontinent, say researchers using a novel method for dating rocks.
A secondary RET mutation in the activation loop conferring resistance to vandetanib
Authors: Nakaoku Takashi , Kohno Takashi , Araki Mitsugu , Niho Seiji , Chauhan Rakhee , Knowles Phillip P. , Tsuchihara Katsuya , Matsumoto Shingo , Shimada Yoko , Mimaki Sachiyo , Ishii Genichiro , Ichikawa Hitoshi , Nagatoishi Satoru , Tsumoto Kouhei , Okuno Yasushi , Yoh Kiyotaka , McDonald Neil Q. , Goto Koichi
Published: February 2018

Resistance to vandetanib, a type I RET kinase inhibitor, developed in a patient with metastatic lung adenocarcinoma harboring a CCDC6-RET fusion that initially exhibited a response to treatment. The resistant tumor acquired a secondary mutation resulting in a serine-to-phenylalanine substitution at codon 904 in the activation loop of the RET kinase domain. The S904F mutation confers resistance to vandetanib by increasing the ATP affinity and autophosphorylation activity of RET kinase. A reduced interaction with the drug is also observed in vitro for the S904F mutant by thermal shift assay. A crystal structure of the S904F mutant reveals a small hydrophobic core around F904 likely to enhance basal kinase activity by stabilizing an active conformer. Our findings indicate that missense mutations in the activation loop of the kinase domain are able to increase kinase activity and confer drug resistance through allosteric effects.
Cellulose nanomaterials: promising sustainable nanomaterials for application in water/wastewater treatment processes
Authors: Mohammed Nishil , Grishkewich Nathan , Tam Kam Chiu
Published: February 2018

Schematic diagram showing the various water/wastewater treatment processes in which CN-based systems can be utilized.
Solid-state fluorescent materials based on coumarin derivatives: polymorphism, stimuli-responsive emission, self-assembly and optical waveguides
Authors: Cui Rong Rong , Lv Yuan Chao , Zhao Yong Sheng , Zhao Na , Li Nan
Published: February 2018

Coumarin-based fluorophores were studied to serve as multifunctionalized solid-state fluorescent materials.
The influence of synthetic hyetograph parameters on simulation results of runoff from urban catchment
Authors: Mazurkiewicz Karolina , Skotnicki Marcin
Published: February 2018

The paper presents the results of analysis of the influence of the maximum intensity (peak) location in the synthetic hyetograph and rainfall duration on the maximum outflow from urban catchment. For the calculation Chicago hyetographs with a duration from 15 minutes to 180 minutes and peak location between 20% and 50% of the total rainfall duration were design. Runoff simulation was performed using the SWMM5 program for three models of urban catchment with area from 0.9 km2 to 6.7 km2. It was found that the increase in the rainfall peak location causes the increase in the maximum outflow up to 17%. For a given catchment the greatest maximum outflow is generated by the rainfall, which time to peak corresponds to the flow time through the catchment. Presented results may be useful for choosing the rainfall parameters for storm sewer systems modeling.
Partizipation: Und jetzt alle!
Authors: Kohrs Jens
Published: February 2018

Sanierung ist ein hartes Geschäft und bedeutet für die Klinik-Mitarbeiter oft schmerzhafte Einschnitte. Wer die Belegschaft bei Veränderungen von vornherein konsequent einbindet, hat es leichter und erreicht zudem mehr.
Electrochemical reactor based on a polymer electrolyte fuel cell for the reduction reaction of CO2
Authors: Sone Yoshitsugu , Sato Kazutaka , Mendoza-Hernandez Omar Samuel , Shironita Sayoko , Shima Asuka , Umeda Minoru
Published: February 2018

The Japan Aerospace Exploration Agency is now developing life support systems for closed environments in space. The reduction reaction of carbon dioxide is an important technique for the sustainable manned operation in space. Recently,  Umeda et al. [J. Appl. Phys. 114, 174908 (2013)] from the Nagaoka University of Technology reported that the reduction reaction of carbon dioxide (CO2) proceeded using a fuel cell under the existence of CO2 and H2 by supplying those gases to the cathode and the anode, respectively. We observed stable reaction when Pt/Ru-C was used as a catalyst for the cathode and Pt-C for the anode. Different organic materials were obtained depending on the alternated potential and temperature. Furthermore, a fuel cell stack with 8 cells connected in series was tested to demonstrate the stable energy generation by feeding CO2 to the cathode and H2 to the anode.
Invited Article: Narrowband terahertz bandpass filters employing stacked bilayer metasurface antireflection structures
Authors: Chang Chun-Chieh , Huang Li , Nogan John , Chen Hou-Tong
Published: February 2018

We experimentally demonstrate high-performance narrowband terahertz (THz) bandpass filters through cascading multiple bilayer metasurface antireflection structures. Each bilayer metasurface, consisting of a square array of silicon pillars with a self-aligned top gold resonator-array and a complementary bottom gold slot-array, enables near-zero reflection and simultaneously close-to-unity single-band transmission at designed operational frequencies in the THz spectral region. The THz bandpass filters based on stacked bilayer metasurfaces allow a fairly narrow, high-transmission passband, and a fast roll-off to an extremely clean background outside the passband, thereby providing superior bandpass performance. The demonstrated scheme of narrowband THz bandpass filtering is of great importance for a variety of applications where spectrally clean, high THz transmission over a narrow bandwidth is desired, such as THz spectroscopy and imaging, molecular detection and monitoring, security screening, and THz wireless communications.
Invited Article: Channel performance for indoor and outdoor terahertz wireless links
Authors: Ma Jianjun , Shrestha Rabi , Moeller Lothar , Mittleman Daniel M.
Published: February 2018

One of the most exciting future applications of terahertz technology is in the area of wireless communications. As 5G systems incorporating a standard for millimeter-wave wireless links approach commercial roll-out, it is becoming clear that even this new infrastructure will not be sufficient to keep pace with the rapidly increasing global demand for bandwidth. One favorable solution that is attracting increasing attention for subsequent generations of wireless technology is to use higher frequencies, above 100 GHz. The implementation of such links will require significant advances in hardware, algorithms, and architecture. Although numerous research groups are exploring aspects of this challenging problem, many basic questions remain unaddressed. Here, we present an experimental effort to characterize THz wireless links in both indoor and outdoor environments. We report measurements at 100, 200, 300, and 400 GHz, using a link with a data rate of 1 Gbit/s. We demonstrate both line-of-sight and non-line-of-sight (specular reflection) links off of interior building walls. This work represents a first step to establish the feasibility of using THz carrier waves for data transmission in diverse situations and environments.
Effects of tonic immobility and corticosterone on mitochondria metabolism in pectoralis major muscle of broiler chickens
Authors: Duan Yujing , Sun Lili , Liu Jie , Fu Wenyan , Wang Song , Ni Yingdong , Zhao Ruqian
Published: February 2018

Tonic immobility (TI), which can be divided into short (STI) or long (LTI) duration, is a trait related to fear and stress response. In a previous study, we found that in broilers that LTI phenotype and chronic corticosterone (CORT) administration caused retarded growth and lower muscle weight compared with their control counterparts. The aim of this study is to determine whether the mitochondrial DNA (mtDNA) copy number and mitochondrial oxidative phosphorylation (OXPHOS), the vital factors involved in regulating energy homeostasis, have been changed by LTI or CORT treatment. The results showed that STI broilers had higher mtDNA copy number and cytochrome c oxidase (COX) enzyme activity compared with LTI broilers. Analysis of mtDNA-encoded OXPHOS genes revealed that the mRNA expression of the COX subunit 1, 2, NADH dehydrogenase (ND) subunits 1, 3 and 6, were also increased in STI broilers compared with LTI broilers. Regarding the transcriptional regulation of mtDNA-encoded OXPHOS genes, no difference was found in the methylation of the mitochondria control region between the TI phenotypes or the CORT treatments. The PGC-1α protein level was higher in STI broilers, but the av uncoupling proteins, did not show significant difference at the protein level between TI phenotypes. These results suggest that the mitochondrial function in pectoralis major muscle of STI broilers is better than that of LTI counterparts. However, chronic CORT administration did not affect the mitochondrial metabolism, indicating the mitochondrial insensitivity to CORT treatment in pectoralis major muscle.
Role of A-kinase anchoring protein 95 in the regulation of cytochrome P450 family 19 subfamily A member 1 (CYP19A1) in human ovarian granulosa cells
Authors: Gu Yu , Xu Wenbin , Zhuang Bole , Fu Wei
Published: February 2018

Irregular expression of cytochrome P450 family 19 subfamily A member 1 (CYP19A1) is involved in the development of polycystic ovary syndrome (PCOS). Activation of the cAMP/protein kinase A (PKA)/cAMP response element-binding protein (CREB) pathway plays a crucial role in FSH regulation of CYP19A1 in human ovarian granulosa cells. A-Kinase anchor protein 95 (AKAP95) is known to confine PKA to the nucleus. However, it is unclear whether anchoring PKA to the nucleus is essential for the induction of CYP19A1 by FSH in human ovarian granulosa cells. Using the human granulosa cell line KGN and primary cultured human luteinised granulosa cells (hLGCs), we found that knockdown of AKAP8, the gene encoding AKAP95, or inhibition of AKAP95 reduced the amount of PKA anchored in the nucleus and attenuated the phosphorylation of CREB by either FSH or activation of the cAMP/PKA pathway. Moreover, knockdown of AKAP8 or inhibition of AKAP95 also significantly attenuated FSH-induced CYP19A1 expression and oestrogen synthesis. Furthermore, significant decreases in AKAP95 and CYP19A1 were observed in hLGCs obtained from PCOS patients. The results of the present study demonstrate a crucial role for AKAP95 in CYP19A1 expression and oestrogen synthesis in hLGCs, which implies that AKAP95 may be involved in the pathogenesis of PCOS.
Local Spectral Gap in the Group of Euclidean Isometries
Authors: Boutonnet Rémi , Ioana Adrian
Published: February 2018

We provide new examples of translation actions on locally compact groups with the “local spectral gap property” introduced in [5]. This property has applications to strong ergodicity, the Banach–Ruziewicz problem, orbit equivalence rigidity, and equidecomposable sets. The main group of study here is the group $\operatorname{Isom}\left (\mathbb{R}^{d}\right )$ of orientation-preserving isometries of the Euclidean space $\mathbb{R}^{d}$, for d ≥ 3. We prove that the translation action of a countable dense subgroup Γ on Isom$\left (\mathbb R^{d}\right )$ has local spectral gap, whenever the translation action of the rotation projection of Γ on SO(d) has spectral gap. Our proof relies on the amenability of $\operatorname{Isom}\left (\mathbb{R}^{d}\right )$ and on work of Lindenstrauss and Varjú [12].
Survival in elderly glioblastoma patients treated with bevacizumab-based regimens in the United States
Authors: Davies Jessica , Reyes-Rivera Irmarie , Pattipaka Thirupathi , Skirboll Stephen , Ugiliweneza Beatrice , Woo Shiao , Boakye Maxwell , Abrey Lauren , Garcia Josep , Burton Eric
Published: February 2018

Background

The efficacy of bevacizumab (BEV) in elderly patients with glioblastoma remains unclear. We evaluated the effect of BEV on survival in this patient population using the Survival, Epidemiology, and End Results (SEER)-Medicare database.

Methods

This retrospective, cohort study analyzed SEER-Medicare data for patients (aged ≥66 years) diagnosed with glioblastoma from 2006 to 2011. Two cohorts were constructed: one comprised patients who had received BEV (BEV cohort); the other comprised patients who had received any anticancer treatment other than BEV (NBEV cohort). The primary analysis used a multivariate Cox proportional hazards model to compare overall survival in the BEV and NBEV cohorts with initiation of BEV as a time-dependent variable, adjusting for potential confounders (age, gender, Charlson comorbidity index, region, race, radiotherapy after initial surgery, and diagnosis of coronary artery disease). Sensitivity analyses were conducted using landmark survival, propensity score modeling, and the impact of poor Karnofsky Performance Status.

Results

We identified 2603 patients (BEV, n = 597; NBEV, n = 2006). In the BEV cohort, most patients were Caucasian males and were younger with fewer comorbidities and more initial resections. In the primary analysis, the BEV cohort showed a lower risk of death compared with the NBEV cohort (hazard ratio, 0.80; 95% confidence interval, 0.72–0.89; P < .01). The survival benefit of BEV appeared independent of the number of temozolomide cycles or frontline treatment with radiotherapy and temozolomide.

Conclusion

BEV exposure was associated with a lower risk of death, providing evidence that there might be a potential benefit of BEV in elderly patients with glioblastoma.
Improving Management of Hospitalized Adults With Uncomplicated Cellulitis or Cutaneous Abscess
Authors: Housman Erica , Livings Sarah E. , Knee Alex , Schimmel Jennifer
Published: February 2018

Implementation of a guideline for the management of hospitalized adults with uncomplicated skin and soft-tissue infections may decrease unnecessary antibiotic use. For cellulitis, treatment with vancomycin and broad-spectrum antibiotics decreased significantly. For cutaneous abscess, treatment with broad-spectrum antibiotics decreased significantly. There were no differences in rates of treatment failure, recurrence, or adverse events.
Combined NMDA Inhibitor Use in a Patient With Multisubstance-induced Psychotic Disorder
Authors: Caloro Matteo , Calabrò Giuseppa , de Pisa Eleonora , Rosini Enrico , Kotzalidis Georgios D. , Lonati Davide , Locatelli Carlo Alessandro , Papa Pietro , Schifano Fabrizio , Girardi Paolo
Published: February 2018

Novel psychoactive substance use is a major social concern. Their use may elicit or uncover unpredictably as yet undescribed clinical pictures. We aimed to illustrate a multisubstance use case indistinguishable from paranoid schizophrenia, so to alert clinicians on possibly misdiagnosing substance-induced psychotic disorders.

Case report:

We describe a case of a 32-year-old man who started at 18 years with cannabinoids and ketamine, and is currently using N-methyl-d-aspartate (NMDA) antagonists. At age 23, he developed social withdrawal after being assaulted by a stranger, but did not consult psychiatrists until age 26; during this period, he was using internet-purchased methoxetamine and ketamine, and was persecutory, irritable, suspicious, and insomniac and discontinued all received medical prescriptions. He added dextromethorphan to his list of used substances. At age 31, while using phencyclidine, and, for the first time, methoxphenidine, he developed a religious delusion, involving God calling him to reach Him, and the near-death experiences ensured by NMDA antagonists backed his purpose. He received Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of multisubstance-induced psychotic disorder and was hospitalized 8 times, 6 of which after visiting the emergency room due to the development of extreme anguish, verbal and physical aggression, and paranoia. He reportedly used methoxphenidine, methoxyphencyclidine, ethylnorketamine, norketamine, and deschlorketamine, to achieve near-death experiences, and eventually to reach God in heavens.

Conclusions:

This case points to the need for better control of drugs sold on the internet. It also illustrates that people using NMDA antagonists may present clinical pictures indistinguishable from those of major psychoses and are likely to be misdiagnosed.
How does abatacept really work in rheumatoid arthritis?
Authors: Bonelli Michael , Scheinecker Clemens
Published: February 2018

Purpose of review

The purpose of this review is to summarize the current knowledge concerning the mechanisms of action of Abatacept in patients with rheumatoid arthritis.

Recent findings

Abatacept (CTLA-4Ig) represents a soluble, recombinant, fully humanized fusion protein, comprising the extracellular domain of CTLA-4 and the Fc portion of IgG1. Abatacept binds to the costimulatory molecules CD80 and CD86 on antigen-presenting cells (APC), thereby blocking interaction with CD28 on T cells. In humans, Abatacept treatment was shown to be effective in patients with various autoinflammatory diseases including rheumatoid arthritis. Although the prevention of T-cell activation by interfering with signaling via CD28 still represents the main mechanism of action Abatacept acts on additional cell populations including regulatory T cells (Treg), monocytes/macrophages, osteoclasts, and B cells.

Effects of Abatacept on other cell populations besides T cells have to be taken into account and might represent a valuable contribution to the therapeutic success.
Anti-DFS70 autoantibodies in HIV-1-positive individuals
Authors: Pérez Dolores , Azoulay Danielle
Published: February 2018

Purpose of review

The aim of this review is to summarize the recent studies regarding the relationship between anti-DFS70 antibodies and HIV-1 infection. Examining the interaction between HIV-1 integrate (HIV-IN) and DFS70 and its role in the integration into the host's chromatin. Then, summarizing the importance of anti-DFS70 autoantibodies binding the DFS70 in the same region as the HIV-IN.

Recent findings

The interaction between HIV-IN and DFS70 protein could be a proficient target in the treatment against HIV-1 infection. The blockade of DFS70 is more effective than the blockade of HIV-IN as anti-HIV-1 drug. The anti-DFS70 autoantibodies could be an interesting therapeutic target for anti-HIV-1 treatment. Currently, there are no studies that measured the levels of anti-DFS70 autoantibodies in HIV-1-infected individuals.

The anti-DFS70 antibodies bind to the DFS70 autoantigen in the same region as the HIV-IN. This fact makes the autoantibodies a potential treatment for HIV-1-infected individuals. Blood levels of anti-DFS70 antibodies have not been measured in HIV-1-infected individuals. This issue opens new lines of research about the protective role of antibodies against HIV-1 infection.
Chimeric Antigen Receptor‐T Cell Therapy
Authors: Buechner Jochen , Kersten Marie José ,   HOVON/LLPC (Lunenburg Lymphoma Phase I/II Consortium) working group, Fuchs Miriam , Salmon Florence , Jäger Ulrich
Published: February 2018

Chimeric antigen receptor (CAR)‐T cell therapy is a new class of cellular immunotherapies that involves ex vivo genetic modification of T cells to incorporate an engineered CAR. After infusion into the patient, the CAR‐expressing T cells recognize specific tumor targets and induce an immune response against them. The technology utilized is fundamentally different from previously available cancer treatments. Currently, most CAR‐T cell therapies use autologous T cells. Tisagenlecleucel (formerly CTL019) is an anti‐CD19 CAR‐T cell therapy that was recently approved in the United States for the treatment of pediatric and young adult patients with relapsed/refractory B‐cell acute lymphoblastic leukemia (B‐ALL). Tisagenlecleucel has shown robust in vivo expansion and long‐term persistence, clinically meaningful durable response and remission rates, and overall survival benefit in pediatric and young adult patients with relapsed/refractory B‐ALL and in relapsed/refractory diffuse large B‐cell lymphoma. Common adverse events (AEs) include cytokine release syndrome, which may require hospitalization and admission to an intensive care unit, neurological toxicities, and B‐cell aplasia. These AEs are manageable when treated by an appropriately trained team. Additional research is required to further develop AE management protocols. In this review, we describe regulatory requirements, clinical considerations, and site‐level requirements for clinical study implementation of CAR‐T cell therapy in Europe. We also provide a case study of the European experience from the first global clinical trial for tisagenlecleucel, which may serve as a useful starting point for investigators and clinicians looking to implement CAR‐T cell therapy at their institutions.
Higher Adherence to Treatment With Low‐Molecular‐Weight‐Heparin Nadroparin Than Enoxaparin Because of Side Effects in Cancer‐Associated Venous Thromboembolism
Authors: van der Wall Sake J. , Klok Frederikus A. , den Exter Paul L. , Barrios Deisy , Morillo Raquel , Cannegieter Suzanne C. , Jimenez David , Huisman Menno V.
Published: February 2018

Current guidelines recommend low‐molecular‐weight‐heparins (LMWH) monotherapy for 3 to 6 months as first‐line treatment for cancer‐associated venous thromboembolism (VTE). In clinical practice, enoxaparin and nadroparin are common agents used. However, differences in therapy adherence between these LMWHs have never been reported. Therefore, our aim was to compare adherence to enoxaparin and nadroparin in patients with cancer‐associated VTE. Consecutive patients with active cancer and objectively confirmed VTE, treated at a Dutch or a Spanish hospital, were followed during LMWH therapy with a maximum of 180 days. Cumulative incidences of discontinuation of both LMWHs were estimated and compared according to the Kaplan‐Meier method, applying a competing risk analysis to correct for mortality. A total of 366 patients were analyzed during LMWH treatment, of whom 284 patients (78%) were treated with enoxaparin and 82 (22%) with nadroparin. The cumulative incidence of discontinuation of enoxaparin and nadroparin treatment because of side effects was 30% (95% confidence interval [CI] 24–36) and 8.8% (95% CI 1.1–15), respectively. Competing risk analysis revealed a higher number of patients discontinuing enoxaparin due to side effects (adjusted hazard ratio [HR]: 2.8; 95% CI 1.06–7.2). Pain at the injection site was the most common reason of discontinuation in patients using enoxaparin, occurring in 32 patients, while it occurred in 1 patient using nadroparin (adjusted HR: 4.0; 95% CI 0.52–31). This analysis reveals that enoxaparin was associated with a higher risk of discontinuation because of side effects compared to nadroparin. However, given the nature of the patient groups, these findings should be followed by future studies.
ACUTE EFFECT OF CAFFEINE ON MACULAR MICROCIRCULATION IN HEALTHY SUBJECTS
Authors: Karti Omer , Zengin Mehmet Ozgur , Kerci Suleyman Gokhan , Ayhan Ziya , Kusbeci Tuncay
Published: February 2018

Purpose:

To evaluate the acute effects of caffeine on macular microvasculature using quantitative optical coherence tomography angiography analysis.

Methods:

Fifty-two healthy subjects aged 24 to 48 years were randomly divided into 2 groups: a control group, which received placebo, and a study group, which was subjected to caffeine. All participants underwent optical coherence tomography angiography at baseline and 1 hour after 200-mg oral caffeine intake in the study group and after oral placebo in the control group. Macular flow area, macular vessel density, and foveal avascular zone (FAZ) area were analyzed in both the groups.

Results:

The study group consisted of 14 men and 12 women with a mean age of 40.6 ± 8.9 years. The mean age of control group was 39.5 ± 9.4 years, which consisted of 13 men and 13 women. Baseline macular flow area, vessel density, and FAZ area measurements of the study and control groups showed no significant difference (P > 0.05). Oral caffeine intake caused a significant reduction in macular flow area (superficial, deep, and choriocapillaris) and vessel density (P < 0.05). However, there was no statistically significant difference in FAZ area after caffeine intake when compared with baseline measurements (P = 0.063).

Conclusion:

We found a significant decrease in macular flow area (superficial, deep, and choriocapillaris) and vessel density after caffeine intake. Our findings are consistent with previous studies using other techniques. We believe that the results of this preliminary study will be useful in future studies about this topic.
CORRELATIONS BETWEEN CHANGES IN PHOTORECEPTOR LAYER AND OTHER CLINICAL CHARACTERISTICS IN CENTRAL SEROUS CHORIORETINOPATHY
Authors: Yu Jia , Jiang Chunhui , Xu Gezhi
Published: February 2018

Purpose:

To clarify the correlations between changes in the photoreceptor layer (PRL) and other clinical characteristics during central serous chorioretinopathy.

Methods:

Patients with central serous chorioretinopathy with one eye affected were enrolled. Photoreceptor layer appearance within the detached area was evaluated, and its correlations with symptom duration, best-corrected visual acuity, and the difference in the foveal outer nuclear layer thickness between the affected and contralateral eyes were analyzed.

Results:

A total of 222 patients were included. The PRL outer border appeared either smooth, granulated, or as scattered dots attached to external limiting membrane. These different appearances were associated with elongation in symptom duration (18, 180, and 1,855 days), decreases in best-corrected visual acuity (6/10, 6/15, and 6/120), and increases in the difference of foveal outer nuclear layer thickness (−16, −32, and −60 μm). Among eyes with smooth PRL outer border, which had similar symptom duration, eyes with foveal PRL defect had poorer best-corrected visual acuity and greater reduction in outer nuclear layer thickness than the other eyes (all P = 0.00).

Conclusion:

Morphologic changes in PRL, best-corrected visual acuity, the reduction in foveal outer nuclear layer thickness, and symptom duration correlate closely but may behave asynchronously. These objective parameters, besides symptom duration, could be helpful when considering the timing of central serous chorioretinopathy treatment.
OPHTHALMIC ARTERY OCCLUSION AFTER FOREHEAD AUTOLOGOUS FAT INJECTION
Authors: Liu Hongtao , Chen Danian , Zhang Junjun
Published: February 2018

Purpose:

To present clinical findings of ophthalmic artery occlusion, a devastating ocular complication because of forehead autologous fat injection.

Methods:

Retrospective study of three eyes of three patients whereby ophthalmic artery occlusion and/or hemiplegia occurred after forehead autologous fat injection in China.

Results:

All patients suffered severe ocular pain, vomiting, and vision loss immediately after the injections and had unilateral permanent blindness.

Conclusion:

Physicians performing cosmetic facial surgery involving autologous fat injection need to be aware of this potential risk and should inform the patient before the surgery.
Corneal Endothelial Tolerance After Iris-Fixated Phakic Intraocular Lens Implantation: A Model to Predict Endothelial Cell Survival
Authors: Chebli Sabrina , Rabilloud Muriel , Burillon Carole , Kocaba Viridiana
Published: February 2018

Purpose:

To evaluate the long-term endothelial tolerance of iris-fixated phakic intraocular lenses (pIOLs) over a 10-year period, to identify predictive factors for endothelial decompensation, and to develop a model to predict endothelial cell survival after pIOL implantation.

Methods:

This retrospective study included 130 eyes in 60 patients who underwent pIOL implantation for correction of high myopia from January 2003 to October 2012 at Edouard Herriot Hospital in Lyon, France. Endothelial cell densities (ECDs) were measured using specular microscopy before and biannually after pIOL implantation. Best-corrected visual acuity was measured before and 6 months after pIOL implantation. The annual postoperative decrease in ECD was estimated using a mixed linear regression model with a random intercept. Patient and eye characteristics were introduced into the model to quantify their effect on ECD change. The main outcome measures were annual postoperative reduction of ECD and best-corrected visual acuity.

Results:

The preoperative ECD was 2770 ± 265 cells/mm2 (2134–3200 cells/mm2). The ECD decreased by 1.83%, on average (95% confidence interval, 1.54–2.10), during the first postoperative year. Thereafter, the mean decrease in annual ECD was estimated to be 0.87% (95% confidence interval, 0.78–0.95). For a cell number of 3500, 3000, 2500, and 2000, the number of years required to reach the threshold of 1500 cells/mm2 was estimated to be approximately 96, 78, 57, and 32 years, respectively. No predictive factors for endothelial decompensation were identified.

Conclusions:

pIOL implantation is a safe surgical means to correct high myopia in phakic patients without compromising corneal endothelium survival.
Clinical presentation of autoimmune and viral encephalitides
Authors: Dubey Divyanshu , Toledano Michel , McKeon Andrew
Published: February 2018

Purpose of review

We describe clinical and diagnostic features of various autoimmune and viral encephalitis subtypes.

Recent findings

Population-based studies have demonstrated both autoimmune and viral causes have similar prevalence and incident rates. Repertoire of autoimmune biomarkers has considerably increased with discovery of many novel neural antibodies including glial fibrillary acidic proteinα-immunoglobulin G. Similarly, with use of next generation sequencing and DNA libraries, many viral causes are being detected which would have been categorized as encephalitis of unknown cause a decade ago.

Autoimmune and viral encephalitides can resemble one another and sometimes autoimmune encephalitis may be triggered by viral infections. Early diagnosis and treatment is the key to both causes, which emphasizes the importance of clinical diagnosis before laboratory confirmation.
Is hemoglobin good for cerebral oxygenation and clinical outcome in acute brain injury?
Authors: English Shane W. , McIntyre Lauralyn
Published: February 2018

Purpose of review

The purpose of this review is to highlight the role of hemoglobin in cerebral physiology and pathophysiology. We review the existing as well as recent evidence detailing the effects of red blood cell transfusion on cerebral oxygenation and clinical outcome.

Recent findings

Hemoglobin is a key component in oxygen delivery, and thus cerebral oxygenation. Higher hemoglobin levels and red blood cell transfusion are associated with higher cerebral oxygen delivery and decreased cerebral ischemic burden. Recent studies suggest that this may be associated with improved clinical outcomes. However, these results are limited to only a few, small studies and the results have not been consistent. Further studies are required.

Hemoglobin is important for cerebral oxygenation and strategies to minimize anemia should be undertaken. Although higher hemoglobin levels are associated with less cerebral ischemia and better clinical outcome, whether this remains true whenever red blood cell transfusion is used to achieve this result remains unclear.
Autophagy: should it play a role in ICU management?
Authors: Rosenthal Martin D. , Carrott Phil , Moore Frederick A.
Published: February 2018

Purpose of review

This review is to discuss the role of autophagy in the critically ill patient population. As the understanding of autophagy continues to expand and evolve, there are certain controversies surrounding whether intensivist should allow the benefit of autophagy to supersede gold standard of insulin therapy or early nutritional support.

Recent findings

The review is relevant as the current literature seems to support under-feeding patients, and perhaps the reason these studies were positive could be prescribed to the mechanisms of autophagy. It is well understood that autophagy is a physiologic response to stress and starvation, and that the inducible form could help patients with end-organ dysfunction return to homeostasis.

The jury is still out as to how autophagy will play into clinical practice as we review several gold standard therapies for the critically ill.
Clozapine for Treatment-Refractory Behavioral Disturbance in Dementia
Authors: Teodorescu Andreea , Dima Lorena , Ifteni Petru , Rogozea Liliana M.
Published: February 2018

Background:

Behavioral and psychological symptoms in dementia significantly contribute to caregiver burden and impose patient hospitalization. The goal of treatment of admitted patients is the rapid remission of symptoms to allow their return to home as soon as possible. Intervention requires an intrusive approach with parenteral treatment and physical restraints, with a negative emotional impact on patients and their families. Despite the large utilization of antipsychotics for behavioral and psychological symptoms, there is no antipsychotic approved by the Food and Drug Administration for agitation in dementia.

Study Question:

To evaluate efficacy and tolerability of clozapine in patients with treatment-resistant agitation associated with dementia.

Study Design:

Cohort study with 337 patients, admitted between January 1, 2012 and December 31, 2016, with dementia according to The Diagnostic and Statistical Manual of Mental Disorders 4th ed. criteria. Clozapine was given in standard titration, starting with 6.25 or 12.5 mg.

Measures and Outcomes:

Efficacy was measured by the need for physical restraints and time to discharge and tolerability by recording all side effects. Data collected included demographics, psychotropics used, physical restraints, length of stay, destination after discharge, and comorbidities.

Results:

Of 337 cases, 315 (93.5%) patients received antipsychotics. There were 27 cases treated with clozapine. Before clozapine initiation, haloperidol was given in 16 cases (55.17%, mean = 7.43 mg/d, SD = ±4.01), and the treatment was stopped mainly because of extrapyramidal side effects. Other antipsychotics used were quetiapine (mean dose = 260 mg/d, SD = ±54.77), risperidone (mean dose = 3.3 mg/d, SD = ±0.57), and olanzapine (mean dose = 8.33 mg/d, SD = ±2.88). Mean dose of clozapine was 59.16 mg/d, (SD = ±40.48), ranging from 12.5 to 200 mg/d. There were a lower number of physical restraints after clozapine initiation than before (12 vs. 34, P < 0.05).

Conclusions:

Clozapine therapy seemed beneficial in treatment-resistant agitation in patients with dementia. The risk–benefit balance must be well weighed when clozapine is chosen. More studies are needed.