bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflection
Authors: Guerrini Anita
Published: January 2019

The Roman physician Galen wrote in his instruction manual On Anatomical Procedures: “As poles to tents and walls to houses, so are bones to living creatures.” In his short treatise On Bones for Beginners he added that bones were the “hardest and driest parts of the living body and, as one might say, the earthiest. . . . All else depends on or is attached to them.” Therefore knowledge of the skeleton must precede any other exploration of the body....
Health in the Early Modern Philosophical Tradition
Authors: Manning Gideon
Published: January 2019

This chapter examines the connections between medicine and philosophy in the seventeenth century with a particular focus on Anne Conway, Rene Descartes, and thinkers influenced by Descartes such as Henricus Regius, Jacques Rohault, and Johannes De Raey. It is shown that, despite the strong dualism associated with Descartes, thinkers of the period were very interested in the close connections between body and mind. One problem confronting these thinkers was how to reconcile their mechanistic, anti-teleological understanding of bodies with the normative concept of health. It is also shown that Descartes was intensely concerned with using philosophy to achieve a good state of both mind and body, a project shared by medical authors who adopted the Cartesian system.
Freud and the Concept of Mental Health
Authors: Hopkins Jim
Published: January 2019

This chapter examines the principles of Sigmund Freud’s epochal theory of psychoanalysis, explaining the source of mental disorders in alienation. His theory is shown to have remarkable parallels in contemporary cognitive science, for instance with the notion of free energy. Other Freudian concepts analyzed here include phantasy, identification, and projection. It is argued that these phenomena are systematically explained by Freud through a three-stage dynamic in which unconscious desire and conflict is resolved through conscious, often fictive or hallucinatory states that yield temporary satisfaction of the hidden desire. Recent work in neuroscience bears out some aspects of Freud’s theory.
Contemporary Accounts of Health
Authors: Kingma Elselijn
Published: January 2019

Contemporary philosophers of medicine have wrestled with the difficulty of defining health, and even over the basic question of whether this is a normative or descriptive concept. Both approaches seem to be prone to objections. The descriptive approach has difficulty defining health in a way that is not prey to counterexamples. Particular attention is given to the naturalistic accounts of Christopher Boorse and Jerome Wakefield. After the drawbacks of these accounts are discussed, it is suggested that normativism may be more promising but typically fails to meet two general conditions: isolating health from other normative states (the circumscription problem) and explaining how health relates to the value of a good life.
The Art of Mystical Narrative
Authors: Fishbane Eitan P.
Published: January 2019

This book studies the Zohar as a work of literature. While the Zohar has long been recognized as a signal achievement of mystical theology, myth, and exegesis, this monograph presents a poetics of zoharic narrative, a morphology of mystical storytelling. Topics examined include mysticism and literature; fiction and pseudepigraphy; diaspora and exile; dramatic monologue and the representation of emotion; voice, gesture, and the theatrics of the zoharic tale; the wandering quest for wisdom; anagnorisis and the poetics of recognition; encounters with the natural world as stimuli for mystical creativity; the dynamic relationship between narrative and exegesis; magical realism and the fantastic in the representation of experience and Being; narrative ethics and the exemplum of virtuous piety in the Zohar; the place of the zoharic frame-tale in the comparative context of medieval Iberian literature, both Jewish and non-Jewish.
Introduction
Authors: Fishbane Eitan P.
Published: January 2019

The first chapter sets the stage for the broader project of the book; it begins with the idea that the Zohar may be approached as a classic of literary art, probing how the term “classic” has been used in the study of religion and philosophical hermeneutics. I will delve into the following issues: the contours of a literary approach to the Zohar and its relationship to the evolution of zoharic authorship and redaction theory; explore the nexus of mysticism and literature (both narrative and poetry) in comparative perspective; address the relationship between fiction, imagined history, and the merging of time between the medieval and (imagined) ancient periods; and explore the manner in which the Zohar operates with a diasporic-exilic consciousness, imagining the Holy Land from the distance of thirteenth-century Castile.
Voice, Gesture, and Drama
Authors: Fishbane Eitan P.
Published: January 2019

Explores the ways in which the Zohar functions as a dramatic and performative literature, as a corpus in which the quest for mystical wisdom and the dynamics of its transmission are represented through exclamatory monologue, physical gesture, and expressions of reverence, lament, gratitude, celebration, and anxiety.
Encounters along the Way
Authors: Fishbane Eitan P.
Published: January 2019

Studies the phenomenon of journey and encounter in zoharic narrative, with special attention to the poetics of anagnorisis — the drama of character unveiling in which superficial appearances are inverted, seeming fools revealed to be mystic sages. Also studies the ways in which encounters with the natural world (including trees, flowers, and stars) serve as stimuli for the discovery and exposition of mystical secrets.
The Zoharic Frame-tale in Context
Authors: Fishbane Eitan P.
Published: January 2019

Situates zoharic narrative literature in its historical and comparative contexts, examining works of Jewish and non-Jewish frametale narratives from this time and place. Through consideration of works by Avraham Ibn Ezra, Yosef Ibn Zabara, Yehudah Al Ḥarizi, Yiẓḥaq Ibn Sahula, Juan Ruiz, and Alfonso X, among others, this chapter demonstrates the vivid ways in which zoharic storytelling ought to be understood as part of a broader cultural phenomenon. Structures, themes, and commonalities studied include: the dynamic of anagnorisis and the wandering quest for wisdom; the extensive use of esoteric speech (the language of secrets, hiddenness, and revelation) in the context of frame-tale narration; the construction of the passionate master-disciple relationship; and the dramatic yearning for Holy Mary and Shekhinah (among kabbalists and Christian writers, respectively) when spiritual seekers are lost on the road and fear for their safety.
Conclusions
Authors: Fishbane Eitan P.
Published: January 2019

IN THIS BOOK I have studied the Zohar as a work of literature, seeking to understand the ways in which this corpus should be appreciated not only as a masterpiece of Jewish thought, theology, and exegesis but also as a great achievement of the Jewish narrative imagination. Presenting a poetics and morphology of zoharic storytelling, I have approached the text less from the vantage point of the history of ideas, and more through the phenomenology of literary forms. In short, I have set out to read the ...
The Importance of ‘Blue Shirts’ in Traffic Policing
Authors: Tudor-Owen J
Published: January 2019

The requirement for transparency and accountability for public spending has seen a focus on quantitative cost–benefit analyses. In the context of traffic policing, the temptation is to emphasize the importance of automated systems of enforcement as these pose an arguably less expensive alternative to using uniformed police. In the context of speed enforcement, automated means of enforcement are a logical way to efficiently distribute resources. However, in other areas of traffic policing, like driver distraction, seatbelt use, random breath testing, the use of uniformed police is essential. Following an overview of empirical research examining traffic enforcement, this article explores theoretical explanations for compliance with the law, focusing on research that has examined the importance of procedural justice. It is suggested that an approach embracing both automated means of enforcement coupled with visible police presence is essential to encourage perceptions of procedural justice and police legitimacy. Further empirical research is needed to model the ideal allocation of funding across automated and non-automatic law enforcement in traffic to maximize public compliance with the law and ultimately reduce crashes.
Which Examination Tests Detect Differences in Cervical Musculoskeletal Impairments in People With Migraine? A Systematic Review and Meta-Analysis
Authors: Szikszay Tibor M , Hoenick Susann , von Korn Karolin , Meise Ruth , Schwarz Annika , Starke Wiebke , Luedtke Kerstin
Published: January 2019

Background

Most patients with migraine report associated neck pain. Whether neck pain is a symptom of migraine or an indicator for associated cervical musculoskeletal impairment has not yet been determined. Physical examination tests to detect cervical impairments in people with headache have been suggested, but results have not been evaluated systematically and combined in meta-analyses.

Purpose

The purpose of this study was to identify musculoskeletal impairments in people with migraine and people who were healthy (healthy controls) by reviewing published data on physical examination results.

Data Sources

PubMed, CINAHL, Web of Science, and the Cochrane Register of Clinical Trials were searched for studies published prior to December 2017.

Study Selection

Publications investigating physical examination procedures that are feasible for use in a physical therapy setting for patients with migraine and healthy controls were independently selected by 2 researchers.

Data Extraction

One researcher extracted the data into predesigned data extraction tables. Entries were checked for correctness by a second researcher. The Downs and Black Scale was used for risk-of-bias assessment by 2 reviewers independently.

Data Synthesis

Thirty-five studies (involving 1033 participants who were healthy [healthy controls] and 1371 participants with migraine) were included in the qualitative synthesis, and 18 were included in the meta-analyses (544 healthy controls and 603 participants with migraine). Overall, studies were rated as having a low to moderate risk of bias. Included studies reported 20 different test procedures. Combined mean effects indicated that 4 of the tests included in the meta-analyses distinguished between patients and controls: range of cervical motion, flexion-rotation, pressure pain thresholds, and forward head posture in a standing position.

Limitations

Manual joint testing and evaluation of trigger points were the 2 most frequently investigated tests not included in the meta-analyses because of heterogeneity of reporting and procedures.

Conclusions

Three tests confirmed the presence of musculoskeletal impairments in participants with migraine when combined in meta-analyses. Pressure pain thresholds added information on sensory processing. Additional tests might be useful but require standardized protocols and reporting.
A Forward Move: Interfacing Biotechnology and Physical Therapy In and Out of the Classroom
Authors: Trumbower Randy D , Wolf Steven L
Published: January 2019

Ongoing advances and discoveries in biotechnology will require physical therapists to stay informed and contribute to their development and implementation. The extent of our profession's involvement in how physical therapists engage biotechnology is determined by us. In this Perspective article, we advocate the need for our profession to educate clinicians alongside scientists, technologists, and engineers and empower them to collectively think more as codevelopers and less as “siloed” builders and consumers of biotechnology. In particular, we highlight the value of augmenting the physical therapy curricula to provide students with new levels of knowledge about the converging fields of engineering and physical therapy. We present successful examples of how such a concept can occur within physical therapist professional education programs and propose strategies to overcome perceived challenges that may stymie this possibility.
Credit Allocation Under Economic Stimulus: Evidence from China
Authors: Cong Lin William , Gao Haoyu , Ponticelli Jacopo , Yang Xiaoguang
Published: January 2019

We study credit allocation across firms and its real effects during China’s economic stimulus plan of 2009–2010. We match confidential loan-level data from the nineteen largest Chinese banks with firm-level data on manufacturing firms. We document that the stimulus-driven credit expansion disproportionately favored state-owned firms and firms with a lower average product of capital, reversing the process of capital reallocation toward private firms that characterized China’s high growth before 2008. We argue that implicit government guarantees for state-connected firms become more prominent during recessions and can explain this reversal.

Received August 23, 2017; editorial decision November 15, 2018 by Editor Philip Strahan.
CE: Caring for Survivors of Hodgkin Lymphoma
Authors: Lin Xin , Corcoran Stacie
Published: January 2019

Hodgkin lymphoma (HL) is a highly curable cancer. Advances in diagnosis and treatment have resulted in excellent cure rates, producing an ever-increasing number of HL survivors who live decades beyond their initial cancer treatment. These survivors, however, are at risk for late effects secondary to the cancer treatments they received years earlier, most notably, subsequent primary cancers, cardiovascular disease, pulmonary toxicity, and endocrine dysfunction. Monitoring and managing such late treatment effects may significantly challenge survivors’ long-term health care providers, who may need to take on increased survivorship care. For physicians and nurses working outside of oncology settings, who are increasingly called upon to collaborate with oncologists when caring for HL survivors, understanding the late treatment effects and potential risk factors facing this growing patient population is essential to the provision of comprehensive long-term care. The authors provide an overview of HL, review the most commonly encountered late adverse effects of treatment, and discuss current recommendations for survivor surveillance and screening.
Massachusetts Voters Reject Nurse Staffing Standards
Authors: Sofer Dalia
Published: January 2019

Nurses, too, were split on the vote.
Parental Efforts to Change Adolescents’ Sexual Orientation Linked to Adverse Mental Health Outcomes
Authors: Rosenberg Karen
Published: January 2019

According to this study:

Efforts by parents or caregivers to change an adolescent's sexual orientation are associated with poor mental health and adjustment in young adulthood.

The negative effects are stronger when parents additionally seek the assistance of therapists or religious leaders in changing the adolescent's sexual orientation.
The Language of Kindness: An Immersive Experience
Authors: Brown Theresa
Published: January 2019

Christie Watson's memoir locates nursing's emotional core.
Little Sparrow
Authors: Meyer Elaine C.
Published: January 2019

Discovering the healing value of a garden sanctuary.
Effects of Thoracic Epidural Anesthesia on Neuronal Cardiac Regulation and Cardiac Function
Authors: Wink Jeroen , Veering Bernadette T. , Aarts Leon P. H. J. , Wouters Patrick F.
Published: January 2019

Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia–induced sympatholysis and cardiovascular control mechanisms. Perhaps these new insights may help identify conditions in which benefits of thoracic epidural anesthesia may not outweigh potential risks. For example, cardiac sympathectomy with high-thoracic epidural anesthesia decreases right ventricular function and attenuates its capacity to cope with increased right ventricular afterload. Although the clinical significance of this pathophysiologic interaction is unknown at present, it identifies a subgroup of patients with established or pending pulmonary hypertension for whom outcome studies are needed. Other new areas of interest include the impact of thoracic epidural anesthesia–induced sympatholysis on cardiovascular control in conditions associated with increased sympathetic tone, surgical stress, and hemodynamic disruption. It was considered appropriate to collect and analyze all recent scientific information on this subject to provide a comprehensive update on the cardiovascular effects of high-thoracic epidural anesthesia and cardiac sympathectomy in healthy and diseased patients.
Elevation of Transient Receptor Potential Vanilloid 1 Function in the Lateral Habenula Mediates Aversive Behaviors in Alcohol-withdrawn Rats
Authors: Gregor Danielle M. , Zuo Wanhong , Fu Rao , Bekker Alex , Ye Jiang-Hong
Published: January 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Recent rat studies indicate that alcohol withdrawal can trigger a negative emotional state including anxiety- and depression-like behaviors and hyperalgesia, as well as elevated glutamatergic transmission and activity in lateral habenula neurons. TRPV1, a vanilloid receptor expressed in the habenula, is involved in pain, alcohol dependence, and glutamatergic transmission. The authors therefore hypothesized that TRPV1 contributes to the changes in both the behavioral phenotypes and the habenula activity in alcohol-withdrawn rats.

Methods

Adult male Long-Evans rats (n = 110 and 280 for electrophysiology and behaviors, respectively), randomly assigned into the alcohol and water (Naïve) groups, were trained to consume either alcohol or water-only using an intermittent-access procedure. Slice electrophysiology was used to measure spontaneous excitatory postsynaptic currents and firing of lateral habenula neurons. The primary outcome was the change in alcohol-related behaviors and lateral habenula activity induced by pharmacologic manipulation of TRPV1 activity.

Results

The basal frequency of spontaneous excitatory postsynaptic currents and firing of lateral habenula neurons in alcohol-withdrawn rats was significantly increased. The TRPV1 antagonist capsazepine (10 µM) induced a stronger inhibition on spontaneous excitatory postsynaptic currents (mean ± SD; by 26.1 ± 27.9% [n = 11] vs. 6.7 ± 18.6% [n = 17], P = 0.027) and firing (by 23.4 ± 17.6% [n = 9] vs. 11.9 ± 16.3% [n = 12], P = 0.025) in Withdrawn rats than Naive rats. By contrast, the TRPV1 agonist capsaicin (3 μM) produced a weaker potentiation in Withdrawn than Naïve rats (spontaneous excitatory postsynaptic currents: by 203.6 ± 124.7% [n = 20] vs. 415.2 ± 424.3% [n = 15], P < 0.001; firing: 38.1 ± 14.7% [n = 11] vs. 73.9 ± 41.9% [n = 11], P < 0.001). Conversely, capsaicin’s actions in Naïve but not in Withdrawn rats were significantly attenuated by the pretreatment of TRPV1 endogenous agonist N-Oleoyldopamine. In Withdrawn rats, intra-habenula infusion of TRPV1 antagonists attenuated hyperalgesia and anxiety-like behaviors, decreased alcohol consumption upon resuming drinking, and elicited a conditioned place preference.

Conclusions

Enhanced TRPV1 function may contribute to increased glutamatergic transmission and activity of lateral habenula neurons, resulting in the aberrant behaviors during ethanol withdrawal.
Neutrophil Extracellular Traps Are Elevated in Patients with Pneumonia-related Acute Respiratory Distress Syndrome
Authors: Bendib Inès , de Chaisemartin Luc , Granger Vanessa , Schlemmer Frédéric , Maitre Bernard , Hüe Sophie , Surenaud Mathieu , Beldi-Ferchiou Asma , Carteaux Guillaume , Razazi Keyvan , Chollet-Martin Sylvie , Mekontso Dessap Armand , de Prost Nicolas
Published: January 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Neutrophil extracellular traps have been associated with tissue damage. Whether these are involved in the pathogenesis of human acute respiratory distress syndrome (ARDS) and could be a potential therapeutic target is unknown. The authors quantified bronchoalveolar and blood neutrophil extracellular traps in patients with pneumonia-related ARDS and assessed their relationship with ventilator-free days.

Methods

Immunocompetent patients with pneumonia and moderate or severe ARDS (n = 35) and controls (n = 4) were included in a prospective monocentric study. Neutrophil extracellular trap concentrations were quantified (as DNA–myeloperoxidase complexes) in bronchoalveolar lavage fluid and serum by enzyme-linked immunosorbent assay. The relationship between bronchoalveolar lavage neutrophil extracellular trap concentrations and the primary clinical endpoint (i.e., the number of live ventilator-free days at day 28) was assessed using linear regression analyses.

Results

There was no significant relationship between bronchoalveolar lavage neutrophil extracellular trap concentrations and ventilator-free days by multiple regression analysis (β coefficient = 2.40; 95% CI, −2.13 to 6.92; P = 0.288). Neutrophil extracellular trap concentrations were significantly higher in bronchoalveolar lavage than in blood of ARDS patients (median [first to third quartiles]:154 [74 to 1,000] vs. 26 [4 to 68] arbitrary units, difference: −94; 95% CI, −341 to −57; P < 0.0001). Bronchoalveolar concentrations of patients were higher than those of controls (154 [74 to 1,000] vs. 4 [4 to 4] arbitrary units, difference: −150; 95% CI, −996 to −64; P < 0.001) and associated with bronchoalveolar interleukin-8 (Spearman’s ρ = 0.42; P = 0.012) and neutrophil concentrations (ρ = 0.57; P < 0.0001). Intensive care unit mortality (12%, n = 2 of 17 vs. 17%, n = 3 of 18; P > 0.99) and the number of ventilator-free days at day 28 (22 [14 to 25] vs. 14 [0 to 21] days; difference: −5; 95% CI, −15 to 0; P = 0.066) did not significantly differ between patients with higher (n = 17) versus lower (n = 18) bronchoalveolar neutrophil extracellular trap concentrations.

Conclusions

Bronchoalveolar neutrophil extracellular trap concentration was not significantly associated with mechanical ventilation duration in pneumonia-related ARDS.
Epidemiological study of the hand tumors in Tunisia: About 383 cases
Authors: Hassini Lassaad , Alaya Zeineb , Jedidi Mehdi , Khalifa Mohamed Ali , Osman Walid , Ben Ayèche Mohamed Laaziz
Published: January 2019

Background:

Tumors of the hand constitute a reason for regular consultation. They represent 15% of the soft-tissue tumors. Epidemiological data available in this area remain few and sometimes discordant as to the regained prevalence. In this context, it appeared interesting to carry out a study of these lesions to try to identify the epidemiological notions relevant to the daily medical practice.

Methods:

We conducted a retrospective study of all hand tumors operated on in the Orthopedic Department of Sahloul University Hospital in Sousse, Tunisia over a period of 18 yr.

Results:

During the period of our study, 383 patients were admitted with a diagnosis of hand tumor. A female predominance was found: 221 women, or 58% of the cases. The average age of patients was 39.5 yr with extremes ranging from 1 to 94 yr. There were 221 soft-tissue tumors (i.e. 57.7% of our population), 114 skin-tissue tumors (29.8%), and 48 bone tumors (12.5%). The prevalence of malignant tumors was therefore 6.26%.

Conclusions:

Our series included 385 hand tumors in 383 patients. It was the sixth largest population in the literature. The data found in this study are comparable to other published data. Soft-tissue tumors were the most frequent, with a prevalence ranging from 69.7% to 97.4%. The prevalence of cutaneous tumors varied from 4.5 to 35.6%. They are benign in 72% to 95%. Finally, in view of these epidemiological data, we can only suggest certain etiopathogenic hypotheses whose truths remain to be confirmed by research.
Pseudomyogenic hemangioendothelioma in the spine
Authors: Klag Elizabeth , Wakely Paul E. , Scharschmidt Thomas J.
Published: January 2019

Pseudomyogenic hemangioendothelioma (PMH), a soft-tissue tumor, commonly arises in the limbs with bone involvement being rare. A case of PMH localized to the thoracic spine is presented as well as a review of the literature, including differential diagnoses, and a discussion of treatment options.
Red meat and processed meat intake and risk of colorectal cancer: a population-based case–control study
Authors: Saliba Walid , Rennert Hedy S. , Gronich Naomi , Gruber Stephen B. , Rennert Gad
Published: January 2019

To examine the association between red meat subtypes intake and risk of colorectal cancer (CRC) among Jewish and Arabs populations in a unique Mediterranean environment. The Molecular Epidemiology of Colorectal Cancer study (n=10 026) is a prospective population-based case–control study in northern Israel. Participants were interviewed in-person about their dietary intake and lifestyle using a questionnaire that included a food-frequency questionnaire. Red meat consumption in Israel was found to be especially low in the Jewish population (1.29±1.45 servings/week), but higher in Arabs (3.0±1.98 servings/week) (P<0.001). Beef was the most commonly consumed red meat by Jews (1.15/1.29 servings/week, 89%) and proportionally less so by Arabs (2.00/3.00, 67%). Processed meat consumption (mostly pork free) was lower among Arabs (0.9±1.56 servings/week) compared with Jews (1.97±2.97 servings/week) (P<0.001). The adjusted odds of CRC per one serving/week of red meat were 1.05 (95% confidence interval: 1.01–1.08) in Jews and 0.94 (0.88–1.01) in Arabs. Compared with no consumption, beef consumption was associated with odds ratio (OR)=0.96 (0.86–1.07) in Jews and 0.94 (0.61–1.45) in Arabs, lamb consumption with OR=1.28 (1.10–1.5) and 1.01 (0.75–1.37), pork consumption with OR=1.44 (1.24–1.67) and 1.07 (0.73–1.56), and processed meat consumption with OR=1.22 (1.10–1.35) and 1.04 (0.82–1.33) in Jews and Arabs, respectively. Overall red meat consumption was associated weakly with CRC risk, significant only for lamb and pork, but not for beef, irrespective of tumor location. Processed meat was associated with mild CRC risk.
CORRELATION OF EN FACE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AVERAGING VERSUS SINGLE-IMAGE QUANTITATIVE MEASUREMENTS WITH RETINAL VEIN OCCLUSION VISUAL OUTCOMES
Authors: Jung Jesse J. , Chen Michael H. , Shi Yue , Nassisi Marco , Marion Kenneth , Sadda Srinivas R. , Hoang Quan V.
Published: January 2019

Purpose:

To demonstrate the effect of averaging multiple en face optical coherence tomography angiography images on the correlation between retinal microvasculature quantitative metrics and best-corrected visual acuity (BCVA) in eyes with retinal vein occlusion.

Methods:

A cross-sectional cohort with unilateral retinal vein occlusion was imaged in both eyes. Five 3 mm × 3-mm spectral domain optical coherence tomography angiography images were averaged, and quantitative parameters from averaged versus single images were correlated with logMAR BCVA. Regression analyses were performed to correlate quantitative metrics with BCVA.

Results:

Ten patients (5 male, average age 64.3 years) were included. Among retinal vein occlusion eyes, vessel length density was significantly less in averaged versus a single image for both the superficial retinal layer (15.5 ± 2.5 vs. 17.8 ± 2.4/mm, P = 0.05) and deep retinal layer (16.2 ± 1.4 vs. 18.5 ± 1.6/mm, P = 0.003). Multivariate linear regression showed an increased R2 value with averaging (0.93 to 0.95, for single and averaged groups, respectively). Foveal avascular zone circularity was associated with BCVA on single images (coefficient = −0.96, P = 0.002), but not with averaged images (P = 0.063).

Conclusion:

Scan averaging of en face optical coherence tomography angiography images improves the clarity of vessels and may allow for more accurate quantification of vessel metrics. Quantitative metrics are significantly associated with BCVA, and averaging does not further improve this association compared with single-scan analysis.
Qualitative Assessment of a Medical Protocols Mobile Application at the Boston Marathon 2016
Authors: Tseng David , d'Hemecourt Pierre , Baggish Aaron L. , Troyanos Chris , Liu James H. , Breaud Alan H. , Dyer K. Sophia
Published: January 2019

Objective:

To examine the creation of a medical protocols mobile application for the Boston Marathon and its use by medical volunteers for the 2016 Boston Marathon.

Design:

Anonymous questionnaire.

Setting:

2016 Boston Marathon.

Participants:

Two hundred ninety-four marathon medical volunteers.

Main Outcome Measures:

Responses regarding ease of use, acceptability, and usefulness of the International Institute of Race Medicine mobile application.

Results:

In total, 88% of medical volunteers who participated in the study felt that the medical protocols mobile application was easy to use. Approximately 72% would use the app again, and 79% would recommend the app to others. However, only 15% of volunteers consistently used the app during the event, and 37% felt like it contributed to clinical decision-making.

Conclusions:

A medical protocols app was found to be useful and well accepted among medical volunteers who reported using the app, but only a minority of respondents used the app on marathon day or felt like it contributed to clinical care. Although new, mobile apps in race medicine should continue to be an area of development as providers increasingly integrate their use into clinical practice.
Evaluation of alexithymia in patients affected by rheumatoid arthritis and psoriatic arthritis
Authors: Chimenti Maria Sole , Fonti Giulia Lavinia , Conigliaro Paola , Hitaj Juna , Triggianese Paola , Teoli Miriam , Galluzzo Marco , Talamonti Marina , Kroegler Barbara , Greco Elisabetta , Perricone Roberto
Published: January 2019

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic autoimmune diseases leading to joint damage, functional limitation, and disability and are typically associated with several comorbidities. Alexithymia is a personality trait characterized by a disregulation of emotion processing and regulation of emotions that involves a dissociation of emotional and physical responses to life events. A broad association between alexithymia and symptoms as depression, inflammation, and pain has been demonstrated. We aimed at evaluate an association among inflammatory arthritis, as RA and PsA, and alexithymia, and a possible link with clinical characteristics and disease activity.

In this cross-sectional study, we enrolled, from January to December 2017, patients affected by RA or PsA referring to the outpatient's clinic of the Rheumatology Unit of the University of Rome Tor Vergata. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. Disease activity, function, quality of life, and clinimetric indexes were assessed.

A total of 50 RA patients and 51 PsA patients were enrolled. The TAS-20 score showed 38.6% (39/101) patients had alexithymia, 26.7% (27/101) patients were in the borderline of alexithymia and 34.7% (35/101) patients did not have alexithymia. A statistical significant association was observed between alexithymia and inflammatory indices (ESR: P = .029, CRP: P = .043) and between alexithymia and clinimetric parameters (ptVAS, pVAS, GH, P < .0001 for all comparisons). A significant trend of association has been demonstrated between alexithymia and female gender and concomitant steroid therapy. No correlations among variables such as age, duration of disease, and comorbidities and alexithymia status were observed.

This study suggests that alexithymia assessment should be a part of the comprehensive management of RA and PsA patients.
Clinical diagnostic value of contrast-enhanced ultrasound and TI-RADS classification for benign and malignant thyroid tumors
Authors: Xu Yan , Qi Xiaojie , Zhao Xia , Ren Wenfeng , Ding Wei
Published: January 2019

To evaluate the diagnostic efficacy and clinical value of contrast-enhanced ultrasonography (CEUS) plus TI-RADS classification in benign and malignant thyroid tumors compared with either method alone.

The informed consent was signed all patients. A total of 370 patients with thyroid tumors of TI-RADS category 3 and 4 were recruited, with 432 thyroid nodules. They respectively received routine ultrasonography and CEUS. The nodules were reclassified according to CEUS scoring, and a combined diagnosis was made. The pathological results were taken as the gold standard. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve were calculated for the 3 diagnostic methods. The diagnostic efficacy was compared by using Student t test, Pearson chi-square (χ
2) test, McNemar chi-square (χ
2) test or Z test. Student t test and logistic regression were employed for comparing different imaging features of benign and malignant thyroid tumors on CEUS and risk analysis.

Of 432 thyroid nodules, there were 258 malignant nodules (59.72%) and 174 benign ones (40.28%). By logistic regression, 6 suspicious features on CEUS were considered significant for differentiating malignant from benign tumors: slow entry of contrast agents during enhancement stage (OR = 15.610, P = .001), slow time to peak (OR = 7.416, P = .002), non-uniform enhancement (OR = 10.076, P = .023), enhancement pattern (irregular) (OR = 36.233, P = .002), enhancement boundary (unclear) (OR = 25.300, P = .012), and no ring-like enhancement (OR = 25.297, P = .004). CEUS plus TI-RADS classification showed a higher diagnostic efficacy for differentiating between benign and malignant thyroid tumors. The Se was 85.66% (0.806–0.896), Sp 83.33% (0.768–0.884), PPV 88.40% (0.836–0.919), NPV 79.67% (0.729–0.851), and AUC 0.867 ± 0.019 (0.815–0.889). The above indicators were of statistical significance as compared with TI-RADS classification or CEUS alone (P <.05).

CEUS can more clearly visualize microvascular distribution of the nodules and offers a new approach to diagnose benign and malignant thyroid tumors. TI-RADS classification plus CEUS is more accurate than TI-RADS classification alone. This combined approach is worthy of clinical popularization.
Hypoplasia of the left lung presenting as hemoptysis
Authors: Zhang Lei , Ai Tao , Wang Li , Zhang Libin , Zhang Ying
Published: January 2019

Rationale:

Congenital pulmonary dysplasia (CPD), a congenital lung anomaly, is a heterogeneous group of developmental disorders with diverse clinical and imaging manifestations, including pulmonary agenesis, pulmonary aplasia, and pulmonary hypoplasia. Patients with CPD always have recurrent respiratory tract infections, dyspnea, and/or wheezing. To the best of the author's knowledge, no case of CPD with mild to moderate hemoptysis has been reported so far. Considering the rarity of this presentation, we herein report a case of hemoptysis caused by CPD.

Patient concerns:

We report on an 11-year-old girl who survived for 11 years with hypoplasia of the left lung without any associated complications except hemoptysis.

Diagnosis:

Left pulmonary hypoplasia.

Interventions:

The patient underwent left lower pulmonary lobe resection.

Outcomes:

The patient recovered favorably after the operation, and no complications were observed. The hemoptysis was controlled and the cough disappeared after the surgery.

Lessons:

CPD is a life-threatening disorder rarely encountered in the clinic, which plays an important role in various pediatric respiratory diseases. Misdiagnosis or delayed diagnosis of pulmonary malformations results in unnecessary treatments and hospitalization. The patients should undergo pulmonary contrast-enhanced CT and bronchoscopy for accurate and timely diagnosis, followed by surgical treatment.
Chronic nodules of sigmoid perforation caused by incarcerated intrauterine contraception device
Authors: Huang Xiaohui , Zhong Rui , Zeng Liqin , He Xuhui , Deng Qingshan , Peng Xiuhong , Li Jieming , Luo Xiping
Published: January 2019

Rationale:

It is extremely rare for an intrauterine contraception device (IUD) to cause uterine perforation and Sigmoid perforation for a long time without being detected.

Patient concerns:

We present a case of a patient who has suffered from abdominal pain after 4 years of placement of an IUD, and found that the IUD was incarcerated by ultrasound.

Diagnoses:

Laparoscopic and hysteroscopic examination revealed that the incarcerated IUD caused uterine perforation and sigmoid perforation for a long time. One end of the intrauterine device completely penetrated the anterior wall muscle layer of the uterus and the full layer of the sigmoid colon, located in the intestinal lumen, and the perforated portion of the sigmoid colon formed a chronic nodule.

Interventions:

We extended the sigmoid colon perforation and uterine perforation by laparoscopy, removed the incarcerated IUD from the uterus through the vagina, trimmed the chronic nodules of the sigmoid perforation, repaired the sigmoid colon, and repaired the uterine perforation.

Outcomes:

The patient was cured and discharged 22 days after surgery. The patient was naturally pregnant 3 months after surgery and delivered by cesarean section 12 months after surgery. We saw a good recovery of the uterus and sigmoid colon during cesarean section.

Lessons:

The patient was placed with an intrauterine device made of a special material and was not monitored after placement, causing the uterus and sigmoid perforation to be undetected for a long time. The IUD placed in the patient should be monitored regularly. If the IUD is found to be incarcerated or displaced, attention should be paid to uterine perforation and intestinal perforation.
Novel PANK2 mutation in a Chinese boy with PANK2-associated neurodegeneration
Authors: Zhang Yingying , Zhou Dong , Yang Tianhua
Published: January 2019

Rationale:

Pantothenate kinase-associated neurodegeneration (PKAN), also called Hallervorden–Spatz Syndrome (HSS), is a rare neurodegeneration with brain iron accumulation from pantothenate kinase 2 gene (PANK2) mutation characterized as extrapyramidal symptoms. However, few studies involving PKAN patients were reported in China. This study was conducted to identify the genetic mutations in a Chinese boy with PKAN, and to review all PANK2 mutations reported in Chinese cases with PKAN.

Patient concern:

We reported a 23-year-old Chinese boy with PKAN, exhibiting difficulty in writing and manipulation using right hand with slow progression for 12 years. He spoke with a severe stutter when he was 15 years old.

Diagnosis:

Considering results of magnetic resonance images, brain computed tomography and medical history, the case was suspected to be related to genetic factors.

Interventions:

Whole exome sequencing was arranged, and the mutations were identified in his parents’ genome.

Outcomes:

In the present study, whole exome sequencing revealed 2 novel mutations (c.1696C > G in exon 7 and c.1160_c.1161insG in exon3) of the PANK2 gene in the proband. c.1696C > G and c.1160_c.1161insG, respectively, were confirmed in his father and mother. We also reviewed 14 different PANK2 mutations, most of which were missense type in Chinese cases. Those mutations did not show apparent hotspots, but exon 3 and 4 were frequently involved.

Lessons:

Two novel compound heterozygous mutations were identified and considered to be pathogenic in PKAN patients. This review of the reports indicated that atypical PKAN is the more common phenotype in China and no apparent genotype-phenotype correlation was found.
Illicit massive silicone injections always induce chronic and definitive silicone blood diffusion with dermatologic complications
Authors: Bertin Chloé , Abbas Rachid , Andrieu Valérie , Michard Florence , Rioux Christophe , Descamps Vincent , Yazdanpanah Yazdan , Bouscarat Fabrice
Published: January 2019

Male-to-female transgender (MtF TG) individuals often report using illegal subcutaneous silicone injections for body feminisation. It leads to silicone dissemination and various dermatologic complications.

We report the long-term complications of these feminisation procedures with blood smear examination and dermatologic examination.

Between July 2015 and December 2015, 77 MtF TG consulting at Bichat Hospital (Paris, France) were included in this cross-sectional study. Blood smear examinations were performed by a trained haematologist to quantify the presence of silicone vacuoles in monocytes.

All patients reported a history of massive amounts of silicone injections (mean 4 L, range 0.5–15 L). Most patients were South American (75/77, 97%). Fifty-nine (59/75, 79%) were HIV-seropositive, mostly with undetectable HIV RNA plasma levels (46/58, 80%). Clinical examinations reported dermatologic complications for all patients: lymphatic or subcutaneous migration of silicone (59%), inflammation (50%), varicose veins (39%), post-inflammatory pigmentation (20%), infection (14%) and abscesses (4%). Blood smear examination showed intracytoplasmic vacuoles containing silicone in monocytes in all patients.

We did not chemically prove the silicone nature of the vacuoles. The design of this study does not allow evaluation of short-term complications that should not be minimized.

Illicit massive silicone injections always induced chronic and definitive silicone blood diffusion with dermatologic complications. This study highlights the dangers and the inefficiency of clandestine esthetic surgery. There is a need for targeted information campaigns with transgender populations about silicone injections. Otherwise, these practices may persist.
Pharmacological and non-pharmacological treatments for opioid-induced constipation
Authors: Zhang Jing , Mao Lanfang , Wang Longde , Lu Cuncun , Du Xiaojuan , Liang Qiankun , Yang Bo , Wu Hongli
Published: January 2019

Background:

Pain is very common and its management with a huge burden for patients and the healthcare system. And the network meta-analysis was designed to provide reference for the clinical practice.

Methods:

PubMed, EMBASE, Cochrane library, CNKI, VIP, Wan Fang, and CBM will be systematically searched their inception to November 2018. Randomized controlled trials that compared the effect of differently pharmacological or non-pharmacological treatments for opioid-induced constipation will be included. The primary outcome is the efficacy of therapeutic regimens. Risk of bias assessment of the included studies will be performed using the Cochrane risk of bias tool. A network meta-analysis will be performed using STATA 13.0 software with WinBUGS 1.4.3 software. Grading of Recommendations Assessment, Development, and Evaluation will be used to assess the overall quality of evidence.

Results:

This study is ongoing and will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will provide a comprehensive evidence on the effectiveness and safety of pharmacological and non-pharmacological treatments for opioid-induced constipation.

PROSPERO registration number:

CRD42018116533.
Risk assessment model for predicting ventricular tachycardia or ventricular fibrillation in ST-segment elevation myocardial infarction patients who received primary percutaneous coronary intervention
Authors: Huang Jiabing , Peng Xiaofan , Fang Zhenfei , Hu Xinqun , Zhou Shenghua
Published: January 2019

Ventricular tachycardia/ventricular fibrillation (VT/VF) is a kind of malignant arrhythmia in ST-segment elevation myocardial infarction (STEMI) patients who received primary percutaneous coronary intervention (PPCI). However, there are no risk assessment tools to anticipate the occurrence of VT/VF.

This study is to build a risk assessment model to predict the possibility of VT/VF onset in STEMI patients undergoing PPCI.

A retrospective study was conducted to analyze the patients who underwent PPCI from January 2006 to May 2015. Subjects were divided into VT/VF group and no VT/VF group based on whether VT/VF had occurred or not. In addition, the VT/VF group was further separated into early-onset group (from the time that symptoms began to before the end of PPCI) and late-onset group (after the end of PPCI) based on the timing of when VT/VF happened. Multivariate regression analysis was carried out to distinguish the independent risk factors of VT/VF and an additional statistical method was executed to build the risk assessment model.

A total of 607 patients were enrolled in this study. Of these patients, 67 cases (11%) experienced VT/VF. In addition, 91% (61) of patients experienced VT/VF within 48 h from the time that the symptoms emerged. Independent risk factors include: age, diabetes mellitus, heart rate, ST-segment maximum elevation, ST-segment total elevation, serum potassium, left ventricular ejection fraction (LVEF), culprit artery was right coronary artery, left main (LM) stenosis, Killip class > I class, and pre-procedure thrombolysis in myocardial infarction (TIMI) flow zero grade. Risk score model and risk rank model have been established to evaluate the possibility of VT/VF. Class I: ≤ 4 points; Class II: > 4 points, ≤ 5.5 points; Class III: > 5.5 points, < 6.5 points; and Class IV ≥ 6.5 points. The higher the class, the higher the risk.

The incidence of VT/VF in STEMI patients undergoing PPCI is 11% and it occurs more frequently from the time that symptoms begin to before the end of PPCI, which, in most cases, occurs within 48 h of the event. Our risk assessment model could predict the possible occurrence of VT/VF.
Gene polymorphism associated with endothelial nitric oxide synthase (4VNTR, G894T, C786T) and unexplained recurrent spontaneous abortion risk
Authors: Zhao Xiaoxuan , Li Qiang , Yu Feifei , Lin Lina , Yin Wenqing , Li Jiawei , Feng Xiaoling
Published: January 2019

To evaluate the association between endothelial nitric oxide synthase gene polymorphisms (4VNTR A/B, G894T, C786T) and risk of URSA.

Related case-control studies were collected by computers. A meta-analysis was conducted using Stata 12.0 software to assess the strength of association.

Altogether 37 articles were examining the relationship between endothelial nitric oxide synthase gene polymorphisms and URSA, among which sixteen (16) studies were related to 4VNTR, twelve (12) to G894T, and nine (9) to C786T, the study suggested that 4VNTR A/B polymorphism was closely connected with URSA risk under all gene models except for recessive model (AA vs. BB + AB). The integrated result which indicated the association between G894T gene mutation and URSA risk had been shown under homozygote (TT vs. GG; OR 1.585, 95%CI 1.175–2.138) and recessive models (TT vs. TG + GG; OR 1.530, 95%CI 1.142–2.052). Considering heterogeneity in the remaining gene models, subgroup analysis was performed on ethnicity, and the results showed that it was the dominant (TT + TG vs. GG; OR 1.585, 95%CI 1.175–2.138) and additive models (T vs. G; OR 1.727, 95%CI 1.372–2.175) of G894T in Asians and the heterozygote model (TG vs. GG; OR 1.015, 95%CI 0.846–1.217) in Caucasians that were associated with URSA (P < .05). Besides C786T gene was significantly connected with URSA under all models except for additive model (T vs. C).

It is of great guiding significance for screening out and preventing URSA among high-risk women via testing on 4VNTR A/B, G894T, C786T eNOS under gene models mentioned above which are closely associated with URSA.