bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction: Contexts
Authors: Schofield Malcolm
Published: January 2021

This chapter presents contexts of different kinds in which Cicero’s political philosophy may helpfully be set. It offers first some brief reminders of Cicero’s prominence in the rhetoric of the Western republican tradition, followed by a brief sketch of his political biography, including those periods of relative or almost total political inactivity in which he composed much of his philosophical oeuvre. A third section identifies three main reasons—respectively philosophical, literary, and historiographical—for his rehabilitation as a serious and seriously interesting philosophical thinker in the scholarship of recent decades. A further section considers Cicero’s ideas about what qualifies someone to write good political philosophy. Finally, some comments are made on the response that his own writings in that mode make to the political crisis of his times, together with a short sketch of key theoretical themes that are to be explored in the chapters that follow.
Government
Authors: Schofield Malcolm
Published: January 2021

In On the commonwealth Cicero explores three main ideas, discussed here in turn. First introduced is the concept of a res publica itself, held together as an association of citizens by the justice inherent in a fairly based legal order. Then Cicero stresses the consilium (deliberation) needed to govern it, and above all secure and maintain its stability, with the recipe a ‘mixed’ system of government such as Republican Rome had historically evolved. Finally, he turns to the leadership required to supply that consilium and to carry it through in action, whether in the ordinary functioning of the res publica or in moments of crisis when its integrity is threatened and a ‘director (rector) of the commonwealth and initiator of public consilium’ is needed. On laws presents and defends a more detailed account of the roles particularly of senate and people, and of their interaction, within the mixed constitution.
Epilogue: Philosophical Debate and Normative Theory
Authors: Schofield Malcolm
Published: January 2021

This short epilogue explores a tension in Cicero between a conception of philosophy as in its very nature a debate, and the idea that the point of doing philosophy is to find and advocate a sound theoretical basis for living our lives. It focuses first on a passage in On laws, where the need for an ethical principle that philosophers might agree sufficient, if accepted, to ‘put res publicae on a firm footing’, is taken to require the silencing of debate and sceptical doubt. On the commonwealth, however, had staged a full-throttled debate on justice. The contrast suggests not a disjunction between philosophy and politics, but between purely theoretical discussion of fundamental ethical and political questions and the requirements of viable guidance on policy and practice in these spheres.
Strigolactones and Auxin Cooperate to Regulate Maize Root Development and Response to Nitrate
Authors: Ravazzolo Laura , Boutet-Mercey Stéphanie , Perreau François , Forestan Cristian , Varotto Serena , Ruperti Benedetto , Quaggiotti Silvia
Published: January 2021

In maize, nitrate regulates root development thanks to the coordinated action of many players. In this study, the involvement of strigolactones (SLs) and auxin as putative components of the nitrate regulation of lateral root (LR) was investigated. To this aim, the endogenous SL content of maize root in response to nitrate was assessed by liquid chromatography with tandem mass Spectrometry (LC–MS/MS) and measurements of LR density in the presence of analogues or inhibitors of auxin and SLs were performed. Furthermore, an untargeted RNA-sequencing (RNA-seq)-based approach was used to better characterize the participation of auxin and SLs to the transcriptional signature of maize root response to nitrate. Our results suggested that N deprivation induces zealactone and carlactonoic acid biosynthesis in root, to a higher extent if compared to P-deprived roots. Moreover, data on LR density led to hypothesize that the induction of LR development early occurring upon nitrate supply involves the inhibition of SL biosynthesis, but that the downstream target of SL shutdown, besides auxin, also includes additional unknown players. Furthermore, RNA-seq results provided a set of putative markers for the auxin- or SL-dependent action of nitrate, meanwhile also allowing to identify novel components of the molecular regulation of maize root response to nitrate. Globally, the existence of at least four different pathways was hypothesized: one dependent on auxin, a second one mediated by SLs, a third deriving from the SL-auxin interplay, and a last one attributable to nitrate itself through further downstream signals. Further work will be necessary to better assess the reliability of the model proposed.
White Men Can’t Jump, but Does It Even Matter? Exit Discrimination in the NBA
Authors: Norris Davon , Moss-Pech Corey
Published: January 2021

Diffuse status characteristics, such as race and gender, affect individuals’ professional opportunities and outcomes. Scholars suggest two possible explanations for these status disparities. First, uncertainty in measuring workers’ performances forces employers to rely on status as a heuristic or proxy for quality. Second, a history of racism and sexism in the United States creates a deeper cultural devaluation of low-status individuals that permeates organizational structures such that status advantage would persist even after accounting for observed worker performance. However, researchers struggle to accurately and objectively measure worker performance, making it difficult to adjudicate between these two perspectives. We overcome this problem using the case of the National Basketball Association (NBA) in which detailed player statistics are widely available to the public and decision makers. We analyze whether there is a racial disparity in the odds of exiting the league using discrete-time event history analysis. Using data from 1980–2017, we demonstrate that after accounting for player performance, Black players have 30% higher odds of exiting the league in a given season. We find this disparity is mostly driven by White bench players allowing us to elucidate how Whiteness operates as a credential in the NBA by giving marginal White players benefits such as longer careers than comparable Black players. These findings demonstrate that racial disparities in workplaces may persist even once performance is captured and in cases like the NBA where we might expect racial disparities to be minimized.
Adapting an integrated neglected tropical disease programme in response to COVID-19
Authors: Clark Amy , Hill Becks , Bannerman Ron , Wohlgemuth Leah , Burrill Jennifer , Agyemang David , Genovezos Chantelle
Published: January 2021

The COVID-19 pandemic hit at a time when the Ascend West and Central Africa programme was nearing the end of its first year of a 3-y programme. This article reflects on key lessons learnt from the rapid adaptation of an integrated neglected tropical disease (NTD) programme to support COVID-19 responses in 11 countries. It shares the experiences of adopting a flexible and directive approach, leveraging the NTD network and relationships, and working in collaboration with multiple ministry departments, commercial sector partners and the UK Foreign Commonwealth Development Office to repurpose over £6 million of budget.
Virome composition in marine fish revealed by meta-transcriptomics
Authors: Geoghegan Jemma L , Di Giallonardo Francesca , Wille Michelle , Ortiz-Baez Ayda Susana , Costa Vincenzo A , Ghaly Timothy , Mifsud Jonathon C O , Turnbull Olivia M H , Bellwood David R , Williamson Jane E , Holmes Edward C
Published: January 2021

Revealing the determinants of virome composition is central to placing disease emergence in a broader evolutionary context. Fish are the most species-rich group of vertebrates and so provide an ideal model system to study the factors that shape virome compositions and their evolution. We characterized the viromes of nineteen wild-caught species of marine fish using total RNA sequencing (meta-transcriptomics) combined with analyses of sequence and protein structural homology to identify divergent viruses that often evade characterization. From this, we identified twenty-five new vertebrate-associated viruses and a further twenty-two viruses likely associated with fish diet or their microbiomes. The vertebrate-associated viruses identified here included the first fish virus in the Matonaviridae (single-strand, positive-sense RNA virus). Other viruses fell within the Astroviridae, Picornaviridae, Arenaviridae, Reoviridae, Hepadnaviridae, Paramyxoviridae, Rhabdoviridae, Hantaviridae, Filoviridae, and Flaviviridae, and were sometimes phylogenetically distinct from known fish viruses. We also show how key metrics of virome composition—viral richness, abundance, and diversity—can be analysed along with host ecological and biological factors as a means to understand virus ecology. Accordingly, these data suggest that that the vertebrate-associated viromes of the fish sampled here are predominantly shaped by the phylogenetic history (i.e. taxonomic order) of their hosts, along with several biological factors including water temperature, habitat depth, community diversity and swimming behaviour. No such correlations were found for viruses associated with porifera, molluscs, arthropods, fungi, and algae, that are unlikely to replicate in fish hosts. Overall, these data indicate that fish harbour particularly large and complex viromes and the vast majority of fish viromes are undescribed.
Teamwork and Coaching for Successful Manuscript Development by Nurse Faculty: A Novel Approach
Authors: Moch Susan D. , Parker Veronica G. , Young Linda K. , Valentine Kathleen L.
Published: January 2021

The current nurse faculty shortage warrants new models for both retaining faculty effectively and coaching new faculty efficiently. An approach for retaining faculty members through meeting publication review criteria while conserving senior faculty mentoring time is proposed. This article describes a successful manuscript development process using teamwork and coaching among faculty. The outcomes of this efficacious process — submission and acceptance of publishable manuscripts — are reported for two institutions: one is research intensive, and the other is teaching intensive. A noted outcome also includes ideas for future manuscript development process replication.
Interactive Poverty Simulation: Nursing Students’ Perceptions of Poverty
Authors: Garrett-Wright Dawn , Haughtigan Kara , Link Kim
Published: January 2021

The purpose of this study was to evaluate the influence of a poverty simulation on the attitudes of baccalaureate nursing students toward those living in poverty. A single-group pretest-posttest design was used. Participants’ attitudes were measured using the Attitude Toward Poverty Scale-Short Form. Results indicated significant improvement in 11 out of 21 items, along with the subscales for stigma and structural perspectives. However, four items, along with the overall personal deficiency domain score, indicated a significant worsening of attitudes. Results of this study are mixed and suggest that valid concerns exist regarding the administration of the simulation.
An Innovative Concept-Based Learning Activity to Identify and Educate Veterans at Risk for Amputation
Authors: Roach Ashley , Lloyd-Penza Mary , Wallace Sharon
Published: January 2021

Nurse educators must create meaningful learning for students while addressing the needs of a rapidly changing health care system. Academic-practice partnerships help ensure that students are up-to-date on current practices while faculty and students partner to support the needs of the practice institution. To address a health care system’s high amputation rates, school of nursing faculty developed a concept-based learning activity to assess and educate patients at risk for amputation. Results included increased student learning that can be applied to other practice settings and improved outcomes for the health care system.
Restrictive Transfusion Strategy after Cardiac Surgery
Authors: Zeroual Norddine , Blin Cinderella , Saour Marine , David Hélène , Aouinti Safa , Picot Marie-Christine , Colson Pascal H. , Gaudard Philippe
Published: January 2021

Background

Recent guidelines on transfusion in cardiac surgery suggest that hemoglobin might not be the only criterion to trigger transfusion. Central venous oxygen saturation (Svo
2), which is related to the balance between tissue oxygen delivery and consumption, may help the decision process of transfusion. We designed a randomized study to test whether central Svo
2–guided transfusion could reduce transfusion incidence after cardiac surgery.

Methods

This single center, single-blinded, randomized controlled trial was conducted on adult patients after cardiac surgery in the intensive care unit (ICU) of a tertiary university hospital. Patients were screened preoperatively and were assigned randomly to two study groups (control or Svo
2) if they developed anemia (hemoglobin less than 9 g/dl), without active bleeding, during their ICU stay. Patients were transfused at each anemia episode during their ICU stay except the Svo
2 patients who were transfused only if the pretransfusion central Svo
2 was less than or equal to 65%. The primary outcome was the proportion of patients transfused in the ICU. The main secondary endpoints were (1) number of erythrocyte units transfused in the ICU and at study discharge, and (2) the proportion of patients transfused at study discharge.

Results

Among 484 screened patients, 100 were randomized, with 50 in each group. All control patients were transfused in the ICU with a total of 94 transfused erythrocyte units. In the Svo
2 group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P < 0.001 vs. controls), with a total of 65 erythrocyte units. At study discharge, eight patients of the Svo
2 group remained nontransfused and the cumulative count of erythrocyte units was 96 in the Svo
2 group and 126 in the control group.

Conclusions

A restrictive transfusion strategy adjusted with central Svo
2 may allow a significant reduction in the incidence of transfusion.

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Slow Mohs Micrographic Surgery for Acral Melanoma Treatment in Korean Patients
Authors: Seo Jimyung , Oh Yeongjoo , Kim Sang Kyum , Roh Mi Ryung , Chung Kee Yang
Published: January 2021

BACKGROUND

Obtaining conventional wide surgical margins is challenging in melanomas occurring at anatomically complex sites (e.g., hands and feet).

OBJECTIVE

We investigated the potential benefits of slow Mohs micrographic surgery (MMS) for acral melanomas.

MATERIALS AND METHODS

This single-center retrospective study investigated 210 patients who underwent slow MMS (n = 66) or wide local excision (WLE, n = 144) for melanomas during 2005 to 2015. Slow MMS was used for melanomas in anatomically complex locations and for high-risk lesions.

RESULTS

Acral melanoma (166/210) was the most common lesion observed in patients, in addition to head and neck (21/210) and trunk (23/210) melanomas. Slow MMS was more commonly performed for acral, and head and neck melanomas (32.5% and 52.4%, respectively) than for trunk melanomas (4.3%, p = .002). Local recurrence of acral melanomas occurred in 3.7% of patients after slow MMS and in 10.7% of patients after WLE. Multivariate analysis showed comparable prognostic outcomes between slow MMS and WLE used for acral melanomas. Compared with WLE, slow MMS resulted in a smaller postoperative defect after acral lesion excision (p < .001).

CONCLUSION

Slow MMS is an effective alternative to WLE for acral melanomas in anatomically complex sites, as evidenced by superior outcomes and maximum tissue conservation.
Clinical Evaluation of Safety and Efficacy of a 670-nm Picosecond Laser for Treatment of Benign Pigmented Lesions in Asians
Authors: Evangelista Kristy E.R. , Manuskiatti Woraphong , Wanitphakdeedecha Rungsima , Techapichetvanich Thanya
Published: January 2021

BACKGROUND

Picosecond lasers are increasingly being investigated in treating pigmentation disorders because they may provide better treatment efficacy and comfort compared with nanosecond lasers.

OBJECTIVE

This study aims to evaluate the efficacy and side effect of a novel 670-nm picosecond laser in the removal of benign pigmented lesions (BPLs) in individuals with Fitzpatrick skin types (FST) III and IV.

MATERIALS AND METHODS

Fifteen subjects with solar lentigines and 7 subjects with ABNOMs received a single treatment with a 670-nm picosecond laser. Blinded physicians assessed the pigment clearance using a 5-category grading system scale. All subjects were evaluated at 1 month, 3 month, and 6 month after a single treatment. Adverse events were recorded at every follow-up visit.

RESULTS

All subjects with lentigines had complete clearance (95%–100%) of lesions during 3-month follow-up after a single treatment session of 670-nm picosecond laser, whereas 75% of the subjects with ABNOMs noted fair lightning (25%–49%) of lesions. Mild hypopigmentation and hyperpigmentation were observed in 9% and 14% of the subjects, respectively, which resolved within 3 months after the treatment.

CONCLUSION

The novel 670-nm picosecond laser is a safe and effective treatment for BPLs in subjects with FST III and IV with low rates of transient adverse effects.
Nasalis-Based V to Y Flap Versus the Bilobed Flap
Authors: Flores Kyle , Degesys Catherine A. , Kearney Elaine , Retterbush Patrick , Merritt Bradley G.
Published: January 2021

BACKGROUND

Reconstructing defects on the nose can be challenging. The bilobed transposition flap and the nasalis-based V to Y (NBVY) flaps can be excellent repair options, each with their own advantages and disadvantages.

OBJECTIVE

To compare bilobed and NBVY flap scar appearances, postoperative complications, scar revision rates, flap sizes, and relative costs.

MATERIALS AND METHODS

We reviewed 95 cases of Mohs surgery defects on the nose repaired with either a bilobed or a NBVY flap from 2010 to 2018 at our institution. Eleven reviewers judged postoperative scar images using a modified visual analog scale.

RESULTS

There were no significant differences in reviewer-rated scar appearances, complication rates, or revision rates between bilobed and NBVY flaps. The NBVY flaps were 50% smaller than bilobed flaps, with significantly lower CPT billing codes. The NBVY flaps yielded better scar appearance scores compared with bilobed flaps on highly sebaceous noses.

CONCLUSION

The NBVY and bilobed flaps demonstrated similar scar appearance outcomes, but the NBVY flap has several advantages. Compared with the bilobed flap, the NBVY flap is smaller, less expensive, and may yield better cosmetic outcomes in patients with highly sebaceous noses.
Frequency and clinical management of numerical and segmental mosaicism in embryo biopsies obtained for preimplantation genetic testing (PGT)
Authors: Rechitsky Svetlana , Simpson Joe L. , Kuliev Anver
Published: January 2021

Preimplantation genetic testing (PGT) for aneuploidy is an established indication to increase the pregnancy rate while still transferring a single embryo. Trophectoderm biopsy in experienced hands is safe with no association with birth defects. Accuracy is high using next-generation sequencing and clinical utility proven; predictive value of achieving pregnancy when transferring a euploid embryo is 10-fold greater than when transferring an aneuploid embryo. In our unit next-generation sequencing results show 8% of embryos having numerical mosaicis and 14% having segmental mosaicism. Mosaicism is defined as 20%–80% aneuploid DNA, compared with <20% in a sample considered nonmosaic euploid. Transfer of a mosaic (20%–80% aneuploid DNA) embryo may be appropriate if there are no euploid embryos in the cohort of a given cycle. Guidelines exist for prioritization of mosaic embryos for transfer.
Assessment of knowledge and practice on birth preparedness and complication readiness among women who gave birth in the last 12 months in southwest, Ethiopia 2016
Authors: Abita Zinie , Shikur Zeru
Published: January 2021

Background:

Avoidable mortality and morbidity remains formidable challenge in many developing countries like Ethiopia. Pregnancy-related complications cannot be reliably predicted and it is necessary to design strategies to overcome problems when they arise. Lack of advance planning for use of a skilled birth attendant for normal births, and particularly inadequate preparation for rapid action in the events of obstetric complications, are well documented factors contributing to delay in receiving skilled obstetric care. Birth preparedness has been globally endorsed as an essential component of safe motherhood programs to reduce delays for care, so as to reduce maternal and neonatal mortality rate.

Methods:

A cross-sectional community based study was conducted to examine knowledge and practice of birth preparedness and complication readiness among women who gave birth in the last 12 months in Mizan-Aman town by using pretested structured questionnaires. The sampling technique was that of systematic sampling and the sample size was 239.

Results:

Data were obtained from 239 mothers, yielding 98% a response rate. Out of total respondents more than half (53.5%) of respondents said that they knew the term “birth preparedness.” More specifically, 44.7%, 50.8%, 31.8% of the respondents were knowledgeable about possible danger signs during pregnancy, during delivery, and postpartum period, respectively. Concerning complication readiness, 50% stated that they were prepared for birth and its complications.

Conclusion and Recommendation:

Knowledge and practices of birth preparedness and complication readiness is not comprehensive according to the result of this study. Many respondents did not know about birth preparedness and had no plans for emergencies. Therefore, community education about preparations for birth and its complications and empowerment of women through expansion of educational opportunities are recommended for improving birth preparedness and the effects of pregnancy-related complications.
PURTSCHER-LIKE RETINOPATHY ASSOCIATED WITH ATYPICAL HEMOLYTIC UREMIC SYNDROME: CASE REPORT AND REVIEW OF OUTCOMES
Authors: Gange William S. , Haghighi Arezu , Toy Brian C.
Published: January 2021

Purpose:

The purpose of this study was to report the case of a patient presenting with newly diagnosed atypical hemolytic uremic syndrome (aHUS) and Purtscher-like retinopathy.

Methods:

This is an observational case report and review of literature. A 38-year-old woman presented with 3 months of rashes, fevers, arthralgias, and abdominal pain. Initial workup was suggestive of hypereosinophilic syndrome or adult-onset Still’s disease. The patient developed acute renal failure and progressively blurry vision bilaterally over the course of 5 days. Funduscopic examination was notable for numerous Purtscher flecken and cotton–wool spots, with rare intraretinal hemorrhages at the posterior pole. The constellation of renal failure, hemolytic anemia, and thrombocytopenia prompted a workup for thrombotic microangiopathy that was remarkable for a mutation in the gene coding for complement protein C9.

Results:

The patient was diagnosed with aHUS and treated with intravenous pulse dose steroids for 3 days and an extended course of eculizumab. The patient's renal failure resolved, and her visual acuity improved, although she had residual visual field constriction and developed bilateral optic atrophy. Outcomes of other cases of Purtscher-like retinopathy related to aHUS are reviewed.

Conclusion:

Purtscher-like retinopathy is a rare but severe ophthalmic complication of aHUS. Eculizumab is an effective treatment for the systemic illness caused by aHUS, and anatomical resolution of Purtscher-like retinopathy may follow, although visual prognosis remains guarded. Recovery of visual acuity may lag behind resolution of macular edema in these patients.
Warthin Tumor of the Caruncle: A Rare Case Report and Review of the Literature
Authors: Iacob Stanca I. , Keyhani Kayvan K. , Farhat Nada A.
Published: January 2021

The authors describe a case of Warthin tumor arising in the caruncle of a 76-year-old man. Clinical examination identified a left medial canthus swelling that was treated by complete local excision. Pathologic examination revealed a benign epithelial tumor with diagnostic features of Warthin tumor. Clinical and histologic features, along with review of the literature, are discussed.
Exenteration and Adjuvant Radiotherapy for Primary Carcinosarcoma of the Anterior Orbit: A Case Report
Authors: Fernandez Christian , Forrest Paul , Sivalingam Meera , Milman Tatyana , Ramesh Sathyadeepak , Shi Wenyin
Published: January 2021

Carcinosarcoma is a malignant mixed tumor composed of epithelial and mesenchymal components which arises in a variety of tissues, including, in rare cases, the orbit. A 75-year-old male with a history of basal cell carcinoma of the left medial canthus, previously treated with surgical resection and adjuvant radiation therapy, presented with a recurrent 3 cm nodule of the left medial canthus. He underwent surgical resection of the left superior and inferior eyelid with pathology revealing invasive squamous cell carcinoma of upper and lower eyelids with deep orbital tissue involvement and undifferentiated pleomorphic sarcoma involving the dermis and periosteum, consistent with carcinosarcoma. Orbital exenteration was subsequently performed. He successfully underwent adjuvant stereotactic body radiation therapy 30 Gy in 5 fractions with no significant side effects. Follow-up MRI revealed posttreatment changes without evidence of recurrent disease.
Evaluation of Antibiotic Prophylaxis for Acute Nonoperative Orbital Fractures
Authors: Esce Antoinette R. , Chavarri Vanina M. , Joshi Amar B. , Meiklejohn Duncan A.
Published: January 2021

Purpose:

The use of antibiotic prophylaxis for the prevention of infection in nonoperative orbital fractures is controversial, with limited high-quality evidence and inconsistent recommendations in the current scientific literature. Our primary study objective was to identify the prophylactic antibiotic prescribing pattern at our institution for nonoperative orbital fractures and to determine the effect of antibiotic prophylaxis.

Methods:

We retrospectively reviewed 16 years of data from a single institution on patients with acute traumatic fractures of the orbital floor or medial orbital wall. Prophylactic administration of antibiotics and complication rates were evaluated, and complication rates and patient characteristics analyzed.

Results:

Of 154 patients with nonoperative orbital fractures, 17 patients (group 1) received IV or oral antibiotics and 137 patients (group 2) did not. No patient in either group had documented infectious orbital complications following their orbital injury. Patients receiving antibiotics were more likely to have a concurrent periorbital laceration (58.8% ± 11.9% vs. 28.5% ± 3.9%; P = 0.01).

Conclusion:

We present the largest cohort yet reported of patients managed without antibiotic prophylaxis for nonoperative orbital fractures, with no infectious complications identified. Currently there is no evidence of utility to prophylactic antibiotics in the setting of nonoperative traumatic orbital fractures. Rather than prescribing antibiotics, we recommend clinicians educate patients on return precautions and offer close follow up for the rare, but potentially severe infectious complications of orbital trauma.
Creation of small incision using CIRCLE software to manage suction loss during small-incision lenticule extraction
Authors: Kankariya Vardhaman P. , Dube Ankita B. , Grentzelos Michael A. , Kymionis George D. , Pallikaris Ioannis G.
Published: January 2021

A 26-year-old woman presented for correction of her refractive error. Small-incision lenticule extraction (SMILE) was planned for both eyes. Toward the end of cap interface cut in her right eye, unstable suction resulting in intrusion of conjunctival tissue under the contact interface was noted. Although femtosecond laser application was completed, it was ineffective in creating the small incision. CIRCLE software was used to create a 50-degree wide small incision alone (310-degree wide hinge), avoiding cap conversion to a flap. Lenticule extraction was performed through the new small incision, and the procedure was completed uneventfully. The uncorrected distance visual acuity was 20/20 on the first postoperative day. Thus, CIRCLE software can be successfully used after suction loss in SMILE alone for the creation of small incision without cap-to-flap conversion, allowing completion of the flapless SMILE procedure.
Gut peptides and the microbiome: focus on ghrelin
Authors: Leeuwendaal Natasha K. , Cryan John F. , Schellekens Harriët
Published: January 2021

Purpose of review

In this review, we present recent insights into the role of the gut microbiota on gastrointestinal (GI) peptide secretion and signalling, with a focus on the orexigenic hormone, ghrelin.

Recent findings

Evidence is accumulating suggesting that secretion of GI peptides is modulated by commensal bacteria present in our GI tract. Recent data shows that the gut microbiome impacts on ghrelinergic signalling through its metabolites, at the level of the ghrelin receptor (growth hormone secretagogue receptor) and highlights concomitant changes in circulating ghrelin levels with specific gut microbiota changes. However, the mechanisms by which the gut microbiota interacts with gut peptide secretion and signalling, including ghrelin, are still largely unknown.

The gut microbiota may directly or indirectly influence secretion of the orexigenic hormone, ghrelin, similar to the modulation of satiety inducing GI hormones. Although data demonstrating a role of the microbiota on ghrelinergic signalling is starting to emerge, future mechanistic studies are needed to understand the full impact of the microbiota-ghrelin axis on metabolism and central-regulated homeostatic and non-homeostatic controls of food intake.
Clinical utility of Ga68 DOTANOC PET/CT imaging in juvenile nasal angiofibroma and the PARIS protocol: a preliminary report
Authors: Thakar Alok , Sakthivel Pirabu , Arunraj Sreedharan T. , Bhalla Ashu S. , Prashanth Arun , Kumar Rakesh , Sharma Suresh C. , Kumar Rakesh
Published: January 2021

Objectives

Juvenile nasopharyngeal angiofibroma (JNA) expresses different somatostatin cell surface receptors and Ga68 [DOTA, 1-Nal3]-octreotide (DOTANOC)-PET/computed tomography (CT) scan may be used for its imaging. Also, functional imaging with DOTANOC-PET/CT may promise of greater accuracy in the detection or exclusion of recurrent/residual JNA.

Methods

In this prospective study, five JNA patients who underwent a DOTANOC-PET-CT scan both preoperatively and postoperatively during June 2018–March 2020 were included. Postcontrast enhancement of a definite lesion was considered residual/recurrent tumor in contrast-enhanced MRI (CEMRI). In DOTANOC-PET/CT, any abnormal uptake apart from physiological sites was considered as residual lesions. Radiological results were categorized as negative, suspicious or definite residual/recurrent tumors. Any discrepancy was resolved by endoscopic biopsies.

Results

Preoperatively all five cases of JNA showed avid DOTANOC expression in the tumor. The mean (SD) value of DOTANOC standardised uptake value in the tumor was 4.3 (1.4) (range = 2.1–6.2). In postoperative CEMRI evaluation, three of five patients had residual tumors and two had normal scans. On DOTANOC-PET/CT, two of five patients had residual tumors and three had normal scans. In one patient with residual tumor, the discrepancy with regard to tumor extent was noted in two scans, and further biopsy confirmed the findings of DOTANOC-PET/CT as accurate.

Conclusion

68Ga-DOTANOC-PET/CT uptake is universal in JNA and appears to be more specific in the identification of residual/recurrent JNA. In residual tumors, DOTANOC-PET/CT may have an advantage over CEMRI in the diagnosis, decision making and planning stereotactic radiation. However, these findings are to be validated in studies with larger patients.
The influence of colour scale in lesion detection and patient-based sensitivity in [68Ga]Ga-PSMA-PET/CT
Authors: Mingels Clemens , Sachpekidis Christos , Bohn Karl P. , Hünermund Jan-Niklas , Schepers Robin , Fech Viktor , Prenosil George , Rominger Axel , Afshar-Oromieh Ali , Alberts Ian
Published: January 2021

Objective

To investigate the influence of colour scales on the interpretation of [68Ga]Ga-PSMA-11 PET/CT for the diagnosis of recurrent prostate cancer.

Methods

50 consecutive patients who underwent [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer were selected for this retrospective study. The scans were randomised, anonymised and read by five different readers first in the visually nonlinear colour scale ‘PET-rainbow’. Scans were then rerandomised and read in the visually linear colour scale ‘hot-metal new’. For each scan in each colour scale the numbers of pathological, equivocal and benign lesions were noted. Scans where the majority of readers (≥3) reported at least one PET-positive lesion were recorded as ‘pathological’. Patient-level sensitivity was obtained by composite standard with 14.8 ± 1.2 months of follow-up.

Results

Increased numbers of lesions per patient were reported for all readers in PET-rainbow compared to hot-metal new (37.4 ± 15.2 vs. 33.9 ± 16.4, respectively, P = 0.0005). On a per-patient basis, 43 scans were rated pathological in PET-rainbow, compared to 39 in hot-metal new. Follow-up was available for 30 patients confirming 26 pathological scans with positive follow-up in PET-rainbow, and 23 in hot-metal new. Three pathological scans were missed in hot-metal new. Patient-level sensitivity was higher for PET-rainbow (0.96) compared to hot-metal new (0.85). Inter-reader reliability was higher for hot-metal new (Fleiss κ = 0.76) compared to PET-rainbow (Fleiss κ = 0.60).

Conclusion

Use of PET-rainbow was associated with improved lesion detection and sensitivity compared to hot-metal new, although at cost of reduced inter-rater agreement. Consequently, the use of PET-rainbow for clinical routine and future studies involving [68Ga]Ga-PSMA-11 is recommended.
Diagnostic performance of 18F-FDG PET/CT for the detection of occult primary tumors in squamous cell carcinoma of unknown primary in the head and neck: a single-center retrospective study
Authors: Chen Bin , Zhang Haoran , Liu Dezhi , Wang Xueju , Ji Bin , Gao Shi
Published: January 2021

Objective

To investigate the diagnostic performance of 18F-FDG PET/computed tomography (CT) for the detection of occult primary tumors in patients with squamous cell carcinoma of unknown primary (SCCUP) in the head and neck.

Patients

From March 2016 to January 2020, 37 patients diagnosed as SCCUP before PET/CT were retrospectively reviewed. The diagnosis of SCCUP was made when an overt primary tumor location could not be found for histologically proven squamous cell cervical lymphadenopathy after a complete diagnostic workup which includes full medical history, physical examinations, flexible rhinolaryngoscopy and CT or MRI. The PET/CT images were visually assessed by two nuclear medicine radiologists. Histopathological investigations after the PET scan served as the reference standard.

Results

The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for SCCUP were 71.4, 43.8, 62.5, 53.9 and 59.5%, respectively. PET/CT allowed identification of previously undetected lesions in 40.5% of the SCCUP patients. A total of 24 PET/CT scans indicated a positive result. Among them, nine were categorized into false-positive because of negative results from subsequent targeted and random biopsies. There were 13 PET/CT scans with a negative result, six of which, however, were revealed to have a primary site by subsequent random biopsies.

Conclusion

18F-FDG PET/CT was shown to be useful in detecting a primary tumor for SCCUP, but had limitations in terms of both false-positive cases and false-negative cases. Therefore, histopathological investigations such as targeted and random biopsy should be viewed as necessary practice irrespective of PET/CT results.
How Mindfulness and Acceptance Could Help Psychiatrists Predict Alexithymia Among Students
Authors: Tamanaeifar Shima , Pirkashani Nikzad Ghanbari , Nooripour Roghieh
Published: January 2021

Mindfulness and acceptance have demonstrated associations with alexithymia facets. As a very limited body of research has explored the predictive strength among alexithymia-related constructs, this study aimed to investigate the prediction of alexithymia based on acceptance and mindfulness among students. The study group consisted of 586 university students, 237 (40.9%) females and 349 (59.1%) males. As for data collection, the five-factor mindfulness questionnaire, Acceptance and Commitment Questionnaire, and the Toronto Alexithymia Scale-2 were applied. A stepwise multiple linear regression was calculated to predict alexithymia based on components of commitment and action, mindfulness facets, and demographic variables (F[5,578] = 77.26, p ≤ 0.001), with an R
2 of 0.41. The predictive variables including description (B = −0.59, t = −8.02, p < 0.001), commitment and action (B = −0.13, t = −4.38, p < 0.001), observation (B = −0.15, t = −2.94, p < 0.01), and no judgment (B = −0.16, t = −2.56, p < 0.05) exhibited significant prediction effects on the adjusted index of alexithymia. The findings contribute to the potential mechanism between mindfulness and alexithymia in intervention that seeks to improve mindfulness and acceptance skills and could prove more effective in treating patients with alexithymia.
Serum Creatinine Monitoring After Acute Kidney Injury in the PICU*
Authors: Robinson Cal , Benisty Kelly , Cockovski Vedran , Joffe Ari R. , Garros Daniel , Riglea Teodora , Pizzi Michael , Palijan Ana , Chanchlani Rahul , Morgan Catherine , Zappitelli Michael
Published: January 2021

Objectives:

It is unknown whether children with acute kidney injury during PICU admission have kidney function monitored after discharge. Objectives: 1) describe postdischarge serum creatinine monitoring after PICU acute kidney injury and 2) determine factors associated with postdischarge serum creatinine monitoring.

Design:

Secondary analysis of longitudinal cohort study data.

Setting:

Two PICUs in Montreal and Edmonton, Canada.

Patients:

Children (0–18 yr old) surviving PICU admission greater than or equal to 2 days from 2005 to 2011. Exclusions: postcardiac surgery and prior kidney disease. Exposure: acute kidney injury by Kidney Disease: Improving Global Outcomes serum creatinine definition.

Interventions:

None.

Measurements:

Primary outcome: postdischarge serum creatinine measured by 90 days, 1 year, and 5–7 years.

Secondary outcomes:

Healthcare events and nephrology follow-up.

ANALYSIS:

Proportions with outcomes; logistic regression to evaluate factors associated with the primary outcome. Kaplan-Meier analysis of time to serum creatinine measurement and healthcare events.

Main Results:

Of n = 277, 69 (25%) had acute kidney injury; 29/69 (42%), 34/69 (49%), and 51/69 (74%) had serum creatinine measured by 90 days, 1 year, and 5–7 year postdischarge, respectively. Acute kidney injury survivors were more likely to have serum creatinine measured versus nonacute kidney injury survivors at all time points (p ≤ 0.01). Factors associated with 90-day serum creatinine measurement were inpatient nephrology consultation (unadjusted odds ratio [95% CI], 14.9 [1.7–127.0]), stage 2–3 acute kidney injury (adjusted odds ratio, 3.4 [1.1–10.2]), and oncologic admission diagnosis (adjusted odds ratio, 10.0 [1.1–93.5]). A higher proportion of acute kidney injury versus nonacute kidney injury survivors were readmitted by 90 days (25 [36%] vs 44 [21%]; p = 0.01) and 1 year (33 [38%] vs 70 [34%]; p = 0.04). Of 24 acute kidney injury survivors diagnosed with chronic kidney disease or hypertension at 5–7 year follow-up, 16 (67%) had serum creatinine measurement and three (13%) had nephrology follow-up postdischarge.

Conclusions:

Half of PICU acute kidney injury survivors have serum creatinine measured within 1-year postdischarge and follow-up is suboptimal for children developing long-term kidney sequelae. Knowledge translation strategies should emphasize the importance of serum creatinine monitoring after childhood acute kidney injury.
Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients*
Authors: Osawa Ichiro , Tsuboi Norihiko , Nozawa Hisataka , Nishimura Nao , Nakagawa Satoshi
Published: January 2021

OBJECTIVES:

Various methods to insert postpyloric feeding tubes at the bedside have been reported, but the optimal method remains controversial. The objective of this study was to evaluate the effect of ultrasound-guided postpyloric feeding tube placement in critically ill children.

DESIGN:

Single-center retrospective observational study.

SETTING:

PICU of tertiary children’s hospital.

PATIENTS:

Children under the age of 16 who underwent postpyloric feeding tube placement in our PICU between September 2017 and August 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 115 patients were included in this study: 30 patients underwent ultrasound-guided postpyloric feeding tube placement and 85 patients underwent blind postpyloric feeding tube placement; the insertion attempts were 32 and 93, respectively. There were no significant differences in patient demographics between the ultrasound-guided group and the blind group. The first-pass success rate of the ultrasound-guided group was higher than that of the blind group (94% [30/32] vs 57% [53/93]; p < 0.001). The median insertion time in the ultrasound-guided group with successful postpyloric feeding tube insertion was 18 minutes (interquartile range, 15–25; range, 8–45; n = 21). There were no complications or adverse events during the placement.

CONCLUSIONS:

In this single-center study, ultrasound-guided postpyloric feeding tube placement was feasible and a significantly high first-pass success rate was observed for critically ill children. Additional investigation with a larger pool of operators and randomized controlled patient assignment is required.
Steatorrhea Versus Normal Stool in Neonatal and Early Infantile Period: Implications for Biliary Atresia
Authors: Okajima Kazuki , Suzuki Tatsuya
Published: January 2021

Physicochemical property of undigested milk fat is theoretically analyzed. With uniqueness of neonatal/early infantile period and fat amount, the highest estimated stiffness of stool is gel or paste level. Therefore, typical stool of breastfed, small amount either watery or “seedy” is incompatible with steatorrhea, which may be useful to diagnose biliary atresia patients.
Clinical updates on phantom limb pain
Authors: Erlenwein Joachim , Diers Martin , Ernst Jennifer , Schulz Friederike , Petzke Frank
Published: January 2021

Introduction:

Most patients with amputation (up to 80%) suffer from phantom limb pain postsurgery. These are often multimorbid patients who also have multiple risk factors for the development of chronic pain from a pain medicine perspective. Surgical removal of the body part and sectioning of peripheral nerves result in a lack of afferent feedback, followed by neuroplastic changes in the sensorimotor cortex. The experience of severe pain, peripheral, spinal, and cortical sensitization mechanisms, and changes in the body scheme contribute to chronic phantom limb pain. Psychosocial factors may also affect the course and the severity of the pain. Modern amputation medicine is an interdisciplinary responsibility.

Methods:

This review aims to provide an interdisciplinary overview of recent evidence-based and clinical knowledge.

Results:

The scientific evidence for best practice is weak and contrasted by various clinical reports describing the polypragmatic use of drugs and interventional techniques. Approaches to restore the body scheme and integration of sensorimotor input are of importance. Modern techniques, including apps and virtual reality, offer an exciting supplement to already established approaches based on mirror therapy. Targeted prosthesis care helps to obtain or restore limb function and at the same time plays an important role reshaping the body scheme.

Discussion:

Consequent prevention and treatment of severe postoperative pain and early integration of pharmacological and nonpharmacological interventions are required to reduce severe phantom limb pain. To obtain or restore body function, foresighted surgical planning and technique as well as an appropriate interdisciplinary management is needed.
Delayed Gadolinium Leakage in Ocular Structures
Authors: Galmiche Chloé , Moal Bertrand , Marnat Gaultier , Sagnier Sharmila , Schweitzer Cédric , Dousset Vincent , Sibon Igor , Tourdias Thomas
Published: January 2021

Background

Gadolinium leakage in ocular structures (GLOS) was recently observed in fluid-attenuated inversion recovery (FLAIR) images obtained the day after an initial gadolinium injection in stroke patients. The specificity of GLOS to stroke and its mechanisms remain unclear.

Objective

We investigated the factors associated with GLOS in a cohort of patients presenting with acute neurological deficits.

Materials and Methods

This retrospective study included consecutive patients admitted to our stroke unit for acute neurological deficit between July 2017 and August 2018 who underwent baseline brain magnetic resonance imaging with the injection of a macrocyclic gadolinium agent and another scan without injection within 72 hours. The patients were separated into a stroke group and a stroke mimic group based on diffusion-weighted images. Gadolinium leakage in ocular structures was defined as a bright signal in the vitreous in follow-up FLAIR compared with baseline FLAIR (pregadolinium). Clinical data were collected together with imaging features from the baseline scans, including the volume of the infarct and of hypoperfusion if applicable, white matter hyperintensities, the number of lacunes, and the number of microbleeds, which were combined to yield a small vessel disease (SVD) score. We compared the prevalence of GLOS in both groups using the χ2 test. In the entire cohort, univariate and multivariate regression models were used to test the associations between GLOS and the collected data.

Results

Among the 467 patients included in the study, GLOS was observed in similar proportions in the stroke group (32.2%, 136/422) and the stroke mimic group (28.9%, 13/45; mean difference, 3.3%; 95% confidence interval, −10.9 to 17.6; P = 0.65). In univariate analysis, GLOS was associated with older age, increased prevalence of vascular risk factors, brain imaging features of SVD (white matter hyperintensities, lacunes, microbleeds), as well as with impairment of renal function and increased dose of gadolinium. No associations were found with factors related to stroke, such as its volume, acute treatment, or rate of recanalization. Multivariate analyses showed that aging (P < 0.001), diabetes (P = 0.010), severe renal failure (P = 0.004), and increased dose of gadolinium (P < 0.001) were independent contributors to GLOS.

Conclusions

Gadolinium leakage in ocular structures, which occurs more commonly at higher concentrations of gadolinium, is not specific to stroke and may represent increased permeability of the blood-retinal barrier associated with age- and vascular risk factor‐related SVD.