bluuebunny/crossref_metadata_2025 huggingface dataset:
How reliable is the next generation of multiplex-PCR for diagnosing prosthetic joint infection compared to the MSIS criteria? Still missing the ideal test
Authors: Lausmann Christian , Kolle Kim Niklas , Citak Mustafa , Abdelaziz Hussein , Schulmeyer Juan , Delgado Gio D , Gehrke Thorsten , Gebauer Matthias , Zahar Akos
Published: September 2020

Introduction:

Identification of the pathogen in case of a periprosthetic joint infection (PJI) remains 1 of the greatest challenges in septic surgery. Rapid germ identification enables timely, specific, antimicrobial therapy. The first multiplex PCR (polymerase chain reaction) generation (Unyvero-i60) enables germ detection within 5 hours with a sensitivity of 78.8% and a specificity of 100%. The aim of this study is to investigate the performance of the new generation of cartridges (Unyvero-ITI) of multiplex PCR in the case of a PJI.

Methods:

In a prospective study, intraoperatively aspirated synovial fluid from 97 patients with aseptic or septic hip or knee revision surgery (49 aseptic, 48 septic) was examined with the multiplex PCR system (Unyvero-ITI) and the results were compared with the MSIS criteria. In addition, the time until the microbiological result was obtained in the event of a germ detection was documented.

Results:

The multiplex PCR showed a germ detection with a sensitivity of 85.1% and a specificity of 98.0%. In 7 cases a false negative result was found and in one patient a false positive result was found. The general accuracy of this test procedure was 91.8%. The detection of germs was carried out within 5 hours with the multiplex PCR compared to 4.9 days in conventional microbiological diagnostics.

Conclusions:

The new generation of multiplex-PCR was able to improve germ detection. The possibility of prompt detection of germs offers the option of faster, targeted antimicrobial therapy. This diagnostic tool offers significant advantages, particularly in the context of an acute periprosthetic infection.
Human Leukocyte Antigen Gene Testing and Carbamazepine-Induced Toxic Epidermal Necrolysis: A Study of Pediatric Practice
Authors: Asgarpour Jessica M.S. , Lam Lauren M. , Vogel Tina K. , Goez Helly R. , Fiorillo Loretta
Published: September 2020

Background

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug-induced dermatologic conditions. SJS/TEN occurs in 1-10 per 10 000 patients taking carbamazepine (CBZ) (Pratt VM, McLeod HL, Rubinstein WS et al. Medical Genetics Summaries. National Center for Biotechnology Information US; 2018: 1-527). The development of SJS/TEN is associated with variable drug metabolism and presence of an at-risk HLA haplotype. HLA-B*15:02 and HLA-A*31:01 haplotypes can produce a hyperimmune response in the setting of CBZ use in patients of Asian and European descent, respectively (Schneider JA, Cohen PR. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A concise review with a comprehensive summary of therapeutic interventions emphasizing supportive measures. Adv Ther. 2017; 34:1235-1244).

Objective

The US Food and Drug Administration (FDA) and the Canadian pharmacogenomics Network for Drug Safety (CPNDS) recommend that patients with high-risk ethnic backgrounds should be genetic tested before initiating CBZ (Sukasem C, Chaichan C, Nakkrut T et al. Association between HLA-B Alleles and Carbamazepine-induced maculopapular exanthema and severe cutaneous reactions in Thai patients. Journal of Immunology Research. 2018; 1-11).We sought out to assess the awareness of this in prescribing practitioners and their standard of practice.

Methods

We created a 15-question survey and distributed to pediatric neurologists and pediatricians at the University of Alberta. We hypothesized that there was a discordance between the standard of practice and the recommendation by the FDA and CPNDS.

Results

The survey results indicated a lack of awareness of the at-risk ethnicities for CBZ-induced SJS/TEN. HLA gene testing was rarely done prior to initiation of CBZ in high-risk patients. In addition, there was a lack of awareness for standard of care for genetic testing in Canada and worldwide.

Conclusions

Our results demonstrate an evident gap between current prescriber practices and existing FDA and CPNDS recommendations to screen for HLA genotypes. We hope that this study captures the realistic potential to improve patient outcomes.
The (de)legitimation of torture: rhetoric, shaming and narrative contestation in two British cases
Authors: Foley Frank
Published: September 2020

Existing studies on democracies’ involvement in torture emphasise how governments have been able to circumvent the international anti-torture norm and shape public discourse on the issue through powerful rhetorical strategies of denial and exception. Less attention has been paid, however, to the rhetoric of opponents of torture and how it impacts on governments and security agencies. This article proposes a typology of four common arguments against torture, which make use variously of ethical, utilitarian and ‘shaming’ rhetoric. These arguments often take a narrative form and are extensively contested by governments. Drawing on the literature on rhetorical coercion, I argue that anti-torture narratives can play an important role in constraining democratic states and significantly reducing their perpetration of torture. Yet the multiplicity of narratives at play opens up opportunities for governments to accept some messages against torture while simultaneously contesting others in a way which enables them to continue their involvement in torture. I develop this argument through a comparative analysis of the role of torture in two British counterterrorism campaigns – against Irish republican terrorism in the 1970s and against jihadist violence after 9/11. Differences in the content and salience of the narratives advanced by critics of the government during the two time periods explain much about why the British government contested some arguments against torture, but accepted others. This variation helps to explain in turn why British security agencies carried out coercive interrogations on a wide scale during the 1970s, while their perpetration of torture was significantly reduced in the post-9/11 case.
Measuring adolescent attitudes towards dementia: The revalidation and refinement of the A-ADS
Authors: Farina Nicolas , Griffiths Alys W , Hughes Laura J , Parveen Sahdia
Published: September 2020

The A-ADS is one the first validated measures of attitudes of dementia in adolescents, though further validation is needed. 630 adolescents were recruited from secondary schools in England. A Principal Component Analysis was completed ( n = 230) followed by a Confirmatory Factor Analysis ( n = 400). Reducing the A-ADS into a single factor, 13-item measure (Brief A-ADS) improved the model fit of the measure (χ2 = 182.75, DF = 65, CMIN/DF = 2.81, p < 0.001, CFI = 0.90, RMSEA = 0.07). The scale demonstrated good internal consistency, good predictive and concurrent validity. Building on the validation of the A-ADS, the Brief A-ADS is suitable to capture attitudes towards dementia amongst adolescents.
Neurological disorders in autism: A systematic review and meta-analysis
Authors: Pan Pei-Yin , Bölte Sven , Kaur Preet , Jamil Sadia , Jonsson Ulf
Published: September 2020

The etiological significance of neurological disorders in autism is debated, but it is clear that they complicate support provision and clinical management, and can have negative impact on outcomes. This systematic review and meta-analysis explored the full range of co-occurring neurological disorders in autism. We estimated the odds of having neurological complications compared to the general population and other neurodevelopmental conditions, as well as the overall prevalence of different neurological disorders. Seventy-nine articles were eligible for the systematic review, including 28 case-control studies, 43 prevalence studies, and 8 cohort studies. Findings were heterogeneous across studies. Overall, autistic individuals were significantly more likely than the general population to exhibit epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headache, and congenital abnormalities of the nervous system, with prevalence estimates ranging from 1.1% (0%–3.3%; hydrocephalus) to 14.2% (11.3%–17.2%; epilepsy). Epilepsy was also more common in autism than in attention-deficit/hyperactivity disorder (odds ratio [95% confidence interval] = 4.06 [2.81–5.88]). Findings indicate that awareness of neurological disorders and neurological check-ups are indicated in autism to ensure adequate physical health care and support. Prospective studies of neurological disorders in children diagnosed with or at risk of autism might further enhance our understanding of causal pathways.

Lay abstract

Neurological disorders, such as epilepsy and cerebral palsy, have been reported to occur among individuals with autism beyond chance and may have an impact on daily living across the lifespan. Although there has been research investigating neurological disorders in autism, the findings are not always conclusive. Previous summaries of existing studies have not evaluated the full range of neurological disorders. This study aimed to comprehensively explore the neurological problems appearing in autism to provide updated information that is needed for better healthcare and support in this population. We looked at already published studies focusing on risk or frequency of neurological disorders in autism. Our results suggest that individuals with autism are more likely than the general population to have a range of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headache, and inborn abnormalities of the nervous system. In order to provide individualized healthcare and support of high quality to individuals diagnosed with autism, health care professionals and other support providers need to be attentive to neurological complications. To further improve our understanding about the link between autism and neurological disorders, future research should follow the neurological health of children who are diagnosed with or are at increased likelihood of autism.
Coherent school improvement: Integrating outcomes-based assessment and trauma-informed practice
Authors: Reierson C. Allison , Becker Stephen R.
Published: September 2020

This literature review tests a framework for coherent implementation of school improvement initiatives. Often in education, initiatives are introduced as disparate, isolated approaches towards improved student learning. As a result, teachers, school-based administration and school districts frequently change their focus, contributing to fragmentation, stagnation and initiative fatigue. Robinson et al. offer ‘five domains of organizational activity’ as key areas of focus for coherent school improvement. We investigate application of Robinson et al.’s five domains to two seemingly disparate school improvement initiatives: outcomes-based assessment (OBA) and trauma-informed practice (TIP) as both represent significant areas of focus in our context. We construct our literature review around the central question: Can two divergent aspects of school improvement: outcomes-based assessment and trauma-informed practice, be aligned through Robinson et al.’s five domains, to coherently support their integration in schools? We found that Robinson et al.’s five domains were a useful tool for alignment of these diverse initiatives and were able to extrapolate beyond application to OBA and TIP, to other school improvement initiatives. Coherence benefits administration, teachers, and most importantly, promotes student achievement. When all elements of school improvement are part of a cohesive whole, all members the school community are better able to understand their role in driving student achievement.
Crossed wires and crooked calls: Imagining the telephone in South Indian comedy films of the 1990s
Authors: Chirumamilla Padma
Published: September 2020

In this article, I argue for the necessity of studying the portrayal of technological infrastructures in popular cinema. Cinema provided a venue within which the potentialities of technological infrastructures could be codified, challenged and (irregularly) absorbed into everyday practice—a process that was especially fraught in postcolonial societies like India. I combine an analysis of the changes in Indian telecommunications policy in the 1990s with close readings of the telephone’s portrayal in two South Indian comedy films, Hello Pakkiram (1990) and Money (1993). These films imagined the telephone as a technology which undergirded a “middle-class” ethos which valued financial security above explicit moral commitment, in contrast to the explicit heroism of the “mass films” that shaped an earlier era of South Indian cinema. I conclude by reaffirming the necessity of thinking through mediations of technological infrastructures to gain more nuanced critical purchase on their place in our everyday lives.
Justifying pension reforms: Comparing policy discourses in Norway and the UK
Authors: Ring Patrick , Ervik Rune , Lindén Tord Skogedal
Published: September 2020

The latest UK and Norwegian state pension reforms have reflected contrasting policy design in the balance of private pensions, savings and state provision. Nevertheless, we argue that both governments have in many ways adopted strikingly similar approaches in seeking public acceptance of these potentially controversial reforms, employing a similar repertoire of discursive elements to persuade populations about their logic and rationality. Based on critical analysis of government policy papers, speeches and parliamentary debates, we find that both countries emphasise ‘sustainability’ and ‘fairness’ within an increasingly individualised context where both systems are characterized as facilitating individuals’ efforts to attain security in retirement through ‘choice’ or ‘flexibility’. Significantly, contrasting symbolic metaphors are adopted to situate these reforms, and their proponents, within the heritage and traditions of their different welfare systems, which we find is a key element in successfully implementing the reforms. We note the implications of this research for the analysis of European state pension reform.
Networked publics in #NoDAPL protests: Interactions among activist publics and influence of locality and proximity on socially mediated networks
Authors: Xu Sifan , Luttman Shelby
Published: September 2020

Hashtag “#NoDAPL” was used by environmental activists for a series of protests against the construction of the Dakota Access Pipeline beginning in early 2016. Utilizing 2 million tweets with the main hashtag, as well as the auxiliary hashtags, from around 550,000 unique users between November 2016 and February 2017, the study investigated the interactions among four groups—regular activists, Native American activists, reporters, and organizations identified based on their bio information, and the effects of physical location on network attention. Exponential random graph models (ERGMs) on the retweet network showed that Native American activists occupied the most prominent positions and that different groups assumed different network roles. Location analysis based on Poisson regression showed that physical proximity’s effects on attention depended on group status, and the effects were moderated by users’ authority. Implications of the study results on networked publics and the influence of locality and proximity on socially mediated networks were discussed.
‘Refugees are not welcome’: Digital racism, online place-making and the evolving categorization of Syrians in Turkey
Authors: Ozduzen Ozge , Korkut Umut , Ozduzen Cansu
Published: September 2020

This article argues that digital publics unleash and bolster everyday racism, creating an unregulated space where anonymity and ubiquity enable the dissemination of racist message. By creating broader visibility and wider reach of racist texts and facilitating more participation for racists, social media platforms such as Twitter normalize gendered and place-based racialization of refugees. Recently, hostility and hate became the norm in derogating the refugee identity on social media platforms. To investigate the complexity of digital racism, this article presents a unique case study on Twitter, capturing the widespread user reactions in the aftermath of the mass resettlement of Syrians in Turkey. It examines varying racialization of Syrians on the Turkish Twittersphere, using sentiment and qualitative content analyses of hashtags and mentions on Syrians, when they hit Twitter trends for Turkey for a year, first, for mundane events and, second, during the Turkish state’s occupation in Northern Syria.
‘A Walk 21/1/35’: a psychiatric-psychoanalytic fragment meets the new walking studies
Authors: Phelan Sarah , Philo Chris
Published: September 2020

This paper reconstructs a fragment of psychiatric-psychoanalytical geography, interfacing it with the ‘new walking studies’, centring on a walk conducted in 1935 by a man experiencing mental health problems in Glasgow, Scotland. This man, a patient of the psychiatrist Thomas Ferguson Rodger, had mobility problems that rendered walking difficult – prone to stumbling, staggering, wavering – but with the likelihood of these problems being psychosomatic in origin. Through analytic sessions enacting a kind of ‘make-do’ psychoanalysis, the patient reflected on his mobility problems, as when relating his own walking ‘experiment’. Explanations advanced for his difficulties mixed psychoanalytic tropes with a gathering self-awareness of how fraught childhood experiences, had created the frame for an adult existence continually shying away from wider encounters and challenges beyond the domestic sphere. Central here was forward momentum being lost, whether walking or advancing through a life-course, with material and metaphoric senses of being stalled or stuck – spatially, environmentally – constantly entraining one another. This case study is deployed to illustrate claims about the ‘worlding’ of psychoanalysis, and to offer provocations for how such a psychiatric-psychoanalytic geography fragment might be illuminated by work on the cultural geographies of walking.
Intensive Glycemic Control for Diabetic Foot Ulcer Healing: A Multicentric, Randomized, Parallel Arm, Single-Blind, Controlled Study Protocol (INGLOBE Study)
Authors: Rastogi Ashu , Mukhopadhyay Satinath , Sahoo Jay Prakash , Mennon Arun , Ghosh Amritava , Jha Sujjet , Bal Arun
Published: September 2020

Hyperglycemia impairs healing of diabetic foot ulcer (DFU). But there is no evidence regarding benefit of intensive glucose control for healing of DFU. We plan to conduct a randomized, parallel arm, controlled study to assess the role of intensive glycemic management in comparison to conventional glucose control for healing of DFU. Participants with neuropathic DFU (infected or uninfected) having hemoglobin A1c (HbA1c) >8% and without evidence of osteomyelitis from 7 tertiary care hospitals will be enrolled. They will undergo a 2-week run-in phase for optimization of comorbidities, ulcer debridement, and counseling regarding self-monitoring of blood glucose (SMBG). Subsequently, they will be randomized to “intensive glycemic control” arm defined by glycemic targets of fasting blood glucose (FBG) <130 mg/dL, postprandial BG <180 mg/dL, and HbA1c <8%, with basal-bolus insulin regimen and frequent titration of insulin to achieve glycemic targets. The “conventional” arm will continue on prior treatment (oral antidiabetic drugs) with no titration unless meeting rescue criteria. Ulcer area will be calculated by automated wound assessment device (WoundlyClinial app) weekly for first 4 weeks, and less frequently until the 24th week. Standard treatment for DFU, off-loading, and counseling for foot care will be provided in both arms. The primary outcome measure will be number of wounds closed at 12th and 24th weeks. A multivariate regression analysis will be performed to identify the predictors of wound healing with baseline HbA1c, diabetes duration, wound size, wound duration, and background therapies as independent variable. This study will provide the much needed guidance to set optimum glucose targets in people with DFU.
How Many Angels Can Dance on the Head of a Patch Pipette? Understanding Neuronal Hyperexcitability in Angelman Syndrome
Authors: Stafstrom Carl E.
Published: September 2020

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Acute Thrombosis of an Infrarenal Abdominal Aortic Aneurysm Presenting as Bilateral Critical Lower Limb Ischemia
Authors: Li Hai-Lei , Chan Yiu Che , Cui Dong-Zhe , Cheng Stephen W.
Published: September 2020

Background:

Intraluminal thrombosis in the aneurysm sac is commonly seen in abdominal aortic aneurysm (AAA). Complete acute thrombosis of an AAA is a rare and catastrophic event.

Method:

We report a patient with acute AAA thrombosis presenting as bilateral lower limbs critical ischemia. A79-year-old male with a past history of AAA presented with acute onset of bilateral leg pain, coolness, weakness and numbness. His lower extremity pulses including femorals were absent bilaterally on physical examination. Urgent computed tomography angiography showed an infrarenal AAA measuring 45 mm in diameter. The aneurysm sac and bilateral common iliac arteries were completely occluded. Emergency open repair of AAA and bilateral iliac thrombectomy were successfully performed under general anesthesia.

Result:

Bilateral femoral pulses were present and the neurological deficits were completely resolved after operation. Patient recovered well and was asymptomatic at 3-month follow-up.

Conclusion:

Acute thrombosis of aortic aneurysm could be an unusual cause of lower limb ischemia, prompt diagnosis followed by surgical revascularization is essential to avoid prolonged ischemia.
Reduction of Excessive Arteriovenous Fistula Flow Using a Stent Graft
Authors: Hong Joon Ho
Published: September 2020

The excessive flow of arteriovenous fistulas is usually reduced by banding, plication or tapering of the inflow lumen with a suture or various external devices. However, these procedures are often associated with unpredictable outcomes. Presented here is an easy, safe and reliable method that deploys and constrains a stent graft in the inflow segment of the fistula in order to achieve long-lasting flow reduction.
A Case-Control Study on the Therapeutic Effect of Mediastinoscope-Assisted and Thoracoscope-Assisted Esophagectomy
Authors: Guo Li , Zhao Qian , Wang Kairui , Zhao Duowen , Ye Xiaofeng , Li Tao
Published: September 2020

Objective. To compare the clinical efficacies of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Materials and Methods. Seventy-six patients with esophageal cancer who underwent minimally invasive esophagectomy at the General Hospital of Ningxia Medical University between June 2015 and January 2019 were retrospectively evaluated. Among them, 28 patients underwent mediastinoscope-assisted transhiatal esophagectomy (MATHE), and 48 received thoracoscope-assisted transthoracic esophagectomy (TATTE). The perioperative clinical data and follow-up data of the 2 groups were compared. Results. All operations were successful in both groups. MATHE was favorable in terms of operation time, intraoperative blood loss, drainage volume 3 days after surgery, postoperative hospital stay, and hypoproteinemia ( P < .05). Lymph node dissections were less than those in the TATTE ( P < .05). No significant differences in long-term postoperative complications and survival rate were found between the 2 groups ( P > .05). Conclusion. MATHE has the advantages of minimal trauma, shorter operation time, less intraoperative blood loss, and faster recovery. More adequate tumor clearance in terms of lymph node dissection can be achieved with TATTE. However, the comparison of survival rates between the 2 groups is similar.
Exploring how the diagnostic process stratifies children with intellectual disability navigating the service system in Ontario, Canada
Authors: Don Anna , O’Byrne Patrick
Published: September 2020

Children with intellectual disability experience a higher prevalence of dental disease, obesity, challenging behaviours, and mental health disorders compared to children without intellectual disability. Children with intellectual disability concurrently face health and social service navigational barriers that are associated with unresolved health needs and hospital admissions, and parent burnout and employment interruptions. In this study, we explored the knowledge gap of how carers and governmental agencies, providing services, understand intellectual disability using discourse analysis, and a theoretical framework applying Deleuze and Guattari’s concepts of the rhizome and stratification. We found that children with intellectual disability were stratified into eligible or ineligible service recipients through the diagnostic process that prioritized specified characteristics. Carers did not perceive that their children’s unique characteristics and needs were accounted for within the diagnostic process and expressed feelings of being dismissed by clinicians and providers in decision-making about priority needs and services.
Setting up distinctive outcome measures for each osteoarthritis phenotype
Authors: Roman-Blas Jorge A. , Mendoza-Torres Lenny A. , Largo Raquel , Herrero-Beaumont Gabriel
Published: September 2020

Osteoarthritis (OA) is an evolving chronic joint disease with a huge global impact. Given the intricate nature of the etiopathogenesis and subsequent high heterogeneity in the clinical course of OA, it is crucial to discriminate between etiopathogenic endotypes and clinical phenotypes, especially in the early stages of the disease. In this sense, we propose that an OA phenotype should be properly assessed with a set of outcome measures including those specifically related to the main underlying pathophysiological mechanisms. Thus, each OA phenotype can be related to different and clinically meaningful outcomes. OA phenotyping would lead to an adequate patient stratification in well-designed clinical trials and the discovery of precise therapeutic approaches. A significant effort will be required in this field in light of inconclusive results of clinical trials of tissue-targeting agents for the treatment of OA.
Antibacterial Activity of Endostemon tereticaulis (Poir.) M. Ashby Essential Oil and Ethanolic Extract Against Resistant Pathogenic Bacteria
Authors: Namata Abba Bala , Romane Abderrahmane , Ilagouma Amadou Tidjani
Published: September 2020

Endostemon tereticaulis (poir.) M.Ashby is a species of the Lamiaceae family present in Niger. This plant is used in traditional medicine due to its various biological potentialities. The present study investigated the chemical composition of the essential oil and the antibacterial activity of the essential oil and ethanolic extract of Endostemon tereticaulis against resistant pathogenic bacteria. Gas chromatography-mass spectrometry analysis of the essential oil led to the identification of 43 compounds representing 99.55% of the total essential oil. The major components were caryophyllene oxide (15.17%) followed by α-humulene (13.96%), α-copaene (11.75%), ( E)-β-caryophyllene (8.44%), and δ-cadinene (6.78%). The antibacterial activity was tested against multiresistant Acinetobacter baumannii P1483, Salmonella spp. H1548, extended-spectrum β-lactamase- Escherichia coli Bu8566, Enterobacter cloacae Bu147, Proteus mirabilis Bu190 , Pseudomonas aeruginosa (ATCC 27853), Klebsiella pneumoniae (ATCC 700603), Escherichia coli (ATCC 25922), Enterococcus faecium H3434, methicillin-resistant Staphylococcus aureus P1123, and Staphylococcus aureus (ATCC 25923). The antibacterial assays revealed that the essential oil was more active than the ethanolic extract against the studied bacteria with minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) values ranging from 0.06 to 2 mg/mL. Also, the ethanolic extract was effective against the bacteria tested with MIC and MBC values ranging from 0.12 to 3 mg/mL. This study showed that Endostemon tereticaulis essential oil is rich in bioactive compounds. Ethanolic extract and essential oil exhibited potential antibacterial activity. These results provide a scientific basis for the use of this plant in traditional medicine. The current study described for the first time the antibacterial activity of Endostemon tereticaulis.
Simultaneous Determination of 9 Main Components of Lonicera japonica Thunb. by UPLC-MS/MS and Analysed Combine With Chemometrics
Authors: Liu Songtao , Yang Lin , Wang Song , Pan Junying
Published: September 2020

The purpose of this article is to establish a method to use ultra-high performance liquid chromatography (UPLC)-mass spectrometry (MS)/MS to simultaneously determine 9 main components of Lonicera japonica Thunb. in negative-ion scanning mode, and the main components were analyzed by chemometrics. The chromatographic separation uses the Thermo Hypersil GOLD column (100 mm × 2.1 mm, 1.9 µm) with a constant temperature of 45 °C. The mobile phase consists of methanol and water containing 0.2% formic acid. The results show that 9 compounds had a good linear relationship ( R² > 0.9991), and both intraday and interday precisions and stability have the eligible ranges of relative SDs (RSDs; 0.96%-2.26%, 0.52%-3.04%, and 0.85%-2.15%, respectively). The recovery rates were between 75.90% and 110.58%. The results of chemometrics including hierarchical cluster analysis and principal component analysis showed that there were obvious differences in the content of active components in L. japonica from different regions, and the compounds with the highest contribution to the drug were identified. Through the UPLC-MS/MS combined chemometrics analysis of L. japonica, this experiment can provide a reference for further research on the modernization and innovation of L. japonica and the application research of a high level and multidirection.
Rationale of Orthosiphon aristatus for Healing Diabetic Foot Ulcer
Authors: Abdullah Farah Izana , Chua Lee Suan , Mohd Bohari Siti Pauliena , Sari Eka
Published: September 2020

Orthosiphon aristatus (Blume) Miq. is traditionally used for wound healing in South East Asia and scientifically proven for its antidiabetic potential. Wounds due to diabetes, especially diabetic foot ulcer (DFU), always involve a complicated healing process. The present work aims to review the information on the rationale of the phytochemicals from O. aristatus in promoting DFU healing. The findings showed that the DFU healing potential of O. aristatus was characterized by a reduction in the blood glucose level, mainly attributed to the significant concentration of constituents such as caffeic acid, rosmarinic acid, and sinensetin in the plant extract. These phytochemicals possibly induce insulin secretion and sensitivity, improve the lipid profile, and stimulate glucose uptake. Furthermore, the healing effect may also be contributed to the antioxidant, anti-inflammatory, and antihyperglycemic properties of the plant. The roles of phytochemicals have been systematically postulated in the 4 phases of the healing process. Moreover, no adverse toxic sign or abnormality has been reported upon oral administration of the plant extract. This suggests that O. aristatus extract could be a potential diabetic wound healing phytomedicine for further preclinical and clinical studies.
Does Moonlight Increase Predation Risk for Elusive Mammals in Costa Rica?
Authors: Botts Ryan T. , Eppert Amy A. , Wiegman Timothy J. , Blankenship Steven R. , Rodriguez Abner , Wagner Abigail P. , Ullrich Sierra E. , Allen Gabrielle R. , Garley Wyatt M. , Asselin Ellen M. , Mooring Michael S.
Published: September 2020

An increasing body of evidence indicates that moonlight influences the nocturnal activity patterns of tropical mammals, both predators and prey. One explanation is that brighter moonlight is associated with increased risk of predation (Predation Risk hypothesis), but it has also been proposed that nocturnal activity may be influenced by the sensory ecology of a species, with species that rely on visual detection of food and danger predicted to increase their activity during bright moonlight, while species relying on non-visual senses should decrease activity (Visual Acuity hypothesis). Lack of an objective measure of “visual acuity” has made this second hypothesis difficult to test, therefore we employed a novel approach to better understand the role of lunar illumination in driving activity patterns by using the tapetum lucidum as a proxy for “night vision” acuity. To test the alternative predictions, we analyzed a large dataset from our long-term camera trap study in Costa Rica using activity overlap, relative abundance, and circular statistical techniques. Mixed models explored the influence of illumination factors (moonrise/set, cloud cover, season) and night vision acuity (tapetum type) on nocturnal and lunar phase-related activity patterns. Our results support the underlying assumptions of the predation risk and visual acuity models, but indicate that neither can fully predict lunar-related activity patterns. With diurnal human “super predators” forcing a global increase in activity during the night by mammals, our findings can contribute to a better understanding of nocturnal activity patterns and the development of conservation approaches to mitigate forced temporal niche shifts.
Does the Presence of Neuropathic Pain Influence the Response to Hyaluronic Acid in Patients with Knee Osteoarthritis?
Authors: Tiendrebeogo Evarice , Choueiri Magda , Chevalier Xavier , Conrozier Thierry , Eymard Florent
Published: September 2020

Objectives

Up to 50% of patients with symptomatic knee osteoarthritis (OA) present with neuropathic pain (NP) features. We assessed the impact of NP according to DN4 (Douleurs Neuropathiques 4 questions) score on the response to intra-articular (IA) hyaluronic acid (HA) injections and the effects of HA injections on NP.

Materials and Methods

We conducted a post hoc analysis from a multicenter, randomized, double-blind, noninferiority trial comparing the efficacy of 2 HA in symptomatic knee OA at 24 weeks. At baseline, demographic, anthropometric, radiologic data, and symptoms were recorded. The symptomatic effect of HA was assessed by VAS pain, patient global assessment (PGA), WOMAC, DN4, and OMERACT-OARSI response.

Results

A total of 187 patients were included. NP according to DN4 score was present in 20 patients (10.7%) at baseline. Most common positive DN4 items were tingling (36.9%) and burning (36.4%). NP was associated with WOMAC pain score ( P = 0.02). The presence of NP at baseline did not affect the symptomatic improvement after HA injections according to the VAS pain ( P = 0.71), PGA ( P = 050), WOMAC pain ( P = 0.89), WOMAC function ( P = 0.52), and rate of OMERACT-OARSI responders ( P = 0.21). The prevalence of patients with NP decreased by 50% ( n = 10) at 24 weeks after HA injections. Most improved DN4 items were itching (90%), hypoesthesia to pinprick (88%), and burning (50%).

Conclusion

In our study, NP was associated with pain severity, but did not influence the response to IA HA. On the other hand, HA injections reduced some NP features, especially itching, sting hypoesthesia, and burning.
Location Distribution of 2,087 Osteochondral Lesions of the Talus
Authors: van Diepen Pascal R. , Dahmen Jari , Altink J. Nienke , Stufkens Sjoerd A.S. , Kerkhoffs Gino M.M.J.
Published: September 2020

Objective

The primary aim of this study was to evaluate the exact location distribution in patients with osteochondral lesions of the talus (OLTs) using a 9-grid scheme. The secondary aim is to match lesion location to lesion size, arthroscopic or open operation, and trauma occurrence.

Methods

A systematic review was performed in the databases PubMed, EMBASE, and Cochrane. Search terms consisted of “talus” and “osteochondral lesion.” Two independent reviewers evaluated search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome measure was OLT location in the 9 zone-grid. Secondary outcome measures were OLT size in 9-zones, preoperative radiological modality use, demographic lesion size variables as well as open or arthroscopic treatment.

Results

Fifty-one articles with 2,087 OLTs were included. Heterogeneity concerning methodological nature was observed and methodological quality was low. The posteromedial (28%) and centromedial (31%) zones combined as one location was the location with the highest incidence of OLTs with a rate of 59%. Individual OLT size was reported for only 153 lesions (7%). Preoperative combination of X-ray and magnetic resonance imaging (MRI), and/or computed tomography (CT) was reported in 20 studies (43%). Trauma was reported in 78% of patients. Furthermore, 67% was treated arthroscopically and 76% received primary OLT treatment.

Conclusion

The majority of OLTs are located in the posteromedial and centromedial zone, while the largest OLTs were reported in the centrocentral zone. Further research is required to identify the prognostic impact of location occurrence on the outcomes following OLT treatment.
The Self-employed and the EU Court of Justice: towards new social protection of vulnerable EU citizens?
Authors: Nato Alessandro
Published: September 2020

European citizens have been exposed to social exclusion risks due to the economic crisis and the retrenchment in the welfare state budget. Among those exposed, we find workers and self-employed workers. The Member States of Central and Northern Europe have tried to restrict the free movement of workers and the self-employed and limit access to social benefits for European citizens from Eastern Europe. On the other hand, the European institutions have tried to save the notion of the European citizen as the promoter of the integration process. Recently, the Court of Justice seems to have reprised the role of bulwark against the social exclusion of migrant European citizens in the host Member State. Adding to Florea Gusa and Tarola, the Dakneviciute case law confirms the new interpretative trend of the Court of Justice towards greater protection of the migrant self-employed worker who needs to access the welfare of the host Member State in a period of vulnerability. The recommendation is that this course continues, allowing us to overcome the restrictive jurisprudence developed in the Dano trend.
Malignancy risk in adults with growth hormone deficiency undergoing long-term treatment with biosimilar somatropin (Omnitrope®): data from the PATRO Adults study
Authors: Beck-Peccoz Paolo , Höybye Charlotte , Murray Robert D , Simsek Suat , Zabransky Markus , Zouater Hichem , Stalla Günter
Published: September 2020

Background:

To assess the safety (particularly the occurrence of malignancies) of growth hormone (GH) replacement (Omnitrope®) in adults with GH deficiency, using data from the ongoing PATRO Adults post-marketing surveillance study.

Methods:

PATRO Adults is being conducted in hospitals and specialized endocrinology clinics across Europe. All enrolled patients who receive ⩾1 dose of Omnitrope® are included in the safety population. Malignancies are listed as adverse events under the MedDRA System Organ Class ‘neoplasms, benign, malignant and unspecified (including cysts and polyps)’.

Results:

As of July 2018, 1293 patients had been enrolled in the study and 983 (76.0%) remained active in the study. Approximately half [ n = 637 (49.3%)] of the patients were GH treatment-naïve on study entry. The majority of enrolled patients had multiple pituitary hormone deficiency ( n = 1128, 87.2%). A total of 41 on-study malignancies were reported in 33 patients (2.6%; incidence rate 7.94 per 1000 patient-years). The most common cancers were basal cell carcinoma ( n = 13), prostate ( n = 6), breast, kidney and malignant melanoma (each n = 3). Treatment with Omnitrope® was discontinued following diagnosis of malignancy in 16 patients. The tumors occurred after a mean of 79.4 months of recombinant hormone GH (rhGH) treatment overall.

Conclusion:

Based on this snapshot of data from PATRO Adults, Omnitrope® treatment is tolerated in adult patients with GH deficiency in a real-life clinical practice setting. Our results do not generally support a carcinogenic effect of rhGH in adults with GH deficiency, although an increased risk of second new malignancies in patients with previous cancer cannot be excluded based on the current dataset.
Lack of evidence for the effectiveness or safety of over-the-counter cannabidiol products
Authors: Chesney Edward , McGuire Philip , Freeman Tom P. , Strang John , Englund Amir
Published: September 2020

Over the past 5 years, public interest in the potential health benefits of cannabidiol (CBD) has increased exponentially, and a wide range of over-the-counter (OTC) preparations of CBD are now available. A substantial proportion of the population appears to have used these products, yet the extent to which they are effective or safe is unclear. We reviewed the evidence for whether CBD has significant pharmacological and symptomatic effects at the doses typically found in OTC preparations. We found that most of the evidence for beneficial effects is derived from studies of pure, pharmaceutical grade CBD at relatively high doses. Relatively few studies have examined the effect of OTC CBD preparations, or of CBD at low doses. Thus, at present, there is little evidence that OTC CBD products have health benefits, and their safety has not been investigated. Controlled trials of OTC and low-dose CBD preparations are needed to resolve these issues.
Endoscopic ultrasound–guided luminal remodeling as a novel technique to restore gastroduodenal continuity
Authors: El Bacha Hicham , Jung Carlo , Brieau Bertrand , Bordacahar Benoit , Leblanc Sarah , Barret Maximillien , de Chaumont Arthus , Dousset Bertand , Prat Frederic
Published: September 2020

Pyloric exclusion is a method of treatment for duodenal injury. Surgery is usually needed to restore digestive continuity in due time, yet a new surgical procedure can be challenging due to fibrotic adhesion development. We present here a retrospective case series of three patients with pyloric exclusion who underwent endoscopic ultrasound–guided duodenal repermeabilization using metallic stents. All procedures were successful with no complication and allowed regular feeding. This case series shows that endoscopic ultrasound–guided recanalization is a feasible and safe procedure.
Holmium laser lithotripsy with semirigid ureterorenoscopy in treatment of upper ureteral and renal pelvis stones under spinal anesthesia
Authors: Aras Bekir , Alkiş Okan , İvelik Halil İ , Sevim Mehmet , Başer Aykut
Published: September 2020

Extracorporeal shockwave lithotripsy and especially flexible ureterorenoscopy (URS) are first-choice treatments of upper ureteral and renal pelvis stones. In our study, we aimed to demonstrate that the treatment of upper ureteral and renal pelvis stones smaller than 2 cm could be performed by semirigid URS under spinal anesthesia. The data of 292 patients were retrospectively analyzed. Stones were localized in upper ureter and renal pelvis in 191 (65.4%) and 101 (34.6%) patients, respectively. The stone-free rate was found to be 72.6%. The final stone-free rate was 95.2% after additional treatments administered to 80 patients with residues. While no peri-operative complication was observed, hematuria was observed in three patients during the post-operative period, high fever was observed in 27 patients and sepsis was observed in four patients. It is a well-known fact that flexible URS is the first-choice surgical method in the treatment of upper ureteral and renal pelvis stones. In the current study, we aimed to investigate whether laser lithotripsy with semirigid URS could also be a good and cheap alternative in clinical practice, and if upper urinary tract surgeries could be performed with spinal anesthesia especially in patients with a high risk of general anesthesia.

Level of evidence:
Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain
Authors: Prater Christopher , Tepe Melissa , Battaglia Patrick
Published: September 2020

Background

Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home.

Methods

We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores.

Results

Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/− 6.1 and the mean follow-up PDQ was 81.9 +/− 7.7, resulting in a mean improvement of −10.6 (95% CI 1.2 - −22.3, P = .08). Participants in the chiropractic team (mean change −25.0, P = .01) and those completing the study before COVID-19 (mean change = −22.6, P < .01) were found to have significantly greater improvement at follow-up.

Conclusion

This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.
Primary stability of a cementless modular revision hip stem in relation with the femoral defect size: A biomechanical study
Authors: Ellenrieder Martin , Souffrant Robert , Schulze Christian , Kluess Daniel , Mittelmeier Wolfram , Bader Rainer
Published: September 2020

Purpose:

Cementless modular fluted hip stems are commonly used in revision arthroplasty. Nevertheless, there is a wide spectrum of recommendations concerning the minimum bone stock required to enable osseous ingrowth and implant–bone micromotions <100 µm. This experimental study investigated the primary stability of a tapered cementless fluted revision stem depending on different types of bone defects.

Methods:

Implant–bone interface movements with a bimodular stem were examined under cyclic axial and torsional loading using composite femora. In four degrees of freedom, the implant subsidence and micromotions were captured with linear variable differential transformers for the intact femora and seven different defects ranging from Paprosky type I to type IIIB.

Results:

With a 7-cm length of intact diaphysis proximal to the isthmus (Paprosky IIIA), mean implant–bone micromotions of 66 µm occurred. An implant–bone contact zone of only 5 cm (Paprosky IIIA) resulted in micromotions notably over 100 µm and significantly increased subsidence ( p < 0.05). With a Paprosky IIIB defect (3 cm of intact diaphysis) rotational instability occurred in all specimens.

Conclusions:

Aside from critically increased interfacial micromotions (>100 µm), rotational instability emerged as a mechanism of fixation failure when the implant–bone contact zone was only 5 cm or less. Hence, future studies investigating the implant fixation in the case of femoral bone defects should consider both axial and torsional loading. With regard to the clinical application, our data suggest maintaining 7 cm of diaphyseal implant–bone contact for a safe anchorage of cementless fluted hip revision stems.