bluuebunny/crossref_metadata_2025 huggingface dataset:
Laryngoscopy Grade Improvement and Difficult Airway Resolution in Infants With Robin Sequence Undergoing Mandibular Distraction Osteogenesis: A Multi-Institutional Study
Authors: Siegel Nicholas , Lopez Joseph , Shi Aria C. , Neimanis Sara , Jodeh Diana , Khavanin Nima , Redett Richard J. , Sterni Laura M. , Walsh Jonathan M. , Dalesio Nicholas M. , Rottgers S. Alex , Morrison Clinton S. , Steinberg Jordan P.
Published: October 2020

Objective:

Mandibular distraction osteogenesis (MDO) aims to relieve tongue-based airway obstruction in Robin Sequence (RS). We investigated direct laryngoscopy grade (DLG) improvement and difficult airway (DA) resolution following MDO.

Design:

Retrospective cohort analysis.

Setting:

Three tertiary care institutions.

Patients:

Sixty-four infants with RS who underwent a single MDO procedure in their first year of life were identified from January 2010 to January 2019.

Main Outcome Measures:

The primary outcome was DLG pre- and post-MDO. Secondary outcomes included DA designation, pre- and post-MDO polysomnographic assessment for obstructive sleep apnea (OSA), length of stay, need for gastrostomy, and major/minor adverse events.

Results:

Median DLG improved from II pre-MDO to I at the time of distractor removal (n = 43, P < .001). No significant change was seen in patients with a third recorded time point (eg, palatoplasty; n = 78, P = .52). Twenty-six (47%) of 55 patients were designated as DA pre-MDO, and 10 (18%) of 55 patients retained the label post-MDO ( P < .01). Five (50%) of these 10 patients appeared to be inappropriately retained. Median obstructive apnea–hypopnea index improved from 38.6 (range 31.2-62.8) pre-MDO to 2.9 (range 1-3.9) post-MDO (n = 12; P = .002).

Conclusion:

Mandibular distraction osteogenesis allowed for DLG improvement that was stably maintained as well as functional improvement in OSA, with minimal morbidity. Difficult airway designation persisted in the electronic record of some infants despite clinical resolution.
Teaching Students to Transform
Authors: Gottenborg Emily , Anstett Tyler , Diaz Manuel , Pierce Read , Sweigart Joseph , Glasheen Jeffrey J.
Published: October 2020

Training in leadership and health system transformation is increasingly important in undergraduate medical education in order to develop a pipeline of engaged physicians dedicated to transforming health care. Despite this growing need, it is unclear whether current leadership training methods have long-term impact on students’ career trajectory. The authors analyzed career outcomes from 6 years of the Health Innovations Scholars Program (HISP) to better understand how the program affected the 46 graduates’ future involvement in health system transformation and leadership. Eighty-eight percent of the graduates remained involved in quality improvement, 70% held leadership positions, 31% participated in health innovation, and 15% participated in patient safety initiatives. Project involvement of the graduates represented both primary and secondary catalysts for health system change, leading to 28 unique catalyst events. HISP is a model for directing trainees’ career trajectory toward engagement in health system leadership and redesign.
Histopathologic Change of a Case of Gastric Oxyntic Neoplasm (Gastric Adenocarcinoma of Fundic Gland Mucosa Type) Through 5 Years With Concurrent Other Oxyntic Gland Lesions
Authors: Sato Yoko , Sato Taiki , Matsushima Jun , Fujii Akiko , Ono Yuko , Suda Toshikuni , Katayama Yasumi , Ban Shinichi
Published: October 2020

Some gastric epithelial neoplasms show predominant chief cell differentiation (oxyntic gland neoplasms), in which the entity of “gastric adenocarcinoma of fundic gland type” was firstly designated, whereas a possible more aggressive subgroup “gastric adenocarcinoma of fundic gland mucosa type” (GA-FGM) was subsequently proposed. However, the histopathologic progression mode of these neoplasms has not been sufficiently reported. In this article, we describe a case of GA-FGM in which we could observe its progression during 5 years. The tumor was removed by endoscopic submucosal dissection 5 years after the first biopsy, which had already shown a feature of oxyntic gland neoplasm. During the follow-up period, the endoscopy revealed little change in the tumor appearance. However, the histology of endoscopic submucosal dissection showed submucosal extension with its histological progression. Besides, other oxyntic gland neoplasms of the stomach were observed metachronously or synchronously, giving an implication about a common pathogenetic basis of these lesions.
Expatriate Consumers’ Adaptations and Food Brand Choices: A Compensatory Control Perspective
Authors: Miocevic Dario , Zdravkovic Srdan
Published: October 2020

The number of expatriates has been steadily growing during the last two decades. For these reasons, academia has exhibited a growing research interest in expatriates’ food consumption choices. Although interest is there, the extant literature is inconclusive about conditions under which expatriate consumers make trade-offs between host-country (local) and global food products and brands. The present study presents mechanisms that explain expatriate consumers’ compensatory coping behaviors and choices between local versus global food brands. By drawing on compensatory control theory and the person–environment fit framework, the authors test the influence of adaptation efforts and retail system properties on expatriate consumers’ food brand choices. Survey findings from 232 expatriates who currently live in five Middle Eastern countries reveal that a higher engagement in adaptation efforts (acculturation and general adjustment) leads to a dominant preference for local (vs. global) food brands. Moreover, this study illuminates the importance of retail system properties by showing that a host country’s retail system development positively moderates the relationship between adaptation efforts and local food brand choices, whereas retail similarity has a negative impact.
Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis
Authors: Elizondo-Rodríguez Jorge , Simental-Mendía Mario , Peña-Martínez Victor , Vilchez-Cavazos Félix , Tamez-Mata Yadira , Acosta-Olivo Carlos
Published: October 2020

Background:

Plantar fasciitis is the most common cause of heel pain, and injection therapies are part of the treatment modalities. This study aimed to compare 2 intralesional injection therapies for plantar fasciitis: corticosteroid and botulinum toxin A, compared with a third control group using a local anesthetic. The clinical evolution, as well as changes in the thickness of the plantar fascia and ankle dorsiflexion, was evaluated.

Methods:

A randomized, controlled, double-blind trial design was used. Patients were divided into 3 groups: group 1, anesthetic only; group 2, corticosteroid; and group 3, botulinum toxin A (BoNT-A). We used an ultrasonographic evaluation to measure the plantar fascia thickness. The results were evaluated using the Maryland Foot Score and a 10-cm visual analog scale. Clinical scores were recorded at the beginning of the study, at 2 weeks, and at 1, 3, and 6 months. We evaluated 78 patients for study eligibility. The 3 intervention groups were homogeneous.

Results:

All patients showed better clinical outcomes compared with their initial evaluations, without differences between groups at the end of follow-up. The thickness of plantar fascia diminished at the final evaluation, and ankle dorsiflexion was better compared with the initial values without difference between treatment groups.

Conclusion:

Considering all the evaluated outcomes, no significant differences between treatment groups were observed. The pain relief and functional improvement obtained with the different treatments was maintained during the 6-month follow-up.

Level of Evidence:

Level I, therapeutic study.
Relationship Between Tibiotalar Joint Space and Ankle Function Following Ankle Surgery
Authors: Mullens Jess , Stake Ingrid K. , Matheny Lauren M. , Daney Blake , Clanton Thomas O.
Published: October 2020

Background:

Joint-preserving procedures of the ankle may postpone the need for ankle arthrodesis (AA) or total ankle replacement (TAR). The challenge for the surgeon is to determine which patients may benefit from these joint-preserving procedures. We hypothesized that patents with less than 2 mm of ankle joint space on preoperative radiographs would report inferior outcomes following joint-preserving surgery compared with those with 2 mm or greater joint space.

Methods:

Patients 18 years of age or older treated with joint-preserving ankle surgery with a minimum of 2 years of follow-up were considered for study inclusion. The ankle joint space was measured on standardized weightbearing preoperative radiographs. At follow-up, patients completed questionnaires including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, the Short Form-12 (SF-12) Physical Component Summary and Mental Component Summary, the Tegner Activity Scale, and satisfaction with outcome.

Results:

A total of 251 patients were included in the study. Forty-three patients had an ankle joint space of less than 2 mm. Compared with the 208 patients with an ankle joint space of 2 mm or greater, they had inferior FAAM ADL, FAAM Sports, and SF-12 Physical Component Summary scores ( P = .001, P = .001, and P = .006, respectively). Additionally, a statistically significant positive correlation between joint space distance and the FAAM ADL ( P = .012, r = 0.158), FAAM Sports ( P < .001, r = 0.301), and SF-12 Physical Component Summary ( P < .010, r = 0.163) scores was found.

Conclusion:

Patients with a preoperatively narrowed ankle joint space of less than 2 mm had significantly lower outcome scores following joint-preserving ankle surgery compared with patients with preserved ankle joint space. These results may assist clinicians in selecting patients who may benefit from ankle joint–preserving procedures, as well as counseling patients with a narrowed ankle joint space regarding expected outcome after joint-preserving ankle surgery.

Level of Evidence:

Level II, prognostic comparative study.
Moving sensors for improved estimation of dynamic structures: Experimental validation
Authors: Chierichetti Maria , Demetriou Michael
Published: October 2020

In the monitoring of structural systems, the use of multiple high-end sensors may prove to be economically prohibitive. The alternative approach would be to use fewer devices capable of moving across the span of the structural system. In the proposed approach, a velocity sensor that is able to move across the spatial domain and obtain point-wise velocity measurements is combined to a novel dynamic observer. Based on the measured velocities, a state estimator is developed, the gain of which depends on the motion of the sensor. The motion of the sensor is defined using Lyapunov redesign methods and depends only on the estimation error at the current sensor position. The guidance policy is performance based and steers the sensor to spatial regions of the structure with larger estimation errors. The proposed approach is validated with a one-dimensional flexible structure, mathematically described by an Euler–Bernoulli partial differential equation. The moving sensor is realized through the use of a laser scanning vibrometer that provides both the moving measurements and additional measurements against which the proposed approach will be validated. Once measurements over a large number of locations are acquired, the experimental results are fed to the algorithm that selects the instantaneous sensor location. Experimental results for linear and nonlinear beam cases are presented to show the feasibility and robustness of the proposed approach.
Autistic traits are related to worse performance in a volatile reward learning task despite adaptive learning rates
Authors: Goris Judith , Silvetti Massimo , Verguts Tom , Wiersema Jan R , Brass Marcel , Braem Senne
Published: October 2020

Recent theories propose that autism is characterized by an impairment in determining when to learn and when not. We investigated this by estimating learning rate in environments varying in volatility and uncertainty. Specifically, we correlated autistic traits (in 163 neurotypical participants) with modelled learning behaviour during probabilistic reward learning under the following three conditions: a Stationary Low Noise condition with stable reward contingencies, a Volatile condition with changing reward contingencies and a Stationary High Noise condition where reward probabilities for all options were 60%, resulting in an uncertain, noisy environment. Consistent with earlier findings, we found less optimal decision-making in the Volatile condition for participants with more autistic traits. However, we observed no correlations between underlying adjustments in learning rates and autistic traits, suggesting no impairment in updating learning rates in response to volatile versus noisy environments. Exploratory analyses indicated that impaired performance in the Volatile condition in participants with more autistic traits, was specific to trials with reward contingencies opposite to those initially learned, suggesting a primacy bias. We conclude that performance in volatile environments is lower in participants with more autistic traits, but this cannot be unambiguously attributed to difficulties with adjusting learning rates.

Lay abstract

Recent theories propose that autism is characterized by an impairment in determining when to learn and when not. Here, we investigated this hypothesis by estimating learning rates (i.e. the speed with which one learns) in three different environments that differed in rule stability and uncertainty. We found that neurotypical participants with more autistic traits performed worse in a volatile environment (with unstable rules), as they chose less often for the most rewarding option. Exploratory analyses indicated that performance was specifically worse when reward rules were opposite to those initially learned for participants with more autistic traits. However, there were no differences in the adjustment of learning rates between participants with more versus less autistic traits. Together, these results suggest that performance in volatile environments is lower in participants with more autistic traits, but that this performance difference cannot be unambiguously explained by an impairment in adjusting learning rates.
An exploration of webcam-travel: Connecting to place and nature through webcams during the COVID-19 lockdown of 2020
Authors: Jarratt David
Published: October 2020

During the COVID-19 pandemic and subsequent lockdown of 2020, freedom to travel was restricted but there was a remarkable increase in webcam-travel, which can be defined as visiting place-based webcams online. Media commentators suggested that this technology was being used to connect with places and nature; an observation mirrored by webcam hosting organisations. This study examines the surge in popularity of these webcams which reflect a wide range of sites – often natural environments. It goes on to explore the attributes of webcam-travel to explain its rise during lockdown, primarily by employing an online questionnaire. It reveals that this experience is marked by feelings of freedom, nostalgia, and connection – each of which offers potential wellness benefits. Respondents exercised their freedom through these virtual portals to connect to nature, the outdoors, and places that they associated with happy memories pre-lockdown. This article also suggests that webcam-travel links to an increased likelihood to physically visit these sites in the future. Therefore, this research may be relevant to both academics and practitioners with an interest in the experience economy.
Latinx Youth’s Funds of Knowledge: Empowering Activist Identities in a Nuevo South College Access Program
Authors: Bennett Cathryn B. , Ramos Delma , Wyatt Rod
Published: October 2020

This paper highlights Latinx youth’s community engagement and activist identities during their participation in CHANCE ( Campamento Hispano Abriendo Nuestro Camino a la Educación), a college access program at UNC Greensboro. We examined Latinx youth’s activist identities using critical qualitative inquiry. Findings reveal collective consciousness and responsibility to the Latinx community. Implications and significance for higher education demonstrate how college access pathway programs, such as CHANCE, reinforce Latinx students’ scholar-activist identities.
Feminist and Furious: Diversity Work(ers) Against Game Studies of Empire!
Authors: Mejeur Cody , Butt Mahli-Ann R. , Cole Alayna
Published: October 2020

This article builds on Games of Empire by centering the experiences of diversity workers in Game Studies of Empire. Our data were gathered through qualitative mixed methods of in-depth surveys and semi-structured interviews. Participants self-identified to be included in the study, all thinking critically through the definitions of “diversity,” “diversity work(er),” and “game studies.” Thus, this study reports on a tapestry of knowledge and experiences from the various educators and advocates of diversity across academia and the games industry. Diversity workers in Game Studies of Empire are often exploited by their affective attachment to diversity and perform significant unrecognized and uncompensated affective labor. Empire uses diversity workers to produce a quantifiable and tokenizable product of bodies and lived experiences that can be used to further profits for companies, universities, and other institutions. Diversity work(ers) against Game Studies of Empire unite! We will have nothing to lose when we become unchained.
Dignity Rights for a Pandemic
Authors: May James R. , Daly Erin
Published: October 2020

The concept of human dignity means, quite simply, that every person has inherent equal worth. This incontrovertible but profound concept is derived from the body of dignity law that has developed since the end of World War II at the international, regional, national, and subnational levels, where dignity has become the central axis around which law rotates.

Both the UN Charter and the Universal Declaration of Human Rights confirm the foundational place of the recognition of human dignity in the building of the new postwar world order. Advancing human dignity also is a central premise of the binding International Covenant on Civil and Political Rights and International Covenant on Economic, Social and Cultural Rights, and virtually all subsequent instruments addressing human well-being. The right to dignity is guaranteed by the national constitutions of more than 160 countries.

Further, courts around the globe have applied the right to dignity thousands of times in cases involving issues that matter everyday to everyday people, including involving poverty, employment, marriage, adoption, incarceration, education, safety, health, discrimination, immigration, and police brutality, and many more. The pandemic wrought by Covid-19 has tested the boundaries of dignity’s role under the of law. Millions are infected. Hundreds of thousands have died. Nations have closed their borders. People are quarantined, desparate, and desparing, leading to social and economic dislocation not seen since the Great Depression.

This article highlights the normative and legal dimensions of dignity, and how taking account of dignity under law can improve outcomes during the pandemic. It theorizes that, while not a cure, recognizing dignity under law can be therapeutic in these troubling times.
The NMR Spin Systems of Scutellaria 8β,13-Epoxy-neo-clerod-3-en-15,16-olides and Revision of 1H and 13C NMR Spectra Reported Data
Authors: Coll Toledano Josep
Published: October 2020

The present review of NMR spectroscopic structural elucidation data of new compounds isolated from Scutellaria species is focused on the title compounds, displaying a peculiar 13-spiro feature. It contains a compilation of 1H and 13C NMR data of these diterpenoids grouped by similar substitution patterns. Comparing shielding effects pointed out not only the identity of some compounds (already reported) but also potential misassignments and convenient revisions to get unambiguous structural proposals.
Jasminum grandiflorum: Influence of Flower Processing and Geographic Origin on Flower Absolute Composition
Authors: Braun Norbert A. , Sim Sherina
Published: October 2020

Five Jasminum grandiflorum flower absolutes harvested as flower buds and processed in the “ J. sambac-way” in different locations in the southern Indian state of Tamil Nadu were analyzed using gas chromatography (GC) and GC-mass spectrometry. These absolutes were compared with 5 commercial Indian J. grandiflorum flower absolutes manufactured in the traditional “ J. grandiflorum-way” from open flowers. Focus was placed on 42 key ingredients to investigate the influence of such a flower processing on the absolute composition. Our study established olfactive and composition differences of such absolutes produced via the “ J. sambac-way.” In addition, geographic variations in this species were analyzed by comparing 5 commercial Indian J. grandiflorum flower absolutes with absolutes from Egypt and Morocco, respectively. A composition range of the absolutes was established for the 3 main J. grandiflorum flower grower countries using a total of 14 commercial samples. The 12 main ingredients in the absolutes showed variations between 4.3% and 89.7%.
Quality-of-life issues and symptoms reported by patients living with haematological malignancy: a qualitative study
Authors: Goswami Pushpendra , Oliva Esther N. , Ionova Tatyana , Else Roger , Kell Jonathan , Fielding Adele K. , Jennings Daniel M. , Karakantza Marina , Al-Ismail Saad , Collins Graham P. , McConnell Stewart , Langton Catherine , Salek Sam
Published: October 2020

Background:

Our aim was to identify health-related quality-of-life (HRQoL) issues and symptoms in patients with haematological malignancies (HMs) and develop a conceptual framework to reflect the inter-relation between them.

Methods:

A total of 129 patients with HMs were interviewed in a UK multicentre qualitative study. All interviews were audio recorded, transcribed and analysed using NVivo-11.

Results:

Overall, 34 issues were reported by patients and were grouped into two parts: quality of life (QoL) and symptoms. The most prevalent HRQoL issues were: eating and drinking habits; social life; physical activity; sleep; and psychological well-being. Furthermore, most prevalent disease-related symptoms were: tiredness; feeling unwell; breathlessness; lack of energy; and back pain. The most prevalent treatment side effects were: tiredness; feeling sick; disturbance in sense of taste; and breathlessness.

Conclusions:

Both HMs and their treatments have a significant impact on patients’ HRQoL, in particular on issues such as job-role change, body image and impact on finances.
Treatment strategy for elderly patients with the isolated greater trochanteric fracture
Authors: Oc Yunus , Varol Ali , Yazar Ethem Aytac , Ak Semih , Akpolat Ahmet Onur , Kilinc Bekir Eray
Published: October 2020

Background:

The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment.

Methods:

Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination.

Results:

This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404).

Conclusion:

Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery
Mucinous myoepithelioma: A report of a new variant
Authors: Guo Xin , Watanabe Jiro , Nakatani Hiroaki , Fukushima Kei , Yamada Sohsuke
Published: October 2020

Myoepitheliomas account for approximately 1.5% of all salivary gland tumors and arise most frequently from the parotid gland. Recently, a new myoepithelioma variant, called mucinous myoepithelioma, has attracted widespread attention. These tumors are recognized as a unique subtype of myoepithelioma, characterized by the presence of abundant mucin. We herein report the findings of an 86-year-old Japanese woman who presented with a hard mass of the right parotid gland behind her right ear which was gradually increasing in size. The patient had undergone a fine-needle aspiration biopsy 4 years earlier, and a cytological evaluation of a biopsy specimen had shown features of pleomorphic adenoma. A resection was thus performed and the tissue was found to be an encapsulated, soft and solid mass, and the cut surface was observed to be a capsulated and well-defined tumor lesion with myxoid-looking foci of gray-white coloration. Microscopic examination revealed that this lesion was composed of a proliferation of bland-looking epithelial and myoepithelial cells, arranged in a solid or reticular growth fashion in an abundant myxomatous or hyalinized stroma. These neoplastic epithelial cells had centrally located small nuclei with fine chromatin and abundant clear to eosinophilic cytoplasm, often containing mucin in a uniform pattern. Immunohistochemical staining demonstrated the tumor cells to be positive for AE1/AE3, S-100 and mucicarmine. Our findings suggest this case to be one myoepithelioma variant of mucinous myoepithelioma, and more experience related to this myoepithelioma variant is necessary to better understand its biological behavior and make an accurate diagnosis for a proper treatment.
Use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system
Authors: Tsukahara Satoshi , Shimohira Masashi , Nagai Keiichi , Ohta Kengo , Sawada Yusuke , Hashizume Takuya , Goto Taeko , Shibamoto Yuta
Published: October 2020

Background

A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has been reported to allow super-selective catheterization. A 1.6-Fr. microcatheter has recently become available as the small microcatheter for the triaxial system, in addition to 0.014-in. pushable bare platinum coils that may be introduced into the 1.6-Fr. microcatheter.

Purpose

The purpose of the present study was to evaluate the feasibility of 0.014-in. pushable bare platinum coils in embolization through the 1.6-Fr. microcatheter of the triaxial system.

Material and Methods

Between November 2015 and October 2019, 19 embolizations were performed on 18 patients, 9 males and 9 females with a median age of 77 years (range, 41–88 years), using 0.014-in. pushable bare platinum coils through the 1.6-Fr. microcatheter of the triaxial system. The technical success rate, clinical success rate, and complications associated with the procedure were assessed. Technical success was defined as the successful delivery and placement of 0.014-in. pushable bare platinum coils, and clinical success as the immediate postembolic complete cessation of blood flow confirmed by digital subtraction angiography.

Results

Eighty-four 0.014-in. pushable bare platinum coils were delivered and 19 arteries were successfully embolized. The median number of 0.014-in. pushable bare platinum coils was 4 (range, 1–12). The technical success rate was 100% (84/84) and the clinical success rate was also 100% (19/19). There were no complications associated with the procedures.

Conclusion

The use of 0.014-in. pushable bare platinum coils in super-selective embolization through the 1.6-Fr. microcatheter of the triaxial system appears to be feasible and safe.
Variations of Sagittal Alignment in Standing Versus Sitting Positions Under the Roussouly Classification in Asymptomatic Subjects
Authors: Sun Zhuoran , Zhou Siyu , Jiang Shuai , Zou Da , Yu Miao , Li Weishi
Published: October 2020

Study Design:

Prospective radiological analysis.

Objective:

To investigate the characteristics of the sagittal spinopelvic alignment in the standing and sitting positions under the Roussouly classification in a healthy population.

Methods:

This study using standing and sitting lateral radiographs included 143 volunteers whose spinopelvic parameters were measured. The parameters were compared in the standing and sitting positions. The lumbo-pelvic profile was identified according to the Roussouly classification. The differences in the values of the parameters between the standing and sitting positions were analyzed. The different frequencies of the unchanged apex were assessed.

Results:

All parameter values except the thoracolumbar angle (TLK) were significantly altered. With regard to the classification of the lumbopelvic profile, 15 (10.5%) subjects were excluded because they were evaluated as not belonging to any of the Roussouly types. The remaining 128 subjects were evaluated and classified as follows: 19 (14.8%), type 1; 53 (41.4%), type 2; 9 (7.0%), type 3 + anteverted pelvis (AP); 33 (25.8%), type 3; and 14 (10.9%), type 4. The differences in the pelvic tilt (PT), sacral slope (SS), and thoracic pelvic angle (TPA) values were significantly lower in types 1 and 2 than in other Roussouly types. Corresponding variations in the apical vertebra for the sagittal lumbar curves in the sitting position were observed.

Conclusions:

Subjects with Roussouly type 1 and type 2 sagittal alignments were found to be less capable of performing changes in alignment when changing to the sitting position. The characteristics of the apical movement were also different.
BJP and Donyi-Polo: New Challenges to Christianity in Arunachal Pradesh and Northeast India
Authors: Daughrity Dyron B.
Published: October 2020

Located on the disputed border with China, Arunachal Pradesh is the most remote of India’s northeastern states. Christianity is growing there—from 1 percent in 1971 to 30 percent in 2011—but that number may have reached a plateau. Arunachal Pradesh is undergoing rapid sociocultural change. While Hinduism is not well-established in the region, there is tremendous interest in a relatively new religion called Donyi-Polo. Some Hindus argue Donyi-Polo is actually a branch of Hinduism, and they are having some success in making this claim. This article explores the changing religious, political, and cultural dynamics of Arunachal Pradesh.
The Synod on Young People, a Laboratory of Synodality
Authors: Becquart Nathalie
Published: October 2020

The Fifteenth Ordinary General Assembly of the Synod of Bishops, held in October 2018 with the theme “Young People, Faith, and Vocational Discernment,” was truly a profound experience of “walking together” under the guidance of the Spirit. Through a process including two years of preparation with local consultations and a Pre-Synod with three hundred youth from all over the world, the church has been deeply listening to the young adults between the ages of sixteen and twenty-nine. Thus the church has understood clearly how synodality is truly a key to the proclamation and transmission of the faith today.
Epicrania fugax: Report of eight cases with some novel features
Authors: Chowdhury Debashish , Chawla Tanushree , Duggal Ashish
Published: October 2020

Introduction:

Epicrania fugax (EF) is an epicranial headache syndrome characterized by short lasting headache paroxysms which spread in a typical linear/zigzag pattern. The definition of EF has evolved over time, and new phenotypes have been observed in various studies.

Aim:

We present eight cases diagnosed as EF according to the International Classification of Headaches Disorders, 3rd edition criteria and highlight certain novel characteristics which will help in the further categorization of this disorder.

Methods:

We prospectively studied eight cases of EF who presented to our headache clinic from January 2016 to September 2020. Demographic and detailed clinical data were collected and analyzed.

Results:

The mean age of onset of the cohort was 42 ± 10.47 years with a median duration of symptoms being 1 year. There were 5 male and 3 female patients. The mean visual analog scale score was 5.25 ± 1.83. Headache frequency had high intra and interindividual variability. Four patients had a typical spread of pain along the distribution of greater occipital, and supraorbital, nerves. Four patients had an atypical presentation with midline headache, transverse occipital, and bilateral simultaneous hemicranium involvement. Headache paroxysm was followed by a prolonged fixed pain in the same linear distribution in three patients. One patient had ipsilateral redness in the eye. All eight patients required medical intervention with amitriptyline or neuromodulators, five of whom reported a significant reduction in their headache symptoms.

Conclusion:

Our case series highlights a few interesting features which need further exploration with larger studies. Firstly, the atypical distribution of the pain trajectory forces us to dig deeper into the pathogenesis of the disorder. Secondly, our data also suggest a possibility of EF triggered “linear headaches.” EF is a relatively uncommon headache disorder that can be managed easily with neuromodulators but the lack of awareness of the condition often leads to delayed diagnosis.
Reduced-intensity therapy for pediatric lymphoblastic leukemia: impact of residual disease early in remission induction
Authors: Sidhom Iman , Shaaban Khaled , Youssef Sarah H. , Ali Nesreen , Gohar Seham , Rashed Wafaa M. , Mehanna Mai , Salem Sherine , Soliman Sonya , Yassin Dina , Mansour Emad , Coustan-Smith Elaine , Ribeiro Raul C. , Rivera Gaston K.
Published: October 2020

Legacy data show that ∼40% of children with acute lymphoblastic leukemia (ALL) were cured with limited antimetabolite-based chemotherapy regimens. However, identifying patients with very-low-risk (VLR) ALL remains imprecise. Patients selected based on a combination of presenting features and a minimal residual disease (MRD) level <0.01% on day 19 of induction therapy had excellent outcomes with low-intensity treatment. We investigated the impact of MRD levels between 0.001% and <0.01% early in remission induction on the outcome of VLR ALL treated with a low-intensity regimen. Between October of 2011 and September of 2015, 200 consecutive patients with B-precursor ALL with favorable clinicopathologic features and MRD levels <0.01%, as assessed by flow cytometry in the bone marrow on day 19 and at the end of induction therapy, received reduced-intensity therapy. The 5-year event-free survival was 89.5% (± 2.2% standard error [SE]), and the overall survival was 95.5% (± 1.5% SE). The 5-year cumulative incidence of relapse (CIR) was 7% (95% confidence interval, 4-11%). MRD levels were between 0.001% and <0.01% on day 19 in 29 patients. These patients had a 5-year CIR that was significantly higher than that of patients with undetectable residual leukemia (17.2% ± 7.2% vs 5.3% ± 1.7%, respectively; P = .02). Our study shows that children with VLR ALL can be treated successfully with decreased-intensity therapy, and it suggests that the classification criteria for VLR can be further refined by using a more sensitive MRD assay.
Safety of venetoclax rapid dose escalation in CLL patients previously treated with B-cell receptor signaling antagonists
Authors: Koenig Kristin L. , Huang Ying , Dotson Emily K. , Sheredy Shane , Bhat Seema A. , Byrd John C. , Desmond Emily , Ford Jill , Iarocci Shauna , Jones Jeffrey A. , Lucas Margaret S. , Moran Mollie E. , Wiczer Tracy E. , Woyach Jennifer A. , Awan Farrukh T. , Rogers Kerry A.
Published: October 2020

Venetoclax has efficacy in patients relapsing after B-cell receptor pathway inhibitors (BCRis); however, because of the risk of tumor lysis syndrome (TLS), a 5-week dose ramp-up is required to attain the target dose. Patients relapsing after BCRis frequently have proliferative disease, requiring a faster time to target dose than this scheme allows. This limitation can potentially be overcome with rapid dose escalation (RDE). We analyzed 33 chronic lymphocytic leukemia patients who underwent venetoclax RDE after prior BTKi treatment. Median time to target dose was 9 days. Seventeen patients (52%) developed laboratory TLS, and 5 (15%) developed clinical TLS, all as a result of renal injury. TLS was seen in more patients with a higher initial tumor burden. TLS occurred at all dose levels, with most episodes occurring at the 50- and 100-mg doses. Most interestingly, a decrease in absolute lymphocyte count (ALC) from pre–venetoclax dose to 24 hours post–venetoclax dose of 10 × 103/μL was associated with an increased risk of TLS (hazard ratio, 1.32; P = .02), after controlling for venetoclax dose level. Venetoclax RDE with close in-hospital monitoring at experienced centers and in select patients is feasible. The rapidity with which ALC drops helps predict TLS and could help guide dose-escalation decisions.
Long-term prognosis of new adult-onset asthma in obese patients
Authors: Ilmarinen Pinja , Pardo Adrienn , Tuomisto Leena E. , Vähätalo Iida , Niemelä Onni , Nieminen Pentti , Kankaanranta Hannu
Published: October 2020

Background

Obesity has been associated with poor outcomes of asthma in cross-sectional studies, but long-term effect of obesity on asthma remains unknown.

Aims

To study the effects of obesity, found at the time of diagnosis of adult-onset asthma, on 12-year prognosis by focusing on oral corticosteroid (OCS) use and respiratory-related hospital admissions.

Methods

Patients diagnosed with adult-onset asthma (n=203) were divided into three categories based on diagnostic body mass index (BMI) (<25 kg·m−2, 25–29.9 kg·m−2, ≥30 kg·m−2) and followed for 12 years as part of the Seinäjoki Adult Asthma Study. Self-reported and dispensed OCS were assessed for the 12-year period. Data on hospital admissions were analysed based on medical records.

Results

12 years after diagnosis, 86% of the patients who were obese (BMI ≥30 kg·m−2) at diagnosis remained obese. During the follow-up, no difference was found in weight gain between the BMI categories. During the 12-year follow-up, patients obese at diagnosis reported more frequent use of OCS courses (46.9%versus23.1%, p=0.028), were dispensed OCS more often (81.6%versus56.9%, p=0.014) and at higher doses (median 1350 (interquartile range 280–3180) mgversus600 (0–1650) mg prednisolone, p=0.010) compared to normal-weight patients. Furthermore, patients who were obese had more often one or more respiratory-related hospitalisations compared to normal-weight patients (38.8%versus16.9%, p=0.033). In multivariate logistic regression analyses, obesity predicted OCS use and hospital admissions.

Conclusions

In adult-onset asthma, patients obese at diagnosis mostly remained obese at long-term and had more exacerbations and respiratory-related hospital admissions compared to normal-weight patients during 12-year follow-up. Weight loss should be a priority in their treatment to prevent this outcome.
European Respiratory Society statement on sleep apnoea, sleepiness and driving risk
Authors: Bonsignore Maria R. , Randerath Winfried , Schiza Sofia , Verbraecken Johan , Elliott Mark W. , Riha Renata , Barbe Ferran , Bouloukaki Izolde , Castrogiovanni Alessandra , Deleanu Oana , Goncalves Marta , Leger Damien , Marrone Oreste , Penzel Thomas , Ryan Silke , Smyth Dan , Teran-Santos Joaquin , Turino Cecilia , McNicholas Walter T.
Published: October 2020

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
European Respiratory Society statement on thoracic ultrasound
Authors: Laursen Christian B. , Clive Amelia , Hallifax Rob , Pietersen Pia Iben , Asciak Rachelle , Davidsen Jesper Rømhild , Bhatnagar Rahul , Bedawi Eihab O. , Jacobsen Niels , Coleman Courtney , Edey Anthony , Via Gabriele , Volpicelli Giovanni , Massard Gilbert , Raimondi Francesco , Evison Matthew , Konge Lars , Annema Jouke , Rahman Najib M. , Maskell Nick
Published: October 2020

Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
Cellular senescence: friend or foe to respiratory viral infections?
Authors: Kelley William J. , Zemans Rachel L. , Goldstein Daniel R.
Published: October 2020

Cellular senescence permanently arrests the replication of various cell types and contributes to age-associated diseases. In particular, cellular senescence may enhance chronic lung diseases including COPD and idiopathic pulmonary fibrosis. However, the role cellular senescence plays in the pathophysiology of acute inflammatory diseases, especially viral infections, is less well understood. There is evidence that cellular senescence prevents viral replication by increasing antiviral cytokines, but other evidence shows that senescence may enhance viral replication by downregulating antiviral signalling. Furthermore, cellular senescence leads to the secretion of inflammatory mediators, which may either promote host defence or exacerbate immune pathology during viral infections. In this Perspective article, we summarise how senescence contributes to physiology and disease, the role of senescence in chronic lung diseases, and how senescence impacts acute respiratory viral infections. Finally, we develop a potential framework for how senescence may contribute, both positively and negatively, to the pathophysiology of viral respiratory infections, including severe acute respiratory syndrome due to the coronavirus SARS-CoV-2.
An innovative phase II trial to establish proof of efficacy and optimal dose of a new inhaled epithelial sodium channel inhibitor BI 1265162 in adults and adolescents with cystic fibrosis: BALANCE-CFTM1
Authors: Goss Christopher H. , Jain Raksha , Seibold Wolfgang , Picard Anne-Caroline , Hsu Ming-Chi , Gupta Abhya , Fajac Isabelle
Published: October 2020

Inhibition of the epithelial sodium channel (ENaC) represents an important, mutation-agnostic therapeutic approach to restore airway surface liquid in patients with cystic fibrosis (CF). A phase II trial of the ENaC inhibitor BI 1265162, inhaledviathe Respimat® Soft Mist™ inhaler, in patients aged ≥12 years with CF is being conducted to assess the efficacy and safety of BI 1265162, on top of standard CF treatment (www.clinicaltrials.govidentifierNCT04059094).

BALANCE-CF™ 1 is a multinational, randomised, double-blind, placebo-controlled, parallel-group, dose-ranging trial consisting of 2 weeks’ screening, 4 weeks’ randomised treatment and 1 week follow-up. 98 patients, including ≥21 adolescents, will be randomised. First, 28 patients will be allocated to the highest dose of BI 1265162 (200 µg twice daily) or placebo in a 1:1 ratio. The remaining 70 patients will be allocated to one of five treatment arms (200 µg, 100 µg, 50 µg, 20 µg or placebo twice daily), with a final distribution ratio of 2:1:1:1:2. Recruitment and randomisation will begin with adult patients. An independent data monitoring committee will review safety data to advise on inclusion of adolescents and study continuation. A futility analysis will be conducted after 28 patients to prevent exposure of further patients in case of insufficient evidence of clinical efficacy. The design ensures that potential for effect is assessed ahead of wider enrolment, allowing investigation of a dose–response effect with minimal patient numbers.

The results will increase understanding of efficacy, safety and optimal dosing of the inhaled ENaC inhibitor BI 1265162 in adults and adolescents with CF.