bluuebunny/crossref_metadata_2025 huggingface dataset:
The Other Woman (Collation)
Authors: Eisner Martin
Published: September 2021

This chapter investigates the significance of Dante’s decision to include his desires for another woman, whom he calls the ‘donna gentile’. Beginning with Kirkup’s discovery of a fresco in the Florentine Bargello that depicts a young Dante, the chapter explores how later readers have dealt with Dante’s introduction of this conflict of desires, which begins with Dante’s own reconsideration of the episode in the Convivio. While some have claimed that Dante later revised the work, this conflict of desires is crucial to the logic of his work. Although less widely adapted than his encounter with Beatrice, the ‘donna gentile’ episode has attracted some of Dante’s most attentive readers, from contemporaries such as Cino da Pistoia and Cecco d’Ascoli to the modernist poets W. B. Yeats and Eugenio Montale. Arguing for the profound significance of this episode, this chapter highlights Dante as not only the lover of Beatrice, but also the poet of multiple loves.
Expressive insubordination
Authors: Trotzke Andreas , Villalba Xavier
Published: September 2021

In this chapter, the expressive speech act of so-called ‘that-exclamatives’ is compared in both Germanic and Romance languages. The chapter first points out important semantic differences between that-exclamatives in the two language groups by mainly focusing on the languages Catalan and German. In order to explain those differences, a detailed syntactic account is provided of the different systems of syntactic complementation in the expression of that-exclamatives in Germanic and Romance languages. The conclusion of the chapter is that only German that-exclamatives can be referred to as cases of so-called ‘insubordination’ (i.e., syntactic configurations that feature subordinated syntax, but are used as root clauses), whereas Catalan that-exclamatives instantiate a syntactic form that is distinct from both wh-exclamatives and subordinated syntactic configurations.
The Nature of the Commonwealth
Authors: Mortimer Sarah
Published: September 2021

An important catalyst for the upsurge of interest in analysing earthly political communities came in 1510, when the French king Louis XII called a Council of the Church to Pisa. Like previous Councils, it encouraged debate about the location, representation, and exercise of power, but the Council at Pisa was especially notable because its defenders—including Jacques Almain and John Mair—leaned heavily on the concept of natural law in making their case against the Pope. By appealing to natural law they made clear that they saw their writings as relevant not only to the internal workings of the Church, but to all communities, temporal as well as ecclesiastical. Soon new arguments began to circulate in Europe in which the basis of political power was grounded in natural law rather than in any direct grant of power from God. These arguments helped to explain why political power was diffused among a number of independent communities rather than united in the Empire, and they could also be used to show how and why the Church was different from the state or temporal community. This chapter also considers alternative ideas about the relationship between Christianity and politics, including those developed by Thomas More, Niccolò Machiavelli, and Francesco Guicciardini.
Church and Commonwealth in the Catholic World
Authors: Mortimer Sarah
Published: September 2021

Early in 1532, the Catholic professor Fransisco de Vitoria lectured his students ‘On the Power of the Church’ at the University of Salamanca. Efforts like this to defend the status of the Church led, perhaps paradoxically, to a new appreciation of the state’s foundations and its basis in the order of nature. Vitoria was anxious to protect the authority of the universal Church, he also believed that there should exist a multiplicity of civil powers, each with its own integrity and degree of autonomy. While there could only be one true Church, there could and should be many commonwealths; he, like many others, was sceptical of imperial ambitions in the temporal sphere. His thinking, and that of other Catholics like Bartolomé de Las Casas, generated a critique of political or temporal empire that would gather momentum as reports of Spanish cruelty in the New World began to circulate. Yet there were also Catholics, like Juan Ginés de Sepúlveda, who embraced the pursuit of empire and sought to defend it, often using classical ideas but adapting them to current circumstances. As this clash of beliefs unfolded, it came to include lengthy reflection on power, natural rights and authority, including the influential work of Fernando Vázquez de Menchaca. At the heart of the debate was a question about the relationship between a universal natural law and the particular rules and commands of specific communities, be they the Catholic Church or localized political communities.
The Science of Politics
Authors: Mortimer Sarah
Published: September 2021

In 1576 Louis Le Roy published a new and expanded edition of his translation of Aristotle’s Politics. In the late-sixteenth century, the starting point for academic political reflection remained the Politics, a text which underlined the importance of participation in the constitution. Although Bodin’s alternative concept of sovereignty was widely admired, many readers were troubled by Bodin’s political and religious ideas and wanted to preserve a role for the Aristotelian idea of political justice and for the Church. The effect was a revitalization of politics as an academic disciple or science, in which the civil community was examined alongside the Church. Leading figures in this process include John Case and Richard Hooker in England and Pierre Grégoire in France. In Emden, Johannes Althusius developed a political theory which he described as a reworking of Aristotle; he emphasized the concept of ‘consociation’ and used it to defend the sovereignty of the people. Henning Arnisaeus challenged Althusius’s claims, preferring to see sovereignty as divisible, shared in the Holy Roman Empire between the Emperor and the Princes, and requiring the use of arcana imperii or secrets of state. This chapter shows that the Aristotelian tradition remained important as a way of portraying a hierarchically organized political society as natural to human beings, but that in the wake of Bodin’s writing there was a shift in emphasis away from questions of virtue and distributive justice and towards a discussion of the nature of sovereign power.
Beyond Sovereignty
Authors: Mortimer Sarah
Published: September 2021

Most texts examined so far were designed to explain where power lay within a local, seemingly autonomous political community. But local circumstances were shaped by the international situation, and the relationship between the local political community and the wider human society of which it was part became an increasingly important issue towards the end of the sixteenth century. In the face of continuing Habsburg dominance on the European continent, Protestants like Alberico Gentili began to articulate new ideas of a shared human society and of the law of peoples (ius gentium), using these to justify military intervention. The relationship between the law of peoples, the law of war, and Christian principles came to be debated more intensely, especially as political tensions deepened. With the outbreak of the Thirty Years War in 1618, calls for solidarity among co-religionists intensified, but this period also saw a major new account of the laws of nature which explicitly distinguished these from Christianity (although not from religion). In De Jure Belli ac Pacis (1625), Hugo Grotius argued that the authority of the civil magistrate needed to be connected to the natural law if his commands were to be seen as legitimate, while he defined this natural law in terms of ‘strict right’, distinct from considerations of virtue, distributive justice, or Christian charity. His achievement was to suggest how human beings with diverse opinions about salvation and merit could live peacefully together.
Epilogue and Conclusion
Authors: Mortimer Sarah
Published: September 2021

This chapter draws together the themes of the book and looks forward to the later-seventeenth century. It argues that for much of the sixteenth century politics was subordinate to religion; temporal authorities needed the additional sanctions provided by religious belief if they were to exert any power over the consciences of individuals. The effect was to entangle temporal power in the deepening conflicts over religious truth, and thus to reveal the brittleness of any conception of political authority which relied on the support of the Church. At the same time, older traditions of political thought did not go away and often became stronger. The circulation of classical ideas, the discovery of new peoples, the growing interest in historical change and development all suggested alternative ways of legitimizing political power, often using natural law and avoiding any reliance on specifically Christian commitments. What happened in the early-seventeenth century, and most obviously in the writing of Hugo Grotius, was a move not only to ground political society in a particular conception of human nature (conceived of juridically, as a source of rights and obligations) but also to detach Christianity from that view of human nature. It was this understanding of human beings which enabled the development of a social contract tradition through the seventeenth century and beyond, and became an important source for modern liberalism. The questions it raised would help to shape the thought of the next century.
A BTB-TAZ protein is required for gene activation byCauliflower mosaic virus 35Smultimerized enhancers
Authors: Irigoyen Sonia , Ramasamy Manikandan , Misra Anjali , McKnight Thomas D , Mandadi Kranthi K
Published: September 2021

The Arabidopsis (Arabidopsis thaliana) BTB-TAZ DOMAIN PROTEIN 2 (BT2) contains an N-terminal BTB domain, a central TAZ zinc-finger protein–protein interaction domain, and a C-terminal calmodulin-binding domain. We previously demonstrated that BT2 regulates telomerase activity and mediates multiple responses to nutrients, hormones, and abiotic stresses in Arabidopsis. Here, we describe the essential role of BT2 in activation of genes by multimerized Cauliflower mosaic virus 35S (35S) enhancers. Loss of BT2 function in several well-characterized 35S enhancer activation-tagged lines resulted in suppression of the activation phenotypes. Suppression of the phenotypes was associated with decreased transcript abundance of the tagged genes. Nuclear run-on assays, mRNA decay studies, and bisulfite sequencing revealed that BT2 is required to maintain the transcriptionally active state of the multimerized 35S enhancers, and lack of BT2 leads to hypermethylation of the 35S enhancers. The TAZ domain and the Ca++/calmodulin-binding domain of BT2 are critical for its function and 35S enhancer activity. We further demonstrate that BT2 requires CULLIN3 and two bromodomain-containing Global Transcription factor group E proteins (GTE9 and GTE11), to regulate 35S enhancer activity. We propose that the BT2-CULLIN3 ubiquitin ligase, through interactions with GTE9 and GTE11, regulates 35S enhancer activity in Arabidopsis.
Brachypodium distachyon UNICULME4 and LAXATUM-A are redundantly required for development
Authors: Liu Shengbin , Magne Kévin , Daniel Sylviane , Sibout Richard , Ratet Pascal
Published: September 2021

In cultivated grasses, tillering, leaf, and inflorescence architecture, as well as abscission ability, are major agronomical traits. In barley (Hordeum vulgare), maize (Zea mays), rice (Oryza sativa), and brachypodium (Brachypodium distachyon), NOOT-BOP-COCH-LIKE (NBCL) genes are essential regulators of vegetative and reproductive development. Grass species usually possess 2–4 NBCL copies and until now a single study in O. sativa showed that the disruption of all NBCL genes strongly altered O. sativa leaf development. To improve our understanding of the role of NBCL genes in grasses, we extended the study of the two NBCL paralogs BdUNICULME4 (CUL4) and BdLAXATUM-A (LAXA) in the nondomesticated grass B. distachyon. For this, we applied reversed genetics and generated original B. distachyon single and double nbcl mutants by clustered regularly interspaced short palindromic repeats – CRISPR associated protein 9 (CRISPR-Cas9) approaches and genetic crossing between nbcl targeting induced local lesions in genomes (TILLING) mutants. Through the study of original single laxa CRISPR–Cas9 null alleles, we validated functions previously proposed for LAXA in tillering, leaf patterning, inflorescence, and flower development and also unveiled roles for these genes in seed yield. Furthermore, the characterization of cul4laxa double mutants revealed essential functions for nbcl genes in B. distachyon development, especially in the regulation of tillering, stem cell elongation and secondary cell wall composition as well as for the transition toward the reproductive phase. Our results also highlight recurrent antagonist interactions between NBCLs occurring in multiple aspects of B. distachyon development.
Quantitative Sensory Testing Protocols to Evaluate Central and Peripheral Sensitization in Knee OA: A Scoping Review
Authors: Rankin Jonathan , Rudy-Froese Benjamin , Hoyt Curtis , Ramsahoi Keenu , Gareau Liam , Howatt William , Carlesso Lisa
Published: September 2021

Objective

This scoping review analyzed various quantitative sensory testing methodologies used in the assessment of sensitization and how sensitization is defined in people with knee osteoarthritis.

Design

A scoping review.

Setting

All clinical and research settings.

Subjects

Non-surgical adults with knee osteoarthritis.

Methods

This scoping review was guided by existing scoping review methodologies. Relevant studies were extracted from the following electronic databases: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Allied and Complementary Medicine Database, and the Cumulative Index to Nursing Allied Health Literature. Abstract and full article screening and data extraction were performed in pairs. Information on quantitative sensory testing techniques and parameters was extracted and summarized in tables. General and technique specific definitions of sensitization were extracted from included texts.

Results

Our search yielded 4,199 articles, of which 50 were included in our review. The most common quantitative sensory test was pressure pain threshold. In total 28 unique testing sites were found speaking to the high degree of variability between studies. Sensitization was poorly defined with only 8 studies fully operationalizing it, 22 partially, and the remainder did not provide sufficient information to meet our criteria.

Conclusions

This scoping review has provided an overview of the most common methods of quantitative sensory testing being implemented in the assessment of nervous system sensitization to nociceptive signaling in people with knee osteoarthritis. This study provides a foundation for future development of quantitative sensory testing methodology for research and clinical practice in the osteoarthritis population.
External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance
Authors: Sherman David A , Lehmann Tim , Baumeister Jochen , Gokeler Alli , Donovan Luke , Norte Grant E
Published: September 2021

Objective

External focus (EF) of attention leads to improved balance performance. Consideration of the neuromodulatory effects of EF may inform its clinical utility in addressing neuroplastic impairments after musculoskeletal injuries. We aimed to determine whether electrocortical activity and balance performance changed with attentional foci that prioritized differing sensory feedback and whether changes in electrocortical activity and balance were associated.

Methods

Individuals who were healthy (n = 15) performed a single-limb balance task under 3 conditions: internal focus (IF), somatosensory focus [EF with a baton (EF-baton)], and visual focus [EF with a laser (EF-laser)]. Electrocortical activity and postural sway were recorded concurrently using electroencephalography and a triaxial force plate. Electroencephalographic signals were decomposed, localized, and clustered to generate power spectral density in θ and α-2 frequency bands. Postural sway signals were analyzed with center-of-pressure sway metrics (eg, area, distance, velocity) and knee angle. The relationship between percent change in clustered brain activity and task performance metrics was assessed.

Results

Both EF conditions resulted in increased cortical activity and improved balance performance compared to IF. EF-laser had the largest effect, demonstrating increased frontal θ power (d = 0.64), decreased central θ power (d = −0.30), and decreased bilateral motor, bilateral parietal, and occipital α-2 power (d = −1.38 to −4.27) as well as a shorter path distance (d = −0.94) and a deeper (d = 0.70) and less variable (d = −1.15) knee angle than IF. Weak to moderate associations exist between increases in cortical activity and improved balance performance (ρ = 0.405–0.584).

Conclusions

EF resulted in increased cortical activity associated with cognitive, motor, somatosensory, and visual processing. EF-laser, which prioritized visual feedback, had the largest and broadest effects. Changes in cortical activity resulting from EF were independently associated with improved balance performance.

Impact

This study demonstrates that goal-oriented attention results in functional increases in brain activity compared to internally directed self-focus. These results suggest EF may target neurophysiologic impairments and improve balance in clinical populations.
Iraq experience in handling the COVID-19 pandemic: implications of public health challenges and lessons learned for future epidemic preparedness planning
Authors: Lami Faris , Rashak Hiba Abdulrahman , Khaleel Hanan Abdulghafoor , Mahdi Sinan Ghazi , Adnan Firas , Khader Yousef S , Alhilfi Riyadh A , Lehlewa Asaad
Published: September 2021

Background

Iraq has been exceptionally challenged by the COVID-19 pandemic due to the already exhausted healthcare system.

Objectives

To describe the epidemiological situation of COVID-19 in Iraq, the government’s response to the pandemic, and provide recommendations for further action.

Methods

A desk review of secondary data using the available reports on the epidemiological situation in Iraq as well as official governmental sources was conducted.

Results

The major surge in the number of COVID-19 cases occurred in the first week of June and continued to increase dramatically until mid-October when a significant decrease happened. With a few exceptions, the reproductive number R has been consistently above 1. Patients aged 30–39 years (25.6%) were the most affected, while those aged 60–69 years (26.7%) had the highest deaths rates. Iraq tried to contain the pandemic through several regulations: border control, enforcing curfew, mask-wearing, and social distancing, COVID-19 isolation centers, expanding lab capacity, contact tracing, as well as several supportive economic measures. However, the extent of implementing these regulations is questionable.

Conclusion

Additional administrative and scientific measures with special emphasis on handling mass gathering, coordination with media and better training of healthcare workers particularly on infection prevention and control.
Structural Breaks in an Endogenous Growth Model
Authors: Cogley Timothy , Jovanovic Boyan
Published: September 2021

We study the effects of parameter uncertainty prompted by structural breaks. In our model, agents respond differently to uncertainty prompted by regime shifts in shock processes than they react to comparable perceived increases in shock volatility. The magnitude of the response to an increase in uncertainty about TFP associated with a structural break is greater than that of a response to a comparable perceived rise in volatility. This is because lifetime utility varies more when shocks shift beliefs and perceived wealth.
Spatial Equilibrium, Search Frictions, and Dynamic Efficiency in the Taxi Industry
Authors: Buchholz Nicholas
Published: September 2021

This article analyses the dynamic spatial equilibrium of taxicabs and shows how common taxi regulations lead to substantial inefficiencies as a result of search frictions and mis-allocation. To analyse the role of regulation on frictions and efficiency, I pose a dynamic model of spatial search and matching between taxis and passengers. Using a comprehensive dataset of New York City yellow medallion taxis, I use this model to compute the equilibrium spatial distribution of vacant taxis and estimate intraday demand given price and medallion regulations. My estimates show that the weekday New York market achieves about $\$$5.7 million in daily welfare or about $\$$27 per trip, but an additional 53 thousand customers fail to find cabs due to search frictions. Counterfactual analysis shows that implementing simple tariff pricing changes can enhance allocative efficiency and expand the market, offering daily consumer surplus gains of up to $\$$227 thousand and up to 49 thousand additional daily taxi-passenger matches, a similar magnitude to the gain in matches generated by adopting a perfect static matching technology.
BASDAI cut-off values corresponding to ASDAS cut-off values
Authors: Kwon Oh Chan , Park Min-Chan
Published: September 2021

Objective

To determine cut-off values of BASDAI that can discriminate the four disease activity states (inactive disease, moderate disease activity, high disease activity and very high disease activity), separated by the validated Ankylosing Spondylitis Disease Activity Score (ASDAS) cut-off values (1.3, 2.1 and 3.5).

Methods

We included 333 patients with axial SpA whose data on BASDAI and ASDAS-CRP were available. Receiver operating characteristic curve analysis was performed to determine the BASDAI cut-off values that best corresponded to ASDAS-CRP cut-off values. The degree of agreement between disease activity states based on the BASDAI and ASDAS-CRP cut-off values was assessed using weighted kappa.

Results

Of the total 333 patients, 52 (15.6%), 190 (57.1%), 76 (22.8%) and 15 (4.5%) patients had inactive disease, moderate disease activity, high disease activity and very high disease activity, respectively, according to the ASDAS-CRP. Receiver operating characteristic analyses revealed that the BASDAI values 1.9 [area under the curve (AUC) 0.948; 95% CI 0.922, 0.974], 3.5 (AUC 0.926; 95% CI 0.887, 0.966) and 4.9 (AUC 0.917; 95% CI 0.837, 0.996) best corresponded to the ASDAS-CRP values 1.3, 2.1 and 3.5, respectively. The degree of agreement between disease activity states based on the BASDAI and ASDAS-CRP cut-off values was good (weighted kappa: 0.724, P <0.001).

Conclusion

The BASDAI values 1.9, 3.5 and 4.9 corresponded to the ASDAS-CRP values 1.3, 2.1 and 3.5, respectively. These cut-off values could be useful in clinical studies and real-world practice for determining disease activity status when ASDAS-CRP is unavailable.
Brain Activity During Antisaccades to Faces in Adolescence
Authors: Afyouni Alia , Geringswald Franziska , Nazarian Bruno , Grosbras Marie-Helene
Published: September 2021

Cognitive control and social perception both change during adolescence, but little is known of the interaction of these 2 processes. We aimed to characterize developmental changes in brain activity related to the influence of a social stimulus on cognitive control and more specifically on inhibitory control. Children (age 8–11, n = 19), adolescents (age 12–17, n = 20), and adults (age 24–40, n = 19) performed an antisaccade task with either faces or cars as visual stimuli, during functional magnetic resonance brain imaging. We replicate the finding of the engagement of the core oculomotor and face perception brain regions in all age-groups, with increased involvement of frontoparietal oculomotor regions and fusiform face regions with age. The antisaccade-related activity was modulated by stimulus category significantly only in adolescents. This interaction was observed mainly in occipitotemporal regions as well as in supplementary motor cortex and postcentral gyrus. These results indicate a special treatment of social stimuli during adolescence.
Mammalian birnaviruses identified in pigs infected by classical swine fever virus
Authors: Yang Zhe , He Biao , Lu Zongji , Mi Shijiang , Jiang Jianfeng , Liu Zhongdi , Tu Changchun , Gong Wenjie
Published: September 2021

Currently, the Birnaviridae family contains four genera with all members identified from birds, fishes, and insects only. The present study reports a novel birnavirus unexpectedly identified from classical swine fever virus-infected pigs by viral metagenomic analysis, which is, therefore, named as porcine birnavirus (PBRV). Follow-up reverse transcription-polymerase chain reaction (RT-PCR) screening of archived tissues of diseased pigs identified 16 PBRV strains from nine provinces/autonomous regions in China spanning 21 years (1998–2019), and the viral loads of PBRV in clinical samples were 105.08–107.95 genome copies per 0.1 g tissue, showing the replication of PBRVs in the pigs. Genome-based sequence comparison showed that PBRVs are genetically distant from existing members within the Birnaviridae family with 45.8–61.6 per cent and 46.2–63.2 per cent nucleotide sequence similarities in segments A and B, respectively, and the relatively closed viruses are avibirnavirus strains. In addition, indels of 57, 5, and 18 amino acid residues occurred in 16, 2, and 7 locations of the PBRV polyprotein and VP5 and VP1 proteins, respectively, as compared to the reference avibirnaviruses. Phylogenetic analysis showed that PBRVs formed an independent genotype separated from four other genera, which could be classified into two or three subgenotypes (PBRV-A1-2 and PBRV-B1-3) based on the nucleotide sequences of full preVP2 and VP1 genes, respectively. All results showed that PBRV represents a novel porcine virus species, which constitutes the first mammalian birnavirus taxon, thereby naming as Mambirnavirus genus is proposed.
The Wheat Stem Rust (Puccinia graminis f. sp. tritici) Population from Washington Contains the Most Virulent Isolates Reported on Barley
Authors: Upadhaya Arjun , Upadhaya Sudha GC , Brueggeman Robert
Published: September 2021

A diverse sexual population of wheat stem rust, Puccinia graminis f. sp. tritici, exists in the Pacific Northwest region of the United States because of the natural presence of Mahonia spp. that serves as alternate hosts to complete its sexual life cycle. The region appears to be a center of stem rust diversity in North America where novel virulence gene combinations can emerge that could overcome deployed barley and wheat stem rust resistances. A total of 100 single pustule isolates derived from stem rust samples collected from barley in Eastern Washington during the 2019 growing season were assayed for virulence on the two known effective barley stem rust resistance genes/loci, Rpg1 and the rpg4/5-mediated resistance locus (RMRL) at the seedling stage. Interestingly, 99% of the P. graminis f. sp. tritici isolates assayed were virulent on barley variety Morex carrying the Rpg1 gene, and 62% of the isolates were virulent on the variety Golden Promise transformant (H228.2c) that carries a single-copy insertion of the Rpg1 gene from Morex and is more resistant than Morex to many Rpg1 avirulent isolates. Also, 16% of the isolates were virulent on the near isogenic line HQ-1, which carries the RMRL introgression from the barley line Q21861 in the susceptible Harrington background. Alarmingly, 10% of the isolates were virulent on barley line Q21861, which contains both Rpg1 and RMRL. Thus, we report on the first P. graminis f. sp. tritici isolates worldwide with virulence on both Rpg1 and RMRL when stacked together, representing the most virulent P. graminis f. sp. tritici isolates reported on barley.
A Qualitative Study on the Experience and Training Needs of ICU Nurses for Incontinence-Associated Dermatitis
Authors: Zhang Yu , Zhang Peng , Liu Jun-E , Gao Fengli
Published: September 2021

OBJECTIVE

To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management.

METHODS

This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semistructured interviews. The content analysis method was used to analyze, summarize, and refine the interview data.

RESULTS

The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD.

CONCLUSIONS

The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.
Cement-augmented dynamic hip screw (DHS) to manage intertrochanteric fractures (ITFs) in the elderly: a prospective case series
Authors: El-Senbsy Alaa M. , Khalifa Ahmed A. , Tammam Hamdy , Said El Sayed , Refae Hesham
Published: September 2021

Background:

The purpose of this study was to report early results in managing intertrochanteric fractures (ITF) in an elderly patient cohort using a cement augmented dynamic hip screw (DHS) by a relatively easy technique with cheap instruments available in any operative room.

Methods:

In this prospective study, 25 patients aged 70 yr or more who were diagnosed with ITF were included. Conventional DHS instruments were used for fixation. An endotracheal tube, and a disposable 50-cc plastic syringe with a nozzle were used to inject low viscosity polymethylmethacrylate (PMMA) bone cement inside the lag screw tract to obtain cement augmentation.

Results:

After an average follow-up of 8.3±2.1 mo, 20 patients (11 women and nine men) with a mean age of 76.9±5.8 yr were available for assessment. Sixteen patients were classified as AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2, and four were classified as AO/OTA 31-A1. The average operative time was 70.3±9.5 min. All patients achieved radiographic fracture union by the last follow-up with an average tip apex distance of 21.8±1.9 mm. the average functional outcome according to the Salvati and Wilson scoring system was 27.4±5.9; 80% of the patients scored excellent and good. No complications were reported to the cement augmentation technique particularly lag screw cut out, implant failure, and femoral head avascular necrosis.

Conclusions:

Managing ITFs in elderly patients using a cement-augmented DHS revealed an acceptable functional and radiographic outcome with the use of a relatively easy, inexpensive, and safe technique.

Level of Evidence:

Level IV.
Five-year follow-up of endoscopic resection of symptomatic os trigonum: a prospective interventional cohort study of a possible cause of ankle and big toe pain
Authors: Rakha Mohamed , Sallam Asser
Published: September 2021

Background:

The authors aimed to evaluate the functional outcomes of endoscopic resection and debridement of symptomatic os trigonum and associated inflammatory changes including the flexor hallucis longus (FHL) pathologies.

Methods:

A prospective interventional study was conducted including 28 patients with 32 symptomatic os trigonum in the period from January 2010 to March 2016. The mean age of patients was 23.6 yr (range, 12 to 45 yr). All patients completed a minimum follow-up of 5 yr. Outcomes were assessed by the 100-mm visual analogue scale (VAS), American Orthopedic Foot and Ankle Society score (AOFAS), and the postoperative complication rate.

Results:

Endoscopic examination revealed tibiotalar and subtalar hypertrophic synovitis in 14/32 and 13/32 patients, respectively. A small bony prominence encroached upon the FHL in 3/32 patients, 18/32 patients had FHL tenosynovitis, and the FHL tendon was constricted at its entry point into the tarsal tunnel requiring release of the flexor retinaculum in one patient. The mean AOFAS and the VAS scores significantly improved at final follow-up. The degree of improvement of AOFAS and the VAS scores was greater for the posterior ankle impingement group than the os trigonum fracture group. All patients experienced no major complications.

Conclusions:

Posterior endoscopic excision of a symptomatic os trigonum is safe, feasible, and has excellent results in patients with various sporting or occupational activities. The degree of improvement is greater for patients without os trigonum fracture.

Level of Evidence:

Level IV.
Applications and Error Ratios of Calibration Techniques in EOS, Orthoroentgenogram, and Teleoroentgenogram for Length Measurement: A Comparative Study
Authors: Asma Ali , Nichols Louise Reid , Ulusaloglu Armagan C. , Kazmi Faaiza , Rogers Kenneth J. , Drozdowski Barbara , Bowen James Richard
Published: September 2021

Background:

Accurate length measurements of extremity bones are essential in treating limb deformities and length discrepancies in children.

Objective:

This study aimed to determine errors in common techniques used to measure lower limb lengths in children.

Methods:

Precision and instrument errors in length measurements were studied utilizing electro-optical system (EOS), orthoroentgenogram, and teleoroentgenogram The goal was to measure a 70-cm metallic rod phantom (average length of the lower extremity of a 10-year-old boy in the 50th percentile) in 3 phases. In Phase 1, the length measurements were performed in an EOS unit with internal calibrations, a magball/magstrip in various scan positions, and measurement with TraumaCAD software. In Phase 2, the measurements were repeated utilizing a single radiation “shot” teleoroentgenogram. In Phase 3, an orthoroentgenogram was utilized with a radiopaque ruler reference. The reliability and validity of measurements were calibrated by 4 physicians (a radiologist, senior orthopaedic attending, and 2 orthopaedic fellows).

Results:

EOS measurements utilizing internal references had excellent accuracy (for a 700-mm real length, magnification error (ME)] of 0.09%. Teleoroentgenogram with a magball reference and measurements performed with automatic calibration by TraumaCAD program results in ME of 1.83% with insignificant intraobserver/interobserver difference. Teleoroentgenogram with a magball or magstrip reference measured manually showed that the magball has higher intraobserver/interobserver variance than magstrip, with a 6.60 and 0.33-mm SD, respectively. The length by manual measurement utilizing the magstrip has ME of 2.21%. Orthoroentgenogram is accurate with ME of 0.26%, but does not allow anatomical analysis and is also radiation-costly.

Conclusion:

EOS and orthoroentgenogram are very accurate for length measurements. Teleoroentgenogram is less accurate in measuring length; however, addition of an external reference (magball, magstrip) placed lateral to the target improves accuracy. Automatic calibration with computer-based analysis of the external reference improves the accuracy more than manual calibration. If manual calibration is utilized, the length measurement is less accurate with the magball than the magstrip.

Level of Evidence:

Level II—comparative in vitro study.
Alternative Noninvasive Treatment of Unstable Extra-articular Proximal and Middle Phalangeal Fractures: A Static Linear Traction Orthosis Design
Authors: MacDonald Kristen , Larocerie-Salgado Juliana , Chinchalkar Shrikant
Published: September 2021

Extra-articular unstable proximal and middle phalanx fractures are typically managed with surgical means with common complications of tendon tethering, stiffness, and secondary hand dysfunction. As a result, alternative conservative measures are being explored. The use of static linear traction through the application of an orthosis allows for fracture reduction and anatomic healing, with successful range of motion outcomes.
Protein Kinase D3 Promotes the Reconstruction of OSCC Immune Escape Niche Via Regulating MHC-I and Immune Inhibit Molecules Expression
Authors: Lv Die , Chen Jiao , Kang Yingzhu , Luo Min , Chen Hongli , Cui Bomiao , Wang Liwei , Wang Jingnan , Zhou Xuedong , Feng Yun , Huang Libin , Zhang Ping
Published: September 2021

Protein kinase D3 (PKD3) has been involved in various aspects of tumorigenesis and progression in many kinds of cancer types. However, whether PKD3 regulates immune escape in tumor microenvironment is rarely reported. Here, we explored the function and mechanism of PKD3 in reconstructing the immune escape niche of oral squamous cell carcinoma (OSCC). Both the Western blotting analysis in OSCC cells and the gene expression correlation analysis from The Cancer Genome Atlas shows that the expression of Fas and programmed cell death-ligand 1 (PD-L1) was positively correlated with PKD3, while major histocompatibility complex-I (MHC-I) was negatively correlated with PKD3. Knockdown of PKD3 significantly decreased the expression of Fas and PD-L1 and increased the expression of MHC-I. Furthermore, when PKD3 was overexpressed in oral precancerous cells, Fas, PD-L1, and MHC-I showed an opposite trend to that observed when PKD3 was knocked down. In addition, PKD3 knockdown decreased the secretion of transforming growth factor β, CC-chemokine ligand 21, interleukin-10 by OSCC cells. Finally, the tumor cell antigen, which was extracted from PKD3 knockdown OSCC cells, significantly induced the growth and activation of T lymphocytes. These results demonstrate that PKD3 promotes the immune escape of OSCC cells by regulating the expression of Fas, PD-L1, MHC-I, transforming growth factor β, CC-chemokine ligand 21, interleukin-10, and plays a key role in reconstructing the tumor immune escape niche.
Cardiovascular toxicity of contemporary antiretroviral therapy
Authors: Vos Alinda G. , Venter W.D.F.
Published: September 2021

Purpose of review

HIV treatment has evolved since the introduction of antiretroviral therapy (ART) in the 1990s. Earlier treatment strategies, and the introduction of integrase inhibitors in preferred first-line ART have fundamentally changed cardiovascular side effects due to HIV infection and ART. This review provides an update on cardiovascular toxicity of contemporary ART.

Recent findings

Cardiovascular disease (CVD) risk, including heart failure, is still increased in people living with HIV (PLWH). Exposure to older antiretrovirals, including stavudine and zidovudine, still impact on CVD risk through persistent changes in body fat distribution years after discontinuation. Protease inhibitors (PI) and efavirenz have associated metabolic disturbances and increased risk of CVD, although use is decreasing worldwide. Integrase inhibitors and CCR5 antagonists seem to have negligible immediate CVD toxicity. Weight gain on newer antiretrovirals including integrase inhibitors is a reason for concern.

CVD risk should be monitored carefully in PLWH who were exposed to first generation ART, efavirenz or to PIs. Registries should capture ART use and CVD events to stay informed on actual clinical risk in the current era of rapid initiation on integrase inhibitor-based ART.
Hand grip strength and health-related quality of life in postmenopausal women: a national population-based study
Authors: Hong Yun Soo , Kim Hoon
Published: September 2021

Objective:

Muscle strength progressively decreases after menopause. Hand grip strength (HGS) reflects overall muscle strength and may be associated with health-related quality of life (HRQoL). We aimed to assess the association between HGS and HRQoL in postmenopausal women.

Methods:

We used nationally representative data on 6,059 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2014-2018). HGS was determined as the maximum value in kilograms (kg) achieved using either hand. HRQoL was estimated using the European Quality of Life Questionnaire-Five Dimensions (EQ-5D) questionnaire. The prevalence ratios of having moderate/severe problems on the EQ-5D were evaluated with adjustment for covariates using complex survey analysis.

Results:

The prevalence of having a problem in at least one of the HRQoL dimensions among postmenopausal women was 43.6%. Compared with participants with the lowest quintile of HGS, women in the highest quintile had a significantly lower prevalence of moderate/severe problems in most dimensions (fully adjusted prevalence ratios [95% confidence intervals]; 0.73 [0.60-0.89], 0.45 [0.28-0.72], 0.52 [0.38-0.71], 0.74 [0.63-0.87], and 0.91 [0.70-1.18] for mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, respectively). The associations between HGS and EQ-5D index were stronger among the participants who were older (65-79 y), had a higher body mass index (≥ 25.0 kg/m2), had low physical activity, had a longer duration since menopause (≥ 10 y), and had a chronic disease.

Conclusions:

Higher HGS was associated with a lower prevalence of moderate/severe problems in each dimension of the EQ-5D in postmenopausal women. These associations were more apparent in individuals who were older, had higher body mass index, or had a chronic disease.
Identifying the different subtypes in menopausal symptoms among middle-aged women in China: a latent class analysis
Authors: Zhao Di , Lv Gaorong , Zhang Yunxue , Xie Zihui , Wang Qing , Zhou Miao , Li Ping
Published: September 2021

Objective:

Many studies have focused on the severity and prevalence of menopausal symptoms among middle-aged women, which are limited by heterogeneity and diversity of subtypes. Subtyping facilitates the adaptation to prevention and clinical intervention strategies that target women. To determine the existence of significant subgroups of women with similar menopausal symptoms, a person-centered approach was used to identify potential profiles of women during the menopausal transition. In addition, we aimed to examine the association between latent subtypes and individual factors.

Methods:

This cross-sectional study included 797 middle-aged women, aged 40 to 60 years, who were recruited from Shandong Province, China, between December 2017 and August 2018. We identified the subtypes in menopausal symptoms by performing a latent class analysis according to the self-reported Menopause Rating Scale and evaluated the robustness of our identified subtypes using a sensitivity analysis. Multinomial logistic regression was performed to explore the association between emergent latent subtypes and sociodemographic, clinical, and psychosocial characteristics.

Results:

The mean age of participants was 49.83 ± 5.05 years. (1) Four potential classes were identified in middle-aged women: “severe symptoms” (14.9%), “dominant sleep-emotion symptoms” (31.4%), “physical/mental exhaustion symptoms” (32.5%), and “no symptoms” (21.2%). The four classes were also verified using a sensitivity analysis according to age and menopause status subgroups, which revealed the robust subtypes of menopausal symptoms. (2) The odds ratio of neuroticism, chronic diseases, and gynecological diseases were significantly higher for the “severe symptoms,” “dominant sleep-emotion symptoms,” and “physical/mental exhaustion symptoms” classes, compared to the “no symptoms” class, while the odds ratio of mindfulness and social support were lower.

Conclusions:

A person-centered approach for middle-aged women could address the unmet need to understand the heterogeneity of menopausal symptoms. Subtyping facilitates the identification of the potential causes of menopausal symptoms and the development of personalized interventions.

Video Summary:

http://links.lww.com/MENO/A830.
Rat Models of Partial-body Irradiation with Bone Marrow-sparing (Leg-out PBI) Designed for FDA Approval of Countermeasures for Mitigation of Acute and Delayed Injuries by Radiation
Authors: Fish Brian L. , MacVittie Thomas J. , Gao Feng , Narayanan Jayashree , Gasperetti Tracy , Scholler Dana , Sheinin Yuri , Himburg Heather A. , Hart Barry , Medhora Meetha
Published: September 2021

The goal of this study was to develop rat models of partial body irradiation with bone-marrow sparing (leg-out PBI) to test medical countermeasures (MCM) of both acute radiation syndrome (ARS) and delayed effects of acute radiation exposure (DEARE) under the FDA animal rule. The leg-out PBI models were developed in female and male WAG/RijCmcr rats at doses of 12.5–14.5 Gy. Rats received supportive care consisting of fluids and antibiotics. Gastrointestinal ARS (GI-ARS) was assessed by lethality to d 7 and diarrhea scoring to d 10. Differential blood counts were analyzed between d 1–42 for the natural history of hematopoietic ARS (H-ARS). Lethality and breathing intervals (BI) were measured between d 28–110 to assess delayed injury to the lung (L-DEARE). Kidney injury (K-DEARE) was evaluated by measuring elevation of blood urea nitrogen (BUN) between d 90–180. The LD50/30, including both lethality from GI-ARS and H-ARS, for female and male rats are 14.0 Gy and 13.5 Gy, respectively, while the LD50/7 for only GI-ARS are 14.3 Gy and 13.6 Gy, respectively. The all-cause mortalities, including ARS and L-DEARE, through 120 d (LD50/120) are 13.5 Gy and 12.9 Gy, respectively. Secondary end points confirmed occurrence of four distinct sequelae representing GI, hematopoietic, lung, and kidney toxicities after leg-out PBI. Adult rat models of leg-out PBI showed the acute and long-term sequelae of radiation damage that has been reported in human radiation exposure case studies. Sex-specific differences were observed in the DRR between females and males. These rat models are among the most useful for the development and approval of countermeasures for mitigation of radiation injuries under the FDA animal rule.
Acute Proteomic Changes in Non-human Primate Kidney after Partial-body Radiation with Minimal Bone Marrow Sparing
Authors: Huang Weiliang , Yu Jianshi , Farese Ann M. , MacVittie Thomas J. , Kane Maureen A.
Published: September 2021

Near total body exposure to high-dose ionizing radiation results in organ-specific sequelae, including acute radiation syndromes and delayed effects of acute radiation exposure. Among these sequelae are acute kidney injury and chronic kidney injury. Reports that neither oxidative stress nor inflammation are dominant mechanisms defining radiation nephropathy inspired an unbiased, discovery-based proteomic interrogation in order to identify mechanistic pathways of injury. We quantitatively profiled the proteome of kidney from non-human primates following 12 Gy partial body irradiation with 2.5% bone marrow sparing over a time period of 3 wk. Kidney was analyzed by liquid chromatography-tandem mass spectrometry. Out of the 3,432 unique proteins that were identified, we found that 265 proteins showed significant and consistent responses across at least three time points post-irradiation, of which 230 proteins showed strong upregulation while 35 proteins showed downregulation. Bioinformatics analysis revealed significant pathway and upstream regulator perturbations post-high dose irradiation and shed light on underlying mechanisms of radiation damage. These data will be useful for a greater understanding of the molecular mechanisms of injury in well-characterized animal models of partial body irradiation with minimal bone marrow sparing. These data may be potentially useful in the future development of medical countermeasures.