bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiation Burdens
Authors: Kaur Raminder
Published: July 2020

Chapter 1 introduces the terrain with a focus on how people resist the radiation burdens that they have been subjected to in and around the Kudankulam Nuclear Power Plant in the peninsular region of Tamil Nadu. These burdens ranged from the biomedical, ecological, economic, socio-psychological, and political in terms of the authoritative mechanisms, severe policing and surveillance to which campaigners were subjected. After a discussion on national development and democracy, the chapter elaborates on how people reacted to the weight of the burdens by drawing upon India’s non-violent freedom struggle, and by mobilizing a Tamil and modernized version of Gandhian self-reliance and alternative proposals for the nation’s energy agenda. The chapter ends with a focus on a conceptual understanding of criticality—a multi-layered and multi-situated space to appreciate the ever-changing encounters, ruptures, and tensions of socio-political conduct from the everyday to the extraordinary, the ambivalent to the more outspoken and resistive.
Digitalia
Authors: Kaur Raminder
Published: July 2020

Digitalia or the significance of social media to everyday life and modern movements is no less significant to the case of Kudankulam. Chapter 9 therefore foregrounds digital activism by focusing on the content and reception of a public letter from British to Indian politicians on the Kudankulam issue. It was written collaboratively in May 2012 by diverse activists in Britain to highlight concerns about mandatory procedures and environmental, democratic, and human rights abuses against non-violent protestors. The letter’s reception evident in news readers’ commentaries point to another series of debates that highlight, on one end of the spectrum, colonial legacies, the stranglehold grip of nationalism and suspicions about the ‘foreign hand’; and on the other, the promise of transparency, accountability, and recompense. In its fallout, the potentials and hurdles in the way of forging a transnational anti-nuclear movement across the global south and north, the formerly colonized and colonizing, are highlighted.
Ethics Through History
Authors: Irwin Terence
Published: July 2020

This book is a selective discussion of the tradition in moral philosophy that runs from Socrates to the present. The main themes: (1) Plato, Aristotle, Epicurus, and the Stoics take different positions in debates the relation between morality (including right action and the character of virtuous agents) and the human good. Aquinas’ version of an Aristotelian view identifies the human good with the fulfilment of human nature and capacities in a just society. These facts about the human good can be discovered by rational reflexion on human nature and human needs. (2) These views both about the content of ethics and about the sources of ethical knowledge are questioned by Scotus and later writers on natural law. Voluntarists take the principles of natural law and moral right to be the products of will; naturalists take them to be discovered by reason. (3) The dispute about will and reason is the source of the long dispute between sentimentalists (Hutcheson, Hume) and rationalists (Butler, Price, Reid) about whether moral judgment has a non-rational or a rational basis. Kant tries to resolve this dispute. (4) These arguments lead to further discussion about what makes morally right actions right. Sentimentalists, followed by Mill and Sidgwick and by later utilitarians, argue that actions are right in so far as they maximize pleasure. Others, including the rationalists, Kant, Ross, and Rawls, argue that moral principles are not subordinate to utility.
Introduction and historical background
Authors: Bernstein Joel
Published: July 2020

Chapter 1 provides an introduction to the subject of polymorphism in molecular crystals, including definitions, terminology, nomenclature, and historical development of the subject since the first recognition of the phenomenon in 1823. Topics covered include the difficulty in establishing a database for statistical study of polymorphism, the frequency of occurrence of polymorphism, the literature sources of polymorphic compounds, and literature sources of examples of polymorphism, that is, Cambridge Structural Database, Powder Diffraction File, the patent literature, and the scientific literature. Statistics on crystal polymorphism among the elements in inorganic compounds and macromolecular (i.e., biological) molecules precede the historical perspective. The chapter closes with a brief survey of the commercial importance of polymorphism.
Analytical techniques for studying and characterizing polymorphs and polymorphic transitions
Authors: Bernstein Joel
Published: July 2020

Chapter 4 deals with the analytical methods for the characterization of solid forms, including optical and hot stage microscopy, thermal methods (differential scanning calorimetry, thermal gravimetric analysis, etc.), X-ray diffraction methods (powder and single crystal methods), infrared and Raman spectroscopy, solid state nuclear magnetic resonance spectroscopy, electron microscopy, atomic force microscopy, scanning tunneling microscopy, and pycnometry (density measurements). The principles of each of these techniques are outlined, followed by representative examples of their application in the investigation and characterization of polymorphic systems. The integration of a number of analytical tools—“hyphenated techniques”—into a particular instrument is described for a number of cases, followed by a discussion of the experimental approach for determining if two samples comprise polymorphs of the same compound.
Polymorphism and patents
Authors: Bernstein Joel
Published: July 2020

A brief introduction to patents is followed by a discussion of the two main issues of patents on (pharmaceutical) polymorphs from the scientific perspective: novelty and obviousness, with an emphasis on the latter. The issues, decisions, and ramifications of six landmark patent litigations involving solid forms are described. These involved the following drugs: cefadroxil, terazosin hydrochloride, ranitidine hydrochloride, paroxetine hydrochloride, armodafinil, and tapentadol hydrochloride. The chapter closes with a description of the litigation on the synthetic sweetener aspartame which involved an issue of habit (shape) rather than the form (crystal structure).
New biomarkers in SLE: from bench to bedside
Authors: Capecchi Riccardo , Puxeddu Ilaria , Pratesi Federico , Migliorini Paola
Published: July 2020

Biomarkers may have a diagnostic or monitoring value, or may predict response to therapy or disease course. The aim of this review is to discuss new serum and urinary biomarkers recently proposed for the diagnosis and management of SLE patients. Novel sensitive and specific assays have been proposed to evaluate complement proteins, ‘old’ biomarkers that are still a cornerstone in the management of this disease. Chemokines and lectins have been evaluated as surrogate biomarkers of IFN signature. Other cytokines like the B cell activating factor (BAFF) family cytokines are directly related to perturbations of the B cell compartment as key pathogenetic mechanism of the disease. A large number of urine biomarkers have been proposed, either related to the migration and homing of leukocytes to the kidney or to the local regulation of inflammatory circuits and the survival of renal intrinsic cells. The combination of traditional disease-specific biomarkers and novel serum or urine biomarkers may represent the best choice to correctly classify, stage and treat patients with SLE.
Takotsubo syndrome and rheumatic diseases—a critical systematic review
Authors: Lin Weiqin , Tay Sen Hee , Mak Anselm
Published: July 2020

Since its description in 1990, Takotsubo syndrome (TTS), an acute cardiac condition triggered by physical or emotional stress, has been believed to be related to catecholamine surge from overwhelming sympathetic activity. While symptomatology, biochemical features, ECG and echocardiogram alterations are largely indistinguishable from acute coronary syndrome, the absence of culprit coronary lesions often necessitates further investigations, uncovering underlying inflammatory processes. Mechanistically, animal models of TTS reveal early neutrophil infiltration followed by staged ingression of two subtypes of macrophages (M1, M2) mediating initial acute inflammatory changes (M1), followed by switching to anti-inflammatory signals (M2) that enhance myocardial tissue recovery. Here, we begin with a description of two TTS patients with primary Sjögren’s syndrome and Takayasu’s arteritis, followed by a systematic literature review that summarizes the demographic and clinical features of TTS patients with rheumatological conditions. Potential impact of disease manifestations and treatment of rheumatological conditions on TTS are critically discussed.
Reducing Stigma Toward Individuals With Schizophrenia Using a Brief Video: A Randomized Controlled Trial of Young Adults
Authors: Amsalem Doron , Yang Lawrence H , Jankowski Samantha , Lieff Sarah A , Markowitz John C , Dixon Lisa B
Published: July 2020

Objective

Stigma decreases healthcare seeking and treatment adherence and increases the duration of untreated psychosis among people with first-episode psychosis (FEP). This study evaluated the efficacy of a brief video-based intervention in reducing stigma among youth toward individuals with FEP and schizophrenia. We hypothesized that the social-contact-based video intervention group would reduce stigma more than written vignette and control groups, and the vignette more than the control group.

Methods

Using Amazon Mechanical Turk, we recruited and assigned 1203 individuals aged 18–30 to either (a) video intervention, (b) written description of the same content (“vignette”), or (c) nonintervention control arm. In the 90-second video intervention, an empowered young woman with schizophrenia described her FEP and the aspects of successful coping with her everyday life difficulties, exposing the viewer to schizophrenia in the context of her personal narrative. Web-based self-report questionnaires assessed stigma domains, including social distance, stereotyping, separateness, social restriction, and perceived recovery.

Results

A MANOVA showed a significant between-group effects for all 5 stigma-related subscales (P < .001). Post hoc pairwise tests showed significant differences between video and vignette vs control for all 5 stigma domains. Video and vignette groups differed significantly on social distance, stereotyping, and social restriction. Secondary analyses revealed gender differences across stigma domains in the video group only, with women reporting lower stigma.

Conclusions

A very brief social contact-based video intervention efficaciously reduced stigma toward individuals with FEP. This is the first study to demonstrate such an effect. Further research should examine its long-term sustainability.
Preparing Nursing Graduates to Engage in Difficult Conversations with Patients
Authors: Kantor Debra P. , Stadelman Alaine
Published: July 2020

The need for faculty to create opportunities to practice communication skills.
Childhood and Adolescent Smoking Linked to Adult Smoking
Authors: Rosenberg Karen
Published: July 2020

According to this study:

People who smoke during childhood and adolescence are more likely to smoke daily as adults and less likely to stop smoking in their 40s.

Efforts should be made to prevent smoking exposure early in life, because it can lead to lifelong smoking patterns that are difficult to break.
Spinal Casting for the Treatment of Severe Early Onset Scoliosis: Utilization of a Nonsurgical Health Care Provider for Cast Application
Authors: Dermott Jennifer A. , Zeller Reinhard , Lebel David E.
Published: July 2020

Background:

Spinal casting with the aim of delaying surgical intervention is a widely accepted but resource intensive conservative management strategy used by spine surgeons to treat severe early onset scoliosis. Opting to use a nonsurgical health care provider for cast application may be an effective use of human resources if the quality of care is not compromised. This study aimed to evaluate the outcomes of spinal cast treatment utilizing a nonsurgical health care provider for cast application.

Methods:

This is a chart and radiographic review of all 30 patients that initiated spinal cast treatment between 2007 and 2018 and have at least 2-year follow-up. A spine surgeon applied all casts before July 14; a physical therapist (PT) applied all subsequent casts. Comparative analyses were performed for baseline data and the amount of correction achieved in initial cast. Complications and delay time to surgery were recorded.

Results:

The PT cast 16 patients (12 female, 10 idiopathic, 64 casts total), average age 3.8±1.4 years and mean major curve of 63±18 degrees. Similarly the spine surgeon cast 14 patients (11 female, 8 idiopathic, 53 casts total), average age 4.4±1.7 years (P=0.30) and mean major curve of 63±11 degrees (P=0.93). In the initial cast the PT obtained 55%±13% (28±12 degrees) correction and the surgeon 44%±12% (36±12 degrees, P=0.09). The average number of casts was similar (4.0 vs. 3.8, P=0.7). The PT had 1 patient develop superior mesenteric artery syndrome, which resolved with cast removal, and the surgeon had 2 patients require extra care related to skin breakdown. With average follow-up of 4.15 years (range, 2.0 to 5.8 y) 11/14 PT patients demonstrate curve improvement compared with their initial presentation and 2 patients have undergone surgical intervention (3.2 and 4.3 y after first cast). The surgeon’s average delay time to surgery was 4.3 years (range, 1.8 to 8.7 y after first cast, n=10).

Conclusions:

The results of this study support our current model of care utilizing a nonsurgical health care practitioner for spinal cast application.

Level of Evidence:

Level III—retrospective comparative.
Disparities in Surgical Recommendation for Stage I Non–Small Cell Lung Cancer
Authors: Rapp Joseph L. , Tuminello Stephanie , Alpert Naomi , Flores Raja M. , Taioli Emanuela
Published: July 2020

Objectives:

Sociodemographic disparities in lung cancer prevalence, treatment options offered, and outcomes have been well documented. In stage I non–small cell lung cancer (NSCLC), the standard of care is surgical resection. This study explores disparities in surgical recommendations in stage I NSCLC, when surgery is considered curative.

Materials and Methods:

Patients diagnosed with primary stage I NSCLC from 2007 to 2016 were identified from the Surveillance, Epidemiology, and End Results database (N=56,534). Associations between sociodemographic variables and surgical recommendation were assessed using multivariable logistic regression models. Survival impact was investigated using Cox-proportional hazards regression and propensity matching techniques.

Results:

Of the 76.9% patients recommended surgery, 95% underwent surgery. Recommended surgery was inversely associated with increasing age (P<0.01), non-Hispanic Black race (adjusted odds ratio [ORadj] 0.64, 95% confidence interval [CI]: 0.59-0.70), Hispanic ethnicity (ORadj 0.75, 95% CI: 0.67-0.84), nonprivate/Medicare insurance (Medicaid: ORadj 0.55, 95% CI: 0.51-0.60; insured with unknown plan: ORadj 0.74, 95% CI: 0.69-0.79; uninsured: ORadj 0.45, 95% CI: 0.36-0.55), and single status (ORadj 0.66, 95% CI: 0.63-0.70). Patients who were not recommended surgery were at increased risk of death compared with those who were recommended.

Conclusion:

In a cohort of NSCLC patients, nonclinical factors identified a subgroup of patients who were less likely to be recommended surgery.
A Novel Quantitative Method for Analyzing Desmopressin in Human Plasma Using Liquid Chromatography–Tandem Mass Spectrometry
Authors: de Jager Nico C. B. , Heijdra Jessica M. , Pistorius Marcel , Kruip Marieke J. H. A. , Leebeek Frank W. G. , Cnossen Marjon H. , Mathôt Ron A. A.
Published: July 2020

Background:

Desmopressin (d-aminod-arginine vasopressin: dDAVP) is used for the treatment of patients with hemophilia A and Von Willebrand disease. Studies on the rationale of dosing are scarce and mainly focus on the underlying causes of the vast differences in desmopressin response among individuals. The aim of this study was to develop and validate a liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for the quantification of desmopressin in human plasma for identifying its pharmacokinetics and its therapeutic effect relationship in patients with bleeding disorder.

Methods:

The method entails solid-phase extraction with ion exchange for sample clean-up, followed by an LC-MS/MS run. The technique has been validated for analytical selectivity as well as specificity, process efficiency, linearity, accuracy, imprecision, and stability.

Results:

This method showed good selectivity because no significant chromatographic matrix interferences were observed. The determination coefficient (R2) of the calibration curves was ≥0.990. Analyte accuracy ranged from 89.2% to 111.8%, and the between- and within-run imprecision was less than 9.3% in a plasma concentration and range from 60 to 3200 pg/mL. Samples were stable during 3 freeze/thaw cycles with an additional 120 hours of storage at room temperature (21°C–24°C) and 96 hours in the autosampler (10°C). The total run time was approximately 5 minutes.

Conclusions:

The LC-MS/MS method presented enables quantification of desmopressin in human plasma, and it is sensitive, specific, efficient, accurate, and precise. This analytical technique is a valuable and useful tool to study the interpatient variability of pharmacokinetics.
Experimental models of sarcoidosis: where are we now?
Authors: Jeny Florence , Grutters Jan C.
Published: July 2020

Purpose of review

Sarcoidosis remains a mysterious disease that presents many challenges both in pathogenetic understanding and in the management of patients. This review presents experimental models for sarcoidosis developed since 2016 and discusses their strengths and weaknesses and how they have contributed to the understanding and therapeutic approaches in this disease. In addition, future directions are proposed to overcome the limitations of current models.

Recent findings

New cellular models using infectious antigen as trigger, and transgenic models in mice have recently been developed to study signaling pathways potentially implicated in the pathogenesis of sarcoidosis.

No model fully reproduces sarcoidosis, but most of them generate data supporting key concepts and some open up therapeutic perspectives, like mTOR inhibition or IL-1β blocking. However, there are still many limitations to these models, largely related to the complexity of sarcoidosis, which might be overcome with new technologies, such as mathematical modeling.
Immunology of sarcoidosis: old companions, new relationships
Authors: Cinetto Francesco , Scarpa Riccardo , Dell’Edera Alessandro , Jones Mark G.
Published: July 2020

Purpose of review

The immune determinants of granuloma formation and disease progression in sarcoidosis have not been completely disclosed, and the role of both innate and the adaptive immunity is still under investigation.

Recent findings

M2 macrophage polarization, previously thought to be a specific feature of a progressing and fibrosing disease, has been related to the initial steps of granuloma formation both in animal and in-vitro models. The dysregulation of specific metabolic pathways and autophagy has been associated with disease activity and progression. T cells have been reported to be strongly influenced by a macrophage-driven microenvironment and more dangerous when acquiring hybrid phenotypes (e.g. Th17.1) or even becoming anergic, leading to disease chronicization. Locally released serum amyloid A was suggested to induce a more pro-inflammatory Th17 transcription program. The possible role of in-situ humoral immunity and bone marrow-derived mesenchymal stromal cells has also been highlighted.

Evidence points at microenvironment and cell functional features rather than cell polarization or differentiation as determinants of pathogenesis. In terms of therapeutic implications, future advances will rely on molecular disease profiling, aiming at personalized and combined therapeutic approaches.
Actions of immune cells in the hypertensive kidney
Authors: Lu Xiaohan , Crowley Steven D.
Published: July 2020

Purpose of review

Inflammatory processes play a critical role in the pathogenesis of hypertension. Innate and adaptive immune responses participate in blood pressure (BP) elevation and end-organ damage. In this review, we discuss recent studies illustrating mechanisms through which immune cells and cytokines regulate BP via their actions in the kidney.

Recent findings

Cells of the innate immune system, including monocytes, neutrophils, and dendritic cells, can all promote BP elevation via effects on kidney function. These innate immune cells can directly impact oxidative stress and cytokine generation in the kidney and/or present antigens to lymphocytes for the engagement of the adaptive immune system. Once activated by dendritic cells, effector memory T cells accumulate in the hypertensive kidney and facilitate renal salt and water retention. Individual subsets of activated T cells can secrete tumor necrosis factor-alpha (TNF-α), interleukin-17a (IL-17a), and interferon-gamma (IFN-γ), each of which has augmented the elevation of blood pressure in hypertensive models by enhancing renal sodium transport. B cells, regulate blood pressure via vasopressin receptor 2 (V2R)-dependent effects on fluid transport in the kidney.

Immune cells of the innate and adaptive immune systems drive sodium retention and blood pressure elevation in part by altering renal solute transport.
The importance of anal cancer screening and high-resolution anoscopy to gastroenterology practice
Authors: Bull-Henry Kathy , Morris Bridget , Buchwald Ulrike K.
Published: July 2020

Purpose of review

Although human papillomavirus (HPV)-related anal squamous cell cancer (ASCC) is rare, its incidence has been rising and in high-risk populations exceeds the incidence of cancers for which screening programs are implemented. Therefore, targeted screening techniques are being evaluated with high-resolution anoscopy (HRA) as the current gold standard because of its ability to detect anal intraepithelial dysplasia (AIN) and premalignant high-grade squamous intraepithelial lesions (HSILs). However, a scarcity of trained providers presents a barrier to screening.

Recent findings

ASCC incidence is rising especially in elderly women and young black men. Premalignant HSIL may not only progress to ASCC but also regress. Biomarkers such as HPV type, p16 immunostaining and DNA methylation markers may emerge as predictors of disease progression.

HRA with acetic acid and Lugol's iodine staining can be used to detect HSIL and ASCC. Recent studies suggest that anal cancer screening may have an impact on the stage of ASCC at diagnosis and the incidence of anal cancer.

The Anal Cancer HSIL Outcomes Research (ANCHOR) study is underway to determine whether treating HSIL effects ASCC incidence.

Although there are no consensus screening guidelines for anal cancer, it is reasonable to screen high-risk populations with physical examination, anal cytology and HRA. Gastroenterologists can support anal cancer screening programmes through identifying patients at risk, performing noninvasive screening and considering to incorporate endoscopic techniques to examine the anal canal.

Video abstract

http://links.lww.com/COG/A32.
18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in muscle-invasive bladder cancer
Authors: Einerhand Sarah M.H. , van Gennep Erik J. , Mertens Laura S. , Hendricksen Kees , Donswijk Maarten L. , van der Poel Henk G. , van Rhijn Bas W.G.
Published: July 2020

Purpose of review

In this narrative review, we assessed the role of18F-fluoro-2-deoxy-D-glucose-positron emission tomography/CT (FDG-PET/CT) in preoperative staging and response evaluation of neoadjuvant chemotherapy in muscle-invasive bladder carcinoma (MIBC), and to assess its incremental value to contrast-enhanced (CE)CT and MRI in terms of patient management at initial diagnosis and detection of recurrence.

Recent findings

A literature search in PubMed yielded 46 original reports, of which 15 compared FDG-PET/CT with CECT and one with MRI. For primary tumor assessment, FDG-PET/CT proved not accurate enough (13 reports;n = 7–70). For lymph node assessment, sensitivity of FDG-PET/CT is superior to CT with comparable specificity in 19 studies (n = 15–233). For detection of distant metastases, data from eight studies (n = 43–79) suggests that FDG-PET/CT is accurate, although comparative studies are lacking. Limited evidence (four studies,n = 19–50) suggests that FDG-PET/CT is not accurate for response evaluation of neoadjuvant chemotherapy. FDG-PET/CT incited change(s) in patient management in 18–68% of patients (five reports;n = 57–103). For detection of recurrence, seven studies (n = 29–287) indicated that FDG-PET/CT is accurate.

Most studies evaluated FDG-PET/CT for lymph node assessment and reported higher sensitivity than CT, with comparable specificity. FDG-PET/CT showed incremental value to CECT for recurrence and often incited change(s) in patient management.
PET imaging in urology: a rapidly growing successful collaboration
Authors: Farolfi Andrea , Koschel Samantha , Murphy Declan G. , Fanti Stefano
Published: July 2020

Purpose of review

To discuss and highlight the recent findings in urological oncology focusing on nuclear medicine advances on imaging and therapy.

Recent findings

Testicular tumors: 18F-FDG as the standard positron emission tomography (PET) tracer with proven good accuracy in detecting metastatic testicular cancer; urothelial cancer: good accuracy of 18F-FDG PET in detecting distant metastases but poor results in detecting local disease; prostate cancer: prostate-specific membrane antigen (PSMA) is a promising target for imaging prostate cancer with unprecedented accuracy in both staging and restaging and prospective studies were recently published. In castration-resistant prostate cancer, PSMA-targeting radionuclide therapy is showing potential as a curative possibility (e.g. using 177Lu-PSMA); renal cell cancer (RCC): besides FDG other PET radiotracers are under clinical evaluation (e.g. antibody-based molecular imaging, metabolic radiotracers and PSMA-based tracers). PSMA-based imaging may have applications in staging clear-cell RCC and in the selection and in the antiangiogenic treatment's response assessment. Possible role of PSMA-targeting radionuclide therapy?

In urological oncology, the use of 18F-FDG has been limited by a generally low tumor uptake and physiological 18F-FDG excretion by the urinary system. Other radiotracers are increasing the urologist's portfolio allowing imaging of several biochemical pathways. Theragnostic possibilities are also under investigation thanks to PSMA-based tracers.
Staphylococcus aureus biofilms: an opportunistic pathogen with multidrug resistance
Authors: Silva-Santana Giorgio , Cabral-Oliveira Guilherme Goulart , Oliveira Dryelle Rodrigues , Nogueira Barbara Araújo , Pereira-Ribeiro Paula Marcele Afonso , Mattos-Guaraldi Ana Luíza
Published: July 2020

Studies related to bacterial biofilm formation are extremely relevant because of their constant association with several human diseases. The organization of this sessile microbial community provides protection against opsonization and phagocytosis. It is responsible for hampering not only the immune system performance against infections but also antimicrobial activity. Staphylococcus aureus is part of healthy human microbiota including skin and nasal vestibule. However, many strains have become opportunistic pathogens because of the ability of biofilm formation in implants and medical devices by using them as route of access to bloodstream. S. aureus’ ability of biofilm formation is widely known and it has been responsible for several infections, such as endocarditis, bacteremia and sepsis. Several factors contribute to biofilm formation including expression of specific genes and interaction between proteins involved in adhesion to substrate. This work aims to explore the main aspects related to biofilm formation by S. aureus, using tools as data index bases from the scientific literature: Google Scholar, LILACS, MEDLINE (PubMed), SciELO, Scopus and Book/eBook, between July 2018 and February 2019, in English, Spanish and Portuguese. This review aims to provide a better understanding of biofilm formation and its impact on host health.
Perianal Reactivation of Herpes Simplex Virus Type 2 After Laser-Assisted Hair Removal
Authors: Reis Joel , Santos Fábio Videira
Published: July 2020

We report a case of perianal reactivation of herpes simplex virus type 2 in a 27-year-old man, who was HIV positive with good immunovirological status, after a laser-assisted (alexandrite) hair removal session. We discuss the clinical and laboratory features and the role of prophylaxis with antivirals, particularly in certain patients such as immunocompromised ones.
Pregnancies and Time to Pregnancy in Women With and Without a Previous Chlamydia trachomatis Infection
Authors: Hoenderboom Bernice M. , van Bergen Jan E.A.M. , Dukers-Muijrers Nicole H.T.M. , Götz Hannelore M. , Hoebe Christian J.P.A. , de Vries Henry J.C. , van den Broek Ingrid V.F. , de Vries Frank , Land Jolande A. , van der Sande Marianne A.B. , Morré Servaas A. , van Benthem Birgit H.B.
Published: July 2020

Background

A Chlamydia trachomatis infection (chlamydia) can result in tubal factor infertility in women. To assess if this association results in fewer pregnant women, we aimed to assess pregnancy incidences and time to pregnancy among women with a previous chlamydia infection compared with women without one and who were participating in the Netherlands Chlamydia Cohort Study (NECCST).

Methods

The NECCST is a cohort of women of reproductive age tested for chlamydia in a chlamydia screening trial between 2008 and 2011 and reinvited for NECCST in 2015 to 2016. Chlamydia status (positive/negative) was defined using chlamydia screening trial–nucleic acid amplification test results, chlamydia immunoglobulin G presence in serum, or self-reported chlamydia infections. Data on pregnancies were collected via questionnaires in 2015–2016 and 2017–2018. Overall pregnancies (i.e., planned and unplanned) and time to pregnancy (among women with a pregnancy intention) were compared between chlamydia-positive and chlamydia-negative women using Cox regressions.

Results

Of 5704 women enrolled, 1717 (30.1%; 95% confidence interval [CI], 28.9–31.3) women was chlamydia positive. Overall pregnancy proportions were similar in chlamydia-positive and chlamydia-negative women (49.0% [95% CI, 46.5–51.4] versus 50.5% [95% CI, 48.9–52.0]). Pregnancies per 1000 person-years were 53.2 (95% CI, 51.5–55.0) for chlamydia negatives and 83.0 (95% CI, 78.5–87.9) for chlamydia positives. Among women with a pregnancy intention, 12% of chlamydia-positive women had a time to pregnancy of >12 months compared with 8% of chlamydia negatives (P < 0.01).

Conclusions

Overall pregnancy rates were not lower in chlamydia-positive women compared with chlamydia-negative women, but among women with a pregnancy intention, time to pregnancy was longer and pregnancy rates were lower in chlamydia-positive women.

Trial registration number: Dutch Trial Register NTR-5597.
Oculocardiac Reflex in A 15-Year-Old With Orbital Fractures and Epidural Hematoma
Authors: Bliss Amy , Cox Daniel , Chaulk David
Published: July 2020

The oculocardiac reflex has been well described in the literature and was first defined in 1908 by Aschner. The phenomenon involves the afferent limb of the ophthalmic division of the trigeminal nerve as well as the efferent pathway involving the vagal nerve leading to negative chronotropic effects. It results in a decrease in heart rate and oftentimes a decrease in blood pressure associated with compression of the eye or traction of the extraocular muscles. This reflex has clinical significance in both the operating room during ophthalmic procedures and in the emergency department in patients having sustained craniofacial trauma. The typical dysrhythmia described in literature is sinus bradycardia. Our patient, however, had a ventricular escape rhythm with a complete left bundle branch block pattern.
Sonographic Evaluation of the Optimal Needle Insertion Site in the Biceps Femoris Short Head
Authors: Shin Seyoung , Kim Ki Hoon , Kim Dong Hwee
Published: July 2020

Objective

The aim of the study was to identify the optimal needle placement for electromyographic examination of the biceps femoris short head muscle in relation to the biceps femoris long head tendon through sonographic evaluation.

Design

This cross-sectional observational study involved 36 lower limbs of 18 healthy volunteers. The distances and angles indicating the relationships between the common fibular nerve and the medial or lateral border of the biceps femoris long head tendon were measured at 5 and 7 cm proximal to the tip of the fibular head (P1 and P2, respectively) using ultrasonography.

Results

The median values of the distance between the biceps femoris long head tendon and the common fibular nerve were significantly longer in the lateral approach than in the medial approach at the P1 and P2 levels. The median values of the angles between the vertical line to the biceps femoris long head tendon and the common fibular nerve were significantly larger in the lateral approach than in the medial approach at both levels.

Conclusions

The common fibular nerve is located just below the medial border of the biceps femoris long head tendon at a near-vertical degree from the skin. It is strongly recommended that the needle should be inserted on the lateral side of the biceps femoris long head tendon during needle electromyographic examination of the biceps femoris short head muscle.
Jaw Pain and Oromandibular Dysfunction After a Complex Hospital Course
Authors: Smith Sarah , Lam Ny-Ying
Published: July 2020

A 38-yr-old man presented to the emergency department with severe chest pain and was found to have a type A aortic dissection. Forty-eight hours after an emergency mechanical Bentall and ascending hemiarch replacement, the patient developed agitation prompting administration of high-dose haloperidol. He was found to have evidence of multiple acute infarcts on head computed tomography/computed tomography angiography and brain magnetic resonance imaging. Four days later, he began to complain of jaw pain and difficulty opening his mouth. After admission to inpatient rehabilitation, he was found to have strong activity in the masseters bilaterally at rest on electromyography, indicating a diagnosis of oromandibular dystonia. Starting in the intensive care unit, the patient reported jaw pain and dysfunction for 40 days before having a diagnosis of oromandibular dystonia. At this point, treatment with onabotulinumtoxinA injections and baclofen did not provide relief. Because of an extended delay in diagnosis, it is believed that the patient has developed joint contractures. Oromandibular dystonia is an important diagnosis to consider in patients who experience jaw pain or difficulty with mouth opening. Treatment of this condition can decrease pain and trauma to oral structures as well as improve ability to perform oral hygiene, eat, and communicate.
Improved Function in a Runner With Hereditary Spastic Paraparesis With Use of Extracorporeal Shockwave Therapy
Authors: Rovito Craig , Paganoni Sabrina , Babu Suma , Tenforde Adam S.
Published: July 2020

A 59-yr-old male marathon runner presented with recent diagnosis of hereditary spastic paraplegia in the setting of gait deviation and spasticity. He noted asymmetric wear pattern of his right shoe and toe drag, with recent development of left lower limb pain and cramping attributed to spasticity. He elected to proceed with radial extracorporeal shockwave treatment targeting the affected muscles. The night following initial treatment, he was able to run 2 mins per mile faster over a 4-mile run with resolution of toe drag. He completed six sessions of radial extracorporeal shockwave treatment along with maintaining regular cardiovascular exercise and strength training. He was seen 6 wks after a series of treatment with recent worsening and toe drag that recurred. He completed further sessions with return to improved function seen after his initial series of shockwave and ability to return to running up to 13 miles. His neurologic symptoms remained controlled without noted progression. This case illustrates the potential use of radial extracorporeal shockwave treatment in spasticity management of hereditary spastic paraplegia and that more frequent sessions may be required to maintain benefits of treatment.
Change in Center of Pressure Progression in the Foot Provides Clues for Functional Improvement of the More Affected Lower Limb During Post-stroke Gait Rehabilitation
Authors: Choi Hyuk Sung , Choi Hanboram , Kang Suk , Jung Jung Woo , Kim Woo-Sub
Published: July 2020

Objective

The aim of this study was to determine the clinical significance of the anterior-posterior displacement of the center of pressure in the foot (apCoP) in post-stroke gait rehabilitation.

Design

This observational study was conducted in a tertiary hospital. Forty-two subacute post-stroke patients were included. The apCoP was measured twice with a wearable insole foot pressure measurement system, time interval more than 7 days. The results were compared between the first and second tests. The relationship between apCoP changes and spatiotemporal parameter changes were investigated.

Results

The apCoP increased significantly between tests. The change in walking speed was significantly predicted by the change in the apCoP on the less affected side. The change in asymmetry of the single support phase was significantly correlated with the change in the apCoP on the more affected side.

Conclusion

The change in apCoP provides information about the restoration of body support, body forward progression control, and propulsion in the more affected lower limb during early post-stroke rehabilitation. The apCoP can be a useful parameter for the monitoring of functional changes in the more affected lower limb during post-stroke gait rehabilitation.
Advances in Classification and Treatment of Non-Hodgkin Lymphoma
Authors: Rule Simon , Johns Sophie
Published: July 2020

Mantle cell lymphoma is a rare, aggressive, and largely incurable form of non-Hodgkin lymphoma. There are a number of well-characterized prognostic features but nothing that can help guide therapy. Treatment with chemotherapy is generally effective in the short term, but relapse is inevitable and subsequent treatment is challenging. The use of Bruton tyrosine kinase inhibitors, however, has transformed practice. These agents are highly active in relapsed disease and are very well-tolerated drugs. Chemotherapy-free combinations using Bruton tyrosine kinase inhibitors look very exciting and will likely evolve to be part of frontline care in the future.
Proliferation of HIV-infected renal epithelial cells following virus acquisition from infected macrophages
Authors: Hughes Kelly , Akturk Guray , Gnjatic Sacha , Chen Benjamin , Klotman Mary , Blasi Maria
Published: July 2020

Objectives:

HIV-1 can infect and persist in different organs and tissues, resulting in the generation of multiple viral compartments and reservoirs. Increasing evidence supports the kidney as such a reservoir. Previous work demonstrated that HIV-1 infected CD4+ T-cells transfer virus to renal tubule epithelial (RTE) cells through cell-to-cell contact. In addition to CD4+ T cells, macrophages represent the other major target of HIV-1. Renal macrophages induce and regulate inflammatory responses and are critical to homeostatic regulation of the kidney environment. Combined with their ability to harbour virus, macrophages may also play an important role in the spread of HIV-1 infection in the kidney.

Design and methods:

Multiparametric histochemistry analysis was performed on kidney biopsies from individuals with HIV-1 associated nephropathy (HIVAN). Primary monocyte-derived macrophages were infected with a GFP-expressing replication competent HIV-1. HIV-1 transfer from macrophages to RTE cells was carried out in a coculture system and evaluated by fluorescence-microscopy and flow-cytometry. Live imaging was performed to assess the fate of HIV-1 infected RTE cells over time.

Results:

We show that macrophages are abundantly present in the renal inflammatory infiltrate of individuals with HIVAN. We observed contact-dependent HIV-1 transfer from infected macrophages to both primary and immortalized renal cells. Live imaging of HIV-1 infected RTE cells revealed four different fates: proliferation, hypertrophy, latency and cell death.

Conclusion:

Our study suggests that macrophages may play a role in the dissemination of HIV-1 in the kidney and that proliferation of infected renal cells may contribute to HIV-1 persistence in this compartment.
What we talk about when we talk about durable viral suppression
Authors: Diepstra Karen , Lu Haidong , McManus Kathleen A. , Rogawski McQuade Elizabeth T. , Rhodes Anne G. , Westreich Daniel
Published: July 2020

As policies built on ‘Undetectable = Untransmittable’ become more popular, use of durable viral suppression (DVS) as an outcome in analyses is increasing. We identified a case series of recent HIV-related publications that study the DVS outcome. The majority did not distinguish between a definition of DVS and the operationalization of that definition. Clearer discussion of DVS, including a formal definition, is needed to ensure better comparability across studies and ultimately better public health outcomes.
Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) From Dolutegravir (DTG)+F/TAF or DTG+F/Tenofovir Disoproxil Fumarate (TDF) in the Presence of Pre-existing NRTI Resistance
Authors: Acosta Rima K. , Willkom Madeleine , Andreatta Kristen , Liu Hui , Martin Ross , Parvangada Aiyappa , Martin Hal , Collins Sean , White Kirsten L.
Published: July 2020

Background:

Study 4030 was a phase 3, randomized, double-blinded study of 565 HIV-1 RNA-suppressed participants switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or dolutegravir (DTG)+F/TAF. Nucleoside reverse transcriptase inhibitor (NRTI), non-NRTI, and protease inhibitor resistance (-R) was allowed, but integrase strand transfer inhibitor-R was excluded. Here, we describe the detailed resistance analysis.

Methods:

Historical plasma HIV-1 RNA genotypes and baseline proviral DNA genotypes were analyzed. Documented or investigator-suspected NRTI-R was grouped for stratification into 3 categories of level of resistance. Viral blips were assessed through week 48. Virologic failures had genotypic and phenotypic resistance analyses at week 48, confirmed failure, or last visit, if HIV-1 RNA did not resuppress to <50 copies/mL while on study drug.

Results:

In total, 83% (470/565) of participants had baseline genotypic data available with NRTI-R detected in 24% (138/565), including 5% (30/565) with K65R/E/N or ≥3 thymidine analog mutations and 19% (108/565) with other NRTI-R mutations. M184V/I was present in 14% (81/565). Pre-existing integrase strand transfer inhibitor-R mutations were found in 4% (20/565) of participants. Primary non-NRTI-R and protease inhibitor-R mutations were present in 21% (118/565) and 7% (38/565) of participants. High rates of viral suppression were maintained in all groups through week 48; blips were observed in only 15 participants (2.7%). Three participants met criteria for resistance analysis (all in DTG+F/TAF arm); none developed treatment-emergent resistance to study drugs.

Conclusions:

Participants with baseline NRTI resistance, much of which was previously undocumented, maintained suppression 48 weeks after switching to B/F/TAF or DTG+F/TAF triple therapy. Blips and virologic failure were uncommon using either regimen, with no treatment-emergent resistance.
Cognitive Reserve and Its Determinants in Newly HIV Diagnosed Antiretroviral-Naive Adults From Periurban and Informal Settlements: Evidence From an HIV Hyperendemic South African Setting
Authors: Narsi Kalpesh , Tomita Andrew , Ramlall Suvira
Published: July 2020

Background:

Cognitive reserve (CR), the brain's capacity to resist pathology, plays an essential role in preserving the cognitive health of people living with HIV. Cognitive health differs by the HIV clinical stage, but there are few studies on CR in newly diagnosed antiretroviral treatment (ART)-naive HIV-positive adults to inform early intervention in sub-Saharan Africa.

Method:

We investigated the CR profile and its determinants among 211 newly diagnosed ART-naive HIV-positive participants from 2 clinics that serve periurban and informal settlement communities in KwaZulu-Natal, South Africa. CR domains in education, work, and leisure were assessed using the Cognitive Reserve Index questionnaire (CRIq). The CR determinants included major depression, substance use, CD4 count, history of head injury/medical comorbidity, in addition to sociodemographic status. Regression models were fitted to investigate relationships between the total/domain scores and their determinants.

Results:

CRIq-Total scores were concentrated in the low-medium/medium functioning range with no individual in the extreme low or high CR functioning group. The determinants of CRIq-Total and CRIq-Education were older age, higher education attainment, and being employed. For the CRIq-Work domain, we found older age associated with lower CR. Major depression was only associated with lower CRIq-Leisure.

Conclusion:

ART scale-up will undoubtedly improve the longevity of individuals living with HIV, but we found high degree of suboptimal CR in a relatively young group of newly diagnosed ART-naive HIV-positive individuals from periurban and informal settlement communities. Early intervention focusing on increasing CR especially in socioeconomically vulnerable populations is needed to mitigate HIV-associated neurocognitive impairment and promote long-term healthy independent living.