bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttranscriptional modifications in mitochondrial tRNA and its implication in mitochondrial translation and disease
Authors: Kazuhito Tomizawa , Wei Fan-Yan
Published: August 2020

A fundamental aspect of mitochondria is that they possess DNA and protein translation machinery. Mitochondrial DNA encodes 22 tRNAs that translate mitochondrial mRNAs to 13 polypeptides of respiratory complexes. Various chemical modifications have been identified in mitochondrial tRNAs via complex enzymatic processes. A growing body of evidence has demonstrated that these modifications are essential for translation by regulating tRNA stability, structure and mRNA binding, and can be dynamically regulated by the metabolic environment. Importantly, the hypomodification of mitochondrial tRNA due to pathogenic mutations in mitochondrial tRNA genes or nuclear genes encoding modifying enzymes can result in life-threatening mitochondrial diseases in humans. Thus, the mitochondrial tRNA modification is a fundamental mechanism underlying the tight regulation of mitochondrial translation and is essential for life. In this review, we focus on recent findings on the physiological roles of 5-taurinomethyl modification (herein referred as taurine modification) in mitochondrial tRNAs. We summarize the findings in human patients and animal models with a deficiency of taurine modifications and provide pathogenic links to mitochondrial diseases. We anticipate that this review will help understand the complexity of mitochondrial biology and disease.
Where is the tantric mainstream? Discussions with a Bengali Brahmin god-maker in Kolkata
Authors: Bradbury James Samuel
Published: August 2020

The idea of Hindu Tantra as an esoteric, transgressive, or otherwise fringe practice has been revised to account for a ‘tantric mainstream’ in Indian religious life. However, this tantric mainstream has been faintly reflected in the ethnographic record, which would be otherwise well--suited to explore how religious categories are formed in broader social contexts. The religious world of the Bhattacharyas, a Śākta Brahmin family from East Bengal that now lives in suburban Kolkata, evinces some of the challenges in identifying ‘the tantric’ while suggesting alternative framings of ritual practices. Tapan Bhattacharya, a member of the family in his sixties, not only conducted pūjās to the tantric goddess Dakṣiṇā Kālī in their household shrine; he also sculpted the clay statues of deities (pratimā) that were used in local community rituals. Tapan’s nephew, Souvik, drew upon tantric classifications to explain the relations between mainstream household and community pūjās on one hand, and transgressive rituals on the other. Tantra, as understood by members of this household, encompassed a much wider set of relations than conventional binaries of tantra/not-tantra have allowed for. Taking their cue, I locate mainstream Śākta Tantra within the broader contexts of their religious world and the categories that make sense therein, while ultimately recognising that this family’s framings of contemporary religious culture will be matched by other, competing perspectives.
Image-guided endonasal endoscopic excision of Meckel’s cave trigeminal schwannoma from cavernous and petrous carotid artery
Authors: Almomen Ali , Alyousif Amal , Ali Zainab , Al Yaeesh Ibrahim , AlOmirin Ahmed , Al Yahya Abdulwahab , AlSuqair Hesham , Almolani Fadhel
Published: August 2020

Trigeminal schwannoma is the second most common schwannoma after vestibular schwannoma. Symptoms vary depending on the anatomical structures affected by the tumor, including facial pain, paresthesia, dizziness and ataxia. The primary goals are controlling the symptoms and the maintenance of cranial nerves’ integrity perioperatively. We report a 39-year-old lady who was complaining of mild right-sided headache, vision and hearing loss, right facial weakness and dysphagia. CT and MRI showed a large dumbbell-shaped tumor originating from the trigeminal fossa abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa. An image-guided endonasal endoscopic removal was successfully done. Image-guided endonasal endoscopic removal of a trigeminal schwannoma abutting the petrous and cavernous carotid artery and extending to the infratemporal fossa is a safe, effective approach, as it offers excellent visualization, accurate localization and safe dissection of the tumor from the critical anatomical neurovascular structures surrounding it.
Rescuing Vapers Versus Rescuing Smokers: The Ethics
Authors: Eyal Nir
Published: August 2020

Suppose for the sake of argument that wide access to electronic cigarettes would help a great many smokers quit and others avoid smoking, with a dramatic cumulative effect on population health. But suppose also that nowadays, teenagers rarely benefit from that effect, because most do not smoke and are not expected to smoke as adults. Many teenagers do vape. When the net effect of vaping on general public health is expected to remain very positive, should we nevertheless fight vaping, so as to protect teenagers from the direct risks of vaping? For example, what to do if and when certain targeted regulations that would protect teenagers would also, by making it harder to vape, substantially increase smoking in the general population? This situation may be common, and, by pitting the health interests of the general population against those of teenagers, poses an ethical dilemma. This article argues philosophically that if such tradeoffs between the health interests of adolescents and those of the general population exist, morally it is both permissible and preferable to promote the health of the general population.

Implications

In the debate about electronic-cigarette based tobacco harm reduction, some disagreements are factual, for example, disagreements about how harmful vaping is to human lungs, and how much the option of vaping helps smokers quit. However, there is also an ethical debate: if tradeoffs between the health interests of adolescents at risk of vaping and those of the general population (driven by those of smokers) exist, who should be prioritized? This article argues that morally it is sometimes, at least, both permissible and preferable to promote the health of the general population over those of adolescents at risk of vaping.
“Because There’s Just Something About That Menthol”: Exploring African American Smokers’ Perspectives on Menthol Smoking and Local Menthol Sales Restrictions
Authors: D’Silva Joanne , O’Gara Erin , Fryer Craig S , Boyle Raymond G
Published: August 2020

Introduction

Local governments are pursuing policies to limit the availability of menthol cigarettes at the point-of-sale. Although African Americans are disproportionately impacted by menthol cigarettes, little is known about African American smokers’ perspectives on emerging menthol policy. The purpose of this study was to fill a gap in the literature by exploring African American adult (25+) smoker perspectives on menthol and a local menthol sales restriction.

Methods

In-depth semi-structured interviews were conducted with African American smokers (n = 27) in the Minneapolis–St. Paul area June–September 2017. Interviews explored smoking behaviors, harm perceptions, perspectives of menthol in the community and reactions to local menthol sales restrictions. The framework method guided identification of key themes and synthesis of findings.

Results

Almost all (96%) participants smoked Newport cigarettes. The majority of participants indicated that menthol cigarettes were more harmful than non-menthol cigarettes, citing strength and additives and because they were targeted to African Americans. Some participants were receptive to policy change while others viewed the policy as inconvenient and unfair. Overall, there was a lack of understanding of the policy’s intended public health impact. Some participants indicated that the policy would have no impact on their purchasing or smoking behaviors while others who were contemplating quitting noted that a menthol restriction was encouragement to prompt a quit attempt.

Conclusions

Sales restrictions can provide a unique opportunity to persuade menthol smokers to quit. Efforts are needed to increase awareness and support of these policies as well as to support African American menthol smokers achieve cessation.

Implications

There is growing momentum to restrict local menthol tobacco sales; however, little is known about perceptions among populations most impacted. In Minneapolis–St. Paul, where menthol restrictions were passed in 2017, African American smokers expressed limited awareness and uneven policy support. While some participants were unconvinced the restriction would impact smoking, others indicated it would encourage decreased consumption and prompt quit attempts. There is a need for public education to increase awareness of menthol’s harms, to help menthol smokers quit, and to increase support for menthol policies.
Ecophysiological traits of mixotrophic Strombidium spp
Authors: Maselli Maira , Altenburger Andreas , Stoecker Diane K , Hansen Per Juel
Published: August 2020

Ciliates represent an important trophic link between nanoplankton and mesoplankton. Many species acquire functional chloroplasts from photosynthetic prey, being thus mixotrophs. Little is known about which algae they exploit, and of the relevance of inorganic carbon assimilation to their metabolism. To get insights into these aspects, laboratory cultures of three mixotrophic Strombidium spp. were established and 35 photosynthetic algal species were tested as prey. The relative contributions of ingestion and photosynthesis to total carbon uptake were determined, and responses to prey starvation were studied. Ciliate growth was supported by algal species in the 2–12 μm size range, with cryptophytes and chlorophytes being the best prey types. Inorganic carbon incorporation was only quantitatively important when prey concentration was low (3–100 μgCL−1), when it led to increased gross growth efficiencies. Chla specific inorganic carbon uptake rates were reduced by 60–90% compared to that of the photosynthetic prey. Inorganic carbon uptake alone could not sustain survival of cultures and ciliate populations declined by 25–30% during 5 days of starvation. The results suggest that mixotrophy in Strombidium spp. may substantially bolster the efficiency of trophic transfer when biomass of small primary producers is low.
Corrigendum: Bond Risk Premiums with Machine Learning
Authors: Bianchi Daniele , Büchner Matthias , Hoogteijling Tobias , Tamoni Andrea
Published: August 2020

In this note we revisit the empirical results in Bianchi, Büchner, and Tamoni (2020) after correcting for using information not available at the time the forecast was made. Although we note a decrease in out-of-sample $R^2$, the revised analysis confirms that bond excess return predictability from neural networks remains statistically and economically significant.
Ten-year risk of cerebrovascular accidents in incident rheumatoid arthritis: a population-based study of trends over time
Authors: Yazdani Kiana , Xie Hui , Avina-Zubieta J Antonio , Zheng Yufei , Abrahamowicz Michal , Lacaille Diane
Published: August 2020

Objective

To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population.

Methods

We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected.

Results

Overall, 23 545 RA and 47 090 general population experienced 658 and 1220 incident CVAs, respectively. A spline Cox model with a knot at year of onset 1999 was selected. A significant decline in risk of CVA was observed in individuals with RA onset after 1999 [0.90 (0.86, 0.95); P = 0.0001]. The change in CVA risk over time differed significantly in RA with onset from 1999 onwards compared with the general population (P-value of interaction term = 0.03), but not before 1999 (P = 0.06).

Conclusion

Our findings suggest that people with RA onset from 1999 onwards, had a significantly greater decline in 10-year risk of CVA compared with the general population.
Substantia nigra pars reticulata-mediated sleep and motor activity regulation
Authors: Lai Yuan-Yang , Kodama Tohru , Hsieh Kung-Chiao , Nguyen Darian , Siegel Jerome M
Published: August 2020

Study Objectives

The substantia nigra pars reticulata (SNR) is a major output nucleus of the basal ganglia. Animal studies have shown that lesions of the SNR cause hyposomnia and motor hyperactivity, indicating that the SNR may play a role in the control of sleep and motor activity.

Methods

Eight 8- to 10-week-old adult male Sprague-Dawley rats were used. After 3 days of baseline polysomnographic recording, dialysates were collected from the lateral SNR across natural sleep–wake states. Muscimol and bicuculline were microinfused into the lateral SNR.

Results

We found that GABA release in the lateral SNR is negatively correlated with slow wave sleep (SWS; R = −0.266, p < 0.01, n = 240) and positively correlated with waking (R = 0.265, p < 0.01, n = 240) in rats. Microinfusion of muscimol into the lateral SNR decreased sleep time and sleep quality, as well as eliciting motor hyperactivity in wake and increased periodic leg movement in SWS, while bicuculline infused into the lateral SNR increased sleep and decreased motor activity in SWS in rats. Muscimol infusion skewed the distribution of inter-movement intervals, with most between 10 and 20 s, while a flat distribution of intervals between 10 and 90 s was seen in baseline conditions.

Conclusions

Activation of the lateral SNR is important for inducing sleep and inhibiting motor activity prior to and during sleep, and thus to the maintenance of sleep. Abnormal function of the lateral SNR may cause hyposomnia and motor hyperactivity in quiet wake and in sleep.
Medication Abortion Up to 70 Days of Gestation
Authors:   Committee on Practice Bulletins—Gynecology,   Society of Family Planning
Published: August 2020

Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications (1).
Rapid and Complete Response to Combination Anti-CTLA-4 and Anti-PD-1 Checkpoint Inhibitor Therapy in a Patient With Stage IV Refractory End-stage Epithelioid Sarcoma: A Case Report
Authors: Pecora Andrew , Halpern Steven , Weber Melinda , Paleoudis Elli G. , Panush David , Patterson Francis , Toretsky Jeffery
Published: August 2020

Epithelioid sarcoma, in the relapse-refractory setting, has limited expected survival. SMARCB1 inactivation, common in epithelioid sarcoma, causes loss of INI1 protein expression and overexpression of the cancer cell growth promoting methyltransferase enzyme, EZH2. We treated a 19-year-old male with stage IV SMARCB1 inactivated epithelioid sarcoma presenting with recurrent end stage (Eastern Cooperative Oncology Group Performance Status 4) rapidly progressing bulky disease with combination ipilimumab and nivolumab. He failed standard therapy and an EZH2 inhibitor (tazemetostat). He presented (May 13, 2019) with a large (16.1×18.6 cm) soft tissue back mass extending from T10 to L3. Complete clinical regression of the back mass occurred within 2 weeks (May 28, 2019) of cycle 1 of combined checkpoint inhibition therapy followed by a positron emission tomography–negative complete remission (October 11, 2019). After a second negative positron emission tomography/computed tomography scan (January 13, 2020), checkpoint inhibition therapy was discontinued. He has returned to normal activities with a normal physical examination and Eastern Cooperative Oncology Group Performance Status of 0 at his last visit (June 29, 2020). In conclusion, combined checkpoint inhibition therapy warrants further study in the salvage setting in patients with epithelioid and other INI1 protein–deficient sarcomas seemingly regardless of prior therapy, extent of disease, and performance status.
Safety of Immunotherapy Rechallenge After Immune-related Adverse Events in Patients With Advanced Cancer
Authors: Kartolo Adi , Holstead Ryan , Khalid Sidra , Emack Jeffrey , Hopman Wilma , Baetz Tara
Published: August 2020

This retrospective study aimed to investigate the safety profile of continuing or rechallenging patients with advanced cancer who developed grade≥2 immune-related adverse events (irAEs) on immunotherapy-based regimens. Our study had 25, 20, and 40 patients (N=85) in the Treatment Continuation (TCG), Non-Rechallenge (NRG), and Rechallenge Groups (RG), respectively. Subsequent irAEs recurrence were more common in RG than TCG and NRG (78% vs. 56% vs. 25%, P<0.001). The same subsequent irAEs recurrences occurred on 42% of RG, 4% of TCG, and 15% of NRG (P<0.001). On the RG, there was a nonstatistical trend of shortening interval time between time from treatment rechallenge to subsequent irAEs when compared with time from first treatment to initial grade≥2 irAEs (5.86 vs. 8.86 wk, P=0.114). Patients who had cardiac irAEs were not rechallenged. Several high-risk features were identified to prognosticate risk of irAEs recurrences upon treatment rechallenge, including age 65 years and above (P=0.007), programmed cell death protein 1 inhibitors (P<0.001), grade 3 irAEs (P=0.003), pneumonitis type (P=0.048), any systemic corticosteroid use (P=0.001)/high-dose systemic corticosteroid use (P=0.007)/prolonged ≥4-week corticosteroid use (P=0.001) for irAEs management, and early development of irAEs (P=0.003). Our study concluded that it was relatively safe to continue or rechallenge patients with advanced cancers on immunotherapy-based regimens postdevelopment of certain grade≥2 irAEs, except for cardiac, neurological, or any grade 4 irAEs. Subsequent irAEs were common, no more severe, involved the same organ sites, and occurred more quickly than the original irAE. Close monitoring of all potential irAEs is required when rechallenging a patient on immunotherapy, especially for patients with high-risk features.
Metastatic Melanoma Negative for 5 Melanocytic Markers, Complete Regressed Primary Cutaneous Melanoma, and Melanoma-Associated Leukoderma in the Same Patient
Authors: Ramos-Rodríguez Claudia , García-Arpa Mónica , Relea-Calatayud Ma. Fernanda , González-López Lucía , Romero-Aguilera Guillermo
Published: August 2020

Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black–bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.
Differentiation of Basal Cell Carcinoma and Trichoepithelioma: An Immunohistochemical Study
Authors: Carrasquillo Osward Y. , Cruzval-O'Reilly Estefanía , Sánchez Julio E. , Valentín-Nogueras Sheila M.
Published: August 2020

Basal cell carcinoma (BCC) is the most common malignancy of the skin. It is an epithelial neoplasm with origin in the precursor cells of the interfollicular epidermis. Even though it has low metastatic potential, delay in management may lead to local destruction and morbidity. In contrast, trichoepithelioma (TE) is a benign tumor originating from the outer root sheath of the hair follicle. Similar to BCC, TE tends to affect the head and neck region. Both neoplasms may exhibit clinical and histopathological similarities, making them prone to misdiagnosis. Multiple immunomarkers have been used to distinguish among these entities, but so far, no single agent or combination of agents appear to be neither sensitive nor specific enough to differentiate between them. This study was divided into 2 parts. First, 17 cases of BCC and 14 cases of TE were stained with androgen receptor and bcl-2. Then, 27 cases of borderline/equivocal of BCC and 13 cases of borderline/equivocal TE were stained with the same protocol. Sensitivity and specificity were calculated for each individual immunomarker and for the combination of them. Androgen receptor positivity was 100% specific for BCC and borderline/equivocal BCC, whereas bcl-2 diffuse staining pattern demonstrated a sensitivity of 82.4% for BCC and 88.9% borderline/equivocal BCC. When both immunomarkers were combined, the sensitivity for BCC decreased (70.6%) but the specificity remained high (100%). Similarly, the sensitivity for borderline/equivocal BCC was 55.6%, whereas the specificity was 100%. Although moderately sensitive, combining both immunomarkers showed an excellent specificity to discriminate between BCC and TE.
Marcus Gunn Jaw-Winking Synkinesis With Ipsilateral Eyelid Myokymia
Authors: Althaqib Rawan N. , Khan Arif O. , Alsuhaibani Adel H.
Published: August 2020

Marcus Gunn jaw-winking synkinesis (MGJWS) is not well understood. Ipsilateral eyelid myokymia is a potential feature of MGJWS. This finding suggests that peripheral dysinnervation is likely to be a part of MGJWS.

Supplemental Digital Content is available in the text.

Purpose:

To describe a novel observation of ipsilateral eyelid myokymia in the context of Marcus Gunn jaw-winking synkinesis (MGJWS).

Methods:

A retrospective case series of 5 patients observed to have myokymia in the context of MGJWS in 2 tertiary hospitals in Riyadh, Saudi Arabia was conducted. Demographic profile including age and gender, and clinical features were analyzed.

Results:

Five patients (3 males and 2 females) with MGJWS were noted to demonstrate the phenomenon of ipsilateral eyelid myokymia. All but 1 had right-sided MGJWS. The myokymia was seen as upper eyelid twitching in a vertical fashion along the levator palpebrae superioris muscle field of action. All subjects also had ipsilateral Monocular elevation deficiency.

Conclusion:

Ipsilateral upper eyelid myokymia is a potential feature of MGJWS. Monocular elevation seems to be a constant feature among MGJWS patients with levator muscle myokymia.
Ear Preference and Interaural Threshold Asymmetry
Authors: Chang Jolie L. , Huwyler Camille M. , Cueva Kristine L. , Henderson-Sabes Jennifer , Cheung Steven W.
Published: August 2020

Objective:

To define the relationships among ear preference strength, audiometric interaural asymmetry magnitude, and hearing impairment.

Study Design:

Prospective, cross-sectional.

Setting:

Academic audiology clinic.

Patients:

Adults.

Interventions:

Diagnostic.

Main Outcome Measures:

Patient-reported ear preference strength using a seven-category preference (no preference; left or right somewhat, strongly, or completely) scheme, hearing disability level on the Speech, Spatial, and Qualities of Hearing scale, and audiometric interaural threshold asymmetry were analyzed in three study cohorts: 1) normal hearing (thresholds ≤ 25 dB, n = 66), 2) symmetric hearing loss (any single threshold > 25 dB, n = 81), and 3) asymmetric hearing loss (maximum average interaural threshold difference at any two adjacent frequencies (IThrDmax2)≥ 15 dB, n = 112).

Results:

Receiver operating characteristic curves for somewhat, strongly, and completely ear preference levels using IThrDmax2 cutoff values at 15, 30, and 45 dB showed good to excellent classifier performance (all curve areas ≥ 0.84). The mapping of ear preference strength to the most likely IThrDmax2 range by odds ratio analysis demonstrated: no preference (< 15 dB), somewhat (15–29 dB), strongly (30–44 dB), and completely (≥ 45 dB). Complete dependence on one ear was associated with the most severe degradation in spatial hearing function.

Conclusion:

Categorical ratings of ear preference strength may be mapped to ranges of audiometric threshold asymmetry magnitude and spatial hearing disability level. Querying ear preference strength in routine clinical practice would enable practitioners to identify patients with asymmetric hearing more expeditiously and promote timely evaluation and treatment.
Correlation of Radiologic Versus Endoscopic Visualization of the Middle Ear: Implications for Endoscopic Ear Surgery
Authors: Bonali Marco , Fermi Matteo , Alicandri-Ciufelli Matteo , Mattioli Francesco , Villari Domenico , Presutti Livio , Anschuetz Lukas
Published: August 2020

Objectives:

To determine the limits of visualization during transcanal endoscopic ear surgery (EES) by correlating the relationship between radiologic and endoscopic anatomy using angled optics.

Methods:

Radiology and endoscopic visualization of tensor fold, protympanum, facial sinus (FS), sinus tympani (ST), subtympanic sinus (STS), hypotympanum, and aditus ad antrum were analyzed using a transcanal approach in 30 human temporal bones specimens with different angled endoscopes (0 degree, 45 degrees, 70 degrees) to check for the full visualization of these regions. High-resolution computed tomography (CT) was performed prior to dissection to classify retrotympanic anatomy. According to previously published descriptions, FS, ST, and STS were classified into types A, B, and C depending on their morphology relative to the mastoid segment of the facial nerve. These radiologic findings were compared to endoscopic visualization of these same structures using a Chi-squared test.

Results:

Visualization of the posterior wall of three different retrotympanic areas was significantly associated (FS p < 0.01; ST p < 0.01; STS p = 0.02) with the radiologic classification and endoscopic optical angle. Angled endoscopy improved visual access to the other subsites, especially the aditus ad antrum and the tensor fold (>70% with 45 degrees and 70 degrees).

Conclusion:

Complete visual access to the hidden recesses of the middle ear can be achieved using angled endoscopes (45 degrees and 70 degrees). We observed a statistically significant association of endoscopic visualization to radiologic description of the retrotympanum on CT and the optical angle used. The prediction of the endoscopic exposure of the retrotympanum from the preoperative CT is possible. Even with the use of 70 degrees lens, retrotympanum is not fully visualized on transcanal endoscopy if a type C retrotympanic recesses (posterior and medial to the facial nerve) is present. This represents a technical limit of exclusive transcanal EES.
Facial Paralysis in a Babylonian Plaque
Authors: Fulco William J. , Levy Sabrina L. , Canalis Rinaldo F.
Published: August 2020

Hypothesis:

A terra cotta plaque [LMU 2551] from the Neo-Babylonian period (c.629-539 BCE), housed in the museum of the Archaeology Center at Loyola Marymount University, Los Angeles, is a representation of right peripheral facial paralysis.

Background:

Ancient representations of pathology are rare and often difficult to identify. This is particularly true of Assyrian-Babylonian cultures where, despite numerous surviving medical texts, artistic examples of disease are almost non-existent.

Methods:

Precise caliper measurements and archaeological analysis of LMU 2551 were used to confirm the authors’ hypothesis.

Results:

The facial distortions portrayed in LMU 2551 are not accidental. Measurements show a pronounced asymmetry of the lower face where the length from the mid-philtrum to the oral commissure and from the lateral edge of the ala nasi to the mid-ipsilateral nasolabial fold are twice as long in the left than in the right side. The left eye is closed, whereas the right is widely open.

Conclusion:

The described plaque is among the oldest representations of facial paralysis on record. It correlates with contemporary Babylonian texts describing neurological disorders but its function is unknown.
Transmastoid Labyrinthectomy for Menière's Disease: Experience and Outcomes
Authors: Bergmark Regan W. , Semco Robert S. , Abdul-Aziz Dunia , Rauch Steven D.
Published: August 2020

Objective:

To characterize presurgical symptoms and treatment history and postoperative course in patients with medically recalcitrant Menière's disease undergoing transmastoid labyrinthectomy in the post-intratympanic gentamicin era.

Study Design:

Retrospective case series.

Setting:

Tertiary academic medical center.

Patients:

All patients who underwent transmastoid labyrinthectomy for medically recalcitrant Menière's disease in 2003 to 2019 by the senior author.

Interventions:

Review of patients’ medical records for: preoperative history of drop attacks, gentamicin injections, endolymphatic sac decompression or vestibular neurectomy, preoperative audiograms, length of hospital stay, postoperative complications, and persistent symptoms or challenging recovery.

Main Outcome Measures:

Presurgical clinical history and proximal postoperative outcomes.

Results:

Seventy-two patients with a mean age of 56.7 (standard deviation [SD] 10.7) were included. All cases were unilateral. Forty-three patients (59.7%) suffered from drop attacks. Sixty-two (86.1%) had failed sufficient symptom control with gentamicin injections. The mean preoperative word recognition score was 36.4% (SD 23.7) versus 95.1% (SD 8.5) in the contralateral ear. The mean pure-tone average (PTA) of the ipsilateral ear before surgery was 65.5 dB (SD 18.0) versus 16.2 (SD 13.5) for the contralateral ear. Mean hospital stay was 2.0 days (SD 0.87 days, range of 1–5 d). Three patients (4.2%) had prolonged postoperative vertigo.

Conclusions:

Transmastoid labyrinthectomy at our center is performed for unilateral Menière's disease, generally when intratympanic gentamicin has failed. A majority of surgical patients suffer from drop attacks preoperatively. Hospital stay is typically brief.
Efficacy of Sofosbuvir/Ledipasvir in Adolescents With Chronic Hepatitis C Genotypes 1, 3, and 4
Authors: Serranti Daniele , Nebbia Gabriella , Cananzi Mara , Nicastro Emanuele , Di Dato Fabiola , Nuti Federica , Garazzino Silvia , Silvestro Erika , Giacomet Vania , Forlanini Federica , Pinon Michele , Calvo Pier Luigi , Riva Silvia , Dodi Icilio , Cangelosi Antonina Marta , Antonucci Roberto , Ricci Silvia , Bartolini Elisa , Mastrangelo Greta , Trapani Sandra , Lenge Matteo , Gaio Paola , Vajro Pietro , Iorio Raffaele , D’Antiga Lorenzo , Indolfi Giuseppe
Published: August 2020

Objectives:

Sofosbuvir/Ledipasvir (SOF/LDV) has been approved by the European Medicine Agency (EMA) for the treatment of children and adolescents (at least 3 years of age) with chronic hepatitis C (CHC) genotype 1, 3, and 4 infection. The aim of this study was to evaluate the efficacy and safety of SOF/LDV in adolescents (12 to <18 years old) with CHC in the real‐world setting.

Methods:

Prospective, open‐label, multicentre study involving 12 Italian centres. Patients received the fixed‐dose combination of SOF/LDV (400/90 mg) once daily ± ribavirin as per EMA approval and recommendations. The key efficacy endpoint was sustained virological response 12 weeks after the end of treatment (SVR12) as per intention‐to‐treat analysis. Safety was assessed by adverse events and clinical/laboratory data.

Results:

Seventy‐eight consecutive adolescents (median age 15.2 years, range 12–17.9; girls 53.8%) were enrolled and treated between June 2018 and December 2019. Genotype distribution was as follows: genotype 1 (82.1%), 3 (2.5%), and 4 (15.4%). Seventy‐six (97.4%) patients completed treatment and follow‐up. Overall, SVR12 was 98.7%. One patient was lost to follow‐up after 4 weeks of treatment; 1 patient completed treatment and missed the follow‐up visit. No virological breakthrough or relapse were observed. No patient experienced grade 3 to 4 adverse event or serious adverse event.

Conclusions:

The results of this real‐world study confirmed the high efficacy and the optimal safety profile of SOF/LDV for treatment of CHC in adolescents.
Factors Associated With Success and Failure of Weaning Children From Prolonged Enteral Nutrition
Authors: Dipasquale Valeria , Lecoeur Katia , Aumar Madeleine , Guimber Dominique , Coopman Stéphanie , Nicolas Audrey , Turck Dominique , Gottrand Frédéric , Ley Delphine
Published: August 2020

Objectives:

The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure.

Methods:

This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for ≥6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow‐up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis.

Results:

Ninety‐four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 ± 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow‐up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio = 5.7, 95% confidence interval [1.2–27.0], P = 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio = 6.2, 95% confidence interval [0.05–0.5], P = 0.005).

Conclusions:

Our progressive, mostly outpatient‐based, patient‐tailored program of weaning from EN is effective for tube‐dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at‐risk patients for whom alternative weaning strategies may need to be considered.
Fall Prevention Decision Making of Acute Care Registered Nurses
Authors: Fehlberg Elizabeth A. , Cook Christa L. , Bjarnadottir Ragnhildur I. , McDaniel Anna M. , Shorr Ronald I. , Lucero Robert J.
Published: August 2020

OBJECTIVE

The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making.

BACKGROUND

The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment.

METHODS

Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked.

RESULTS

Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention.

CONCLUSIONS

Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.
Clinical Nurses' Perceptions of Authentic Nurse Leadership and Healthy Work Environment
Authors: Raso Rosanne , Fitzpatrick Joyce J. , Masick Kevin
Published: August 2020

OBJECTIVE

The aim of this study was to determine the relationship between clinical nurses' perception of the authentic nurse leadership of their manager and their perception of the work environment on their unit.

BACKGROUND

Authentic leadership (AL) and healthy work environments contribute to staff engagement and improved patient outcomes. There is limited research linking these 2 variables.

METHODS

Two hundred fifty-four clinical nurses at a national conference participated in a cross-sectional, correlational, descriptive study using the Authentic Nurse Leadership Questionnaire and the Critical Elements of a Healthy Work Environment Survey.

RESULTS

Overall, nurses rated the authentic nurse leadership of their manager as present most of the time and agreed their work environment was healthy. There was a moderate correlation between AL and healthy work environment. Background variables were not significantly related to nurses' perceptions of the authentic nurse leadership of their manager or their work environment.

CONCLUSIONS

This is the 1st study using these authentic nurse leadership and healthy work environment frameworks. In this novel nursing model of AL, caring is an attribute that was valued by frontline nurses. This is a call to action for leadership development at every level using AL principles and for the improvement of lagging domains in nursing work environments, both critically needed during challenging healthcare times and for the ultimate purpose of improving patient and workforce outcomes.
Women Are Less Likely to Be Tested for HIV or Offered Preexposure Prophylaxis at the Time of Sexually Transmitted Infection Diagnosis
Authors: Yumori Caitlin , Zucker Jason , Theodore Deborah , Chang Michelle , Carnevale Caroline , Slowikowski Jacek , LaSota Elijah , Olender Susan , Gordon Peter , Cohall Alwyn , Sobieszczyk Magdalena E.
Published: August 2020

Background

Ending the HIV epidemic requires linkage of at-risk individuals from diverse health care settings to comprehensive HIV prevention services. Sexually transmitted infections (STIs) are significant biomarkers of HIV risk and should trigger preexposure prophylaxis (PrEP) discussion. We reviewed STI testing practices outside of sexual health clinics to identify opportunities for improvement in the provision of HIV prevention services.

Methods

An electronic sexual health dashboard was used to identify patient encounters with a positive gonorrhea, chlamydia, and/or rapid plasma reagin test result between January 1, 2019, and August 23, 2019, at a large urban academic medical center. A retrospective chart review was performed to assess HIV testing, completeness of STI screening, and HIV prevention discussion; inadequate screening was defined as no HIV test in 12 months before STI diagnosis.

Results

A total of 815 patients with 856 patient encounters were included. Patients were predominantly female (64.4%); median age was 24 years (range, 18–85 years). The most common test and most common positive test result was the genitourinary gonorrhea/chlamydia nucleic acid amplification test. Multisite testing was rare (7.5% of patient encounters) and performed more frequently in men than in women (20.3% vs. 0.36%). Women were also more likely to be inadequately screened for HIV (15.1% vs. 25.8%).

Documentation of PrEP discussion was rare (4.7% of patient encounters) compared with safe sex (44.6%) and condoms (49.8%). Preexposure prophylaxis was discussed almost exclusively with men compared with women (17% vs. 1.1%).

Conclusions

In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multisite STI screening, and discussion of PrEP were particularly infrequent among women.
Implementing Group Model Building With the Shape Up Under 5 Community Committee Working to Prevent Early Childhood Obesity in Somerville, Massachusetts
Authors: Calancie Larissa , Fullerton Karen , Appel Julia M. , Korn Ariella R. , Hennessy Erin , Hovmand Peter , Economos Christina D.
Published: August 2020

Objective:

To describe our process of using group model building (GMB) with the Shape Up Under 5 Committee; measure the effects on Committee members; and describe the community-wide health messaging campaign that resulted from the process.

Design:

Pilot study.

Setting:

Somerville, Massachusetts.

Participants:

Members of the Shape Up Under 5 Committee, a multisector group of professionals.

Intervention:

Research team convened the Committee and facilitated GMB from October 2015 to June 2017.

Main Outcome Measures:

Boundary objects produced during GMB activities; committee members' perspectives on early childhood obesity in their community; and Committee members' knowledge, engagement, and trust at the conclusion of each meeting.

Results:

Working together using GMB activities and with support from the research team, the Committee created a community-wide campaign that provided evidence-based messages to reach an entire city that emphasized diversity and reaching immigrants and community members who spoke languages other than English. More than 80% of Committee members reported changes in their perspectives related to early childhood obesity at the conclusion of the pilot test. Six perspective shift themes emerged from interviews and open-ended survey items: exposure to new perspectives about challenges community members face; increased awareness of others working on similar issues; increased knowledge about early childhood obesity; seeing value in creating a space to work across sectors; appreciating complexity and linkages between early childhood obesity prevention and other community issues; and how participation in committee influences members' priorities in their own work. Knowledge of and engagement with early childhood obesity prevention varied at the conclusion of each meeting, as did increases in trust among Committee members.

Conclusion:

Group model building is a promising approach to support multisector groups working to address early childhood obesity in their community. Meeting activities may have had differential impacts on members' knowledge of and engagement with early childhood obesity.
Assessing the Strategies That Children's Hospitals Adopt to Engage the Social Determinants of Health in US Cities
Authors: Franz Berkeley , Flint Julia , Cronin Cory E.
Published: August 2020

Context:

There is growing evidence that social factors contribute disproportionately to health outcomes in the United States as compared with health care services. As a result, nonprofit hospitals are incorporating strategies to address social needs into their Internal Revenue Service (IRS)–mandated community benefit work. Much of the research base on this subject, however, has focused on the efforts of adult-serving hospitals.

Objective:

The aim of this study was to determine whether communities surrounding children's hospitals are unique with regard to social needs and categorize how children's hospitals are addressing social needs in their IRS-mandated community benefit work.

Methods:

Using county-level health and economic data, we compared community characteristics of children's hospital counties with the national average. We then coded and analyzed the community benefit reports of all nonprofit children's hospitals in the United States to categorize the different strategies that hospitals adopt to address social needs.

Results:

Children's hospitals (N = 168) serve communities with greater social needs than the national average. In terms of community benefit investments, children's hospitals were more likely to identify social needs in their community health needs assessment than adult-serving hospitals, but still less than half identified or addressed 1 or more social needs. Children's hospitals were more likely to adopt interventions that address broader population health rather than strategies that focus on clinical services or children and adolescents in particular.

Conclusions:

Pediatric health care institutions have a profound opportunity to reduce health disparities by altering the social environments in which children develop. Policy makers and scholars should provide support and resources to increase community benefit investments in this area.
Cardiac and Blood Pressure Safety of Transdermal Rivastigmine in Elderly Patients With Dementia With Lewy Bodies
Authors: Isik Ahmet T. , Ates Bulut Esra , Dokuzlar Ozge , Kaya Derya , Erken Neziha , Dost Gunay Fatma S. , Ontan Mehmet S.
Published: August 2020

Background:

Dementia with Lewy bodies (DLB) is the second most common dementia. Features of DLB include postganglionic cardiac sympathetic denervation and autonomic instability. Rivastigmine therapy, an acetylcholinesterase inhibitor, is widely used in the primary treatment of DLB; however, the cardiovascular safety and tolerability of transdermal rivastigmine needs to be reviewed.

Objective:

To evaluate whether transdermal rivastigmine has an effect on blood pressure, heart rate, and electrocardiography measurements.

Materials and Methods:

A total of 722 patients diagnosed with dementia were retrospectively screened. Fifty-seven of 98 DLB patients who received transdermal rivastigmine treatment with available serial electrocardiography and blood pressure measurements were included in the study. Baseline and follow-up measurements were compared for patients on the 9.5 to 13.3 mg/d rivastigmine dose for at least 4 weeks.

Results:

The mean age of the patients was 80.77±6.04, and the majority were women (63%). A total of 8 cases with bradycardia and 5 with orthostatic hypotension were detected during follow-up, and rivastigmine patch was stopped in one of those 8 patients due to symptomatic bradycardia. Nonetheless, there was no difference between baseline and follow-up measurements of the patients, including heart rate, cardiac rhythm, electrocardiographic intervals, blood pressure, pulse pressure, and postural blood pressure changes.

Conclusions:

Transdermal rivastigmine therapy is not associated with arrhythmogenic or hypotensive effects in the elderly patients with DLB. However, when prescribing transdermal rivastigmine, physicians should pay attention to newly emerging orthostatic hypotension during the follow-up in these patients.